Muscle and Tendons

What is the forgotten part of ortho?

No radiographic lesion does not mean no lesion is present

What is a contusion?

Muscle injury with variable degree of hemorrhage and fiber rupture secondary to external trauma

What is a strain/elongation?

Longitudinal stretching or tearing of muscle fibers secondary to overstretching or overuse

Where do strains occur?

Near a musclo-tendon junction

What are the grades of strains?

Grade 1 rupture of a few fibers

Grade 4 complete rupture

What do most contusions or strains cause?

Disruption of normal muscle-tendon architecture due to edema, hemorrhage, or over stretching

What are the C/S of contusions and strains?

Depends on severity and chronicity

Can be very hard to identify. You need to palpate and feel for swelling

What are severe contusions associated with?

Fracture

Why do you want rads with contusions and strains?

Rule out fracture

What bloodwork changes can be present with contusions and strains?

Elevated CK and myoglobinuria

What is required for myofibril regeneration?

Sarcolemmal cells survive

Endomysial sheath not destroyed

Mild contusions and strains

What happens if myofibrils cannot regenerate?

Fibrous interposition

How do you treat contusions and strain?

Rest

NSAIDs

Hot or cold compresses depending on time of presentation (heat in first 24 hours)

What is compartment syndrome?

There is increased pressure in a nonstretchable fascia compartment usually due to bleeding after trauma

This can lead to necrosis

How do you treat compartment syndrome?

Epimysium incision

What causes lacerations?

Penetration by blunt object

Where do lacerations occur most often?

near carpus or tarsus

What are C/S of lacerations?

Open wound and lameness without weight bearing

What should you do if there is a laceration?

Rads to exclude CE or fracture

US

What is the first thing to do if there is a laceration?

Stabilize the patient

How do you treat muscle lacerations?

Apposition sutures and deep sutures

Can use absorbable or non-absorbable

Immobilize for 5 days and restrict activity for 6 weeks

How do you treat tendon lacerations?

Surgery with strong long-lasting suture because it has slow healing with delicate blood supply

What do you need to do after tendon repair?

Protect repair with immobilization for at least 3 weeks

Allow progressive return to function and PT

What are the specific myotendinous pathologies?

Achilles rupture, other tears and lacerations, biceps tenosynovitis, infraspinatus fibrous contracture, femoral quadriceps contracture, gracilis and semitendinosus fibrotic myopathy

Describe achilles rupture?

Usually in active dogs

Acute or chronic and can be partial or complete

Rupture can occur at the gastroc, superficial digital flexor, or the complete tendon at the calcaneus

What is a complete achilles rupture?

Hyperflexion of tarsus

Hyperextension of digits

What is a partial achilles rupture?

Preserved SDF tendon

Less hyperflexion of tarsus and hyperflexion of digits is present

How do you diagnose achilles rupture?

Plantigrade stance (tarsus hyperflexion)

Muscle, tendon, insertion palpation

US

Rads

How do you treat an achilles rupture?

Surgery is needed to fix it

A brace can help if owner cannot afford sx

How do you do a achilles surgery?

Suture of all 3 parts (gastroc, SDF, common tendon of biceps femoris, gracilis, semitendinosus)

Suture of the whole complex if chronic

What do you do postop of a achilles repair?

Immobilization of joint and has a good prognosis

What happens if there is a digital flexor trauma?

Evaluate location and depth to determine need for repair

What tendon will always need to be repaired?

Patella because of high loads

What is biceps tenosynovitis?

Umbrella term including tearing, inflammation of tendon AND synovial sheath

What causes biceps tenosynovitis?

Trauma or overuse

What is the signalment for biceps tenosynovitis?

Working and active dogs with intermittent lameness worsening after exercise

How do you diagnose biceps tenosynovitis?

Biceps test on PE

Flex shoulder and extend elbow to maximize tension on biceps

Feel biceps tendon on shoulder and dog should react to pain while you do this

Also Rads, US, MRI, arthroscopy

How do you fell for muscle atrophy on front limb?

Compare scapular spines

How do you treat biceps tenosynovitis?

Start medically with peritendinous injections and weight management

If needed do a tenotomy or tenodesis

What is the prognosis of biceps tenosynovitis?

Medical has variable results but start with it anyway

Surgery has good prognosis

What is the signalment for infraspinatus fibrous contracture?

Hunting dogs, young adults that had a prior trauma and contusion leading to fibrosis and progressive lameness

Nonpainful and no swelling

How is the limb positioned with infraspinatus fibrous contracture?

External rotation abduction

How do you treat infraspinatus fibrous contracture?

Resect myotendinous contracture. The dog will recover very rapidly after that

What is the signalment for femoral quadriceps contracture?

Young dogs that had a distal femoral fracture and the contracture occurs

Can occur a few days after not using the limb anymore

Why do you always need to have the owner cause some movement of the hind limb with a hind limb fracture?

If they do not move it then a femoral quadriceps contracture can occur very rapidly

How do you treat femoral quadriceps contracture?

Remove adhesions, lengthen quadriceps, or shorten the femur

Prognosis is guarded as it is really hard to fix it after it occurs

What is the signalment for gracilis and semitendinosus fibrotic myopathy?

German shepherds, belgian shepherds, young adults

What is gracilis and semitendinosus fibrotic myopathy?

There will be a thickened fibrous band on caudal aspect of the thigh caudal to thigh

There is lameness with a jerk but no pain

50% bilateral

What is the recurrence rate for gracilis and semitendinosus fibrotic myopathy?

2-4 months after surgery

Prognosis is guarded