Lecture 38 4/29/25

Question 1

What is cellulitis?

Answer 1

subcutaneous infection/inflammation

Question 2

What is the presentation of cellulitis?

Answer 2

-acute grade 4/5 lameness and diffuse swelling/pitting edema
-usually one limb but can be multiple
-usually precipitated by a small skin scrape/wound that allows bacteria to colonize
-typically normal commensals; Staph, Strep, E. coli

Question 3

What are the treatment steps for cellulitis?

Answer 3

-broad spectrum antibiotics
-pain management/NSAIDs
-compressive bandage

Question 4

What is the prognosis for cellulitis?

Answer 4

-excellent for life
-good to excellent for athletics with early management
-prognosis decreases with lymphedema

Question 5

What are the characteristics of lymphangitis/lymphedema?

Answer 5

-almost always concurrent with cellulitis or develops during cellulitis progression
-signs include progressive swelling of proximal limb, sheath, and ventral edema

Question 6

What are the characteristics of chronic progressive lymphedema?

Answer 6

-occurs with repeat episodes of cellulitis/lymphangitis
-scar tissue builds up
-every episode/flair is typically worse than previous one

Question 7

What are the treatment options for chronic progressive lymphedema?

Answer 7

-hyperbaric oxygen therapy
-mitigate flairs
-culture/treat intermittent infection
-therapeutic exercise

Question 8

What is the presentation of medial meniscus injury?

Answer 8

-grade 3+/5 lameness
-effusion of medial femorotibial joint
-poor healing capacity due to minimal blood flow
-injured most commonly at caudal pole; least accessible area via arthroscopy

Question 9

What are the treatment options for medial meniscus injuries?

Answer 9

*orthobiologics
-intralesional stem cells
-synovial stem cells
-protein-rich plasma/APS
*rest
*controlled return to work

Question 10

What is the prognosis for medial meniscus injury?

Answer 10

-good for life
-guarded for athletics

Question 11

What are the characteristics of cranial medial meniscotibial ligament injury?

Answer 11

-usually diagnosed via arthroscopy
-not typically a “stand alone” injury
-often in conjunction with medial meniscal tear or synovitis/arthritis

Question 12

What are the treatment options for cranial medial meniscotibial ligament injury?

Answer 12

orthobiologics, including intralesional and intrasynovial injections

Question 13

What is the prognosis for cranial medial meniscotibial ligament injury?

Answer 13

-good for life
-guarded for athletics

Question 14

What are the characteristics of patellar ligament, lateral meniscus, and lateral collateral ligament injuries?

Answer 14

-usually secondary to trauma
-treated with intralesional orthobiologics
-good prognosis for life
-guarded prognosis for athletics

Question 15

What are the characteristics of cranial cruciate lig. injury?

Answer 15

-present with grade 4/5 lameness
-effusion seen in medial femorotibial joint and femoropatellar joint
-direct drawer sign positive; very painful
-definitive diagnosis via arthroscopy
-guarded prognosis for life
-grave prognosis for athletics

Question 16

What are the characteristics of the reciprocal apparatus?

Answer 16

-large medial patellar ligament
-“hooks” over proximal aspect of medial femoral trochlea
-prevents stifle flexion and allows for muscle relaxation
-to “unhook,” quadriceps activate to pull patella dorsally, allowing stifle to flex

Question 17

What is the typical signalment of upward fixation of the patella?

Answer 17

-young, underdeveloped but fast-growing breeds
-older muscle-wasted, emaciated animals +/- PPID
-ponies and minis over-represented

Question 18

What is the presentation of upward fixation of the patella?

Answer 18

-horse cannot flex stifle and advance limb
-typically intermittent but can be constant
-tests to set it off include backing, sudden stops, standing for a period before walking off, and tail pulls to the side with release

Question 19

What are the treatment options for intermittent upward fixation of the patella?

Answer 19

*exercise to develop the quadriceps
*medial patellar ligament fenestration
-skin block
-insert needle into ligament and split tendon by raising and lowering hub at several sites
-promote scar tissue and shortening/strengthening of ligament

Question 20

What are the treatment options for constant upward fixation of the patella?

Answer 20

*medial patellar ligament desmotomy
-salvage procedure only
-induces patellar instability via fragmentation and arthritic changes

Question 21

What is the prognosis for upward fixation of the patella?

Answer 21

*intermittent:
-excellent for life
-good to excellent for athletics
*constant:
-good for life
-guarded to good for athletics dependent on desmotomy outcome

Question 22

What are the characteristics of cervical facet osteoarthritis?

Answer 22

-osteoarthritis of cervical facet joints
-history may include reluctance to bend or turn, refusal to jump fences, and general poor performance

Question 23

What is the presentation of cervical facet osteoarthritis?

Answer 23

-reduced range of motion to carrot stretch
-may have palpable pain over joint
-muscle atrophy or hypertonicity
-can have mild forelimb lameness
-can have concurrent neurologic dz
-most common around c4 to c7

Question 24

What are the treatment steps for cervical facet osteoarthritis?

Answer 24

-typical OA approach
-corticosteroid injections
-shockwave
-mobility exercises
-chiropractic

Question 25

What is the prognosis for cervical facet osteoarthritis?

Answer 25

-depends on degree of spinal cord compression -decreases with concurrent neurologic deficits -good to excellent for life -guarded to good with aggressive management for athletics

Question 26

What are the characteristics of topline dysfunction?

Answer 26

-traditionally "back pain," but does not actually describe clinical dz or help with treatment -history may include noticed pain or just poor performance -present with concurrent hind limb lameness and some degree of weakness, stiffness, and/or pain on MSK exam

Question 27

What is assessed during a hands-on exam when looking for topline dysfunction?

Answer 27

-muscle hypertonicity -muscle/soft tissue pain -lateral perturbations

Question 28

What should be done in areas of concern during a hands-on exam when looking for topline dysfunction?

Answer 28

-detailed dorsal spinous process palpation and mobilization -try to repeat the findings of concern

Question 29

What are signs of generalized pain from topline dysfunction?

Answer 29

-muscle spasm -splinting -avoidance

Question 30

What are the treatment steps for topline dysfunction?

Answer 30

-treat underlying cause(s) -therapeutic exercise -radiofrequency -electroacupuncture -chiropractic -possibly NSAIDs -possibly thoracolumbar facet injections

Question 31

What is the prognosis for topline dysfunction?

Answer 31

-depends on severity and discipline -excellent for life -guarded to good for athletics depending on commitment of owner

Question 32

What are the characteristics of overriding dorsal spinous processes?

Answer 32

-usually present with same symptoms as topline dysfunction -should have a focal area of pain on palpation of DSP or interspinous ligaments

Question 33

What are the diagnostics for overriding DSPs?

Answer 33

-improvement with local analgesia -possible bone scan/nuclear scintigraphy -radiographs; important to note rads alone do not correlate with clinical dz

Question 34

What is the treatment for overriding DSPs?

Answer 34

-conservative treatment is the same as topline dysfunction treatment -surgical treatment can include interspinous ligament desmotomy or wedge resection of DSP

Question 35

What is the prognosis for overriding DSPs?

Answer 35

-excellent for life -variable/unknown for athletics