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Year 4 > Equine Orthopoedics > Flashcards

Equine Orthopoedics Flashcards

1
Q

How would you identify acute and chronic tendon injury on US?

A

Acute: hypoechoic (darker) areas
Chronic: heterogenous pattern of variable amounts of hypoechogenicity and hyperechogenicity

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2
Q

What is an exostosis?

A

Benign outgrowth of cartilaginous tissue on a bone

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3
Q

How do you treat exostosis on the distal radius?

A

If impinging on tendons: tenoscopic exam
If not impinging: look for another source of lameness. If none found but still positive to carpal sheath block: do tenoscopy

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4
Q

What would you suspect if you saw acoustic shadowing on an US of a tendon sheath?

A

Foreign body

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5
Q

Why is it so important to treat incomplete radial fractures?

A

Radius is a weight-bearing bone so is at high risk of propagating leading to a complete fracture (commonly fatal)

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6
Q

How do you treat radial fractures?

A

Stabilisation (need to stabilise joint above and below)
Bandage from foot to as high as possible
Ideally 2 splints (caudal and lateral):
Caudal: foot to olecranon
Lateral: foot to withers
Box rest and cross-tie to prevent lying down
Repeat rads in 2-4 weeks

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7
Q

What should you do in a case of suspected radial fracture with no obvious fracture line on x-ray?

A

Treat as if it’s fractured and re-radiograph in 2 weeks- fracture will be more obvious then

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8
Q

What would make you suspect an ulna fracture?

A

Horse can’t extend carpus (failure of passive stay apparatus)

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9
Q

How would you stabilise an ulna fracture for referral?

A

Splint at the palmar aspect to lock carpus in extension

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10
Q

Give some differentials for a positive response to carpal sheath anaesthesia

A

Tendinitis of the DDFT or SDFT

Osteochondroma/ exostosis

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11
Q

Should you splint a humeral fracture?

A

NO!
It will act as a fulcrum and make things worse
Poor prognosis

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12
Q

How do you treat deltoid tuberosity fractures of the humerus?

A

If radius is not involved:
Clean and debride wound and remove bone fragments
Treat conservatively, let wound heal by 2nd intention
Good prognosis

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13
Q

How do you treat a bicipital tendon injury?

A

Controlled exercise
Intra-lesional therapies
Shock wave for insertional injuries
Bicipital bursoscopy

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14
Q

Which is the best radiographic view to diagnose a humeral tubercle fracture?

A

Skyline (cranioproximal-craniodistal oblique)

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15
Q

How do you treat osseous cyst-like lesions of the shoulder?

A

Arthroscopic surgery

Joint medication: corticosteroids, IRAP

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16
Q

How do you treat osteoarthritis?

A 
Arthroscopic evaluation
Intra-articular corticosteroids
IRAP
NSAIDs
Weight management
Dietary modification (eg adding omega 3 fatty acids)
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17
Q

What are the 3 compartments of the stifle?

A

Femoropatellar

Medial and lateral femorotibial (divided by an intact septum)

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18
Q

In the stifle, does the femoropatellar compartment communicate more with the medial or lateral femorotibial compartment?

A

Medial

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19
Q

Give some clinical signs of OCD of the stifle

A

Stifle effusion

Lameness

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20
Q

Which part of the stifle is most affected by OCD?

A

Lateral trochlear ridge of (distal) femur

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21
Q

Give the treatment options for OCD

A

Conservative: if <8-12 months old. Dietary advice, exercise restriction.
Surgery: if >12 months old. Removal of osteochondral fragments. Curettage to healthy subchondral bone.

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22
Q

How old are horses when they present with osseous cyst-like lesions?

A

1-3 years +

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23
Q

Which femoral condyle is usually affected by osseous cyst-like lesions?

A

Medial

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24
Q

Give some clinical signs of an osseous cyst-like lesion

A

Lameness ++

+/- joint effusion

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25
Q

Give the treatment options for an osseous cyst-like lesion

A

Inject joint with intra-articular corticosteroids
Inject cyst under GA (with corticosteroids)
Debride cyst (may worsen it)
Bone screw across cyst

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26
Q

How can you treat a patellar fracture?

A

Surgical removal if <1/3, or fixation

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27
Q

What are the treatment options for a complete fracture of the femur/tibia?

A

If adult/ >250kg/ comminuted/open: euthanasia

If foal or weanling: possible to repair but requires high expertise

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28
Q

How do you treat tibial stress fractures?

A

Rest/alteration to exercise regime

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29
Q

Give some clinical signs of pelvic fractures

A

Pain/swelling/muscle spasm
Lameness
Signs of shock (if iliac arteries are severed)
Muscle atrophy
Nerve damage (decreased muscle/anal tone)
Sharp discontinuity on rectal exam

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30
Q

Give the treatment options for pelvic fractures

A 
NSAIDs
Box rest (cross tie for >1 month if major fracture), 2 months box rest with daily walking out, then 2 months field rest
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31
Q

Give some clinical signs of sacroiliac disease

A

Lameness
Poor performance
Pelvic asymmetry (muscle atrophy)
Pain/swelling

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32
Q

Give the treatment options for sacroiliac disease

A

Acute: 4-8 weeks box rest, NSAIDs, physio
Chronic: work + NSAIDs, aim to build up limb/pelvic muscles, peri-lesional injections of corticosteroids, physio, shockwave analgesia

33
Q

Give the clinical signs of aortoiliac thrombosis

A

Poor performance to severe/acute onset lameness
Distressed/kicking out
Affected limbs feel cool/reduced saphenous filling time
Rectal exam: reduced pulse amplitude

34
Q

What is the treatment for aortoiliac thrombosis?

A

NSAIDs
Platelet inhibitors eg aspirin
Guarded prognosis

35
Q

How do you treat incomplete mineralisation of the carpal bones?

A

Restricted exercise
Bandage with a light splint (don’t include digit)
Repeat radiographs every 2 weeks
Balanced nutrition

36
Q

How do you treat peri-articular laxity causing angular limb deformities in foals?

A

Controlled exercises to strengthen peri-articular soft tissues
Exercise in pool
Be careful with bandaging

37
Q

Give the causes of angular limb deformities

A

Congenital: incomplete mineralisation of carpal bones, peri-articular laxity

Acquired: imbalanced nutrition, trauma, genetics (rapid growth)

38
Q

What are the treatment options for angular limb deformities in foals?

A 
Limited exercise
Bandages, splints
Corrective hoof trimming
Limit mare and foal nutrition
Surgery (growth acceleration/retardation)
39
Q

How do you ‘accelerate growth’ when treating ALD?

A

Periosteal elevation on the concave side, just proximal to physis
Does not over-correct
Always combine with hoof trimming

40
Q

How do you ‘retard growth’ when treating ALD?

A

Use implants to bridge the physis on the convex side (side that is growing fastest)
Risk of over-correction- remove the implants once straightened!
Always combine with hoof balancing

41
Q

How do you treat digital hyperextension in neonates and what causes it?

A

Caused by laxity of flexor tendons
Tx: laxity reduces with exercise, corrects in 1-2 weeks
If severe, protect the heel bulbs (palmar/plantar extensions)

42
Q

What are the treatment options for flexural limb deformities?

A

Conservative: physio, splints, farriery if DIP joint (to extend the toe), analgesia
Medical: oxytetracycline (diluted in saline)
Surgical: desmotomy

43
Q

How do you surgically treat a FLD of the DIP joint?

A

Desmotomy of the AL-DDFT (accessory ligament of DDFT)

Combine with conservative tx

44
Q

How would you treat a FLD of the carpal joint?

A

Palmar/plantar splint
Oxytetracycline
Analgesia
Surgery: palpate which tendons are most affected when extension is forced:
-If SDFT: proximal check lig desmotomy
-If DDFT: distal +/- proximal check lig desmotomy
-Severe cases: both proximal and distal

45
Q

Give some clinical signs of septic arthritis in foals

A 
May be reluctant to stand
Joint effusion
Peri-articular swelling
Lameness
Filling of mare's udder
46
Q

How would you identify septic physitis on a radiograph?

A

Irregular/widened physis
Radiolucency
Soft tissue swelling

47
Q

How do you diagnose septic synovitis?

A 
Synoviocentesis into an EDTA tube:
Turbid, serosanguinous, reduced viscosity
>20x10^9/L cells
>80% neutrophils
Total protein >30g/L

Can also do culture and sensitivity

48
Q

How do you treat septic synovitis?

A

Lavage synovial structure
Antimicrobials
NSAIDs

49
Q

How would you recognise stress-related dorsal metacarpal/tarsal disease on a radiograph?

A

Increased cortex thickness (due to modelling in response to loading)

50
Q

How do you treat dorsal metacarpal/tarsal disease?

A

Rest

Stimulate remodelling and healing by drilling/placement of a screw

51
Q

How do you treat diaphysial fractures of MC3/MT3?

A

Internal fixation

52
Q

What are ‘splints’?

A

Periostitis between 3rd metacarpal/tarsal bones and splint bones (periosteal new bone formation)
Secondary to damage to suspensory ligament
Most commonly between MC3 and MC2, and MT3 and MT4

53
Q

Are ‘splints’ clinically relevant?

If so, how do you treat them?

A

Many are of no clinical significance, but if extensive, can impinge on suspensory ligament: infiltrate with corticosteroids, removal in some cases

54
Q

How do you treat fractured splint bones based on their location?

A

Proximal: need healing/fixing
Mid: most can be removed
Distal: can be removed

55
Q

Which diagnostic procedure could you use in a lameness without clinical signs, or inconclusive radiographs?

A

Scintigraphy

56
Q

Which carpal bone is more at risk of slab/bi-articular fractures?

A

Third carpal bone

57
Q

How do you treat slab/bi-articular fractures of the carpal bones?

A

If incomplete and non-displaced: 6 months rest
Surgery:
Thin fractures: surgically remove
Internal fixation

58
Q

What is the function of the palmar intercarpal ligaments?

A

Prevent dorsal displacement of intercarpal joint

59
Q

What is the only treatment option for multiple palmar fragmentation?

A

Arthrodesis

60
Q

How do you treat OA of the tarsal joint?

A

Intra-articular steroids
Intra-articular ethanol
Surgical arthrodesis

61
Q

How does the prognosis for suspensory desmitis differ between the FL and HL?
Why does it differ?

A

FL: usually favourable prognosis without surgery
HL: usually unfavourable prognosis without surgery
Due to risk of compartment syndrome in the HL: close proximity of suspensory ligament to MT3 and thick fascia -> pressure on plantar metatarsal nerves
Can transect fascia to relieve pressure or transect nerves innervating the suspensory ligament (lateral plantar nerve)

62
Q

What is the treatment for suspensory ligament desmitis of the FL?

A 
Controlled exercise for 3-4 months
Shock wave (analgesia, stimulates healing)
If recurrent/non-responsive: intra-lesional PRP, stem cells, neurectomy
63
Q

What is the treatment for suspensory ligament desmitis of the HL?

A

Surgery:
Can transect fascia to relieve pressure and prevent compartment syndrome
Can also transect nerves that innervate the suspensory ligament (lateral plantar nerve)

64
Q

How do you identify C6 on a radiograph?

A

It is shorter than C5
Has a transverse process split into a cranial, caudal and ventral part
Ventral process= how we recognise it on radiographs

65
Q

How do you identify C7 on a radiograph?

A

Shorter than C6

Has a small dorsal spinous process

66
Q

How do you identify T1 on a radiograph?

A

Has a large dorsal spinous process

67
Q

Give some presenting signs of neck pain

A

Neck stiffness/pain/’locking’
Acute trauma
Poor performance/ problems performing specific manouvres
Ataxia (usually low-grade)

68
Q

Why are disc problems rare in horses?

A

No nucleus pulposus (only fibrous intervertebal discs)

69
Q

Give some presenting signs back pain

A 
Poor performance
Behavioural changes
Uncomfortable when ridden
Stiffness in the back
Back spasms
Difficulty in being tacked up
Bucking/rearing
70
Q

How do you treat fractures of the withers?

A

2-3 months box rest

NSAIDs

71
Q

How would you recognise saddle-induced trauma?

A

Dry spot under saddle after riding
Indicates excessive pressure
Often see hair loss/swelling/increased sensitivity

72
Q

How do you treat saddle-induced trauma?

A

Rest/ice
US therapy
Low-powered laser for indolent wounds
Correct inciting cause

73
Q

What are the clinical signs of supraspinous ligament damage?

A

Rigid gait/elevated head/reduced stride
Heat/pain/swelling (acute)
Thickening of ligament (chronic)

74
Q

How do you diagnose supraspinous ligament damage?

A

US

75
Q

How do you treat supraspinous ligament damage?

A

Acute: cold compress, NSAIDs, rest
Chronic: physio, shockwave analgesia?

76
Q

What is ‘kissing spine’?

A

Impingement of the dorsal spinous processes

Not always significant

77
Q

How do you diagnose ‘kissing spine’?

A

Confirm significance
Intra-lesional LA
Exclude other causes of pain first

78
Q

What are the treatment options for impinging dorsal spinous processes?

A

Medical/conservative: PBz, shockwave therapy, phyio

Surgical: removal of all/part of the affected dorsal spinous processes

79
Q

How can you treat dorsal articular facet arthropathy (spine arthritis)?

A 
Light plane of work +/- NSAIDs
Oral supplements?
Phyio
Shockwave therapy
US-guided periarticular injections

Year 4 (51 decks)

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