Upper Limb Lameness

Question 1

What is the prognosis for obturator paralysis?

Answer 1

Guarded - especially if bilateral

Question 2

Describe Grade 1 sciatic nerve paralysis:

Answer 2

Loss of motor function (proprioception) but full sensation at the pastern. Recovery in a few days.

Question 3

Describe Grade 4 femoral paralysis:

Answer 3

Cow sits in frog leg position unable to correct itself.

Prognosis - hopeless

Question 4

Injections administered into the gluteals of thinly muscled young animals may damage what nerve?

Answer 4

Sciatic

Question 5

Describe Grade 3 sciatic nerve paralysis:

Answer 5

Loss of sensation to tibial nerve as well - no superficial sensation below the fetlock. Recovery in 2-4 weeks.

Question 6

What is ‘patella locking’?

Answer 6

Upward fixation of the patella - the patella becomes temporarily fixed on the medial aspect of the upper part of the femoral trochlear

Question 7

What are the clinical signs of septic arthritis?

Answer 7

• Sudden onset lameness
• Recumbency (if several joints affected)
• Swollen joint/s - heat, pain, +/- fever
• Rapid muscle atrophy of affected limb
• After several weeks - capsular fibrosis causes limited joint movement

Question 8

What is a common entry point for bacteria in newborn calves?

Answer 8

Umbilicus

Question 9

What nerve damage does this animal appear to be suffering from? How can you tell?

Answer 9

Tibial nerve paralysis - stifle is dropped, hock is over-flexed and the weight bearing surface is still firmly on the ground

Question 10

What procedure is being performed here?

Answer 10

Reduction of a dislocated hip

Question 11

What treatment would you provide for sacro-iliac luxation?

Answer 11

NSAIDs and rest

Salvage slaughter

Question 12

What is the treatment for spastic paresis (‘elso heel’)?

Answer 12

Patial / total tibial neurectomy

Question 13

How does spastic paresis (‘Elso heel’) present?

Answer 13

• In growing cattle 3-6m old
• Affects one or both indlimbs
  
  • Excessive tone and spastic contracture of the gastocnemius muscles - gross over extension of the hock

Question 14

Describe Grade 3 femoral paralysis:

Answer 14

No patella reflex. Unable to support weight when lifted.

Prognosis - poor

Question 15

This animal is able to support its own weight but is unable to extend and joints of the limb. What might be the cause?

Answer 15

Radial nerve paralysis (at a high level)

Question 16

Describe Grade 2 sciatic nerve paralysis:

Answer 16

Loss of function of peroneal branch - lose sensation to anterior pastern. Recovery 7-10 days.

Question 17

What treatment would you recommend in a case of stifle instability?

Answer 17

No treatment - recommend slaughter on welfare grounds

Question 18

How do minor fractures of the tuber coxae appear?

Answer 18

As ‘dropped’ or ‘knocked’ hips

Question 19

What nerve damage does this animal appear to be suffering from? How can you tell?

Answer 19

Tibial nerve paralysis - Hock over-flexed while weight bearing surface remains on the ground

Question 20

Describe Grade 2 femoral paralysis:

Answer 20

Absent patella reflex. Legs behind when trying to stand. Walk a few paces before falling after lifting.

Prognosis - good if nursed correctly

Question 21

What is typically the cause of peripheral nerve injuries in cattle and how do they present?

Answer 21

• Usually associated with dystocia or secondary to metabolic diseases causing recumbency
• Present as dysfunction of the limb rather than lameness
  
  • weakness
  • paralysis
  • poor muscle tone
  • decreased - absent reflexes

Question 22

How do you treat a dislocated hip?

Answer 22

• Traction under heavy sedation
  
  • Place animal in lateral recumbency with affected hip dorsally
  • Fix cows body to a solid object using heavy rope through the inguinal area
  • Apply block and tackle to affected olimb and secure this to another traction point
  • Apply traction while at the same time rotating the femur by pushing down on the stifle and lfting the hock
  • Successful rotation accompanied by an audible ‘clunk’
  • Leave the cow in sternal recumbency - do not reverse xylazine sedation
• Quite sucessful if done within 12hrs
• Poor prognosis if they reluxate

Question 23

What is a possible sequelae of tibial paralysis?

Answer 23

Partial / complete rupture of the gastrocnemius muscle

Question 24

How would you treat septic arthritis?

Answer 24

• In adult cattle - unrewarding
• Calves treatment may be sucessful if:
  
  • treated early
  • high dose of systemic antibiotics given over several weeks
  • not more than 2 joints affected
  • no other systemic signs
• Procaine penicillin and ampicillin, amoxycillin or oxytetracycline
• NSAIDs to alleviate pain
• Some value in joint lavage of single affected joint (best prognosis for fetlock)

Question 25

Describe Grade 1 femoral paralysis:

Answer 25

Legs go out behind when trying to stand but can stand and walk normally when lifted Prognosis - good if nursed correctly

Question 26

What is this cow likely to be suffering from? How can you tell?

Answer 26

Severe sacro-iliac luxation - the loin area is dropped and the tuber coxae are very pronounced (raised in relation to the vertebral coloumn)

Question 27

What might you find on post mortem of an animal with stifle instability?

Answer 27

* Excessive volume of joint fluid * Medial meniscus seoerated from joint capsule * Ruptured cruciate ligament * Articular surface of medial condyle showing excessive ear * Large areas of osteophytes surrounding articular surfaces * Excessive calcification of synovial membrane

Question 28

This cow is *completely unable to support her own weight* and her forelimb appears to 'hang'. What might be the cause?

Answer 28

Brachial plexus injury/paralysis - may have been caused by a haematoma or abscess between the scapula and the ribs

Question 29

How would you treat leg fractures?

Answer 29

Upper limb: usually not possible to treat Below the hock: respond well to casting for 5-6wks (stabilize joint above and below)

Question 30

How would you confirm hip dislocation if a cow?

Answer 30

Deep palpation while the limb is rotated / flexed and extended. Will feel abnormal movement of the head of the femur and hear loud creaking noises.

Question 31

This animal is able to support its own weight but is unable to extend its fetlock. What might be the cause?

Answer 31

Radial nerve paralysis (low level)

Question 32

Where is the sciatic nerve most vulnerable to damage and what is the most common cause?

Answer 32

Most vulnerable at the level of the pelvis and the femur. Damage usually due to severe intra-pelvic pressure associated with dystocia.

Question 33

What is the main cause of obturator paralysis and what does it result in?

Answer 33

Commonly associated with 'hip-lock' dystocia * Paralysis of the adducting muscles of the hind limb - affected leg/s push out to the side * Normal sensation of lower limbs

Question 34

Where is the insertion of the peroneus tertius muscle?

Answer 34

Proximal metatarsal

Question 35

How can you go about examining an animal you susoect to have upper limb lameness?

Answer 35

* Have someone walk the animal * Touch the interdigital space (stick / water jet) * foot lesion - should lift foot * upper limb - reluctant to lift foot * Rule out claw lameness * Lightly sedate with xylazine * Feel the joints of the lame limb and pelvis as the sedated animal walks * listen for clunks / crepitus

Question 36

How do you treat pelvic fractures and what is the prognosis?

Answer 36

Lameness usually only minor. No treatment required and prognosis is good.

Question 37

Describe Grade 4 sciatic nerve paralysis:

Answer 37

Loss of deep pain reflexes. No sensation at pastern. Recovery *at least* 4 weeks.

Question 38

When is radial paralysis most commonly seen?

Answer 38

In cows that have been recumbent for some time because of milk fever Also in cows cast on hard surfaces or blunt trauma to the shoulder area

Question 39

How would you treat upward fixation of the patella?

Answer 39

* Standing sedation (xylazine) * Palpation and positive identification of medial, middle and lateral patella ligaments - **important!** * Surgical prep and local anaesthesia over area of medial patellar ligament * Vertical 2-3cm incision made just anterior to the medial patellar ligament * Ligament cut using a curved tenotome * Insert 2-3 skin sutures * Relief should be immediate * Condition often bilateral - do other limb prophylactically?

Question 40

What can you see in this cows leg and what is the most likely cause?

Answer 40

Knuckling of the fetlock and extension of the hock - peroneal paralysis Associated with milk fever and 'downer cow syndrome'

Question 41

What might cause damage to the femoral nerve in adult cattle v calves?

Answer 41

Adult cattle: overstretching of the nerve when recumbent cattle try to rise Calves: in newborns following excessive traction when hip or stifle locked

Question 42

How does an animal with upward fixation of the patella walk?

Answer 42

With a jerky movement - leg gets caught behind in extension for a longer than normal period of time and is then jerked upwards and forwards as the patella frees itself

Question 43

What is sacro-iliac luxation often associated with?

Answer 43

Dystocia and milk fever

Question 44

This cow is recently calved. What does this posture indicate?

Answer 44

Bilateral sciatic nerve damage

Question 45

How do you go about stifle examination in a standing animal?

Answer 45

* Gait examined from a distance * weight bearing on the toe * restricted movement of the stifle joint * limb facing more laterally * Palpation of the stifle * patella ligaments should be easily palpated * joint effusion evident between liagments * crepitus felt on joint manipulation * light sedation and palpation while animal is walking slowly

Question 46

What do you do if a cow with a pelvic fracture has a piece of ileum protruding through the skin?

Answer 46

Remove the protruding piece of bone (bone cutters / fetotomy wire) - would will heal over