PRESENTATION
BROCHURE
ATLAS OF
ATLAS OF CANINE ARTHROLOGY
CANINE ARTHROLOGY
U PD AT ED ED IT IO N
JESÚS LABORDA VAL JULIO GIL GARCÍA MIGUEL GIMENO DOMÍNGUEZ JAVIER NUVIALA ORTÍN AMAIA UNZUETA GALARZA
3D
ANIMATIONS
ATLAS
ANIMATIONS INCLUDED
CANINE ARTHROLOGY
Updated edition
OF
Atlas of Canine Arthrology
ATLAS OF CANINE ARTHROLOGY UPD ATED EDIT ION
JESÚS LABORDA VAL JULIO GIL GARCÍA MIGUEL GIMENO DOMÍNGUEZ JAVIER NUVIALA ORTÍN AMAIA UNZUETA GALARZA
3D
ANIMATIONS
eBook
available
This work is intended as a practical atlas that provides a comprehensive description of the anatomy of each component found in a dog’s articulations. However, in this updated edition of Atlas of Canine Arthrology, the information provided in the previous version has been enhanced and complemented with new tools, 3D animations, and self-evaluation tests that will help readers acquire knowledge and form a better understanding of joint anatomy and function – elements of great importance for each dog’s physical health and well-being.
RETAIL PRICE TARGET AUDIENCE: ✱ Small animal vets. Arthrology. ✱ Veterinary students. FORMAT: 22 × 28 cm NUMBER OF PAGES: 108 BINDING: hardcover ISBN: 978-84-17640-75-0
€95
Authors JESÚS LABORDA VAL Professor at the Department of Animal Anatomy, Embryology, and Genetics (University of Zaragoza’s Faculty of Veterinary Medicine) since 1989. JULIO GIL GARCÍA Lecturer at the Department of Animal Anatomy, Embryology, and Genetics (University of Zaragoza’s Faculty of Veterinary Medicine). MIGUEL GIMENO DOMÍNGUEZ Lecturer at the Department of Animal Anatomy, Embryology, and Genetics (University of Zaragoza’s Faculty of Veterinary Medicine).
JAVIER NUVIALA ORTÍN Associate professor at the Department of Animal Anatomy, Embryology, and Genetics (University of Zaragoza’s Faculty of Veterinary Medicine). AMAIA UNZUETA GALARZA Head of Radiology and Endoscopy Services at the University of Zaragoza’s Veterinary Hospital.
KEY FEATURES:
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Detailed description of each joint accompanied by high-quality graphical material. High quality illustrations. 3D animations that allow the reader to visualise the joints in all possible positions. Self-assessment tests that allow readers to consolidate their knowledge
Atlas of Canine Arthrology Updated edition
Presentation This new version of Atlas of Canine Arthrology responds to the veterinary surgeon’s patent and everyday need for a visual, practical, and useful reference work that offers comprehensive information about dog joints. The diseases that affect these musculoskeletal structures require increasingly specialised attention and this atlas provides veterinary surgeons with the precise anatomical information they require. The book starts by reviewing general points, such as characteristics of articular cartilage,the ossification timeline of skeletal elements, the different types of joints, or the components of synovial joints. It continues with a systematic description of the joints found in each area of the body, including the head, trunk region, and the limbs, with a special emphasis on the joints’ geometry and viable movements, arthrocentesis and the technique’s indications, and the most commonly encountered complications, such as dislocation, subluxation, or dysplasia. Particular importance is placed on ensuring a clear visual portrait of the joints’ components and their arrangement within each structure. As such, each joint is depicted through illustrations created using a novel technique which outlines the joint, muscular, and vascular structures displayed over actual photographs of bones, while X-rays are used to complete the schematic information in each illustration. The amount of text, which focuses on the use of appropriate anatomical nomenclature to describe the joint structures, their functional significance, and the points to consider when carrying out each diagnostic and therapeutic procedure, has intentionally been reduced to underscore the importance of the images. There are also illustrations of the clinically most suitable sites for the veterinary surgeon to perform joint aspiration (arthrocentesis). In addition, the book includes QR codes to access to 3D animations and self-assessment tests to improve their knowledge. In summary, in this updated edition of Atlas of Canine Arthrology, the information presented in the previous edition is now enriched and complemented with new tools, 3D animations and self-evaluation tests which will help readers acquire knowledge and develop a better understanding of joint anatomy and function – elements of great importance in the physical health and well-being of man’s best friend.
Authors Jesús Laborda Val Doctor Laborda obtained both a degree (1981) and PhD (1987) in veterinary medicine at the University of Zaragoza. He has been a professor at the Department of Animal Anatomy, Embryology, and Genetics within the University of Zaragoza’s Faculty of Veterinary Medicine since 1989. Jesús has also coauthored the books El encéfalo del perro: secciones y resonancias magnéticas (The Canine Brain: Sections and Magnetic Resonance Imaging), Artrocentesis en el caballo (Arthrocentesis in Horses), and Dog Anatomy. Dissection Protocols.
Julio Gil García Doctor Julio Gil obtained a degree (1976) and PhD (1987) in veterinary medicine both at the University of Zaragoza. He also earned a degree and later a PhD in biological sciences at the University of Valencia (1985) and the Complutense University of Madrid (2008), respectively. From 1991 to the present date, he has lectured at the Department of Animal Anatomy, Embryology, and Genetics, which forms part of the University of Zaragoza’s Faculty of Veterinary Medicine. Julio has coauthored the books El encéfalo del perro: secciones y resonancias magnéticas (The Canine Brain: Sections and Magnetic Resonance Imaging), Artrocentesis en el caballo (Arthrocentesis in Horses), and Dog Anatomy. Dissection Protocols.
Miguel Gimeno Domínguez Doctor Gimeno holds a degree (1977) and PhD (1981) in veterinary medicine, both from the University of Zaragoza. Since 1991 he has lectured at the Department of Animal Anatomy, Embryology, and Genetics, which belongs to the University of Zaragoza’s Faculty of Veterinary Medicine. Miguel has coauthored the books El encéfalo del perro: secciones y resonancias magnéticas (The Canine Brain: Sections and Magnetic Resonance Imaging), Artrocentesis en el caballo (Arthrocentesis in Horses), and Dog Anatomy. Dissection Protocols.
Atlas of Canine Arthrology Updated edition
Javier Nuviala Ortín Dr Nuviala earned his degree (1987) and PhD (2007) in veterinary medicine at the University of Zaragoza. He has been an associate professor at the Department of Animal Anatomy, Embryology, and Genetics within the University of Zaragoza’s Faculty of Veterinary Medicine since 2007. Javier has edited technical and scientific veterinary publications for the publishing company Grupo Asís Biomedia since 1999. In 2017, he became an editor and scientific consultant for the Dr Herriot veterinary agency. He has coauthored the books El encéfalo del perro: secciones y resonancias magnéticas (The Canine Brain: Sections and Magnetic Resonance Imaging), Artrocentesis en el caballo (Arthrocentesis in Horses), and Dog Anatomy: Dissection Protocols.
Amaia Unzueta Galarza Ms Unzueta earned her degree in veterinary medicine at the University of Zaragoza in 1993. After several years working as an associate intern at the Faculty of Veterinary Medicine’s Internal Medicine and Radiology Service, in 2003 she obtained a permanent position as the Head of Radiology and Endoscopy Services at the University of Zaragoza’s Veterinary Hospital, where she still works today. From 2003 to the present date, Amaia has reconciled her role at the veterinary hospital with academic duties as an associate lecturer in diagnostic imaging. She is also a professor of the internal course imparted at the University of Zaragoza Veterinary Hospital and titled “Masters in Small Animal Surgery”, which she has been teaching since 2010. In the 2016/2017 academic year, Ms Unzueta taught and supervised a postgraduate programme in endoscopy at the University of Zaragoza. Besides her teaching roles, between 2008 and 2016 Amaia was the Deputy Director of the Small Animals Department at the University of Zaragoza Veterinary Hospital. Furthermore, she has published several articles in Spanish and international journals, coauthored the book Handbook of Radiographic Positions and Projections in Dogs, and collaborated on three books in the area of small animal surgery: The Caudal Abdomen, The Cranial Abdomen, and The Thorax.
Table of contents 1. General aspects
3. Thoracic limb
Angles and joints Characteristics of articular cartilage Structure Components Alterations Treatments for cartilage diseases and traumatic injuries
Ossification of the thoracic limb Ossification of the pelvic limb Characteristics of synovial joint Structure Synovial fluid Synovial fluid flow
2. Head and axial region Joints of the head Intermandibular symphysis Temporomandibular joint Clinical notes Arthrocentesis
Joints of the vertebral column Intervertebral joints Sacrum Coccygeal joints Intervertebral discs Atlanto-occipital joint Atlanto-axial joint Intrathecal puncture
Joints between vertebrae and ribs Costotranverse joints
Joints of the sternum Sternocostal joints Sternal joints
Joints Shoulder Arthrocentesis Elbow Dysplasia Clinical notes Arthrocentesis Luxations Carpus Arthrocentesis Metacarpophalangeal joints Arthrocentesis Joints of the manus Proximal interphalangeal joint Distal interphalangeal joint Arthrocentesis of the digit Vascularisation
Self-assessment
4. Pelvic limb Joints Hip Dysplasia Puncture for biopsy Luxation and subluxation Stifle The drawer test Arthrocentesis Tarsus Arthrocentesis The pes Metatarsophalangeal joints Joints of the digits
Self-assessment
Joints of the thoracic limb Costoscapular joint
Joints of the pelvic limb Sacroiliac joint
Self-assessment
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ATLAS OF CANINE ARTHROLOGY U P D AT E D E D ITIO N
JESÚS LABORDA VAL JULIO GIL GARCÍA MIGUEL GIMENO DOMÍNGUEZ JAVIER NUVIALA ORTÍN AMAIA UNZUETA GALARZA
3D
ANIMATIONS
GENERAL
ASPECTS
CHARACTERISTICS OF ARTICULAR CARTILAGE The articular surfaces, which are formed by cartilage over bone, serve to transfer forces from one bone to another, regardless of the dog’s position or the movement it makes (Fig. 1).
BIOMECHANICAL FORCES ACTING ON CHONDROCYTES
Stress loads
Shear loads
Compression loads
FIGURE 1. Biomechanical forces acting on chondrocytes.
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GENERAL
ASPECTS
STRUCTURE OF ARTICULAR CARTILAGE
Articular cartilage ranges from 1–6 mm thick, with thicker layers forming wherever it has to bear greater loads. Its structure and composition is such that it optimises the transfer of forces with minimal wear.
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1. Surface zone
Composed of flattened chondrocytes along with collagen fibres running parallel to the joint. 2. Intermediate zone Comprised of a less dense layer of oval chondrocytes.
3. Middle zone
Contains circular chondrocytes gathered into small groups. Aggrecan and type II collagen, which are arranged obliquely, are actively synthesised in this region. 4. Deep zone Comprises circular chondrocytes that tend to form columns. The type II
collagen is situated perpendicular to the joint. 5. Calcified zone Composed of flattened, elongated chondrocytes that produce type X collagen which is destined to become fibrocartilage that will absorb shocks together with the subchondral bone.
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GENERAL
ASPECTS
COMPONENTS OF ARTICULAR CARTILAGE Cartilage is hypocellular, avascular, and alymphatic.
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1. Synovial fluid
Synovial fluid is produced by synoviocytes. One of its main constituents is hyaluronic acid, which lubricates the articular surfaces thanks to its viscoelastic properties. Hyaluronic acid is in turn comprised of N-acetylglucosamine and glucuronic acid. 2. Extracellular matrix Represents 95 % of cartilage. Besides water (65–75 %), the extracellular matrix contains collagen, proteoglycans, and glycoproteins. ■ Type II collagen, a main component of cartilage, is a fibrillar protein that
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prevents ruptures when the cartilage is subject to a load. Proteoglycans are hydrophilic carbohydrates that endow cartilage with compressive strength. In hyaline cartilage, the main proteoglycan is aggrecan, which is formed from chondroitin sulphate and keratan sulphate. Other proteoglycans include decorin, biglycan, fibromodulin. Glycoproteins act as binding agents and link up with the other constituents of cartilage. Some of the most characteristic glycoproteins are the integrins, fibronectin, thrombospon-
din, and cartilage oligomeric matrix protein (COMP). 3. Cells Chondrocytes make up 5 % of cartilage. They are the cellular component of cartilage and maintain the structure of the extracellular matrix by producing collagen and proteoglycans. They bind to the extracellular matrix by means of glycoproteins such as integrins and take up position in lacunae. Chondrocytes are oxygenated by diffusion from the synovial fluid and obtain their energy from glycolysis (Cori cycle). Their anabolism and catabolism are regulated by growth factors and integrins. 4. Fibres These are mainly composed of collagen. Their composition and direction determines the cartilage’s resistance to different kinds of load. There are different types, each with a varying composition of collagen: ■ Type II collagen. This is the most abundant type, reaching up to 80 %. It provides resistance to repeat loads. ■ Type VI collagen. Does not exceed 5 %. Helps ensure adhesion to the chondrocytes. ■ Type IX collagen. Accounts for up to 15 %. Connects with proteoglycans. ■ Type X collagen. Up to 5 %. Serves to form three-dimensional networks in the calcified zone. ■ Type XI collagen. Reaches up to 15 %. Helps chondrocytes in the production of type II collagen. These are the most typical sorts of collagen found in cartilage; there are in fact up to 21 types in different parts of the body.
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GENERAL
ASPECTS
ALTERATIONS OF ARTICULAR CARTILAGE
Normal No observable deterioration.
Surface lesion The lesion reaches as far as the surface layer of articular cartilage.
Intermediate lesion The deterioration reaches the intermediate layer of articular cartilage.
Middle lesion The damage reaches the middle layer of articular cartilage.
Deep lesion The deterioration extends as far as the deep layer of articular cartilage.
Damage to the bone The lesion goes down to the subchondral bone.
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GENERAL
ASPECTS
ALTERATIONS OF ARTICULAR CARTILAGE
Details of some of the lesions
Microtraumas damage both the chondrocytes and the extracellular matrix, stimulating chondrocyte apoptosis, collagen degradation, and the loss of proteoglycans. They are painless lesions because these areas do not have any nerves. When a chondral fracture occurs, it elicits an inflammatory reaction that leads to rapid cartilage degeneration due to chondrocyte apoptosis. As chondrocytes do not migrate to the damaged areas, this process ultimately results in a loss of articular surface. Osteochondral fractures also involve damage to the subchondral bone, which triggers the typical inflammatory response accompanied by heat, redness, and pain.The original haematoma is replaced by fibrous tissue through bone marrow cell migration and an increase in growth factors. After around 6–8 weeks, the tissue repair produces an increase in the amount of chondrocytes, extracellular matrix, and proteoglycans; but there is also greater endochondral ossification, which does not have the same composition as normal cartilage because it incorporates more type I collagen fibres. After 12 months, the residual tissue resembles fibroblasts. The limited intrinsic healing capacity of traumatic and microtraumatic injuries is due to the fact that chondrocytes in the nearby cartilage cannot migrate to the injury site and produce a new matrix which would facilitate regeneration or repair. Finally, this is followed by continuous deterioration of the surrounding cartilage through a combination of mechanical wear and enzymatic degradation and eventually osteoarthritis.
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1. Cartilage degeneration and fracture 2. Chondral fracture 3. Inflammatory reaction 4. Subchondral bone damage
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GENERAL
TREATMENTS FOR CARTILAGE DISEASES
ASPECTS
Autologous osteochondral graft transplants consist of harvesting cylindrical osteochondral grafts from other areas subject to lower loads and implanting them in the damaged area. These procedures give better outcomes with lesions measuring 2–3 cm². Allogenic osteochondral grafts use autologous chondrocytes isolated from small cartilage biopsies and cultivated in a laboratory. These are then implanted in the injured area, under a flap of periosteum sutured to the margins of the area being repaired. This technique stimulates cartilage healing. The lack of a meniscus following a partial or total meniscectomy must be resolved by means of a partial meniscus replacement or a meniscal allograft transplantation, often using a two-step procedure.
AND TRAUMATIC INJURIES
The aim of current and future treatments is to restore synovial joint function by regenerating or repairing the cartilage found at the damaged surface. Bone marrow stimulation techniques, such as microfracture or abrasion arthroplasty, are modifications of the Pridie drilling method. Pridie drilling is based on the perforation and superficial abrasion of the subchondral bone plate. This induces blood loss and causes fibroblasts and mesenchymal stem cells to invade the damaged area under repair where they primarily develop into a fibrous tissue. Current and future therapeutic indications
Details of the experimental procedures ■ Chondroitin sulphate reduces the loss of articular cartilage and mitigates damage to the subchondral bone. Both chondroitin sulphate and glucosamine can be absorbed via the digestive tract. ■ Glucocorticoids, however, have been administered parenterally, but their effects are limited and short-lived. In fact they act by restricting chondrocyte proliferation and the synthesis of extracellular matrix, including collagen and proteoglycans. Paracetamol (an NSAID) has not demonstrated a chondroprotective effect. ■ Extracellular matrix metalloproteinase (MMP) inhibitors are zinc dependent. ■ Growth factors possess an intense anabolic effect. ■ Cytokine inhibitors are still being studied but they have shown promising results. ■ Articular cartilage replacements and implants are also at the experimental stage. ■ The extracellular matrix is replaced by carbon fibres or polymers. These are implanted along with cells and/or growth factors.
Several techniques are often combined, including some of the following: ■ Surgical and arthroscopic procedures. ■ Experimental procedures. ■ Intrinsic repair with local mesenchymal cells. ■ Cell therapy. ■ Isolated cells: autologous chondrocyte implantation (ACI). ■ Collagen-covered autologous chondrocyte implantation (CACI). ■ Matrix-induced autologous chondrocyte implantation (MACI). ■ Tissue engineering. Surgical procedures Current surgical procedures can be categorised as follows: ■ Repair techniques. ■ Arthroscopic debridement. ■ Subchondral bone microfracture. ■ Replacement techniques. ■ Osteochondral grafts. ■ Osteochondral allografts. ■ Transcondylar bone graft. ■ Synthetic cylinders. ■ Coating osteochondral defects with a prosthetic material.
The best results for osteochondral graft transplants are obtained with lesions measuring 2-3 cm².
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JOINTS
OF THE TRUNK
JOINTS OF THE THORACIC LIMB JOINTS
Rhomboid muscle
Costoscapular joint, or thoracic girdle
Muscular synsarcosis.
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A synsarcosis is a special type of joint in which the bones involved (scapula with ribs and thoracic vertebrae) are connected by muscles: - Rhomboids - Trapezius
Trapezius muscle
- Ventral serratus
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- Pectoralis The axillary fossa is the space delimited by these muscles.
OSTEOLOGY
1 Scapula. 2 Ribs. 3 Thoracic vertebrae. 4 Axillary fossa.
GEOMETRY AND MOVEMENTS
M. serratus ventralis
Pectoral muscles
Extension
Flexion
The medial surface of the scapula slides over the lateral surface of the ribs, allowing flexion and extension movements of the thoracic limb.
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JOINTS
BETWEEN VERTEBRAE AND OTHER BONES
Lateral positioning
Latero-lateral radiograph 2
Caudal-cranial positioning
3
Caudal-cranial radiograph
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The brachial plexus is found in the axillary fossa, from where it must be accessed for blockage with anaesthesia. For this, the cranial border of the scapula covered by the supraspinal muscle is used as a reference. Palpation of the greater tubercle of the humerus serves as a guide (the dorsal border of the m. cleidocervicalis is used as a complementary reference). The needle is introduced parallel to the ribs.
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JOINTS
OF THE TRUNK
JOINTS OF THE PELVIC LIMB JOINTS
Sacroiliac joint, or pelvic girdle
Synovial and cartilaginous.
GEOMETRY AND MOVEMENTS
Flat with roughened surfaces to impede slide. Movements are very limited. In old dogs this is a synostosis (fusion of the bones).
Dorsal sacroiliac ligament
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OSTEOLOGY 1 Ilium. 2 Sacrum.
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TYPES OF JOINTS Planar
Ventral sacroiliac ligament
Articular facet of the ilium
Articular facet of the sacrum
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JOINTS
BETWEEN VERTEBRAE AND OTHER BONES
Ventrodorsal positioning
The two coxales are joined by means of the pelvic symphysis which ossifies in the dog in a caudocranial direction. Ossification reaches approximately the caudal third of the symphysis. The cranial two thirds remain joined by fibrocartilaginous tissue.
Ventrodorsal radiograph DOWNLOAD THE SELF-ASSESSMENT TEST FOR THIS CHAPTER
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