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Veterinary Arthroscopy for the Small
Animal Practitioner
Veterinary Arthroscopy for the Small
Animal Practitioner
Edited By
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any
means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to
reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Timothy C. McCarthy to be identified as the author of this work has been asserted in accordance with law.
Registered Office
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
Editorial Office
111 River Street, Hoboken, NJ 07030, USA
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print
versions of this book may not be available in other formats.
10 9 8 7 6 5 4 3 2 1
I dedicate this book to all my patients.
Without their participation, this would not have been possible
vii
Contents
Preface xi
Acknowledgments xiii
About the Companion Website xiv
2 General Technique 23
2.1 Anesthesia, Patient Support, and Pain Management 23
2.2 Postoperative Care 23
2.3 Patient Preparation, Positioning, and Operating Room Setup 24
2.3.1 Shoulder Joint 24
2.3.2 Elbow Joint 26
2.3.3 Radiocarpal Joint 28
2.3.4 Hip Joint 29
2.3.5 Stifle Joint 29
2.3.6 Tibiotarsal Joint 31
2.4 Portal Placement-General 31
References 34
viii Contents
3 Shoulder Joint 36
3.1 Patient Preparation, Positioning, and Operating Room Setup 36
3.2 Portal Sites and Portal Placement 37
3.2.1 Telescope Portals 37
3.2.2 Operative Portals 39
3.2.3 Egress Portals 40
3.3 Nerves of Concern with Shoulder Joint Arthroscopy 40
3.4 Examination Protocol and Normal Arthroscopic Anatomy 41
3.5 Diseases of the Shoulder Diagnosed and Managed with Arthroscopy 47
3.5.1 Osteochondritis Dissecans (OCD) 47
3.5.1.1 OCD Lesion Removal and Management 59
3.5.2 Bicipital Tendon Injuries 73
3.5.3 Soft Tissue Injuries of the Shoulder with or Without Shoulder Instability 81
3.5.4 Ununited Caudal Glenoid Ossification Center (UCGOC) 95
3.5.5 Ununited Supraglenoid Tubercle (USGT) 100
3.5.6 Arthroscopic-Assisted Intra-Articular Fracture Repair 100
3.5.7 Arthroscopic Biopsy of Intra-Articular Neoplasia 101
3.5.8 Glenoid Cartilage Defects 102
3.5.9 Chondromalacia 104
3.5.10 Infraspinatus Muscle Contracture 104
References 106
Index 305
xi
Preface
While writing this book, my 50 year anniversary of grad- interviewed with the head of the program and, during
uation from Veterinary School occurred. Fifty years! the interview, it was obvious that if I applied for the
This has been an incredible journey! Beyond my wildest masters degree program there was no chance that I
dreams. I never thought that I would be where I am would be accepted but if I applied for the PhD program
today and would have done the things that I have done. I was guaranteed to be accepted. Interesting but it
I never dreamed that the first edition of this book would worked. Six years later I passed the ACVS examination
be translated into Russian or that I would be invited to and became a board-certified surgeon and, in a few
Russia to launch its sale and teach Russian Veterinarians. years later, won my PhD. ACVS recently initiated fel-
I never dreamed that I would travel to teach in 14 coun- lowship training in minimally invasive surgery, and I
tries and 23 states. That I would publish books about my was selected as a founding fellow in this program for
professional work. both small animal soft tissue surgery and small animal
It is amazing that I was even able to become a orthopedics, the only veterinarian to qualify for both
Veterinarian. I am so dyslexic that I struggled to learn to categories.
read. When I started the fifth grade, I was reading at a At my 25 year class reunion, I was informed that at a
second grade level. Spelling was impossible. In the third previous time I had been unanimously selected as the
grade, I was able to get 49 out of 50 words WRONG on a classmate least likely to go back to school AND they
review spelling test even after spending uncountable were “Stunned” that I was board certified. My reply was
hours with my parents trying to learn spelling using that no one is more stunned than I.
flash cards. People with really bad handwriting are Getting into endoscopy happened totally by chance. I
probably dyslexic and with really bad handwriting no got a call from a local veterinarian asking if I wanted to
one can tell how the word was spelled. I think that I got buy a used gastroscope that he had. As a surgeon, I had
into Veterinary School with the lowest grades in the his- never really thought about doing GI endoscopy but
tory of Veterinary Medicine, but Baxter Black and I thought, “hey why not” since no one in the area was
debate who’s was worst. If it were not for Dr. Don Bailey, providing this service. I did not buy that endoscope but
I would not have been accepted. He worked for Dr. bought another one that was in better shape for $550
Davis, who was head of the admission committee when with a light source and all the instruments that I needed.
I applied, all through Veterinary School and graduated A little later, I bought a laparoscope to do liver biopsies
at the top of this class. I managed to not flunk out and and then an arthroscope. I never thought that I would
graduated at the bottom of the class, again Baxter Black pay for this equipment, but I thought it would be fun, I
and I argue about who was really “last in class.” And might be able to practice better medicine, and I could
they call the person who graduates last in class “Dr.” afford the expense.
It was obvious in my first job out of school that I I started putting endoscopes everywhere and added to
wanted to do surgery. Residency programs for advanced the list of procedures that could be performed by trying
training were a new entity 50 years ago and they were new things on my patients. Many of the endoscopic first
few and far between. Then how does someone with ever procedures were performed on patients with clini-
grades barely above 2.0 get into a residency program? cal problems. Using the axiom of “Above all do no
NOT! I finally thought that I needed to try CSU, my harm” and combining endoscopy with transition to tra-
“amalater.” They did not have a residency program, but ditional approaches, there were an unbelievingly low
there was the graduate program at the Surgery Lab. I number of problems or complications. Very few firsts
xii Preface
were planned or thought about ahead of time and many with my first Psychologist, I unloaded everything that
were spur of the moment events added to an already was bothering me, things that I never thought I would
ongoing procedure or immediately before surgery by ever tell anyone, at the end of the session she said that I
asking the question, can I do this with a scope? In cases saved about nine months of therapy because I was ready
where the question was asked before surgery the discus- and she did not have to spend that time breaking down
sion with the client was, I would like to try this with my resistance. We went from there. I am a much happier
minimally invasive technique, I have never done this person, I have eliminated my anger issues, and I am
before or this has never been done before, if I cannot do much more resilient to the stresses in life.
this with minimally invasive technique I will do it the Early in this saga, I made the statement in my lec-
traditional old way, and the cost will by the same how tures: “Endoscopy is a quantum leap forward in our
matter how it gets done. I never had a client say no to diagnostic and therapeutic armamentarium.” This was
this plan. Sure, I had to eat some of the cost on many and still is true. Now I say “A patient comes into every
early cases, but this is the easiest, most effective, cheap- veterinary practice every day who would benefit from a
est continuing education I have ever gotten and has minimally invasive procedure” This is also true or when
benefitted the patients, clients, my practice, my happi- I get pushy: “Every patient who comes into every veteri-
ness, plus my pocketbook thousands of times over the nary practice every day would benefit from a minimally
cost. Sixty endoscopes and over 7000 procedures later I invasive procedure” and this is almost true.
am writing the second edition of this book. Enjoy your endoscopes. They are the best burnout
I know that I am different and do not follow the book. protection that you can buy.
I am so dyslexic that I cannot read about what I am not
supposed to be able to do. I also never learned to come
in out of the rain because my mother took me out in the
rain. In the first grade, when we had art class all the
class got coloring books, but the teacher did not give me
one. Being a typical first grader, I was devastated and
did not understand why I did not get a coloring book.
The teacher then brought me a large blank piece of
paper and told me that my mother did not want me to
have a coloring book but wanted me to make my own
drawings. So, I never learned to color between the lines.
In fact, I never learned that there were lines. When
someone says something about thinking outside the box
my question is, what is a box?
As I said at the beginning, my career has been an
incredible journey. But it has not all been easy or fun.
There have been times of miserable struggle. I belong to
the face book group; “Not one more vet,” because I am a
suicide survivor. Twice in my life I have been at the edge.
Fortunately, I never acted on my thoughts of suicide and
am here to tell about the experience. If I can get through
this so can you. I looked for and got help from my friends
and great help from some great Psychologists. I also have
to admit that I am really stubborn and wasn’t going to let
the b’s win. If you are in trouble, get help! Working with
a psychologist has changed my life. It does not mean that
if you see a Psychologist that there is something wrong
with you. Get over this mental block. Unburden yourself
to them, that is what they are there for. At my first visit
xiii
Acknowledgments
This work would not have been accomplished without a great number of people and animals who collectively made
this possible. I simply put it to paper.
First to my parents for bringing me into this world and for their unending support, encouragement, and love.
To Dr. Don and Betty Bailey for introducing me to Veterinary Medicine, for getting me into Veterinary School, and
for their continued support throughout my career.
To all my teachers and professors, from my first-grade teacher Mrs. Mathews, through high school and college for
their efforts to educate and stimulate me but especially to Drs Jim Creed, Glenn Severin, Pat Chase, Harry Gorman,
and Henry Swan.
To my colleagues who referred the cases that provided me with the material for learning these techniques. And to
the clients who entrusted me with their beloved pets.
To Dr. Karl Storz, his daughter Ms. Sible Storz, and his grandson Mr. Karl-Christian Storz for their interest in
Veterinary Medicine and support of our profession. To all the staff of the Veterinary Division of the Karl Storz
Endoscope Company for their educational endeavors and instrumentation development for our profession. Especially
to Dr. Christopher Chamness for his support, encouragement, and friendship.
To all the younger veterinarians who have picked up the reins and are driving all aspects of endoscopy forward at
an ever-increasing rate. I am thrilled that I now only see smoke and taillights. This is a thrill to watch.
And most importantly, to my wife and son for their patience and for allowing me the time to complete this
project.
Other documents randomly have
different content
que á la impotencia: y comensant pel sistema representatiu, tan bon
punt com se va evidenciar sa ineficacia, van transformarlo en
régimen parlamentari, ab tan dolent éxit, que avuy per avuy pesa
damunt d’un y altre lo més complet descrédit, no per llurs culpas
sinó per las dels que s’han empenyat en ferne instruments de
imposició. Las nacions grans d’Europa viuhen constantment en
plena crisis política, agravada fins á un extrem alarmador per l’estat
ruinós en que totas tenen la hisenda pública.
Las duas escolas, en tots llurs matisos, s’han deixat encegar tant per
la corrent de uniformitat, que ni han sapigut veure lo que passava en
alguns pochs Estats, que per llur fortuna havian seguit la corrent
contraria. Pera ellas, ha sigut en va que’ls Estats Units d’América
hagin trobat en lo sistema particularista la solució que’s busca
inutilment dins del unitarisme, y en va ha sigut també que en lo
meteix cor d’Europa algunas petitas agrupacions hagin obtingut
iguals ventatjas pel meteix camí que la Unió americana. L’afany de
concentració y’l prejudici de que la unitat dels Estats exigeix la
destrucció de totas las varietats organisadas, són pera una y altra
escola lligaduras que no las deixan sortir del cércol en que s’han
tancat. Llurs ensaigs y probas no poden ferse sinó baix la base del
Estat simple. La idea del Estat compost, ó format per medi de la
agrupació d’Estats simples, es pera’ls polítichs d’Europa tan
disbaratada, que ni los honors de la discussió li concedeixen. Los
tractadistas de dret públich acostuman dedicar al sistema federatiu
sols unas pocas ratllas, com d’almoyna, en las quals se transparenta
sempre lo menyspreu y compassió ab que’l miran.
Y mal que pesi als tractadistas y polítichs d’Europa, aqueix sistema es
l’únich que pót resoldre’ls problemas davant dels quals ells s’han vist
impotents. Teórica y practicament, l’Estat compost es l’únich que
equilibra tots los interessos, armonisa la llibertat y la igualtat, é
impulsa als pobles cap al progrés y la millora.
Suposem que’ls nostres lectors voldrán saber quinas son las rahons
de oportunitat y conveniencia que’ns obligan á adoptar pera las
nostras aspiracions un qualificatiu menys precís y propi que altres
que podriam emplear, y’ns sembla ja sentir que’ns diuhen: “Si desde
l’Estat unitari, ó sigui d’aquell que te’l poder concentrat, fins á la
independencia completa dels varis trossos ó regions que’l forman, no
hi ha més que federalisme; si la forma federal es la única que pot
pendre’l particularisme regionalista quan no arriva á la separació,
¿per qué no hem de usar lo nom que técnicament expressa la nostra
idea? Perque hem d’amagarnos de dir lo que som á tothom que
vulgui saberho?”
“Faties, non omnibus una, Nee diversa tamen, qualem decet esse
sororum.”
Per poch que’s reflexioni, apareixerá clar, que totas las ventatjas que
havem indicat son fillas de la conformitat de la organisació
particularista ab las ensenyansas de la naturalesa. Aspirant, no á la
uniformitat, sinó á la unió, emplea los medis que portan á aquesta, y
rebutja los que poden produhir aquella. No cerca res per la
imposició, y ho espera tot de l’associació. Essent lo contrari del
sistema de opressió, que segons gráfica expressió de Herbert
Spencer, surt del militarisme, sa forsa principal es l’industrialisme, y
fugint del régimen de cooperació forsada, que va acompanyat de la
desigualtat de classes, tendeix á la cooperació voluntaria basada en
llur igualtat legal.
Per lo dit se pot veure ben clar quina ha de ser la situació dels
particularistas dins del ordre general de ideas que uneix als que de
més distinta manera pensan en altras materias. Ningú de nosaltres té
d’abdicar de las que millor li semblin pera’l bé del pays, com no
abdica de cap de las sevas lo qui milita en qualsevol dels cent y un
matisos del unitarisme. No sóls no te d’abdicar d’ellas, sino que’l
deber seu es lo de propagarlas y fer prossélits. Lo que hi ha, es que té
de considerarse com formant part d’una meteixa familia ab tots los
que aspiran á la nova organisació del Estat, ni més ni menys que’n
forman també una sola los unitaristas. Aixis com aquestos, pensin
com vulguin en altras materias, se troban més aprop dels que tenen
lo matís més oposat que dels particularistas que en altras materias
pensan com ells, aixis també nosaltres hem de trobarnos més aprop
dels que participan del nostre ordre general de ideas, sigui lo que
sigui llur matís, que no pas dels unitaristas que en altras qüestions
coincideixen ab los nostres punts de vista.
D’aquí prové que entre nosaltres poguem entendrens los que més
separats sembla que’ns trobem, veyent moltas vegadas ab sorpresa
que coincidim en apreciacions y desitjos; cosa que no pot succehir
jamay als unificadors. Mes, si’l fet nos sorprén, no es pas perque no
sigui llógich; es perqué estem acostumats á mirar las cosas á través
del prisma unitarista. La llibertat es una aspiració natural al home, es
un sentiment general. ¿Qué té d’estrany, donchs, que la llibertat nos
uneixi?
Y lo meteix podriam dir del poder judicial que ha d’aplicar las lleys
que obligan als membres de tots los Estats associats. Lo meteix pot
estar representat per tribunals de dret responsables, que per jurats
que resolguin segons llur conciencia, sens deure compte á cap poder