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Sesamoid: disease
Synonym(s): Sesamoiditis, Sesamoid degeneration
Introduction
- Cause: chronic inflammation of the sesamoid bones.
- Cause of lameness and incidental finding in the racing greyhound.
- Lameness in large pet breeds, eg Rottweiler.
- Signs: often an insidious onset, progressive forelimb lameness in young dogs, or can also be acute onset lameness in adults.
- Diagnosis: clinical signs and radiography.
- Treatment: conservative, or surgical removal of sesamoids.
- Prognosis: guarded for resolution.
Presenting signs
- Lameness (usually in the forelimbs) Lameness: general - investigation Lameness: forelimb - investigation.
- Pain on flexion of metacarpo-phalangeal joints.
- Reduced range of motion.
- Joint swelling/effusion in acute stage; fibrosis and degenerative joint disease in later stage.
Age predisposition
- Young growing dogs (3-4 months) but may present at any age.
Breed/Species predisposition
- Large breed, eg Rottweiler Rottweiler.
- Racing Greyhounds Greyhound.
Cost considerations
- Often require chronic conservative management.
Pathogenesis
Etiology
- Lytic lesions possible manifestation of osteochondrosis Osteochondrosis.
- Inflammatory changes seen with enthesiophyte formation, possible traumatic etiology.
- Degenerative secondary changes may be present in the metacarpo-phalangeal joint.
Pathophysiology
- Fragmentation of the sesamoid bone may be result of abnormal endochondral ossification, ie a manifestation of osteochondrosis.
- Multiple exostoses within the soft tissue attachments of the sesamoid may have a traumatic etiology.
- There may be calcification around the sesamoid bones or osteophytosis around the metacarpo-phalangeal joint.
- These changes may be secondary to joint trauma or instability.
- Repeated stress on palmar surface of sesamoids by digital flexor tendons during hyperextension of metacarpo-phalangeal joints may → fatigue fractures and degeneration of the underlying bone and soft tissues.
- Digits 2 and 5: flexor tendon pressure solely on inner sesamoids 2 and 7.
- Digits 2 and 5: metacarpal bones are asymmetrical so axial condyle bears more load.
- Histologically see bone fracture and necrosis supporting vascular compromise theory.
Timecourse
- Slow, progressive lameness seen over weeks to months in the young dog.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Harasen G (2009) Sesamoid disease. Can Vet J 50 (10), 1095 PubMed.
- Daniel A, Read R A & Cake M A (2008) Vascular foramina of the metacarpophalangeal sesamoid bones of Greyhounds and their relationship to sesamoid disease. Am J Vet Res 69 (6), 716-721 PubMed.
- Matthews K G, Koblick P D, Whitehair J G & Bradley C (2001) Fragmented palmar metacarpo-phalangeal sesamoids in dogs: a long-term evaluation. Vet Comp Ortho Traumatol 14 (1), 7-14 UCDavis.
- Vaughan L C & France C (1986) Abnormalities of the volar and plantar sesamoid bones in Rottweilers. JSAP 27 (9), 551-8 VetMedResource.
- Bennett D & Kelly D F (1985) Sesamoid disease as a cause of lameness in young dogs. JSAP 26 (10), 567-79 VetMedResource.
- Bateman J K (1959) Fractured sesamoids in the greyhound. Vet Rec 71, 101.
Other sources of information
- Robins G M & Read R A (1998)diseases of the sesamoid bones.In:Canine Sports Medicine and Surgery.Bloomberg M S, Dee J F & Taylor R A (eds) W B Saunders Company, Philadelphia, pp 255-264.
- Robins G M & Read R A (1993)diseases of the sesamoid bones.In:Disease mechanisms in small animal surgery.2nd edn. pp 1094.