Flashcards in Tendon and LIgament Dz Deck (44):
How can tendon be damaged? LOOK UP
- breaking/dehiscnece of fibres
- mechanically induced or weakening d/t degeneration
How can muscles be damaged?
> less commonly specifically dx
- injuries similar to tendon
How can tendon/lig dz present?
- acute with trauma
- diffuse, painful, oedema if acute
- organised and established in chronic cases
> specific functional disability
Is laeration always traumatic?
- no can be chronic
Dxx for tendon and liggament dz?
> clinical signs
- swelling, gap
- gap, loss of linear orientation of fibres
Outline pathophysiology of tendon injury repair. Which tendons will heal faster? Eg?
- fibroblasts and collage fibres line up along line of actio
- SHEATHED tendons less vascular so hal slower (eg. digital extensors) cf. vascular (eg. common calcaneal Achilles)
Time to heal tendon injuries?
- 6 weeks to regain 50% normal strength (repair must be supported for 6 weeks)
- 1 year to regain average 80% normal strengt h
Tx tendon injury?
> specific support to protect tendon from loading
- trans-articular fixator
> 1* surgical repair for lacerations
- tendon sutures to manage load
- direc contact of healthy edges (debride if necessary)
- suture of epitendon to promote healing
> ultrasound monitoring healing (@6/8 weeks etc.)
How long should ESF be left on for tendon repair?
- 6 weeks
- then bandage for 2 weeks
HOw big a gap will interfere with tendon healing?
What ar ethe 2 most common tendon repair sutures?
- locking loop
- 3 loop pulley
What is a sprain?
- can be mild/moderate/severe
- 1*/2*/3* degree (stretch, rupture, total laceration)
- ^ level of soft tissue damage, swelling, pain and instability
What suture material should be used for TENDON repair?
- non-absorbable eg. Prolene
- sheath simple interrupted absorbable
Presentation of strains ? PE?
- acute and chronic presentation
- especially ROM
- radiography + stressed views (to demonstrate strains, pull limbs in direction of strains etc.)
- ultrasound (not very useful fr ligament)
- manipulation under GA
> always check for ancillary damage
- rest, reduce swelling (drugs, cooling)
- external coaptation (suppot)
- ligament repair
- internal ligament splintage
- attention to oher structures
- arthrodesis (salvage)
- degree of tx depedns on instability, pain and healing potential
LIkely damage associated with ddrop from a height? Tx?
- palmar carpal ligaments sprained
- need arhrodesis, will not heal conservatively
Surgical repair of ligament?
- screws at insertion of the ligament, figure of 8 suture between the 2
How long do ligament injuries take to heal?
slow healing ~ 6-8 weeks
- not always acceptable function (reevaluate)
- extra chronic capsular tisue formed
- 2* OA
> may require arthrodesis at a later stage
What angle is normal for stress radiographs of the carpus?
How is an arthrodesis carreid out? Which joints is this always required in (first line ?
- remove articular cartilage
- bone graft to stimulate bone healing
- stabilise joint
> TMT (tarsal luxation??)
> Carpal ligaments (carpal hyperextension)
Is ligament dz common in smallies?
NO except for cranial cruciate in dogs!
Which direction does cranial and caudal cruciate run?
Cranial = cranial tibia, caudal femur (proximal and lateral to distal and medial)
Caudal = caudal tibia, cranial femur
Pathophysiology of cruciate disease?
- normally related to degeneratin
- can be acute (trauma/degenerative ligament gicing way)
- assocated with MPL (medial patella luxation) which is seen in young growing animals so even if only found incidentally in older animals check the cruciates!
- causes a debilitating cranio-caudal instability in the stifle
- 60% cases involve medial meniscus
Does meniscal injury occour spontaneously in animals?
NO rarely, always affected d/t cruciate dz
How do human and animal cruciate injuries differ?
- human traumatic
- animals gradual degneration n
What is MPL?
- medial patella luxation
What caues the clinical signs seen with cruciate dz? LOOK UP
- as dog ,oves forwards, weight thrust forwards, must resist reactive forces acting caudally
- stifle is vulnerable to this caudal force (d/t round profile of the femur slipping accross the tibial plataeu)
- cranial cruciate resists this force so if ruptured, joint becomes unstable when loaded
-> if femur can move across tibia, mensci can be damaged stuff
Presentation and predisposed animals of cruciate rupture?
- middle aged (2-10 yrs)
- overweight, neutered
- medium/large breed (lab, rotty, spanial, bull breeds, NOT sighthounds)
> Hx: insiduous onset pelvic limb lameness
- may be bilateral
- acute onset can occour
Main Ddx for pelvic limb lamensss seen with cruciate dz?
- hip and LS disease
> cruciate usually more unilateral
FIndings on PE with cruciate rupture?
> muscle atrophy (quads and hamstrings)
> stifle effusion
> medial buttress
- soft tissue thicking medial aspect of joint
> craniocaudal stifle instability (cranial drawer and tibial thrust)
> pain on manipulation
- sit test (sit with leg to the side)
When may PE tibial thrust/cranial drawer be unhelpful? How cna these be ID?
- partial degeneration (not complete)
Most common reason for OA In the stifle?
> cranial cruciate MOST COMMON
- paella luxation
- articular fx
Conservative tx of cruciate dz? When is this indicated?
> appropriate if:
- lameness liinal
- low pain
- small dogs slow return to function, stimulation of OA change, no control of meniscal damage (so cant tell if recovery slow d/t crusiate or menisci)
Advantages of surgical tx? Problems?
- improve joint stability
- speed up recovery
- tx meniscal lesions (always necesary)
> joint still never be 100% stable, DJD sill present though less (residual lameness)
Surgical tx options of cranial cruciate repair? LOOK UP
> implant in a position analgous to cranial cruciate (CCL)
- temporarily restores joint stability
- allows fibrous tissue to stabilise stifle
> changing mechanics of stifle
- negates the need for CCL support
*Any surgery should involve inspection and debridement of menisci*
Outline lateral suture technique. What suture material is used? How long does it need to remain for before brekaing down?
- lateral tibio-fabella suture placed
- extracapsular but same line as the CCL
- meniscus inspected via arthrotomy
= tibial plateau levelling osteotomy
- changes angle tibia meets the femur, allows articular surfaces to bear more of caudal shear force from tibial thrust
- will start bearing weight straight after sx
= tibial tuberosity advancement
- line of patella tendon advanced
- makes it parallel to line of force transfer across joint
- tension in tendon cancels out compression across the joint
- prevents caudal movement of the femur
= closed wedge tibial ostectomy
- similar to TPLO but displacement of tibial tuberosity
- tendinitis possible d/t strain on patella tendon
- wedge rather than circular osteotomy to collapse bone
= triple tibial osteotomy
- mixture TTA/CWTO
- decreases displacmeent
- more complex surgery
- specialist equipement needed
How long do most cruciate surgeries take to heal? Post op care?
> lead walks for 6-8weeks (rest)
- ^ 5min/2w
> coldp ack 48hrs
> warm packs and PROM BID/TID
> rads @ 6-8weeks (not lateral suture)
> NO hydrotherapy initially
Rehabilitation after cruciate surgery?
- physio and gradual increase in lead excercise
Which tendon is prone to damage? ECHO
common calcaneal tendon?? achilles (extends and flexxes the ???