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Flashcards in Equine MSK diseases 3 Deck (100)
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Discuss the use of scintigraphy in the diagnosis of back pain in horses

- Extremely sensitive for bone lesions incl. fractures, new bone, infective processes and bone tumours
- Often unrewarding for back soft tissue injuries
- Good for pelvic disorders


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

- Imaging of supraspinous ligament
- Imaging of spinous processes
- Identification of overriding dorsal spinous processes (kissing spine)
- Poor for muscle injuries
- Good for pelvis, esp. ilial fracures


Describe the ultrasonographic appearance of overriding dorsal spinous processes in horses

- Tips of spines appear very close together
Marked narrowing at the affected interspinous spaces
- Pseudoarthrosis may be visible: anechoic area surrounded by well-defined capsule


List the tests, other than imaging, that can be used for the diagnosis of back pain in horses

- Lab tests (muscle enzyme activities - AST, CK, lactate)
- Local anaesthetic blocks
- Infiltration of steroids
- Electrical stimulation of epaxial musculature (rare)


Why is trial treatment with NSAIDs useful in the diagnosis of back pain in horses?

Confirmation of presence of pain - differentiate between behaviour and pain


Outline the management of a horse with back pain

- Conservative: box rest, physiotherapy
- Surgical for some causes e.g. kissing spine, some fractures
- Keep horse as light as possible, diet altered accordingly
- May need to consider effect of rider (poor rider, or heavy)


Discuss the prognosis for chronic soft tissue injuries causing back pain in horses

- Guarded prognnosis
- Difficult to confirm
- Need to start treatment including rest, controlled, exercise and physio for several months before declaring unfit for work


List possible causes of lameness originating the equine foot

- Solar/white line infection
- Thrush
- Solar bruising/solar pain
- Hoof wall lesions
- Wounds
- Laminitis
- Foot imbalance/caudal foot pain
- Navicular disease
- DIP joint pain/DJD
- Foot penetrations
- Fractures


List the key features of the initial observation in a lameness examination of the horse

- Weight bearing or not? (Stance)
- Foot balance (conformation)
- Uneven wear of hoof/shoe
- Compare left and right foot
- Shoeing (type, when shod)


Which tendons are affected by a palmar imbalance in horses?

More pressure on flexor tendons


Outline the key features of the physical examination of a lame horse relating to the feet

- Palpate for heat, pain, swelling, digital pulses
- Check show and nail position
- Check sole surface


List the conditions that commonly cause heat, pain, swelling of the foot and palpable digital pulses in the horse

- Laminitis
- Infection
- Sole bruising
- Fractures
- Joint effusions


Outline the typical findings on physical examination in a case of laminitis

- Hot feet, bounding digital pulses
- Can be single limb (overload laminitis), both FLs, or all 4 limbs
- Other systemic signs e.g. tachyC and sweating may be present


Outline the typical findings on physical examination in a case of infection in the equine foot

- Hot foot, bounding digital pulses
- Usually unilateral (sole or white line infections)


Outline the typical findings on physical examination in a case of solar bruising in a horse

- Hot foot, bounding digital pulse
- Usually unilateral, can be bilateral
- Usually FL (takes more weigh)
- Hoof testers/paring away hoof reveals bruising/haemorrhage


Outline the typical findings on physical examination in a cause of foot fractures in a horse

- Hot foot, bounding pulse
- If P2 may have swelling and palpable crepitus


What are the key considerations for when evaluating the movement of a horse in a lameness examination

- Degree of lameness
- Limb/limbs affected
- Effect of surface
- Effect of load (left reign vs right reign)
- Effect of flexion of distal limb
- Need to rule out fractures prior to trotting horse


List the contraindications for diagnostic anaesthesia in a lameness examination in a horse

- Suspected fractures
- Severe soft tissue injuries e.g. DDFT rupture
- Risk of infection e.g. current infection at injection site such as mud fever, or if cannot be performed sterile


List the options for diagnostic anaesthesia for the diagnosis of lameness originating in the equine foot

- Perineural anaesthesia
- Intra-articular anaesthesia
- Distal interphalangeal joint
- Navicular bursal block
- Digital flexor tendon sheath block


What is the main difficulty with diagnostic anaesthesia in the equine foot?

Communication and overlap between different areas is inconsistent between horses e.g. DIP is up against navicular bursa, sometimes communicates allowing perfusion of local anaesthetic between structures, sometimes does not


For which conditions of the equine foot is radiography the first line of diagnostics

- Suspected fracture
- Laminitis
- Suspected bone lesions/foot penetrations


What are the standard views of the equine foot?

- Lateromedial
- Upright pedal
- Upright navicular
- Flexor navicular


What is the first line diagnostic test for synovial sepsis?

Arthrocentesis - no nerve blocks, no radiographs


When is use of ultrasonography indicated in equine foot lameness?

Only soft tissue lesions, limited value due to hoof


When is use of gamma scintigraphy indicated in equine foot lameness?

- Used in non-displaced pedal bone fractures (non radiographic signs)
- May not see much


Discuss the use of MRI in the diagnosis of equine foot lameness

- Very useful, allows assessment of all structures in the foot
- Good for soft tissues e.g. DDFT insertion on P3, collateral ligs of DIP joint
- Expensive


Outline the aetiology of laminitis

- Ischaemic necrosis → vasoconstriction
- Damage to interlaminar bodies, loss of epidermal/dermal junction, separation of laminae
- → separation of P3 from hoof wall


Outline the clinical signs of acute laminitis

- Uni/bi/quadrilateral lameness possible
- Hot foot, bounding pulse, characteristic stance
- TachyC, hypertension, sweating
- Severe: depression at coronary band, protrusion/haemorrhage at sole at toe region


Outline the diagnosis of laminitis

- Radiography
- Lateromedial view with markers on sole and coronary band, and dorsal hoof wall
- Divergence of hoof wall and dorsal P3 measured
- Remodelling in toe area in chronic cases


Discuss the prognostic factors for laminitis

- <5˚ separation = good prognosis
- >15˚ separation = poor prognosis
- Rapid deviation = poor
- Slow = better