71. arthroscopy

Question 1

how are arthroscopes described

Answer 1

1. diameter (1.9, 2.3, 2.7)2. length (short 8 cm, long 12.5 cm)3. lens angle (0, 30, 70 degrees)

Question 2

bending of the athroscopic shows up as how on the field of view

Answer 2

black crescent at the periphery of the field of view or migration of the arthroscopic image across the monitor screen

Question 3

advantage of high definition cameras

Answer 3

more pixel lines per screensharper image

Question 4

3 chip camera

Answer 4

1. zoom2. white balance3. image captureusually clip on, but also direct coupling systems

Question 5

what resolution setting is recommended for arthroscopy

Answer 5

high horizontal resolution

Question 6

light sources for arthroscopy

Answer 6

1. Halogen–more yellow color2. Xenon–MOST COMMON, increased light intensity and higher color temperature with greater visual clarity and color rendition

Question 7

T/F fiberoptic light cables heat up significantly and should NOT be placed directly against the patient

Answer 7

TRUEmay cause thermal injury if too close to the patient

Question 8

benefits and optimal irrigation pressure for arthroscopy

Answer 8

1. increases field of vision2. removes debris3. distends/expands jointSaline or LRS (no diff but LRS may be more physiologic)60 mm Hgdelivered with gravity flow or fluid pump (better when using shaver)

Question 9

a 30 degree arthroscope allows for the equivalent of how many degrees of view

Answer 9

60 degrees

Question 10

how to obtain a higher flow rate with gravity fluid pumping

Answer 10

–increase diameter of tubing–elevation of the bad 8-9 feet –using a pressure bag–3-5 L bags– Y adapters

Question 11

T/Fflexion of a distended joint will increase intraarticular pressure

Answer 11

TRUE

Question 12

what is the major advantage of working through a cannula

Answer 12

ease of instrument insertion

Question 13

what is the most common reason for failing to locate the appropriate instrument portal site

Answer 13

entering the skin at too oblique of an angle and crossing over the arthroscopeor having the arthroscope too close

Question 14

Where is the typical location of the scope portal for stifle arthroscopy

Answer 14

SCOPE portal LATERALLY (parapatellar)INSTRUMENT portal MEDIALLY (parapatellar)egress is advanced under the patellar tendon

Question 15

the absence of articular carriage at the center of the trochlear notch is indicative of what

Answer 15

NORMAL–frequent finding in normal joints

Question 16

According to Jardel VCOT 2010 what is the approximate relationship btwn a typical arthroscopic portal, instrument portal, and egress portal to pertinent neuro vascular structures on the medial elbow

Answer 16

SCOPE: 23.1 mm caudal to brachial artery, 21 mm caudal to median nerve, 4 mm cranial to ulnar nerveINSTRUMENT: 16.3 mm caudal to brachial artery ,13.5 mm caudal to median nerve, 12 mm cranial to ulnar nerveEGRESS: 21.4 mm caudal to ulnar nerve

Question 17

according to Werner VCOT 2009 what is the SN and SP of arthroscopy for estimating RUI in dogs

Answer 17

SN 98%SP 89%

Question 18

what is triangulation

Answer 18

instrumentation of the joint such that the instrument and the scope angle together to form the apex of a triangle

Question 19

indications of shoulder arthroscopy

Answer 19

–OC/OCD fragment removal and/or debridement–disease of biceps brachia tendon–assess OA–synovial bx —synovial culture and lavage

Question 20

lateral shoulder arthroscopy portals for OCD

Answer 20

1. camera portal: craniodistal to acromion2. instrument portal: caudally in triangulation with scope 2 cm caudal to acromion3. egress: directed craniocaudal and medially at the level of the greater tubercleaxillary artery and nerve caudallysuprascapular artery and nerve cranially

Question 21

lateral shoulder arthroscopy portals for biceps brachii tendon

Answer 21

1. camera portal: craniodistal to acromion further caudal than with OCD lesion2. instrument portal: cranially in triangulation with scope 2 cm cranial to acromion can be medial to biceps brachia3. egress: caudally to acromionaxillary artery and nerve caudallysuprascapular artery and nerve cranially

Question 22

surgical anatomy to view in shoulder arthroscopy

Answer 22

MCL (medial glenohumeral lig Y)Subscapularis tendonbiceps brachii tendon (has normal labrum or fibrous cuff)Glenoidsupraglenoid tuberclehumeral headcaudal joint pouchjoint capsule

Question 23

medial elbow joint portals

Answer 23

camera: distocaudal to medial epicondyleegress: palpate olecranon process and insert needle on the medial side of process instrument: cranially to triangulate with scopeulnar nerve btwn egress and cameramedian artery and nerve cranially

Question 24

hip arthroscopic portals

Answer 24

camera: perpendicular to limb just dorsal to greater trochanteregress: right hip 3 o’clock to greater trochanter 5 o’clock if left hipcaution ischiatic/sciatic nerve and caudal gluteal artery caudallyvisualize: round ligament, femoral head, acetabulum/acetabular labrum, transacetabular ligament

Question 25

stifle arthroscopy

Answer 25

2.7 mm 30 degree short arthroscopeneed shaver for infra patellar fat pad (with aggressive cutter) on oscillation modestifle distractorsvarious knifes