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Y4 EQ - Orthopaedics > Pastern and fetlock > Flashcards

Pastern and fetlock Flashcards

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1
Q

Where is the pastern joint?

A

Between P1 and P2

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2
Q

Which ligaments/tendons lie at the palmar aspect of the pastern joint?

A

SDFT branch
Straight sesamoidean ligament
Oblique sesamoidean ligaments
Palmar scutum

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3
Q

Which ligament lies on the medial/lateral aspect of the pastern joint?

A

Collateral ligaments

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4
Q

Where does the distal sesamoidean ligament insert?

A

Onto the palmar/plantar scutum

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5
Q

Is the pastern joint a high or low motion joint?

A

Low

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6
Q

Is the pastern joint a high or low loading joint?

A

High

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7
Q

Where is the fetlock joint?

A

Between the 3rd metacarpal/tarsal bone and P1
Also proximal sesamoid bone

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8
Q

Which tendon is found at the dorsal aspect of the fetlock joint?

A

Common extensor tendon and extensor branch

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9
Q

Which tendons/ligaments are found at the palmar/plantar aspect of the fetlock joint?

A

Suspensory ligament
Collateral sesamoidean ligaments
Straight sesamoidean ligament
Oblique sesamoidean ligament

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10
Q

How is the fetlock joint stabilised?

A

Collateral/collateral sesamoidean ligaments

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11
Q

Is the fetlock joint a high or low motion joint?

A

High

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12
Q

The fetlock is primarily supported by which structure?

A

Suspensory ligament

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13
Q

Describe the initial investigation into pastern/fetlock problems

A

Clinical examination - Pain/lameness, swelling (synovial/soft tissue), heat, instability, ROM

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14
Q

Describe diagnostic analgesia of the pastern/fetlock

A

Perineural: ASNB (abaxial sesamoidean nerve block – blocks the foot and pastern); L4/6NB
Intra-synovial: PIPJ; MCPJ; (DFTS)

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15
Q

The L4 nerve block blocks which nerves?

A

Medial/lateral palmar and palmar metacarpal n.

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16
Q

The L6 nerve block blocks which nerves?

A

Medial/lateral plantar and plantar metatarsal n.
Dorsal metatarsal n. (med/lat)

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17
Q

Which radiographic views would you use for the pastern?

A

DP = front to back
LM = side to side
DMPLO = 45 degree angle dorsomedial
DLPMO = 45 degree angle dorsolateral

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18
Q

Which radiographic views would you use for the fetlock?

A

DP, LM, DMPLO, DLPMO, flexed LM

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19
Q

Which other imaging techniques can be used in the pastern/fetlock?

A

Ultrasonography
Advanced imaging e.g. nuclear scintigraphy, MRI or CT

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20
Q

Name 4 conditions of the equine pastern

A

Osteoarthritis
Osteochondrosis
Soft tissue injuries
Fractures/subluxation

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21
Q

What is a common term used to describe pastern osteoarthritis?

A

Articular ringbone

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22
Q

What is osteoarthritis?

A

Progressive destruction of articular cartilage with subchondral bone thickening and osteophyte production

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23
Q

What may severe cases of osteoarthritis have?

A

Cystic formation/joint collapse

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24
Q

How does arthritis occur?

A

Maybe insidious or secondary to other problem (e.g. trauma, sepsis, osteochondrosis)

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25
What are the clinical signs of pastern osteoarthritis?
Lameness (mild to moderate) Bony thickening over dorsal pastern
26
How is pastern osteoarthritis diagnosed?
Diagnostic anaesthesia: Perineural or intra-articular Radiography - Standard projections - Changes often dorsal
27
How is pastern osteoarthritis managed?
- Rest/light exercise - Intra-articular medication - Shoeing - NSAIDs - Arthrodesis (surgical, chemical)
28
What is sclerosis?
Subchondral bone formation - an abnormal increase in density and hardening of bone
29
How common are osteoarthritis and osteochondrosis in the pastern?
Osteoarthritis = common Osteochondrosis = uncommon
30
How does osteochondrosis manifest?
Osseous cysts (P1 or P2) or palmar/plantar osteochondral fragmentation
31
How is osteochondrosis managed?
Management often palliative Guarded prognosis
32
Name 2 common soft tissue injuries of the pastern joint
SDFT branch injury Distal sesamoidean ligament injury - Oblique or straight sesamoidean ligament
33
How do horses with soft tissue injuries of the pastern joint present?
Usually present acutely lame following traumatic injury Moderate lameness and soft tissue swelling
34
What is the best method for diagnosing soft tissue injuries?
Ultrasonography
35
How are soft tissue injuries managed?
Rest, NSAIDs, monitor healing by ultrasound
36
Describe the main features of P1 fractures
Sagittal, frontal, comminuted Often seen in racehorses
37
Describe the pathway of P1 fractures
P1 fractures begin at sagittal groove at articular surface - Extend distally (short <30mm; long>30mm) - Complete fractures exit lateral cortex or through PIPJ
38
Describe the features of P2 fractures
Palmar/plantar eminence, comminuted Usually due to acute overload injury
39
What are the common clinical findings of pastern fractures?
Usually acute onset severe lameness +/- instability +/- joint effusion
40
How are pastern fractures diagnosed?
Radiography
41
How are pastern fracture managed?
- First aid stabilisation: Zone 1 external coaptation - Conservative = Short, incomplete fractures - Surgical = Internal fixation – most cases - Euthanasia = Comminuted, open, unstable
42
What are the two main causes of pastern subluxation
Traumatic event (e.g. cattle grid/fence) Fracture/subluxation common (e.g. avulsion fracture)
43
How do cases of pastern subluxation present?
Acute lameness/instability Marked soft tissue swelling
44
How is pastern subluxation diagnosed?
Radiography +/- stress
45
How is pastern subluxation managed?
Initially stabilise through external co-aptation (zone 1) but often require pastern arthrodesis
46
List the main problems occurring at the equine fetlock
- PSB fractures - Sesamoiditis - Osteochondral fragmentation of P1 - Osteochondrosis - Osteoarthritis - Subchondral bone disease/POD - Chronic proliferative synovitis - Subluxation
47
What types of fractures can occur in the proximal sesamoid bone?
Apical (<30% of bone), mid-body, axial, basilar and comminuted may be unilateral or bilateral
48
What are the causes of proximal sesamoid bone fractures?
Usually acute trauma but may be due to non-adaptive modelling
49
How do cases of proximal sesamoid bone fractures present?
Clinical signs usually acute lameness with swelling and pain on palpation +/- joint effusion
50
How are proximal sesamoid bone fractures diagnosed?
- Standard radiographic projections but may need additional oblique views - Ultrasonography important as may also have concurrent SL injuries
51
Describe when conservative management of proximal sesamoid bone fractures is indicated
Uniaxial PSB fractures in foals Non-articular
52
Describe when surgical management of proximal sesamoid bone fractures is indicated
Fragment removal (e.g. apical fracture removed arthroscopically) Fracture repair (e.g.mid-body)
53
Describe when euthanasia for proximal sesamoid bone fractures is indicated
Biaxial/comminuted fractures
54
Define sesamoiditis
Inflammation around the soft tissues of the palmar fetlock Increased size/no. vascular channels
55
Sesamoiditis is most commonly seen in which horses?
Young performance horses
56
Sesamoiditis may indicate which injury?
May be an indicator of SL branch/annular ligament injury
57
How is sesamoiditis managed?
Rest/NSAIDs + local cold therapy Shockwave therapy in refractory cases
58
How is Osteochondral fragmentation of P1 managed?
- May not be clinically relevant (or relevant at high speed) so need to prove significance (e.g. diagnostic analgesia) - Radiography: Check contralateral limb - Fragment removal frequently performed arthroscopically
59
Name the clinical form of osteochondrosis
Osteochondritis dissecans
60
Describe the main features of osteochondrosis of the fetlock region
Includes OCD of the sagittal ridge of Mc/MtIII and osseous cysts of distal McIII OCD may be seen as flattening of the sagittal ridge to separate fragmentation Usually seen in young horses (1-4 fetlocks involved) with joint effusion +/- lameness
61
Describe management of osteochondrosis
Surgical removal of fragments (OCD) or curettage of the cyst
62
Describe fetlock osteoarthritis
Degenerative joint disease resulting in joint effusion, cartilage loss, osteophyte production and loss of joint function May be secondary to trauma, sepsis, osteochondrosis
63
Describe the clinical findings of fetlock osteoarthritis
Lameness exacerbated by fetlock flexion; reduced ROM Positive i/a anaesthesia
64
What would be seen on radiography of a fetlock with osteoarthritis?
Periarticular osteophyte formation (particularly proximodorsal aspect of P1 and dorsoproximal and dorsodistal margins of PSBs), modelling of proximal aspects of the dorsal and palmar sagittal ridges, subchondral bone sclerosis and joint space reduction
65
Describe management of mild/early cases of fetlock osteoarthritis
Intra-articular medication e.g. hyaluranon/ corticosteroids
66
Describe management of moderate cases of fetlock osteoarthritis
NSAIDs, i/a corticosteroids, IRAP, polyacrylamide gel
67
Describe management of severe cases of fetlock osteoarthritis
Arthrodesis (salvage) Euthanasia
68
What is Palmar/plantar osteochondral disease
Degenerative condition of the distal condyles of young racehorses
69
How does palmar/plantar osteochondral disease occur in young racehorses?
Repetitive high strain on bone and articular tissues leading to cartilage loss with eventual collapse of the articular surface Associated with repeated corticosteroid use?
70
Describe the clinical signs of palmar/plantar osteochondral disease
Mild/moderate lameness in 1 or more limbs localised to the fetlock
71
How does palmar/plantar osteochondral disease appear on radiography?
Minimal signs to focal increases in bone density (sclerosis) and change in contour of the subchondral bone Advanced imaging include nuclear scintigraphy and MRI
72
How is palmar/plantar osteochondral disease in young racehorses managed?
Alteration in exercise schedule
73
Describe the aetiology of chronic proliferative synovitis
- Usually forelimb - Chronic repetitive trauma to dorsal aspect of fetlock due to hyperextension - Can lead to supracondylar bone lysis
74
What are the clinical signs of chronic proliferative synovitis?
Lameness, reduced range of motion, heat/pai
75
How does chronic proliferative synovitis present on radiography?
Crescent shaped bone loss distal McIII Soft tissue swelling
76
How does chronic proliferative synovitis present on ultrasound?
Thickening of dorsal synovial pad
77
How is chronic proliferative synovitis managed?
Intra-articular medication; surgical resection
78
How does fetlock subluxation occur?
Often due to trauma Disruption of the collateral ligaments +/- avulsion fracture
79
How is fetlock subluxation diagnosed?
Acute, severe lameness +/- overt luxation Radiography +/- stress
80
How id fetlock subluxation treated?
Closed reduction + cast - Will fibrose but may end up with OA Arthrodesis if unstable

Y4 EQ - Orthopaedics (14 decks)

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