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224 Cards in this Set
- Front
- Back
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Osteochondrosis most commonly affects what joints of the forelimb?
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Shoulder, elbow, fetlock, pastern bone cyst
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Ostochondrosis most commonly affects what joints of the hind limbs?
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Stifle - QH
Hock - TB, and WB Fetlock proximal to P1 |
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What is the most common source of lameness in the horse?
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The foot
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Quarter horses and Thoroughbreds most commonly have?
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Navicular disease
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Ponies, arabians, and draft horses rarely have
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Navicular disease
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Paso Fino's typically injure their?
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suspensory ligament
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Minature horses and ponies typically injure?
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luxated stifles and shoulders and laminitis.
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Bone Spavin is
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OA of distal hock joint.
Boney exostosis on medial aspect of hindlimb |
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OA of the distal hock joint is ?
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Bone Spavin
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Hunter jumpers and dressage horses typically get
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OA of distal hocks, sore feet, and suspensory ligament problems
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Race Horses typically get?
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Bone chips in the front fetlocks and carpi?
Bowed tendons - SDF Sore front feet |
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If a horse warms out of a lameness it is?
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OA
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If lameness gets worse with exercise it is
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soft tissue injury
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If lameness doesn't get better with Bute, it is usually?
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Neuro problem .
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Does horse respond to stall rest?
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Then it is soft tissue - OA may not respond.
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Pigeon toed horses typically get
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lateral wear
ringbone |
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Big horses with small feet will have
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navilcular problems and
laminitis |
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If the feet are mismatched the one that is lame typically has what?
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higher heel.
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A smaller foot is indicative of what?
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lack of weight bearing - atrophy
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Horses with navicular pain can have what disuse atrophy?
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Disuse atrophy of the frog
Contracted heels. |
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If the heels are uneven on one foot, which side is the painful side?
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upward - coronary band will displace upward
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Horses that wear the outside of the toe more than inside could have
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Bone spavin
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An increased pulse pressure in the digital pulses is indicative of
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inflammation.
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The hooftester will show navicular pain at the
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Frog
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The hooftester will show laminitis pain at the
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toe.
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A hard swelling of the pastern is called
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Ringbone.
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Joint effusion in the tarsocrural joint is usally caused by
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OC lesions
Not lame TB, WB, and standardbreds |
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Grade 1 lameness
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Subtle or inconsistent at a trot
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Grade 2 lameness
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consistent at the trot
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Grade 3 lameness
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Obvious at trot, not seen at walk
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Grade 4 lameness
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seen at walk and trot
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Grade 5 lameness
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non-weight bearing or toe touching
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Flexion test - 0
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No change in baseline lameness
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Flexion test - 1
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mild, 2- 3 bad steps then normal
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Flexion test -2
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moderate, horse lameness increases half of circle
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Flexon test - 3
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sever, limps more full circle
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If the distal limb flexion test (MC 3 perpendicular to ground for 30 seconds) is positive, it shows what?
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pain is below carpus.
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Carpus flexion test is specific for
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Carpal lesions.
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Shoulder flexion test
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hard to differentiate elbow versus shoulder pain
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Hock flexion test shows
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Hock, stifle, hip and proximal suspensory pain.
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Stifle extension test shows
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Hock, stifle, hip and proximal suspensory pain.
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What is the best way to prepare a limb for nerve block
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Clip, and clean
Leave final scrub on for 5 - 7 minutes then clean it off with alcohol |
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What is the nerve block agent of choice for horses?
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Carbocaine - mepivicaine
Lasts 45 - 60 minutes. Works by blocking Na channels, no nerve depolarization |
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Why not use other nerve blocking agents
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Lidocaine is too irritating
Marcaine lasts 4 - 6 hours - use only if really painful |
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Posterior digital nerve block is performed how
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Performed just proximal to collateral cartilages on medial and lateral aspect of palmar pastern
Below communicating dorsal branch |
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Posterior digital nerve block desensitizes what?
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navicular area - bone and associated ligaments
impar and CSL distal DDFT, Navicular bursa Sole of foot, toe first then heel Palmar aspect of the coffin joint. 80 % of the foot - not dorsal toe. |
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To block the navicular bone and surrounding structures, and to test for sheared or bruised heels use what nerve block?
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Posterior, digital nerve block
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Navicular disease includes what problems?
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Pain from navicular bone or surrounding structures
impar or CSL ligament Distal DDFT Navicular bursitis |
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Navicular disease signalment
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QH and TB
chronic begins at 7 - 9 years of age often lame after being shod usually bilateral forelimb problem. Big horse with small feet |
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Navicular disease etiology
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long toe with low heels.
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During exam a horse with navicular disease usually ______ and has _____?
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points foot
contracted heels atrophied frogs increased digital pulses |
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If horse has navicular disease, after block the lameness can??
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Switch to other limb
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Radiographic finidings of navicular disease
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Lateral spurs @ CSL
sclerosis of the bone Synovial invaginations on 60 degree DP Cortical erosion |
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Which radiographic view is best for diagnosing navicular disease?
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Flexor view
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Treatment for Navicular disease
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Corrective shoeing - increase heel angle 2 degrees to take 25 % of the pressure off.
DO NOT use egbar shoe. improve breakover by square or rockered toe Phenylbutazone |
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What type of shoe should be used with navicular disease?
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2 degree wedge
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What drug claims to increase blood supply to foot?
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Isoxoprine - not used here
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Supplement treatment of navicular disease
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Cosequin
IV legend - hyaluronic acid - weak AI IM adequan - better AI - enzyme scavenger - stops collegenase |
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Joint steroidal AI characteristics
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Vetalog - Triamcinolone- 1 ml /joint
Betamethasone - more potent than Vetalog Both have effects for 6 - 8 wks Depomedrol - methylp - Harsh on cartilage use only on Low Motion joints - pastern- lower hock. |
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If Bute and shoeing
Coffin joint injection Navicular bursa injections fail then do ? |
PDN neurectomy
70 % remain sound for 2 years. only do in older horse because when fails - nothing else can be done. |
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Complications of PDN neurectomy
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Nerve regrowth
painful neuroma rupture of DDFT Vascular problems Severe hoof abscess - owner must check foot - horse cant feel abscess |
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Sheared heels
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Mechanical breakdown of heel bulb
caused by overusing one heel vs the other Longer heel hits ground first - overused |
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Sheared heels caused by
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improper shoeing
poor hoof conformation secondary to heel bulb laceration |
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Sheared heel DX
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PE, hooftester to heel
rads to rule out navicular disease unilateral PDN block on painful heel |
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Sheared heel TX
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Straight or eggbar shoe
unweight affected heel float heel several shoeings to correct |
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Bruised heel
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Corn
lesion between bar and heel of hoof Common in front feet |
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Bruised heel caused by
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overdue shoes
shoe too small peigone toed conformation long- toe - low heel |
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Bruised heel TX
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remove offending shoe
float heall so non-weight bearing for 6 wks |
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Abaxial nerve block is performed where?
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below fetlock - sesmoids
Using 3 mls of carbocaine on the medial and lateral palmar nerves. |
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Abaxial nerve block desensitizes what structures?
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entire foot including toe
Pastern |
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Abaxial nerve block works against what problems
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laminitis
hoof abscess white line disease keratoma high and low ringbone |
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Laminitis is
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systemic problem resulting in destruction of the laminae of the foot
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An acute severe lameness secondary to a systemic problem is
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laminitis
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Laminitis etiology
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endotoxemia
grain overload GI disease Black walnut shavings excessive steroids - +/- cushinoid retained placenta excessive exercise on hard ground |
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Laminitis pathology
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Complex event leading to ischemia and necrosis of laminae
Metalloproteinases enzymatic destruction of laminea Strept, bovis releases MM |
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Laminitis results in
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loss of opposing force to DDFT
coffin bone rotation circumflex artery pinches - more ischemia - more problems |
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Laminitis signalment
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overweight horses
ponies and minis on spring grass Cushing horses RARE in foals |
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Laminitis PE findings
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walking on egg shells
boudning digital pulses hooftester positive at toes |
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In chronic cases of laminitis you will find?
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rings wider at heel than toe
stretched laminae - white line deformed feet. |
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Laminitis DX
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ABaxial nerve block
Rads - dorsal laminae thickening rotation of P3 spurs or deterioration of P3 |
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Laminitis TX
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EMERGENCY - Acute
ice feet for 48 hrs to stop MMP's BUte - stop pain Banamine - stop endotoxemia DMSO - O2 radical scavenger - 500 mls in LRS IV |
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Why is it important to stop pain in laminitis and colic horses?
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Pain stimulates SNS which decreases blood supply to feet and gut. Stopping pain increases blood supply
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After 48 hrs of treatment with ice for laminitis what drugs are used
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Ace - pain
Isoxoprine - increase blood supply Pentoxyphylline - antiTNFa effects Heparin - |
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Additional TX for laminitis
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confine to stall
deep bedding or sand frog support to oppose DDFT - lily pads, soft ride boots rads every week for rotation measurement |
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What shoe should be used after acute episode of laminitis
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Heartbar - coutneracts DDF
Trim heels and shorten toes |
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What is the salvage procedure in horses
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Deep Flexor tenotomy
Stops pull of DDFT on PS Farrier can be more aggressive |
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Laminitis complications
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Damaged blood supply to toe
debride necrotic tissue Abscess - ABX |
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Laminitis prognosis
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< 8 degrees - return to work
8 - 12 degrees - some riding > 12 degrees - pasture pet. |
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A "sinker" occurs when
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the laminae detach all the way around the hoof and P3 sinks, and rotates
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Hoof Abcesses occur when?
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rainy, muddy weather
few days after shoeing worsens over time grade 4 of 5 lameness |
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Hoof abscess PE
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Usually unilateral
non-weight bearing walks on toe of foot distal limb swelling increased digital pulse, heat soft painful spont on coronary band |
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Locate hoof abscess via
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nerve block to get more aggressive with hoof tester
Rads - gas pocket |
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hoof abscess TX
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establish drainage
flush with betadine soak epsom salts for 3 - 5 days |
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What do you NOT want to TX hoof abscess with
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bute or ABX until popped! need it to progress until it pops.
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White line disease
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separation of lamine from hoof capsule
hot humid environmnets bacteria - fungus - destroy laminae common in chronic cases |
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White line disease PE
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Most not lame
Not sensitive |
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White line TX
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Small defect - fill with iodine soaked cotton ball and replace shoe
Large defect - remove undermined hoof wall |
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White line shoe
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Full support shoe to stabilize foot and let hoof grow out.
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Keratoma
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recurrent hoof abscess in same location
benign hoof tumor swilrs of abnormal keratin tumor of keratin at toe |
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Keratoma DX
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History
defect in hoof radiographs P3 lysis due to prssure of tumor |
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Keratoma TX
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surgical excision thru bottom of foot or through hoof capsule
usually has a stalk |
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Pedal osteitis
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inflammation and demineralization of coffin bone
Thin soled horses with repetiive brusing thoroughbreds |
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Pedal osteitis PE
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entire sole is sore, but especially the toe
Rads Grade 1 - 2 lame |
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Pedal osteitis TX
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sole paint to toughen feet
full pads bute good prognosis |
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Low Ringbone
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OA of coffin joint
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High Ringbone
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OA of pastern OA
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Ringbone can occur secondary to
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trauma
pigeon toed conformation OCD lesion - P2 bone cyst |
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Ringbone Clinical signs
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progressive lamenss
boney exostosis at pastern worsened by trotting on hard ground lower limb flexion |
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Ringbone DX
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Abaxial nerve block
intra=articular pastern joing block rads |
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Ringbone TX
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Rounded toe shoe to ease breakover
bute intra-articular injections - can use dep because low motion joint ARthrodesis of pastern - can't do coffin. |
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Ringbone prognosis
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High ringbone - good with surgery - few years
Low ringbone - poor - no surgical option - high motion joint - can't fuse it |
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Low 4 - point nerve block targets
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Medial and lateral palmar nerves
metacarpal nerves |
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Low 4 point blocks what structures
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Fetlock joint
Digital tendon sheath Suspensory branches tendon |
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Inflammation of the fetlock joint
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Osslets
Common in TB and SB racehorses usually forelimbs |
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Fetlock joint inflammation clinical signs
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secondary to chronic inflammation
Grade 1 to 2 lameness Increased joint effusion in the fetlock joint pain on flexion of fetlock. |
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If a horse is sore after a race, but gets over it quickly, and has no radiographic lesion, it most likely has
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increased joint effusion in the fetlock joint
Grade 1 - 2 lameness |
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Fetlock joint will block to what procedure
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low 4 point
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Fetlock TX
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Phenlybutazone
Rest IV Legend |
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If you need to inject the fetlock joint use _____ and not _____ because ____.
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triamcinolone or vetalog
Not: depomedrol it is a high motion joint |
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Hyperplastic synovial pad
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villonodular synovitis
proliferative synovitis caused by trauma to pad from hyperextension of the fetlock - it protects the joint during hyperextension |
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Hyperplastic synovial pad clinical signs
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will be lame after a race but resolves with rest
reoccurring fetlock effusion pain on fetlock flexion |
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Hyperplastic synovial pad diagnosis
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radiograph or US
lysis or demineralization of dorsal distal MC 3 or no lesions. |
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Hyperplastic synovial pad treatment
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Arthroscopic surgery to remove pad is best option
NSAIDs and intra-articular medications |
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Hyperplastic synovial pad prognosis
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Good if no cartilage or degenerative joint disease is present.
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Sesmoiditis
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Inflammation and boney lysis of sesamoid bones
secondary to trauma common in racehorses but may see in any horse |
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Sesmoiditis blocks to what procedure
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Low 4 point
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Sesmoiditis DX
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Rads - increased vascular channels or lysis
US - irregular boney margin at attachment of suspensory branches |
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Sesmoiditis TX
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Rest
NSAIDS IA medications limiting factor is suspensory branch desmitis Bisphosphate - osteoclast inhibitor |
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In treating sesmoiditis it will take the sesmoids how long to heal
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6 - 8 months
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Tendonitis/tenosynovitis
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Inflammation within the digital tendon sheath
+/- damage to tendon structures within the sheath |
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Increased tendon sheath effusion with no clinical signs of lameness
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windpuff
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Tenosynovitis is caused by
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secondary trauma
overuse damage to superficial or deep flexor tendons within the digital sheath |
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tenosynovitis blocks to
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4 point or to tendon sheath.
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Tenosynovitis DX
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US to assess tendon structures and adnesion and fluid within sheath
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Tenosynovitis TX
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Stall rest
Ice 20 minutes daily for few days support bandage NSAIDS - bute |
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If you need to inject for tenosynovitis use ___ and not _____ because
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Triamcinolone or vetalog
never depomedrol into soft tissue |
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Tenosynovitis prognosis
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Good if no tendon lesions
Fair with lesions |
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Annular ligament resection
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Chronic tendon sheath distention
Fibrosis causes ressure releases pressure within sheath Fair prognosis Sepsis is problem |
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Fetlock chip fractures
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Racehorse injury
occurs at high speeds with hyperflexion of fetlock joint Chip on proximal P1 |
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Fetlock chip clinical signs
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increased joint effusion
pain on lower limb flexion may or may not show lameness - not large weight bearing surface |
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Fetlock chip best TX
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Arthroscopic surgery
Post- op stall rest for 6 weeks 6 weeks in paddock 30 days exercise before racing |
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If Fetlock chip not removed and joint just injected ....
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will develop DJD
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A proximal palmar metacarpal blocks what
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superficial and deep flexor tendons
suspensory ligament desmitis Splints Bucked shin complex |
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Superficial digital flexor tendonitis
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Common in TB racehorses
Barrel racing horses jumping horses Forelimbs>> hindlimbs |
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Bowed tendon is
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SDFT
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Flexor tendonitis clinical signs
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Grade 3 - to 4 lameness
Improves with time : 7 - 10 days heat and pain on palpation Swelling Sore to lower limb flexion |
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Flexor tendonitis DX
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Blocks to proximal metacarpal nerves
Rads to rule out other probs US |
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Type I Flexor tendon damage
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< 25 % of CSA
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Type II Flexor tendon damage
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diffuse, 25 - 50 % CSA
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Type 3 Flexor tendon damage
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Localized, mostly anechoic
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Type 4 flexor tendon damage
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Core lesion, anechoic lesion
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Flexor tendon damage TX
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Ice for 20 minutes numerous times daily for 7 days
Stall rest NSAIDS Support bandage |
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How does ice help
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It prevents metaloproteases from eating the tendon.
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Length of treatment of flexor tendon per ligament
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Inferior check ligament - 3 mo
Superficial flexor - 7 - 10 mos Deep flexor tendon - 10 - 12 mo Inferior< superficial< dee |
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When can horse start back after flexor tendon injury?
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70 - 80 % healed
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When working through a controlled exercise program how much do you add and how fast
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5 minutes every 3 days
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When can horse return to work after controlled exercise program
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When can walk, trot, and canter 30 min.
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Treatment of Type 3 and 4 Flexor tendon injuries
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Decompress with needle aspiration
rest won't fix it. |
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Deep Digital Flexor Tendonitis shoe treatment
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raise heal 2 degrees takes 25% of pressure off DDFT, but increases pressure on SDFT and susensory ligament
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When do you use a wedge shoe?
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to reduce pressure on the DDFT or navicular bone.
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suspensory ligament desmitis signalment
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Common in fore limbs of english performace horses
Common in hindlimbs of cutting, roping and barrel horses Paso finos |
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Suspensory ligament clinical signs
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fetlock wanting to drop.
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Suspensory ligament functions
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supports fetlock joint
proximal body distal suspensory branches. |
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Suspensory ligament with hock flexion test
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will get worse
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There is a ligament around the _______ suspensory ligament
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hindlimb - won't allow swelling - compartment syndrome
Forelimb does not have one |
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Suspensory ligament desmitis DX
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Rads
Avulsion Sclerosis |
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Suspensory ligament desmitis TX
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similar to tendonitis
Ice support badnage NSAIDS Stall rest decompress hind only stem cell |
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Splints
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inflammation of interosseous ligament
Attaches splint (MC2 to MC4) to cannon bone (MC 3) |
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Splints clinical signs
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Boney exostosis over splint bone
Acutely - heat and pain on palpation Lame initially but resolves |
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Splints DX
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Radiographs to rule out fracture
anesthesia block |
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Splints TX
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Ice, rest, NSAIDs bandage
Local inflitration of cortisone to decrease inflammation. Paint with DMSO |
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Bucked shin complex
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2 year old race horses in training
Dorsal metacarpal disease Overuse of MC 3 that is remodeling painful to palpation of dorsal cannon bone only lame at high speeds |
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MC 3 cortical fracture TX
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drill through cortex to allow vascularization from bone marrow cavity
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Tarsus includes what 4 joints
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Tarsocrural, Proximal intertarsal, distal intertarsal
Tarsometatarsal. |
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What tarsal pouches communicate?
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Tarsocrual and proximal intertarsal communicate 100% of the time
Distal inter and tarsometatarsal communicate 25 % of the time |
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Bog Spavin is
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synovitis of tarsocrual joint.
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Etiology of Bog Spavin
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Osteochondrosis
Trauma Septic Idiopathic |
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Clinical signs of Bog Spavin
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Tarsocrual joint effusion
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If Bone Spavin is caused by trauma the horse is_____. If it is caused by OCD the horse is ______.
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Grade 3 or 5 lame and worsened by hock flexion
Not lame |
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Bog Spavin DX
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Radiographs - OCD of DIRT, Medial and lateral trochlea of talus and medial or lateral malleolus of tibia
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TX of OCD of tarsus
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ARthroscopic
Prognosis good - 90 % can return to performance |
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Older horse with Bog Spavin DX
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Rads to rule out fracture
Obtain joint fluid - sepsis |
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Normal joint fluid values
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TP < 2.5
Cells < 1000 98% MN Few PMN |
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Septic joint fluid values
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TP 4 - 6 g/dl
Cells > 35000 - 100000 or more > 50 % PMN = sepsis |
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Inflammed joint fluid values
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TP = 3 - 4 g.dl
Cells up to 20000 Still > 50 % MN About 10 -20 % PMN |
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Older horse Bog Spavin TX
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intra articular medications with vetalog (triamcinolone)
Bandage Stall rest |
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What are the low motion joints in a horse?
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DIT
TMT Pastern |
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What is the "spavin test"
|
hock flexion
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To block pain of Bog Spavin, how many injections do you need to make?
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2 because DIT and TMT only communicate 25% of the time
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What is the most common hind limb lameness in horses?
|
Bog Spavin
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How do you treat Bog Spavin in adult horse?
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Intra articular anesthesia
Block both DIT and TMT Only 25 % communication Ease breakover - square toe shoes KEEP HORSE IN WORK - rest won't help |
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What do you inject the DIT and TMT joint with when Bog Spavin is due to DJD?
|
Depo medrol
Destroys cartilage, and bone will spot weld and horse will be fixed because Low motion joints. |
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Curb
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Thickening of plantar ligament
Due to: Trauma, Bad confrmation, Pinful to palpation, +/- lameness |
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Curb DX
|
Visual exam
Ultrasound plantar ligament Radiograph to rule out boney lesion |
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Curb DX
|
NSAIDS
Rest Ice Topical DMSO and steroids |
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Stringhalt
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abnormal mechanical gait
Involuntary hyperflexion of the hock SEcondary to laceration over extensor tendons in hindlimbs. |
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Stringhalt DDX
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Upward fixation of patella
Fibrotic myopathy |
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Stringhalt TX
|
Lateral digital extensor tenectomy
Remove portion of muscle belly standing sedation |
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Rupture peroneus tertius
|
Loss of reciprocal function
Bears weight normally stifle flexes, hock doesn't dimple in achilles tendone above hock |
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Ruptured peroneus tertius TX
|
Stall rest 6 - 12 weeks
handwalking when reciprocal apparatus returns |
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Thoroughpin
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Tenosynovitis of tarsal sheath
|
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Thoroughpin TX
|
Vetalog - triamcinolone
NSAIDs Bandage Rest |
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Thoroughpin DX
|
usually good for returning to performance
synovial distention persists permanent blemish |
|
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Capped Hock
|
Bursitis of calcaneon bursa
resolves with NSAIDs and rest Permanent blemish |
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Stifle joint pouches
|
Femoropatellar
Medial femorotibial Lateral femorotibila |
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Which stifle joints communicate
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Femoropatellar and Medial femorotibial never communicate with the alteral femorotibial
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Traumatic gonitis pathogenesis
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Terrible Triade
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What is the Terrible Triad
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Collateral ligament damage
meniscal damage anterior cruciate ligament injury +/- tibial emminence avulsion fracture |
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Gonitis Clinical signs
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Femorotibial and femoropatellar joint effusion
Chornic cases feel boney lump at proximal medial aspect of tibia where collateral ligament attaches |
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Gonitis TX
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NSAIDS
Intra-articular medicaton STall rest 4 - 6 months Chondroprotective agents Adequan IM |
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Gonitis prognosis
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Poor
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OCD of stifle anatomy and signalment
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Femoropatellar joint - weanling -Lateral trochlear ridge of distal femur lesion -
Subchondrol bone cyst in older horse - 2 - 5 yrs - medial femorotibial joint |
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OCD of the LTR TX
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arthroscopic surgery
4 -6 mo small area turnout NSAIDS Adequan IM |
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Adequan MOA
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Potent anti-enzymatic
Hyaluronase Carilaginase MMPs |
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Subchondral bone cysts DX
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Block to medial FT joint - between middle and medial FP ligaments
Radiographs |
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Subchondral bone cysts TX
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surgery
enucleation of bone cyst Forage 6 months post-op care |
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What is complication of subchondral bone cyst on PP exam?
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May still see lesion but is sound
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Upward fixation of patella signalment
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Sheltand ponies, minis
hereditary poor muscle tone Young horses begining training |
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Upward fixation of patella etiology
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mechanical lameness
patella gest caught on meidal patellar ligament periodiaclly unable to flex stifle or hock and drag extended limb behind them. abnormal laxity of patellar ligaments |
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Upward fixation of patella TX
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Radiograph to R/O other causes
conditioning exercise on hill work Cut lateral patellar ligament if permanent Cause inflammation to cause ligament to shrink - internal blistering |
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Complications of medial patellar desmotomy,
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instability of stifle joint
leads to distal patella fragmentation OA stifle joint |
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Fibrotic myopathy
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muscle trauma
semitendinosus muscle secondary to pulled muslce or IM shots Fibrosis adhesions and scar tissue of ST and SM mm |
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Fibrotic myopathy DX
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Gait of slapping foot on ground and hoof sliding backward.
Fibrosis scar tissue palpable |
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Fibrotic myopathy TX
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Surgical transection of fibrotic scar
standing sedation, local anesthesia large area of dead space suture dehiscence common |
