Lameness Diagnosis

Question 1

Diagnostic nerve blocks in forelimb

Answer 1

1. Palmar digital n
2. Abaxial sesamoid n
3. Distal metacarpal (low volar/low palmar) “Low 4 point block”
4. Proximal metacarpal (high volar/high palmar) “High 4 point block”

Question 2

Palmar digital nerve block

Answer 2

Blocks:
Medial and lateral digital nerves

Desensitizes:
Palmar portion of hoof, hoof cushion, navicular bursa

Needle inserted:
About 1 cm proximal to cartilage of hoof, between flexor tendons and neurovascular bundles

Question 3

Abaxial sesamoid nerve block

Answer 3

Blocks:
Medial and lateral digital nerves
Dorsal branches of these nerves

Desensitizes: entire hoof

Needle inserted:
Abaxial to proximal sesamoids

Question 4

Distal metacarpal (low palmar/low volar) “Low 4 point block”

Answer 4

Blocks:
Medial and lateral palmar
Medial and lateral metacarpal

Desensitizes: Fetlock and below

Needle inserted:
Between flexor tendons and interosseus, immediately distal of buttons

Question 5

Proximal metacarpal (high volar/high palmar) “High 4 point block”

Answer 5

Blocks:
Medial and lateral palmar
Medial and lateral metacarpal

Desensitizes: Carpus and below

Needle Inserted:
Between flexor tendons and interosseus, just distal to carpus and axial to splint bones

Question 6

Synovial injection of coffin joint

Answer 6

Needle inserted 1 cm proximal of coronary band

Question 7

Synovial injection of pastern joint

Answer 7

Needle inserted deep to tendon of common digital extensor

Question 8

Synovial injection of fetlock joint

Answer 8

Needle inserted between suspensory ligament and 3rd metacarpal

Question 9

Synovial injection of carpus

Answer 9

2 sites, one proximal (tibiotarsal joint) and one distal (middle tarsal joint)

Question 10

Six point nerve block of hindlimb t

Answer 10

Blocks:
Medial and lateral palmar
Medial and lateral metatarsal
Medial and lateral dorsal metatarsal

Question 11

What nerves supply sensory information beyond carpus?

Answer 11

Median and ulnar