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Arthroscopy A diagnostic and therapeutic tool for the orthopedic patient

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  1. ArthroscopyA diagnostic and therapeutic tool for the orthopedic patient Barbro Nordquist, DVM Puget Sound Veterinary Referral Center

  2. Human Arthroscopy • Interest dates back to Roman times • The lichtleiter-1806 • Incandescent light bulb-1879 • Cystoscope developed • Arthroscopy-1918 • Evaluation of the human stifle • Modern arthroscopy-1959

  3. Veterinary Arthroscopy • Large animal arthroscopy-early 1970s • Well accepted mid 1980s • Small animal arthroscopy-late 1970s • Further evaluated in 1980s

  4. Advantages • Enhanced visualization • Improved precision • Magnification • Evaluation of different compartments • Decreased post operative pain • Earlier return to normal activity

  5. Disadvantages • Steep learning curve • Video game players at advantage • Potential need for conversion • Based on arthroscopic findings • Cost of instrumentation • Purchase • Repair

  6. Potential Complications • Extravasation of fluid into soft tissues • Collapses the joint • Increased surgical time • Iatrogenic trauma to joint surface • Experience • Inappropriately sized scope • Infection • Nerve damage

  7. Instrumentation • Arthroscope • Various sizes • Diameter • Length • Lens angle • External end • Camera • Light source • Cannula interlock

  8. Instrumentation • The tower • Monitor • Light source • Documentation • Video recording • Still images • Irrigation • Shaver

  9. Instrumentation • Hand instruments • Probes • Grasping forceps • Knives • Curettes • Shaver/burr

  10. Diagnostic work up • Radiographs • Elbows 3 views • Shoulder 2 views • Stifle 2 views • Sedation • Dexmedetomidine 2.5 mcg/kg IV along with Hydromorphone 0.05 mg/kg IV

  11. Elbow Joint • Pathology • Ununited anconeal process • Medial coronoid disease • Osteochondritis dissecans • Incongruity

  12. Elbow Joint

  13. Elbow Joint

  14. Elbow Joint [Please follow YouTube link to view presentation with video…]

  15. Elbow Joint

  16. Elbow Joint

  17. Elbow Joint

  18. Elbow Joint

  19. Elbow Joint

  20. Elbow Joint

  21. Shoulder Joint • Pathology • Osteochondritis dissecans • Biceps tenosynovitis or tendon tear

  22. Shoulder Joint [Please follow YouTube link to view presentation with video…]

  23. Shoulder Joint

  24. Shoulder Joint

  25. Shoulder Joint

  26. Stifle Joint • Cranial cruciate ligament rupture • Meniscal injury • Osteochondritis dissecans

  27. Stifle Joint

  28. Stifle Joint

  29. Stifle Joint

  30. Other Joints • Less frequently done • Hip joint • Prior to TPO • Tarsal joint • Limited joint space • trauma

  31. When to Refer

  32. Acknowledgements • The team at the AEC/PSVRC for organizing this • Dr. Kei Hayashi at UC Davis and Matt Willis from Karl Storz for providing images • Dr. Mark Fuller for the shoulder joint video To all of you for coming