Bryan - Sa Surgery - Specific Joints - Fall 3Rd Year

Front 1

Scapular luxation is more common in _________. How is this treated?

Back 1

cats
(tx: wire scapula to the ribs)

Front 2

An avulsion fracture of the supraglenoid tubercle involves which muscle? How 'bout an avulsion of the acromion process?

Back 2

Supraglenoid = biceps
Acromion = deltoid

Front 3

Ability to abduct the forelimb >30 degrees while holding the scapula down indicates damage to which structure(s)?

Back 3

Medial glenohumeral ligament laxity

Front 4

What is the most common form of shoulder luxation?
a) cranial
b) caudal
c) medial
d) lateral

Back 4

c) medial

Front 5

How can bicipital tenosynovitis be diagnosed using physical examination?

Back 5

Flex shoulder and push tendon medially and watch for PAINFUL RESPONSE = tenosynovitis

Front 6

How is chronic bicipital tenosynovitis treated? What must be done in terms of physical therapy after this?

Back 6

Tx: cut tendon off @ shoulder; screw it to humerus.
PT: gotta build up brachialis muscle to prevent functional lameness

Front 7

Which of the following can lead to sweeny?
a) supraspinatous insertionopathy
b) supraspinatous tendonopathy
c) infraspinatous contracture
d) infraspinatous bursal ossification

Back 7

b) supraspinatous tendonopathy

Front 8

Which of the following is characterized by a "kissing" lesion on the biceps?
a) supraspinatous insertionopathy
b) supraspinatous tendonopathy
c) infraspinatous contracture
d) infraspinatous bursal ossification

Back 8

a) supraspinatous insertionopathy

Front 9

OA of the elbow is common in which small animal?

Back 9

Cats!

Front 10

What are four common diseases/conditions associated with elbow dysplasia?

Back 10

fragmented coronoid process
ununited anconeal process
OCD of medial humeral condyle
elbow incongruity

Front 11

Which ligament usually ruptures concurrently with elbow luxation?

Back 11

Collateral ligament rupture

Front 12

What is the prognosis for elbow luxation treated <8hours? >8 hours? > 3 weeks?

Back 12

<8 hours - pretty good
>8 hrs - poor
>3 wks - grave

Front 13

Which of the following are true regarding ununited anconeal process?
a) large breeds mostly
b) often bilateral
c) anconeal process growth plate closes by 24 weeks
d) treatment involves removal of anconeal fragment

Back 13

a) large breeds mostly
c) anconeal process growth plate closes by 24 weeks

Front 14

Which view is good to diagnose chronic bicipital tenosynovitis?

Back 14

Skyline view

Front 15

How is ununited anconeal process treated <24 wks? >24 wks?

Back 15

<24 wks - medical mgmt
>24 wks - surgery (cut ulna proximally, free interosseus lig, pin ulna, screw anconeus down)

Front 16

What is the weight distribution between the radius and the medial coronoid process in the dog?

Back 16

75% radius
25% process

Front 17

Fragmented medial coronoid process is best seen on which view?

Back 17

lateral flexed

Front 18

Which of the following are true regarding a fragmented medial coronoid process?
a) it is actually an OCD lesion
b) occurs more commonly in retrievers
c) often bilateral
d) congenital component to pathogenesis

Back 18

b) occurs more commonly in retrievers
c) often bilateral
d) congenital component to pathogenesis

Front 19

What is the ONLY muscle crossing the hip and the knee? Where does it originate?

Back 19

Rectus femoris; origin on the craniodorsal buttress (just cranial to lunate surface of acetabular fossa)

Front 20

Which structures are directly involved in hip stabilization?

Back 20

Round ligament of femoral head
Acetabular labrum
Joint capsule
Transverse acetabular ligament

Front 21

Which muscle does the femoral nerve lie in? What does this nerve control?

Back 21

Lies in the humping muscle (iliopsoas); controls the quads

Front 22

What is meant by a "bimodal signalment" for hip dysplasia?

Back 22

2 times animal feels pain: synovitis at 4-11 months; dull increase in OA over years (2-12)

Front 23

A "bodybuilder" looking dog with shoulder hypertrophy and gluteal atrophy likely has...

Back 23

...bilateral hip dysplasia

Front 24

What are your major rule-outs for pain upon hip extension in dogs?

Back 24

Hip dysplasia
Lumbosacral disease
Femoral head/neck fractures
Iliopsoas muscle strain

Front 25

Which of the following are NOT congruent with hip dysplasia?
a) positive Ravioli test
b) Maginot line
c) poor acetabular rim coverage of the humeral head
d) joint subluxation

Back 25

a) positive ORTOLANI test
b) MORGAN'S line
c) poor acetabular rim coverage of the FEMORAL head

Front 26

Which of the following are FALSE concerning the Ortolani test?
a) must be performed under general anesthesia
b) hip and stifle are flexed at right angles
c) dogs with normal hips or advanced arthritis have a negative Ortalani
d) the Barlow test involves subluxation of the hip

Back 26

a) must be performed under SEDATION (doesn't need general anesthesia necessarily)

Front 27

The capital physeal scar should be fused by...

Back 27

...6 mos!

Front 28

What is the EARLIEST sign of hip dysplasia?
a) Morgan's line
b) joint subluxation
c) flat acetabular rim
d) osteophytes around acetabulum

Back 28

b) joint subluxation

Front 29

Which of the following describe OFA rads?
a) reliable at 4 months of age
b) only measures phenotype
c) quantifies hip laxity
d) performed with legs perfectly straight
e) graded by board certifed radiologists

Back 29

b) only measures phenotype
d) performed with legs perfectly straight
e) graded by board certifed radiologists
(note - must be at least 2 yrs old; one view can't get hip laxity)

Front 30

Which of the following describe Penn-Hip rads?
a) reliable at 4 months of age
b) only measures phenotype
c) quantifies hip laxity
d) performed with legs perfectly straight
e) graded by board certifed radiologists

Back 30

a) reliable at 4 months of age
b) only measures phenotype
c) quantifies hip laxity
(note - compression/distraction views taken; must be trained/certified for these)

Front 31

What are the two choices for surgical hip dysplasia treatment in young dogs? Which one is performed before signs of pain manifest?

Back 31

Juvenile Pubic Symphysiodesis (performed before pain)
Triple Pelvic Osteotomy

Front 32

What is a good candidate for a juvenile pelvic symphysiodesis?

Back 32

13-20 wks, non-painful
Predisposed breed or shows early signs on Penn-Hip

Front 33

What is a good candidate for a triple pelvic osteotomy? What is the major complication of this procedure?

Back 33

15-20 months
Clinical signs of hip dysplasia
CRISP Ortolani sign
Good joint congruency on frogleg view
(complication - urethral damage/impingement; sciatic neurapraxia)

Front 34

What are ways to medically manage hip dysplasia in adults?

Back 34

WEIGHT LOSS
Physical therapy
NSAIDs and analgesia
Elk velvet antler, fish oil, etc

Front 35

What are the 2 surgical treatment options for hip dysplasia in adults?

Back 35

Femoral head and neck excision (FHNE)
Total Hip Replacement

Front 36

What is an ideal patient for FHNE?

Back 36

Skeletally mature pt, fails medical treatment. THE SMALLER THE BETTER!

Front 37

What is the ideal patient for a total hip replacement?

Back 37

Skeletally mature pt, fails medical tx, usually >40lbs, HIGHLY COMPLIANT OWNERS

Front 38

What is the most common type of coxofemoral luxation? How can this be diagnosed on palpation?

Back 38

Craniodorsal (iliac crest, greater trochanter of femur, and ischiatic tuberosity make a LINE and not a triangle)

Front 39

T or F:
Due to the 50% failure rate, closed reduction of a coxofemoral luxation + Ehmer sling is pretty worthless.

Back 39

False!
Might as well try...you might be in the 50% in which it sticks!

Front 40

Open reduction of a coxofemoral luxation can involve:
a) capsulorraphy + toggle rod
b) capsulorraphy + ileal-femoral suture
c) FHNE
d) TPO

Back 40

a, b, and c are correct!
Note - if hip dysplasia is present, this is when you do a FHNE. TPO can be done but you need a capsulorraphy b4

Front 41

A young growing dog with acute lameness is...

Back 41

...AN EMERGENCY GROWTH PLATE FRACTURE UNTIL PROVEN OTHERWISE

Front 42

T or F:
"Apple coring" after femoral head injury provides a poor prognosis.

Back 42

False!
This is a GOOD sign and shows that vascularity has been re-established! STRICT REST at this point!

Front 43

Which of the following is correct regarding the CCL?
a) wedge shaped in cross-section
b) attaches to the lateral meniscus
c) relaxes on stifle extension
d) provides medial-lateral stability in flexion

Back 43

d) provides medial-lateral stability in flexion
(note, the CCL tightens on extension and attaches to the medial meniscus)

Front 44

Which tibial meniscus is mobile? Which is often damaged in conjunction w/the CCL?

Back 44

Lateral is mobile
Medial + CCL damaged together

Front 45

How does CCL disease typically manifest in juvenile dogs?

Back 45

CCL avulsion

Front 46

Which dogs are at the highest risk for CCL disease?

Back 46

4-7yo female spayed Newfoundlands, rotties, labs, & etc

Front 47

Which dog has CCL disease?

Back 47

On the left - note legs sticking out sideways

Front 48

Where do you palpate for joint effusion in the stifle?

Back 48

Just caudal to patellar tendon, should be a "valley" in normal dogs. Effusion makes the caudal border of the patellar ligament tough to palpate.

Front 49

What are some physical exam signs of CCL disease in dogs?

Back 49

Sit funny
Medial buttressing at stifle
Stifle joint effusion
Cranial drawer
Cranial tibial thrust

Front 50

Describe the bands of the CCL and when they are tight/loose.

Back 50

Craniomedial band (tight in extension and in flexion)
Caudolateral band (tight in extension, loose in flexion)

Front 51

A dog has a drawer sign in flexion but not in extension. What gives?
a) this is the "puppy drawer"
b) the caudal cruciate is ruptured
c) CCL rupture with concurrent patellar subluxation
d) rupture of craniomedial band of CCL

Back 51

d) rupture of craniomedial band of CCL

Front 52

What are some radiographic signs of CCL disease?

Back 52

Cranial displacement of fat pad
Periarticular osteophyte (pagoda sign)
Cranial translation of the tibia

Front 53

With CCL rupture, what becomes the primary stabilizer in the stifle?

Back 53

Meniscus

Front 54

What are the 3 major surgeries providing stifle stabilization?

Back 54

TPLO (Tibial Plateau Leveling Osteotomy)
TTA (tibial tuberosity advancement)
Lateral fabellotibial suture

Front 55

Which of the following is NOT congruent with a TTA?
a) addresses dynamic stability of the stifle
b) 100% chance of patellar tendonopathy
c) more optimal for cases with severe slopes
d) cut is in the non weight bearing tibia
e) good static stability

Back 55

c) more optimal for cases with severe slopes
e) good static stability
(these describe the TPLO)

Front 56

Which of the following is NOT congruent with a TPLO?
a) addresses dynamic stability of the stifle
b) creates a "super lever arm" for the quadriceps
c) more optimal for cases with severe slopes
d) cut is in the weight bearing tibia
e) addresses rotary and static stability

Back 56

b) creates a "super lever arm" for the quadriceps (This is TTA)
e) addresses rotary and static stability (does NOT address rotary stability)

Front 57

What are the landmarks for securing the lateral tibial fabellar suture? What suture is used?

Back 57

Fabella to origin of cranial tibial m. (use 1# test monofilament per # body wt and round up to nearest 10)

Front 58

What is a good patient for tibial/fabellar suture?

Back 58

Older dog w/poor healing, dogs w/comorbidities, small dogs/cats or cash-strapped owners

Front 59

What is an ideal patient for a TPLO?

Back 59

Young larger/giant breed dogs, maybe very atheletic/active dogs

Front 60

What is your post-op care for TPLO ?

Back 60

E-COLLAR
Pain meds (NSAIDs and Tramadol)
Rest (8-12wks + sling walk)
Recheck exam/films before rehab starts

Front 61

What is your post-op care for tibial/fabellar suture?

Back 61

E-COLLAR
Pain meds (NSAIDs and Tramadol, maybe hydromorphone)
Rest (8wks rest)
Recheck exam/films before rehab starts

Front 62

Oh no! My dog fell off a cliff! WHat is the most likely stifle injury and which structures are damaged?

Back 62

Stifle luxation (collateral and cruciate ligaments & menisci)

Front 63

T or F:
Most commonly, large dogs get lateral patellar luxation while small dogs get medial.

Back 63

False!
Both get medial most commonly but large breeds are more likely to get lateral than small breeds

Front 64

Which type of patellar luxation is typically congenital? Which type of patellar luxation presents more lame (lamer)?

Back 64

Lateral luxations for both!

Front 65

What are the 7 aspects leading to medial patellar luxation?

Back 65

1. Coxa vara (bowed femur)
2. Genu varum (cowboy legs)
3. Shallow trochlear groove, undersized medial trochlear ridge
4. Tilted joint/ joint torsion
5. Medial tibial tuberosity torsion
6. Medial bowing of the proximal tibia
7. Lateral torsion of the distal tibia

Front 66

What are the 7 aspects leading to lateral patellar luxation?

Back 66

1. Coxa valga (bowed in femur)
2. Genu valga (knock-kneed)
3. Shallow trochlear groove, undersized medial trochlear ridge
4. Tilted joint/ joint torsion
5. Lateral tibial tuberosity torsion
6. Lateral bowing of the proximal tibia
7. Medial torsion of the distal tibia

Front 67

How can the patella be luxated laterally (on physical exam)?

Back 67

Partially flex stifle
Rotate toes laterally
Push patella laterally

Front 68

How can the patella be luxated medially (on physical exam)?

Back 68

Extend stifle
Rotate toes medially
Push patella medially

Front 69

Which grades of patellar luxation require surgery?

Back 69

Grades 2-4

Front 70

Choose the grade of patellar luxation that...
...is treated w/therapy
...is predisposed to CCL rupture
...is usually accompanied by limb deformities
...patella can be luxated but goes back in to groove by itself

Back 70

treated w/therapy (grade 1)
CCL rupture (grade 3)
Limb deformities (grade 4)
Patella can luxate but goes back in groove (grade 2)

Front 71

What are the components of patellar luxation surgery?

Back 71

Deepen trochlear groove
Release medial retinaculum
Lateral transposition and imbrication of tibial tuberosity

Front 72

What is the major motion joint in the hock?

Back 72

Talocrural

Front 73

Which lateral collateral ligament of the hock is stable in extension?

Back 73

Long is stable in extension (short in flexion)

Front 74

Which is NOT part of the common calcanean tendon?
a) Semimembranosus
b) Gracilis
c) Biceps femoris
d) Gastrocnemius
e) Lateral digital flexor

Back 74

a) Semimembranosus (SEMITENDINOSUS)
e) Lateral digital flexor (SUPERFICIAL DF)

Front 75

How are transections of the common calcanean tendons repaired?

Back 75

3-loop pulley suture
Maybe semitendinosus muscle flap (for improved blood supply)
6 week splinting!

Front 76

What is the treatment for tarso-metatarsal or intertarsal luxations?

Back 76

ARTHRODESIS ONLY