Magnetic resonance imaging of selected limb joints in dogs

The presented paper presents updated information concerning magnetic resonance imaging (MRI) of shoulder joint, elbow joint and knee joint in dogs. It describes indications, planes, standard sequences, slice thickness to perform MRI examination of above mentioned joints. Besides general information about basic physics use in magnetic resonance imaging, and practical information about magnetic resonance and it usage in orthopedic examination are given.     

Evaluation of the passive function of the biceps brachii muscle-tendon unit in limitation of shoulder and elbow joint ranges of motion in horses

OBJECTIVE: To quantify the passive contribution of the biceps brachii muscle-tendon unit to the limits of elbow joint extension during shoulder joint flexion in horses. SAMPLE POPULATION: Normal right forelimb specimens from 6 Thoroughbred cadavers. PROCEDURE: Specimens included the scapula, humerus, radius-ulna, biceps brachii muscle-tendon unit, and stabilizers of the shoulder and elbow joints. Specimens were mounted to a rigid board by transfixation pins through the humerus and instrumented for mechanical manipulation of the limb and joint angle and load measurements. Flexion and extension limits of shoulder and elbow joint ranges of motion were measured in each joint separately, while the other joint was fixed. Measurements were made before and after transection of the biceps brachii muscle-tendon unit. RESULTS: The biceps brachii muscle-tendon unit limited elbow joint extension when the shoulder joint was fixed in flexion, limited shoulder joint flexion when the elbow joint was fixed in extension, and inhibited shoulder joint extension to a lesser degree when the elbow joint was fixed at midrange angles of 75 degrees to 90 degrees. CONCLUSIONS AND CLINICAL RELEVANCE: Clinical manipulation of the elbow joint into hyperextension during shoulder joint flexion is indicative of biceps brachii injury.     

Transarticular application of external skeletal fixation.

External skeletal fixators provide a useful alternative to external coaptation techniques for immobilization of joints in selected patients. This is especially true when the orthopedic injury involves an open wound requiring daily treatment. Devices such as the K-E splint, the Rudy external fixator boot, and acrylic frame fixators are economical and effective for transarticular fixation in small animal patients. Clinical indications for these techniques have included fixation of tibial or radial fractures with a short distal fragment; arthrodesis of the elbow, carpus, stifle, or tarsus; protection of Achilles tendon repairs; protection of collateral ligament repairs of the tarsocrural joint; and protection when multiple ligaments of the stifle joint have been reconstructed. Use of contoured rods has facilitated transarticular application of type II Kirschner-Ehmer splints. Use of acrylic frames and the Rudy boot technique have extended safe use of transarticular external fixation to extremely small patients not accommodated by the Kirschner system alone. An understanding of the advantages and disadvantages inherent in each of these techniques is critical to proper selection of the best method for a given patient. Attention to the basic principles of pin selection, pin insertion, and frame design are needed for successful execution of the chosen technique.     

Osteochondrosis of the elbow: a review of the pathogenesis and a new approach to treatment

SUMMARY To test the hypothesis that joint incongruity contributes to the pathogenesis of elbow osteochondrosis, the left and right radius and ulna of 20 young large breed dogs were measured to determine any variation in length and to observe any incongruity of the elbow joint. Both lame and normal dogs were included in the study. Nine of the 20 dogs had marked disparity in radial and ulnar lengths yet only one had obvious elbow joint incongruity. The use of a sliding osteotomy for the treatment of fragmented coronoid process and a lengthening osteotomy for the treatment of an ununited anconeal process is also discussed. All four dogs treated with a sliding osteotomy showed a marked clinical improvement, and two of the three dogs treated with a lengthening osteotomy showed radiographic fusion of the anconeal process.     

Osteomyelitis secondary to trauma involving the proximal end of the radius in horses: five cases (1987-2001)

OBJECTIVE: To determine clinical, radiographic, and scintigraphic abnormalities in and treatment and outcome of horses with trauma-induced osteomyelitis of the proximal aspect of the radius. DESIGN: Retrospective study. ANIMALS: 5 horses. PROCEDURE: Data collected from the medical records included signalment; history; horse use; degree of lameness; radiographic, ultrasonographic, and scintigraphic findings; treatment; and outcome. RESULTS: Duration of lameness prior to referral ranged from 14 to 60 days. Mean severity of lameness was grade 3 of 5, and all horses had a single limb affected. All horses had signs of pain during elbow joint manipulation and digital palpation over the lateral aspect of the proximal end of the radius. Radiographic lesions consisted of periosteal proliferation, osteolysis, and subchondral bone lysis. Scintigraphy in 3 horses revealed intense pharmaceutical uptake diffusely involving the proximal end of the radius. Two horses had sepsis of the elbow joint. All horses were treated with antimicrobials long-term; 1 horse was also treated by local perfusion of the radial medullary cavity through an indwelling cannulated screw. At follow-up, all horses had returned to their previous function. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that osteomyelitis of the proximal end of the radius can result from a traumatic injury to the antebrachium. Because lesions may be an extension of septic arthritis, a thorough examination of the wound area and elbow joint is recommended. Prolonged systemic antimicrobial treatment can result in a successful outcome.     

Developmental orthopedic disease.

Developmental orthopedic diseases are a common cause of pain and lameness in young dogs. Most occur in large-breed dogs with rapid growth rates. This article reviews the signalment, etiology and pathogenesis, clinical signs, diagnosis, treatment, and prognosis for many of the common developmental orthopedic diseases, including hypertrophic osteodystrophy, panosteitis, osteochondrosis, Legg-Calve-Perthes disease, hip dysplasia, elbow dysplasia, and pes verus.     

Successful closed reduction and conservative management with traumatic elbow luxation and medial collateral ligament rupture in an equid

A 9-year-old donkey jenny (212 kg) presented with an acute, nonweight-bearing left forelimb lameness of 24- to 36-h duration. The limb was held in flexion and abduction, with the toe above the ground, and was unable to be manually straightened. There was significant palpable swelling along the medial aspect of the elbow joint. Radiographic evaluation revealed a medial luxation of the elbow joint with rupture of the medial collateral ligament. Closed reduction was accomplished under injectable anaesthesia without complication. The patient was weight-bearing and comfortable on the limb immediately upon recovery from anaesthesia. The jenny was tied and kept standing for 60 days. Full limb bandages, splints (extending proximal to the scapula), hobbles, NSAIDs and cold laser therapy were utilised, decreased and discontinued. At 74 days, a rehab programme was initiated. At 8 months post-injury, the patient was not lame and was back to her previous level of exercise. Although elbow luxation has been described as having a guarded prognosis, there has now been success in 4/5 (80%) reported cases when treatment has been attempted. Closed reduction without surgical intervention in adult animals with elbow luxation can be successful, likely dependent on the level of associated injury.     

Surgical treatment for multiple lesions of elbow dysplasia in two dogs

The presence of an ununited coronoid process, an ununited anconeal process and an ectopic proximolateral radial ossification center are described in a single elbow joint of a ten month old unspayed Great Dane. This animal and a nine month old spayed Saint Bernard, also with an ununited coronoid process, both had marked degenerative osteoarthritis associated with the instabilities.

Chronic lameness and significant palpable elbow joint enlargement(s) were apparent in both dogs. Radiography was used to identify the lesions and surgical treatment produced satisfactory remission of signs.

     

Effects of electrostimulated acupuncture on ground reaction forces and pain scores in dogs with chronic elbow joint arthritis

OBJECTIVE: To determine whether use of electrostimuluated acupuncture (ESA) would result in significant improvements in ground reaction forces and lameness scores in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia. DESIGN: Randomized, controlled, crossover clinical trial. ANIMALS: 9 dogs with chronic forelimb lameness and radiographic evidence of elbow joint osteoarthritis. PROCEDURES: All dogs had a 3-week control acclimation period during which gait analysis was performed weekly. Dogs then received ESA once weekly for 3 weeks followed by a sham treatment once weekly for 3 weeks or received the sham treatment followed by ESA. Gait analysis was repeated prior to each treatment, and owners were asked to provide pain scores by use of a visual analog scale method. RESULTS: Treatment (control, acupuncture, or sham) did not have a significant effect on ground reaction forces for any limb. Owners of 8 of the 9 dogs were able to correctly guess the time period when ESA was delivered. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that ESA did not have any significant effects on severity of lameness, as determined by measurement of ground reaction forces, or severity of pain, as determined by visual analog scale pain scores, in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia.     

Clinical effectiveness and safety of intraarticular administration of a 117mTin radiocolloid (Synovetin OATM) for treatment of early and intermediate grade osteoarthritis of the elbow in a dose finding study conducted in 44 dogs

Osteoarthritis of the elbow joint secondary to elbow dysplasia is common in dogs. Intraarticular radionuclide injection is thought to suppress both synovitis and inflammatory pain mediators in the joint which are not directly addressed by current treatments. This dose-finding investigation was a longitudinal, prospective, experimental parallel group, post-test study with repeated measures. Forty-four dogs, with low to intermediate-grade osteoarthritis, received a single injection into their most clinically affected elbow joint and were randomized into three treatment cohorts; 37 MBq, 64.75 MBq, or 92.5 MBq (normalized to the body surface area of a 22 kg dog) of ^117mSn radiocolloid. Dogs were assessed monthly by owners, using the canine Brief Pain Inventory (cBPI), and at 1, 3, 6, 9, and 12 months intervals by investigators. Positive responses to treatment were observed by both owners and clinicians in all dose groups with the medium dose group having the highest and most durable response rate based on cBPI scores. The results of this study support the use of ^117mSn radiocolloid as a primary treatment of osteoarthritis in low to intermediate-grade osteoarthritis of the canine elbow.     

Elbow joint luxation in a 1-month-old foal

This paper reports on luxation of the elbow joint without concomitant fracture in a 1-month-old foal. Conservative treatment, with closed reduction and full-limb bandaging, including caudal and lateral splints, seemed successful initially, however, failed to provide enough stability and luxation recurred, and open reduction and surgical placement of prosthetic collateral ligaments was required. Luxation of the elbow joint should be considered when acute non-weight bearing forelimb lameness occurs associated with pain and swelling in the area of the elbow in young foals. Closed reduction failed to provide sufficient joint stability.     

Orthopedic examination in the cat: clinical tips for ruling in/out common musculoskeletal disease

PATIENT GROUP: The majority of cats will develop radiographic evidence of degenerative joint disease by the time they are 12 years of age, and many will suffer from a decline in quality of life associated with undiagnosed and untreated orthopedic disease. PRACTICAL RELEVANCE: A focused, efficient orthopedic examination, including gait observation and palpation (awake and under sedation), supplemented with appropriate history, is key in ruling in, or out, clinically important musculoskeletal disease. Identifying problems assists in both developing a diagnostic plan and monitoring response to treatment. CLINICAL CHALLENGES: Many clinicians feel uncomfortable in their ability to reliably perform an orthopedic examination in the cat, and diagnosis and evaluation of response to treatment in cats with orthopedic disease can be challenging. Hands-on training in feline orthopedic examination is limited in many veterinary curricula. Additional constraints may include failure to obtain important information in the history that indicates feline orthopedic disease, lack of appropriate facilities in which to conduct a complete orthopedic examination, and inability to obtain the most important information during the time available to conduct the examination. These problems can create gaps in the practitioner's ability to provide excellent care for a large proportion of the feline population. GOALS: The above challenges can mostly be overcome with advanced planning and with consideration of the unique behavioral aspects related to feline handling. As discussed in this review, the aim of the initial orthopedic examination is to localize the problem to a specific limb, ideally to a region or joint of the limb, which can further direct diagnostics such as radiography or arthrocentesis. This should provide a basis for follow-up and assessment of whether treatment strategies are effective.     

Intrathoracic and concurrent orthopedic injury associated with traumatic rib fracture in cats: 75 cases (1980-1998)

OBJECTIVE: To characterize rib, intrathoracic, and concurrent orthopedic injuries, and prognosis associated with traumatic rib fracture in cats. DESIGN: Retrospective study. ANIMALS: 75 cats. PROCEDURE: Medical records from January 1980 to August 1998 were examined for cats with traumatic rib fracture. Signalment, cause of trauma, interval from trauma to evaluation at a veterinary teaching hospital, referral status and date, method of diagnosis, duration of hospitalization, number and location of rib fractures, presence of flail chest, costal cartilage involvement, intrathoracic and concurrent orthopedic injury, and clinical outcome were reviewed. RESULTS: Median age was 3 years. Twenty-five (58%) cats with reported cause of trauma were injured by interaction with another animal. Forty-seven (78%) cats that were treated survived. Cats that died had a median duration of hospitalization of < 1 day. Ten (13%) cats had flail chest. Sixty-five (87%) cats had intrathoracic injury (median, 2 injuries). Nine (100%) cats without detected intrathoracic injury that were treated survived. Thirty-five (47%) cats had concurrent orthopedic injury. Cats with flail chest, pleural effusion, or diaphragmatic hernia were significantly more likely to die than cats without each injury. CONCLUSIONS AND CLINICAL RELEVANCE: Traumatic rib fracture in cats is associated with intrathoracic and concurrent orthopedic injury. Aggressive treatment of cats with traumatic rib fracture is warranted, because the prognosis is generally favorable. Diagnosis and treatment of intrathoracic injury associated with traumatic rib fracture in cats should precede management of concurrent orthopedic injury.     

Correlation of ultrasonographic observations with anatomic features and radiography of the elbow joint in dogs

OBJECTIVE: To define the ultrasonographic appearance of the elbow joint of dogs and to develop an ultrasonographic imaging protocol to reliably accomplish complete evaluation of that joint. ANIMALS: 11 clinically normal mixed-breed dogs. PROCEDURE: Ultrasonographic observations (by use of a 5 to 10 MHz linear array probe) were made of 22 elbow joints in cadaveric forelimbs from clinically normal dogs. Images in standard anatomic planes were recorded with a multi-image camera, on videotape, or onto a computer. The anatomic plane of the ultrasonographic beam and position of the ultrasonographic probe were also recorded. Dissection of each elbow joint was performed, and anatomic features were correlated with ultrasonographic images. RESULTS: Structures clearly identified ultrasonographically included the lateral and medial humeral epicondyles, the humeroradial and humeroulnar joints, anconeal process, medial coronoid process, hyaline cartilage covering the proximal articular surface of the radius, collateral ligaments, tendons of triceps brachii and supinator muscles, and the supinator tendon and sesamoid in the supinator cartilage. An ultrasonographic imaging protocol for examination of the elbow joint was developed. CONCLUSIONS AND CLINICAL RELEVANCE: Precise correlations were established between the gross anatomic appearance of the elbow joint and the ultrasonographic images of its component structures. The ultrasonographic imaging protocol will enable complete examination of all regions of the joint for detection of pathologic lesions.     

Effect of humeral osteotomy on joint surface contact in canine elbow joints

OBJECTIVE: To determine the effect of sliding and wedge osteotomies of the humerus on the joint surface contact areas in anatomically normal elbow joints of dogs. SAMPLE POPULATION: Left thoracic limbs from 5 skeletally mature mixed-breed canine cadavers. PROCEDURE: Joint casting was performed by placement of colored polymethylmethacrylate in the elbow joint cavity followed by loading in a materials testing system at physiologic angle and load. Joint casting was performed in unaltered specimens, after 10 degrees medial opening wedge osteotomy, and after lateral sliding osteotomy of the proximal portion of the humerus. Computer-aided analysis of photographs of proximal radial and ulnar articular surfaces after each casting procedure was performed. RESULTS: The lateral sliding humeral osteotomy and 10 degrees medial opening wedge osteotomy significantly altered joint surface contact regions of the canine elbow joint. Osteotomies resulted in a reduction in the size of the radial, ulnar, and combined radioulnar contact areas. Both osteotomies also resulted in craniolateral migration of the radial contact area and craniomedial recession of the ulnar contact area. Although the reduction in ulnar contact area with these treatments is consistent with our hypotheses, the reduction in radial contact area was not anticipated. CONCLUSIONS AND CLINICAL RELEVANCE: Humeral osteotomies alter joint surface contact areas of the canine elbow joint in vitro. Humeral osteotomies may decrease contact areas on the diseased region of the joint in dogs with elbow dysplasia; however, the overall decrease in joint surface contact area suggests that these procedures may induce focal increases in pressure that may cause iatrogenic cartilage damage when applied in vivo.     

Osteochondrosis of the elbow joint in young dogs

Osteochondrosis is a failure of the normal process of endochondral ossification. In the elbow joint there are three manifestations of osteochondrosis, namely osteochondritis dissecans of the medial condyle of the humerus, ununited coronoid process and ununited anconeal process. This paper describes a series of sixty-eight cases diagnosed at a referral centre over a 10-year period. Ununited coronoid process and OCD of the medial condyle are not readily diagnosed because the lesions are difficult to demonstrate radiographically, but signs of degenerative joint disease of the elbow in young dogs of the medium to large breeds is strongly suggestive. Surgical treatment is indicated and the surgical approach to the medial aspect of the joint is described.     

Traumatic partial elbow luxation in a dog

Traumatic partial elbow luxation (unilateral medial humeroulnar) was diagnosed in a 2.5-year-old crossbreed dog. Previous reports of traumatic elbow luxation in the dog described lateral and less frequently medial humeroradioulnar luxations. The treatment consisted of closed reduction of the affected joint under general anaesthesia. The functional outcome was excellent.     

In vitro force mapping of normal canine humeroradial and humeroulnar joints

OBJECTIVE: To determine the distribution of force between the articular surfaces of the humerus and radius and between the humerus and ulna in normal canine forelimbs. SAMPLE POPULATION: 12 cadaveric canine right forelimbs. PROCEDURE: Transarticular force maps were created by placing a tactile array pressure sensor into the elbow joint cavity and loading cadaveric forelimbs in a materials testing system. Mean joint forces were determined at loads of 50, 100, 150, and 200 N. RESULTS: All tests produced 2 distinct areas of high load that corresponded with the proximal articular surfaces of the radius and ulna. Mean forces for the radial proximal articular surface were slightly but significantly greater than for the ulna, averaging 51% to 52% of total force for all applied loads. CONCLUSIONS AND CLINICAL RELEVANCE: The proximal articular surface of the ulna contributes substantially to load transfer through the canine elbow joint. Abnormalities, which increase this load, might contribute to canine elbow joint dysplasia, specifically fragmentation of the medial coronoid process and osteochondritis dissecans of the medial aspect of the humeral condyle. In the treatment of these conditions, the normal force distribution within the canine elbow joint should be taken into consideration.     

Behavior of Mustela putorius furo (the domestic ferret).

Behavior patterns exhibited by the domestic ferret, although similar to its wild cousins, are distinctly domestic in nature. Domestic ferrets use many different types of behaviors, including body posturing, animations, vocalizations, and scent markings. These behaviors may differ somewhat from ferret to ferret. The domestic ferret is best understood by observation and recognition of its behavior patterns and interactions as it plays and communicates with both humans and animals within its home environment. As with all other species of animals kept as pets, the clinician will be greatly benefited by urging the pet owner to regularly note typical behavior patterns for their individual pet. Following is a brief summary of behavioral changes noted in domestic ferrets that may aid the owner or keeper in the detection of potential illness or injury: A normally active ferret suddenly becoming quiet or vice-versa Any sudden increase or decrease in daily food and water intake Routine behaviors performed out of context or order, especially in older animals Any sudden increase or decrease in the speed at which routine behaviors are performed (such as urination, defecation, grooming, food, or water intake) Any sudden increase in the effort required to perform normal or routine behaviors Any sudden changes in personality or attitude toward other ferrets or toward other animals or people. The previous information was gathered over the last 15 years from personal observations, experiences, and studies of ferrets in the shelter, home, and animal hospital environments. This information regarding ferret behavior can assist the veterinarian in differentiating between normal and abnormal behaviors in domestic ferrets. This increased understanding of ferret behavior can aid in the diagnosis of injury and disease and assist the veterinarian in educating clients regarding ferret behavior, care, and recognition of potential disease.