Musculoskeletal System. Functions Movement Shape of body.
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Transcript of Musculoskeletal System. Functions Movement Shape of body.
Musculoskeletal Musculoskeletal SystemSystem
FunctionsFunctions MovementMovement
Shape of Shape of bodybody
Disruption of FunctionDisruption of Function
TraumaTrauma– FractureFracture– Ligament RuptureLigament Rupture
Degenerative diseaseDegenerative disease– Osteochondritis dissecans (OCD)Osteochondritis dissecans (OCD)– Degenerative joint disease (DJD)Degenerative joint disease (DJD)– Ununited Anconeal Process (UAP)Ununited Anconeal Process (UAP)
Disruption of functionDisruption of function
InflammationInflammation– MyositisMyositis– PanosteitisPanosteitis
Poor conformationPoor conformation– Luxating patellaLuxating patella
NeoplasiaNeoplasia– OsteosarcomaOsteosarcoma
Musculoskeletal DiseasesMusculoskeletal Diseases Usually painful, need Usually painful, need
analgesicsanalgesics– Feel better, heal better, Feel better, heal better,
eat better, etceat better, etc FracturesFractures
– CausesCausesOther traumasOther traumasBone diseaseBone diseaseRepeated stressRepeated stress
Barbaro
MS DiseasesMS Diseases
FracturesFractures– TypesTypes
Open (compound) – broken skinOpen (compound) – broken skinClosed – intact skinClosed – intact skinSimple – 1 breakSimple – 1 breakComminuted –multiple piecesComminuted –multiple piecesStable – ends apposed and fixed (ie Stable – ends apposed and fixed (ie
greenstick)greenstick)UnstableUnstableCompressionCompression
Fracture????
MS Diseases - FracturesMS Diseases - Fractures
SignsSigns– History of traumaHistory of trauma– Pain or localized tendernessPain or localized tenderness– LamenessLameness– Deformity of boneDeformity of bone– Loss of functionLoss of function– Localized swelling or bruisingLocalized swelling or bruising
Dx – X-raysDx – X-rays
Fractures - TreatmentFractures - Treatment Stabilize joints above Stabilize joints above
and below the fractureand below the fracture External devicesExternal devices
– SplintsSplintsPermanent or temporaryPermanent or temporaryWood, metal, plastic, Wood, metal, plastic,
newspapernewspaperAdequate padding – Adequate padding –
protect limbprotect limbKeep dry, decrease Keep dry, decrease
activityactivityFoul odor => necrotic Foul odor => necrotic
tissue, infectiontissue, infectionSwollen toes => too tightSwollen toes => too tight
Fractures – TreatmentFractures – Treatment CastsCasts
– Plaster of Paris, Plaster of Paris, fiberglassfiberglass
– PermanentPermanent
Fractures: Fixation devicesFractures: Fixation devices
Robert Jones bandage plastic splint metasplint application
Schroeder-Thomas splint
Fractures: Long BoneFractures: Long Bone
External fixation External fixation
RxRx– Internal fixation devicesInternal fixation devices
Intramedullary pinIntramedullary pin– Provides good stability along axis of boneProvides good stability along axis of bone– Rotation can be problemRotation can be problem– Removed after fracture healsRemoved after fracture heals– Sterile surgical conditionSterile surgical condition
Fractures: Long boneFractures: Long bone
Internal Fixation – Bone PlateInternal Fixation – Bone Plate
Comminuted fractureComminuted fracture Best stabilizationBest stabilization Should be removed after healing – Should be removed after healing –
most are notmost are not Requires specialized instruments and Requires specialized instruments and
surgery techniquessurgery techniques Provides early return to functionProvides early return to function
Fracture: Bone plateFracture: Bone plate Which bone? Where is fracture?Which bone? Where is fracture?
http://www.youtube.com/watch?http://www.youtube.com/watch?v=Wls_Pyop-v=Wls_Pyop-D0&feature=channel_pageD0&feature=channel_page
Bone Fractures – Client InfoBone Fractures – Client Info
Restrict activityRestrict activity Watch for drainage, swelling, heat Watch for drainage, swelling, heat Metal (plate, pin) stronger than bone Metal (plate, pin) stronger than bone
– refracture may occur– refracture may occur Follow up x-rays necessaryFollow up x-rays necessary Metal should be removed after Metal should be removed after
healinghealing Metal may cause cold sensitivityMetal may cause cold sensitivity
Ligament Injury – Anterior Cruciate Ligament Injury – Anterior Cruciate LigamentLigament
ACL and PCL (posterior cruciate ACL and PCL (posterior cruciate ligament) stabilize knee jointligament) stabilize knee joint
Intra-articular structuresIntra-articular structures Ruptured ACL – most common knee Ruptured ACL – most common knee
injury => DJDinjury => DJD May be complete rupture or partial May be complete rupture or partial
tear => unstable joint => DJDtear => unstable joint => DJD
Anterior and Posterior Cruciate Anterior and Posterior Cruciate LigamentsLigaments
ACL and PCLACL and PCL
Occurrence – sudden hyperextension or Occurrence – sudden hyperextension or lateral extension of knee during exerciselateral extension of knee during exercise
Middle age, obese, inactive or highly Middle age, obese, inactive or highly athletic dogs; rare in catsathletic dogs; rare in cats
Sudden non weight bearing or limpingSudden non weight bearing or limping Swelling of knee jointSwelling of knee joint Rupture of contra lateral ACL often occurs Rupture of contra lateral ACL often occurs
within 1 yearwithin 1 year Mensical tear often accompanies ligament Mensical tear often accompanies ligament
teartear
ACL – DxACL – Dx
Anterior drawer movementAnterior drawer movement
ACL – RepairACL – Repair
Surgical stabilization most successfulSurgical stabilization most successful– Goal: stabilize knee to return function Goal: stabilize knee to return function
and minimize DJDand minimize DJD– Extra capsular stabilizationExtra capsular stabilization
Most successful <30#Most successful <30#Suture material from flabella to tibial crest Suture material from flabella to tibial crest
and imbrication of jointand imbrication of joint
ACL – RepairACL – Repair
Ligament rupture Ligament rupture
http://www.youtube.com/watch?http://www.youtube.com/watch?v=9jg9E2nBt_E&feature=relatedv=9jg9E2nBt_E&feature=related
http://www.youtube.com/watch?http://www.youtube.com/watch?v=4nU2QZjjBygv=4nU2QZjjByg
http://www.youtube.com/watch?v=-http://www.youtube.com/watch?v=-1pxxX4TXko&feature=fvw1pxxX4TXko&feature=fvw
ACL – Client infoACL – Client info
Restrict activity 3-4 weeks post surgeryRestrict activity 3-4 weeks post surgery– Cage restCage rest– Leash walk only to urinate and defecateLeash walk only to urinate and defecate
Gradually increase exercise 4-8 wks post Gradually increase exercise 4-8 wks post sxsx
Full activity 8-12 weeksFull activity 8-12 weeks Opposite cruciate often tears within 1 yrOpposite cruciate often tears within 1 yr Weight loss helpsWeight loss helps DJD of stifle joint likelyDJD of stifle joint likely If no surgery, joint thickens - fibrosisIf no surgery, joint thickens - fibrosis
GradesGrades– I - Patella manually displaced but pops back I - Patella manually displaced but pops back
into placeinto place– II – Spontaneously or manually displaced till II – Spontaneously or manually displaced till
manually repositioned or patient extends manually repositioned or patient extends stifle jointstifle joint
– III – Patella luxated most of the time but can III – Patella luxated most of the time but can be manually replaced; movement of stifle be manually replaced; movement of stifle joint reluxates patellajoint reluxates patella
– IV – patella permanently luxated; unable to IV – patella permanently luxated; unable to replacereplace
Patella LuxationPatella Luxation
Patella LuxationPatella Luxation
Grades III and IV – crouching, Grades III and IV – crouching, bowlegged or knock-kneed stance for bowlegged or knock-kneed stance for medial or lateral luxations, medial or lateral luxations, respectivelyrespectively
Pain: occurs as patella relocates or Pain: occurs as patella relocates or abrasion creates contact with boneabrasion creates contact with bone
Patella LuxationPatella Luxation
Patella LuxationPatella Luxation
Medial Patella LuxationMedial Patella Luxation Patella is in circlePatella is in circle Patellar groove indicated by arrowPatellar groove indicated by arrow
Patella outof groove
Patella in groove
Patella luxation: LateralPatella luxation: Lateral
Seen in older dogs as the soft tissue of stifle Seen in older dogs as the soft tissue of stifle deteriorates; often accompanies hip dysplasiadeteriorates; often accompanies hip dysplasia
Produces more functional disruption than medial Produces more functional disruption than medial luxationluxation
Clinical signsClinical signs– Acute lameness often associated with Acute lameness often associated with
trauma or strenuous exercisetrauma or strenuous exercise– Knock-kneed stance is sometimes seenKnock-kneed stance is sometimes seen– If bilateral, animal may be unable to If bilateral, animal may be unable to
standstand
Patella luxation: MedialPatella luxation: Medial 75% of cases75% of cases 1 of most common stifle joint abnormalities in 1 of most common stifle joint abnormalities in
dogsdogs Bilateral involvement - 50% of casesBilateral involvement - 50% of cases May occur in cats but not suspected, not lameMay occur in cats but not suspected, not lame Clinical signsClinical signs
– Usually bilateralUsually bilateral– Young (5-6 mo)Young (5-6 mo)– Cow-hocked (knock-kneed)Cow-hocked (knock-kneed)– Foot twists laterally when weight bearingFoot twists laterally when weight bearing– Skipping or intermittent hindlimb lamesnessSkipping or intermittent hindlimb lamesness
Patella Luxation - MedialPatella Luxation - Medial
DxDx– Toy and miniature dog breeds (yorkies, Toy and miniature dog breeds (yorkies,
Poms, Pekes, Chihuahuas, Boston Poms, Pekes, Chihuahuas, Boston terriersterriers
– Palpate patella when knee is flexedPalpate patella when knee is flexed– X-rays show deformity and patellar X-rays show deformity and patellar
displacementdisplacement
Patella LuxationPatella Luxation
DiagnosticsDiagnostics– Labs - ?Labs - ?– X-rays – indicated for Grade III & IV X-rays – indicated for Grade III & IV
luxationsluxations– Arthrocentesis/synovial fluid analysis – Arthrocentesis/synovial fluid analysis –
minimal changesminimal changes
Patella LuxationPatella Luxation
TreatmentTreatment– I & II – outpatient treatmentI & II – outpatient treatment
NSAIDS – minimize pain, decrease NSAIDS – minimize pain, decrease inflammationinflammation
No steroids: SE and articular cartilage No steroids: SE and articular cartilage damage in long term usedamage in long term use
+/- chondroprotective drugs – glucosamines, +/- chondroprotective drugs – glucosamines, chondroitin sulfatechondroitin sulfate
Patella LuxationPatella Luxation
Treatment – II, III & IV – Treatment – II, III & IV – – Surgical repair only optionSurgical repair only option
Deepen trochlear grooveDeepen trochlear grooveTibial crest transposition for malalignmentTibial crest transposition for malalignment Imbrication of joint capsule to stabilize Imbrication of joint capsule to stabilize
patella in groovepatella in groove
RxRx– Surgical repair is only treatment Surgical repair is only treatment
(3 surgical options)(3 surgical options)– 1) Deepen trochlear groove1) Deepen trochlear groove
Patella luxation: RepairPatella luxation: Repair
1A) Trochlear block resection (also deepens trochlear 1A) Trochlear block resection (also deepens trochlear groove)groove)
Patella luxation: RepairPatella luxation: Repair
Patella luxation: Surgical repairPatella luxation: Surgical repair
2) Transposition of tibial crest2) Transposition of tibial crest
Medial luxation patella
http://video.google.com/videosearch?http://video.google.com/videosearch?hl=en&q=patella+luxation+surgeryhl=en&q=patella+luxation+surgery&um=1&ie=UTF-8&sa=N&tab=wv#&um=1&ie=UTF-8&sa=N&tab=wv#
http://www.youtube.com/watch?http://www.youtube.com/watch?v=GfnQbIk284gv=GfnQbIk284g
Patella LuxationPatella Luxation
Client infoClient info– After Sx, limit exercise for 2-3 wkAfter Sx, limit exercise for 2-3 wk– Support bandage (1-2 wk) should be Support bandage (1-2 wk) should be
kept drykept dry– NSAIDs for pain reliefNSAIDs for pain relief– Ice pack for 5-10 min q 8 hrs for 3-5 Ice pack for 5-10 min q 8 hrs for 3-5
days post surgerydays post surgery– Physical therapy for rehab (swimming) Physical therapy for rehab (swimming)
helpful for animals reluctant to bear wthelpful for animals reluctant to bear wt– Will probably have some DJD later in lifeWill probably have some DJD later in life
Patella LuxationPatella Luxation
Client InfoClient Info– May be inheritableMay be inheritable– Can worsen overtime esp without Can worsen overtime esp without
surgerysurgery
Hip DysplasiaHip Dysplasia
Def: Malformation and degenearion of the Def: Malformation and degenearion of the coxofemoral jointcoxofemoral joint
PathophysiologyPathophysiology– Developmental defect initiated by a genetic Developmental defect initiated by a genetic
predisposition to subluxation of the immature predisposition to subluxation of the immature hip jointhip joint
– Poor alignment between femoral head and Poor alignment between femoral head and acetabulum => abnormal forces on joint=> acetabulum => abnormal forces on joint=> irregularly shaped acetabula and femoral headirregularly shaped acetabula and femoral head
– Also overload articular cartilage => Also overload articular cartilage => microfractures and osteoarthritismicrofractures and osteoarthritis
Hip DysplasiaHip Dysplasia One of most common One of most common
skeletal diseases in skeletal diseases in dogsdogs
Incidence in cats Incidence in cats lower that dogslower that dogs
Breeds: Large breed Breeds: Large breed dogs – St. Bernards, dogs – St. Bernards, G. Shepherds, Labs, G. Shepherds, Labs, Golden Ret, Golden Ret, RottweilersRottweilers
Hip DysplasiaHip Dysplasia
Lowest prevalence are nearest in size Lowest prevalence are nearest in size to ancestral dogto ancestral dog– skin is tight, thin, smooth skin is tight, thin, smooth – slender/trimslender/trim– muscles are full, hardmuscles are full, hard– low fat % (1-2%)low fat % (1-2%)– fleet footed, well-coordinatedfleet footed, well-coordinated
CollieDobermanCollieDalmatianI WolfhoundG ShorthairAfghan houndBelgium TervurenSiberian Husky
Incidence of HDIncidence of HD Highest prevalenceHighest prevalence
– giant breeds (2-3 x ancestral dog)giant breeds (2-3 x ancestral dog)– bones are coarse and largebones are coarse and large– feet are large and splayedfeet are large and splayed– head is wide/oversizedhead is wide/oversized– heavy, round, stockyheavy, round, stocky– fat % (5-10% of ancestral dog)fat % (5-10% of ancestral dog)– muscles less developedmuscles less developed– less graceful, slowerless graceful, slower– Grow/mature rapidlyGrow/mature rapidly
Within a breed, the faster growers are more prone to Within a breed, the faster growers are more prone to HDHD
Pups of wolves, foxes are slow growing, late maturing Pups of wolves, foxes are slow growing, late maturing vs dogsvs dogs
St BernardNewfoundlandBull mastiffEng SetterGordon SetterOE SheepdogS SpanielAkitaChes Bay RetrieverG RetrieverElkhoundRottG Shep
Hip Dysplasia – Clinical SignsHip Dysplasia – Clinical Signs Depends on degree of joint laxity, OA, and Depends on degree of joint laxity, OA, and
chronicity of diseasechronicity of disease– Early – related to joint laxityEarly – related to joint laxity– Later – related to jt degenerationLater – related to jt degeneration– May present as early as 4-5 monthsMay present as early as 4-5 months
HXHX– Decreased activityDecreased activity
Difficulty risingDifficulty rising Reluctance to run, jump, climbReluctance to run, jump, climb
– Intermittent or persistent hind limb lameness; Intermittent or persistent hind limb lameness; worse after exerciseworse after exercise
– Bunny hopping or swaying gaitBunny hopping or swaying gait– Narrow hind limb stanceNarrow hind limb stance
Hip Dysplasia – PEHip Dysplasia – PE
Pain on palpation of hipsPain on palpation of hips Joint laxity (positive ortolani Joint laxity (positive ortolani
sign) – early disease – sign) – early disease – subluxation of hipsubluxation of hip
CrepitusCrepitus Decreased ROM of hip jointsDecreased ROM of hip joints Atrophy of thigh musclesAtrophy of thigh muscles Hypertrophy of shoulder musclesHypertrophy of shoulder muscles
Hip DysplasiaHip Dysplasia DxDx
– X-rays provide definitive diagnosisX-rays provide definitive diagnosisQuality depends on positioning, exposure Quality depends on positioning, exposure
technique, darkroom techniquetechnique, darkroom technique– VD positionVD position– Hind limbs extended fully and parallelHind limbs extended fully and parallel– Totally rotate legs mediallyTotally rotate legs medially– Bilateral symmetryBilateral symmetry– Flattening of femoral head, Flattening of femoral head, – Shallow acetabulumShallow acetabulum– Periarticular osteophyte productionPeriarticular osteophyte production– Thickening of femoral neckThickening of femoral neck
Hip DysplasiaHip Dysplasia
OFA CertificationOFA Certification– Anesthesia/sedation usually required for Anesthesia/sedation usually required for
positioningpositioning– OFA requires animals to be >2 yr of age; 7 OFA requires animals to be >2 yr of age; 7
grades of hipsgrades of hips Excellent—near perfect hipsExcellent—near perfect hips Good—normalGood—normal Fair—less than ideal, but within normal limitsFair—less than ideal, but within normal limits Near normal—borderline conformation Near normal—borderline conformation Mild Dysplasia—minimal deviation with slight Mild Dysplasia—minimal deviation with slight
flattening of femoral headflattening of femoral head Moderate Dysplasia—Moderate Dysplasia— Severe Dysplasia—complete dislocation of hip w/ Severe Dysplasia—complete dislocation of hip w/
flattening of acetabulum and femoral headflattening of acetabulum and femoral head
Hip Dysplasia: Normal hipsHip Dysplasia: Normal hips
Normal hipsNormal hips– round head except where lig of round head except where lig of
femoral head attachesfemoral head attaches– Joint space (J) is consistentJoint space (J) is consistent
Hip Dysplasia: OFA guidelinesHip Dysplasia: OFA guidelines
Borderline—no consensus between radiologists to classify hip as Normal or Dysplastic
1. femurs not parallel2. Obturator foramen less rounded on R and
wing of ileum larger on R3. R acetabulum appears shallower4. L acetabulum appears deeper5. Fabellae appear more medial to femur midline6. Wedge-shaped jt space due to lateral femoral
rotation (looks like HD)
Normal dog
Good positioning
Poor positioning
Hip DysplasiaHip Dysplasia
Penn Hip Registry – distraction Penn Hip Registry – distraction radiographyradiography
Dorsolateral subluxation (DLS)Dorsolateral subluxation (DLS) Dorsal acetabular rim view x-raysDorsal acetabular rim view x-rays
Hip Dysplasia – TreatmentHip Dysplasia – Treatment MedicalMedical
– OutpatientOutpatient– Analgesics and AntiinflammatoriesAnalgesics and Antiinflammatories
Minimize joint pain=> use legs => decrease atrophyMinimize joint pain=> use legs => decrease atrophy– Does not correct problem; degenerative process Does not correct problem; degenerative process
progresses anywayprogresses anyway– Temporary relief of painTemporary relief of pain– Carprofen, erodolac, deracoxib, tepoxalinCarprofen, erodolac, deracoxib, tepoxalin– Avoid corticosteroids – articular cartilage damage in long Avoid corticosteroids – articular cartilage damage in long
term useterm use– Do not combine NSAIDS Do not combine NSAIDS – Do not combine NSAIDS with steroidsDo not combine NSAIDS with steroids– Wait several days when changing NSAIDsWait several days when changing NSAIDs– Glucosamine and chondroitin sulfate supplements - Glucosamine and chondroitin sulfate supplements -
chondroprotective chondroprotective
Hip Dysplasia – TreatmentHip Dysplasia – Treatment
SurgicalSurgical– TPO – triple pelvie osteotomyTPO – triple pelvie osteotomy
6-12 months age 6-12 months age Preventive to correct alignment of jointPreventive to correct alignment of joint
– Juvenile Pubic SymphysiodesisJuvenile Pubic SymphysiodesisPubic symphysis fused earlyPubic symphysis fused earlyCauses better alignment of acetabulum with Causes better alignment of acetabulum with
femoral headfemoral headCan be done 3-4 months; minimal effect Can be done 3-4 months; minimal effect
after 6 moafter 6 mo
Hip Dysplasia – TreatmentHip Dysplasia – Treatment SurgicalSurgical
– Total hip replacementTotal hip replacement Salvage procedure in mature dogs with severed DJD Salvage procedure in mature dogs with severed DJD
unresponsive to medical Txunresponsive to medical Tx Pain free in 90% of casesPain free in 90% of cases Unilateral replacement provides acceptable function Unilateral replacement provides acceptable function
in 80% of casesin 80% of cases– Excision Arthroplasty or Femoral Head Excision Arthroplasty or Femoral Head
OstectomyOstectomy Forms “false” jointForms “false” joint Removal of femoral head and neck to prevent joint Removal of femoral head and neck to prevent joint
painpain Salvage procedure when medical treatment not Salvage procedure when medical treatment not
working and other sx too expensiveworking and other sx too expensive Best - < 20#; good musculatureBest - < 20#; good musculature Abnormal gaitAbnormal gait
Total Hip Replacement and FHOTotal Hip Replacement and FHO
Hip dysplasiaHip dysplasia
http://www.youtube.com/watch?http://www.youtube.com/watch?v=HTwi8TRs6z8v=HTwi8TRs6z8
Hip Dysplasia – Client InfoHip Dysplasia – Client Info
Weight control important to decrease load Weight control important to decrease load on painful jointon painful joint
Swimming excellent activitySwimming excellent activity Physiotherapy – decreases joint stiffness, Physiotherapy – decreases joint stiffness,
helps maintain muscle integrityhelps maintain muscle integrity Joint degeneration progressiveJoint degeneration progressive May be heritable – do not breedMay be heritable – do not breed Special diets designed for fast growing Special diets designed for fast growing
dogs may decrease severitydogs may decrease severity
Legg-Calve-Perthes Disease (LCP)Legg-Calve-Perthes Disease (LCP)
Spontaneous degeneration of the femoral head Spontaneous degeneration of the femoral head and neck leading to collapse of the coxofemoral and neck leading to collapse of the coxofemoral joint and osteoarthritisjoint and osteoarthritis
Avascular necrosis of femoral head and neckAvascular necrosis of femoral head and neck Cause unknownCause unknown Infarction of the blood vessels of the proximal Infarction of the blood vessels of the proximal
femurfemur Necrosis of subchondral bone => collapse and Necrosis of subchondral bone => collapse and
deformation of femoral head deformation of femoral head Articular cartilage thickened, cleft development, Articular cartilage thickened, cleft development,
fraying fraying
LCPLCP
SignalmentSignalment– Miniature, toy and small breeds, terriersMiniature, toy and small breeds, terriers– 5-8 months old; range 3-13 mo5-8 months old; range 3-13 mo
Clinical signsClinical signs– Lameness, gradual onset over 2-3 monthsLameness, gradual onset over 2-3 months– Usually unilateralUsually unilateral– Pain on manipulation of hipPain on manipulation of hip– Occasional crepitus in hipOccasional crepitus in hip– Atrophy of thigh musclesAtrophy of thigh muscles
LCPLCP
DiagnosisDiagnosis– X-raysX-rays
Early - Decreased bone density of epiphysis, Early - Decreased bone density of epiphysis, sclerosis and thickening of femoral necksclerosis and thickening of femoral neck
Later- lucent areas in femoral neckLater- lucent areas in femoral neckEnd-stage – flattening and extreme End-stage – flattening and extreme
deformation of the femoral head, severe deformation of the femoral head, severe osteoarthritisosteoarthritis
LCPLCP
Legg-Perthes DiseaseLegg-Perthes DiseaseCollapse of femoral head 14 mo post-op FHO
LCPLCP
TreatmentTreatment– Rest and analgesicsRest and analgesics– Analgesics, anti-inflammatory drugs and Analgesics, anti-inflammatory drugs and
cold packing 3-5 days postcold packing 3-5 days post– ROM exercisesROM exercises
LCPLCP
Client educationClient education– Recovery from surgery takes 3-6 monthsRecovery from surgery takes 3-6 months– Glucosamines and chondroitin sulfateGlucosamines and chondroitin sulfate– May be hereditary – do not breed May be hereditary – do not breed – With sx – good to excellent prognosis for With sx – good to excellent prognosis for
full recoveryfull recovery– Conservative therapy – alleviate Conservative therapy – alleviate
lameness in 2-3 months in 25%lameness in 2-3 months in 25%
Osteochondrosis Dissecans (OCD)Osteochondrosis Dissecans (OCD)
Definition of osteochondrosis Definition of osteochondrosis – Pathologic process in growing cartilage, Pathologic process in growing cartilage,
primarily characterized by a disturbance of primarily characterized by a disturbance of endochondral ossification that leads to endochondral ossification that leads to excessive retention of cartilageexcessive retention of cartilage
– Ossification is slowed, cartilage thickens, is Ossification is slowed, cartilage thickens, is weaker and susceptible to stress, disrupts weaker and susceptible to stress, disrupts blood supply => necrosis of boneblood supply => necrosis of bone
– Osteochondrosis dissecans - Formation of a Osteochondrosis dissecans - Formation of a cartilage flap over the area of bone necrosiscartilage flap over the area of bone necrosis
– Bilateral disease commonBilateral disease common– Most commonly affected joints: shoulder, Most commonly affected joints: shoulder,
elbow, stifle, hockelbow, stifle, hock
OCD: PathologyOCD: Pathology
OCDOCD Signalment: Large and giant breedsSignalment: Large and giant breeds
– Great Danes, Labs, Newfoundlands, rottweilers, Great Danes, Labs, Newfoundlands, rottweilers, Bernese Mountain dogs, Englishsetters, Old Bernese Mountain dogs, Englishsetters, Old English sheepdogs English sheepdogs
– Age: 4-8 monthsAge: 4-8 months Hx:Hx:
– Lameness – sudden or slowly increasingLameness – sudden or slowly increasing 1 or more limbs1 or more limbs Worse after exerciseWorse after exercise
Risk Factors: Risk Factors: – Diet with 3x rec levels of CaDiet with 3x rec levels of Ca– Rapid growthand weight gainRapid growthand weight gain
OCDOCD
PE:PE:– Pain on palpation or movement of Pain on palpation or movement of
affected jointaffected joint– Usually weight bearing lamenessUsually weight bearing lameness– Joint effusion commonJoint effusion common– Muscle atrophy if chronicMuscle atrophy if chronic– Hock OCD- hyperextension of the Hock OCD- hyperextension of the
tarsocrural jttarsocrural jt
OCD: Shoulder m. atrophyOCD: Shoulder m. atrophy
OCD – diagnosisOCD – diagnosis
X-raysX-rays– Flattening of subchondral bone or Flattening of subchondral bone or
subchondral lucencysubchondral lucency– Flap visualized if calcifiedFlap visualized if calcified– Calcified bodies within the joint (joint Calcified bodies within the joint (joint
mice)mice) Joint tap and analysis of synovial Joint tap and analysis of synovial
fluid fluid ArthroscopyArthroscopy
OCD: DxOCD: Dx
OCD: lesionOCD: lesion
Great Dane humeral headsOCD normal
OCD – TreatmentOCD – Treatment
Early – no flapEarly – no flap– Restrict activity levelRestrict activity level– Weight controlWeight control
Flap (OCD)Flap (OCD)– Surgical removal of flap or joint miceSurgical removal of flap or joint mice– AntiinflammatoriesAntiinflammatories– No corticosteroidsNo corticosteroids– Chondroprotective drugs (gluocosamine, Chondroprotective drugs (gluocosamine,
etc)etc)
OCD – Client InfoOCD – Client Info
Heritibility – do not breedHeritibility – do not breed DJD may develop even with surgeryDJD may develop even with surgery Limit activity for 4-6 weeksLimit activity for 4-6 weeks PT early onPT early on Control weightControl weight Restrict weight gain and growth in Restrict weight gain and growth in
young dogsyoung dogs
OCD – PrognosisOCD – Prognosis
Shoulder – good to excellentShoulder – good to excellent Elbow, stifle, hock – fair to guardedElbow, stifle, hock – fair to guarded
PanosteitisPanosteitis
Definition: a self limiting condition Definition: a self limiting condition affecting one or more of the long bones of affecting one or more of the long bones of young medium to large breed dogs that is young medium to large breed dogs that is characterized clinically by high density of characterized clinically by high density of the bone marrow cavitythe bone marrow cavity
Cause unknownCause unknown PainfulPainful May be one leg or become a shifting leg May be one leg or become a shifting leg
lamenesslameness
PanosteitisPanosteitis
SignalmentSignalment– Age – 5-18 monthsAge – 5-18 months– DogsDogs
Hx:Hx:– No traumaNo trauma– Lameness of varying intensityLameness of varying intensity– Usually front legs but hind legs alsoUsually front legs but hind legs also– Can be shifting leg lamenessCan be shifting leg lameness– Severe: inappetance, weight loss, depressionSevere: inappetance, weight loss, depression
PanosteitisPanosteitis
PEPE– Pain on deep palpation of long bones in Pain on deep palpation of long bones in
affected limbsaffected limbs– +/- low grade fever+/- low grade fever– +/- muscle atrophy+/- muscle atrophy
PanosteitisPanosteitis
DiagnosticsDiagnostics– X-rays: radiographic densities within X-rays: radiographic densities within
the medulla of long bonesthe medulla of long bones
PanosteitisPanosteitisNormal density of bones Panosteitis
PanosteitisPanosteitis
TreatmentTreatment– NSAIDs- minimize pain; decrease NSAIDs- minimize pain; decrease
inflammationinflammation– Does not affect duration of diseaseDoes not affect duration of disease– Acetominophen not recommendedAcetominophen not recommended
PanosteitisPanosteitis
Client InfoClient Info– Recheck q 2 weeksRecheck q 2 weeks– Self-limiting diseaseSelf-limiting disease– Treatment symptomaticTreatment symptomatic– Multiple limb involvementMultiple limb involvement– Lameness – few days to monthsLameness – few days to months
LuxationsLuxations
Hip luxations are most commonHip luxations are most common
Joint capsule must tear and ligament of femoral head must Joint capsule must tear and ligament of femoral head must teartear
TypesTypes– CraniodorsalCraniodorsal
most commonmost common leg appears shorterleg appears shorter stifle rotates outwardstifle rotates outward
– CranioventralCranioventral Usually results from unsuccessful reduction of craniodorsal Usually results from unsuccessful reduction of craniodorsal
luxationluxation Stifle rotates inwardStifle rotates inward Leg appears longerLeg appears longer
Hip LuxationHip Luxation SignsSigns
– Hx of traumaHx of trauma– Acute lameness; non wt-bearingAcute lameness; non wt-bearing– Possible swelling dorsal to hip jointPossible swelling dorsal to hip joint– Luxated limb shorter if legs extended in Luxated limb shorter if legs extended in
VD positionVD position
Hip Luxation: DxHip Luxation: Dx
DxDx– Thumb between greater trochanter—ischial Thumb between greater trochanter—ischial
tuberositytuberosity Rotate femur away from bodyRotate femur away from body
– Disparity in leg lengthsDisparity in leg lengths– X-ray to r/o femoral neck fracture, Legg-PerthesX-ray to r/o femoral neck fracture, Legg-Perthes
Hip LuxationHip Luxation
Hip LuxationHip Luxation RxRx
– Closed reductionClosed reduction anesthesia required for proper muscle relaxationanesthesia required for proper muscle relaxation
– Using traction, rotate and pull head back in Using traction, rotate and pull head back in placeplace
– Open reductionOpen reduction Replace head of femur andReplace head of femur and suture soft tissue around suture soft tissue around acetabulum to keep it in placeacetabulum to keep it in place
– Either way, bandage in Either way, bandage in abduction x 2 wk (Ehmer sling)abduction x 2 wk (Ehmer sling)
Hip LuxationHip Luxation
Client infoClient info– Px depends on:Px depends on:
Stability of the reduced jointStability of the reduced jointSoft tissue damageSoft tissue damageLength of time prior to reduction of luxationLength of time prior to reduction of luxation
– Arthritis may occurArthritis may occur– Consider FHO/hip replacement if hip Consider FHO/hip replacement if hip
does not stay reduceddoes not stay reduced
Luxation – ElbowLuxation – Elbow
Less commonLess common Difficult to reduceDifficult to reduce
DJDDJD
http://www.youtube.com/watch?http://www.youtube.com/watch?v=PXMRDRetmgUv=PXMRDRetmgU
MyopathiesMyopathies
Def—Diseases of musclesDef—Diseases of muscles Inflammatory myopathiesInflammatory myopathies
– Bacterial myositis (dogs and cats)Bacterial myositis (dogs and cats) Occurs following bite wd or contamination following Occurs following bite wd or contamination following
SxSx Usually Usually Staphilococcus Staphilococcus and and Clostridium Clostridium sppspp
– Protozoal myositisProtozoal myositis Cysts form within muscles of Cysts form within muscles of ToxoplasmosisToxoplasmosis-positive -positive
catscats
Myopathies - Myopathies - Immune-mediated Immune-mediated MyopathiesMyopathies
Polymyositis—immune-mediated disease of dogs Polymyositis—immune-mediated disease of dogs and catsand cats– SignsSigns
Large breed dogs, middle-ageLarge breed dogs, middle-age Weakness that gets worse with exerciseWeakness that gets worse with exercise Stiff, stilted gaitStiff, stilted gait Hyperesthesia on palpationHyperesthesia on palpation Fever, depressionFever, depression Megaesophagus may develop (w/ aspiration Megaesophagus may develop (w/ aspiration
pneumonia)pneumonia) Muscle atrophyMuscle atrophy IdiopathicIdiopathic Dx—Dx—
– Elevated muscle enzymes (CPK)Elevated muscle enzymes (CPK)– Muscle biopsyMuscle biopsy
Rx—Prednisone (2.2 mg/kg daily)Rx—Prednisone (2.2 mg/kg daily)
MyopathiesMyopathies Immune-mediated MyopathiesImmune-mediated Myopathies
– Masticatory muscle myositis (atrophic myositis, Masticatory muscle myositis (atrophic myositis, eosinophilic myositis)eosinophilic myositis)
SignsSigns– Involves muscles of mastication (temporalis, masseter)Involves muscles of mastication (temporalis, masseter)
These muscles have a special fiber type that has These muscles have a special fiber type that has antigenic properties similar to antigenic properties antigenic properties similar to antigenic properties of bacteriaof bacteria
– Muscles swelling initiallyMuscles swelling initially– Muscle atrophy Muscle atrophy
and fibrosisand fibrosis Rx—GlucocorticoidsRx—Glucocorticoids
Acute Chronic
MyopathiesMyopathies
Acquired myopathiesAcquired myopathies– Feline myopathyFeline myopathy
Usually due to renal dysfunction and loss of KUsually due to renal dysfunction and loss of K++ in in urineurine
SignsSigns– Cats of all ages, sexes, breedsCats of all ages, sexes, breeds– Hypokalemia results in cervical ventroflexionHypokalemia results in cervical ventroflexion– Wt lossWt loss– Periodic weakness, muscle painPeriodic weakness, muscle pain
Rx—supplementation of Rx—supplementation of
potassium potassium
Bone TumorsBone Tumors Most bone tumors are Most bone tumors are osteosarcomasosteosarcomas (~100% (~100%
malignant)malignant)
– Cause: unknownCause: unknown– Signs (dist radius, prox humerus, dist femur, prox Signs (dist radius, prox humerus, dist femur, prox
tibia)tibia) Middle-age, large-breed dogsMiddle-age, large-breed dogs LamenessLameness Wt lossWt loss Pain, swelling of affected limbPain, swelling of affected limb
Dx: x-rays show lysis/proliferation of new bone Dx: x-rays show lysis/proliferation of new bone tissuetissue
Bone TumorsBone Tumors
videovideo
http://www.youtube.com/watch?http://www.youtube.com/watch?v=t88NK39rO_ov=t88NK39rO_o
Bone TumorBone Tumor DxDx
– Biopsy for definitive diagnosisBiopsy for definitive diagnosis– Thoracic radiographs to r/o metastatic diseaseThoracic radiographs to r/o metastatic disease
RxRx– Amputation of affected limbAmputation of affected limb– ChemotherapyChemotherapy– Radiation therapyRadiation therapy– No recommended drug therapies for catsNo recommended drug therapies for cats
Client infoClient info– Bone cancer is a fatal diseaseBone cancer is a fatal disease– Survival time up to 12 mo with aggressive therapySurvival time up to 12 mo with aggressive therapy– Biopsy is needed to confirm diagnosisBiopsy is needed to confirm diagnosis– Amputation is necessary for comfort of animal, but it doesn’t Amputation is necessary for comfort of animal, but it doesn’t
affect likelihood of metastasis or survivalaffect likelihood of metastasis or survival– Drug therapy and follow-up lab work are expensiveDrug therapy and follow-up lab work are expensive
DeclawDeclaw Considered “inhumane” by some peopleConsidered “inhumane” by some people Outlawed in some European countriesOutlawed in some European countries San Francisco “advises” against itSan Francisco “advises” against it It is an amputation of the last joint of cat’s toesIt is an amputation of the last joint of cat’s toes
DeclawDeclaw Reasons why owners declaw catsReasons why owners declaw cats
– Shredded furniture, drapesShredded furniture, drapes– Scratched by catScratched by cat
ProcedureProcedure– Apply tourniquet to legApply tourniquet to leg– Anesthetize, remove clawsAnesthetize, remove claws– Tight bandages x 3 dTight bandages x 3 d– Send homeSend home
Do not declaw outside Do not declaw outside catcat
Dock TailsDock Tails Also banned in some European Also banned in some European
countriescountries Done at 2-5 days oldDone at 2-5 days old No anesthesiaNo anesthesia 1 stitch1 stitch