Post on 22-Dec-2015
transcript
ADVERSITY“I am not afraid of storms for I am learning how to sail my ship.”
-Louisa May Alcott
DISEASES OF THE MUSCULOSKELETAL
SYSTEMPART 3
POOR CONFORMATION: LUXATING PATELLA
POOR CONFORMATION: LUXATING PATELLA
POOR CONFORMATION: LUXATING PATELLA
POOR CONFORMATION: LUXATING PATELLA
PATELLA INGROOVE
PATELLAOUT OFGROOVE
POOR CONFORMATION
KNOCK-KNEED/PIGEON-TOED, ORCOW-HOCKED STANCE MAY OCCURIN LATERAL LUXATIONS
BOW-LEGGED STANCE MAY OCCURIN MEDIAL LUXATIONS
POOR CONFORMATION: TREATMENT OF PATELLAR LUXATION
TROCHLEAR WEDGE RESECTION
POOR CONFORMATION: TROCHLEAR WEDGE RESECTION
POOR CONFORMATION: TIBIAL CREST TRANSPOSITION
POOR CONFORMATION: TIBIAL CREST TRANSPOSITION
POOR CONFORMATION: HIP DYSPLASIA
YOUNG DOGS 5-8 mos AND MATUREANIMALS WITH CHRONIC DISEASE
POOR CONFORMATION: HIP YSPLASIA
POOR CONFORMATION: HIP DYSPLASIA
Poor conformation combined with genetic, environmental and nutritional factors
Acetabular vs. Femoral hip dysplasia
POOR CONFORMATION: HIP DYSPLASIA
• PHYSICAL EXAM FINDINGS Pain on palpation of hips Joint laxity (positive ortolani sign) – early disease – subluxation of hip
Crepitus Decreased ROM of hip joints Atrophy of thigh muscles Hypertrophy of shoulder muscles
POOR CONFORMATION: HIP DYSPLASIA
http://www.youtube.com/watch?v=2rRKDheDrLs&NR=1
http://www.youtube.com/watch?v=SHCIT87jY0M&feature=related
Hip Dysplasia: Radiographic view
For standard Orthopedic Foundation for Animals–type radiographs to evaluate hip conformation, extend the hips and internally rotate the tibias until the patella lies directly over the trochlear grooves. Be sure the pelvis is straight, with symmetric obturator foramina.
ventrodorsal view of the pelvis with rear limbs extended symmetrically and rotated inward to center the patellae over the trochlear grooves
POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION
"normal" radiographically may be further classified as excellent, good, fair, or near normal
POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION
HIP DYSPLASIA and OFA CERTIFICATION
dysplasia are categorized as mild, moderate, or severe
PennHip Evaluation
Distraction View
Compression view
Extended View
HIP DYSPLASIA TREATMENT
NSAIDs
NEUTRICEUTICALS/CHONDROPROTECTIVE AGENTS
HIP DYSPLASIA TREATMENT: MEDICAL MANAGEMENT
• Aspirin or buffered aspirin: 10-25 mg/kg q 8-12 hr or as needed: Discontinue if vomiting occurs.
• Carprofen (Rimadyl): 2 mg/kg PO q 24 hr
• Deracoxib (Deramaxx): For chronic dosing use 1-2 mg/kg PO q 24 hr as needed.
• Etodolac (EtoGesic): 10-15 mg/kg PO q 24 hr
• Firocoxib (Previcox): 5 mg/kg PO q 24 hr. Do not use in puppies less than 7 months of age or in dogs weighing less than 7 pounds.
• Meloxicam(Metacam): 0.2 mg/kg first dose; then 0.1 mg/kg thereafter q 24 hr PO.
• Tepoxalin (Zubrin): 20 mg/kg PO q 24 hr x 1 treatment; then 10 mg/kg PO q 24 h. This is similar to carprofen and ketoprofen.
HIP DYSPLASIA TREATMENT: MEDICAL MANAGEMENT
• Polysulfated glycosaminoglycan (Adequan):
• Polysulfated glycosaminoglycans prevent cartilage breakdown by inhibiting the enzymes of cartilage degradation during inflammation. Discontinue use if there is no improvement after the third week. Caution,
may increase bleeding time.
• Cosequin: Note that dose is based primarily on empiricism and manufacturer's recommendations. Adverse effects have not been reported although hypersensitivity is
possible. Cosequin is a brand name for glucosamine HCL combined with chondroitin
sulfate which may stimulate synthesis of synovial fluid, inhibit degradation, and improve healing of articular cartilage.
Hip Dysplasia – Treatment
• Surgical Total hip replacement
Salvage procedure in mature dogs with severed DJD unresponsive to medical Tx
Pain free in 90% of cases Unilateral replacement provides acceptable function in 80% of
cases Excision Arthroplasty or Femoral Head Ostectomy
Forms “false” joint Removal of femoral head and neck to prevent joint pain Salvage procedure when medical treatment not working and
other sx too expensive Best - < 20#; good musculature Abnormal gait
Triple Pelvic Osteotomy
Arthroscopy – Juvenile patientsA, Ventrodorsal radiograph of an immature dog with subluxation of the femoral heads and minimal evidence of DJD, typifying a candidate for triple pelvic osteotomy. B, Ventrodorsal radiograph of a dog with advanced hip dysplasia and osteophyte formation. This dog may be a candidate for total hip replacement or femoral head ostectomy if clinical signs cannot be managed medically.
Arthroscopic view of a normal hip joint
HIP DYSPLASIA TREATMENTTRIPLE PELVIC OSTEOTOMY
HIP DYSPLASIA TREATMENT
FEMORAL HEAD OSTECTOMY
“False joint” forms from scar/fibrous tissue
HIP DYSPLASIA TREATMENT
www.kahalapethospital.com/yahoo_site_admin/as...
artreality.com
JUVENILE PUBIC SYMPHYSIODESIS
• Juvenile pubic symphysiodesis (JPS) surgery is a prophylactic procedure performed in puppies 10 to 20 weeks of age that have been diagnosed with hip dysplasia
• causes premature closure of the cranial pubic symphysis
PennHip distraction view of a Labrador puppy at 14 weeks. The DI is 0.55.
The same dog at 50 weeks (36 weeks post-JPS).
Hip Dysplasia – Client Info• Weight control important to decrease load on painful joint
• Swimming excellent activity
• Lameness may occur due to surgical shortening of the affected limb
• Physiotherapy – decreases joint stiffness, helps maintain muscle integrity
• Joint degeneration progressive
• May be heritable – do not breed
• Special diets designed for fast growing dogs may decrease severity