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


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

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


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


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


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


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


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


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


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


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


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


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


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


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


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

musculoskeletal system. functions movement shape of body

Documents

function slide

djd slide

page slide

barbaro slide

tight slide

long bone slide

ligament tear slide

fiberglass permanent