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MSK2 > Equine MSK diseases > Flashcards

Equine MSK diseases Flashcards

1
Q

List the causes of equine synovial sepsis in adults

A
  • Trauma
  • Post injection
  • Post-surgery
  • Idiopathic
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2
Q

What is the most common cause of synovial sepsis in foals?

A
  • Haematogenous spread of infection

- Septicaemia next most common cause

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3
Q

What are the most common pathogens identified in equine synovial sepsis?

A
  • Aerobic or facultative anaerobes
  • E. coli, Streps, Staphs
  • If traumatic, often mixed infection including Clostridia
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4
Q

How may trauma lead to synovial sepsis in the horse?

A
  • Direct inoculation of the joint
  • Abscess erosion into joint after initial injury
  • Osteomyelitis
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5
Q

What condition would the following findings be indicative of in a horse?

A
  • Warm joint
  • Joint effusion
  • Localised oedema/cellulitis
  • Pain on palpation and flexion
  • Marked lameness
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6
Q

Describe the appearance of an open joint with synovial sepsis in horses

A
  • Active discharge of synovial fluid from wound
  • Viscous synovial fluid initially, the becomes more watery
  • Lameness less severe vs. closed
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7
Q

Describe the appearance of a closed joint with synovial sepsis in horses

A
  • Usually penetrating injury with original entry wound sealed
  • No discharge of synovial fluid
  • Joint distension and pressure
  • Removal of fluid allows alleviation of distension and lameness
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8
Q

Outline the method for synoviocentesis in horses

A
  • In field or hospital
  • Must be aseptic: clip, surgical scrub (>3min contact time for chlor-hex or pov-io), sterile equipment, sterile gloves, no touch technique
  • Sedate horse
  • Enter away from wounds/cellulitis/dermatitis/source of infection
  • Large bore needle
  • Leave in place for further tests/adminisitration of antibiotics
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9
Q

What is a potential complication for synoviocentesis in chronic wounds in horses?

A

Cellulitis may be extensive, preventing access to joint

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10
Q

In which cases is synovial proliferation most likely to occur in horses?

A
  • Fetlock proximal pouches, tarsocrural joints
  • Chronic synovitis
  • Chronic infection
  • Open joints where most of fluid has drained
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11
Q

What should be used to collect the synovial fluid from synoviocentesis in a horse?

A

EDTA, +/- culture bottle

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12
Q

Outline how synovial proliferation can be overcome in order to obtain a sample from synoviocentesis in a horse

A
  • Gentle aspiration and infusion of air to move synovial fronds from end of needle
  • Go for most dependent/distended point
  • Avoid areas of synovial proliferation
  • Infuse small amounts of saline and re-aspirate (will alter all parameters)
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13
Q

What would the following joint fluid analysis results suggest in a horse?

  • Yellow, turbid appearance
  • Total protein 46g/l
  • Watery viscosity
  • WBC: 57x10^9/L, 91% neutrophils
  • pH 7.0
A
  • Synovial sepsis
  • Normals: clear/slightly yellow, clear
  • Total protein 10-20g, infected >40g/l
  • Viscosity: form 2.5-5cm string from fingers, 5-7cm string from syringe
  • WBC count: 0.2x10^9/l, <10% neutrophils, some lymphocytes and mononuclear cells
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14
Q

How can it be determined whether or not a wound is communicating with the joint space in horses?

A
  • Inject 50-200ml of sterile isotonic electrolyte solution
  • If joint not involved, should achieve moderate degree of distension
  • Move horse a few steps so joint is flexed and extended
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15
Q

What should be done prior to removing a needle following synoviocentesis in horses?

A
  • Drain excess fluid and administer intra-articular antibiotics
  • Even if is to go under GA and flush, will make horse more comfortable and improve chance off recovery
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16
Q

When is radiogrpahy indicated in the investigation of synovial sepsis in horses?

A 
- Where there is a chance of osteomyelitis
(all foals)
- Any causes of blunt trauma
- Possibility of fracture
- Foreign body
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17
Q

If radiography is performed prior to synoviocentesis, what does gas in the joint capsule indicate in horses?

A

Open joint

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18
Q

Outline the role of ultrasonography in the investigation of synovial sepsis in horses

A
  • Identify radiolucent foreign bodies

- Soft tissue damage e.g. SDFT in plantar calcaneal injuries, DDFT in medial hock and tarsal sheath injuries

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19
Q

What are the principles of synovial sepsis treatment in horses?

A
  • Must be ASAP and aggressive
  • Systemic and intra-articular antibiotics
  • Joint lavage and drainage
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20
Q

What are the options for lavage in a case f synovial sepsis of a horse?

A
  • Through and through lavage
  • Arthroscopic lavage
  • Repeated open lavage and drainage
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21
Q

Outline the aspects that must be ensured when performing through and through lavage for a case of synovial sepsis in a horse

A
  • Large vols. of fluid (3-5L for small joints, 5-10L for large joints)
  • Ensure joint distended and flushed (finger over needle end or close flushing catheters to prevent premature drainage)
  • Multiple portals and rotate for lavage and drainage
  • Adminster fluids under pressure
  • Ensure wound is explored, flushed and debrided
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22
Q

What portals should be used for through and through lavage of a tarsocrural joint in synovial sepsis in a horse?

A
  • Dorsomedial
  • Dorsolateral
  • Plantaromedial
  • Plantarolateral
  • Move ingress through all of these
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23
Q

When if through and through lavage for synovial sepsis not a good option?

A
  • Chronic or concurrent infection
  • Heavy gross contamination e.g. distal limb lacerations in hunting field
  • Fractures or foreign bodies that need further treatment
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24
Q

Outline the advantages of using arthroscopy for lavage for synovial sepsis in a horse

A
  • Allows visualisation and surgical manipulation of regions e.g. heavily contaminated regions
  • Removal of fractures/foreign bodies
  • Debridement of osteomyelitis
  • Resection of synovial proliferation in chronic cases
  • Can facilitate further surgical intervention as required
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25
Q

In what cases is arthroscopic lavage for synovial sepsis in horses indicated?

A
  • Infection is chronic or recurrent
  • Heavy gross contamination
  • Fractures or foreign bodies that need further treatment
  • Wounds >24yrs old
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26
Q

In what cases is repeated open lavage for synovial sepsis in horses indicated?

A

Chronic, refractory or heavily contaminated cases, or to maintain arthrotomy wounds for continuous drainage

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27
Q

What are the disadvantages of repeated open lavage in the treatment of synovial sepsis in horses?

A
  • Very expensive
  • Time consuming
  • Difficult to maintain sterility
  • Chronic inflammation means poor prognosis for return to athletic function
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28
Q

Justify the use of systemic antibiotics in the treatment of synovial sepsis in horses

A

In most cases there is another source of sepsis, cutaneous wound, cellulitis or osteomyelitis which may not be affected by intra-articular antibiotics

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29
Q

Justify the use of intra-articular antibiotics in the treatment of synovial sepsis in horses

A

Reach 1000x the concentration of systemic antibiotics without systemic side effects

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30
Q

Identify the systemic antibiotics that are commonly used in the treatment of synovial sepsis

A
  • Broad spec based on C+S
  • Penicillin + aminoglycoside
  • Or 3rd gen cephalosporins
  • Enrofloxacin alternative option (not licensed, not for animals <3yo or lactating mares)
  • Gentamicin most effective and least toxic given 6.6mg/kg IV SID
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31
Q

Identify the antibiotics that are used intra-articularly in the treatment of synovial sepsis in horses

A
  • Gentamicin
  • Amikacin
  • Sodium penicillin
  • Ceftiofur
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32
Q

Give alternative options to the typical antibiotics used in the treatment of synovial sepsis in horses

A
  • Impregnated PMMA beads
  • Bio-absorbable slow release drug
  • Regional perfusion
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33
Q

Outline PMMA beads in the treatment of synovial sepsis in horses

A
  • Best for low motion/chronically infected joints
  • Slow release of anitbiotics over 2 weeks
  • Only gentamicin available commercially, but can make own
  • Mechanical effect can be consideration for long term issues in high motion joints
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34
Q

Outline bio-absorbable slow release antibiotics in the treatment of synovial sepsis in horses

A
  • Commercially available only gentamicin impregnated collagen (high cost)
  • Good for refractory cases
  • Suitable in high motion joints, tendon sheaths
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35
Q

Outline regional perfusion of antibiotics in the treatment of synovial sepsis in horses

A
  • Tourniquet and intravenous/intraosseus injection
  • Most suitable for foals, or horses under GA
  • Higher concentrations achieved with intra-articular administration
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36
Q

Describe the analgesia used in the treatment of synovial sepsis in horses

A
  • Must use NSAIDs

- DMSO

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37
Q

Explain why NSAIDs must be used in the treatment of synovial sepsis in horses

A
  • Reduce joint pain
  • Increase mobilisation
  • Decrease joint stiffness
  • Decrease Pg release
  • reduce collagen joint destruction
  • reduce risk of contralateral limb laminitis
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38
Q

Discuss the use of DMSO in the treatment of synovial sepsis in horses

A
  • Administered into lavage solution
  • Provides analgesia and anti-inflammatory effects
  • Care with handling
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39
Q

Discuss bandaging in the management of synovial sepsis in a horse

A
  • Essential, along with wound care
  • Maintains sterility, provides comfort, optimal wound healing
  • First layer should be sterile
  • Bandage keep clean and dry to avoid reintroducing infection
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40
Q

Outline the post-operative care in a case of synovial sepsis in a horse

A
  • Rest essential, but not complete box rest
  • Once active inflammation resolved: passive flexion, gentle hand walking, in hand grazing
  • Physiotherapy
  • Gradually increase exercise
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41
Q

Explain the importance of passive flexion, hand walking etc. in the post-op care for synovial sepsis in horses

A
  • Mobilise joint
  • Improve drainage and lymphatic flow
  • reduce oedema
  • Promote lubrication
  • Decrease capsulitis
42
Q

What additional drugs can be used in the management of synovial sepsis in horses for long term treatment? How should these be used?

A
  • Hyaluron, PsGAGs, low dose corticosteroids
  • Best once infection resolved
  • Any route other than intra-articular
43
Q

Discuss the prognosis for synovial sepsis in adult horses

A
  • Very good with appropriate treatment
  • Prognosis for resolution of infection adn return to athletic function: >80%
  • Prognosis for return to athletic function reduced in horses with pre-existing arthritis and articular damage
  • Bony damage, osteomyelitis, severe contamination, wounds that cannot be closed, chronic wounds: worse prognosis
  • Site of infection affects prognosis
44
Q

Which sites are typically associated with a worse prognosis following synovial sepsis in mature horses?

A
  • Distal tarsal joints
  • Calcaneal bursal
  • Navicular bursal infections
45
Q

Outline the prognosis for synovial sepsis in foals and identify factors affecting the outcome

A
  • 50% for resolution of infection, only 30% achieve racing performance
  • Septicaemia, osteomyelitis and hypogammaglobulinaemia affect outcome
46
Q

Where do tendon sheaths occur and what is their function?

A
  • Points of friction, occur wherever tendons cross high motion joints e.g tarsal and carpal joins
  • Surround and protect, enabling tendon to glide smoothly
47
Q

Describe the tendon sheaths of the fetlock joint (name, location, structure)

A
  • Common digital synovial sheath
  • Reaches from distal cannon to middle phalanx
  • Palmar aspect has 9 pouches
  • Encloses superficial and deep flexor tendons
48
Q

Describe the appearance of swelling of the fetlock tendon sheath

A
  • Most easily visible proximal and palmar to fetlock joint

- Also known as windgalls

49
Q

What are tendon bursae?

A
  • Fluid filled sacs that facilitate sliding at major pressure points e.g. between bones and muscles/tendons/ligaments or between skin and bones/muscles/tendons/ligaments
  • Synovial structures with synovial membrane and synovial fluid
50
Q

Explain the presence of synovial bursae

A
  • Presence inconstant depending on mechanical challenges, age, body condition
  • Trauma can lead to acquired bursae
51
Q

Briefly outline the structure of tendons

A
  • Collagen fibrils organised into fibres, then organised into parallel bundles
  • Primary bundles (fibres) and secondary bundles (fascicles)
  • Structure maintained by loose connective tissue - endo-, peri- and epitenon
52
Q

Compare the roles of the endo-, peri- and epitenon

A
  • Endo: holds fibres together to form fascicles
  • Peri: holds fascicles together
  • Epi: surrounds the whole tendon
53
Q

Describe the structure of the point of insertion of tendons

A

transition from tendon to bone via fibrous cartilage which becomes progressively mineralised towards the bone

54
Q

Explain the function of the patellar ligaments of the equine stifle

A

Locks stifle and maintains limb in a weight bearing position with minimal muscular effort

55
Q

Explain the function of the cruciate ligaments of the stifle

A

Resist cranio-caudal movement of the stifle

56
Q

Explain why ligaments have poor ability to heal

A
  • Low metabolic funciton
  • Poorly vascularised
  • Poor innervation
57
Q

Where does failure of tendons and ligaments commonly occur and why?

A

Mostly within the muscle or within the bone at the site of attachment - biomechanically very strong, attachments are weak points

58
Q

Where do the flexor tendons of the equine distal limb originate?

A

Caudomedial humerus

59
Q

Where does the suspensory ligament of the equine distal limb originate and insert?

A
  • Origin: Palmar carpal ligament and metacarpal bone

- Insertion: sesamoid bones (extensor branches)

60
Q

Explain the value of ultrasonography of the equine distal limb?

A
  • Structures involved can be identified
  • Degree and extent of injury can be assessed
  • Healing/response to treatment can be monitored
61
Q

Describe the grading for changes in echogenicity in tendon injuries

A
  • Type 1: slightly less echogenic than normal
  • Type 2: half echogenic and half anechoic
  • Type 3: mostly anechoic
  • Type 4: completely anechoic
62
Q

Describe the fibre pattern/alignment scoring using in ultrasonography for tendon injuries in horses

A
  • 0: >75% fibres aligned parallel to target path
  • 1: 50-75% of fibres aligned parallel to target path
  • 2: 25-50% fibres aligned parallel to target path
  • 3: <25% fibres aligned parallel to target path
63
Q

Describe the normal ultrasonographic appearance of the SDFT

A
  • Homogenic and echogenic
  • Slightly less echogenic than DDFT
  • NB training can cause 10% increase in CSA and mild decrease in echogenicity
64
Q

Describe the normal ultrasonographic appearance of the DDFT

A
  • Homogenic and echogenic
  • Increased echogenicity compared with SDFt
  • Hypoechoic region in hindlimb at insertion of ALDDFT
  • Bilobed apperance in pastern
65
Q

Describe the normal ultrasonographic appearance of the ALDDFT

A

Homogenous and echogenic

66
Q

Describe the normal ultrasonographic appearance of the suspensory ligament

A
  • Heterogenous: muscle, connective tissue, fat and ligament fibres
  • Can contain hypoechoic areas (compare to contralateral limb)
  • Branches are homogenous and echogenic
67
Q

Compare the ultrasonographic appearance of a chronic healing tendon lesion vs. an acute lesion

A

Chronic healing lesions lack hypoechoic regions typically associated with acute lesions, but may remain grossly enlarged variable healing

68
Q

Which transducer frequency should be use for ultrasonography of equine distal limb?

A

10MHz

69
Q

What is the purpose of stand-off pads used in ultrasonography?

A
  • Increase distance between transduce and superficial structures
  • Adjust to uneven contours
70
Q

When taking a history for lameness, what lameness specific questions should be considered?

A
  • Prior lameness?
  • Duration of lameness
  • Onset and change in lameness
  • Last shoeing
  • Exacerbated by anything?
  • Medications and response to treatment
  • Any previous evaluations and if so, what was found?
71
Q

In a lameness workup, what factors are of particular importance in the physical examination?

A
  • Conformation
  • Foot balance
  • Distal limb conformation
  • Comparative observation
  • Posture (e.g. toe pointing?)
  • palpation of hoof, FL, HL, soft tissues, synovial effusion, ROM
72
Q

Briefly outline the palpation of soft tissues in the investigation of lameness

A
  • Palpate flexed and extended

- Looking for tendinitis and desmitis

73
Q

Outline the assessment of ROM in a lameness examination (i.e the normal ROM for each joint in the limb of a horse)

A
  • DIP cannot be assessed, PIP low motion joint cannot be assessed
  • MCP joints: bulbs of heal touch ergot
  • Carpus: high ROM, cannon can be brough almost parallel to radius
  • Tarsus and stifle: flex together, cannon should come horizontal to ground
74
Q

What would the ability to flex and extend the hock and stifle separately indicate in a horse?

A
  • Are linked by peroneus tertius
  • If ruptured, can flex hock and stifle separately
  • Occurs secondary to hyperextension of hock
75
Q

What signs of lameness should be looked out for in a dynamic lameness evaulation in the horse?

A
  • Shortened strides/abnormal tracking
  • Fetlock drop
  • Arc of flight altered
  • Abnormal landing of foot
  • Head/pelvic movement (most reliable)
76
Q

What would the following signs indicate in a horse at trot?

Head nod when right FL placed

A

Lame on left fore

77
Q

What would the following signs indicate in a horse at trot?

Shortened strides on RH, hip rises higher on RHS

A

Right hind lameness

78
Q

Identify the grade of lameness that fits with the following description:
mild, inconsistent lameness in straight line (subtle or inconsistent head nod or pelvic hike)

A

Grade 1

79
Q

Identify the grade of lameness that fits with the following description: severe lameness; extreme head nod/pelvic hike; horse is lame in walk but can be trotted

A

Grade 4

80
Q

Identify the grade of lameness that fits with the following description: moderate and consistent lameness (consistent head nod or pelvic hike, moving by several cm )

A

Grade 2

81
Q

Identify the grade of lameness that fits with the following description: obvious, marked lameness (head and pelvis move by several cm) head and neck nod seen with HL lameness

A

Grade 3

82
Q

Identify the grade of lameness that fits with the following description: severe, non-weight bearing lameness, horse cannot and should not be trotted

A

Grade 5

83
Q

What may be seen when lunging a horse with a forelimb lameness?

A
  • Exacerbation of weight bearing lameness on inside limb
  • Exacerbation of swinging leg lameness of outside limb
  • Distal injuries may be worse on hard, proximal injuries may be worse on soft
84
Q

If a horse is investigated for lameness, and all other tests are negative but a flexion test is positive, how should this be interpreted?

A

Unlikely to be significant, if all else is negative

85
Q

What are the options for diagnostic analgesia in the work up of lameness in horses?

A
  • Perineural
  • Intrasynovial
  • Local infiltration
86
Q

What conditions would contraindicate use of local analgesia in the investigation of equine lameness?

A
  • Fracture
  • Infection
  • Temperament issues
87
Q

What is required for intrasynovial anaesthesia for the investigation of lameness in a horse?

A
  • 5 min sterile prep
  • Sterile gloves
  • Sterile technique
  • Fresh bottle of anaesthetic
88
Q

What is required in order for diagnostic analgesia to be a useful test?

A

Need consistent lameness

89
Q

Describe the normal conformation of the equine forelimb when viewed from the front and from the side

A
  • Front: limb biseced by vertical line from shoulder to ground
  • Side: vertical intersects the elbow, carpal and metacarpophalangeal jionts
90
Q

Describe the normal conformation of the equine hindlimb when viewed from the front and from the side

A
  • Front: limb bisected by vertical line from the hip joint to the ground
  • Side: vertical line from tuber ischium touches point of hock and entire plantar aspect of the metatarsus
91
Q

What is the normal ground:dorsal hoof wall angle in the fore and hind limbs of a horse?

A
  • Fore: 45-50˚

- Hind: 50-55˚

92
Q

Describe the normal mediolateral balance of a horses foot

A

Coronary band and weight bearing surface of the foot should be parallel to the ground and perpendicular to a vertical line that bisects the third metacarpal bone

93
Q

What is a fluctuant swelling of the coronary band in the horse characteristic of?

A

Effusion of the distal interphalangeal joint

94
Q

What is an obvious dip in the coronary band in the horse characteristic of?

A

Distal displacement of the distal phalanx

95
Q

Compare the lameness on the lunge for a medial aspect of the foot vs other lesions

A
  • Most lameness in the foot will be exacerbated when affect limb is on the inside of the circle
  • If lesion is n medial aspect of foot, horse will likely be more lame when that limb is on the outside
96
Q

Identify the flexion tests that are commonly carried out in the horse

A
  • Distal forelimb (metacarpophalangeal joint and below)
  • Proximal forelimb (carpus and above)
  • Distal hindlimb (metatarsophalangeal joint and below)
  • Proximal hindlimb (tarsus and above)
97
Q

Outline the back examination in a horse

A
  • Palpate specific muscles: stenomandibularis, brachiocephalicus - difficult, but can find and palpate fascial boundaries between 3 lanes (transversospinalis, longissimus, iliocostalis) in the Th-L region
  • Palpate for pain, tension, spasm
  • Flex spine - ventro, dorsi and lateroflexion, should have easy flexion over a few degrees
98
Q

In horses, what may result from severe spasms of longissimus dorsi and other epaxial muscles on one side? How can this be identified?

A
  • Functional scoliosis

- Pressure over affected muscle is very painful

99
Q

How is pain or instability of the pelvic girdle assessed in horses?

A

Push tuber coxae ventrally and medially using both hands

100
Q

Discuss the use of radiography in the diagnosis of back pain in horses

A
  • Thoracic: good, large lung fields, spinous processes and vertebral bodies easily identifiable
  • Lumbar generally unrewarding
  • Pelvic useful for fractures, arthritis
  • Sacroiliac disease difficult to confirm radiographically

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