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Sesamoid Bone in the Tendon of the Supinator Muscle of Dogs: Incidence and Comparison of Radiographic and Computed Tomographic Features

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Sesamoid Bone in the Tendon of the Supinator Muscle of Dogs: Incidence and Comparison of Radiographic and Computed Tomographic Features Sesamoid bone in the tendon of the supinator muscle of dogs: incidence and comparison of radiographic and computed tomographic features Word count: 8473 Manon Dorny Student number: 01609678 Supervisor: Dr. Ingrid Gielen Supervisor: Prof. dr. Wim Van Den Broeck Supervisor: Dr. Aquilino Villamonte Chevalier A dissertation submitted to Ghent University in partial fulfilment of the requirements for the degree of Master of Veterinary Medicine Academic year: 2018 - 2019 Ghent University, its employees and/or students, give no warranty that the information provided in this thesis is accurate or exhaustive, nor that the content of this thesis will not constitute or result in any infringement of third-party rights. Ghent University, its employees and/or students do not accept any liability or responsibility for any use which may be made of the content or information given in the thesis, nor for any reliance which may be placed on any advice or information provided in this thesis. ACKNOWLEDGEMENTS I would like to thank the people that helped me accomplish this thesis and helped me achieve my degree in veterinary science. First of all I would like to thank Dr. Ingrid Gielen, Dr. Aquilino Villamonte Chevalier and Prof. Dr. Wim Van Den Broeck. I thank them all for their time spend in helping me with my research, their useful advice and their endless patience. Without their help, I wouldn’t have been able to accomplish this thesis. Next I would like to thank my family and friends for their continuing support and motivation during the last years of vet school. My parents and partner especially, for all the mental breakdowns they had to endure in periods of exams and deadlines. Thank you to my dad and father in law for proofreading this study and helping me improve my English writing skills. Last I would like to thank my sister who was studying veterinary science with me. It was a tough few years, we laughed together, cried together, but in the end we made it together. TABLE OF CONTENT FRONT PAGE CLAUSE ACKNOWLEDGEMENTS TABLE OF CONTENT SUMMARY...................................................................................................................................... 5 1. Introduction.................................................................................................................................... 7 1.1. Anatomy of the elbow.................................................................................................. 7 1.2. Elbow dysplasia........................................................................................................... 10 Medial coronoid disease................................................................................ 10 Osteochondrosis of the medial humeral condyle........................................... 10 Ununited anconeal process............................................................................ 11 Elbow incongruity........................................................................................... 12 Incomplete ossification of the humeral condyles........................................... 12 1.3. Sesamoid bones.......................................................................................................... 12 2. Problem and aims......................................................................................................................... 14 3. Material and method.................................................................................................................... 14 4. Results........................................................................................................................................... 15 5. Discussion..................................................................................................................................... 16 6. Conclusion..................................................................................................................................... 19 APPENDIX..................................................................................................................................... 20 REFERENCES.................................................................................................................................. 21 Summary Sesamoid bones are present in different tendons and muscles. They develop in spots with pressure or friction. This study focuses on the sesamoid bone in the supinator muscle of the dog. The supinator muscle originates on the lateral collateral ligament of the elbow and the lateral epicondyle of the humerus. Sometimes this muscle contains a sesamoid bone in its origin. This sesamoid bone is located craniolateral of the head of the radius and occasionally they articulate. Sesamoid bones can be important in diagnosing elbow dysplasia, as they can be confused for a fragment of, for example, the medial coronoid process. In this study X-rays and CT scans of 100 dogs were scored by 3 observers with different degrees of experience. A scoring sheet was made to assess the elbows for a sesamoid bone and elbow dysplasia. The incidence of the presence of a sesamoid bone was evaluated on X-ray and CT. Interobserver statistics were performed using the Cohen’s Kappa statistics and the association between the sesamoid bone and elbow dysplasia was assessed using Chi square statistics. On X-ray the incidence of a sesamoid was an average of 8,33% of the dogs. In 43,52% of these dogs a bilateral sesamoid bone was observed. On CT a sesamoid was found in 26% of the dogs. In 76,92% of these dogs a bilateral sesamoid bone was observed. An average of 72% of the sesamoid bones were missed on X-ray. The sesamoid bone was round to oval shaped with a diameter of 0,5-6,56 mm x 0,5- 6,2 mm. The Kappa value for X-ray was 0,6910 (substantial agreement) and for CT 1,00 (perfect agreement). There was a weak positive association between elbow dysplasia and appearance of a sesamoid bone in the supinator muscle (χ2 = 9,1474; p = 0,002491). CT is clearly superior to X-ray for assessing this sesamoid bone. For assessing the X-rays experience is important, but for CT it made no difference in this study. There is an association between elbow dysplasia and the appearance of a sesamoid bone, but further research is needed to assess this correlation. Samenvatting Sesambeenderen komen voor op verschillende plaatsen in het lichaam. Ze ontstaan op plaatsen waar er druk of wrijving wordt uitgeoefend. In dit onderzoek wordt de focus gelegd op het sesambeen in de musculus supinator ter hoogte van het ellebooggewricht van de hond. In de aanhechting van deze spier op de laterale collateraalband van de elleboog en de laterale epicondyl van de humerus bevindt zich bij sommige honden een sesambeen. Dit sesambeen bevindt zich craniolateraal van het hoofd van de radius en articuleert hier soms mee. Sesamsbeenderen kunnen belangrijk zijn, aangezien ze verward kunnen worden met een fragment van bijvoorbeeld de mediale processus coronoideus. In dit onderzoek werden radiografieën en CT scans van de ellebogen van 100 honden bekeken door 3 onderzoekers met verschillend niveau van expertise. Een scoreblad werd ingevuld m.b.t. aanwezigheid van het sesambeen en elleboog dysplasie. Er werd nagegaan in hoeveel percent van de honden een dergelijk sesambeen voorkwam op RX en CT. Interobserver statistiek werd toegepast a.d.h.v. Cohen’s Kappa statistiek. Daarnaast heeft men ook gekeken naar aanwezigheid van elleboog dysplasie en of er een verband was met aanwezigheid van het sesambeen (χ2 statistiek). Bij gemiddeld 8,33% van de honden werd een sesambeen gevonden op RX. Gemiddeld 43,52% van deze honden had bilateraal een sesambeen. Op CT werd in 26% van de honden een sesambeen gevonden. Daar hadden 76,92% van de honden bilateraal een sesambeen. Er werden gemiddeld 72% van de sesambeenderen gemist op RX. het sesambeen was rond tot ovaal van vorm met een diameter van 0,5-6,56mm x 0,5-6,2mm. De Kappa waarde voor RX was 0,6910 (voldoende tot goede 5 overeenstemming) en voor CT 1,00 (perfecte overeenstemming). Er bleek een zwakke positieve associatie tussen aanwezigheid van het sesambeen en aanwezigheid van elleboog dysplasie (χ2 = 9,1474; p = 0,002491). CT is dus duidelijk superieur t.o.v. RX om dit sesambeen te beoordelen. Op RX is ervaring een pluspunt om dit sesambeen te kunnen onderscheiden, maar op CT is er geen onderscheid op vlak van ervaring. het sesambeen is gecorreleerd met aanwezigheid van elleboog dysplasie, maar verder onderzoek is nodig om deze correlatie te beoordelen. 6 1. Introduction 1.1. Anatomy of the elbow The elbow is a joint consisting of 3 bones, the humerus, the radius and the ulna (Fig 1). The humerus is a long bone that ends distally in the humeral condyle. The humeral condyle consists of two parts, the medial trochlea humeri and the lateral capitulum humeri. The capitulum humeri articulates with the head of the radius. The trochlea humeri articulates with the trochlear notch of the ulna and a portion of the fovea of the radius. Caudally on the humeral condyle the olecranon fossa is located. This is the fossa fitted for the olecranon of the ulna when the leg is in extension. On the cranial side of the humeral condyle is the radial fossa. The head of the radius fits in that fossa when the elbow is in flexion. Both of these fossae communicate with each other through the foramen supratrochleare. On the medial and the lateral side of the humeral condyles are the epicondyles. These structures are mainly insertion points for different muscles and ligaments. The radius is also
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