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194 Cards in this Set
- Front
- Back
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List three common radiographic signs of degenerative joint disease.
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Intracapsular soft tissue swelling
Osteophytes Enthesiophytes |
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Joint mice, sub-chondral bone sclerosis, and sub-chondral bone cysts are occassionally associated with the following disease process on a radiograph.
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Degenterative joint disease
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True or false: Decreased joint space is a radiographic sign of degenerative joint disease only when the limb is in a weight bearing position.
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True
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The origin or insertion of a tendon, ligament, or joint capsule to bone
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Enthesis
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The formation of new bone at the origin or insertion of a tendon to bone is called...
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Enthesophyte
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What does enthesophyte formation occur secondarily to?
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Chronic strain, trauma, previous avulsion
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A joint rediograph shows signs of severe intracapsular swelling, cartilage destruction, a narrowed joint space, and sub-chondral bone lysis. If the lesion occurs in a single joint, one likely differential diagnosis would be...
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Septic arthritis
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What radiographic signs may be seen with septic arthritis?
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Severe intracapsular soft tissue swelling
Cartilage destruction Narrowed joint space Sub-chondral bone lysis |
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List three radiographic signs associated with erosive polyarthritis.
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Sub-chondral erosion of bone
Sub-luxation of joints Intracapsular soft tissue swelling |
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What is sub-luxation of a joint?
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Lysis at the attachment site for ligaments
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On a radiograph of the manus, there appears to be severe inracapsular soft tissue swelling, subchondral bone lysis, and subluxation at the level of the carpal and phalangeal joints. The distal ends of the phalanges appear to taper, like pencils. List three differential diagnoses?
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Erosive polyarthritis
Rheumatoid arthritis Feline non-infectious polyarthritis |
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Erosive polyarthritis most commonly affects which joints?
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Carpus/tarsus and distally, especially in the metacarpal and metatarsal bones.
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Areas of lysis that leave bones with a pencil-like appearance are a characteristic of this joint disease.
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Erosive polyarthritis
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On a stifle radiograph, the bone appears normal, but there is significant soft tissue swelling. Similar findings are seen in the tarsal and carpus joints. List two differential diagnoses.
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Non-erosive polyarthritis
Systemic Lupus Erythematosus |
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Non-erosive polyarthritis most commonly affects which three joints?
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Tarsus
Carpus Stifle |
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A joint lesion is monoarticular, with lobulated, asymmetric intracapsular soft tissue swelling. There are areas of aggressive bony lysis along the articular surface. What is the likely cause of these lesions?
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Joint associated tumors
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List some of the most common sites for joint associated tumors.
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Stifle
Elbow Shoulder |
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Can septic arthritis be a monoarticular lesion, polyarticular lesion, or either?
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Either
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List some possible causes of septic arthritis.
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Direct innoculation (monoarticular)
Bacteremia (polyarticular) Fungal |
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What are two characteristics that define an aggressive joint lesion?
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Intracapsular ST swilling
Lysis of multiple bones in joint |
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The flattening of an articular surface due to a subchondral defect is a pathognomonic sign of...
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Osteochondrosis
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When can OCD flaps be seen on a radiograph?
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When they are mineralized
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Is osteochondrosis a unilateral or bilateral disease?
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Bilateral
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List some radiographic signs of osteochondrosis.
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Subchondral defect/flattening of articular surface
Mineralized joint mouse = OCD Intracapsular soft tissue swelling Degenerative joint disease Sclerosis surrounding lesion |
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Where in the shoulder are osteochondrosis lesions typically found?
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Caudal humeral head
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Where in the elbow are osteochondrosis lesions usually found?
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Medial aspect of distal humeral condyle.
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Osteochondrosis usually afftects which region of the tarsal joint?
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Medial trochlea of the talus
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In the stifle, osteochondrosis lesions are typically found where?
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Lateral femoral condyle.
(Medial condyle less commonly) |
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At what age does osteochondrosis typically manifest itself?
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6-10 months
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Osteochondrosis is more commonly a bilateral disease in which joint: the stifle or the tarsus?
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Stifle
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Roentgen signs of this disease include increased intramedullary opacity in the diaphysis of long bones, usually near the nutrient foramen, and blurring of the trabecular pattern of the bone. Eventually these opacities become more defined, and solid periosteal reactions may been seen on the adjacent bony cortex.
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Panosteitis
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Is panosteitis a disease of one limb or several?
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Several limbs
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Intra-medullary opacities of the long bones are indicative of which bone disease?
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Panosteitis
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An antebrachium of a 5 month old Weinmaraner is radiographed and there is evidence of extracapsular ST swelling around the meaphyses of the radius and ulna, and there are linear lucencies that run parallel to the physes. A pronounced periosteal reaction is centered around the metaphyses of these bones. What is a likely diagnosis?
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Hypertrophic osteodystrophy
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Which region of the bone is affected by hypertrophic osteodystrophy?
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Metaphysis
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These three bones are most commonly affected in hypertrophic osteodystrophy.
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Radius
Ulna Tibia |
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An apparent "double physis" is a radiographic indicator of what juvenile bone disease?
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Hypertrophic osteodystrophy
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What breeds are most susceptible to hypertrophic osteodystrophy?
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Large, rapidly growing dogs
(Weinmaraner, Great Dane) |
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At what age do clinical signs of hypertrophic osteodystrophy typically become evident?
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3-5 months
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List a juvenile disease of the diaphysis and metaphysis of the long bones. It primarily affects large and giant breed dogs.
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Panosteitis
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Describe the pathogenesis of panosteitis.
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Adipose cells in the bone marrow degenerate, and are replaced by a proliferation of stromal lattice cells.
These stromal cells undergo intramembranous ossification. This is when the animals usually present with clinical signs. Trabecular medullary bone is removed, and adipocytes in the bone marrow regenerate. |
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True or false: Panosteitis is associated with a high calorie diet low in protein.
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False. High calorie, high protein
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Panosteitis is a cyclic disease that runs a course of approximately...
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90 days
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Is lameness associated with panosteitis usually weight-bearing or non-weight bearing?
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Weight bearing
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Does panosteitis generally begin in the forelimbs or hindlimbs?
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Forelimbs
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This juvenile bone disease presents commonly with an acute onset, shifting-leg lameness. The lameness persists over 2-14 days.
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Panosteitis
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About how long do clinical signs of panosteitis last?
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2-14 days (1 week average)
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This disease involves avascular necrosis of the femoral head.
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Perthes disease
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What is the typical signalment of a Perthes disease patient?
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Young, small breed dog under 10 kg. Males and females equally affected.
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Is Perthes disease a disease of young dogs or older dogs?
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Young dogs
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Does Perthes' disease more males or females?
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Equally affects males and females
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When in bone development does Perthes disease occur?
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Before the closure of the capital femoral physis.
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List the two ways in which lameness presents in Perthes disease.
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Slow onset weight bearing lameness that worsens over 6-8 weeks
Acute onset lameness |
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These findings will be present with Perthes disease on an orthopedic exam.
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Pain
Decreased range of motion Muscle atrophy Crepitus |
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In this disease, the femoral epiphysis collapses due to an interruption of blood flow and subsequent ischemia.
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Perthes disease
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What radiographic evidence will be seen in cases of Perthes disease?
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Deformity of femoral head
Shortening or lysis of femoral neck Focal areas of decreased bone opacity in the femoral epiphysis |
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A young animal presents with pain, crepitus, and decreased range of motion in the coxofemoral joint. List dome possible differential diagnoses.
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Perthes disease (avascular necrosis of the femoral head)
Trauma to the physis Coxofemoral luxation Muscle strain or sprain Medial patellar luxation |
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When is conservative treament of Perthes disease most likely to be successful?
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If the disease is caught realy enough and activity is restricted to prevent eventual collapse of the femoral head and neck. However, most cases present in more advances stages of the disease, and so only 25% of cases resolve with conservative treatment.
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Describe conservative treatment of Perthes disease.
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NSAIDs
Restricted activity Non-weight bearing activities, like swimming |
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How is Perthes disease treated surgically?
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Femoral head and neck osteotomy (FHO)
+/- Total hip replacement |
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True or false: Most patients with Perthes disease are surgical candidated by the time they present to a veterinarian.
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True
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Describe the difficulties of doing a total hip replacement in a patient with Perthes disease.
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Size limitation: Most Perthes patients are smaller dogs, and total hip replacement is not physically feasible in dogs under 10 kg. (Due to size availability of components, and the mechanical stresses of drilling/screwing into small bones.)
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What is the prognosis for Perthes disease after surgery?
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Good, provided that appropriate physical therapy is done post-operatively.
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True or false: Degenerative joint disease is a non-inflammatory disease.
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True
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This joint disease is characterised by articular cartilage degeneration, marginal bone hypertrophy, and synovial membrane changes.
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DJD/osteoarthrosis
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How rapidly does osteoarthrosis prgoress?
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Slowly progressing
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What is the end stage result of advanced osteoarthrosis?
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Ankylosis
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Is DJD with no identifiable cause primary or secondary?
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Primary
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Is primary or secondary DJD more common in small animals?
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Secondary
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Is ankylosis more noticable in simple joints or those with many small bones? Give an example.
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Joints with small bones, like the carpus and hock
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Osteoarthrosis is diagnosed based on the following diagnostics:
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Clinical signs
Radiographs Physical and orthopedic exam Other: bone scan, MRI, CT, arthroscopy, biopsy |
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List some clinical signs of osteoarthrosis.
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Stiffness
Exercise intolerance Lethargy Joint effusion Lameness Pain |
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List some physical clinical findings often observed while examining an osteoarthrosis patient.
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Decreased range of motion
Crepitus Muscle atrophy (disuse) Muscle assymmetry |
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List some radiographic signs often seen with osteoarthrosis.
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Osteophytes
Joint effusion Subchondral bone sclerosis Bone remodeling Thickening of periarticular soft tissues. |
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List five important principles for managing degenerative joint disease.
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1. WEIGHT MANAGEMENT
2. Nutritional supplementation 3. Exercise in moderation 4. Physical rehabilitation 5. NSAIDs and other medical therapies |
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Why is supplementation with omega-3 fatty acids often recommended in patients with dejenerative joint disease?
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Converts arachidonic acid to eicosapentanoic acid to decrease pain and inflammation.
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What are some suggested benefits of chondroprotectives?
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Promote cartilage matrix synthesis
Slow cartilage degradation Decrease break down products Some have anti-inflammatory effects. |
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What is a DMOA?
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Disease modifying osteoarthritic agent
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List some chondroprotective supplements.
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Chondroitin sulfate (GAG)
PSGAG Hyaluronic acid Manganese (GAG cofactor) Ascorbate (free radical scavenger) |
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What caveats should be included when recommending the use of chondroprotectives to a client?
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Slow acting-- response may take months.
Expensive Reports of success are anecdotal, and there is little scientific evidence to the benefits of chondroprotectives. |
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List some FDA-approved brand-name chondroprotectives and their routes of administration.
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Adequan (IM)
Cosequin (oral) Glycoflex (oral) |
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This class of chondroprotectives has a heparinoid-like activity and can decrease platelet counts.
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Poly-sulfated glycosaminoglycans (PSGAG)
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Why is exercise in moderation important for maintaining healthy joints?
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Normal joint movement allows for the weeping-imbibing motion of synovial fluid circulation, keeping the joints adequately bathed and protected.
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How do NSAIDs act to treat osteoarthrosis?
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Reduce levels of pro-inflammatory mediators like thromboxanes, prostaclandins, prostacyclins and oxygen radicals by inhibiting COX-1 and COX-2 pathways.
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COX-1 and COX-2 are made from this, in response to cell damage.
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Arachidonic acid
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List a well-known NSAID that inhibits both COX-1 and COX-2.
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Aspirin
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Which COX is more responsible for maintaining and protecting normal body structures?
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COX-1
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Which COX is more of an "inducible" enzyme that is synthesized during inflammation?
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COX-2
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List some COX-1 sparing NSAIDs.
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Etodolac
Carprofen Deracoxib Meloxicam Previcox |
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List some common side effects of NSAIDs.
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GI ulcers and upsets
Nephrotoxicity Hepatotoxicity (carprofen) Keratoconjunctivitis sicca (etodolac) |
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List some contraindications of NSAID use.
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Coagulopathy
Ulcers Steroid usage Using another NSAID Hepatic or renal disease Dehydration (affects renal perfusion) Shock |
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Why should NSAIDs and steroids not be given concurrently?
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Steroids inhibit the formation of arachadonic acid, the molecule upon which COX-1 and COX-2 operate to mediate inflammation. Just blocking the same reaction farther up the cascade.
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Where in the inflammatory cascade do steroid drugs act?
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Inhibit phospholipase-A2
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Why, if NSAIDs shouldn't be combined with steroids or other NSAIDs, can they be combined with narcotics?
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Narcotics act on the opioid receptors that affect pain perception in the brain, and do not play a role in the inflammatory cascade.
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List some side effects of steroid drugs.
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May decrease collagen and proteoglycan synthesis and matrix proteoglycan content.
Also adverse systemic effects dur to non-selective COX inhibition |
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This drug class decreases catabolic activity in the diseased joint by inhibiting metalloproteinase and protecting the cartilage.
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Steroids
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List some sources of septic arthritis.
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Hematogenous, from septicemia
Exogenous innoculation |
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List some methods of treating septic arthritis.
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Antimicrobials
+/- surgical lavage, arthroscopic lavage, drain placement, open joint management (in severe cases) |
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When shoud antibiotics be started in the event of septic arthritis?
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As soon an arthrocentesis is done, start broad-spectrum antibiotics until susceptibility results in.
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How long should antibiotics be given for septic arthritis cases?
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4-6 weeks, or for 2 weeks beyond the resolution of clinical signs.
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List two forms of non-erosive polyarthritis.
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Idiopathic immune-mediated.
Systemic lupus erythematosus |
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How is non-erosive polyarthritis treated?
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Prednisone
Azathioprine (idiopathic) Pred + levamisole (SLE) Cyclosporine Cyclophosphamide Chlorambucil in cats with SLE |
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List two types of erosive polyarthritis.
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Rheumatoid arthritis
Feline chronic progressive polyarthritis |
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How is rheumatoid arthritis treated?
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Combination of immunosuppressive drugs
+/- Arthrodesis |
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How is feline chronic progressive polyarthritis treated? Is it erosive or non-erosive?
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Erosive polyarthritis
Tx: Prednisolone and chlorambucil |
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Describe the normal development of bone.
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Fetal skeleton cartilage model
Cartilage cells replaced by osteoclasts and osteoblasts Mineralization and resorption of cartilage, replaced by bone Primary ossification centers (compact bone) Secondary ossificationc centers (cancellous bone) |
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The ossification centers at the epiphyses of bone are considered... and produce... bone.
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Secondary
Cancellous |
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The ossification center in the diaphysis of a bone is considered... and produces... bone.
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Primary
Trabecular |
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Longitudinal bone growth occurs on which side of the physis?
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Metaphyseal side
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Most superficial cartilage layer, being the gliding surface of the articular cartilage.
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Tangential layer
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This layer of the articular cartilage provides compressive support and has increased cellularity.
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Transitional zone
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This layer of the carticular cartilage has chondrocytes oriented perpendicular to the joint surface. It provides compressive support.
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Radial zone
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This region of the articular cartilage marks the demarcation between the radial zone and the zone of calcified cartilage.
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Tide mark
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Thiz zone of the articular cartilage anchors it to the bone.
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Zone of calcified cartilage
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Which layers of the articular cartilage are directly vascularized: Superficial, middle, and/or deep?
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Deep only
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Describe how endochondral ossification works.
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The cartilage matrix calcifies and is invaded by blood vessels. These vessels provide an influx of osteoblasts, osteoclasts, nutrients, etc. Osteoid is produced, which is a scaffold for bone production.
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Which two layers of articular cartilage comprise the "deep" cartilage, where direct vascularization occurs?
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Zone of calcified catilage
Subchondral bone |
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Physes at both the epiphyseal and metaphyseal regions have all of the same layers of cartilage, except for this zone.
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Tangential zone (epiphyseal/articular cartilage only)
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The rate of cartilage production is matched by the rate of ... until skeletal maturity.
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Bone replacement
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Describe what happens to the physeal cartilage as a bone reaches maturity.
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Chondrocytes in the former proliferative zones now function to maintain the joint surface and transfer energy to the underlying subchondral bone.
The diffuse zone of calcified cartilage narrows to a thin zone as bone replacement outpaces cartilage production. This zone helps maintain the articular cartilage. |
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Is osteochondrosis a developmental disease or a degenerative disease?
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Developmental
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Osteochondrosis results from an interruption in this developmental process.
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Endochondral ossification
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This disease results from an interruption in endochondral ossification at the osteochondral junction, leading to a thickened focal defect on the developing articular cartilage that eventually degenerates.
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Osteochondrosis
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True or false: Osteochondrosis can affect any growth plate in the body.
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True
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Why does the thickened articular cartilage seen in osteochondrosis undergo necrosis?
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There is reduced diffusion of nutrients from the underlying blood vessels and overlying synovium, so that the degenerate cartilage doesn't receive adequate nourishment.
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Name for a protuberance that should become calcified to main bone.
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Apophysis
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Describe the pathenogenesis of osteochondrosis.
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Thickening of articular cartilage leads to poor diffusion of nutrients. The deep cartilage undergoes necrosis, and increases susceptibility to trauma and damage. As a result, the matrix molecules become more like articular cartilage that doesn't undergo ossification.
The noncalcified and calcified catilages separate at the tidemark, resulting in a flap. |
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When does osteochondrosis become osteochondritis dissecans?
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When there is separation of the calcified and non-calcified layers of cartilage and a flap is formed.
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List the three possible outcomes of formation of an OCD lesion.
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Flap may reattach to subchondral bone if there is bleeding into the defect.
Vertical fracture of articular cartilage may form due to trauma, irritation, and influx of synovial fluid into the defect. Fragments may detach and form joint mice. |
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Describe what is meant by a "kissing lesion."
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When an OCD cartilage flap forms and damages the opposing joint surface at the same place.
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List three hormones that may play a role in development of osteochondrosis.
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Excess growth hormone
Testosterone Estrogen |
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How does testosterone contribute to osteochondrosis?
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Stimulates epiphyseal growth, delays endochondral ossification, and synergizes with growth hormones.
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How does estrogen contribute to osteochondrosis?
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Encourages carilage calcification
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List five factors that contribute to osteochondrosis.
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Trauma/Mechanical stresses
Anatomical factors Hormones Overnutrition Rapid growth rates Heredity |
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Excesses of this mineral have been linked to formation of osteochrondrosis in dogs.
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Calcium
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Osteochondrosis occurs more frequently in which gender in canines?
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Males
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Describe the signalment of the typical patient presenting with osteochondrosis.
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Rapidly growing male large/giant-breed dog
High plane of nutrition Period of rapid growth Heredity |
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Abnormalities of blood vessels have been and may lead to development of osteochondrosis.
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Pigs
Horses Humans |
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Osteochondrosis of the shoulder presents most commonly at this age...
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5-10 months of age
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Osteochondrosis of the should occurs at this site.
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Caudal aspect of the humeral head
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A 10 month old St. Bernard puppy presents with a mild forelimb lameness of gradual onset. The affected limb is externally rotated and the elbow is abducted. There is mild atrophy of the supraspinatus, infraspinatus and deltoideus muscles, and the scapulohumeral joint is painful on manipulation. What is a primary differential diagnosis?
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Osteochondrosis of the shoulder
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True or false: Although osteochondrosis of the shoulder is often bilateral, the associated lameness tends to be unilateral.
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True
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When is medical management of osteochondrosis appropriate?
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Patient under 7 months of age
Small radiographic lesions No joint mice No clinical pain |
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When is surgical management of osteochondrosis appropriate?
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Persistent lameness over 6 weeks
Presents with pain and lameness OCD flap present Patient over 8 months of age Large lesion Joint mice present |
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Is osteochondritis dissecans primarily a disease best managed by medical treatment or surgical treatment?
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Surgical usually
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Clinical signs of elbow osteochondritis appear at what age? What about lameness?
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Under 1 year
Lameness at 5-7 months of age |
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Osteochondosis lesions occur at which area of the elbow joint?
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Distal trochlear ridge of the medial aspect of the humeral condyle
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At what age does stifle osteochondrosis typically present itself?
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4-9 months
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Is stifle osteochondrosis usually unilateral or bilateral?
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Bilateral
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Where in the stifle does osteochondrosis present?
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Medial aspect of lateral femoral condyle
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A crouched, crab-walking gait is most evident when osteochondrosis affects this joint.
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Stifle joints, usually both
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At what age do patients usually present with hock osteochondritis?
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5-7 months of age
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Osteochondrosis of the hock typically manifests itself at what site?
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Medial trochlear ridge of the talus
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Osteochondrosis at which joint produces a non-weaightbearing lameness most commonly?
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The hock
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Osteochondrosis of the hock is most commonly seen in these two dog breeds.
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Rottweilers
Labrador retrievers |
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Describe the medical management of osteochondrosis.
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Strict cage rest for 4-6 weeks
NSAIDs Disease modifying osteoarthritic agents (DMOAs) Restricted diet (fewer calories and Ca) Used for very small lesions and older dogs with advanced disease |
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What are the goals of treating osteoarthritis surgically?
|
Remove cartilage flaps and joint mice
Remove non-adherent cartilage in periphery of lesion Stimulate defect to heal by stimulation (curettage, forage, abrasion arthroplasty) |
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List three methods for stimulating cartilage repair.
|
Curettage
Forage Abrasion arthroplasty |
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This surgical appraoch to the joint involves separating between muscle bellies to achieve limited joint exposure from the outside.
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Arthrotomy
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This surgical approach to joint access is less invasive, allowing for complete exploration of the joint and lavage. It is more technically defficult than other appraoches, requiring specialized equipment and training.
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Arthroscopy
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Describe the post-operative care protocol following surgery to repair osteochondrosis lesions.
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Limited activity for 4 weeks
Modified RJ bandage Mild physical therapy |
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List some complications of osteochondrosis surgery.
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Seroma
Wound dehiscence Infection Chronic lameness |
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What is the prognosis following surgical repair of shoulder osteochondrosis?
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Good to excellent
75% of dogs not lame post-op |
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What is the prognosis following surgical repair of elbow osteochondrosis?
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Guarded
DJD progresses after medical and surgical management |
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What is the prognosis following surgical repair of stifle osteochondrosis?
|
Guarded
DJD commonly progresses even after surgery |
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What is the prognosis following surgical repair of hock osteochondrosis?
|
Poor
Moderate to severe lameness persists even after surgical intervention. |
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This disease also goes by the names eosinophilic osteomyelitis, eosinophilic panosteitis, and enostosis.
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Panosteitis
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This disease affects the diaphysis and metaphysis of the long bones of large and giant breed dogs.
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Panosteitis
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Describe the pathenogenesis of panosteitis.
|
Adipose cells in bone marrow degenerate, and stromal cells of the medulla proliferate. This leads to intramembranous ossification, when patients present with pain. The medullary trabecular bone eventually is removed and adipose bone marrow regenerates. This occurs over a cycle of 90+ days.
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Panosteitis is a process that occurs over the course of how long?
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90 days or more
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With what historical issues will a patient with panosteitis present?
|
Weightbearing lameness
-Acute onset -Mild to moderate -Persisting from 2-14 days -Not influenced by exercise or rest -Shifting leg lameness, multiple limb involvement |
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Does panosteitis typically begin in the forelimbs or hindlimbs?
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Forelimbs
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At what age does panosteitis typically manifest itself?
|
5-18 months
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Which gender is more commonly affected by panosteitis?
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Males
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Which bone is most commonly affected by panosteitis?
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Ulna
(radius 2nd) |
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What radiographic findings are indicative of panosteitis?
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Endosteal bone production, subendosteal bone production
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Is panosteitis best treated through medical or surgical means?
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Medical-- this is not a surgical disease
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True or false: Panosteitis is typically a self limiting disease that resolves with time.
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True
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List some specific treatment modalities for alleviating panosteitis.
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NSAIDS for duration of episode
Exercise restriction during lameness Weight reduction |
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What is the prognosis for a typical panosteitis case?
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Excellent
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Refers to the delayed formation of bone by a physis.
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Retained cartilagenous core
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List two common sites of retained cartilagenous core.
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Distal ulna
Distal femur |
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How does a retained cartilage core affect bone growth?
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Retards bone growth
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Describe the typical signalment of a dog with retained cartilagenous core.
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Juvenile large breed dog in a stage of active bone growth
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At what age does a retained cartilage core typically present itself?
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3-4 months
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Describe the lameness associated with a retained cartlagenous core.
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Mild lameness of insidious onset
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Retained cartilagenous coure causes the assocated limb to deviate in which direction: Varus or valgus?
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Valgus
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True or false: Dogs with a retained cartiloagenous core have often consumed a diet low in Ca++.
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False. High Ca++
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Radiographic signs of this disease include a flame shape to the distal physis.
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Retained cartilagenous core
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How is a retained cartilagenous core repaired if surgery is indicated for severe bone deformity?
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Osteotomy done early-- straighten out bone by cutting, or "releasing" deformed bone.
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How is a retained cartilagenous core usually treated.
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Not usually necessary, except for a change in diet to decrease the plane of nutrition.
Severe cases may require osteotomy |
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What is the prognosis for most cases of retained cartilagenous core?
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Good
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This developmental disease also goes by the names canine skeletal scurvy, isiopathic osteodystromy, or Barlow's disease.
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Hypertrophic osteodystrophy
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List the typical signalment of a patient with hypertrophic osteodystrophy.
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Juvenile giant breed dog in stage of rapid growth, usually male
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