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202 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which is worse in laminitis, sinking or ventral rotation of foot?
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Sinking
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Name 4 sequellae to laminitis
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subsolar abscess
osteitis/myelitis malformation of hoof wall chronic laminitis |
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The major result of acute laminitis of is______ of the laminae?
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ischemia
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When would you want to decrease perfusion to the foot in laminitis? (2)
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endotoxemia or carb overload
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how would you treat the foot mechanically in laminitis?
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shorten the toes
elevate the heel remove shoes provide support to the frog |
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How much hoof wall is left when hoof wall resection is done in laminitis?
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1-2 cm distal to coronary band
(done upward from ground) |
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What is a last ditch effort procedure for laminitis?
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DDF tenotomy
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What structures are involved in navicular syndrome?
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navicular bone, navicular bursa, collateral ligs of navicular bone, impar ligament, DIP joint
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What is the most likely pathophysiology for navicular syndrome?
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Degenerative dz process
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Which limb is most affected in navicular syndrome?
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Forelimb
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Another name for the navicular syndrome components?
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podotrochlear apparatus
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T/F: with navicular syndrome, there is always pain when using hoof testers?
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FALSE: variable sensitivity to hoof testers
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How does the foot typically look with navic syndrome?
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toe is upright or boxy with contracted heels---usually noticed when horse ownership is changed
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When trotting horse with navicular syndrome, which side of circle is affected limb worse?
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INSIDE of circle
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How would you dx navicular syndrome other than clinical signs?
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Palmar digital nerve block should resolve the lameness
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T/F: With navicular syndrome, there is always a positive lower flexion test
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FALSE: highly variable
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What is the most sensitive diagnostic technique for dx navicular syndrome?
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Nuclear scintigraphy--
although MRI is the gold standard for evaluation of the foot**** |
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What are the basic shoeing elements for use in navicular syndrome? (4)
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shorten the toes
elevate the heel shoe with rolled, square, or rocker toe egg bar shoe (fitted full) |
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What is the sx treatment of choice for navicular syndrome? and what should be done prior to this?
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palmar digital neurectomy
always due nerve block at the same level prior to sx!!! |
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Name 6 complications seen with palmar digital neurectomy sx
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neuroma formation
undetected deep puncture rupture of DDF tendon avascular necrosis of laminae (rare) recurrence or persistence of lameness---poor sx technique! stumbling/tripping during exercise |
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Navicular syndrome prognosis???
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GUARDED same as navicular fx prognosis
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Possible tx options for navicular bone fx although it is rare?
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PD neurectomy
lag screw fixation rest and shoeing shock wave therapy |
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What are the clinical signs of a coffin bone fx?
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DIP joint effusion, increased digital pulses, heat in the foot, painful response to hoof testers
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How is coffin bone often fx?
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most due to high speed injury but also external trauma
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Why do rads sometimes suck for dx of P3 fx?
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may not be seen on rads for 1-3 weeks after--- repeat in 1-3 weeks and perform bone scintigraphy
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What type of fx (1-6) is the extensor process fx?
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Type 4
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When could non-sx tx be used in P3 fx?
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when it doesn't involve the extensor process --all but type 4
steel bar shoe with side clips and 6 mo of stall rest |
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How would you tx a type 3 P3 fx (mid saggital)?
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cortical screw in lag fashion
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What is the difference b/t tx for small type 4 fx vs large type 4 fx?
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small type 4---remove fragment with arthroscopy
large type 4--- IF screw compression |
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what is the most common type of P3 fx?
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wing fx
best prog for non-articular wing fx--type 1 |
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T/F: you may only see lameness with a foot abscess, and no other clin signs?
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TRUE
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what is the term gravel when dealing with foot abscesses?
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infection of the white line that extends proximally and eventually drains at the coronary band
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What is a foot abscess prognosis?
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generally EXCELLENT unless deep sepsis or complications (obviously!)
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What is the most common cause of a deep penetrating wound in the foot?
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Nail or stiff wire--OUCH!!
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T/F: deep penetrating wound of the foot is a medical emergency
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YES!!
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What is the TOC for deep penetrating wound of the foot?
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Navicular buroscopy, debride, and lavage
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What structure does pedal osteitis refer to?
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inflammation of P3
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How does pedal osteitis happen? (3)
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thin/flat soles
repetitive concussive trauma exercise over hard surfaces |
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What is side bone?
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ossification of the collateral cartilages of P3
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T/F: There is always lameness associated with side bone
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F: none to mild lameness
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Name 3 tx options for side bone
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1: shoeing--full fitted shoe with roller motion***
2: PD neurectomy 3: corrective trimming---rasping hoof walls at quarters to encourage expansion of collateral cartilages |
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What is unique about the fetlock joint in horses?
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greatest ROM of all joints
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OCD of the proximal dorsal articular margin of P1 is most often due to?
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Repetitive trauma
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What is the most common chip fx seen in TBs?
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OCD of prox dorsal articular margin of P1
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What is the TOC for OCD of prox dorsal articular margin of P1 and what is the prog?
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arthroscopic removal of fragment
generally good to excellent prog! |
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What is the major cause for dorsal frontal fx of the proximal articular surface of P1?
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acute high speed injury
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OCD of prox dorsal articular margin of P1 is most common in _____ horses and dorsal frontal fx of prox articular surface of P1 is most common in ____??
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1) TBs
2) STBs (Metatarsal) |
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Tx options for dorsal frontal fx...P1?
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--stall rest 3-4 mo (if incomplete)
--IF compression with screws if complete and for some incomplete |
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What are the 3 types of non-comminuted mid-saggital fx of P1?
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short incomplete (< 30mm)
long incomplete complete |
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What is contraindicated in dx of mid-saggital fx of P1?
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Dx anesthesia especially in long fx**
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How would you treat a short fx of P1 (mid sagittal non-comminuted)?
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if < 15mm---stall rest for about 4 mo
longer fx--screws in lag fashion |
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What is the major cause for proximal sesamoid bone fx?
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Overloading
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What is the most common type of proximal sesamoid bone fx?
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Apical
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How would you treat a apical sesamoid fx?
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removal of the fragment
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How could a mid-body fx of proximal sesamoid be treated?
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internal fixation with cerclage wire or lag screws
CAREER LIMITING FX |
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how could you treat a basilar prox sesamoid fx?
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cancellous bone graft for large frag
or remove small fragments (> 3mm had worse prognosis) |
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How would you treat an abaxial fx of prox sesamoid bone?
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Non-articular---4-6 mo rest
Articular---remove fragment |
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What is axial fx of prox sesamoid bone associated with most often?
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fx of lateral condyle of cannon bone
if this is so----very poor prognosis* |
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What is the most common condylar fx seen in the cannon bone?
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MC 3--TB
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What dx tools are used to dx condylar fx of cannon bone?
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PE, hx, clinical signs
Painful lower limb flexion test RADS** 4 views + DP flexedcview |
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What is the TOC for condylar fx of cannon bone?
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IF compression using cortical screws in lag fashion--closed
if short incomplete---rest is ok |
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What leads to splints formation?
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desmitis/periostitis--->fibroust CT proliferation---->calcification--->bony exostosis of splint bones
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What is the ligament involved in the pathogenesis of splints?
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Interosseus ligament: connects the splint bones to the cannon bone
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What type of conformation can predispose horses to splints?
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bench knee conformation---more stress put onto MC/MT 2 and therefore strain injury to the interosseus ligament
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T/F: splints affects adults primarily
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FALSE: a dz of young horses
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Onset of clinical signs in horses with splints is associated with what?
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early hard training in young horses--too much stress!!!
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Tx options for splints?
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anti-inflammatories, rest, controlled exercise, shock wave therapy
sx---remove exostosis and distal aspect of bone (wait until acute inflammation is gone first) |
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What will make the prognosis for splints less favorable?
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concurrent suspensory desmitis!
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what area of the splints is most affected in a fx?
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The distal 1/3
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What foot/location is most affected in TB and STBs when splints are fx?
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Left 2, Right 4
TB: carpal STB: tarsal |
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What is significant about STBs and splint bone fx?
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81% have concurrent suspensory desmitis (67% of TBs)
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Acute lameness in splint bone fx is noticed where, when trotting in a circle?
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OUTSIDE of circle---affected limb
opposite of navicular syndrome! |
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Primary event associated with DJD in horses?
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synovitis or capsulitis
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what is the final common pathway of DJD?
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irreversible damage to the articular cartilage
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What are the 4 major players in the role of the synovium in DJD/OA?
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PGs--PGE
IL-1**** most important (stim release of MMP) MMP 1, 3 free radicals |
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How is the ECM made up?
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mostly type 2 collagen framework
hydrophilic, ionic--like a sponge (70-80% water) |
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what changes occur in breakdown of articular cartilage in DJD?
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decreased PGs, type 2 collagen degradation
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What is MMP-1 and MMP-3?
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1: tissue collagenase
3: stromelysin |
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What are the 3 clinical manifestations of DJD?
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Pain
Effusion Decreased ROM |
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What is the role of NSAIDs in OA tx?
Role of corticosteroids in OA tx? |
Bute--- cox inhibitor (decreased PGs)
Methylpred--cox and lipox inhib (suppress MMPs) |
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When wouldn't you use a IL-1 receptor antagonist in OA?
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subchondral bone cysts or soft tissue injuries present
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What are PSGAGs?
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GAGs hold onto the water
Chondroitin sulfate*** Adequan is a type of med chondroprotective, increase HA, anabolic effects |
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What are potential SE of Adequan chondroprotective meds?
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alter coag profiles, elevate some MICs of abx in synovial fluid
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What is ring bone?
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OA of interphalangeal joints
high: PIP joint Low: DIP joint |
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Describe the interphalangeal joints
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High load, low motion joints
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What is a sx tx option for high ring bone?
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PIP arthrodesis
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What is another name for DJD of the fetlock joint?
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villonodular synovitis
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What changes are seen in P1 in villonodular synovitis?
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osteophytes
osteochondral fragmentation chondroma formation |
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What changes are seen in the cannon bone in villonodular synovitis?
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supracondylar lysis of the cortex
osteochondoris transverse ridge arthrosis blah blah blah |
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Tx of fetlock DJD?
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basics: rest, NSAIDs, +/- adequan
removal of fragments |
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Carpal joints for STB and TBs with DJD?
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STB: middle carpal joint
TB: middle and radial |
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Where are osteophytes and chip fx seen in carpal joint DJD?
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distal, dorsal radial carpal bone
distal, dorsalateral radial bone proximal, dorsomedial C3 proximal, dorso intermediate carpal bone |
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what is the most common location for subchondral sclerosis in carpal DJD?
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radial facet of C3--dx with NS
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The palmar intercarpal ligament most frequently injured in carpal DJD is?
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lateral branch of medial intercarpal ligament
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The most common site for a slab fx in carpal DJD?
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radial facet of C3 (like sclerosis)
--slab fx involves distal and proximal articular surface where as chip fx involves only one surface |
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Tx of carpal DJD?
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same basic tx as other joints
--small or chronic slab fx can be removed (STB <14mm, TB <8mm) --large fx: screws |
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What is another name for OA of the distal tarsal joint?
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Bone spavin
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what is the most frequent and important cause of lameness in the horse??
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BONE SPAVIN
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Clinical signs associated with bone spavin?
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scuffed toes
short stride cranially sore/stiff at beginning of workout but gets better positive upper flexion test (hock) |
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What is the most commonly injected joint in the horse?
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distal tarsal joint!
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Tx for bone spavin--distal tarsal joint DJD?
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similar to other OA tx early on
Tildren (with Banamine) Natural ankylosis---resolves lameness |
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what if there isn't natural ankylosis when dealing with bone spavin? Next step?
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1) drill out articular cartilage and subchondral bone---promotes ankylosis: 65-80% success
2: Medical-- steroid injections, MIA injections, Ethyl alcohol inj |
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What are some complications involved with using MIA (monoiodoacetate injections) for bone spavin tx?
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--severe pain post inj
need to check arthrogram first to check joint communications |
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What areas does the palmar digital nerve block desensitize?
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heel and solar region
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What is a major caution when doing digital nerve block?
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digital tendon sheath
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what does abaxial sesamoid block?
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entire foot and part of pastern
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cautions for abaxial sesamoid block?
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digital tendon sheath and fetlock joint
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Low palmar/plantar blocks what?
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foot, pastern, part of fetlock region
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What structure do stress fx of the proximal palmar/plantar cannon bone involve?
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Suspensory ligament
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What are the 2 patterns of stress fx?
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1) intermittent, vague lameness=prox suspensory desmitis or stress rxn
2) acute onset of mod to severe lameness= avulsion fx |
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Stress fx tx??
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conservative: rest, anti-inflamm, ESWT
sx: fasciotomy, intra lesional injection |
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What is the best dx method to dx stress fx in long bones?
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Nuclear scintigraphy
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What are 5 risk factors for septic arthritis?
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STB, intra-articular injections, FPT, digital tendon sheath, Adequan or PSGAGs
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What is the most common site for septic synovitis?
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Digital tendon sheath
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What type of bacteria are most common in sepsis due to injections vs trauma/foals?
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INjection: coag + strep
Trauma/foal: E.coli- gram negs |
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When do infections due to injections begin to show clinical signs?
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Not for at least 5 days and can take up to 3-4 weeks.
If lame in 12-24 hrs---non-septic flare rx |
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What is the most significant clinical sign of septic arthritis/tenosynovitis?
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LAMENESS--along with effusion, soft tissue swelling, heat, pain
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What are the dx steps used to dx septic arthritis or any wound?
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1. digital exploration--if wound
2. synovial fluid cytology (before flush) 3. distension of joint with saline 4. contrast radiography |
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What is the problem with a synovial fluid culture?
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60-75% of the time it is positive if infected---therefore, ALWAYS do a synovial fluid cytology
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How would you treat a septic joint?
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1. LAVAGE---fluids under P (1-2 L if standing, 3-6 L if recumbent)
2. ABX--aminoglycosides common exploratory, NSAIDs, bandage, rest |
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T/F: It is ok to use intra-articular meds when a septic joint is being treated?
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NO--- don't use IA meds for several months
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What is OCD?
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Failure of proper endochondral ossification-->thickening and retention of hypertrophic zone of cartilage growth
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Where is the most common site for OCD in horses?
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Stifle
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What are some factors that contribute to OCD formation?
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genetics, diet (high carb, low Cu, high Zn), trauma, rapid growth
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What are the major sites for SBC and OCD in the stifle?
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OCD--lateral ridge of trochlea of femur
SBC--medial femoral condyle |
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T/F: OCD is most commonly bilateral
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TRUE: OCD---frequently Bilateral
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What are the 3 main clinical signs of OCD of the stifle?
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Lameness, effusion, +/- gluteal atrophy
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SBC vs OCD in the stifle?
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SBC: no jt effusion, more severe lameness, worse prognosis
OCD: jt effusion, young horses have lameness or hard athletic trainers |
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How would you treat OCD of the stifle?
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arthroscopic debridement and conservative tx
--size of fragment is related to outcome |
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How would you treat SBC of the stifle?
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arthroscopic debridement--young horses
older horses-- inject lining of cyst with steroids and debride outside ( no longer poor response to sx) |
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What is the most common site for OCD of the hock?
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DIRT--distal intermediate ridge of the tibia
this may be the most common OCD site of all in STBs |
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What are the 3 categories in OCD of the distal dorsal cannon bone?
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type 1: subchondral flattening
type 2: flat w/ bony fragment type 3: flattening + loose osseous body |
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What is the first sign of OCD of the distal dorsal cannon bone? Is this seen in OCD of palmar/plantar aspect of P1
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JOINT EFFUSION---rarely seen in P1 OCD
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T/F: OCD of the palmar/plantar aspect of P1 always has to be treated
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FALSE--- if this is an incidental finding, no tx necessary
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What is the prognosis of OCD of the shoulder joint?
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POOR--least favorable and very rare
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What clinical signs would you see in a horse with OCD of the shoulder joint?
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scuffed toes, muscle atrophy, lameness, young horse
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Name the 3 basic components of the tendon?
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Tendon-- muscle
bone-tendon tendon tissue proper---mostly type 1 collagen |
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Where does the majority of repair tissue come from in tendon injuries?
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Extratendinous vascular supply of the paratenon ---not intratendinous!
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What is the gold std for dx ligament and tendon injuries?
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U/S
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What is the most common traumatic tendinitis in athletic horses?
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SDF tendinitis
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Where does SDF tendinitis happen more?
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FORELIMB
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What is unique about the SDF tendon in the mid-cannon region?
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It has the smallest cross-sectional area---therefore, greater strain on the tendon with loading and fetlock extension
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What are contributing factors for SDF tendinitis?
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lack of conditioning/inadequate training and muscle weakness and fatigue
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What does SDF tendinitis look like on PE and what other injury resembles this?
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--bowed tendon (curved out)
can resemble Plantar/palmar ligament desmitis |
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What are tx options for SDF tendonitis?
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-rest, cold therapy, bandage, no turn out
--tendon splitting if acute injury Sx: superior check lig desmotomy or desmotomy of palmar annular lig |
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What is thoroughpin?
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Tarsal sheath tenosynovitis---tendon sheath of DDF as it passes over hock
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What can inferior check ligament desmitis predispose to?
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ICL and SDF tendon adhesions!
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What breeds are more likely to get inferior check lig desmitis?
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STB and drafts --older horses
POOR PROG |
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What is the most common ligamentous injury in sport horses?
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Suspensory desmitis
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What is the prognosis for suspensory desmitis?
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worse prog if involves BRANCHES
GUARDED STB--better if forelimb and worse if hindlimb and opp for TBs |
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What may be a predisposing factor for distal sesamoidean desmitis?
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upright conformation of the pastern bone
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How would you treat distal sesamoidean desmitis?
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egg bar shoe---take P off the pastern region
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What is plantar ligament desmitis?
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curbed hock---looks like SDF tendinitis
seen more in STB |
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What are the common locations for bursitis?
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calcaneus, cunean, trochanter, navicular bone, bicipital
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In which joints of the stifle is there effusion when the cranial cruciate ligament is ruptured?
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medial femorotibial and femoro-patellar
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What meniscus is most commonly injured?
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MEDIAL---either alone or with CrCL tear
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What are predisposing factors for upward fixation of the patella?
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--poor quadriceps tone
---straight hindlimb conformation --loss of retropatellar fat pad |
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What can't the horse do to its hind limb when the patella is fixed upward?
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can't flex the leg
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What are some tx options for upward fix of patella? 5
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1. exercise quadriceps (hills)
2. shoe with elevated heel 3. injections of counter irritants over patellar ligs 4. medial patellar desmotomy 5. medial patellar splitting |
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What are 2 common complications with medial patellar ligament desmotomy?
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Chondromalacia and fragmentation of distal aspect of patella
---don't see with fenestration of the ligament |
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What is the number 1 goal for emergency mgmt of long bone fx?
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minimize any further trauma!!!
sedatives, fx stabilization |
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Type of stabilization for forelimb phalangeal-distal metacarpus fx?
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light but tight bandage, Kimzey splint on dorsal aspect
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Type of stabilization for mid cannon to distal radius?
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R-J bandage ground to elbow and 2 splints (caudal and lateral)
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Stabilization for mid to proximal radius?
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R-J bandage, 1 lateral splint above elbow to shoulder and one caudal splint below elbow (limit shoulder abduction)
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Stabilization for fx proximal to elbow?
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heavy musculature helps protect area
caudal splint to keep leg in extension--no triceps apparatus |
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How would you immobilize a femur or pelvix fx?
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cannot immobilize
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Describe transport of a horse with fx
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hindlimb fx: face forward
forelimb fx: face backwards neonatals: recumbent don't tie head tight confinement bring trailer to horse vans and large gooseneck trailers |
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How does traumatic disruption of the suspensory apparatus occur?
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acute hyperextension of fetlock joint
---FRONT LIMB MOST OFTEN OUCH* |
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What is the weakest part of the suspensory app in well conditioned horses? poorly conditioned?
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sesamoids--well conditioned
ligaments--poor conditioned |
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What is the definitive tx for TDSA?
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Fetlock arthrodesis
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T/F: digital flexor tendon lacerations are medical emergencies?
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TRUE--- lacerate SDF or DDF tendon--EMERGENCY
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What is the prognosis for a tendon laceration involving the tendon sheath?
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WORSE PROGNOSIS--Adhesions possible
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What does an SDF tendon laceration look like compared to DDF tendon laceration?
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SDF: dropped fetlock, foot on ground
DDF: toe flipped upward |
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What does suspensory ligament transection look like?
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foot flipped upward and standing on distal aspect of cannon bone
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What are tx options for SDF tendon laceration?
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if it is partial--- wound care, bandage, NSAIDs, abx, stall rest
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What does sx tx of tendon lacerations entail?
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re-appose ends---reduce adhesion formation
--non-absorb suture --3 loop pulley system complete stabilization with cast (1/2 limb in front and full limb in hind) -shoe with elevation of heel |
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Describe an extensor tendon injury?
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No stabilization needed
No splint No suture of ends of tendon not immed. life threatening |
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When purchasing services, what is the proper order of priority?
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NIB-NISH, Mandatory FSS, Optional FSS, UNICOR, Commercial
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1
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what type of fx occurs most often in P2 and what is the TOC?
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Comminuted
PIP arthrodesis |
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What type of fx occurs most often in P1?
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mid saggital comminuted
-interfrag compression or ESF if severe |
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What fx have the worst progs?
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P1, Radius, humerus, scapula, femur, tibia
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What is one of the most common upper limb fx in the horse?
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Ulna--dropped elbow, cannot extend leg
good prognosis |
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What is unique about radial fx?
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most often contaminated due to external trauma
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What is the most common fx site in the scapula?
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supraglenoid tubercle
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TOC for adult with comminuted femoral fx?
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Euthanasia
foals--double plate but still guarded prog |
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When would you arthrodese the fetlock joint?
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severe DJD of fetlock joint or traumatic disruption of suspensory apparatus
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what is the TOC for fetlock arthrodesis?
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ISF using DCP dorsal and palmar/plantar tension band
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What is the TOC for jaw fx?
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caudal mandibular fx--conservative
or simple interdental wiring with ESF/ISF and curing polymers |
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what are complications of jaw fx?
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malocculsion, loss of teeth, chronic draining tracts, osteomyelitis
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What is the clinical healing time for adults and foals in jaw fx?
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foal: 3-4 weeks
adults: 6-8 weeks |
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What are common sites affected by cervical vertebral arthritis?
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C5-6> C6-7> C 4-5
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What is one of the most common causes of back pain?
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kissing spines---impingement of dorsal spinous processes---T-L
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What is the main predisposing factor for kissing spines?
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poor conformation---also rider, ill fitted saddle, poor conditioning
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what is the best dx technique for kissing spines?
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NS
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Tx for kissing spines?
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anti-inflamm injections, NSAIDs, saddle fit properly, ESWT, acupuncture, gel pad, modified exercise routine
Sx: partial excision of every other spinous process |
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Sacroiliac subluxation clinical signs include?
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muscle spasm, pain, hind limb lameness, reluctance to jump, prominent tuber sacrale (hunters bump)
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Sacroiliac prognosis?
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Guarded
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what is a knocked down hip?
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displaced fx of tuber coxae
--swollen, painful, asymmetric from behind |
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How do you dx a pelvic fx?
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PE, clinical signs, rectal palp*, NS, rads, intra-artic anesthesia
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What breeds is coxofemoral lux common in?
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foals, minis, ponies
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most common location of coxofemoral luxation?
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cranio-dorsal
guarded prog |
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CO's and OINC's are final approving authority for all surveys on GP property under what amount?
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2500
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1
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