1. “In the depth of winter, I finally realized that within me there lay an invincible summer.”
-Albert Camus

2. DISEASES OF THE MUSCULOSKELETAL SYSTEM
PART 4

3. LEGG-CALVE-PERTHES DISEASE aka AVASCULAR NECROSIS of the FEMORAL HEAD
YOUNG, SMALL BREEED DOGS

4. LEGG-CALVE-PERTHES DISEASE
Considered a developmental disorder but could also occur in trauma

5. LEGG-CALVE-PERTHES DISEASE
Clinical signs
Pain in the hip
Atrophy of the muscles of the affected limb
Gradual onset of lameness

6. LEGG-CALVE-PERTHES DISEASE: TREATMENT
FEMORAL HEAD AND NECK EXCISION (FHNE) or FEMORAL HEAD OSTECTOMY (FHO)

7. LEGG-CALVE-PERTHES DISEASE: TREATMENT
CLIENT INFO
Post-operative treatment requires early and active use of the limb as soon as 2 weeks after surgery
Exercise and passive range-of-motion exercises should be done daily
Animals may have both hips involved – surgeon is likely to separate procedures by 8-10 weeks

8. YOU ARE THE COMMON DENOMINATOR
“Every person is responsible for what they have become, but the only ones to admit it are the successful ones.

9. DEGENERATIVE DISORDERS: OSTEOCHONDROSIS DISSECANS

10. OSTEOCHONDROSIS DISSECANS
FAILURE OF THE LOWER LAYERS OF ARTICULAR CARTILAGE TO MATURE INTO
BONE RESULTS IN THICKENED CARTILAGE THAT IS PRONE TO INJURY

11. OSTEOCHONDROSIS DISSECANS
Failure of the articular cartilage to become cemented to underlying bone, together with constant trauma during exercise, results in formation of a non-healing flap or joint mouse
This disorder can occur in several joints
Shoulder
Stifle
Hock
Elbow
CLINICAL SIGNS
Lameness in young, large breed dogs

12. OSTEOCHONDROSIS DISSECANS
CARTILAGE FLAP OF THE SCAPULOHUMERAL
JOINT WHICH IS THE MOST COMMON LOCATION

13. DIAGNOSIS

14. OSTEOCHONDRITIS DISSECANS
JOINT MOUSE IN THE STIFLE JOINT

15. OSTEOCHONDROSIS DISSECANS: TREATMENT
SURGICAL REMOVAL OF THE FLAP OR JOINT MOUSE via ARTHROSCOPY
ALMOST IMMEDIATE RETURN TO NORMAL FUNCTION
VIDEO

16. INFLAMMATORY CONDITIONS: PANOSTEITIS
LARGE, MEDIUM BREEDS AT A YOUNG AGE 6-18 MONTHS
CAUSE: UNKNOWN, BUT THERE ARE MANY SUSPECTED CONTRIBUTORS

17. PANOSTEITIS INFLAMMATION IN THE MARROW
PELVIS
LESIONS OF PANOSTEITIS
FEMUR
INFLAMMATION IN THE MARROW
CAVITIES OF LONG BONES THAT LEADS
TO PAIN, LAMENESS, AND FEVER

18. PANOSTEITIS
INCREASED MEDULLARY OPACITY

19. TREATMENT OF PANOSTEITIS INCLUDES NSAIDS AND CAGE REST
THIS DISEASE IS SELF-LIMITING AND HAS A GOOD PROGNOSIS!

20. TRAUMA: LUXATIONS
HX OF TRAUMA, ACUTE LAMENESS, NON WEIGHT BEARING, POSSIBLE
SWELLING OVER THE AFFECTED JOINT

21. COXOFEMORAL LUXATIONS
CRANIODORSAL LUXATION IS THE
MOST COMMON TYPE

22. LUXATIONS
TREATMENT
Closed reduction: femoral head is replaced back into the acetabulum under anesthesia
Open reduction: femoral head is surgically replaced into the acetabulum and the soft tissue structures are used to secure the reduction.

23. STABILIZING REDUCED LUXATIONS
THE EHMER SLING IS USED AFTER CLOSED REDUCTION OF THE LUXATED
HIP JOINT; THE DOG SHOULD BE CONFINED FOR 7-10 DAYS

24. ELBOW LUXATION
IT IS CRITICAL TO ALWAYS PERFORM 2 RADIOGRAPHS THAT ARE AT 90∘TO EACH OTHER
THESE ARE CALLED ORTHOGONAL VIEWS
THIS IS TRUE FOR ALL RADIOGRAPHS & NOT ONLY ORTHOPEDICS

25. STABILIZING REDUCED LUXATIONS
THIS VELPEAU SLING IS USED TO PREVENT WEIGHT BEARING ON THE FORELIMB

26. NEOPLASIA OF THE BONE MOST COMMON IN LARGE BREED
MALE DOGS OLDER THAN 7 YRS OF
AGE

27. NEOPLASIA 85%-90% OF BONE CANCER IN DOGS IS OSTEOSARCOMA
THE DISTAL RADIUS IS THE MOST COMMON LOCATION

28. NEOPLASIA: DIAGNOSIS RADIOGRAPHS AND BIOPSY SHOULD BE PERFORMED TO
OSTEOLYSIS
PROLIFERATION
OF BONE
PERIOSTEAL REACTION
RADIOGRAPHS AND BIOPSY SHOULD BE PERFORMED TO
CONFIRM DIAGNOSIS

29. NEOPLASIA
METASTASIS OF OSTEOSARCOMA TO THE LUNGS; THERE IS USUALLY ALREADY
SOME MICROSCOPIC SREAD OF TUMOR BY THE TIME IT IS DIAGNOSED

30. NEOPLASIA
AMPUTATION OF THE AFFECTED LIMB ALONG WITH CHEMOTHERAPY IS A COMMON TREATMENT PLAN
SURVIVAL TIME IS ~12 MONTHS EVEN WITH AGGRESSIVE THERAPY

31. MYOPATHIES MYOPATHIES are diseases that affect the muscle
Inflammatory (bacterial, protozoal)
Immune-mediated
Acquired (secondary to other diseases)
Diagnosis is usually made by muscle biopsy and treatment directed toward the primary cause

32. IMMUNE-MEDIATED MYOPATHIES: MASTICATORY MUSCLE MYOSITIS (aka atrophic myositis, eosinophilic myositis)
CLINICAL SIGNS INCLUDE: ELEVATED 3RD EYELIDS, ATROPHY OF THE JAW
MUSCLES, AND INABILITY TO OPEN THE MOUTH (TRISMUS)

33. IMMUNE-MEDIATED MYOPATHIES: MASTICATORY MUSCLE MYOSITIS (aka atrophic myositis, eosinophilic myositis)
The muscles of mastication contain a special type of fiber (2M) that has antigenic properties possibly shared with bacteria.
The treatment of choice is glucocorticoids (steroids).

34. ACQUIRED MYOPATHIES: FELINE POLYMYOPATHY
CERVICAL VENTROFLEXION OF THE NECK, PERIODIC WEAKNESS, AND MUSCLE PAIN 2° TO HYPOKALEMIA
TREATMENT: Potassium supplementation, diet change