Lameness

Question 1

What injury causes a ‘palmar bow’

Answer 1

SDFT

Question 2

Clinical signs of inflammatory phase after tendon injury

Answer 2

Lameness​
Pain on palpation​
Heat​
Swelling

Question 3

Clinical signs of reparative/proliferative phase after tendon injury

Answer 3

Reduction or absenceof lameness​
Resolution of signs ofinflammation​
Tendon still palpablyenlarged and soft​
Signs of re-injury ifexercised too early​

Question 4

Clinical signs of remodelling/maturation phase after a tendon injury

Answer 4

Tendon size decreases​
Tendon less pliable​
Reduced fetlock extension​
Contractures

Question 5

What is the length of the inflammatory phase after tendon injury?

Answer 5

Days

Question 6

What is the length of the reparative/proliferative/fibrosis phase after tendon injury?

Answer 6

Weeks

Question 7

What is the length of the remodelling/maturation phase after tendon injury?

Answer 7

Months

Question 8

What cells are present in the inflammatory phase of tendon healing?

Answer 8

Neutrophils, macrophages, monocytes

Question 9

What cells are present in the reparative/proliferative (fibrosis) stage of tendon healing?

Answer 9

Fibroblasts (++)

Question 10

What collagen type is present in healthy tendon?

Answer 10

Collagen type I

Question 11

What collagen type is present in tendon after injury?

Answer 11

Collagen type III

Question 12

What is occurring with collagen in the tendon in the remodelling/maturation phase of tendon healing?

Answer 12

Transformation from type III to type I

Question 13

What are the 4 things affecting the structural properties of tendons?

Answer 13

Crimp
Glycosaminoglycans (GAGs)
Cartilage Oligometric Matrix Peptide (COMP)
Collagen

Question 14

Why are tendons more predisposed to injury as horses age?

Answer 14

Crimp and COMP reduce with age

Question 15

What does this shoe do?

Answer 15

Heartbar shoe
Pedal bone support (load transferred from hoof wall to sole and better loading of heel region)

Question 16

Modern technologies offering improved benefits to the heart bar shoe

Answer 16

Pads (raised profile where frog sits)
Resins and impression materials (injected into space between pad and sole to reduce concussion and transfer force across whole sole)

Question 17

Benefits of heart bar shoe, pads or packing in laminitis?

Answer 17

Pedal bone support

Question 18

Benefits of heart bar shoes in navicular syndrome/palmar heel pain

Answer 18

Restrict independent heel movement

Question 19

How can you immobilise a pedal bone fracture in the acute phase of injury to speed up healing?

Answer 19

Heart bar shoe and packing

Question 20

How can you reduce concussive and contusive forces on the sole of the foot in horses prone to bruising?

Answer 20

Pads and packing

Question 21

Do horses with poor confirmation benefit from farriery/additional support?

Answer 21

Yes, reduces pain and improves confirmation

Question 22

How does a bar shoe help after keratoma resection?

Answer 22

Foot is structurally compromised

Question 23

Why are graduated shoes indicated in DDFT tear within the foot?

Answer 23

Reduce strain on DDFT because it doesn’t have as far to travel. Offloads tendon and reduces pressure applied to the navicular bone. Raised heel also alters breakover to reduce pressures applied to distal interphalangeal joint

Question 24

Are graduated pads a long or short term solution to lameness? Why?

Answer 24

Short-term
Horses with heel pain already have poor foot conformation (long toe, low heel, thin sole). Raising the heel contributes to poor conformation as it encourages the heel to grow parallel to the shoe (hoof make end up worse than before treatment)

Question 25

Pathways to arthritis (2)

Answer 25

Abnormal cartilage Abnormal stress on normal cartilage

Question 26

Components of cartilage

Answer 26

Chondrocytes GAG Collagen Water and mobile ions Hyaluronic acid

Question 27

Clinical signs of joint problems (in order of increasing severity)

Answer 27

Synovitis Partial thickness cartilage erosions Full thickness erosions Subchondral bone lesions Peri-articular new bone Peri-articular soft tissue damage (including collateral ligaments) Peri-articular fibrosis Joint ankylosis

Question 28

Which joints can often have extreme radiographic changes (lysis, new bone formation, ankylosis) but minimal lameness?

Answer 28

Low motion (proximal interphalangeal or distal tarsal joints)

Question 29

What % response to a joint block is considered a positive response and why?

Answer 29

50% or above (pain can come from periarticular soft tissues and subchondral bone which don't block completely)

Question 30

Main changes in joint fluid with OA

Answer 30

Reduction in viscosity (due to lack of GAGs and hyaloronic acid) Protein levels and cell count may be normal

Question 31

Considerations when assessing orthopaedic pain

Answer 31

Lameness severity score Mobility, behaviour and interactions Grimace/pain face scoring Behaviour when ridden

Question 32

Treatment options for osteoarthritis in a low motion joint

Answer 32

(Goal is fusion of joint) Intra-articular steroids Systemic NSAIDs Neurectomy Chemical arthrodesis (tarsal joints only) Surgical arthrodesis

Question 33

Contraindications for chemical arthrodesis

Answer 33

Never use in proximal intertarsal joint as it communicates with the high motion tarsocrural joint

Question 34

What can be injected into the joint in chemical arthrodesis for osteoarthritis?

Answer 34

Monoiodoacetate (MIA) Ethanol