Ultrasonographic Evaluation of Dogs with Cranial Cruciate Ligament Rupture Undergoing to Arthrotomy

Background: The cranial cruciate ligament rupture (CrCLR) is the most common disease of the stifle joint in dogs. One of the major concerns in the assessment of these animals is diagnosing the presence of a medial meniscus tears, which is a frequent consequence due to the instability of the joint. Ultrasonography is indicated in the evaluation of the menisci from human and canine patients, and the results are similar to magnetic resonance imaging. The aim of this study was to compare the ultrasonography and the arthrotomy in the evaluation of the cranial cruciate ligament and medial meniscus of dogs with CrCLR undergoing surgery for stifle stabilization.Materials, Methods & Results: Ultrasonographic examination was performed prior to arthrotomy in 23 dogs with diagnosis of complete CrCLR and five with suspected partial CrCLR undergoing for stifle joint stabilization surgery. The ultrasonography identified the complete rupture in 82.6% and the arthrotomy in 100% of the joints with this diagnosis. In the joints with suspected CrCLR during the clinical exam, arthrotomy and ultrasonography identified respectively three and four joints with partial CrCLR, and two and one with healthy ligaments. There was no difference between the two techniques in the assessment of the cranial cruciate ligament (P = 0.20). The ultrasonography identified medial meniscal tears in 39.3%, while arthrotomy was found in 21.4% (P = 0.0006) of the joints. The most frequent meniscal tear type observed in the arthrotomy was folded caudal horn. The ultrasonography was able only in differentiate presence and absence of meniscal injury. Besides the real tear that affects the meniscus morphology, the ultrasound also identified echogenicity and echotexture changes in the medial (5/28) and lateral (8/28) menisci. Other changes observed in all joints evaluated by ultrasound were the presence of effusion and synovial membrane thickening.Discussion: The complete and almost complete CrCLR are diagnosed by clinical examination through the evaluation of instability of the stifle joint, which is not possible in partial CrCLR in stable joints. In this study of the five evaluated stable joints, the ultrasound correctly identified the partial CrCLR in three joints and the ligament integrity in one of the joints when compared to arthrotomy. In animals with stifle joint instability the meniscus assessment is fundamental as it is one of the main causes of persistent lameness in dogs subjected to conservative or surgical treatment. Ultrasonography cannot differentiate the types of meniscal tears but identified approximately 1.8 times more medial meniscus tears compared to arthrotomy. Despite the bucket handle being the most common tear of medial meniscus in dogs with CrCLR, four of the six meniscal tears identified by arthrotomy were folded caudal horn. This lesion causes cranial displacement of the caudal horn which may have facilitated its identification by minimally invasive arthrotomy, being the probable reason for its high incidence in this study. Echogenicity and echotexture changes without affecting the meniscus morphology were related with intrasubstance degeneration described in human medicine. Ultrasonography is not the better technique to assess the CrCL but can assist in identifying partial ruptures. Because it has results similar to magnetic resonance imaging, ultrasonography is an important tool in the diagnosis of meniscus tears

Utilização da ultrassonografia como método auxiliar no posicionamento de marcadores em análise de movimento de equinos

A análise cinemática do movimento é baseada na reconstrução de pontos anatômicos específicos identificados por marcadores de superfície. Esses pontos de referência geralmente não correspondem a pontos, mas a áreas relativamente grandes e curvas de difícil identificação pela palpação. A colocação precisa dos marcadores de superfície é ainda mais difícil e há grande variabilidade entre examinadores. Neste estudo 16 examinadores foram submetidos à identificação da borda lateral da tuberosidade isquiática esquerda de um cavalo usando a palpação e a ultrassonografia para colocar um marcador de superfície. Imagens de cada procedimento de marcação foram adquiridas utilizando duas câmeras de vídeo digital e processadas utilizando o sistema de videogrametria DVideow.  O software Matlab foi usado para determinar a posição dos respectivos vetores. As posições dos marcadores foram comparadas para avaliar a variabilidade entre os examinadores e a precisão do método empregado através do teste de Bartlett e teste t pareado respectivamente. A ultrassonografia melhorou significativamente a localização dos pontos anatômicos de cada examinador (p = 0,04) e reduziu a variabilidade no posicionamento dos marcadores de superfície quando comparada a palpação (p = 0,0028). A variabilidade das distâncias calculadas (média ± dp) foi de 2,89 ± 2,24 cm e 1,63 ± 0,98 cm usando a palpação e a ultrassonografia respectivamente. A ultrassonografia reduziu a variabilidade entre examinadores e permitiu a visualização do ponto anatômico correspondente.Kinematic motion analysis is based on the reconstruction of selected bony anatomical landmarks identified by surface markers. Anatomical landmarks generally do not correspond to points but rather to relatively large and curved areas and their identification by palpation is not easy. Precise placement of surface markers is even more difficult and there is great variability between operators. In this study 16 examiners were asked to identify the lateral border of the left ischial tuberosity in a horse using palpation and ultrasonography for placement of a corresponding skin surface marker. Images of each marking procedure were captured using two video cameras and processed using the DVideow videogrammetry. A custom-written Matlab code was used to determine the position of the respective vectors. The positions of the markers were then compared to assess inter-examiner variability and the precision of the methods employed using the Bartletttest and the paired t-test respectively. Ultrasonography significantly improved the location of the anatomical landmark by each examiner (p = 0.04) and reduced the variability in the position of the surface marker when compared to palpation (p = 0.0028). The variability of the calculated distances (mean ± SD) was 2.89 ± 2.24 cm and 1.63 ± 0.98 cm using palpation and ultrasonography respectively. Ultrasound guidance reduced inter-examiner variability and allowed visualization of the corresponding bony anatomical landmark

Ultrasonography as an ancillary method for the positioning of markers in equine motion analysis

Kinematic motion analysis is based on the reconstruction of selected bony anatomical landmarks identified by surface markers. Anatomical landmarks generally do not correspond to points but rather to relatively large and curved areas and their identification by palpation is not easy. Precise placement of surface markers is even more difficult and there is great variability between operators. In this study 16 examiners were asked to identify the lateral border of the left ischial tuberosity in a horse using palpation and ultrasonography for placement of a corresponding skin surface marker. Images of each marking procedure were captured using two video cameras and processed using the DVideow videogrammetry. A custom-written Matlab code was used to determine the position of the respective vectors. The positions of the markers were then compared to assess inter-examiner variability and the precision of the methods employed using the Bartletttest and the paired t-test respectively. Ultrasonography significantly improved the location of the anatomical landmark by each examiner (p = 0.04) and reduced the variability in the position of the surface marker when compared to palpation (p = 0.0028). The variability of the calculated distances (mean ± SD) was 2.89 ± 2.24 cm and 1.63 ± 0.98 cm using palpation and ultrasonography respectively. Ultrasound guidance reduced inter-examiner variability and allowed visualization of the corresponding bony anatomical landmark

Ultrasonographic evaluation of large and small dogs with stifle joint diseases.

A ultrassonografia (US) é pouco utilizada na avaliação musculoesquelética de pequenos animais, ao contrário do que ocorre na medicina humana. Com o avanço tecnológico e o advento de transdutores de alta frequência, articulações pequenas como as dos dígitos em humanos são frequentemente avaliadas. Neste estudo comparamos a US com a radiografia (RX) na avaliação de 85 cães, grandes e pequenos, com diferentes afecções da articulação femorotibiopatelar (FTP), e com a artrotomia na avaliação do ligamento cruzado cranial (LCCr) e do menisco medial de 28 cães com ruptura do LCCr (RLCCr) parcial e completa. Não houve diferença na avaliação da efusão intra-articular comparando a US e a RX, porém na US foi possível diferenciar a efusão do espessamento da membrana sinovial (EMS). A graduação dos osteófitos periarticulares foi maior na US (P< 0,0001). A claudicação crônica causou maior severidade dos osteófitos tanto na RX como na US, mas não das alterações inflamatórias (efusão e EMS) quando comparada com a aguda. Articulações com RLCCr apresentaram alterações mais severas comparadas com a luxação medial de patela. Cães pequenos apresentaram menor severidade dos osteófitos periarticulares na US (P=0,0003) e RX (P=0,005) e das alterações inflamatórias: efusão na US (P=0,0013) e RX (P<0,0001), e EMS (P=0,0022) comparados com cães grandes. Não houve diferença entre a US e a artrotomia na avaliação do LCCr (P=0,20). Todas as articulações em que a US detectou RLCCr completa tiveram diagnóstico clínico de ruptura completa confirmada pela artrotomia. A US detectou lesão verdadeira do menisco em 39,3% (11/28) das articulações, 1,8 vezes mais que a artrotomia (P=0,0006), a qual identificou lesão em 21,4% (6/28) das articulações. Os dados deste estudo sugerem que a US é superior a RX na detecção de discretos osteófitos periarticulares. Cães pequenos apresentam menor severidade das alterações da osteoartrite (OA) comparados com os grandes. O grau de osteófitos é mais severo nos casos crônicos, porém as alterações inflamatórias da OA não diferem entre a fase aguda e crônica. A US é capaz de identificar lesões dos meniscos mediais não observadas na artrotomia, e apesar de não ser a modalidade de imagem mais indicada para avaliação do LCCr, pode auxiliar na identificação das rupturas parciais.Compared to human medicine musculoskeletal ultrasound is seldom used in veterinary practice. With the technological advancement and the advent of high-frequency transducers, small joints like those of human digits are often evaluated. In this study, we compared the US with radiography (RX) in the evaluation of 85 large and small dogs with different affections of the stifle joint (SJ) and with the arthrotomy inspection in the evaluation of the cranial cruciate ligament (CrCL) and the medial meniscus of 28 dogs with partial and complete rupture of the CrCL undergoing stabilization surgery. There was no difference in the evaluation of intra-articular effusion comparing US and RX, but in the US it was possible to differentiate the effusion of synovial membrane thickening (SMT). The degree of periarticular osteophytes was higher in the US (P<0.0001), which detected osteophytes not observed in RX. Joints with chronic lameness presented increase osteophytes scores in both RX and US, but not in the inflammatory changes (effusion and SMT) when compared to those with acute lameness. Joints with ruptured LCCr showed more severe alterations compared to those with medial patellar dislocation. Small dogs presented lower periarticular osteophytes scores in the US (P = 0.0003) and RX (P = 0.005) and inflammatory changes: effusion in US (P = 0.0013) and RX (P<0.0001), and SMT (P = 0.0022) compared to large dogs. There was no difference between the US and the arthrotomy in the LCCr evaluation (P = 0.20). All joints in which the US detected complete RLCCr had clinical diagnosis of complete rupture confirmed by arthrotomy. The US detected true meniscal injury in 39.3% (11/28) of the joints, 1.8 times more than the arthrotomy (P = 0.0006), which identified a lesion in 21.4% (6/28) of joints. The data from this study suggest that the US is superior to RX in the detection of discrete periarticular osteophytes. Small dogs have a lower severity of osteoarthritis (OA) changes compared to large ones. The degree of periarticular osteophytes is more severe in chronic cases, but the inflammatory alterations of OA do not differ between the acute and chronic phases. The US can identify lesions of the medial meniscus not observed in the arthrotomy, and although it is not the most suitable imaging modality for the evaluation of LCCr, it may help in the identification of partial ruptures

Ultrasonographic Evaluation of Dogs with Cranial Cruciate Ligament Rupture Undergoing to Arthrotomy

Background: The cranial cruciate ligament rupture (CrCLR) is the most common disease of the stifle joint in dogs. One of the major concerns in the assessment of these animals is diagnosing the presence of a medial meniscus tears, which is a frequent consequence due to the instability of the joint. Ultrasonography is indicated in the evaluation of the menisci from human and canine patients, and the results are similar to magnetic resonance imaging. The aim of this study was to compare the ultrasonography and the arthrotomy in the evaluation of the cranial cruciate ligament and medial meniscus of dogs with CrCLR undergoing surgery for stifle stabilization.Materials, Methods & Results: Ultrasonographic examination was performed prior to arthrotomy in 23 dogs with diagnosis of complete CrCLR and five with suspected partial CrCLR undergoing for stifle joint stabilization surgery. The ultrasonography identified the complete rupture in 82.6% and the arthrotomy in 100% of the joints with this diagnosis. In the joints with suspected CrCLR during the clinical exam, arthrotomy and ultrasonography identified respectively three and four joints with partial CrCLR, and two and one with healthy ligaments. There was no difference between the two techniques in the assessment of the cranial cruciate ligament (P = 0.20). The ultrasonography identified medial meniscal tears in 39.3%, while arthrotomy was found in 21.4% (P = 0.0006) of the joints. The most frequent meniscal tear type observed in the arthrotomy was folded caudal horn. The ultrasonography was able only in differentiate presence and absence of meniscal injury. Besides the real tear that affects the meniscus morphology, the ultrasound also identified echogenicity and echotexture changes in the medial (5/28) and lateral (8/28) menisci. Other changes observed in all joints evaluated by ultrasound were the presence of effusion and synovial membrane thickening.Discussion: The complete and almost complete CrCLR are diagnosed by clinical examination through the evaluation of instability of the stifle joint, which is not possible in partial CrCLR in stable joints. In this study of the five evaluated stable joints, the ultrasound correctly identified the partial CrCLR in three joints and the ligament integrity in one of the joints when compared to arthrotomy. In animals with stifle joint instability the meniscus assessment is fundamental as it is one of the main causes of persistent lameness in dogs subjected to conservative or surgical treatment. Ultrasonography cannot differentiate the types of meniscal tears but identified approximately 1.8 times more medial meniscus tears compared to arthrotomy. Despite the bucket handle being the most common tear of medial meniscus in dogs with CrCLR, four of the six meniscal tears identified by arthrotomy were folded caudal horn. This lesion causes cranial displacement of the caudal horn which may have facilitated its identification by minimally invasive arthrotomy, being the probable reason for its high incidence in this study. Echogenicity and echotexture changes without affecting the meniscus morphology were related with intrasubstance degeneration described in human medicine. Ultrasonography is not the better technique to assess the CrCL but can assist in identifying partial ruptures. Because it has results similar to magnetic resonance imaging, ultrasonography is an important tool in the diagnosis of meniscus tears

OSTEOMIELITE CAUSADA POR Escherichia coli E Bacillus spp. EM PAPAGAIO VERDADEIRO - RELATO DE CASO

The objective is to describe a case of osteomyelitis of a Blue-fronted Parrot (Amazona aestiva) with fractured left pelvic member accompanied of osteolysis, which was attended at the Veterinary Hospital of the Federal University of Mato Grosso, Campus Sinop-MT. After clinical examination, radiographic, bacterial culture and antibiotic susceptibility testing, was confirmed the diagnosis of osteomyelitis caused by Escherichia coli and Bacillus spp. Osteomyelitis is an inflammatory process accompanied by bone destruction caused by an infectious microorganism, can be found in acute and chronic forms. The diagnosis of osteomyelitis depends not only on radiographic findings but other tests such as culture and antibiotic susceptibility testing. In this case Escherichia coli was sensitive to all antimicrobial used, but Bacillus spp. was resistant to some of antibacterials used: Enrofloxacin, Ampicillin, Chloramphenicol, Tetracycline, Norfloxacin and Ciprofloxacin. The treatment chosen for the case was amputation of the affected limb. This is the first description of the occurrence of osteomyelitis caused by the bacterium Escherichia coli and Bacillus spp. in a Blue-fronted Parrot in the state of Mato Grosso, Brazil.O objetivo do presente trabalho foi descrever um caso de osteomielite em papagaio verdadeiro (Amazona aestiva,) com fratura no membro pélvico esquerdo, acompanhada de osteólise, que foi atendido no Hospital Veterinário da Universidade Federal de Mato Grosso, Campus Sinop-MT. Após exames clínico, radiográficos, cultura bacteriana e antibiograma, confirmou-se o diagnóstico de osteomielite, causada pelas bactérias Escherichia coli e Bacillus spp. A osteomielite é um processo inflamatório, acompanhado de destruição óssea, causada por um microrganismo infectante e que pode ser encontrada nas formas aguda e crônica. O diagnóstico da osteomielite depende, não só de achados radiográficos, mas de outros exames como cultura e antibiograma. No presente caso, Escherichia coli mostrou-se sensível a todos os antibacterianos utilizados; mas Bacillus spp. mostrou-se resistente a alguns dos antibacterianos utilizados: Enrofloxacina, Ampicilina, Cloranfenicol, Tetraciclina, Norfloxacin e Ciprofloxacina. O tratamento escolhido para o caso foi amputação do membro acometido. Este é a primeira descrição da ocorrência de osteomielite causada pela bactéria Escherichia coli e Bacillus spp. em um papagaio verdadeiro no estado do Mato Grosso

Infiltrative Lipoma Causing Lumbar Nerve Root Compression in a Dog

Background: Lipomas are benign soft tissue mesenchymal neoplasms composed of adipose cells and are usually found in the subcutaneous tissue. Occasionally, lipomas may invade muscles or grow between them, in which case they are characterized as infiltrative lipomas. Clinical signs resulting from an intermuscular lipoma compressing peripheral nerves are rarely encountered in dogs. This case report aims to describe the neurological signs, diagnosis, and clinical evaluation of a dog diagnosed with infiltrative lipoma compressing a lumbar spinal nerve root.Case: A 12-year-old neutered male Fox Paulistinha, weighing 10.5 kg, was presented with difficulties in walking for the past 15 days with no previous history of trauma. On physical examination, the presence of three cutaneous nodules was noted in the ventral thoracic region, with onset of one year and slow and progressive growth. A cytological evaluation of the nodules was performed, and lipoma was diagnosed. At the neurological examination, the patient presented ambulatory paraparesis with marked motor deficit and atrophy of the quadriceps muscles of the left pelvic limb. Conscious proprioceptive deficit, the absence of patellar reflex, and diminished withdrawal reflex were observed in the left hind limb, in addition to diffuse pain on epaxial palpation of the lumbar region. Electroneuromyography showed increased insertion activity in the left gastrocnemius muscle and moderate spontaneous activity (fibrillation). Persistence of 10% was observed in the F-wave study of the left tibial nerve. These findings indicate partial involvement of the roots of the left sciatic-tibial nerve. Magnetic resonance imaging (MRI) showed the presence of a mass measuring 3.18 × 1.04 × 1.4 cm, interspersed with the paravertebral muscles, and located adjacent to the L2 and L3 spinous processes. An ultrasound-guided fine needle aspiration biopsy of the mass was performed and the findings of the cytopathological analysis of the collected material were considered consistent with lipoma. In view of these findings, surgical removal was recommended. However, the owner chose to attempt conservative treatment to control pain. Thus, the patient was treated with gabapentin, tramadol hydrochloride, carprofen, dipyrone, omeprazole, and physiotherapy. The animal exhibited a good response to conservative treatment, regaining its hind limb mobility in approximately 30 days.Discussion: Infiltrative lipomas compressing nerve roots are rarely described, with only one report of infiltrative lipoma in the lumbar region causing nerve root compression in dogs found in the literature. MRI was beneficial in this case, since it helped in determine the shape, location, and extent of the mass causing compression of the left L2 nerve root. The history and neurological examination findings in the patient described in this report were accounted for by the presence of an infiltrative lipoma compressing the left nerve root of L2. Surgical excision is the treatment of choice for intramuscular lipomas in most cases since conservative treatment elicits only a limited response. In contradiction to the literature, the dog in this report experienced a good response to conservative treatment, returning to normal mobility approximately 30 days after starting treatment. After six months of follow-up, the dog had not experienced a recurrence of the clinical signs. However, since the tumor has not been removed, clinical relapse is expected to occur in the future. Thus, despite the good response to conservative treatment in this case, we recommend the surgical excision of the tumor in order to decompress the affected nerve root. Although infiltrative lipomas compressing nerve roots are rare, clinicians should consider them as differential diagnosis when there is a presence of subcutaneous lipomas and neurologic signs of radiculopathy