Comparison of two caudolateral approaches to the scapulohumeral joint for treatment of osteochondritis dissecans in dogs

Two caudolateral approaches to the canine scapulohumeral joint that do not require myotomy, tenotomy, or osteotomy were used to expose the humeral heads of both scapulohumeral joints in 10 clinically normal dogs. One approach (method 1) was used on the left shoulder of 5 dogs and on the right shoulder of the other 5 dogs. The other approach (method 2) was used on the opposite joints. The amount of humeral head articular cartilage that could be exposed with each approach was measured. The amount of articular cartilage exposed with method 1 was significantly greater than that exposed with method 2 (P less than 0.0001). Method 1 also provided for exposure of the caudomedial aspect of the scapulohumeral joint. Method 1 was used unilaterally in 20 dogs with osteochondritis dissecans. This approach provided excellent exposure of the humeral head and osteochondritis dissecans lesion. Of the 16 dogs that were available for follow-up evaluation, 1 developed a seroma after surgery. Other complications were not observed or reported.     

A technique for internal fixation of scapulohumeral luxation using scapulohumeral tension sutures in three alpacas and one miniature steer

Objective— To report a technique for open reduction and internal fixation of scapulohumeral joint luxation in large animals, and outcome.
Study Design— Clinical case reports.
Animals— Mature alpacas (n=3) and immature miniature steer (1).
Methods— Shoulder joint luxation was diagnosed by physical examination and confirmed by radiography. Open reduction was performed with internal fixation using lateral tension band sutures.
Results— Animals maintained shoulder joint reduction and were sound with radiographically normal shoulder joints (n=2) and normal range of motion without appreciable gait abnormalities (4) at follow-up 8–36 months later.
Conclusions— In contrast to previous reports of open reduction with internal fixation of shoulder joint luxation in large animals, open reduction and use of lateral scapulohumeral tension sutures resulted in functionally normal shoulder joints.
Clinical Relevance— Stabilization of the shoulder joint with lateral scapulohumeral tension sutures after open reduction is effective, technically simple, and should be considered in large animal species weighing <100 kg.     

Vacuum phenomenon in equine carpal, metacarpophalangeal and metatarsophalangeal joints

In order to establish the incidence of vacuum phenomenon in horses' carpal, metacarpophalangeal and metatarsophalangeal joints, stress-flexed radiographs were made of normal joints, joints with known pathology and in anaesthetised horses with joints under traction. Focal intra-articular radiolucencies were identified in normal stress-flexed carpal, metacarpophalangeal and metatarsophalangeal joints. These radiolucencies can be confused with those associated with pathological conditions.     

VACUUM PHENOMENON OF THE CANINE SPINE: CT FINDINGS IN 3 PATIENTS

The vacuum phenomenon was identified in the spine of 3 dogs by computed tomography. Gas from the vacuum phenomenon was clearly present in the disc space in 2 dogs. In the other the disc space was collapsed, and the gas was in the caudal vertebral endplate. In humans, gas accumulation in the intervertebral disc caused by the vacuum phenomenon seen on computed tomography spinal images is a sign of degenerative disc disease rather than infection. It may also be seen in the apophyseal joints and in the vertebral canal associated with the vacuum phenomenon in the disc or apophyseal joints. The recognition of the vacuum phenomenon in the spine in veterinary patients will likely become more important as computed tomography imaging becomes more common with the increased availability of this imaging procedure.     

PREVALENCE OF COMPUTED TOMOGRAPHIC SUBCHONDRAL BONE LESIONS IN THE SCAPULOHUMERAL JOINT OF 32 IMMATURE DOGS WITH THORACIC LIMB LAMENESS

Osteochondrosis is a common developmental abnormality affecting the subchondral bone of immature, large breed dogs. The purpose of this retrospective study was to describe CT lesions detected in scapulohumeral joints of 32 immature dogs undergoing CT for thoracic limb lameness. Eight dogs (14 scapulohumeral joints) had arthroscopy following imaging. Thirteen dogs (19 scapulohumeral joints) were found to have CT lesions, including 10 dogs (16 scapulohumeral joints) with subchondral bone lesions and 3 dogs with enthesopathy of the supraspinatus tendon. In one dog, subchondral bone lesions appeared as large oval defects within the mid‐aspect of the glenoid cavities, bilaterally. These lesions resembled osseous cyst‐like lesions commonly identified in the horse. This is the first report of such a presentation of a subchondral bone lesion in the glenoid cavity of a dog. In all dogs, small, focal, round or linear lucent defects were visible within the cortical bone at the junction of the greater tubercle and intertubercular groove. These structures were thought to represent vascular channels. Findings from this study support the use of CT as an adjunct modality for the identification and characterization of scapulohumeral subchondral bone lesions in immature dogs with thoracic limb lameness.     

Surgical Approach to the Equine Scapulohumeral Joint Through a Longitudinal Infraspinatus Tenotomy

Surgical curettage of an osteochondrosis lesion in an equine scapulohumeral joint was performed. A modified approach to the scapulohumeral joint through a longitudinal infraspinatus tenotomy is described. This technique was performed on a second horse that was free of osteochondrosis lesions to further assess the clinical course of healing following this technique. Both operative sites healed well with no evidence of dehiscence. Previously, four similar clinical cases of osteochondrosis were operated on at the same institution through a transverse infraspinatus tenotomy. All four cases exhibited dehiscence with attendant septic arthritis during the postoperative period. The use of a longitudinal infraspinatus tenotomy to approach the equine scapulohumeral joint for surgical curettage does not appear to clinically compromise the lateral collateral support of the shoulder. When compared retrospectively to other cases of transverse infraspinatus tenotomy performed at this clinic, the described technique appears to have a less complicated postoperative period.     

Radiographic measurement of craniocaudal instability in stifle joints of clinically normal dogs and dogs with injury of a cranial cruciate ligament

OBJECTIVE: To determine craniocaudal laxity of the stifle joint of dogs when joints were positioned in tibial compression or neutral position. SAMPLE POPULATION: 19 normal stifle joints in 10 clinically normal dogs, 29 stifle joints with varying injury to the cranial cruciate ligament (10 complete ruptures alone, 10 complete ruptures with concomitant damage to the medial meniscus, 6 partial ruptures alone, and 3 partial ruptures with concomitant meniscal tearing), and 19 unaffected contralateral stifle joints in those 29 dogs. PROCEDURE: Relative displacement of bony landmarks was measured on paired lateral radiographs (neutral and tibial compression positions). Two measuring techniques were customized for use in dogs. RESULTS: The first technique failed to distinguish results in normal stifle joints from those in stifle joints with partial deficiency of cranial cruciate ligaments. Significant differences were found for joints with complete rupture, compared with stifle joints in clinically normal dogs. The second technique detected differences between normal stifle joints and injured joints with partial or complete rupture of the cranial cruciate ligament. Significant differences were not detected between joints with partial versus complete rupture. Adjusting data to account for size of dog did not improve results. CONCLUSIONS AND CLINICAL RELEVANCE: A wide range in measurements of laxity was found for stifle joints with intact cranial cruciate ligaments. Differences in degree of damage to the ligament and medial meniscus cannot be deduced from the amount of relative displacement measured on radiographs. Pathologic changes to the cranial cruciate ligament will not necessarily induce detectable changes in laxity of stifle joints in dogs.     

Supraspinatus and biceps brachii tendinopathy in dogs

Calcifying tendinopathy was seen on radiographic views of the scapulohumeral joint in 12 of 183 (7 per cent) dogs reviewed retrospectively. Calcifying tendinopathy was identified only in large breed dogs, five being labradors. All the affected dogs, except one, were presented for unilateral thoracic limb lameness, which was typically of a chronic and intermittent pattern. Pain on manipulation of the scapulohumeral joint in the lame leg was present in eight of 12 dogs (67 per cent). Calcification of the supraspinatus tendon was seen in eight dogs and calcification of the biceps brachii tendon was seen in the other four dogs. Radiographic changes indicative of biceps brachii tendon avulsion were found in conjunction with calcification of the contralateral biceps brachii tendon in two dogs. Filling defects, indicative of bicipital tenosynovitis, were also seen in positive contrast arthrograms of two dogs with biceps brachii calcification. Of the eight dogs for which radiographic views of both scapulohumeral joints were available, six dogs had bilateral radiographic signs of calcifying tendinopathy. Overall, radiographic signs of calcifying tendinopathy were seen in 18 scapulohumeral joints, but lameness was apparent in only nine limbs, suggesting the lesion may at times be asymptomatic. Further prospective investigation of calcifying tendinopathy is needed to determine why lameness does not always appear to be associated with the presence of the lesion.     

Unusual Selective Immunoglobulin Deficiency in an Arabian Foal

A 10-month-old Arabian foal was evaluated for a suspected immunoglobulin (Ig) M deficiency. Decreased to nondetectable concentrations of IgM, IgA, and IgG (T), and a normal concentration of IgG, were present. Results of in vitro testing of the blood lymphocyte blastogenesis showed a weak response to the B-cell mitogen, lipopolysaccharide (LPS), but normal responses to T-cell mitogens. Results of postmortem examination showed synovitis of the left tibiotarsal and both scapulohumeral joints. Atrophy and edema of the lymph nodes and lymphocyte depletion in the thymus and spleen were seen. A subacute inflammatory infiltrate was observed in the kidney, synovium, liver, and brain. Etiologic agents were not identified. This case represents a previously unreported form of immunodeficiency disease in the horse.     

Progressive ossifying myositis in a cat

Progressive ossifying myositis was diagnosed in a 2-year-old female cat. Clinical signs consisted of cervical pruritus, a stiff gait involving the forelimbs, and decreased range of motion of the scapulohumeral joints. The signs progressed over a 2-month period to involve the hindlimbs and coxofemoral joints. The primary cause of this disease is unknown and treatment is palliative. Treatment with diphosphonate disodium etidronate was unsuccessful in controlling the clinical signs in this case.     

Vacuum disk and facet phenomenon in a dog with cauda equina syndrome

A 7-year-old castrated male Rottweiler was evaluated for an 18-month history of bilateral hind limb lameness, signs of pain on rising, and mild ataxia. A gas-filled lumbosacral disk space (vacuum disk phenomenon) was revealed by use of computed tomography. Additional smaller gas bubbles were in the periphery of the disk and between the degenerated L5-L6 dorsal articular facets (vacuum facet phenomenon). Vacuum disk and facet phenomena have been described in humans with degenerative disk and vertebral articular facet joint disease; gas attracted from surrounding tissues accumulates within clefts of the degenerated disk or in unstable facet joints. Vacuum disk phenomenon has been reported in dogs and indicates degenerative disk disease. The phenomenon is more commonly observed by use of computed tomography, compared with conventional radiography, and can be elicited by hyperextension of the vertebral column.     

Effects of intra-articular administration of methylprednisolone acetate on normal equine articular cartilage

The effects of the corticosteroid 6-alpha-methylprednisolone acetate on normal equine articular cartilage were evaluated, using the middle carpal joint in 4 clinically normal young horses. One middle carpal joint of each horse was injected 3 times with 100 mg of 6-alpha-methylprednisolone acetate, at 14-day intervals. The opposite middle carpal joint (control) was injected with 2.5 ml of lactated Ringer solution at the same intervals. Effects were studied until 8 weeks after the first injection. Evaluation included clinical and radiographic examination, and gross, microscopic, and biochemical evaluation of joint tissues. Horses remained clinically normal during the study, and significant radiographic changes were not observed. Safranin-0 matrix staining intensity and uronic acid content were significantly (P less than 0.05) lower and hydroxyproline content was significantly (P less than 0.05) higher in articular cartilage of corticosteroid-injected joints vs control joints.     

A Comparison of Two Surgical Approaches to the Scapulohumeral Joint in Dogs

Two scapulohumeral arthrotomy techniques were evaluated and compared in 10 normal, young adult greyhounds. A caudolateral approach with craniodorsal retraction of the teres minor muscle (no-tenotomy) and a craniolateral approach with tenotomy of the infraspinatus tendon were each performed unilaterally in 5 dogs. The dogs were evaluated using force plate gait analysis, lameness evaluation, radiography, and goniometry for 5 weeks and then euthanatized. Tenotomy sites and sections of the humeral articular cartilage were collected from shoulder joints that had been operated on and examined microscopically. The same surgical approach was then performed on the contralateral shoulder in the cadavers and exposure of the humeral articular cartilage was measured using planimetry. Peak vertical force applied to the operated limbs in the tenotomy group was significantly less than preoperative levels on day 3 and significantly less than the no-tenotomy group on days 21 and 28. The peak vertical force applied to the operated limbs in the no-tenotomy group was not significantly different from preoperative levels during the study. Scapulohumeral arthrotomy by tenotomy of the infraspinatus resulted in decreased range-of-motion and joint extension compared with joints operated on without tenotomies, but provided significantly greater exposure to the articular surface. Scapulohumeral arthrotomy with craniodorsal retraction of the teres minor muscle did not significantly alter goniometric measurements compared with unoperated joints. Both techniques resulted in similar subjective lameness scores and caused no gross microscopic or radiographic evidence of articular cartilage damage.     

Products resulting from cleavage of the interglobular domain of aggrecan in samples of synovial fluid collected from dogs with early- and late-stage osteoarthritis

OBJECTIVE: To investigate interglobular domain (IGD) cleavage of aggrecan in dogs with naturally developing osteoarthritis (OA). SAMPLE POPULATION: Samples of synovial fluid (SF) obtained from 3 cubital (elbow) joints and 3 stifle joints of 4 clinically normal dogs, 24 elbow joints of 12 dogs with early-stage OA, 8 stifle joints of 5 dogs with early-stage OA, and 10 stifle joints of 9 dogs with late-stage OA. PROCEDURE: Fractions of SF were assayed for total glycosaminoglycan (GAG) content and also subjected to Western blot analysis by use of monoclonal antibodies against neoepitopes generated by cleavage of the IGD of the aggrecan protein core by matrix metalloproteinase (MMP; BC-14) and aggrecanase (BC-3). RESULTS: Total GAG content of SF from joints of clinically normal dogs did not differ from that of dogs with early-stage OA. The GAG content of SF from joints of dogs with late-stage OA was significantly lower, compared with GAG content for other SF samples. Aggrecanase-generated fragments were detected in SF from all groups but not in all samples. Matrix metalloproteinase-generated fragments were not detected in any SF samples. In early-stage OA, high-molecular-weight aggrecanase-generated aggrecan catabolites were evident. CONCLUSIONS AND CLINICAL RELEVANCE: GAG content of SF obtained from dogs with late-stage OA is significantly decreased, suggesting proteoglycan depletion of cartilage. Aggrecanases, but not MMPs, are the major proteolytic enzymes responsible for IGD cleavage of aggrecan in canine joints. Analyses of SF samples to detect aggrecanase-generated catabolites may provide an early biomarker for discriminating early- and late-stage OA in dogs.     

Comparison of the nonionic contrast agents, iopromide and iotrolan, for positive-contrast arthrography of the scapulohumeral joint in dogs.

Arthrographic quality and synovial inflammatory response were examined to compare the use of iopromide with that of iotrolan for arthrography of the scapulohumeral joint in 6 dogs. Radiographs obtained 1 and 3 minutes after injection of either nonionic compound were of similar quality, but radiographs obtained 5 minutes after injection of iotrolan were significantly (P less than 0.05) better than those obtained after injection of iopromide. Results of analysis of synovial fluid samples obtained at 1, 3, 7, and 14 days after injection of contrast media were not significantly different between the 2 groups. Histologic examination of synovium and articular cartilage 2 weeks after injection of iopromide or iotrolan revealed minimal inflammatory response for both contrast agents. Injection of iopromide and iotrolan into the scapulohumeral joints of dogs had less effect on synovial fluid than that reported after injection of ionic compounds.     

Cartilage matrix changes in the developing epiphysis: early events on the pathway to equine osteochondrosis?

REASONS FOR PERFORMING STUDY: The earliest osteochondrosis (OC) microscopic lesion reported in the literature was present in the femorotibial joint of a 2-day-old foal suggesting that OC lesions and factors initiating them may arise prior to birth. OBJECTIVE: To examine the developing equine epiphysis to detect histological changes that could be precursors to OC lesions. METHODS: Osteochondral samples from 21 equine fetuses and 13 foals were harvested from selected sites in the scapulohumeral, humeroradial, metacarpophalangeal, femoropatellar, femorotibial, tarsocrural and metatarsophalangeal joints. Sections were stained with safranin O and picrosiruis red to assess cartilage changes and structural arrangement of the collagen matrix. RESULTS: Extracellular matrix changes observed included perivascular areas of paleness of the proteoglycan matrix associated with hypocellularity and, sometimes, necrotic chondrocytes. These changes were most abundant in the youngest fetuses and in the femoropatellar/femorotibial (FP/FT) joints. Indentations of the ossification front were also observed in most specimens, but, most frequently, in scapulohumeral and FP/FT joints. A cartilage canal was almost always present in these indentations. The vascular density of the cartilage was higher in the youngest fetuses. In these fetuses, the most vascularised joints were the metacarpo- and metatarsophalangeal joints but their cartilage canals regressed quickly. After birth, the most vascularised cartilage was present in the FP/FT joint. Articular cartilage differentiated into 4 zones early in fetal life and the epiphyseal cartilage also had a distinct zonal cartilage structure. A striking difference was observed in the collagen structure at the junction of the proliferative and hypertrophic zones where OCD lesions occur. CONCLUSION: Matrix and ossification front changes were frequently observed and significantly associated with cartilage canals suggesting that they may be physiological changes associated with matrix remodelling and development. The collagen structure was variable through the growing epiphysis and a differential in biomechanical properties at focal sites may predispose them to injury.     

Clinical and pathologic analyses of bicipital tenosynovitis in dogs

OBJECTIVE: To determine the clinical and pathologic findings in dogs with primary bicipital tenosynovitis. ANIMALS: 19 dogs with 20 shoulder joints treated surgically for bicipital tenosynovitis and 8 shoulder joints from 4 clinically normal dogs. PROCEDURE: Histologic abnormalities of tendon sheaths of the biceps brachii in affected dogs were determined by use of comparison with findings in clinically normal dogs. Specimens were graded for inflammation, fibrosis, villous hypertrophy, vascular prominence, and synovial cell proliferation. Histopathologic results were statistically evaluated for relationship with clinical findings and treatment before surgery. RESULTS: Synovial villous hypertrophy and vascular prominence were the most consistent histologic findings in 16 and 14 of 20 affected joints, respectively. Evidence of inflammation was lacking in 6 joints. Ten joints had inflammatory cell infiltration of the tendon sheath. Plasma cells and lymphocytes were the most common infiltrates; however, the type and amount of inflammatory cell infiltrate were variable. Fibrosis of the tendon sheath was seen in 8 joints, and synovial cell proliferation was seen in 11 joints. Other changes included accumulation of hemosiderin, focal calcification, osseous metaplasia, lysis of collagen, and fibrocartilaginous metaplasia. No significant relationship was detected between histopathologic findings and clinical findings or treatment before surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Inflammation was more variable than hypothesized and may not be a consistent pathophysiologic feature of bicipital tenosynovitis. In some dogs, this disease may be the result of a degenerative process rather than an inflammatory process.     

A Comparison of Two Surgical Approaches to the Equine Femoropatellar Joint for the Treatment of Osteochondritis Dissecans

The femoropatellar joints of four mature, clinically normal horses were surgically entered by a craniolateral or a lateral approach. Visualization of intra-articular structures was documented for each approach. Horses were euthanized 21, 42, and 63 days after surgery. Joint healing was evaluated clinically, and the joints were subjected to gross pathological and histopathological examination. Healing was by first intention following arthrotomy in six limbs. Skin dehiscence occurred in two limbs with healing by second intention. Subcutaneous seromas developed which resulted in peri-incisional swelling in seven limbs. The lateral approach to the femoropatellar joint provided greater exposure of the lateral femoral trochlear ridge and articular surface of the patella.
Surgery was performed on nine joints of seven clinical patients with osteochondritis dissecans. The craniolateral approach was used on four joints, and the lateral approach was used on five joints. Skin dehiscence occurred following four arthrotomies. Location of the lesion was concluded to be the main criterion for selection of the surgical approach.     

Use of infrared spectroscopy for diagnosis of traumatic arthritis in horses

OBJECTIVE: To evaluate use of infrared spectroscopy for diagnosis of traumatic arthritis in horses. ANIMALS: 48 horses with traumatic arthritis and 5 clinically and radiographically normal horses. PROCEDURES: Synovial fluid samples were collected from 77 joints in 48 horses with traumatic arthritis. Paired samples (affected and control joints) from 29 horses and independent samples from an affected (n = 12) or control (7) joint from 19 horses were collected for model calibration. A second set of 20 normal validation samples was collected from 5 clinically and radiographically normal horses. Fourier transform infrared spectra of synovial fluids were acquired and manipulated, and data from affected joints were compared with controls to identify spectroscopic features that differed significantly between groups. A classification model that used linear discriminant analysis was developed. Performance of the model was determined by use of the 2 validation datasets. RESULTS: A classification model based on 3 infrared regions classified spectra from the calibration dataset with overall accuracy of 97% (sensitivity, 93%; specificity, 100%). The model, with cost-adjusted prior probabilities of 0.60:0.40, yielded overall accuracy of 89% (sensitivity, 83%; specificity, 100%) for the first validation sample dataset and 100% correct classification of the second set of independent normal control joints. CONCLUSIONS AND CLINICAL RELEVANCE: The infrared spectroscopic patterns of fluid from joints with traumatic arthritis differed significantly from the corresponding patterns for controls. These alterations in absorption patterns may be used via an appropriate classification algorithm to differentiate the spectra of affected joints from those of controls.     

COMPUTED TOMOGRAPHY OF CANINE ELBOW JOINTS AFFECTED BY PRIMARY AND CONCOMITANT FLEXOR ENTHESOPATHY

Flexor enthesopathy is an important differential diagnosis for elbow lameness in dogs. The disorder can be a primary cause of elbow lameness or concomitant with other elbow pathology. Since treatment differs for primary and concomitant forms of flexor enthesopathy, a noninvasive method for distinguishing between them is needed. In the current prospective study, computed tomographic (CT) examination was performed before and after IV injection of contrast in 17 dogs with primary flexor enthesopathy, 24 dogs with concomitant flexor enthesopathy, 13 dogs with elbow dysplasia, and seven normal dogs. Dogs were assigned to groups based on results of clinical examination and at least three other imaging modalities. Computed tomographic lesions consistent with flexor enthesopathy were found in all clinically affected joints with primary flexor enthesopathy and in 29 of the 30 clinically affected joints with concomitant flexor enthesopathy. Those lesions were not found in sound elbows or joints affected by elbow dysplasia. Flexor lesions detected in dogs with primary flexor enthesopathy were not significantly different from those detected in dogs with the concomitant form. Findings indicated that CT can be applied to detect flexor enthesopathy, but a distinction between the primary and concomitant forms was not always possible. Authors recommend the use of multiple diagnostic techniques for treatment planning in affected dogs.