Flexural Limb Deformities

Question 1

How are FLDs named?

Answer 1

Named for the joint involved, not the tendon inovlved

Question 2

FLDs affect what tissue?

Answer 2

Soft tissues

Question 3

What joints are primarily affected by congenital FLDs 0-1mo of age?

Answer 3

Carpus, metacarpophalangeal region

Question 4

What joints are primarily affected by FLDs acquired at 1-6 mo of age?

Answer 4

Metacarpphalangeal region, prox interphalangeal region

Question 5

What joints are most commonly affected by congenital FLD?

Answer 5

MCP and carpi

Question 6

What age do congenital FLDs present?

Answer 6

1st month of age

Question 7

What causes congenital FLDs?

Answer 7

In-utero malpositioning, disease of mare during pregnancy

Question 8

What diseases of the mare during pregnancy can cause FLDs?

Answer 8

Goiters, sudan grass ingestion, influenza

Question 9

What are congenital FLDs?

Answer 9

Digital hyperextension, ruptured CDET

Question 10

Caused by flaccidity of flexor muscles

Answer 10

Digital hyperextension

Question 11

What is the most common congenital FLD?

Answer 11

Digital hyperextension

Question 12

Attempting to bear weight but unable to keep toes on the ground

Answer 12

Digital hyperextension

Question 13

What are sequential risks assoc w/digital hyperextension?

Answer 13

Skin/heel bulb ulceration

Question 14

How do you treat digital hyperextension?

Answer 14

Light bandage

Question 15

What is contraindicated for treating digital hyperextension?

Answer 15

Splints and thick bandages

Question 16

Why are splints and thick bandages contraindicated for digital hyperflexion?

Answer 16

Relaxes soft tissue by taking weight/work off of them

Question 17

How do you treat digital hyperextension?

Answer 17

Controlled exercise, NSAIDs, Oxytetracycline

Question 18

How can farriery help treat digital hyperextension?

Answer 18

Palmar/plantar hoof extensions

Question 19

Swelling @ dorsal fetlock is associated w/which congenital FLD?

Answer 19

Ruptured CDE

Question 20

How will a congenital FLD stand?

Answer 20

Wt-bearing w/o full carpal extension or cannot bear weight at all

Question 21

How do you treat the side effects of chronic NSAID use?

Answer 21

Omeprazole

Question 22

Why do you need to dilute the oxytetracycline to 3g/00mL saline?

Answer 22

Nephrotoxic in hypovolemic animals

Question 23

When should oxytetracycline be administered to help treat FLDs?

Answer 23

1-2x in the first 2-4wk of life

Question 24

Inhibits contraction of collagen matrix and decreases MMP1 expression

Answer 24

Oxytetracycline

Question 25

Prevents myofibroblasts from remodeling the collagen matrix of the affected tendon

Answer 25

Oxytetracycline

Question 26

When splinting/casting an FLD, which joints should be incorporated and which should not?

Answer 26

NO NORMAL JOINTS in the splint

Question 27

How can farriery protect toe from extensive wear assoc. w/FLDs?

Answer 27

Toe extension

Question 28

Other than toe protection, how does a toe extension help correct FLDs?

Answer 28

Stress applied on DDFT to stretch it

Question 29

When surgery is required, it is most commonly performed on which joint?

Answer 29

Carpus

Question 30

What ligaments do you transect to correct a congenital carpal FLD?

Answer 30

FCU and ulnaris lateralis

Question 31

Knuckling over fetlocks; can be enough that the foal stands on dorsal aspect of pastern

Answer 31

Ruptured CDET

Question 32

Swelling over dorsal aspect of carpus

Answer 32

Ruptured CDET

Question 33

Is there a surgical remedy for a ruptured CDET?

Answer 33

No

Question 34

How do you manage a ruptured CDET?

Answer 34

Stall confinement and splint to avoid stumbling

Question 35

Which joints to acquired FLDs most often affect>

Answer 35

MCP and DIP joints

Question 36

What is the pathogenesis of acquired FLDs?

Answer 36

Mismatch in bone and tendon/lig growth

Question 37

At what age do acquired FLDs present?

Answer 37

Between 1-4 mo and then @ yearling age

Question 38

What are factors that predispose to acquired FLDs?

Answer 38

Pain (most commonly) and nutrition

Question 39

How does excessive energy intake result in FLDs?

Answer 39

Rapid growth causes growth mismatch

Question 40

Most cells in the DDFT and ALDDFT are _____

Answer 40

Myofibroblasts

Question 41

How does pain cause an FLD?

Answer 41

Lack of use --> lack of elongation

Question 42

When are you most likely to see and FLD at the DIP?

Answer 42

Between 1-4 months of age

Question 43

Is DIP FLD usually unilateral or bilateral?

Answer 43

Bilateral

Question 44

What is the main clinical sign of a DIP FLD?

Answer 44

Boxy hoof

Question 45

What are components of boxy hoof?

Answer 45

Increased vertical dorsal hoof wall angle, overgrown heels

Question 46

What does boxy hoof predispose to?

Answer 46

Subsolar abscesses

Question 47

How does a functional shortening of the DDFT unit cause DIP FLD?

Answer 47

Excessive tension on P3 rotates it palmarly

Question 48

Dorsal hoof wall angle >60* but <90*

Answer 48

Stage 1

Question 49

Dorsal hoof wall >90* but <115*

Answer 49

Stage 2

Question 50

Dorsal hoof wall >115*

Answer 50

Stage 3

Question 51

Dorsal hoof wall doesn't cross the vertical plane

Answer 51

Stage 1

Question 52

What non-surgical ways can you manage acquired FLD?

Answer 52

Controlled exercise, NSAIDs, casts/splints

Question 53

What farriery techniques can you use to manage acquired FLD?

Answer 53

Toe extension

Question 54

What surgical procedure can you do for a stage 1 DIP FLD?

Answer 54

ICLD

Question 55

What surgical procedure can you do for a stage 2 DIP FLD?

Answer 55

ICLD or DDFT if ICLD doesn't work

Question 56

What surgical procedure can you do for a stage 3 DIP FLD?

Answer 56

DDFT

Question 57

Which DIP FLD sx procedure preserves athletic career?

Answer 57

ICLD

Question 58

What ligament do you cut for an ALDDFT desmotomy (ICLD)?

Answer 58

Inferior check ligament

Question 59

What is the success rate of an ICLD for horses <1 year old? >1 year old?

Answer 59

``` <1 = 90% success >1 = 80% success ```

Question 60

Which breed does not recover well from ICLD if more than 8 months old? What is the success rate in this breed?

Answer 60

Standardbred 60% success if >8mo old

Question 61

What is the easier location to perform a DDFT tenotomy on a horse?

Answer 61

Mid-metacarpus

Question 62

Which DDFT tenotomy approach accesses the DFTS?

Answer 62

Mid-pastern

Question 63

When do FLDs at MCP/MTP usually present?

Answer 63

Between 6-18 mo old

Question 64

Is an FLD in the MCP or MTP more common?

Answer 64

MCP

Question 65

What causes FLD in the MCP/MTP?

Answer 65

Prolonged non-weight bearing (short SDFT)

Question 66

What are clinical signs of MCP/MTP FLD?

Answer 66

Upright pastern, knuckling over at fetlock

Question 67

MCP joint more straight but still <180*

Answer 67

Mild

Question 68

MCP joint at 180* but corrected when horse walks

Answer 68

Moderate

Question 69

MCP joint >180* and does not correct when horse walks

Answer 69

Severe

Question 70

Taut extensor tendons that are prominent enough to be seen on the dorsal aspect of the foot indicate what disease?

Answer 70

MCP/MTP FLD

Question 71

How do you treat MCP/MTP FLD non-surgically?

Answer 71

Controlled exercise, splints

Question 72

How do you "exercise" and MCP/MTP FLD horse?

Answer 72

"Hopping" - lift contralateral limb and lead horse to walk

Question 73

What farriery techniques can you use to treat MCP/MTP FLD?

Answer 73

Raise heels w/wedge pads, toe extension

Question 74

What surgeries can you do to manage MCP/MTP FLD?

Answer 74

ALDDFT or ALSDFT desmotomy (or both)

Question 75

Which surgical technique is used for more severe MCP/MTP FLD?

Answer 75

ALSDFT desmotomy

Question 76

Superior check lig desmotomy that lengtherns the SDF unit and extends the fetlock

Answer 76

ALSDFT desmotomy