Learning Issues:

1. What types of disorders primarily affect the rear limb/stifle of middle age large breed dogs?
	a.Arthritis- Degenerative joint disease, erosive arthropathies, and immune mediated 
arthropathies
	b. Neoplasia- synovial sarcoma, synovioma,lipoma,liposarcomas, tumors such as 
fibrosarcoma or osteosarcoma ( which may erode into joints), villonodular synovitis, localized 
nodular synovitis, synovial cysts, synovial osteochondrometaplasia
	c. Luxating patella- not as common in the large breed dog but can be seen
	d. Hip dysplasia
	e. Trauma- fractures, ligament/tendon tears, muscle damage
	f. Cruciate/meniscal dz
	g. Congenital abnormalities such as osteochondrosis which resolved but left environment 
for early onset of DJD

2. In these disorders, which ones particularly is there an association with difficulty getting up or 
down or conditions where difficult to rise but able to walk well once on all fours:
	Chronic degenerative joint disease or hip dysplasia
	Signs may have become apparent over a long period of time OR occur suddenly after brisk 
activity that results in a tear or other injury of soft tissues of abnormal joint. Lameness after 
prolonged heavy exercise. Will see decrease range of motion and dog often sits rather than stands 
and arises slowly with great difficulty.
	Two common instances where hip dysplasia seemingly ÒworsensÓ: 1. Either full or partial 
cruciate ligament tears or 2/ spinal problems.


3. How much Science Diet does Bonnie really need to be eating? She is stated as being 
overweight.  According to our calculations Bonnie needs about 1811kcal ME per day. This would 
be       cups of food. 

4. what types of disorders can cause effusion of the stifle with distention of the joint capsule on 
either side of the straight patellar ligament, and would cause pain on manipulation of the stifle?
  Nothing specifically mentioned for distention of joint capsule on either side of the straight patellar 
ligament; however things to consider with effusion in general:
	Synovial membrane hypertrophy and hyperplasia
	Joint capsule fibrosis
	Joint capsule neoplasia
	Synovioma
	Metastatic bone neoplasm into joint
	Synovial sarcoma
	Villonodular synovitis
	Localized nodular synovitis
	Synovial cysts
	Tumors eroding into joints (fibrosarc/osteosarc)
	TRAUMA ( cruciate/meniscal tears; bruising)
	OCD of stifle ( normally apparent at youner age but may resolve spontaneously but lead to 
osteoarthritic changes in the middle age dog which can be associate with joint effusion)
	Immune mediated arthropathies
	Non immune mediated and infectious arthropathies

5. What is the significance of a 4-5 mm cranial drawer in the left rear stifle and less than 2mm 
palpable on the Right rear stifle:
	In the normal adult there should not be any cranial drawer unless the examiner is doing the 
procedure improperly.
	Even the 1-2 mm is significant if the test is done correctly and with full sedation (general 
anesthesia as opposed to just sedation) more of a drawer movement may be elicited.  Slight 
movement may indicate a stretched or partially torn ligament where as larger movement usually 
indicates a torn ligament. In a freshly torn cruciate ligament of a relaxed medium sized animal may 
show tibial movement of 5-10mm.  Larger dogs may have less movement than smaller dogs.  
Other factors that dimish full drawer movement include:
	Chronicity
	Animal tenseness
	Partial ligament tears and presence of meniscal injury
Increased drawer movement occurs with multiple ligament tears in traumatized animal or in 
Cushingnoid dogs

6. Is Bonnie doing too much exercise? For a normal/healthy animal of her age, the exercise should 
not be a problem; however, if Bonnie has DJD due to some secondary underylying disorder which  
weakens the muscles and/or joint components then this exercise may be exacerbating subclinical 
illness.  Plus with being overweight, while the goal  with exercise is to help maintain weight, this 
can also cause increase force on the joints with exuberant exercise such as running and may cause 
stretching of the ligaments  leadign to subsequent partial or full tears of the ligament.

7. just because the hip joint appears to be free of palpable laxity or pain when palpated, does this 
rule out the possibility of hip dysfunction? We do not believe this does. Bonnie was only under 
sedation, not general anesthesia and while we would expect pain elicited if the changes were 
severe, this is not always the case. So we could have one of 3 scenarios: 
A. The hips joints could be perfectly normal or just showing signs of normal aging/DJD
B. The Hips joints could have mild conformational problems, which may have never showed 
clinical signs but which may have lead to abnormal forces on joints distally leading to a 
chronic DJD of the stifle and then acute onset of lameness
C. The hips joints could be severely deformed/affected with DJD but Bonnie is not showing 
signs. This does happen occasionally.  This again could be a secondary cause of the problems 
involving the stifle.