ADVERSITY “ I am not afraid of storms for I am learning how to sail my ship.” -Louisa May Alcott

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<ul><li> Slide 1 </li> <li> ADVERSITY I am not afraid of storms for I am learning how to sail my ship. -Louisa May Alcott </li> <li> Slide 2 </li> <li> DISEASES OF THE MUSCULOSKELETAL SYSTEM PART 3 </li> <li> Slide 3 </li> <li> POOR CONFORMATION: LUXATING PATELLA </li> <li> Slide 4 </li> <li> Slide 5 </li> <li> Slide 6 </li> <li> PATELLA IN GROOVE PATELLA OUT OF GROOVE </li> <li> Slide 7 </li> <li> POOR CONFORMATION KNOCK-KNEED/PIGEON-TOED, OR COW-HOCKED STANCE MAY OCCUR IN LATERAL LUXATIONS BOW-LEGGED STANCE MAY OCCUR IN MEDIAL LUXATIONS </li> <li> Slide 8 </li> <li> POOR CONFORMATION: TREATMENT OF PATELLAR LUXATION TROCHLEAR WEDGE RESECTION </li> <li> Slide 9 </li> <li> POOR CONFORMATION: TROCHLEAR WEDGE RESECTION </li> <li> Slide 10 </li> <li> POOR CONFORMATION: TIBIAL CREST TRANSPOSITION </li> <li> Slide 11 </li> <li> Slide 12 </li> <li> POOR CONFORMATION: HIP DYSPLASIA YOUNG DOGS 5-8 mos AND MATURE ANIMALS WITH CHRONIC DISEASE </li> <li> Slide 13 </li> <li> POOR CONFORMATION: HIP YSPLASIA </li> <li> Slide 14 </li> <li> POOR CONFORMATION: HIP DYSPLASIA Poor conformation combined with genetic, environmental and nutritional factors Acetabular vs. Femoral hip dysplasia </li> <li> Slide 15 </li> <li> 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 </li> <li> Slide 16 </li> <li> POOR CONFORMATION: HIP DYSPLASIA http://www.youtube.com/watch?v=2rRKDheDrLs&amp;NR=1 http://www.youtube.com/watch?v=SHCIT87jY0M&amp;feature=related </li> <li> Slide 17 </li> <li> Hip Dysplasia: Radiographic view For standard Orthopedic Foundation for Animalstype 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 </li> <li> Slide 18 </li> <li> POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION "normal" radiographically may be further classified as excellent, good, fair, or near normal </li> <li> Slide 19 </li> <li> POOR CONFORMATION: HIP DYSPLASIA and OFA CERTIFICATION </li> <li> Slide 20 </li> <li> HIP DYSPLASIA and OFA CERTIFICATION dysplasia are categorized as mild, moderate, or severe </li> <li> Slide 21 </li> <li> PennHip Evaluation Distraction View Compression view Extended View </li> <li> Slide 22 </li> <li> HIP DYSPLASIA TREATMENT NSAIDs NEUTRICEUTICALS/CHONDROPROTECTIVE AGENTS </li> <li> Slide 23 </li> <li> 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. </li> <li> Slide 24 </li> <li> 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. </li> <li> Slide 25 </li> <li> 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 - &lt; 20#; good musculature Abnormal gait Triple Pelvic Osteotomy </li> <li> Slide 26 </li> <li> Arthroscopy Juvenile patients A, 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 </li> <li> Slide 27 </li> <li> HIP DYSPLASIA TREATMENT TRIPLE PELVIC OSTEOTOMY </li> <li> Slide 28 </li> <li> HIP DYSPLASIA TREATMENT FEMORAL HEAD OSTECTOMY False joint forms from scar/fibrous tissue </li> <li> Slide 29 </li> <li> HIP DYSPLASIA TREATMENT www.kahalapethospital.com/yahoo_sit e_admin/as... artreality.com </li> <li> Slide 30 </li> <li> 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). </li> <li> Slide 31 </li> <li> 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 </li> </ul>