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equinee > Day 4 - Lameness > Flashcards

Day 4 - Lameness Flashcards

(39 cards)

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1
Q

Causes of injuries (7)

A
  • Trauma
    Septic synovial sheet/joint → pain and even death
  • Congenital
    Coangulation, Navicular diseases Enlarged synovial channels
  • Acquired
  • Infection - septic joint is an emergency
  • Metabolic disturbances - osteoarthritis, clots, hernia, laminitis
  • Circulatory disorders - aortoiliac thrombosis
  • Nervous system

Mechanical and paralytic disorders

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2
Q

Classification of lameness (6)

A
  • Supporting limb lameness
  • Swinging limb lameness
  • Mixed lameness
  • Complementary lameness
  • Untypical lameness
  • Special lameness
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3
Q

Severe left hind limb lameness

A

med. femorotibial osteoarthritis

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4
Q

Provacation tests

A

find out

Shoulder flexion
Elbow flexion
Carpal flexion
Hock flexion
Navicular flexion

Hip flexion
Stifle flexion
Hock flexion
Navicular flexion

Fetlock flexion test
Shoulder flexion test
Lower limb flexion (?)

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5
Q

Supplementary diagnostic tools in lameness

A

US, x-ray, arthroscopy, MRI, CT, synovial analysis

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6
Q

Lameness - local ana

irritant, non irritant and long/short acting

A

Lidocain - irritant

Less irritant
Mepivacaine - short acting
Bupivacaine - long acting (not really used)

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7
Q

Lameness - sedation

A

Xylasine or Detomidine/butorphanol

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8
Q

Deep digital nerve anesthesia - structures ana

A
  • Palmar foot
  • Toe
  • DIP joint
  • +/- distal DDFT lesions
  • Occasionally PIP joint
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9
Q

Abax. Sesamoid Block - structures ana

A
  • as for PDP
  • sometimes includes fetlock joint and sesamoid bone
  • distal DDFT
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10
Q

Distal interphalangeal joint analgesia - structures at 6 ml and 10 ml

A
  • Structures anaesthetised with 6 ml
  • DIP joint
  • Dorsal sole (toe)
  • (not the heel)
  • 10 ml anaesthetic
  • Blocks heel as well
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11
Q

Navicular bursa analgesia - structures

A
  • Navicular bursa
  • Dorsal sole (toe)
  • Navicular bone
  • Navicular ligaments
  • (not the heel)
  • 30 minutes: DIP joint
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12
Q

4 point block (N. digit. palm., nn. metacarpales - structures

A
  • As for PDB plus:
  • Metacarpophalangeal (MCP) region
  • PD nerve onlyàUseful for annular ligament analgesia

Positive 4 block
Differentiate structures with: -
* MCP analgesia
* Digital sheath analgesia

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13
Q

Metacarpophalangeal joint anesthesia - structures

A
  • MCP joint
  • Subchondral bone,
  • After 30 min, distal branches of susp. lig and sesamoids
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14
Q

Metacarpophalangeal joint anesthesia - structures

A
  • MCP joint
  • Subchondral bone,
  • After 30 min, distal branches of susp. lig and sesamoids
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15
Q

Digital flexor tendon sheath (DFTS) analgesia - structures

A
  • Digital sheath
  • Local structures with time
  • Annular ligament
  • Often only a partial improvement
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16
Q

High palmar block - structures

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A
  • Whole metacarpal region
17
Q

Positive subcarpal analgesia - next test

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A

perform middle carpal joint analgesia

18
Q

N. musculocutaneous
Elbow analgesia

19
Q

Pastern ring block

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A
  • induces dorsal branches, and dorsal metatarsal nerves
  • Blocks pastern and foot?
20
Q

Low plantar six point

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A
  • plantar digital nerve
  • plantar metatarsal nerve
  • dorsal metatarsal nerve

Blocks all tissues distal to block
If positive; block fetlock and digital sheat

21
Q

Subtarsal (high plantar)

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A
  • plantar and plantar metatarsal nerves
  • blocks susp. lig, complete ring block
22
Q

Energy storing
Positional

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A

SDFT (Support the hyperextended metacarpophalangeal joint during weight-bearing)

Digital extensor tendons

23
Q

Injuries based on type of horse
Racing thoroughbreds
Show jumpers
Eventers
Dressage

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A
  • Racing Thoroughbreds: SDFT in forelimb - mid metacarpal region
  • Elite show-jumpers: forelimb SDFT & DDFT injuries
  • Elite eventers: forelimb SDFT injuries
  • Dressage horses: hindlimb suspensory ligament injuries
24
Q

Complete rupture, loss of function
Deep digital flexor tendon

Study These Flashcards
A
  • Toe flips up
  • If in the metacarpal/metatarsal region and outside the DFTS
    • Can heal satisfactorily if immobilized
  • If ruptured near the insertion or within the DFTS - poor prognosis
25
Complete rupture, loss of function Suspensory ligament
* Fetlock drops - hyperextension * Grave prognosis * Degenerative / traumatic / catastrophic
26
Non-traumatic tendon & ligament injuries
* Tendinitis/tendinopathy * Desmitis/desmopathy overstrain injuries degenerative proc (most common)
27
Repair of tendon & ligament injuries No regeneration! (4)
1. Intratendinous haemorrhage immediately after injury 2. Inflammatory reaction * Designed to remove damaged tendon tissue 3. Reparative phase * Starts within a few days * Angiogenesis and scar tissue formation 4. Remodelling phase * Gradual, incomplete replacement of type III to type I
28
Superficial digital tendon injury
* Most common site: mid-metacarpal region. Common injury in racehorses and jumpers * Within the DFTS and the carpal sheath. Less common * In the pastern region. Often traumatic - overreach Not US too quickly
29
Superficial digital tendon injury - Tx (3)
Acute phase Subacute phase (fibroplastic phase) Chronic (regenerative) phase
30
Superficial digital tendon injury - Tx Actue phase
Aim to minimize inflammation & limit the action of proteolytic enzymes * Physical therapy – rest, cold, immobilization (Rupert jon to decrease hemorrhage) * Systemic short-acting corticosteroids in first 24-48 hours * Never intralesional steroids – calcification! * NSAID’s – some controversy * (Surgical treatment – tendon splitting, desmotomy of AL-SDFT)
31
Superficial digital tendon injury - Tx Subacute phase
* Progressive mobilization. Should start walking, collagen need to be formed * Ultrasonographic monitoring * Regenerative therapies - tendons do not regenerate! - Mesenchymal stem cell therapy - Stem cells differentiate into tenocytes, regenerate matrix - Soup of growth factors – stimulate cell proliferation & matrix synthesis
32
Superficial digital tendon injury - Tx Chronic phase
* Controlled exercise - Regular ultrasonographic monitoring - to prevent re-injury - Takes time – at least 6-12 months before returning to full work
33
Deep digital flexor tendon injuries
* Metacarpal region --> Majority of injuries within the DFTS * Pastern region - Down to insertion Most distal part can only be imaged with MRI or CT * Poor prognosis * Lesions in fetlock - show jumpers * Limited healing ability of tendons within synovial environment * Adhesion formation * Mesenchymal stem cell therapy * Associated with inf. tenosynovitis
34
Suspensory ligament injuries Forelimb proximal suspensory desmitis
* Pain on palpation * Difficult to palpate most proximal * Lamer with the limb on outer circle * Acute - Reasonable prognosis - Return to exercise in 3-4 months - +/- intralesional therapy * Chronic - More difficult - Blister treatment - Guarded prognosis
35
Suspensory ligament injuries Hindlimb proximal suspensory desmopathy
* No localizing signs * Lamer on outer circle * But often bilateral * Degenerative process * Dressage horses * Straight hock - predisposes * Poor success rate, best is surgery
36
Accessory ligament of the deep digital flexor tendon injuries
* Much more common in the FL than in the HL * Usually painful on palpation * Acute cases – rest, cooling, intralesional treatment, regenerative laser, shockwave * Chronic, non-responsive cases - desmotomy
37
Collateral ligament injuries
* Can be true sprain injuries * Rupture results in luxation/subluxation of joint
38
Digital flexor tendon sheath (DFTS) injuries Primary and secondary tenosynovitis
If lameness - improvement to low 4-point nb. Primary tenosynovitis - Accumulative low-grade trauma - Direct trauma - Abnormal force (hyperextension) - Infectious Secondary tenosynovitis - DDF tendonitis - Damage to the manica flexoria - Damage to the synovial layers
39
Distension of the DFTS Palmar annular ligament syndrome
* Desmopathy of PAL - External trauma and overextension of fetlock * Chronic inflammation – adhesions, fibrosis * Perpetuating condition Inflammation, pressure, stenosis, further inflammation

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