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equinee > Day 4 - Lameness > Flashcards

Day 4 - Lameness Flashcards

1
Q

Causes of injuries (7)

A
  • Trauma
    Septic synovial sheet/joint → pain and even death
  • Congenital
    Coangulation, Navicular diseases Enlarged synovial channels
  • Acquired
  • Infection - septic joint is an emergency
  • Metabolic disturbances - osteoarthritis, clots, hernia, laminitis
  • Circulatory disorders - aortoiliac thrombosis
  • Nervous system

Mechanical and paralytic disorders

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2
Q

Classification of lameness (6)

A
  • Supporting limb lameness
  • Swinging limb lameness
  • Mixed lameness
  • Complementary lameness
  • Untypical lameness
  • Special lameness
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3
Q

Severe left hind limb lameness

A

med. femorotibial osteoarthritis

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4
Q

Provacation tests

A

find out

Shoulder flexion
Elbow flexion
Carpal flexion
Hock flexion
Navicular flexion

Hip flexion
Stifle flexion
Hock flexion
Navicular flexion

Fetlock flexion test
Shoulder flexion test
Lower limb flexion (?)

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5
Q

Supplementary diagnostic tools in lameness

A

US, x-ray, arthroscopy, MRI, CT, synovial analysis

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6
Q

Lameness - local ana

irritant, non irritant and long/short acting

A

Lidocain - irritant

Less irritant
Mepivacaine - short acting
Bupivacaine - long acting (not really used)

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7
Q

Lameness - sedation

A

Xylasine or Detomidine/butorphanol

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8
Q

Deep digital nerve anesthesia - structures ana

A
  • Palmar foot
  • Toe
  • DIP joint
  • +/- distal DDFT lesions
  • Occasionally PIP joint
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9
Q

Abax. Sesamoid Block - structures ana

A
  • as for PDP
  • sometimes includes fetlock joint and sesamoid bone
  • distal DDFT
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10
Q

Distal interphalangeal joint analgesia - structures at 6 ml and 10 ml

A
  • Structures anaesthetised with 6 ml
  • DIP joint
  • Dorsal sole (toe)
  • (not the heel)
  • 10 ml anaesthetic
  • Blocks heel as well
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11
Q

Navicular bursa analgesia - structures

A
  • Navicular bursa
  • Dorsal sole (toe)
  • Navicular bone
  • Navicular ligaments
  • (not the heel)
  • 30 minutes: DIP joint
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12
Q

4 point block (N. digit. palm., nn. metacarpales - structures

A
  • As for PDB plus:
  • Metacarpophalangeal (MCP) region
  • PD nerve onlyàUseful for annular ligament analgesia

Positive 4 block
Differentiate structures with: -
* MCP analgesia
* Digital sheath analgesia

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13
Q

Metacarpophalangeal joint anesthesia - structures

A
  • MCP joint
  • Subchondral bone,
  • After 30 min, distal branches of susp. lig and sesamoids
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14
Q

Metacarpophalangeal joint anesthesia - structures

A
  • MCP joint
  • Subchondral bone,
  • After 30 min, distal branches of susp. lig and sesamoids
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15
Q

Digital flexor tendon sheath (DFTS) analgesia - structures

A
  • Digital sheath
  • Local structures with time
  • Annular ligament
  • Often only a partial improvement
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16
Q

High palmar block - structures

A
  • Whole metacarpal region
17
Q

Positive subcarpal analgesia - next test

A

perform middle carpal joint analgesia

18
Q

N. musculocutaneous
Elbow analgesia

A

..

19
Q

Pastern ring block

A
  • induces dorsal branches, and dorsal metatarsal nerves
  • Blocks pastern and foot?
20
Q

Low plantar six point

A
  • plantar digital nerve
  • plantar metatarsal nerve
  • dorsal metatarsal nerve

Blocks all tissues distal to block
If positive; block fetlock and digital sheat

21
Q

Subtarsal (high plantar)

A
  • plantar and plantar metatarsal nerves
  • blocks susp. lig, complete ring block
22
Q

Energy storing
Positional

A

SDFT (Support the hyperextended metacarpophalangeal joint during weight-bearing)

Digital extensor tendons

23
Q

Injuries based on type of horse
Racing thoroughbreds
Show jumpers
Eventers
Dressage

A
  • Racing Thoroughbreds: SDFT in forelimb - mid metacarpal region
  • Elite show-jumpers: forelimb SDFT & DDFT injuries
  • Elite eventers: forelimb SDFT injuries
  • Dressage horses: hindlimb suspensory ligament injuries
24
Q

Complete rupture, loss of function
Deep digital flexor tendon

A
  • Toe flips up
  • If in the metacarpal/metatarsal region and outside the DFTS
    • Can heal satisfactorily if immobilized
  • If ruptured near the insertion or within the DFTS - poor prognosis
25
Q

Complete rupture, loss of function
Suspensory ligament

A
  • Fetlock drops - hyperextension
  • Grave prognosis
  • Degenerative / traumatic / catastrophic
26
Q

Non-traumatic tendon & ligament injuries

A
  • Tendinitis/tendinopathy
  • Desmitis/desmopathy

overstrain injuries
degenerative proc (most common)

27
Q

Repair of tendon & ligament injuries
No regeneration! (4)

A
  1. Intratendinous haemorrhage immediately after injury
  2. Inflammatory reaction
    * Designed to remove damaged tendon tissue
  3. Reparative phase
    * Starts within a few days
    * Angiogenesis and scar tissue formation
  4. Remodelling phase
    * Gradual, incomplete replacement of type III to type I
28
Q

Superficial digital tendon injury

A
  • Most common site: mid-metacarpal region. Common injury in racehorses and jumpers
  • Within the DFTS and the carpal sheath. Less common
  • In the pastern region. Often traumatic - overreach

Not US too quickly

29
Q

Superficial digital tendon injury - Tx (3)

A

Acute phase
Subacute phase (fibroplastic phase)
Chronic (regenerative) phase

30
Q

Superficial digital tendon injury - Tx
Actue phase

A

Aim to minimize inflammation & limit the action of proteolytic enzymes
* Physical therapy – rest, cold, immobilization (Rupert jon to decrease hemorrhage)
* Systemic short-acting corticosteroids in first 24-48 hours
* Never intralesional steroids – calcification!
* NSAID’s – some controversy
* (Surgical treatment – tendon splitting, desmotomy of AL-SDFT)

31
Q

Superficial digital tendon injury - Tx
Subacute phase

A
  • Progressive mobilization. Should start walking, collagen need to be formed
  • Ultrasonographic monitoring
  • Regenerative therapies - tendons do not regenerate!
  • Mesenchymal stem cell therapy
  • Stem cells differentiate into tenocytes, regenerate matrix
  • Soup of growth factors – stimulate cell proliferation & matrix synthesis
32
Q

Superficial digital tendon injury - Tx
Chronic phase

A
  • Controlled exercise
  • Regular ultrasonographic monitoring
  • to prevent re-injury
  • Takes time – at least 6-12 months before returning to full work
33
Q

Deep digital flexor tendon injuries

A
  • Metacarpal region –> Majority of injuries within the DFTS
  • Pastern region - Down to insertion
    Most distal part can only be imaged with MRI or CT
  • Poor prognosis
  • Lesions in fetlock - show jumpers
  • Limited healing ability of tendons within synovial environment
  • Adhesion formation
  • Mesenchymal stem cell therapy
  • Associated with inf. tenosynovitis
34
Q

Suspensory ligament injuries
Forelimb proximal suspensory desmitis

A
  • Pain on palpation
  • Difficult to palpate most proximal
  • Lamer with the limb on outer circle
  • Acute
  • Reasonable prognosis
  • Return to exercise in 3-4 months
  • +/- intralesional therapy
  • Chronic
  • More difficult
  • Blister treatment
  • Guarded prognosis
35
Q

Suspensory ligament injuries
Hindlimb proximal suspensory desmopathy

A
  • No localizing signs
  • Lamer on outer circle
  • But often bilateral
  • Degenerative process
  • Dressage horses
  • Straight hock - predisposes
  • Poor success rate, best is surgery
36
Q

Accessory ligament of the deep digital flexor tendon injuries

A
  • Much more common in the FL than in the HL
  • Usually painful on palpation
  • Acute cases – rest, cooling, intralesional treatment, regenerative laser, shockwave
  • Chronic, non-responsive cases - desmotomy
37
Q

Collateral ligament injuries

A
  • Can be true sprain injuries
  • Rupture results in luxation/subluxation of joint
38
Q

Digital flexor tendon sheath (DFTS) injuries
Primary and secondary tenosynovitis

A

If lameness - improvement to low 4-point nb.
Primary tenosynovitis
- Accumulative low-grade trauma
- Direct trauma
- Abnormal force (hyperextension)
- Infectious
Secondary tenosynovitis
- DDF tendonitis
- Damage to the manica flexoria
- Damage to the synovial layers

39
Q

Distension of the DFTS
Palmar annular ligament syndrome

A
  • Desmopathy of PAL - External trauma and overextension of fetlock
  • Chronic inflammation – adhesions, fibrosis
  • Perpetuating condition
    Inflammation, pressure, stenosis, further inflammation

equinee (24 decks)

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