SciCombinator

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Concept: Coronoid process of the ulna

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Elbow dysplasia is a common debilitating condition of large and giant breed dogs. Environmental factors and a complex genetic heritability play a role in predisposing dogs to elbow dysplasia with two aetiopathogeneses suggested for the development of the disease. Osteochondrosis was initially thought to cause elbow dysplasia, but more recent evidence has strongly supported various forms of joint incongruity as the most likely cause in most cases. Radioulnar length discrepancies and humeroulnar curvature mismatch have been implicated as the cause of medial coronoid disease and ununited anconeal process, but radial incisure incongruity and biceps/brachialis muscle forces could possibly play a role in some dogs. Treatment of elbow dysplasia should address articular pathology, such as fragmented coronoid process, osteochondrosis, cartilage damage and ununited anconeal process as well as any identified underlying causes. Finally, several palliative procedures have been developed to address more advanced elbow disease and might offer improved outcomes compared to conventional medical management.

Concepts: Medicine, Genetics, Cancer, Causality, Medical school, Play, Dog breed, Coronoid process of the ulna

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Forces exerted by fibrous structures on the medial aspect of the canine elbow joint have been reported to be involved in elbow pathology. The purpose of this paper is to assess the relationships of the ligamentous and muscular structures of this region of the canine elbow joint, and how they relate to the medial coronoid process. Six cadavers of adult German shepherd cross-breed dogs were used in this study to make intra-articular and vascular injections of this region. Some joints were dissected and some were frozen to saw sagittal or dorsal cryosections to assess the relationships of the myotendinous structures. The brachialis muscle tendon passed through the division of the bicipital tendon of insertion which formed a fibrous tendon sheath that was reinforced by the oblique ligament. The biceps' brachii’s main insertion is the radial tuberosity where it inserts along with the cranial branch of the oblique ligament and the cranial branch of the medial collateral ligament. Rotational and compression forces exerted by the insertion of the biceps brachii-brachialis tendon complex onto the ulna might influence medial coronoid disease. Therefore, sectioning these tendons could be considered as a treatment for medial coronoid disease.

Concepts: Muscle, Elbow, Triceps brachii muscle, Joints, Ligament, Tendon, Brachialis muscle, Coronoid process of the ulna

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Objective: The purpose of this study was to describe computed tomography (CT) features of the ununited anconeal process and relate them with the following elbow dysplasia signs: medial coronoid disease, medial humeral condyle changes, osteoarthritis (OA), and radioulnar incongruence. Methods: Computed tomographic images of dogs older than six months with an ununited anconeal process were evaluated (n = 13). Ununited anconeal process features were described as being complete or incomplete, and the degree of displacement, volume, and presence of cysts and sclerosis were also evaluated. Medial coronoid disease was defined as an irregular medial coronoid process shape, presence of sclerosis and fragmentation. Medial humeral condyle changes were defined as subchondral bone flattening, lucencies, and sclerosis. Osteoarthritis was graded depending on the osteophytes size. Radioulnar incongruence was measured on a sagittal view at the base of the medial coronoid process. Results: Eleven elbows had a complete and two had an incomplete ununited anconeal process. All ununited anconeal processes had cystic and sclerotic lesions. Seven ununited anconeal processes were displaced and six were non-displaced. Mean ununited anconeal process volume was 1.35 cm3 (0.61 cm³ - 2.08 cm³). Twelve elbows had signs of medial coronoid disease (4 of them with a fragmented medial coronoid process), and one elbow did not show any evidence of medial coronoid disease. Ten elbows had medial humeral condyle changes. One elbow had grade 1 OA, seven elbows had grade 2, and five elbows grade 3. All elbows had radioulnar incongruence: three elbows had a negative and 10 elbows had a positive radioulnar incongruence. Mean radioulnar incongruence was 1.49 mm (0.63 mm - 2.61 mm). Computed tomographic findings were similar in the majority of the elbows studied: complete ununited anconeal processes with signs of medial coronoid disease, positive radioulnar incongruence, high grade of OA, sclerotic medial humeral condyle changes, and large ununited anconeal process volumes. Clinical significance: Incomplete small ununited anconeal process volumes could be associated with a lower incidence of medial coronoid disease or medial humeral condyle changes. We recommend performing preoperative CT of elbows with an ununited anconeal process to evaluate concurrent lesions.

Concepts: Tomographic reconstruction, Humerus, Elbow, Tomography, Second grade, Brachialis muscle, Brachioradialis, Coronoid process of the ulna

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Arthroscopic reduction and internal fixation for coronoid process fractures has been proposed to overcome limitations of open approaches. Currently, arthroscopy is most frequently used to assist insertion of a retrograde guide wire for a retrograde cannulated screw. The present anatomical study presents an innovative arthroscopic technique to introduce an antegrade guide wire from an accessory anteromedial portal and evaluates its safety and reproducibility.

Concepts: Present, Time, Orthopedic surgery, Anatomy, Surgical procedures, Arthroscopy, Present tense, Coronoid process of the ulna

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There is no universally accepted approachto the elbow for the fixation of coronoid process fractures.This study aims to introduce a novel anterior surgicalapproach for the fixation of the ulnar coronoid fracture, with minimal surgical dissection damage and excellent visualization for reduction and internal fixation.

Concepts: Bone fracture, Fracture, Ulna, Orthopedic surgery, Coronoid process of the ulna

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The grey level of co-occurrence matrix (GLCM) is a texture analysis approach accounting for spatial distribution of the pixels from an image and can be a promising method for exercise-induced muscle damage (EIMD) studies. We followed up the time changes of two GLCM texture parameters and echo intensity (EI) on ultrasound images after eccentric contractions. Thirteen untrained women performed two sets of ten elbow flexions eccentric contractions. Ultrasound images were acquired at baseline and 24 h, 48 h, 72 h and 96 h after exercise. Two GLCM texture parameters were calculated for the brachialis muscle: contrast (CON) and correlation (COR). Peak torque, EI, muscle thickness (MT) and soreness were measured. The peak torque and soreness decreased immediately after the intervention in comparison with all the measures. MT increased immediately after the intervention remaining for 72 h (P<0·05). Significant increases (P<0·05) were observed for COR (48, 72 and 96 h) and EI only at 72 and 96 h. The increasing COR represents high similarity between grey levels, which could be observed on US images after few days on eccentric training for elbow flexors.

Concepts: Optics, Torque, Elbow, English-language films, Muscle contraction, Brachialis muscle, Co-occurrence matrix, Coronoid process of the ulna

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A novel technique, ultrasound-guided injection of the temporalis tendon in adults, is described. Ultrasound-guided injection of the temporalis tendon is based on visualization of the temporalis muscle, temporalis tendon, and coronoid process. A practical step-by-step guide to doing the procedure is given. This technique is effective and reproducible. Two patients successfully treated with this technique will be briefly discussed. The anatomic location and size of the temporalis tendon make it mandatory to use ultrasound to ensure precision.

Concepts: Coronoid process of the ulna, Temporal muscle

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Reconstruction of the most important ligamentous and osseus structures of the elbow after terrible triad injury via the radial head to the lateral collateral ligament complex (LCL) and if necessary beginning at the coronoid process. The aim is a stable concentrically guided elbow with early functional follow-up treatment. The approach depends on the intraoperatively tested stability.

Concepts: Injuries, Coronoid process of the ulna

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Coronoid process hyperplasia (CPH) of the mandible is a rare condition that can be defined as an abnormal bony elongation of histologically normal bone with the symptoms of progressive, painless difficulty in opening the mouth. The purpose of this study is to evaluate the outcomes of five patients with CPH treated by coronoidectomy, relative to post surgery jaw function.

Concepts: Function, Mandible, Anatomy, Outcome, Temporomandibular joint, Jaw, Coronoid process of the ulna

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In several species, developmental skeletal diseases involving abnormal endochondral ossification have been associated with imbalanced mineral intake. Hair analysis reflects long-term mineral status. To determine the mineral content of hair from dogs with or without medial coronoid process disease (MCPD). Dogs with MCPD have a different profile of minerals known to influence metalloenzymes involved in endochondral ossification. After cleansing, chelation and acid digestion of hair samples (n=79 in total: control dogs, n=70 v MCPD, n=9), mineral profile (7 major and 25 trace elements) was determined by inductively coupled plasma-mass spectrometry. Dogs were of similar age (control, 4.05 [1.85-7.70] v MCPD, 4.30 [3.25-6.53] median (IQR) years; P=0.78) and gender (control, n=43/27 v MCPD, n=4/5 males/females). 28/70 (40 per cent) of control and 8/9 (88 per cent) of MCPD dogs were neutered, respectively. Hair from dogs with MCPD contained significantly lower amounts (µg/g/DM) of copper, sulphur and zinc (all at P<0.001). Age, sex and neutered status had no effect on hair mineral status. Based on hair analysis, a role for mineral imbalance including copper, sulphur and zinc in the aetiopathogenesis of canine MCPD is suggested. Hair mineral analysis may prove useful as a biomarker for susceptible puppies.

Concepts: Dietary mineral, Mineral, Copper, Endochondral ossification, Intramembranous ossification, Dog, Skeleton, Coronoid process of the ulna