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15- EQ- Lameness > Coffin OA > Flashcards

Coffin OA Flashcards

1
Q

What is OA

A

degenerative joint disease

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2
Q

what aged horses do we typically see OA in

A

middle aged –> older horse

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3
Q

T/F we won’t see OA in a young horse

A

False

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4
Q

Describe the typical signalment for coffin OA

A

common
all types of horses
front feet more than hind

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5
Q

Describe the typical signalment for pastern joint OA

A

Uncommon
Heavier breeds – cobs & hunters
Hind feet more commonly affect than front

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6
Q

List 7 predisposing factors for OA

A

genetic predisposition
work load (repetitive impacts)
work type (faster gait, landing after jumps)
work surface
hoof imbalance/conformation
nutrition In early life
previous injury

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7
Q

in terms of predisposing factors what does:
- workload (repetitive impacts), work type (faster gait, landing after jumps) and work surface (hard vs cushioned) come under

A

concussion

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8
Q

why does hoof imbalance/conformation lead to OA?

A

abnormal forces in joint area

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9
Q

what typical hoof conformation/imbalance results in OA?

A

Long Toe Low Heel conformation (broken back)

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10
Q

Describe a typical history for OA

A

low grade lameness
often bilateral FL lameness
often insidious onset, can be sudden
reduced performance w/o obvious lameness

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11
Q

Describe what is typically seen on clinical exam with coffin OA

A

effusion in coffin joint (palpate just proximal to coronary band -> squishy)
broken back hoof pastern axis (w/ long toe low heel conformation)

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12
Q

Describe what is typically seen on dynamic exam with coffin joint OA

A

sound at walk
mild lameness at trot (may be bilateral)
more obvious when lunged with lame limb to inside
worse on hard ground
moderate response to distal limb flexion

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13
Q

why would horses with OA be more lame on hard ground than soft?

A

more concussive forces

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14
Q

if we suspect coffin OA, how would we isolate the source of the lameness?

A

Palmar digital nerve block
distal interphalangeal (coffin) joint block

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15
Q

after doing the PDNB (palmar digital nerve block) - how long should we wait before looking at the horse again?

A

10-15 mins

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16
Q

after doing the coffin joint block, how long would we wait before looking at the horse again?

A

5 mins

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17
Q

if we suspect OA, once we have localised our lameness to the foot area what would we do next?

A

Radiography - LM view

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18
Q

List 4 possible findings we may see on rads with OA of coffin joint

A
  • osteophytes @ extensor process (spiky bone) and palmar aspect (near to lateral condyle)
  • new bone growth where joint capsule attaches to P2
  • loss of roundness of joint surfaces
  • mineralised opacity in joint space
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19
Q

T/F MRI or CTs are needed for diagnosis of coffin OA

A

False

20
Q

When would MRI be useful for in diagnosisng coffin OA

A

allows diagnosis of additional pathology e.g. oedema in P3

21
Q

What are the 2 main treatment options for coffin OA

A

NSAIDs
Intra-articular corticosteroids

22
Q

which NSAIDs could we give for OA

A

Phenylbutazone or Suxibuzone

23
Q

when would NSAIDs be given for OA

A

each day ‘or
can be used as required

24
Q

List 2 advantages of using NSAIDs for treating OA

A

cheap and easy to give (in food)
-treats entire horse (good if multiple joints affected)

25
Q

List 3 disadvantages of using NSAIDs to treat OA

A

systemic side effects:
gastric ulceration
RDC- right dorsal colitis
liver and kidney inflammation

26
Q

Name 2 intra-articular corticosteroids that can be used to treat OA

A

Triamcinalone or Methylprednisolone

27
Q

List 3 advantages of intra-articular corticosteroids to treat OA

A

Very potent
focuses on the joint
lasts for approax 6 months (can be repeated)

28
Q

List 3 disadvantages of using intra-articular corticosteroids to treat OA

A

requires skill to administer
will only treat one joint
rare side effects: laminiatis + joint sepsis

29
Q

aside from corticosteroids, List 6 other intra-articular medications can we give for OA?

A

Hyaluronic acid
Polyacrylamide gel (Arthromid)
Chondrogenically primed stem cell allograft (Articell)
Platelet Rich Plasma (PRP)
Interleukin 1 receptor antagonist protein (IRAP)
Bone Marrow Aspirate Concentrate (BMAC)

30
Q

Describe how does hyaluronic acid joint injections work for OA?

A

lubricates the joint, reduced friction
(tend to give alongside steroids in high motion joints)

31
Q

Describe how does polyacrylamide gel joint injections work for OA?

A

hydrogel filler to lubcricte the joint + give cushioning effect

32
Q

Describe how do chondrogenically primed stem cell allograft joint injections work?

A

stem cells from another horse - stimulates chondrocyte repair

33
Q

Describe how do platelet rich plasma joint injections work?

A

horses own plasma- releases nutrients and growth factors

34
Q

Describe how does interleukin 1 receptor antagonist protein joint injections work?

A

anti-inflammatory protein - normally present in joint from blood autograft

35
Q

Describe how do bone marrow aspirate concentrate joint injections work?

A

taken from sternum or tuber coxae and injected into joint

36
Q

in addition to joint injections and NSAIDs, what further medication types do we have for OA?

A

slow acting disease modifying OA agents (SADMOD) - many exist but lack evidence
- oral joint supplements (glucosamine, chondroitin, hyaluronic acid) - doesn’t do any harm to give
- pentosan polysulphate

37
Q

why might it be a good idea to use SAMODs even though there is not a lot of evidence for their efficacy?

A

doesn’t do any harm

38
Q

Describe how does pentosan polysuphate (cartorophen) work?

A

accelerates chondrocyte and synoviocyte metabolism
reduces MMP production -> anti-inflammatory and cartilage repair effects

39
Q

Aside from medications, what other form of tx is needed for coffin OA?

A

corrective farriery

40
Q

List 3 farriery considerations would we typically use for OA

A

shorten toe
support heels (bar shoes)
add cushioning ( rubber pad or sole packing under shoe)

41
Q

what other option is there for managing OA aside from medications + farriery

A

surgery

42
Q

Name 2 possible surgies could we perform to manage OA

A

arthroscopy
palmar digital neurectomy

43
Q

List 2 situations can we use arthroscopy to treat OA

A

If osteochondral fragment present
To debride necrotic cartilage

44
Q

Describe palmar digital neurectomy

A

Section of nerves removed
Long term desensitisation of the foot
Only if other therapies are unsuccessful

45
Q

What is a possible problem with performing a palmar digital neuroectomy

A

if something else occurs like an abscess then you won’t know until it has progressed

46
Q

T/F it isn’t possible to get ris of OA

A

true

47
Q

Describe possible future managements of OA

A

manage workload
careful what surfaces you work them on
ongoing vet treatment and farriery- repeat injections every few years

15- EQ- Lameness (28 decks)

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