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VMS4008 - EQUINE > Acute Lameness > Flashcards

Acute Lameness Flashcards

1
Q

What to say on first contact over the phone ?

A
  • Don’t move horse until vet assessment
  • If haemorrhage -> pressure bandage
    -> If foreign body say wether to remove or leave in situ

(if nail at risk of being pushed further into foot => remove but note direction)
if embedded -> leave in foot

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2
Q

How to do the initial assessment for acute lameness?

A
  • CE - mm colour, Hr, RR, neuro status
  • History -> trauma, sendduen onset, when seen last normal, any wounds ?
  • Sedate if safe to prevent further injury
  • If fract -> bandage/splint to prevent worsening
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3
Q

What further asessment should you do?

A
  • Full hx & CE
  • Plapation / hood testers
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4
Q

What are we looking for on palpation?

A

➢ Swelling/Joint effusion
➢ Wound
➢ Elevated digital pulses?
➢ Solar penetration?
➢ Hoof tester examination*******
➢ Pain on palpation /manipulation
➢ Reduced range of motion
➢ Crepitus
➢ Asymmetry

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5
Q

What are the main 8 causes of Acute severe lameness?

A
  1. Solar abscess/penetration
  2. Laminitis
  3. Cellulitis/lymphangitis
  4. Tendonitis/desmitis
  5. Synovial infection
  6. Fracture
  7. Tendon laceration/rupture
  8. Myopathy
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6
Q

Which diagnostic test would you choose for each condition?

A
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7
Q

HOW to TRANSPORT horses with MSK injury?

A
  • Minimise walking distance
  • Confine horse for leaning
  • Sufficient head/ neck mov to aid balance
  • Slings in ambulance if want to reduce load on all limbs
  • Unload carefully & slowly
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8
Q

Which direction fo transport horse with hind vs front limb issue?

A

-> Forward for fract of HL
-> Backward for fract of FL

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9
Q

What should you ALWAYs try to rule out in acute single limb lameness?

A

Solar abscess/ Nail bind

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10
Q

What is the clinical presentation for nail bind/ solar abscess?

A

Progressive/acute unilateral lameness
Increased digital pulses
Increased heat in foot
+ve hoof tester examination
+/- softening of coronary band/heel bulbs
+/- cellulitis of distal limb

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11
Q

What relevant history fo solar abscess/ nail bind case?

A

Recent farriery (nail bind)
Duration
Any objects removed from the foot
History of laminitis
Tetanus status

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12
Q

What particular test for nail bind?

A

Hoof tester over individual nails can identify painful one

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13
Q

How to manage solar abscess? (pt 1)

A
  • Remove shoe
  • Pare foor & identify tract
  • Follow tract & open abscess (black brown/yellow fluid)
  • Admin of anti-tet & toxoid
  • Hot tub
  • Iodine / epsom salts
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14
Q

How to manage solar abscess? (pt 2)

A

-> Apply poultice to draw out infection
➢ Animalintex most commonly used
➢ Apply hot and wet while abscess draining
➢ Switch to dry poultice when discharge stops
➢ See video for refresher on poulticing technique

NSAIDS

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15
Q

Are ABs indicated for uncomplicated abscesses ?

A

NO

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16
Q

Describe solar bruising?

A
  • Caused by blunt trauma
  • Haemorrhage and inflammation
  • Horses with thin soles/poor conformation
  • Unshod horses
  • Shod horses- shoeing overdue/shoes too small
  • Corn formation – ‘Seat of corn’
  • Can lead to abscess formation
  • May need hoof hardener/pads/hoof boots
  • Treat as abscess – see below
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17
Q

What is the classic presentation of laminitis?

A
  • Acute onset multi-limb lameness
  • Shifting weight/rocking on heels
  • Reluctant to walk with short choppy gait
    → worse on tight turns
  • ‘Bounding’ digital pulses
  • Heat and pain on hoof testers
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18
Q

What are the 3 clinical categories of laminitis?

A
  • Endocrinopathic (80%) -> EMS, PPID
  • Inflamamtory (systemic dx, grain overload, RFM)
  • Traumatic
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19
Q

How to treat Laminitis?

A
  • Strict rest and support the foot
  • Soft, deep bed
  • +/- remove shoes
  • Sole and frog supports
  • Pain relief and suppress inflammation
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20
Q

What pain releif woudl u use in laminitis?

A
  • Phenylbutazone 4.4 mg/kg IV/PO for 24-28 hrs
    2.2 mg/kg PO BID after 48 hrs

Additional pain relief?
* Paracetamol – not licensed
* Gabapentin – not licensed
* Opioid analgesia if severe

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21
Q

What is an ongoing tx for laminitis?

A
  • Ertuglifozon/Canagliflozin -> Sodium-glucose cotransporter 2 inhibitors (SGLT2i)
  • Dietary restriction
  • Low quality or soaked hay
  • Stop concentrates
  • Balancer should be given (vitamin and mineral supplement)
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22
Q

What else can we do for ongoign tx of laminitis?

A

REMEDIAL FARRIERY
- Reduce breakover
- Frog support
- Heart bar shoes
- Wooden shoes/ clogs

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23
Q

Solar panatrations are usually?

A

nails embedded in sole

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24
Q

What sensitive structures may or may not get involved in solar penetrations that we need to be aware of?

A

➢ Deep digital flexor tendon
➢ Distal Interphalangeal Joint
➢ Navicular Bursa
➢ Digital Flexor Tendon Sheath
➢ Navicular bone
➢ Pedal bone

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25
What should we look for with solar penetration ?
- Effusion of DIP/ DFTS -> Pare area aroudn tract - find haemorrhage, follow tract -> leakage? ; sterile probe in tract
26
What diagnostics might we wanna do for solar penetration?
- Xray of foot -> ideally object in situ +/- probe or +/- contrast in tract - MRI - Synoviocentesis of DIP, Nb, DFTS
27
What meds to give for solar penetration?
- Broad ABs (penicillin/ gentamicin) - NSAIDS +/- tetanus
28
IF synovial structures are involved what to do?
arthroscopic debridement and lavage
29
Whta does prognosis depend on?
What structure involved & duration from penetration to sx
30
Pathogenesis of septic arthritis?
* Same as in small animals * Inflammatory response * Cartilage destruction – extends to subchondral bone * PAIN and swelling of infected join * Ultimately leads to degenerative OA
31
Tx for septic arthritis?
- Joint lavage ASAP - Check tetanus status
32
Septic arthritis causes in adult vs foals?
Adults-> laceration near joint or Iatrogenic Foals -> Wound or haematogenous spread
33
Presentation of septic arthritis?
➢ Acute onset/progressive severe lameness ➢ If synovial structure is draining → evidence of synovial fluid and variable lameness ➢ +/-Wound close to/overlying synovial structure ➢ Heat, pain and swelling (joint effusion/tendon sheath effusion)
34
How should we do our CE in septic arthritis case?
- Assess location & depth of wound - Clip hair to visualise - Effusion of synovial structures or evidence of cellulitis - synovial leakage -> prep aseptically & evaluate with sterile gloved finger
35
If unlikely to be septic arthritis what to do?
* Anti-microbials? * Tetanus? * Pain relief?-> ongoign admin avoided as it can mask worsening lameness indicating sepsis
36
What is it is likely septic arthritis?
- confirm with synoviocentesis (DONT do through cellulitic skin) - Sample collected & sent for: cytology, C & S - Pressure test -> distent joint with saline -> see communication - Contrast study
37
What is abnormal synovial fluid like?
➢Serosanguinous/turbid/reduced viscosity ➢High white blood cells and total protein ➢>90 % Neutrophils
38
Tx for septic arthritis?
- Joint lavage (large vol polyionic solution) - Arthroscopy 'Godl standard' +/_ synovial biopsy? - Through and through needle lavage - Systemic ABs (broad but ideally base don C & S) - Intra-articular AB - Intravenous regional perfusion - Nsaid
39
Prognosis for septic arthritis?
* Early diagnosis and aggressive management achieve best outcome * Affected by concurrent damage – worsens prognosis * Osteomyelitis * Soft tissue damage
40
When might septic arthritis caes not present as NWB lame?
if joint open and draining
41
What is Synovitis? (Joint flare)
-Occurs after chemical tx/ anaesthesia (steroids, LA ..) - Low incidence
42
when does joint flare happen?
3-24h post injection
43
Prevention, dx & tx fo joitn flare?
* Prevention - NSAIDs given at time of injection and for 3 days after * Diagnosis – synoviocentesis * Treatment – rest, NSAIDs, cryotherapy +/- corticosteroids
44
What to be careful with in tx of joint synovitis?
Don't mask signs of septic arthritis
45
Describe Acute tendinitis/ Desmitis
* Most commonly sustained during intense exercise * Flexor tendons/suspensory ligaments of forelimbs * Uni- or bilateral * Re-injury of previously injured tendon
46
Clinical Presentation of Acute Tendonotis? Desmitis?
* Localised heat, swelling, pain * Lameness * Often no wound/external trauma
47
Other ddx for desmitis/ tendonitis?
Fracture Bruising /stone in shoe
48
INITIAL tx for acute tendonitis/ Desmitis?
- Cold therapy - Nsaids - Steroids iv? - Bandage limb -> reduce swelling & infl ; RJ bandage + dorsal splint for severe injuries - US exam
49
What diagnostics might we do for acute tendonitis/desmitis?
- Regional anaesthesia? - Radiographs - US - MRI
50
What is the complete TX for tendonitis/ desmitis?
* NSAIDs +/- other anti-inflammatories * Cryotherapy * Bandaging * Box Rest * Remedial farriery * Treatment plan – see Chronic Lameness lecture * Physiotherapy * Re-evaluation * Rehabilitation plan
51
Why do we see lymphangitis & cellulitis?
* Inflammation that causes swelling, pain +/- lameness * Most commonly in hindlimbs * Compromised immune system
52
T/F Lymphamgitis may not respond to conservative tx?
FALSe - it usually does!
53
What does conservative tx involve of lymphangitis?
* Cryotherapy – cold hosing/ice boots * Hand walking or turnout in clean/dry area * Can lead to cellulitis
54
Describe cellulitis
* Bacterial infection * Usually only one hindlimb * Variable lameness, but can be severe * Affects dermis and subcutaneous tissues * Bacteria enter body through a break in skin
55
Signs of cellulitis?
* Heat, pain and lameness * Pyrexia * Pitting oedema * May get fluid leakage/lethargy/anorexia if severe
56
Txfor lymphangitis & cellulitis?
* NSAID’s * Antimicrobials (ab stewardship) * Cryotherpay * +/- box rest or some exercise as appropriate
57
CLs of tendon laceration, rupture/ dispalcement
* Lameness- Maybe not - extensor tendon Will be - flexor tendons & suspensory ligament * Distress-> SDFT luxation * Postural abnormality
58
What postural abnormality for which injury?
59
Draw it
60
What to do in case of tendon/lig rupture
- REFER -Admin of NSAId, AMs? +/- sedation +/- IV fluids - Apply dressing - Provide limb support - Immediate euthanasia?
61
What limb support for what rupture?
➢ Flexor tendon – align dorsal cortices RJB plus splint or cast bandage ➢ Extensor tendon – RJB
62
CLS of Fractures?
➢ Acute, severe lameness ➢ Local heat, pain, swelling ➢ Limb instability ➢ Crepitus ➢ Reduced range of motion ➢ Resentment of flexion/extension ➢ Severe distress
63
Initial tx for fract?
* Control haemorrhage * +/- sedation * NSAID analgesia * +/- Antimicrobials and tetanus prophylaxis * IV fluids then Radiography -> Immobilise -> Transport
64
What aims of immobilisation?
* Prevent further injury * Assist weight bearing * Relieve anxiety * Counteract forces that will displace the fracture * Joint above and below fracture
65
What is exertional rhabdom?
'tying up' -> rule out pelvic fracture / laminitis
66
Dx of ER?
* Blood sample – CK/AST/urea/creatinine * Urine sample - myoglobin * Muscle biopsy
67
Tx for ER?
Initial treatment * Fluid therapy * NSAIDs – care * ACP * Vit E Selenium Ongoing management * Diet * Avoid stress * Avoid rest days/turn out * Dantrolene

VMS4008 - EQUINE (30 decks)

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