Small Ani. Sx- Ortho- Muscles and tendon disease

drraythe's version from 2016-04-29 14:45

intro + mms

Question Answer
what are the 3 main mm probs?Contusions & Strains, Myositis ossificans, Muscle contractures
3 main tendon problems?Rupture / avulsions, Luxations, Bicipital tenosynovitis
Muscle strain is usually due to? which dogs tend to get this problem? which mm are most often affected?due to Overstretching or overuse. usually Sport dogs. the LONG muscles are most often affected (long= bridging 2 joints or more), like the biceps and iliopsoas
what are the two options mm have for healing, and what influences which healing the mm will pick?Can be either regeneration or fibrosis.....this which it picks is influenced by: Innervation, Vascularization, Matrix(bed of damaged mm must be cleaned out), Myoblasts (muscle stem cell basically), Rest
how do you treat mm with a low-to-mild strain?Immobilization, Cold / warm packs (fisr thing- cool it down as much as you can - avoid having big inflammation in the area, stop hematoma. bc hematoma will be absorbed, but wanna have no gap between mm fibers and hematoma would cause a big gap. THEN do warm to enhance blood supply to area for healing and removal of excess fluid and inflammatory mediators), NSAIDs (treat pain--mm strain very painful)
if there is a severe mm strain, how do you treat then?Surgical debridement & decompression, Suture of fascia, Apposition & tension stent patterns, Absorbable suture material, Activity restriction, Physiotherapy
if the mm strain is so severe you must stitch the fascia back together, which patterns do you want to use, and what suture material?Apposition & tension stent patterns--- so usually simple apposition with a tension relieving pattern like this: or like near-far-far-near Use Absorbable suture material bc you dont want that shit in the mm for forever
explain how a Muscle contracture developsRepetitive trauma--> normal muscle replaced by fibrous tissue--> shortening of affected muscle--> loss of fxn
what are the 4 most common mm affected by contracture?m. infraspinatus, m. gracilis, m. semitendinosus, m. quadriceps
*whats the only mm who's contracture we can prevent?quadriceps
* what is the only mm contracture with a good prog?Contracture of the m. Infraspinatus
Contracture of the m. Infraspinatus--> usually happens to who? due to what? What are the clinical signs?usually adult hunting dogs due to repetitive trauma (running through the woods slamming their shoulders into trees) clinical signs are external rotation with reduced shoulder extension
how does contracture of infraspinatus mm appear on US?
how do you treat contracture of infraspinatus?tenotomy! relieves tension, lose fxn of mm but the mm around it can take over and you regain full mobility :)
Contracture of m. Gracilis & m. Semitendinosus---> where are these mm? who tends to get this? why does it happen?mms originate in pelvis, go medially, attach to prox tibia. Usually GSD have prob with this, and it is usually due to overstretching
how would you be able to tell Contracture of m. Gracilis & m. Semitendinosus by watching the dog walk? how else can you dx?special gait- will bring hocks outside and cant extend stile joint when walking, so walk with the stifle joint a little bit flexed. Can also dx with palpation/US (palpation you will feel it is very hard and fibrous on medial thigh)
*how do you tx Contracture of m. Gracilis & m. Semitendinosus?you CAN do Conservative treatment. ***SURGICAL TREATMENT CONTRAINDICATED (if you try to cut mm, get more rxn, more fibrosis, and more loss of fxn :( )
who do you usually see with Contracture of the quadriceps? WHY does this happen?see in Young dogs / cats, it is usually due to Distal Femur fractures (SH FX!) which were Splinted in extension or incorrect fixation!! (THIS IS WHY THIS IS THE ONLY ONE WE CAN PREVENT!)
how do you tx contracture of the quadriceps? what is the prog?try to tx with Physiotherapy, Surgical debridement? (usually produce more trauma), Z -Plasty....but there is poor prognosis. What you should have done with PREVENTiON iN thE FIRST PLACE!!!
HOW can you PREVENT quadricep contractures?treat them properly and ASAP put on a bandage that flexes stifle and hock holds the quadriceps in extension and prevents them from contracting
what is Myositis ossificans? why does it happen?it is Dystrophic calcification in muscles and is Secondary to trauma (Von Willebrand, Tumors, parasites)


Question Answer
wut happun to dis doggie?rupture achilles from calcaneus. prolly most disastrous one in dogs
what are the tendons which make up the achilles tendon?gastroc., SDF, common tendon of biceps femoris, gracilis, and semitendinosus
trauma to the Achilles tendon --> acute vs chronic?in acute they just dont use the leg. But in chronic they start to walk plantigrade
what are the clinical signs of rupture of the achilles (calcaneal) tendon?ROM--> can flex arsus more than contralat side (must fix stifle and flex hock to assess properly) , Palpation, Radiographs, US
how do you fix rupture of the achilles tendon?Sx repair- open, localize tendons, suture tendons
**which patterns due you use to suture tendons back together? what suture material do you use?PATTERNS: Three-loop pulley, Locking loop SUTURE: use NONABSORBABLE suture (prolene) (tendons take FOREVER TO HEAL!)
what can you do to add more support and relieve tension to the sutured tendons while they heal?add a plate! (suture it right to the tendon) ALSO can put external fixator to keep tendon relaxed till it heals
what is Postoperative management of sx tx of rupture of achilles tendon? (how long?)External Fixator 3-4 Weeks, OR calcaneo-tibial screw (which is easier to put in but not as sturdy as external fixator) . Progressive Physiotherapy
what is the best way to ensure that the tendon will be nice and strong when you are done sx tx it?need some tension to have the collagen fibers align-- so let heal an then start stretching to enhance alignment of tendon collagen fibers
Tendon avulsion usually happens in who?young dogs
Extensor digitalis longus avulsion--> (where is this mm/tendon?) WHO tends to get this most often? WHY does this happen?(intraarticular, in stifle joint. attaches laterally.) Tends to happen to young dogs of LARGE breeds (great dane!) and is usually due to trauma.
how can you dx extensor digitalis longus avulsion from rads?see some intraarticular bone density and then will find piece of bone detaching from femur
how do you tx Extensor digitalis longus avulsion?screw the piece of bone back on
3 most common places for Tendon luxations?m. biceps brachii, m. extensor digitalis longus, m. flexor digitalis superficialis
M. flexor digitalis superficialis tendon luxation--> this usually happens why? what condition of the dog can inc chance of this happening? BREED disposition?usually because of trauma, if the dog is OVERWEIGHT this inc the chances of this happening. common in Shetland Sheepdog
M. flexor digitalis superficialis tendon luxation--> where is the retinaculum torn? if you move the joint (tarsus) does it luxate in flexion or extension?Torn retinaculum medial, tendon instability, Luxation in Flexion
Treatment of M. flexor digitalis superficialis tendon luxation?Suture of torn retinaculum medial, Protection with Cerclage wire (loosely applied to provide some lateral stability)
Tenosynovitis bicipital--> WHO tends to get this, and WHAT happens it happen?Middle-large breeds of dogs, usually due to Repetitive trauma/ secondary to other problems (ED)
what are the clinical signs of Tenosynovitis bicipital?Intermittent - Progressive lameness, Worst after exercise
what is the test to test for Tenosynovitis bicipitalput stress of biceps tendon, palpate, flex joint, and press it at the same time. worse after exercise.
how can you dx Tenosynovitis bicipital?Symptoms, Radiographs, Ultrasound, Arthroscopy , flex/extend test
Tenosynovitis bicipital--> how do you tx? is there a medical manage option? sx option?BOTH options. TRY TO START CONSERVATIVE (no good research on how well sx options work) CONSERVATIVE: NSAIDs, Prednisone local, rest. SX: Tenodesis (cut insertion of tendon into the joint and fix it in the proximal humerus, eliminate intra-articular part of the tendon) , Tenotomy (just cut it)