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What 3 joints make up the elbow, and what is the function of each?
- humeroradial: weight bearing function
- humeroulnar: restricts motion to sagittal plane
- proximal radioulnar: transverse plane pronation/ rotation
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Describe the components of the distal humerus and how they articulate with the antebrachium.
- capitulum (lateral)- articulates with radial head
- trochlea (larger, medial)- articulates with the medial portion of the ulnar coronoid process
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What are the 3 major elbow ruleouts?
- elbow dysplasia
- incomplete ossification of humeral condyle
- elbow luxation
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What are types of elbow dysplasia? (4)
- coronoid disease (FCP)
- ununited anconeal process (UAP)
- osteochondrosis dissecans (OCD)
- incongruity
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What are PE findings with elbow dysplasia? (9)
- 8-12 months of age
- abnormal stance and/or gait
- campbell's test (flex and internally rotate)--> painful
- pain on palpation (hyperflexion, extension, medial compartment pressure/ palpation)
- joint effusion
- creptius
- reduced ROM
- muscle atrophy
- periarticular swelling if older presentation
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What imaging modalities are useful in diagnosing each type of elbow dysplasia?
- Coronoid disease: rads, CT, scope
- UAP: rads
- OCD: rads, CT
- Incongruity: CT, scope (usually too subtle to show up on rads; usually go right to scope since it's diagnostic and therapeutic)
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Describe coronoid disease.
- pathology of the medial aspect of the coronoid process of the ulna
- aka medial compartment disease, used to be FCP (fragmented coronoid process)
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Describe humeral condyle OCD.
- usually medial aspect of the humeral condyle
- PE is indistinguishable from FCP and they frequently occur together
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Describe UAP.
anconeal process doesn't unite by 20-24 weeks of age
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What components may play a role in elbow incongruity? (2)
- short radius--> pressure on coronoid process
- short ulna--> pressure on anconeal process
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What is the treatment for FCP? (4)
- removal of fragment by arthroscopy (can do arthrotomy, poorer healing)
- coronoidectomy
- load-shifting procedures (cut humerus or ulna to shift weight and take pressure off the medial joint--> preserve cartilage and make them more comfortable)
- arthritis management
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What is the treatment for elbow OCD? (2)
- excision of cartilage flap
- curettage and microfracture- picking down to bleeding healthy subchondral bone
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What are potential treatment options for UAP? (3)
- lag-screw fixation
- ulnar osteotomy
- fragment removal
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What are treatment options for elbow incongruity?
- For short ulna- dynamic ulna osteotomy- tricepts pull restores elbow congruity by pulling ulna fragment proximally
- For long ulna- ulna ostectomy- shortening of ulna
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What are treatment options for end stage elbow dysplasia? (3)
- partial or total elbow replacement
- arthrodesis
- amputation
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Describe incomplete ossification of the humeral condyle. (4)
- 2 separate ossification centers that should achieve union by 10 weeks
- often bilateral
- often present with lateral condylar fracture
- spaniels
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How do you diagnose IOHC? (2)
- radiolucent line on craniodorsal radiographs (easy to miss d.t superimposition), sclerosis of adjacent bone, always image the other elbow
- CT is the ideal modality
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What is the treatment for IOHC?
surgical fixation with transcondylar positional or lag screw
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All dogs with elbow dysplasia will...
get osteoarthritis!
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What is the most common traumatic elbow luxation? What are clinically presenting signs? (4)
- lateral luxation of the proximal radioulnar joint
- non-weight-bearing, limb abducted, external rotated and slightly flexed
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What is the treatment for traumatic elbow luxation? (4)
- closed reduction
- spica splint for 5-7 days
- exercise restriction for 4-6 weeks
- if chronic or collateral ligaments are disrupted--> open reduction
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