Lameness: Upper Limb Lameness

Question 1

What should be included in an assesment of limb lamness in cattle?

Answer 1

History:
* Speed of onset
* Recent management procedures or observations
* Nutrition

Environment:
* Factors of lameness
* Diet- addition of minerals/vitamins

Clinical examination:
* Swing leg lameness
* Swellings, hairloss, abrasions, discharge
* Heat, pain, swelling, effusions
* Reduced mobility
* Pain
* Flexion tests
* Asymmetry, atrophy, abnormal joint angles
* Degree of lameness scale 0- sound, 10- non weight bearing
* Stethoscope over joints- crepitus (crackling)

Question 2

What special diagnostic techniques may be used for lameness assessment?

Answer 2

• Portable X-ray unit sufffieceny for lower limb images
• Ultrasonography- useful for tendon injuries and investigations of swellings
• Scintigraphy
• Nerve blocks- ring blocks- difficult to palpate nerves
• Thermography

Question 3

Are you able to transport an animal unable to bear weight evenly on all four legs?

Answer 3

• Illegal to slaughter
• Legal for veterinary treatment- measures for comfort required

Question 4

How are different legs and regions splinted?

Answer 4

• Frontleg between foot and radius/ulna: apply one splint lateral and one on palmar aspect from floor to elbow
• Front leg between distal radius and elbow: apply one lateral splint from floor to shoulder joint
• Hindleg affected between foot and proximal meta-tarsus: apply one splint on lateral and one on plantar from floor to stifle
• Hindleg affected between hock and stifle joints: apply one lateral splint from floor to hip

Question 5

What tendon problems can cause lameness in large animal?

Answer 5

1. Contracted tendons
2. Gastrocnemius rupture
3. Flexor tendon injury

Question 6

1. What causes contracted tendons?
2. What does it result in?
3. How is it treated?

Answer 6

1. Unkown- position in utero? , hereditary?
2. Results in flexion of fetlock ± carpus- unable to rise
3. If able to extend into tip-toe, splint or cast, 2-4 weeks
   Surgical: sectioning superficial flexor, then deep ± suspensory ligament- small incision mid metacarpus with GA- cast for 2-4 weeks

Carpal flexion could be joint ill/schmallenberg

Question 7

1. What causes gastrocnemius rupture?
2. How do animals present?
3. What is the differential and how is it checked?
4. How is it treated?

Answer 7

1. Either rotational force on limb or sudden weight-bearing force- secondary to hypophosphataemia
2. Overextended upper limb and lowered hock, swelling may be present
3. Tibial nerve paralysis- skin sensitisation
4. Often poor- box rest with or without leg support in young calves, surgical repair reported

Question 8

1. What usually causes flexor tendon injury?
2. How is it treated?

Answer 8

1. Trauma- can be spontaneous
2. Attend to wound in normal way, IV regional antibiosis useful, can block with heel raised

Question 9

With a flexor tendon injury how can you decifer joint involvement?

Answer 9

• Position- wound near joiny
• Synovial fluid present?
• Explore with sterile probe
• Radiography ± contrast
• Expand synovial compartment- sterile saline, entry away from wound- does it exit at wound

Question 10

What ligament problems can occur in cattle?

Answer 10

• Anterior cruciate ligament rupture
• Patellar fixation- legs fixed in full extension
• Patellar luxation

Question 11

1. How do animals usually present with ACL rupture?
2. How is ACL rupture confirmed?
3. How can is be treated?

Answer 11

1. Common in breeding bulls, usually during dismount- acute onset of lameness
2. Radiography- condyles shifted back in relation to tibia: may also show piece of bone torn off
3. Autograft- better in younger animals

Question 12

1. What does patellar luxation occur secondary to?
2. How can it be treated?
3. How is patellar fixation treated?

Answer 12

1. Femoral nerve paralysis
2. Shortening of the anterior tibio-patellar ligament or tightening of the joint capsule
3. Cut medial patellar ligament in both legs

Question 13

What soft tissue problems can commonly cause lameness in cattle?

Answer 13

• Cellulitis
• Muscle injury/infection

Question 14

1. What causes cellulitis?
2. How does it present?
3. What can be used to differentiate from tendon sheath effusion?
4. How is it treated?

Answer 14

1. Ascending infection from foot lesion or penetrating wound
2. Moderate lameness with rapdily worsening swelling
3. Ultrasonography- abscesess also
4. Deal with foot lesions, agressive ABs (clostridial), NSAIDs

Prognosis guarded

Question 15

1. What can cause peroneus tertius rupture?
2. How does the animal present?
3. How is it treated?

Answer 15

1. Trauma from excessive flexing of hock- woppa box (foot trimming)
2. May appear normal but hock over extended, stifle flexed
3. Usually resolve with box rest

See the difference in normal and ruptured

Question 16

1. How does serratus ventralis rupture present?
2. What predisposes?
3. How is it treated?

Answer 16

1. Unilateral or bilateral with protruding scapula blade dorsally ± local haematoma
2. Calves with Vit E/Selenium deficiency
3. Vit E therapy some resolution- until slaughter weight reached

Question 17

1. What can cause an abscess in the muscle?
2. How is it treated?

Answer 17

1. Puncture wound, spread from adjacent, sepsis, injection site reaction
2. Surgical drainage- hose flushing with cold water and gauze rubbing of inner surface

Question 18

What vitamins and minerals does bone growth require?

Answer 18

Adequate levels of:
* Calcium
* Phosphorus
* Selenium
* Vit D
* Vit E
* Copper
* Vit A

1.5:2 Ca:P

Question 19

What typical osteodystophies may present in fast growin intense diets?

Answer 19

• Ricketts- vit D deficiency
  Epiphyses are enlarged, poorly calcified bone, bending may occur
• Oesteoperosis/malacia- deficiency in copper, calcium or phosphorus, reduced bone tissue

Question 20

1. What is oesteochondrosis?
2. What are the clinical signs?
3. How is it diagnosed?
4. How is it treated?

Answer 20

1. Necrosis of cartilage canal blood vessels
2. Reluctance to move or rise, stiffness, fractures, joint swelling- atlanto-occipital and femoro-patellar joints
3. PM findings- histopath, low serum Ca, elevated serum alkaline phosphotase
4. Euthanasia in severely affected animals

Question 21

1. What causes white muscle disease?
2. When does it usually present?
3. What predisposes?
4. What are the clinical signs?
5. How is it diagnosed?
6. How is it treated?

Answer 21

1. Vit E/selenium deficiency
2. 1 year old- after turnout
3. High levels of unsaturated fats and rapid growth
4. Muscle weakness, stiffness, stilted gait, recumbancy, dyspnoea- rapid death if myocardium involved
5. Serum levels of vit E/selenium, very elevated CK and AST (muscle damage)
6. Consists of parenteral administration of Vit E/selenium

Question 22

1. What breeds are more commonly affected by hip dysplasia?
2. How does the gait appear?

Answer 22

1. Hereford, Abderdeen angus, Galloway, South Devon, Charolais- 3m to 2y
2. Swaying, stifle rotated out, hock inwards

Usually male

Normal on left

Question 23

1. What contributes to DJD?
2. How does it present in bulls?
3. How can it be treated?

Answer 23

1. Poor conformation, rapid weight gain, housing on concrete, older animals (AI studs)
2. Lobido reduced
3. No long term- NSAIDs, possibly surgery and debridment
   Calves DJD of distal interphalageal joint- block sound claw

Question 24

What joints can dislocate on cattle?

Answer 24

• Hip
• Stifle
• Shoulder/Elbow
• Lower limb

Question 25

1. How are hips commonly dislocated? 2. How does it present? 3. What is the DDX? 4. How is it treated?

Answer 25

1. Animal going down in crush with hindlimb raised, cows around parturition 2. Anterior phase reduced, swelling over greater trochanter, crepitus palpaple, femoral head felt in obturator foramen 3. Fractured femur 4. Best prognosis within 12 hours- Closed or open reduction

Question 26

Describe the process of closed reduction and open reduction for hip dislocation

Answer 26

Closed: 1. Lateral recumbancy- affected leg uppermost 2. Stabilise against pulling forces with rope around upper limb secured 3. Tension on leg while rotating stifle down and hock up 4. Or prolonged retraction with sudden release 5. Not worth bothering after 10-12 hours- big blood clot Open: 1. Approach hip joint via biceps femoris 2. Manual relocation with leg under tension 3. Steinman pins from greater trochanter to wing of ileum

Question 27

1. What commonly present with stifle dislocation/signalment? 2. How is it treated?

Answer 27

1. Older animals- often partial. Sudden onset, very painful non-weightbearing. Increased joint mobility 2. Occasionally success with rest and prolonged analgesia

Question 28

1. How does a shoulder/elbow dislocation present? 2. Can shoulder/elboe reduction be treated? 3. Can lower limb dislocate?

Answer 28

1. Increased laxity or reduced anterior phase 2. Closed reduction easy- often dislocates on recovery 3. Rare- check soft tissue- may respond to casting

Question 29

1. What pathogens commonly cause septic arthritis? 2. What are the clinical signs? 3. Can it be treated?

Answer 29

1. T.pyogenes, E.coli, Staphs, Streps, Salmonella, H.somnus, M.bovis 2. Moderate to severe lameness, joint effusion, pain, heat- joint tap to confirm 3. Early cases respond to aggressive and prolonged ABs (clavulanic acid, ceftiofur, neomycin/penicillin, oytets) Unresponsive or delayed: joint lavage GA or IVRA, 1-5l heartmans Intra-articular ABs controversial

Question 30

1. How is Arthrocentesis done? 2. What are the cut offs for the following? Nuclear cell count, PMN cell count, total protein

Answer 30

1. Asepsis- not though wound 18-20g 1inch needle 2. Nuclear CC >25,000 cells/ml, PMN CC >20,000 cells/ml, total protein >45g/l

Question 31

1. When should osteomyeltitis be suspected? 2. How is it diagnosed?

Answer 31

1. Severe lameness without obvious cause- blood borne, adjacent joint capsules 2. Radiography- few early changes

Question 32

When can non-septic effusions occur? Treatment?

Answer 32

Increased pressure or high impact forces Some success with draining fluid

Question 33

What are the clinical signs of long bone fractures?

Answer 33

* Sudden onset * Non-weight bearing * Muscle tone affected * Unusual and abnormal movement * Soft tissue swellings

Question 34

How can a fracture be treated?

Answer 34

* First aid- restrain animal, analgesia/sedation * Casting- foot upto carpus- deep sedation/analgeisa, change cast if severe swelling 2-4 days, every 10-14 days replace anyway, animals need help rising * Internal fixation: possible- expensive * External fixation- can work, useful for open fractures, two pins horizontally- moves force to cast- include foot in cast * Box rest- humerus and femur without displacement * Amputation * Thomas-Extension splint- clothes hanger thing

Question 35

What is the risk of compound fractures?

Answer 35

Risk of infection very high Washing and intense systmic ABs

Question 36

What are potential complications post fracture repair?

Answer 36

* Nerve damage * Non-union * Osteomyeltitis * Abnormal bone growth * Nursing complications

Question 37

1. What causes vertebral body fracture? 2. How can it be resolved?

Answer 37

Grossly excessive force on foetus- neurological damage If no displacement may resolve spontaneously

Question 38

1. What commonly causes pelvic fractures? 2. How does it present?

Answer 38

1. Trauma- mounting, division bars cubicles 2. Usually difficulty walking/asymmetry, lameness rare Rest and analgesia- surgical repair not possible

Question 39

When can epiphyseal displacements occur?

Answer 39

Young animals subjected to severe trauma- calving Surgical repair only option

Question 40

What pelvic and spinal injuries can occur in cattle?

Answer 40

* Tuber coxae/wing of ileum fracture- incidental, no prob usually (unless open wound) * Pelvic fractures * Ankylosing spondylitis- older animals- thoracic/lumbar vertabrae, reduced spinal flexibility (lower libido) * Sacro-iliac dislocation- often perinatal period, can result in nerve damage- dystocia likely in future

Question 41

Why does upper limb lameness present with swinging lameness?

Answer 41

The pain if during the movement of the leg * Shortened stride of sound leg- want to shift leg back * Head up at point of planting foot Lower limb lameness- pain is on planting of the foot

Question 42

Which foot is painful

Answer 42

Left- weight not being fully bared Can see accessory digits

Question 43

What is this condition?

Answer 43

Contracted tendons

Question 44

Which of these images shows tibial nerve paralysis and which gastrocnemius rupture?

Answer 44

* 1st and 3rd Gastrocnemius rupture * 2nd and 4th Tibial nerve paralysis

Question 45

What condition does this image show?

Answer 45

Cellulitis | Inflammation of the connective tissue under the skin

Question 46

What are the differentials for this acute onset on a working bull?

Answer 46

* Ruptured ACL * swelling misleading

Question 47

What condition is this?

Answer 47

Spastic paresis- over activity of the nerve causing hyperextension Treatment- cut the tibial nerve

Question 48

What needs to be worried about from this image? Freshly calved cow, treated for milk fever

Answer 48

* Neuropathy- obturaotr nerve * Dislocation * Fracture | Femoral fracture

Question 49

How is a hygroma treated?

Answer 49

* Clip and preparation * Local infiltration * Incision top and bottom * Break down septae and drain * Pressure bandage