5.Imaging Canine Elbow dysplasia.pdf

Lameness cause Belangrijk te weten Front leg – Large breed dog UAP Elbow dysplasia: terminology INconGRUitY ulna en radius niet samen Ununited anconeal process (non union)...

Lameness cause Belangrijk te weten Front leg – Large breed dog UAP Elbow dysplasia: terminology INconGRUitY ulna en radius niet samen Ununited anconeal process (non union) Flexor enthesopathy Incomplete ossification humeral condyle Osteochondritis dissecans Medial coronoid disease Medial compartment erosion fracture, luxation, arthrosis, infection, neoplasia, auto-immune disorder Coronoïdeus medialis versus Anconeus Coronoïdeus medialis: Geen eigen ossificatiecenter ‘Fractuur/Fragmentatie’ --- fragment komt los van processus Anconeus Eigen ossificatiecenter dat zich sluit tussen 4 en 5 maanden Niet gesloten processus > 6 maanden = pathologisch Humerus – mediaal epicondyl – Eigen ossificatiecenter dat zich sluit tussen 5 en 8 maanden How to diagnose a fragmented medial coronoid process Occurence: common breeds But also uncommon breeds…  Clinical examination Medial coronoid disease (= fragment medial coronoid process) Muscle atrophy Joint swelling Decreased joint mobility Pain at manipulation Crepitation Cane Corso, 2 years Extra tricks: flexion test (1 min), hyperflexion/-extension, light sedation  Clinical examination Medial coronoid disease Lame / stiff gait Bilateral: short steps External rotation of the distal limb American bulldog, 2 years, lame since several months, no distension or pain reaction After sedation with ACP What if you can’t localize the problem? (Puncture the joint) Intra-articular anesthesia Radiographic overview Scintigraphy Effect of intra-articular anesthesia wandelt veel beter  Coronoid lesions: terminology Fragmented medial coronoid process (FCP) = Medial coronoid disease (MCD) Medial compartment syndrome/disease/erosion Fragment Fissure Chondromalacia Erosion De 2 meeste soms te zien op RX kraakbeen zachter dan normaal Andere 2 veel moeilijker  When in doubt? Flexion test XXX Intra-articular anesthesia X Imaging: – Radiography XX – Echography (X) – Arthrogram 0 – CT XXX – MRI X – Scintigraphy X Arthroscopy XXX  Radiography: positioning the elbow zijdelingse opname in relaxie cr cd opname in flexie  Radiography: normal elbow meidiaal epicondyl ook processus anocneus als eerste bekijken extensie flexie processus anconeus processus coronoideus condylus, gewricht mediale epicondyl  heel veel foto's nodig om een goede diagnose te kunnen nemen Radiographic signs of MCD Medial coronoid process Indistinct and/or deformed contour Irregular/reduced bone opacity of the medial coronoid process Osteoarthrosis Sclerosis of the distal section of the semilunar notch Loss of trabecular pattern Many other locations (cranio-proximal radius, epicondyles, …)  Medial coronoid process fragment afgerond afgerond fragment bijna niet te zien Medial coronoid process  Normale situatie de 2 cortica moeten niet meer dan 1/3 van het dikte van het bot Osteoarthrosis: Sclerosis proximal ulna normaal zicht sclerosis van bot sclerosis Osteoarthrosis: Anconeal process  Osteoarthrosis: other locations condyles proximale radius epicondyl  Computed tomography veel meer zien MCD Sensitivity Specificity Radiography 62-98% 64-69% Computed tomography 71-100% 61-93% Gold standard = arthroscopy Computed tomographic signs of MCD Medial coronoid process Fragmentation (28%) Fissure (= non-displaced fragments) (27%) Hypo-attenuating regions (demineralized bone, chondromalacia – altered weight-bearing) Abnormal shape (blunting, blurring, misshapen, irregular margination) (97%) Hyper-attenuating medulla (may predispose to fragmentation but this area also increases in mineral density with dog’s age) Osteoarthrosis … (> 95%) druk plekken  Coronoid process Fissure Osteophyte Fragmentation Chondromalacia Coronoid process  Hypothesis: Ulnar osteotomy Fissure of the medial coronoid process heals without fragment removal less osteoarthritis with a proximal ulnar osteotomy Erosion of the medial compartment Erosion of the medial compartment Radiographic signs: mostly none Losse processus anconeus makkelijk diagnose  Losse processus anconeus Normale elleboog losse processus anconeus Osteochondrose Osteochondrose/OCD OCD or Kissing lesion Flexor enthesopathy minder beschreven Dr. Evelien De Bakker  Humerus Medial humeral epicondyle gaan hier hechten Radius Ulna  CLINICAL FINDINGS Non-specific lameness, distension, limited range of motion, painful elbow Some cases firm, well-defined swelling medial to medial humeral epicondyle  FIRST REPORT... 1966 totaal fout “Ununited medial epicondyle”  DOGS vs HUMANS Humans Dogs Overuse Repetitive concentric Conformation, weight, loading forearm muscles hyperactivity Single traumatic event Less common Less common Acute trauma immature Complete avulsion medial Avulsion small part medial age epicondyle epicondyle  Preformed ossification centre Traumatic avulsion of the medial humeral epicondyle Dystrophic calcification of the flexor muscle origins IMAGING MODALITIES ‘Fokadvies’  Processus coronoïdeus medialis Gradatie hangt af van de osteofyt thv de processus anconeus omdat de medialis moeilijk te zien is Grade 0: onaangetast Graad 1: osteophyte < 3mm Graad 2: osteophyte tussen 3 en 5 mm Graad 3: osteophyte > 5mm of fragment zichtbaar  Processus anconeus Gradatie is eenvoudig: graad 0 : normale elleboog graad 3 : losse processus anconeus