T/F: Immune mediated polyarthritis is an inflammatory arthropathy
What causes biceps brachii tendinopathy?
repetitive strain microtrauma
injury w/ tendon fiber disruption
acute to chronic inflam of tendon and associated synovial tissues
both acute and chronic inflam present histopathologically
Origin of biceps brachii tendiopathy?
Travels in what groove?
origin: supraglenoid tubercle (intra-articular)
travels in intertubercular groove
insertion: medial tuberosity of proximal radius and adjacent ulna
The biceps brachii is constrained by the _____
Biceps Brachii Tendinopathy presents in what dogs?
medium and large breeds
Biceps Brachii Tendinopathy clinical signs presentation
weight bearing lameness that is:
lameness worsens w/ exercise
Biceps Brachii Tendinopathy physical exam findings
- maximally flex shoulder and extend elbow
- deep palpation over intertubercular groove
- apply tension to biceps insertion
- standing exam, under load: tension to biceps
How do we dx Biceps Brachii Tendinopathy?
rads (cant see tendons so use to rule out other shit)
What is the "skyline" radiographic view also known as?
( not commonly used given modern modalities )
Pros and cons of ultrasound for dx of Biceps Brachii Tendinopathy
cons: requires experience
Pros and cons of MRI used for dx Biceps Brachii Tendinopathy
Pros: cross-sectional anatomy of all soft tissues, identify concurrent problems
Con: over/underinterpretation possible
Why is arthroscopy the golden standard dx for Biceps Brachii Tendinopathy?
diagnostic AND therapeutic
practical considerations: if PE suggestive, often used in lieu of other imaging and lateral/craniocaudal radiographs + arthroscopy
Treatment for acute Biceps Brachii Tendinopathy?
confinement for 4-6 weeks
non-steroidal anti-inflam drugs
+/- physical therapy
Treatment options for recurrent/persistent lameness Biceps Brachii Tendinopathy
intraarticular/bicipital tendon sheath infiltrated corticosteroid injection
methylprednisolone acetate (depo-medrol)
sample joint for fluid analysis/culture
strict confinement, 4-6weeks
Indications to do surgery for Biceps Brachii Tendinopathy
medical therapy not working
ruptured biceps tendon
chronic bicipital tenosynovitis
moderate to severe lameness
Biceps Brachii Tendinopathy surgery with arthroscopy: we must ensure that?
must ensure all other supporting structures are intact
T/F: We can go right in and cut the tendon for a Biceps Brachii Tendinopathy case
what is that procedure called?
False- make sure other tendons are normal
What is the surgical procedure called that may be used to treat Biceps Brachii Tendinopathy? Describe the procedure briefly
cut biceps tendon and then move it to a lateral or medial location
maintains most of its function but takes away from the area where it is chronically inflammed
T/F: Tenotomy does not change the normal function of the biceps tendon
FALSE: it changes the normal function
Prognosis for medical tx of Biceps Tendinopathy?
good to poor
lack of confinement
PT improves results
Prognosis for surgical tx of Biceps Tendinopathy?
good to excellent
tenotomy- excellent (easy just to cut it)
tenodesis- "classic" tx, good results, arthroscopic assistance 6/6 = excellent
Shoulder instability does what to the range of motion?
abnormally increases it
Shoulder instability is _____ in the supporting structures of the shoulder
What are the supporting structures of the shoulder?
medial/lateral glenohumeral ligaments
subscapularis tendon (medial)
teres minor, supra- and infraspinatus (lateral)
T/F: repetitive microtrauma can cause shoulder instability
true: "overuse" injury
80% of shoulder instabilities are _____ (which side?)
Signalment seen commonly with shoulder instability?
medium/large breed dogs
What is the usual hx of a P w/ shoulder instability?
+/- active dog
variable lameness: usually subtle, intermittent, occasionally severe
poor response to rest and NSAIDs
What signs do we see when doing a physical on a dog with shoulder instability?
pain on manipulation of joint
medial instability: increased abduction angle, exam requires sedation
Describe the normal and abnormal shoulder abduction angles
many clinical cases fall b/t 30-50
What are the variables in shoulder abduction angle?
variability b/t breeds and individuals
How do we make a diagnosis for shoulder instability using the increased abduction angle?
diagnosis: compare with the contralateral limb
How do we diagnose shoulder instability?
How good are rads at diagnosing shoulder instability?
standard views rule out other conditions
normal or nonspecific degenerative changes
T/F: MRI may overdiagnose severity of shoulder instability
What is the best way to evaluate/diagnose shoulder instability?
arthroscopy- diagnostic and therapeutic if PE is supportive
What is the treatment for mild shoulder instability?
rest, PT, hobbles
What is the tx for moderate shoulder instability?
arthroscopic radiofrequency shrinkage of attenuated ligaments and joint capsule
thermal insult induces repair
weakens tissue before it strengthens
rest, PT, hobbles
What is the tx for severe shoulder instability?
medial glenohumeral ligament reconstruction
velpeau sling instead of hobbles
Hobbles for shoulder instability....
post op rehab is how long?
how long is activity restricted?
retraining begins when?
What do we use after surgical repair for more severe shoulder instability?
velpeau sling 2-4 weeks postop
After shoulder surgery, how long does the animal wear hobbles?
3-4 months (after the sling was on for 2-4 weeks)
How long is recovery for should instability surgery?
______: muscle shortening not caused by active contraction
What is infraspinatus contracture?
acute, traumatic disruption of muscle fibers
With infraspinatus contracture, the normal muscle-tendon unit is replaced with?
Fibrosis and contracture are secondary to ____
T/F: there has been no documentation of supraspinatus contracture
False: similar lesions have been documented
What animals do we see infraspinatus contracture in?
active, adult, medium to large breed dogs
hunting breeds: spaniels, pointers, retrievers
infraspinatus contracture: acute lameness subsides in ____ days
infraspinatus contracture: chronic static lameness occurs ____ after acute
2-4 weeks later
How does an animal present when they have infraspinatus contracture?
non-painful, non-weightbearing lameness
infraspinatus contracture: _____ rotation of the shoulder and ____ displacement of the elbow
Infraspinatus contracture physical exam findings: the scapulohumeral joint cannot be ____ rotated. What happens when the shoulder is rotated?
T/F: on phyical exam for a P with infraspinatus contracture, they have pain on manipulation of the joint
False- usually no pain
infraspinatus contracture on PE has ____ range of motion
Treatment options for infraspinatus contracture?
conservative treatment unhelpful
tenectomy of infraspinatus tendon
release other capsular adhesions
physical therapy is ideal
Traumatic shoulder luxation signalment and hx
any breed or age of dogs, rare in cats
hx of trauma or evidence of injury
PE traumatic shoulder luxation findings
non weight bearing lameness
pain on palpation of shoulder
malpositioning of greater tubercle
Traumatic shoulder medial luxation: distal limb _____
Traumatic shoulder lateral luxation: distal limb _____
What is the most common traumatic shoulder luxation?
medial is most common
Nomenclature for traumatic shoulder luxation
named for the position of the humeral head relative to the glenoid
What are the indicatoins for closed reduction treatment for traumatic shoulder luxaton?
recent injury, no fractures
What is the closed reduction treatment for traumatic shoulder luxaton?
distract limb, move humerus toward glenoid
stable joint; apply coaptation for 2 weeks- velpeau sling for medial luxation or spica (for lateral, cranial, caudal luxation)
Indications for surgical treatment of traumatic shoulder luxation?
Describe the surgery for traumatic shoulder luxation
open reductoin + ligament repair:
simple arthrotomy to evaluate/reduce joint
imbrication (tight closure)/repair of capsule during closure
glenohumeral ligament reconstruction
What is the prognosis for traumatic shoulder luxation?
good to excellent
T/F: Most traumatic shoulder luxations are amenable to closed reduction
T/F: closed reduction for traumatic shoulder luxaton is generally not successful
FALSE: generally successful
Does closed reduction for traumatic shoulder luxation restore normal joint function?
Goal of open reduction for traumatic shoulder luxation?
to maintain normal joint motion
function is typically good long term
Open reduction for traumatic shoulder luxation consists of reconstruction of _____ and _____