Day 5 - Lameness 2 (Diseases) Flashcards
Osteoarthritis - pathogenesis
Pathogen.: degradation and destruction of articular cartilage causing progressive loss of hyaline cartilage
- Subchondral sclerosis
- Decreased range of motion
- Subchondral cysts
- Osteophytes
- Synovitis, capsulitis (fibrosis)
Angular limb deformities
Osteoarthritis - CS
- Joint effusion increased
- Lameness
- Joint range of motion decreased
- Changes in the synovia
- Cartilage damage (Osteoarthritis)
- New bone formation (Osteophytes)
Osteoarthritis - Dx
- Lameness Examination
- Visualisation, Palpation
- Examination during motion
- Provocating tests (flexion is painful)
- Perineural and intrasynovial anesthesia
- Diagnostic imaging: X-rays, Ultrasound
- Diagnostic arthroscopy
Osteoarthritis - joint cartilage
- Chondrocytes: Matrix degeneration
- PSGAG: loss? –> decr water binding capasity
- Hyaluronic acid: Lubricant
- Stratum fibrosum: Stability, motion
- Stratum synoviae: HA, and Collagen production
OA: DITJ - TMTJ Bone spavin
dist. intertarsal joint (DITJ)
tarsomtatarsal joint (TMTJ)
- adults
- recurrance of compression and rotation
- Conformational abnormalities
- Metabolic causes protein and mineral imbalances endocrine disorders
OA: DITJ - TMTJ Bone spavin
CS
- Acute onset of lameness
- Shortened cranial phase of the strait
- low arc of foot flight
- In chronic cases: palpable bony swelling
- Positive hock flexion test
- Mild case: improves in training
- Severe case: worsening during work
- Outside of the hoof (shoe) is wearing off
OA: DITJ - TMTJ Bone spavin
Dx
Diagnostic anesthesia
- Intraarticular anaesthesia
- TibFib (N. tibialis and peroneus)
OA: DITJ - TMTJ Bone spavin
Tx
- I.A. injection into the tarsometatarsal joint:
- Na-hyaluronat + Glycocorticoids
- Cunean tenectomy
- Chemical / surgical arthrodesis
- Osteosynthesis with LCP..
- Kerf-cut cylinder
- Orthopedic shoeing:
Synovial analysis - causes of synovial damage
- Congenital cartilage developmental disturbance
- Subchondral sclerosis
- Damage of healthy cartilage
Synovial analysis - Tx
Corticosteroids - Short acting, Long acting
Short acting
* Dexamethason,
* Flumethason,
* Hydrocortison,
* Triamcinolon acetat
Long acting
* Methylprednisolon acetat
* Triamcinolon hexacteonid
* Bethametason acetat
Methylprednisolon acetat, Triamcinolon acetate
Synovial analysis - Tx
NSAIDS
Fenilbutazone, Flunixin meglumin, Firocox, Carprofen
Synovial analysis - Tx
Na-hyaluronate
Na-hyaluronate
Hyaluronic acid
Decreases joint effusion
Synovial analysis - Tx
PSGAG’s
Glycosaminoglycans - Adequan
* Effect: anabolic on synovial fibroblasts and chrondrociytes (Hyaluronic acid and collagen
production)
* Inhibition of cytokines and PGE synthesis
* Increases Synovia viscosity
* Antiinflammatory effect
Synovial analysis - Tx
Tildren
Biphosphonate
Goal: inhibition of subchondral bone production
* Inhibition of osteoclast activity (bone resorption)
* Anti-inflammatory effect
* No direct effect on cartilage
* Side effects: nephrotoxicity especially if given too fast
Synovial analysis - Tx
Rest
Rest
* After treatment: few days generally accepted
* Reason:
Decrease clearance
Increase time of effect
* No EBM support to date
Synovial injury - surgical (4)
- Arthrotomy
- Synovectomy
- Chondroplasty
- Arthrodesis
Synovial injury - surgical
Chondroplasty
- Debridement (shaver)
- Microfracture
- Fixation
- BMAC
- Autograft
- Allograft.
Angle of regular hoof
- 45-50 ° front hoof
- 50-55 ° hind hoof
Trush
Degenerative infective condition of the frog
- Wet, unhygienic
- Predisposing factor: long contracted heels, deep sulci
- Fusobacterium necrophorum
* Clinical signs: Black necrotic exudate, odor
(cellulitis, phlegmon)
* Treatment: Cleaning, Debridement
- Dry clean bedding
- Cooper sulphate; phenol : iodine 7%; 10% formalin
Canker
Chronic hypertrophic moist pododermatitis of the epidermal tissue starting mainly at the frog region
(Moist pasture, unhygenic conditions
Fusobacterium necrophorum, Bacteroides
No lameness
Topical AB
- Superficial or radical debridement??
- AB therapy (procain penicillin, tetracyclin
OCD - pathogen
- Disturbance of cellular differentiantion in the growing cartilage
- Damage to vessels in cartilage canals: Improper vascular supply of the young cartilage
- Loading: mechanical insult, fragmentation on weak points
Result: resorption
OCD - growth rate
Large foals
Hyperinsulinaemia -> rapid removal of T3, T4 from the circulation
* T3 T4 responsible for chondrocyte differentiation + invasion of blood vessels
OCD - predeliction sites (5)
- Neck facet joints
- Shoulder
- Fetlock
- Hock
- Femoropatellar-joint
OCD/OC - shortenings
Clinical forms (5)
OCD/OC – Clinic
* Osteochondrosis (OC)
* Osteochondritis dissecans (OCD)
* Subchondral Bone Cysts
Clinical forms
* Flattening of the joint surface
* Cartilage flaps
* Cartilage with subchondral bone changes
* OCD fragments free in joint
OCD/OC - Diagnosis
- 2-4 months, joint effusion, lameness, normal synnovial fluid. Improve with ana
OCD/OC - Tx surgical and conservative
Arthroscopy
conservative have bad prognosis
Subchondral Bone Cysts
Predil sites and Dx
- Medial Femoral Condyle
- Distal MCIII/MTIII
- Medial proximal Radius epiphysis
- Distal phalanx
- Scapula cavum glenoidale
- Intraarticular block is not always positive
- X-rays
- Scintigraphy
Subchondral Bone Cysts - CS
Lameness after work
Sometimes acutely lame
- Medial Femur Condylus
- Distal MCIII
Joint effusion not always
Subchondral Bone Cysts - Treatment
- Steroid inj. into the cyst
- Extra-articular approach and Parathormon
- Enucleation of the cyst inside lining
- Position screw through the cyst
- Bone Morphogenic Protein-2 into the debrided cyst
- Autologous Osteochondral Transplantation
With regard to strength (transport)
Compression, shear, tension
- Bone is strongest in compression
- Weakest in shear
- Intermediate in tension
A- translation
B- angulation
C- Shortening
Laminitis - pathophysiology
- Hyperinsulinaemia- lamellar lamellar attachment apparatus defomation
- Injury of basement membrane- lysis
Laminitis theories (13)
- Enzymatic theory
- Ischemia/reperfusion injury
- Decreases digital blood flow, lamellar perfusion
- Gram negative – endotoxin
- Hyperinsulinemia, insulin resistance
- Lamellar separation
- Equine Metabolic Syndrome
- Cresty neck
- Increased adipose tissue
- Cushing disease
- Pituitary enlargement
- Corticosteroids
- Supporting limb laminitis
Laminitis - Dx
- Most often both front feet are affected
- Lameness is worse on hard ground
- Digital pulse amplitude occurs
- Radiographic examination
Laminitis - Tx
- Cryotherapy – all four limbs
- Aggressive treatment of primary disease
- Fluids and electrolyte therapy
- Antibiotics and NSAIDs
- Uterine lavage – retained placenta
- Cushing’s disease
Generally to lift heal to get less tension of DDFT
Septic arthritis - general
Foals
*Haematogen – joint/bone
*Gram-negative
*Bacteremia, septicemia
Septic arthritis - Types of infections (3)
S-type: Synovial fluid and synovial membran
E-type: Articular epiphyseal complex
P-type: Majority. Long bones physis and joints. Enerobacteriacae( E. Coli, Salm.) Streptococcus, Rhodococcus
OA - Tx
Conservative:
- Rest
- PSGAGs, Hyaluronic acid
- NSAIDs, Corticosteroids
- Stem cells
Surgical:
- Synovectomy and arthroscopy
