Musculoskeletal Flashcards
MSK01-06; MSK08 (07 is in Miscellaneous); MSK09-11 (308 cards)
1
Q
name the 7 steps of investigation of a lame horse
A
- Take History
- Examine at rest
- Palpate and manipulate limbs
- Observe horse moving
- Flexion tests
- Diagnostic nerve and/or joint blocks
- Diagnostic Imaging
2
Q
this is a clinical sign of musculoskeletal pain
A
lameness
3
Q
what is the best gait for determining which limb(s) is lame?
A
the trot
4
Q
what is the main sign that is key to recognising forelimb lameness
A
head nod
5
Q
what is the cardinal sign of hindlimb lameness?
A
asymmetric movement of the gluteal regions/tubercoxae
6
Q
with unilateral forelimb lameness, what direction with the horse’s head nod with the SOUND limb and with the LAME leg?
A
DOWN with the SOUND limb
UP on the LAME limb
7
Q
a horse with unilateral hindlimb lameness will show increased excursion of gluteal region on which side?
(sound or lame)
A
LAME
(the ‘hip hike’)
8
Q
name the lameness grading scale
graded from 1-5;
an overarching grade when looking at the horse on various surfaces and gaits;
easier to utilise but does not allow for more subtle changes, particularly when performing diognostic anaesthesia
A
AAEP
9
Q
name the lameness grading scale
graded from 1-10;
sliding scale that can be used for each trot up
A
Wyn-Jones
10
Q
name the AAEP lameness grade
Lameness not perceptible under any
circumstance
A
0
11
Q
name the AAEP lameness grade
lameness that is difficult to observe and is not consistently apparent, regardless of circumstances
A
1
12
Q
name the AAEP lameness grade
lameness that is difficult to observe at a walk or when trotting in a straight line, but is consistently apparent under certain circumstances
A
2
13
Q
name the AAEP lameness grade
lameness is consistently observable at a trot under ALL circumstances
A
3
14
Q
name the AAEP lameness grade
lameness is obvious at a walk
A
4
15
Q
name the AAEP lameness grade
non-weightbearing
A
5
16
Q
name the Wyn-Jones lameness grade
sound
A
0
17
Q
name the Wyn-Jones lameness grade
minimal degree of lameness is detectable, which may be inconsistent
A
1
18
Q
name the Wyn-Jones lameness grade
a consistent, but mild, degree of lameness - detectable and consistent subtle head nod
A
2
19
Q
name the Wyn-Jones lameness grade
consistent and obvious head nod/pelvic asymmetry
A
3
20
Q
name the Wyn-Jones lameness grade
pronounced head nod / pelvic asymmetry
A
4
21
Q
name the Wyn-Jones lameness grade
marked head nod/pelvic asymmetry
A
5
22
Q
name the Wyn-Jones lameness grade
very marked head nod/pelvic asymmetry
A
6
23
Q
name the Wyn-Jones lameness grade
difficulty trotting;
only just able to place heels to ground
A
7
24
Q
name the Wyn-Jones lameness grade
minimal weight-bearing, heels not placed on the ground
A
8
25
# name the Wyn-Jones lameness grade
only able to touch the limb to the ground
9
26
# name the Wyn-Jones lameness grade
unable to put limb on ground
10
27
what is the most commonly used local anaesthetics for perineural anaesthesia?
nerve blocks used for assessing lameness
Mepivicaine
| (onset 5-10min; duration 2-3h)
28
# name the nerve block for assessing lameness
1-2mL;
limb position: limb held up, digit in partial flexion;
landmark: axial to the neurovascular bundle at the level of the ungular cartilages (NOT in the mid-pastern region)
palmar/plantar digital nerve block
29
# name the nerve block for assessing lameness
1-2mL;
forelimb position: limb held in partial flexion;
hindlimb position: limb weight bearing or held up;
landmarks: palmar to the medial and lateral neurovascular bundle at the level of the distal aspect of the proximal sesamoid bones
abaxial sesamoid nerve block
30
name 3 landmarks blocked by the abaxial sesamoid nerve block
1. all of the hoof capsule
2. proximal interphalangeal joint
3. palmar pastern region
31
name 5 parts of the palmar pastern region blocked by the abaxial sesamoid nerve block
1. sesamoidean ligaments
2. DDFT
3. SDFT
4. distal part of tendon sheath
5. part of metacarpophalangeal joint
32
# name the nerve block to assess lameness
1-2mL;
forelimb position: limb held up in partial flexion;
hindlimb position: limb weight bearing or held up;
landmarks: distal to button of the splint, 1-2" proximal to DFTS, subcutaneously between suspensory ligament and flexor tendons, at level of the button of the splint, adjacent to the abaxial margin of the extensor tendon
low 4-6 pt nerve block
33
name 3 areas blocked by the low 4-6 pt nerve block
1. everything the abaxial blocks
2. DFTS
3. fetlock region (incl. suspensory branches)
34
name 4 advantages of ultrasound for diagnosing lameness
1. non-invasive
2. readily available
3. relatively cheap
4. horse side
35
name 4 disadvantages of ultrasound for diagnosing lameness
1. fast learning curve
2. can be tricky to interpret
3. anatomy knowledge essential
4. false/artefacts
36
name 5 advantages of radiography for diagnosing lameness
1. relatively cheap
2. readily available
3. easier to interpret than u/s
4. useful for bone pathology
5. horse side
37
name 3 disadvantages of radiography for diagnosing lameness
1. health and safety implications
2. radiographic changes often historical
3. difficult to image proximal limbs/pelvis
38
name 4 advantages of scintigraphy for diagnosing lameness
1. good for 'active' bone pathology
2. occasionally useful for enthesopathy
3. proximal limb/trunk injuries
4. concerns over fractures
39
name 4 disadvantages of scintigraphy for diagnosing lameness
1. referral hospital
2. take 10-14d before a fracture is 'active'
3. expensive (1400-2000)
4. requires min of 48h hospitalisation
40
name 3 advantages of MRI for diagnosing lameness
1. soft tissue and bone
2. particularly within the foot and pastern region
3. standing
41
name 5 disadvantages of MRI for diagnosing lameness
1. referral hospital
2. expensive
3. not good at cartilage
4. susceptible to movement
5. can't go more proximal than carpus/tarsus
.
42
# name the characteristic lameness gait
shortened cranial phase, with an abrupt catching of the forward swing, followed by a slapping of the foot onto the ground ;
occurs on EVERY step of the effected leg;
single leg usually;
scar tissue of semitendinosus muscle
Fibrotic Myopathy
43
# name the characteristic lameness gait
subluxation of scapulohumeral (shoulder) joint ;
muscle atrophy (supraspinatous mm and/or infraspinatous mm);
suprascapular nerver neuropraxia due to blunt trauma
Sweeney
44
what is the 4 treatments for Sweeney
1. anti-inflammatories
2. electrostimulation
3. physiotherapy
4. vit E and selenium supplements
45
# name the characteristic lameness gait
exaggerated upward flexion of a hindlimb or both hindlimbs;
every stride;
affected limb is brought up, underneath the horse, frequently to the ventral abdomen
Stringhalt - neuropathy
46
# name the characteristic lameness gait
draft breed and warmbloods;
early or mild disease can resemble stringhalt or upward fixation of the patella;
EPISODIC hyperflexion and abduction of the hindlimb (for several seconds), before placing foot on ground ;
exacerbated by picking up of the limb
Shiverer
47
what treatment can be tried for shiverer gait?
change to a high fat, low starch and low sugar diet
48
# name the characteristic lameness gait
decreased force of muscle contractions (biceps femoris and quadriceps);
episodically unable to flex the stife, and drag extended limb behind them on the toe;
unilateral > bilateral
upward fixation of the patella
('locking patella')
49
how to treat upward fixation of the patella
exercise
(conditioning, work on hills)
50
what surgery can be done for upward fixation of the patella?
medial patella ligament desmoplasty / desmotomy
51
# name the characteristic lameness gait
often trauma related, resulting in hyperextension of the limb or laceration;
allows hock to extend while stifle is flexed;
characteristic dimple in the contour of the distal aspect of the crus
ruptured peroneus tertius
52
how long should a horse with ruptured peroneus tertius be box rested?
3 months
53
# name the characteristic lameness gait
dropped elbow;
inability to lock out the carpus;
often associated with trauma, young horses turned out together
radial nerve paralysis
54
name 5 differentials for a 'drop elbow'
1. radial nerve paralysis
2. olecranon fracture
3. triceps myopathy
4. shoulder fracture
5. humerus fracture
55
name 5 treatments for radial nerve paralysis
1. time
2. anti-inflammatories
3. electrostimulation
4. physiotherapy
5. vit E and selenium supplements
56
# start of MSK02
name the 7 structures making up the Podotrochlear apparatus of the foot
1. deep digital flexor tendon (DDFT)
2. suspensory ligament of navicular bone
3. collateral sesamoidean ligament
4. distal interphalangeal joint
5. distal sesmoidean impar ligament (DSIL)
6. navicular bursa
7. navicular bone
57
# name the foot pathology
due to single episode of trauma or repetitive overloading (foot imbalance);
diagnose with inspection and hoof testers
bruising
58
name 3 parts of treatment for bruising of the foot
1. rest
2. NSAIDs
3. solar pads or glue on shoes
59
# name the foot pathology
a specific bruise at the angle of the bar;
more common medial than lateral;
usually due to presure from heel of shoe (either shod too short or shoe left on too long)
corns
60
# name the foot pathology
very common cause of lameness;
acute, severe lamness or intermittent;
incr prevalence in winter/wet;
variable clinical signs;
any insult to sole can create ideal inflamm medium for bacterial growth
foot abscess
61
# name the foot pathology
a nail is driven close to the sensitive laminae during shoeing, resulting in compression and pain
nail bind
62
name 3 clinical signs of nail bind
1. lameness
2. incr digital pulses and heat
3. pain on hoof testers over location of nail
63
where do foot abscesses most commonly occur?
around the white line
64
what can be used to soften to hoof to help find the foot abscess for diagnossi
warm poultice
65
name the 3 parts of treatment for a foot abscess
1. release infection & adequate drainage
2. poultice until infection is controlled
3. warm bath with povidone and magnesium salt (5-10min)
66
# name the foot pathology
benign, hyperplasticity mass made of keratin;
originate from epidermal cells of the coronary band;
between sensitive laminae and hoof wall (stratum internum/medium;
usually dorsal half of foot
keratoma
67
# name the foot pathology
inflammation of the distal phalanx;
demineralisation of the solar margin
pedal osteitis
68
name 5 parts of treatment for aseptic or concussive pedal osteitis
1. corrective farriery (with shoes)
2. improve solar palmar angle
3. correct mediolateral imbalance
4. avoid work on hard ground
5. may require 6mo paddock rest
69
# name the foot pathology
recurring foot abscess in the same site;
+ve hoof testers;
+ve PDNB/ABNB;
x-ray or MRI in combo with history to diagnose
septic pedal osteitis
70
name the 3 parts of treatment for septic pedial osteitis
1. surgical debridement
2. abx + NSAIDs
3. hospital plate
71
# name the foot pathology
infection of the ungular/collateral cartilages;
result of a hoof wall crack, puncture wound, or chronic abscess;
chronic abscessation, with intermittent purulent discharge above the coronary band
quittor
72
name the 2 parts of treatment of quittor
1. surgical excision of infected cartilage and surrounding tissue
2. opening of ventral drainage portal
73
# name the foot pathology
pododermatitis of the frog;
bacterial: Fusobacterium necrophorum;
foul smelling, black discharge and degeneration of the frog
thrush
74
name 3 predispositions to thrush
1. damp environment and poor stable sanitation
2. poor hoof health/care
3. sheared heels
75
name 5 parts of treatment for thrush
1. debride frog
2. move to dry clean environment
3. daily hoof cleaning
4. foot baths
5. regular exercise
76
# name the foot pathology
hypertrophic, moist dermatitis of the frog and bulbs of the heel;
gram neg bacterial infection (F. necrophorum) and chronic pododermatitis;
results in abnormal keratin production
canker
77
name the 3 parts of treatment for canker
1. repeat radical debridement
2. topical abx (metronidazole and chloramphenicol)
3. caustic agents
| (difficult!)
78
# start of MSK03
name the foot pathology:
combo of bacteria and fungi produce separation of the white line;
occasionally will cause lameness, but often an incidental finding during trimming;
white line often has a grey/black chalky appearance
seedy toe/white line disease
79
which part of the sole does seedy toe/white line disease start at?
stratum medium and junction of stratum internum
80
# name the foot pathology
vertical cracks in hoof wall from coronary distally
sand cracks
81
# name the foot pathology
vertical cracks in hoof wall from ground proximally
grass cracks
82
name 5 causes of hoof wall cracks
1. chronic foot imbalance
2. lack of trimming
3. trauma
4. nutrition
5. poor hoof quality
83
which radiographic view allows you to see the upright navicular bone
dorsoproximal-palmarodistal oblique (upright navicular)
84
which radiographic view allows you to see the navicular skyline
palmaroproximal-palmarodistal oblique
85
name the 3 types of treatment options for navicular disease
1. farriery
2. surgical
3. medical
86
name the 3 ways to treat navicular disease with farriery
1. shorten toe
2. aid break-over
3. elevate heels
87
name the 4 medical treatments for navicular disease
1. intra-thecal anti-inflammatories
2. intra-articular (DIPj)
3. Biphosphates
4. NSAIDs
88
name 3 intra-thecal anti-inflammatories that can be used to treat navicular disease
1. corticosteroids
2. hyaluronic acid
3. polyacrylamide gel
89
name 2 surgical treatments for navicular disease
1. buroscopy
2. palmar digital neurectomy
90
# name the foot pathology
mineralisation of the ungular cartilages - normal part of the ageing process;
often an incidental finding ;
BUT extensive ossification has been associated with lameness
sidebone
91
name the 3 characteristics of remedial farriery to treat fracture of ungular cartilage
1. bar shoe with extra clips
2. wide bar on fractured side
3. groove hoof wall, proximal to fracture site
92
how long should a horse with fractured ungular cartilage be on box rest?
3-4mo
93
94
name 2 treatments for distal phalanx fractures
1. external coaptation
2. internal fixation
95
# name the type of distal phalanx fracture
abaxial fracture WITHOUT joint involvement
type 1
96
# name the type of distal phalanx fracture
axial, periaxial and abaxial fractures INVOLVING the joint
type 2 & 3
97
name 2 parts of treatment of type 1 distal phalanx fracture
1. cast or bar rim shoe for 2mo
2. box rest 2-4mo
98
name the 2 parts of treatment of type 2 & 3 distal phalanx fractures
1. surgery (lag screw)
2. box rest 2mo, then hand walking 2mo
99
# name the type of distal phalanx fracture
extensor process fragments
type 4
100
# name the type of distal phalanx fracture
multifragment fractures
type 5
101
# name the type of distal phalanx fracture
solar margin fractures
type 6
102
name the treatment for type 4 distal phalanx fractures
remove small fragments,
lag screw large fragments
103
name the conservative treatment for type 5 distal phalanx fractures
rim shoe / cast
104
name the surgical treatment for type 5 distal phalanx fractures
articular joint reconstruction
105
name the treatment for type 6 distal phalanx fractures
usually heal by bony union
106
name the 3 synovial structures present in the middle of the foot that can be damaged by solar penetration
1. DFTS
2. NB
3. DIPj
107
what is the treatment for coronary band laceration
debridement and primary closure
108
# start of MSK05
which part of the long bone is ossified at birth and which part remains partly cartilaginous?
diaphysis ossified at birth;
epiphysis remain partly cartilaginous
109
name th 4 steps of endochondral ossification
1. cartilage proliferation and hypertrophy
2. calcification of cartilage
3. deposition of primary bone
4. remodelling into bony trabeculae
110
this is a focal disturbance in the process of endochondral ossification
osteochondrosis (OC)
111
cartilage superficial to an osteochondrosis lesion can fracture, giving rise to fragments in joints known as these
osteochondrosis dissecans (OCD)
112
name the 3 osteochondrosis stages
1. Osteochondrosis latens
2. osteochondrosis manifesta
3. osteochondrosis dissecans
113
# name the osteochondrosis stage
characterised by a focal area of necrotic cartilage (chondronecrosis), within the epiphyseal cartilage (visible histologically)
osteochondrosis latens
114
# name the osteochondrosis stage
necrotic cartilage results in focal failure of endochondral ossification - visible macroscopically (similar to a bone cyst)
osteochondrosis manifesta
115
# name the osteochondrosis stage
fissure originating from the necrotic cartilage, extends to the articular cartilage, creating a chondral or osteochondral flap;
likely secondary to trauma
osteochondrosis dissecans
116
name 4 things that cause clinical OC (osteochondrosis) progression
1. biomechanical trauma
2. exercise
3. nutrition, hormonal factors and growth rate
4. genetics
117
which mineral is important in the repair of lesions?
collagen and elastin crosslinks
copper
118
what joint in warmbloods is the most common site for osteochondrosis (OC)
tarsocrural
119
what joint in thoroughbreds is most common site for osteochondrosis (OC)
femoropatella
120
which pouch has the most obvious soft, fluctuant swelling in tarsocrural osteochondrosis (OC)
dorsomedial pouch
121
name 3 signs of stifle osteochondrosis (OC) appreciated on clinical exam
1. effusion of femoropatellar joint and medial femorotibial joint
2. soft fluctuant swelling cranial to medial collateral ligament of femorotibial joint
3. soft fluctuant swelling cranial to patella
122
name 3 parts of the fetlock that can be affected by osteochondrosis (OC)
1. dorsal end of sagittal ridge
2. dorsoproximal first phalanx
3. plantar osteochondral fragments (POF)
123
what is the most common part of the fetlock to be affected by osteochondrosis (OC)
dorsoproximal first phalanx
124
name 3 parts of the stifle that are affected by osteochondrosis (OC)
1. lateral trochlear ridge
2. medial femoral condyle subchondral bone cysts
3. distal apex of patella
125
name 4 parts of the tarsus affected by osteochondrosis (OC)
1. distal intermediate ridge of tibia (DIRT)
2. lateral trochlear ridge of talus (LTR)
3. medial malleolus of tibia (MM)
4. medial trochlear ridge of talus (rare!)
126
what is the treatment of choice for most cases of OCD (osteochondrosis dissecans)
arthroscopy
127
what is the most common location in the stifle for a subchondral bone cyst
medial femoral condyle
128
name 4 treatment options for stifle subchondral bone cysts (SBC)
1. arthroscopic debridement
2. intra-cyst injection (corticosteroids, mesenchymal stem cells)
3. bone graft
4. transcortical screw
129
# start of MSK04
name the type of dermis (corium):
vascular, dense connective tissue;
extends elongated distally directed papillae
coronary corium
130
# name the type of dermis (corium):
series of laminae that interdigitate with epidermal laminae
laminar corium
131
# name the type of dermis (corium):
shorter papillae
perioplic, solar, cuneate corium
132
this part of the foot provides sensation, nourishment and attachment for overlying epidermis
dermis (corium)
133
# name the type of epidermis of the foot
single layer proliferating columnar keratinocytes;
lie on and between long dermal papillae;
proliferation forces cells distal intol stratum medium
stratum basale
134
name the 3 types of epidermis that make up the wall
1. stratum internum
2. stratum medium
3. stratum externum
135
# name the part of the hoof wall
epidermal laminae interleave with dermal laminae (550-600);
secondary laminae (150-200);
0.8m^2
stratum internum
136
# name the part of the hoof wall
horn tubules and intertubular horn;
provides strength in every direction
stratum medium
137
# name the part of the hoof wall
thin from perioplic region
stratum externum
138
name the 3 valveless venous plexus - digital veins of the foot
1. dorsal
2. palmar/plantar
3. coronary
139
name 4 causes of failure of dermal/epidermal junction in the foot
1. carb overload
2. septicaemia
3. equine metabolic syndrome/insulin resistance
4. mechanical overload
140
# name the theory of laminitis
older;
endotoxin causes peripheral vasoconstriction;
decr laminar perfusion and necrosis
vascular
141
# name the theory of laminitis
newer and now more accepted;
proteolytic enzymes damage collagen allowing laminar separation
inflammatory
142
name 4 clinical signs of laminitis
1. incr digital pulses
2. if 'sinker' then there is a palpable dip at dorsal coronary band
3. rotation results in pedal bone tip pressing on sole dorsal to frog = convex
4. separation of white line
143
# name the radiographic evidence of laminitis being assessed
angle between dorsal surface hoof wall and dorsal surface P3;
sole thickness at P3 tip
rotation
144
# name the radiographic evidence of laminitis being assessed
founder distance (extensor process P3 to top of coronary band);
sole thickness
sinking
145
name 5 ways to reduce stress on laminae for treatment of acute laminitis
1. remove shoes
2. deep supportive bed
3. cryotherapy
4. small box confinement
5. even weight bearing/heel support
.
146
name 5 pain relief options for acute laminitis treatment
1. non-steroidals
2. morphine IM q4h
3. acepromazine IM + morphine
4. lignocaine + morphine as CRI + acepromazine IM
5. ketamine CRI
.
147
name 3 advantages of glue on shoes for laminitis
1. atraumatic
2. mouldable
3. good for re-intro of exercise
148
name 2 disadvantages of glue on shoes for laminitis
1. poor grip
2. pressure!!
149
name 3 goals of trimming & shoeing as treatment of chronic laminitis
1. hoof capsule realigned to P3
2. frog support
3. reduce breakover
150
# start of MSK06
which angular limb deformity (ALD) is when the leg deviates inwards
varus
151
which angular limb deformity (ALD) is when the leg deviates outwards
valgus
152
which angular limb deformity (ALD) is more of a problem?
varus
153
name 3 congenital causes of angular limb deformities (ALD)
1. incomplete cuboidal bone ossification
2. laxity of the periarticular stuctures 'windswept'
3. aberrant intrauterine ossification
154
name 7 developmental factors for acquired angular limb deformities (ALD)
1. genetic predisposition
2. dietary imbalances
3. trauma
4. exercise
5. physeal dysplasia
6. physeal overload
7. heavy birth rate
155
# name the rapid growth phase (mo) for the growth plate
proximal P1
0-2mo
156
# name the rapid growth phase (mo) for the growth plate
distal MC3/MT3
0-2mo
157
# name the rapid growth phase (mo) for the growth plate
distal radius
0-6mo
158
# name the rapid growth phase (mo) for the growth plate
distal tibia
0-4mo
159
# name the time of radiographic physis closure (mo) for the growth plate
proximal P1
12mo
160
# name the time of radiographic physis closure (mo) for the growth plate
distal MC3/MT3
6mo
161
# name the time of radiographic physis closure (mo) for the growth plate
distal radius
22-36mo
162
# name the time of radiographic physis closure (mo) for the growth plate
distal tibia
17-24mo
163
up to what degree of angular limb deviation is considered normal
up to 4 degrees
164
which side grows FASTER in an angular limb deformity?
the concave or the convex side?
concave side grows faster
| (convex side grows slower)
165
at what points should the fetlock be assessed for angular limb deformities (ALD)
at birth/1d old
and again at 30d
| (or q1-2wks)
166
when must an angular limb deformity (ALD) of the fetlock be resolved by?
by 12wks of age
| (3mo)
167
at what age are angular limb deformities (ALD) of the fetlock usually surgically treated at?
4-6wks of age
168
at what age should you consider surgery for angular limb deformities (ALD) of the carpus
~6 mo
169
name the 2 steps of hoof manipulation to correct valgus (toe out)
1. outside half of hoof wall is rasped (at the sole)
2. extension placed medial
170
name the 2 steps of hoof manipulation to correct varus (toe in)
1. inside half of hood wall is rasped (at the sole)
2. extension placed lateral
171
name 3 risks of hoof manipulation to correct valgus and varus angular limb deformities (ALD)
1. risk of P3 fractures
2. joint stress (distal limb)
3. exothermic reaction (aseptic pedal osteitis, foot abscess)
172
name the 2 surgical options for correction of angular limb deformities (ALD)
1. growth acceleration
2. growth retardation
173
what is the surgical option for growth acceleration to correct angular limb deformities (ALD)
hemicircumferential periosteal elevations
| (aka periosteal strip)
174
what is the surgical option for growth retardation to correct angular limb deformities (ALD)
transphyseal bridge
| (transphyseal screw OR screw and wires)
175
name 4 angular limb deformities (ALD) that cause problems
1. offset knees, 'bench knees'
2. fetlock varus
3. long pasterns
4. mild carpal valgus
176
what is meant by the angular limb deformity (ALD) called offset knees or 'bench knees'
carpal valgus & fetlock varus
177
this is a limb deformity in the saggital plane
flexural limb deformity
178
# name the flexural limb deformity
flaccidity of flexor muscles;
commonly seen in newborns or premature foals;
often self-corrects within a few weeks
digital hyperextension
179
# name the flexural limb deformity
congenital;
limb in permanent flexion;
can be a cause of dystocia;
physically unable to manipulate them straight
contracture
180
name 2 aetiologies for congenital contracture
| (flexural limb deformity)
1. uterine malposition
2. toxic/viral insult in utero
181
name 4 treatments for congenital contracture (flexural limb deformity)
| (early aggressive treatment required!)
1. IV oxytet (3g SID for 3d)
2. corrective farriery
3. bandaging/splints/casts
4. analgesia (metacam/fentanyl)
182
name 3 aetiologies for acquired flexural limb deformities
1. rapid growth
2. nutrition
3. pain (reduced weight bearing)
183
name 4 clinical signs of acquired flexural limb deformities
1. 6wks-6mo old
2. boxy, upright foot
3. broken forwards HPA
4. raised heel, walking on toe
184
# name the type of DIPj acquired flexural limb deformity
dorsal hoof wall does not pass beyond vertical
type 1 (A)
185
# name the type of DIPj acquired flexural limb deformity
dorsal hoof wall passes beyond vertical
type 2 (B)
186
name 4 conservative treatments for acquired DIPj flexural limb deformity
1. dietary changes
2. NSAIDs
3. exercise
4. hoof trimming, bandaging +/- toe extension
187
name 2 surgical treatments for acquired DIPj flexural limb deformity
1. desmotomy of ALDDFT (accessory ligament of deep digital flexor tendon)
2. DDF tenotomy
| (salvage procedures)
188
# name the stage of acquired MCPj flexural limb deformity
straight fetlock, that is palmar to the foot
mild
189
# name the stage of acquired MCPj flexural limb deformity
fetlock is dorsal to the foot, but when weight bearing, fetlock becomes palmar to foot
moderate
190
# name the stage of acquired MCPj flexural limb deformity
fetlock is always dorsal to the foot
severe
191
name 3 treatments for acquired MCPj flexural limb deformities
1. remedial farriery
2. analgesia
3. surgery
192
name the 2 surgical options for correction of acquired MCPj flexural limb deformity
1. ALDDFT tenotomy
2. ALSDFT tenotomy
193
this is inflammtion and disruption of the physis
physitis
194
name 3 aetiologies for physitis
1. overload
2. over exercise
3. rapid growth
195
name 5 clinical signs of physitis
1. 4-8mo old
2. pain on palpation
3. hard swelling over physis
4. distal radius, tibia, MC3 and MT3
5. variable lameness
196
name 2 signs of physitis seen on radiographs
1. metaphyseal flaring
2. hourglass shape to bone
197
name the 3 treatments for physitis
1. reduction in BW or growth rate
2. box rest
3. NSAIDs 2-4wks at low doses
198
# name the grade of cuboidal bone abnormality
some cuboidal bones of the carpus and tarsus have no evidence of ossification
grade 1
199
# name the grade of cuboidal bone abnormality
all cuboidal bones have some form of ossification
grade 2
200
# name the grade of cuboidal bone abnormality
all cuboidal bones (carpus and tarsus) are ossified, but small and rounded edges are present;
joint spaces are wide and lateral styloid process and malleoli are distinctly visible;
prox physes MC3/MT3 are closed
grade 3
201
# name the grade of cuboidal bone abnormality
all criteria of grade 3 are met;
cuboidal bones are shaped like corresponding adult bones and joint spaces have expected width
grade 4
202
what is the treatment for cuboidal bone abnormalities
1. box rest
2. repeat radiographs q2wks
203
# start of MSK08
name 4 aetiologies for synovial sepsis in the adult horse
1. traumatic
2. iatrogenic (joint medication)
3. extension from overlying/adjacent structure
4. very rarely haematogenous
204
name 7 clinical signs of synovial sepsis in adult horse
1. trauma/wound overlying synovial structure
2. visible penetration
3. severe lameness
4. heat/swelling
5. rectal temp usually normal
6. history of joint medication
7. history of cellulitis
205
name 4 ways to diagnose synovial sepsis
1. obvious clinical findings (palpate and u/s)
2. synovial fluid analysis
3. joint distension
4. advanced imaging
206
what tube should be used for cytology of synovial fluid
EDTA
207
what tube should be used for bacteriology of synovial fluid
plain
208
name 4 things to assess in synovial fluid
1. appearance
2. total WCC, % neutrophils
3. total protein
4. lactate/serum amyloid A
209
what volume should be used for joint distension/pressure test in fetlock and carpus joints?
30 mL
210
what volume should be used for joint distension/pressure test in tarsocrural joint
120mL
211
name the 4 parts of treatment for synovial sepsis
1. remove source of infection
2. lavage joint
3. antimicrobials
4. anti-inflammatories
212
name 4 uses of arthroscopy for treating synovial sepsis
1. remove foreign material
2. remove pannus
3. debride tissue
4. assess damage and prognosticate
213
name 4 advantages of needle lavage over arthroscopy for treating synovial sepsis
1. cheap and easy
2. good for acute infection in foals
3. first litre most important
4. multiple widely spaced needles
214
name 3 disadvantages of needle lavage over arthroscopy for treatment of synovial sepsis
1. no visualisation
2. no pannus removal
3. limited FB removal
215
name the 3 steps of intra-venous regional perfusion (IVRP)
1. tourniquet proximal to joint
2. catheter/needle in peripheral vein
3. large volume
216
what is the highest risk factor for foals developing septic arthritis and osteomyelitis
failure of passive transfer
217
# name the type of septic arthritis and osteomyelitis in foals
synovial membrane and fluids
S-type
218
# name the type of septic arthritis and osteomyelitis in foals
articular epiphyseal complex
E-type
219
# name the type of septic arthritis and osteomyelitis in foals
primary infection of physis
P-type
220
name 4 treatments for synovial sepsis in foals
1. abx
2. needle joint lavage if no evidence of osseous involvement
3. anti-inflammatory meds
4. treat concurrent disease
221
what is the characeristic radiological appearance of sequestrum formation
sequestrum surrounded by radiolucent involucrum
222
# start of MSK09
name the 3 general causes of fractures in horses
1. acute trauma
2. pathologic fracture
3. repetitive stress over short intervals of time
223
what is the most common general cause of fractures in horses
repetitive stress over short intervals of time
224
name 6 clinical signs of limb fracture
1. acute, severe lameness
2. local heat, pain on palpation, swelling
3. abnormal angulation or mobility of limb
4. limb shortening
5. crepitus
6. loss of function
225
list 7 differential diagnoses for a patient presenting with acute, severe lameness
1. subsolar abscess
2. fracture
3. septic arthritis, tenosynovitis or bursitis
4. tendon or ligament injury
5. cellulitis or lymphangitis
6. laminitis
7. rhabdomyolysis
226
what 4 limb fractures would have a hopeless prognosis in majority of cases
proximal humerus, radius, tibia and femur
in adult horses (>300kg)
227
what range can the cost for repair of fractures cost?
2,000-10,000
| (can exceed 15,000)
228
name 5 criteria for humane destruction (euthanasia) in a fracture case
1. large open fractures
2. significant comminution
3. proximal long bone fracture
4. recumbency
5. owner request (finances, etc)
229
what should be used as sedation for an adult horse with a fracture
alpha-2 and opiod
xylazine or detomodone +/- butorphanol or morphine
230
what should be used as sedation for a young foal with a fracture
diazepam
231
what should be used as sedation for an older foal with a fracture
butorphanol
232
name 3 reasons accurate stable reduction is required ASAP with a fracture, before moving the patient, attempting radiography or transporting the patient
1. provides pain relief
2. allows horse to regain control of limb
3. minimises further soft tossue injury or further injury to fractured bone
233
name the 3 steps of fracture stabilisation
1. address wounds
2. apply bandage
3. place splint(s) based on biomechanical divisions or type of fracture present
234
# name the type of bandage for stabilisation of fracture
1x diameter on distal limb
3x diameter for higher fractures
Robert Jones
235
# name the type of bandage for stabilisation of fracture
3 layers of cotton wool
better stabilisation
modified Robert Jones + splint
236
name 5 options for splinting material
1. Polyvinylchloride (PVC) pipe splints
2. pine board
3. aluminium or flat steel
4. bandage cast
5. commercial splints
237
name 4 splinting options for a level 1 P1 sagittal/parasaggital fracture
1. Robert Jones bandage
2. modified Robert Jones and lateral and medial splints from ground to proximal metacarpus/tarsus
3. bandage cast
4. compression boot
238
name 2 splinting options for a level 1 P1 frontal fracture
1. bandage cast
2. compression boot
239
name the type of splinting for level 1 palmar (forelimb) process fractures of P1 and P2
apply splint dorsal from ground to proximal metacarpus with fetlock in flexion
| (use of Kimzey leg saver)
240
name the type of splinting for level 1 plantar (hindlimb) process fractures of P1 and P2
apply splint on plantar aspect of limb from ground to top of calcaneus with fetlock in flexion
| (use of Kimzey leg saver)
241
name 3 splint options for a level 2 lateral or medial condylar fracture
1. splinted Robert Jones bandage (lateral and medial splints)
2. bandage cast
3. compression boot
242
name the splinting method for level 2 sesamoid bone fractures of the forelimb
apply splint dorsal from ground to proximal metacarpus with fetlock in flexion
| (use of kimzey leg saver)
243
name the splinting method for level 2 sesamoid bone fractures of the hindlimb
apply splint on plantar aspect of limb from ground to top of calcaneus with fetlock in flexion
| (use of Kimzey leg saver)
244
where should the splint be placed for level 2 fractures of the forelimb to prevent abduction of the limb
1. from ground to elbow
2. on caudal and lateral aspect of limb
245
where should the splint be placed for level 2 fractures of the hindlimb to prevent abduction of the limb
1. from ground to top of tuber calcis
2. on caudal and lateral aspect of limb
246
what 2 splints should be placed for a level three fracture of the forelimb to prevent abduction of limb
1. caudal - elbow to ground
2. lateral - ground to withers
247
what splint should be placed for a level three fracture of the hindlimb to prevent abduction of limb
one splint lateral to level of tuber coxae
248
fractures of what 4 bones are considered level 4 fractures
1. humerus
2. scapula
3. femur
4. pelvis
249
can you place a splint for a level 4 fracture?
no
250
name 3 situations where splinting is NOT required for transport
1. fractures of humerus, scapula, femur and pelvis (level 4)
2. pedal bone fractures
3. fractures where limb stability is preserved
251
why should nerve blocks NOT be performed prior to radiographs of a fracture
to encourage weight-bearing
252
# name the type of fracture
courses completely through the bones and divides bone into 2 or more separate fragments
complete fracture
253
# name the type of fracture
does not course completely through the bone nor divide bone into 2 or more separate fragments
incomplete fracture
254
# name the type of fracture
occur when fracture fragments are separated, angulated, or overriding and no longer in anatomic apposition
displaced fractures
255
# name the type of fracture
fracture remains in anatomic apposition
non-displaced fracture
256
# name the type of fracture
skin has a wound over fracture that introduces contamination and increases risk for infection
open fractures
257
# name the type of fracture
skin overlying fractured bone is intact and not penetrated by injury
closed fractures
258
# name the type of fracture
course through the articular surface of a bone
articular fractures
259
# name the type of fracture
do not extend through an articular surface
non-articular fractures
260
# name the type of fracture
involve the end of a long bone
epiphyseal fracture
261
# name the type of fracture
involve an open physis
physeal fracture
262
# name the type of fracture
involve a region of bone adjacent to growth plate on the side closer to the centre of the long bone
metaphyseal fracture
263
# name the type of fracture
involve the central region of a long bone
diaphyseal fracture
264
# name the type of fracture
course approximately perpendicular to the longitudinal access of the bone
transverse fractures
265
# name the type of fracture
course along a flat plane but obliquely through the bone
oblique fractures
266
# name the type of fracture
have a spiral fracture component through a bone
spiral fractures
267
# name the type of fracture
have transverse and oblique components
butterfly fractures
268
# name the type of fracture
divide bone into only 2 fragments
simple fracture
269
# name the type of fracture
divide bone into 2 major fragments with small bone fragments, usually along the major fracture line
mildly comminuted fractures
270
# name the type of fracture
divide bone into 3 or more major fragments
comminuted fractures
271
name 2 types of stress fractures
1. kick injuries of distal medial radius
2. tibial stress fractures or pelvic fractures in high-level performance horses
272
what is the treatment for stress fractures
min 6wks box rest depending on severity
273
name 5 clinical signs of pelvic fractures
1. overt lameness
2. external swelling or palpable symmetry
3. pain with palpation
4. possible haemorrhagic shock if artery involved
5. muscle atrophy in chronic cases
274
what is the typical treatment for pelvic fractures
conservative with stall rest
275
how can displaced iliac shaft fractures in foals be repaired
internal fixation
276
how can displaced tuber coxae fractures that are draining be treated?
surgically by removing fracture fragment(s)
277
# start of MSK10
name 2 proteoglycans found in tendons
1. lecticans
2. SLRPs
278
# name the component of tendons
fibril forming;
tensile strength
type 1 collagen
279
name 5 risk factors for tendinopathy
1. speed
2. surface
3. weight of horse
4. fatigue
5. shoeing
280
name 3 theories for how fibril damage occurs
1. overstimulation
2. understimulation
3. aberrant differentiation of resident progenitor cells
281
# name the cause of fibril damage/tendinopathy
repetitive subthreshold mechanical strain;
hyperthermia;
ischaemia - reperfusion injury;
imbalance between synthesis and degradation;
ECM and cellular damage
overstimulation
282
# name the cause of fibril damage/tendinopathy
loss of local homeostatic strain results in activation of catabolic cascade;
collagenase upregulated in stress deprived tendons leading to breakdown of the extracellular matrix
understimulation
283
# name the tendon injury
acute onset lameness;
heat, soft painful swelling;
classically in the mid-cannon area;
lameness often resolved quickly for non-severe injuries BUT tendon remains weak
superficial digital flexor (SDFT) injury
284
how long after injury should u/s be used to confirm extent of fibre damage in superficial digital flexor injuries
10-14 d
285
what is the aim of superficial digital flexor tendinopathy treatment
promote longitudinal organisation of collagen fibrils
286
name 4 treatments available for tendinopathy of superficial digital flexor tendon
1. controlled exercise alone
2. stem cells
3. platelet rich plasma (PRP)
4. desmotomy ALSDFT
287
how long should a horse with superficial digital flexor tendinopathy be on box rest and 30min in hand walking
8wks
288
how long after superficial digital flexor injury before a horse should resume full race/competition training
52 wks
289
name 5 locations for deep digital flexor tendinopathy
1. within the foot
2. within digital flexor tendon sheath
3. assoc with osteochondroma in carpal canal
4. assoc with ALDDFT desmitis
5. assoc with injury to sustentaculum tali
290
how to treat deep digital flexor tendinopathy within the digital flexor tendon sheath
tenoscopic debridement
291
what is the most useful way to diagnose deep digital flexor tendinopathy within the foot
MRI
| (sagittal split, core lesions, dorsal fibrillation)
292
name 5 treatments for deep digital flexor tendinopathy within the foot
1. NSAIDs
2. box rest and controlled exercise
3. farriery (elevated heels)
4. bursal medication
5. bursoscopy
293
this extends from the distal 1/3 metacarpus to the T ligament
digital flexor tendon sheath (DFTS)
294
name 3 first aid treatments for complete breakdown of suspensory apparatus
1. Kimzey leg saver splint
2. NSAIDs
3. abx if surgery indicated
295
name 3 treatments for forelimb proximal suspensory desmitis
1. 3mo box rest and controlled exercise
2. shockwave
3. platelet rich plasma intra-lesional
296
what is another name for the accessory ligament of the deep digital flexor tendon (ALDDFT)?
inferior check ligament
297
# start of MSK11
this is the articulation between vertebral column and pelvis;
synovial joint between two flat surfaces
sacro-iliac joint
298
name the 3 ligaments required to provide stability to sacro-iliac joint
1. dorsal
2. ventral
3. interosseus
299
name 4 things to examine the back and pelvis for
1. range of motion
2. pain
3. lameness
4. symmetry
300
# name the radiograph projection of the neck
neutral position;
multiple overlapping views;
position of the neck has some but not massive impact
lateral-lateral
301
# name the radiograph projection of the neck
separates out articular process joints;
taken from both sides
oblique projections
| (lateral 45-55° ventral-dorsal oblique)
302
name 4 clinical presentations of neck pain
1. weak, tripping, reduced neck movement
2. resents contact
3. unwilling to move neck
4. hopping like lameness
303
name 3 indications for nuclear scintigraphy of neck, back and pelvis
1. screening tool for investigation of poor performance
2. investigation of undiagnosed lameness
3. undiagnosed but suspicion of severe pathology - fracture
304
name 4 clinical signs of impingement of the nerve root at the intervertebral foramen caused by degenerative arthropathy
1. localised sweating, pain
2. reluctance to bend the neck
3. stiffness
4. forelimb lameness
305
name 3 clinical signs of type 2 CVCM caused by degenerative arthropathy
1. reduced performance
2. subtle hindlimb gait abnormalities
3. ataxia
306
name 4 medications that can be used to manage impingement of dorsal spinous processes and back pain in general
1. corticosteroids (interspinous space)
2. NSAIDs
3. muscle relaxants
4. biphosphonates
307
name 3 surgical resection options for treatment of impingement of the dorsal spinous processes
1. subtotal ostectomy
2. cranial wedge ostectomy
3. interspinous ligament desmotomy
308
name 4 causes of sacro-iliac joint disease
1. arthrosis and microscopic instability
2. desmitis of the sacro-iliac ligaments or lumbosacral ligaments
3. osteoarthritis of the lumbosacral joint
4. acute sacroiliac injury
