vet-tech-animal-diseases-2-musculoskeletal-diseases-part-1

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darlene.m.nelson
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vet-tech-animal-diseases-2-musculoskeletal-diseases-part-1
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2012-02-05 10:57:37
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vet tech animal diseases musculoskeletal part set
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vet tech animal diseases 2 musculoskeletal diseases part 1 set
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  1. Musculoskeletal System
    • bones - provide structure
    • muscles - perform movement
    • tendons - attach muscle to bone
    • ligaments:
    • - attach bone to bones
    • - torn will cause instability as opposed to lameness
    • 2nd most common reason clients come in (skin is 1st)
  2. Divisions of the skeletal system
    • axial - bones of the head and trunk
    • appendicular - bones of the limbs and visceral skeleton
  3. Bones of the head and trunk
    • skull
    • vertebrae
    • hyoid bone
    • ribs
    • sternum (sternabrae)
  4. Bones of the limbs
    • thoracic limb
    • pelvic limb
    • pelvis
  5. Bones of the visceral skeleton
    • Os cordis
    • Os penis - can break, usually kick or HBC; can't urinate due to swelling
    • Os rostri - in the heart of some larger animals, eg ox, elephant
  6. Joint
    junction between two bones
  7. Arthro-
    prefix used for joints
  8. Articular
    describes surfaces of joints
  9. Arthrology
    study of the joint
  10. Arthritis
    • inflammation of the joints
    • non-specific term - doesn't tell the cause
  11. Dogs
    Have stifles, not knees
  12. Skeletal muscle
    • voluntary => lameness could be nervous system dysfunction
    • striated
  13. Gross anatomy of skeletal muscle
    • belly
    • - thick central portion
    • - can tear - usually perimecium, but can be cell fibers
    • tendon
    • - attaches muscle to bone
    • - a contination of the periosteum of the bone
    • - injury can pull periosteum off bone & cause more injury
    • aponeurosis - connects muscle to muscle
  14. Muscle attachments
    • origin = stable end of attachment
    • insertion = movement end of attachment
  15. Congenital
    • born with a condition
    • does not indicate whether the defect is inherited or not
  16. Congenital Defects of the Musculoskeletal System
    • can affect any bone
    • can be diagnosed in juvenile animals, but may not be apparent until animal is mature
    • spine
    • - Wobbler's syndrome - appears 6-8 yrs old in dobermans
    • sternum
    • - Pectus excavatum
    • thoracic limb
    • - OCD - Osteochndrosis dissecans
    • - Elbow displaysia
    • pelvic limb
    • - Hip displaysia
    • - Legg Perthes
    • - Luxating patellas
  17. Wobbler's disease
    • aka Cervical Spondylomyelopathy
    • horses and dogs (Great Danes & Dobermans)
    • malformation of caudal cervical vertebrae (C5-C7) results in instability
    • Hypertrophy of ventral ligaments compress spinal cord
    • animal exhibits ataxia
    • articular facets deformed & wiggle -> ligaments get thicker to stabilize & thicker as progresses
    • 90% of neuron cell body in brain with axons thru spinal cord or into brain (only 12)
  18. Hypertrophy
    The enlargement of an organ or tissue from the increase in size of its cells.
  19. Ataxia
    lack of muscle control
  20. Wobbler's - Clinical Signs
    • Great Danes - young - < 1 year old
    • Dobermans - older - > 2 years old
    • progressive ataxia of the hind limb with loss of proprioception
    • neck extends fully
    • front legs abormally far apart
    • when walking, will kind of drag hind legs
    • gets worse as it progresses
  21. Proprioception
    • the ability to sense the position and location and orientation and movement of the body and its parts.
    • the sense of how your own limbs are oriented in space
  22. Wobbler's - diagnosis
    • index of suspicion
    • - breed predilection
    • physical exam
    • - abnormal neck carriage
    • - loss of proprioception
    • - wearing of dorsal paw surfaces - maybe tops of toenails worn as well
    • imaging for definitive diagnosis
    • - x-ray - low budget - ~ $200 can diagnose
    • - MRI - better - ~ $2000 - can give more accurate prognosis
  23. Wobbler's - treatment
    • medical
    • - corticosteroids - eg dexamethasone
    • - neck brace - some dogs will tolerate it, some won't
    • surgical
    • - need to do early on, young animals
    • - stabilization using screws
    • - decompression via ventral slot - cut away arch of vertebrae
    • alternative
    • - acupuncture - can keep them mobile
    • mobility aids
    • - wheel chair/cart
    • - biggest problem is physical management of dog in and out of cart
    • similar symptom progression as ALS in humans
    • eventually if not euthanized, diaphragm wil become paralyzed & they will suffocate
  24. Wobbler's - prognosis
    guarded
  25. Pectus excavatum
    • aka Swimmer puppies
    • congenital
    • defect in development of sternum - concave instead of convex
    • puppies have difficulty walking - appear to be swimming @ 21 days (should be walking normally)
    • forces heart & other organs into abnormal positions
    • forces limbs out, instead of down
    • makes it hard to breathe as lungs are collapsed
  26. Pectus excavatum - diagnosis
    • clinical appearance
    • - not a lot looks like this
    • radiographs
  27. Pectus excavatum - treatment
    • surgery
    • hobbling - pushes ribs together, forces sternum to pop
  28. Pectus excavatum - prognosis
    good with treatment
  29. Osteo-
    bone
  30. Chondr-
    cartilage
  31. -Osis
    condition
  32. Dissecans
    • disintegrate, dry up
    • refers to the condition that results in a cartilage flap and inflammatory joint changes
    • cartilage flap eventually breaks free and floats around joint
  33. Osteochondrosis
    aseptic necrosis of the bone and cartilage followed by reossification
  34. Aseptic necrosis
    • bone dies for no known reason; no infection
    • irritates synovial membrane
  35. Osteochondrosis dissecans (OCD)
    • most commonly seen in: Labs, German Shepards
    • also seen in sporting breeds: retrievers, setters
    • location of lesion determines type of disease:
    • - articular surface = OCD
    • - physeal plates = ununited or fragmented bone parts; more common in German Shepherds
    • most commonly affected joints:
    • - shoulder
    • - elbow
    • - stifle
    • - hock
    • young dogs - front limb; < 2 years old
  36. OCD in shoulder
    • common breeds
    • - retrievers, especially labs
    • - other large breed dogs, eg Bernese Mountain dogs
    • theory is that too rapid growth contributes to this
  37. OCD in shoulder - clinical signs
    • lameness in young dogs
    • worsens with activity
    • improves with rest
  38. OCD in shoulder - diagnosis
    • clinical signs
    • imaging - x-rays
  39. OCD in shoulder - treatment
    • surgical removal of flap and joint mice (pieces floating around)
    • - arthroscopic @ large hospital like Angell, Tufts, Woburn
    • always check both shoulders
    • - may also have elbow issues
    • - OCD frequently more universal than local
    • joint will never be normal
    • will have arthritis in probably 4-5 years
  40. OCD in elbow
    • aka elbow dysplasia
    • common breeds:
    • - German Shepherds
    • - Retrievers
    • - other large breed dogs, eg Bernese Mountain dogs
  41. OCD in elbow - pathology
    • ununited anconeal process (UAP)
    • fragmentation of the coronoid process (FCP)
    • when growing bone, epiphyses of joint of UAP, FCP can disconnect
  42. OCD in elbow - clinical signs
    • similar to shoulder OCD
    • lameness worse with exercise
    • young large breed dogs
    • sometimes crepitus - can feel grinding of the bones
  43. OCD in elbow - diagnosis
    • clinical signs
    • imaging
    • - both elbows & both shoulders
    • - multiple x-rays with multiple positions to get good pix
    • -- flexed, extended
    • -- AP, lateral, maybe oblique
  44. OCD in elbow - treatment
    • surgical removal of fragments
    • joint won't be stable
    • will wind up with arthritic elbows
  45. Panosteitis
    • aka Pan O
    • disease of young large breed dogs - eg German Shepherds
    • inflammatory process between periosteum and bone
    • appears to be an immune dysfuntion; not well understood
  46. Panosteitis - clinical signs
    • acute
    • shifting - from leg to leg
    • lameness
    • waxes and wanes
  47. Panosteitis - diagnosis
    • history
    • deep bone pain on palpation
    • - extremely painful
    • imaging
    • lab work
    • - eosinophilia
    • -- elevated eosinophil count
    • -- because media for inflammation
    • sometimes fever 102 - 103.5 deg
    • severe cases can look like Lymes
    • - eosinophilia is not likely Lymes
  48. Panosteitis - treatment
    • symptomatic
    • - analgesics - eg rimadyl (NSAID)
    • self-limiting
    • - rare after 2 years old
    • - will get better on their own
    • - called growing pains in humans
  49. Hip dysplasia
    • probably a form of OCD
    • multifactorial disease
    • can be asymptomatic for years or be symptomatic early on
  50. Hip dysplasia - multifactorial issues
    • genetic predisposition
    • - German Shepherds have been selectively bred away from this
    • environmental and dietary factors
    • - high energy, high growth diet - muscles will outstrip bone growth/strength
    • skeleton/muscle mismatch in growing dogs
    • failure of soft tissues to maintain hip congruity
    • 2 forms:
    • - acetabular - cup can be flatter than normal
    • - femoral - in head and neck
  51. Hip dysplasia - acetabular form
    • most common
    • excessive slope to dorsal rim
    • acetabulum is shallow
  52. Hip dysplasia - femoral form
    • femoral neck is shortened
    • femoral head is squared
  53. Osteophytes
    • aka bone spurs, bone spicules
    • prickles of bone; get bigger and bigger
    • irritate synovial joint
    • cartilage wears away
  54. Hip dysplasia - clinical signs
    • large breed dogs:
    • - highly variable
    • - juvenile to geriatric
    • - lameness that inproves with exercise
    • - reluctance to rise from laying
    • - "bunny hop" gait
    • -- starts at a trot
    • -- can't gallop
    • -- generally indicates some hip arthritis, not necessarily dysplasia
    • - atrophy of thigh muscles - quads & hamstrings
    • - usually complaint is that they don't want to get up
    • - can measure thigh muscles to tel if hip problem
    • -- smaller thigh muscle has hip problems
    • pretty much every corgie, many poodles have hip dysplasia
    • - asymptomatic as they are not heavy
  55. Gaits for dog/cat
    • walk - 4 beated gait
    • trot - 3 beated - front & opposite rear together, other front, other back
    • canter - left 2, right 2
    • gallop - 4 beated gait really fast; all 4 feet off ground at once
  56. Hip dysplasia - diagnosis
    • physical exam
    • - pain over hips
    • -- move all legs around, painful one last
    • - positive ortalani sign
    • -- lateral recumbency, hand on greater trochanter, other hand stifle, pick up, hip goes out of joint (subluxates)
    • imaging
    • - necessary for confirmed diagnosis
    • - under sedation
    • - Orthopedic Foundation for Animals (OFA)
    • -- PENN Hip
  57. Orthopedic Foundation for Animals (OFA)
    • clearinghouse
    • # of staff radiologists
    • take orthopedic x-rays & send them here for evaluation by 3 radiologists
    • you get back a collective report
    • animal must be at least 2 years old (skeleton must be completely mature)
    • must be sedated
    • must include hip, stifle, patella - straight on, normal leg
    • they evaluate:
    • - rotundity of femoral head
    • - depth of acetabulum
    • - shape & size of femoral head
    • historically OFA is the standard for hip evaluation
  58. OFA grading for hip dysplasia
    • excellent - nearly perfect conformation
    • good - normal for age and breed
    • fair - less than ideal, but within normal limits
    • near normal - borderline
    • mild dysplasia - minimal deviation - ususally due to slightly flattened femoral head
    • moderate dysplasia - shallow acetabulum, flattened femoral head
    • severe dysplasia - complete subluxation of hip with flattened femoral head and acetabulum
  59. PENN Hip
    • gives a way to predict dysplasia before 2 years (as young as 12 weeks)
    • x-ray
    • - dog is frog-legged with plastic bar
    • - measure distance between acetabulum & femur
    • - chart based on breed and age will predict whether they may have it
    • $15,000 for training to do this - makes it expensive for client
    • very predictive
  60. Hip dysplasia - treatment factors
    • age
    • - juvenile
    • -- < 1 year old - pelvis not fully ossified
    • -- can see in 6 mo German Shepherd - return puppy, knee replacement, or other radical surgery
    • - geriatric
    • severity of disease
    • - radiographic evidence
    • clinical presentation of patient
    • - degree of lameness
  61. Femoral attachment
    femur attaches to acetabulum woth femoral ligament on fovea capita
  62. Hip dysplasia - treatment in juvenile
    • no damage to joint yet
    • symptomatic
    • less than 1 year old
    • Triple Pelvic Osteotomy (TPO)
    • - $8,000 - $10,000
    • - cut illium, ischium, & pubis to cut off acetabulum & rotate into a better position
    • - orthopedic surgery is (must be) the most sterile surgery
  63. Hip dysplasia - treatment in adult
    • 2 years old or older
    • mildly symptomatic:
    • - bunny hopping
    • - stiff when cold
    • medical management:
    • - Glucosamine/Chondroitin (brand name Cosequin)
    • -- nourishes cartilage & keeps it from wearing
    • -- same as human medicine
    • - NSAIDs
    • -- rimadyl - oldest of NSAIDs
    • -- others include Metacam
    • - Adequan
    • -- injection 2X week
    • -- hyaluronic acid stimulant
    • --- makes joint fluid thicker
    • --- helps produce more synovial fluid
    • can't do TPO as healing time is too long in an adult
    • aspirin
    • - erodes stomach lining
    • - long term - gives bleeding ulcers & may perforate
  64. Hip dysplasia - treatment in adult-geriatric
    • moderate to severe symptoms
    • surgical options
    • - after medical management fails
    • - $5,000 - $7,000
    • - total hip replacement
    • - femoral head excision arthroplasty
    • - try to wait until far enough into dog's life that won't have to redo
  65. Hip dysplasia - treatment with total hip replacement
    • cut angle from greater trochanter to lesser trochanter
    • titanium cup (held in with tissue glue) & titanium head
    • 24 hours after surgery they will walk out
  66. Hip dysplasia - treatment with femoral head excision arthroplasty
    • small dogs:
    • - just take off femoral head
    • - nothing to replace
    • - swim them to build gluteal muscles which will hold the joint together
    • cats:
    • - do this when they break femoral head off femur
    • - just take it out
    • prosthetic - has life expectancy of ~ 5 years in animal, ~ 10-15 in humans
  67. Hip Dysplasia - Ancillary treatments
    • pretty well accepted
    • physical therapy
    • - eg treadmill, ultrasound, massage
    • - strengthens muscles
    • water therapy
    • - supports joints, so animal can do more
    • - swimming is the best exercise for arthritic joints - more resistance, joint supported, no impact
    • carts - when don't want to put to sleep, but nothing else helping
    • sore joint -> less use -> weak muscles -> unstable joint -> more soreness, etc
  68. Hip Dysplasia - non-traditional treatment options
    • acupuncture
    • - cold laser, needle, pressure, implant
    • - gold implants
    • -- looks like BBs
    • -- excellent conductor of electricity
    • -- like leaving needle in
    • - qi/vital force/energy is disrupted
    • - needles (etc) sit in epidermis
    • - fixes the energy
    • homeopathy - for chronic disease
    • herbal therapy - plants contain much more than just the active ingredient in drugs
    • Susan Wynn - alternate/herbal therapy book
  69. Legg Calve Perthes Disease
    • abrreviated Legg Perthes
    • avascular necrosis of the femoral head
    • small breed dogs
    • - < 40 pounds
    • - eg Yorkies, Jack Russells, other terriers
    • young dogs - < 5 years old
    • painful - screaming, holding leg up when usually playful, intense pain over one hip
    • three legged lame
    • quick onset
  70. Legg Calve Perthes Disease - diagnosis
    • radiographs
    • - can see dying bone
    • not a lot looks like this in a small dog
    • usually only one side
  71. Legg Calve Perthes Disease - treatment
    • femoral head excision arthroplasty
    • do not breed - may or may not be genetic
    • same kind of surgery as hip dysplasia
    • don't take as much PT as large dogs
    • gluteal muscles hold everything together after strengthened
  72. Luxating Patellas
    • small breed dogs
    • non-painful acute lameness
    • self-resolving with hyperextension of the stifle - pull leg all the way back and it pops
    • predisposes them to cruciate ligament (internal stability) injury
    • when breed for miniaturiztion - changes bone morphology
    • we breed for temperament, coat, not necessarily soundness
    • when small dogs get going, they are flexing & extending quickly
    • - quadriceps tendon (holds patella) slips to the side, now dog can't bend knee
    • malformation of bone
  73. Luxating Patellas - diagnosis
    • history:
    • - lame, then not
    • - small dog - toy - < 25 pounds @ maturity
    • physical exam:
    • - graded 1-4
    • - grade 1 = extend leg & push fairly hard, will pop out & it pops right back in
    • - grade 4 = leg slightly bent, little pressure will pop it
    • imaging - can see that patella is not aligned
  74. Luxating Patellas - treatment
    • conservative treatment:
    • - NSAIDs
    • - manual replacement
    • surgical correction:
    • - 2 procedures
    • - can do either or both
    • - patellar groove modification
    • - tibial crest transposition
  75. Luxating Patellas - treatment - patellar groove modification
    take off cartilage, make groove deeper, put cartilage back on
  76. Luxating Patellas - treatment - tibial crest transposition
    • tendon in quadriceps attaches to tibial crest
    • tibial crest, instead of being cranial, can be lateral or medial
    • cut it, move it, pin it
  77. Orthopedic conformation
    • head carriage
    • neck angle
    • front leg:
    • - if upright at shoulder, angles of other leg bones will be shallow as well
    • - if correct, legs are springy
    • topline straight - not roached or sagging
    • rear leg:
    • - if straight up & down, will have hip/joint problems by 4-5 years old
    • poor conformation:
    • - puts too much stress on joints & will have problems later
    • - can guide owners - eg right way to exercise dogs with straight limbs - no bouncing, like frisbee
    • ideal conformation is determined by breed standard
  78. Conformation problems in dogs
    • puppies should be evaluated by 8 weeks
    • points of ischium should be level with each other, hocks should be straight down from them
    • potential problems:
    • - cow hocks - hocks turn in, toes out
    • - pigeon toes - hocks turn out, toes in
    • - excessive angulation
    • - lack of angulation
    • upper joints must compensate for abnormal stresses to hock joint
    • - jumping & landing on these can blow out knees
  79. Conformation problems in cats
    • don't see a lot
    • haven't bred them for size/morphology like dogs
    • don't bind them like dogs - eg herding, sledding, more jobs than natural instinct
  80. Keeping good conformation
    • don't overexercise - eg juveniles - no forced walk on hard pavement
    • don't overfeed - keep them lean
    • don't spay/neuter before maturity - grow differently with no sex hormones
    • dogs in wild start hunting when adult; young eat little, grow slowly

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