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Y4 EQ - Orthopaedics > The tarsus > Flashcards

The tarsus Flashcards

1
Q

The tarsus is also know as?

A

The hock

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2
Q

Is the hock a common site of pathology?

A

Yes

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3
Q

Which bones make up the tarsus

A

Tibia proximal, then talus
Central tarsal bone
3rd tarsal bone - Either side of it is the 4th tarsal bone and the fused 1st and 2nd tarsal bones
Distally = 3rd metatarsal bones + splint bones
On the plantar aspect is the calcaneus

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4
Q

Describe the joints in the tarsus

A

Tibia proximal, then talus – between them is the tarsocrural joint
Talocalcaneal joint on the plantar aspect
Proximal intertarsal joint
Distal intertarsal joint
Tarsometatarsal joint

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5
Q

Describe the tarsocrural joint in terms of motion

A

Large, high motion joint – where most of the flexion and extension of the tarsus comes from

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6
Q

Which tarsal bone is involved in the majority of weightbearing?

A

3rd tarsal bone

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7
Q

Which tissues articular with the calcaneus

A

Gastrocnemius muscle and SDFT

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8
Q

Describe communication between the tarsal joints

A

Proximal intertarsal joint – always communicates with the tarsocrural joint
Tarsometatarsal joint – communicates with the distal intertarsal joint in about 40% of cases

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9
Q

Name the tendons and ligaments found on the dorsal aspect of the tarsus

A
  • 2 main extensors – tibialis cranialis and peroneus tertius
  • Also long extensor tendon – extends down to the pedal bone
  • Either side of the tarsus and short (deep) and long (superficial) collateral ligaments
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10
Q

Name the tendons and ligaments found on the plantar aspect of the tarsus

A

Deep digital flexor tendon
Superficial flexor tendon
Tarsal sheaths

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11
Q

Which structure inserts on the calcaneus?

A

Gastrocnemius muscle

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12
Q

Where does the SDFT lie?

A

SDFT and its muscle lies over the top of the gastrocnemius, runs over the top of the calcaneus (held in place by a band of tissue)

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13
Q

Where does the DDFT lie?

A

Deeper is the DDFT – runs over the sustentaculum tali= horizontal shelf that arises from the anteromedial portion of thecalcaneus

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14
Q

Name the 3 calcaneal bursa - from superficial to deep

A

(Acquired) superficial bursae
Intertendinous bursa
Gastrocnemius bursa

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15
Q

Describe the main features of the (Acquired) superficial bursae

A

Between SDFT and skin
“Capped” hock – due to fluid
Occurs right on the point of the hock

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16
Q

Describe the main features of the intertendinous bursa

A
  • Between gastrocnemius and SDFT extending distally
  • Communicates with gastrocnemius bursa
  • Occurs slightly laterally on the point of the hock
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17
Q

Describe the main features of the gastrocnemius bursa

A

Deep between gastrocnemius tendon and tuber calcis

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18
Q

Describe the distribution of Osteochondritis Dissecans in the tarsus

A
  • Mostly: Distal intermediate ridge of the tibia (“DIRT” lesions)
  • Lateral trochlear ridge
  • (Medial malleolus)
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19
Q

What are the clinical signs of Osteochondritis Dissecans in the tarsus

A

Usually young horse (6mo-3yr):
- As it is a developmental condition
- Often found on screening radiographs
Effusion of the tarsocrural joint
(Lameness)
Check other limb/joints!

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20
Q

Describe how Osteochondritis Dissecans in the tarsus appears on radiography

A

Radiolucent osseous fragment located at the level of the distal intermediate ridge of the tibia = OCD DIRT lesion
Also small radiopaque osseous fragments associated with a larger radiolucent defect on the lateral trochlear ridge

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21
Q

How is Osteochondritis Dissecans in the tarsus treated?

A

Arthroscopy treatment to remove fragments

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22
Q

How old must a horse be to have Arthroscopy treatment for Osteochondritis Dissecans in the tarsus? Why?

A

Usually wait until 11 months+
As some subtle fragments may reattach and some may not have formed yet

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23
Q

What are the causes of tarsal bone collapse?

A

Developmental condition
Incomplete ossification:
- Dysmature/premature foal
- Neonatal maladjustment
- Can present as angular limb deformities

24
Q

Before diagnosis of tarsal bone collapse which DDx needs to be ruled out?

A

Septic physitis

25
Q

If a foal is diagnosed with tarsal bone collapse what do you need to tell owners?

A

If seen need warn owners of arthritis in the future as these bones are damaged at a young age

26
Q

How is tarsal bone collapse treated?

A

Supportive therapy until matures – load tarus symmetrically
Prognosis: poor esp if >30% collapse/fragmentation

27
Q

‘bone spavin’ is an equine term for which condition?

A

Osteoarthritis of the lower hock joints

28
Q

Which joints of the tarsus are most affected by osteoarthritis?

A

Mainly tarsometatarsal joint, sometimes also distal metatarsal joint (also PIT/TC/talocalcaneal)

29
Q

‘Juvenile spavin’ occurs as a result of?

A

Osteoarthritis of the small tarsal joints in young horses seen secondary to tarsal bone collapse

30
Q

How does Osteoarthritis of the small tarsal joints occur?

A

Poor conformation can lead to increased stress on the joint
Compression and rotation of small tarsal bones when stops/jumps?
Heritable?

31
Q

Describe the findings on a clinical exam in a horse with Osteoarthritis of the small tarsal joints

A
  1. Palpable exostoses; squared off toes or commonly NAD!
  2. Lameness (mild-moderate)
    - Unilateral/bilateral
    - “choppy, stabby gait”
    - Worse on inside/hard surface
  3. Poor performance/“stiff” - “back pain”
  4. Flexion test +ve - Not specific!!!
  5. Tarsocrural effusion esp with Proximal intertarsal OA
32
Q

Describe the ‘triad of disease’ seen with osteoarthritis of the tarsus

A

If a horse has tarsal pathology it is likely they will sacroiliac pathology and back pain
If the tarsus isn’t generating enough power this has to be made up by other parts of the body to compensate – causing them to strain

33
Q

Describe the use of diagnostic analgesia for Osteoarthritis of the small tarsal joints

A

Intra-articular versus perineural!!
- Joint blocks over nerve blocks
TMT/DIT anaesthesia

34
Q

Why is radiography performed after diagnostic analgesia in osteoarthritis cases?

A

A lot of horses with osteoarthritis have radiographic changes but not significant pain – so need to prove the radiographic changes are significant

35
Q

Describe the use of radiography for Osteoarthritis of the small tarsal joints

A

Four standard views: DP, LM, DMPLO, DLPMO
Poor correlation with clinical signs

36
Q

Describe the radiographic findings of TMT/DIT osteoarthritis

A
  • Complete loss of joint space
  • Mottling and sclerosis of tarsal bones – joint spaces should be crisp black lines
37
Q

Describe systemic medication treatment options for small tarsal osteoarthritis

A

NSAID’s
PSGAGs/HA
Bisphosphonates
Nutraceuticals

38
Q

Describe other treatment options for small tarsal osteoarthritis

A
  • Intra-articular medication = Corticosteroids +/- HA
  • Farriery: Improve breakover; lateral width
  • Chemical arthrodesis with Ethyl alcohol
  • Surgical arthrodesis
39
Q

Describe how ethyl alcohol is used to treat small tarsal OA

A

Alcohol will destroy cartilage and then fuse the tarsal joints
- Pain comes from bone grinding on bone and this will no longer happen
- Do not want to get alcohol in the tarsocrural joint as this is a high motion joint
- Contrast study performed to make sure its going into the right place

40
Q

In which locations can tarsal fractures occur?

A

Malleolar (of the tibia)
Calcaneal
Small tarsal bones

41
Q

How are malleolar fractures treated?

A

Can remove arthroscopically

42
Q

How are calcaneal fractures treated?

A

May be unstable and therefore euthanasia

43
Q

How are small tarsal bone fractures treated?

A

Conservative or internal fixation

44
Q

Describe tarsal Luxations locations

A

Usually TMT or PIT

45
Q

How are distal intertarsal joint luxations prevented?

A

4th tarsal bone

46
Q

How do tarsal luxations present?

A

Severe lameness+ swelling
Stress radiographs

47
Q

How are tarsal luxations treated?

A

Cast +/- internal fixation
Or euthanasia

48
Q

Name 3 soft tissue injuries of the tarsus

A

Collateral ligament injuries
Tarsal sheath swelling
Calcaneal bursa/lateral luxation of SDFT

49
Q

Describe treatment options for Collateral ligament injuries

A

Rest
NSAIDs; cold hosing; bandaging
Physiotherapy
Intra-articular medication?
Monitor with ultrasound
Poor px if OA of joint develops

50
Q

The term ‘thoroughpin’ refers to which condition?

A

Tarsal sheath synoviocoele

51
Q

How does Tarsal sheath synoviocoele present?

A

Mild or no lameness
Large unilateral swelling in caudodistal crus
- Tear in synovial wall
- Valve effect leads to fluid build up
Usually no osseous pathology

52
Q

How does Tarsal sheath synoviocoele present on ultrasound?

A

Effusion+++ with fibrinous deposits
Usually no DDFT lesion

53
Q

Describe management of Tarsal sheath synoviocoele

A
  1. Conservative management
    - Drainage and corticosteroids
    - Tends to recur
  2. Surgical management – enlarge communication tenoscopically
54
Q

Where does a Calcaneal bursa/lateral luxation of SDFT most commonly occur?

A

Tend to tear medial attachment leading to lateral luxation

55
Q

Describe the clinical presentation of a horse with calcaneal bursa/lateral luxation of SDFT

A

Often lots of swelling
Bursal effusion ++
Horse agitated ++
- Don’t want to put their foot down
- May see SDFT “sliding off” point of hock as walks

56
Q

How is calcaneal bursa/lateral luxation of SDFT treated?

A

Rest, NSAIDs
Surgery (debride tear)

Y4 EQ - Orthopaedics (14 decks)

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