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Large Animal Surgery > Diagnosing Lameness in the Horse > Flashcards

Diagnosing Lameness in the Horse Flashcards

1
Q

What is the definition of lameness?

A

Alteratiion of the normal gait pattern caused by a functional or structural disorder in the locomotor system.

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2
Q

What is lameness usually due to?

A

PAIN!

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3
Q

What can be 3 general forms of lameness?

A

Neurologic
Metabolic
Mechanical

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4
Q

When performing a pre-purchase exam, who do you work for?

A

Buyer

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5
Q

What are the 7 classic steps of a lameness exam?

A 
History
PE
Palpation
Observation at exercise
Flexion tests
Diagnostic nerve blocks
Diagnostic imaging
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6
Q

What is the primary goal of a lameness exam?

A

Localization and diagnosis.

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7
Q

When trying to determine duration of the lameness, what is a better question to ask the owner?

A

When was the horse last normal?

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8
Q

What are you looking for on the distance portion of a lameness exam?

A

Symmetry

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9
Q

What are you looking for on the close-up portion of a lameness exam?

A

Symmetry

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10
Q

What is a good thing to do to help establish normals?

A

Looks at the contralateral limb.

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11
Q

What should you do with EVERY lameness you see?

A

Put hoof testers on it.

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12
Q

What are 2 things you are assessing when observing stride?

A

Length of stride

Foot placement

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13
Q

What are 6 things to watch for when observing at exercise?

A 
Stride
Foot flight arc
Path of the foot flight
Foot strike
Joint angles
Gluteal excursion
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14
Q

What gait is lameness graded at?

A

At a trot

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15
Q

What is the best surface for a lameness exam?

A

Firm and even

NOTE: You may need different surfaces, hills etc.

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16
Q

“Down on the sound” means..?

A

The head will bob down when the horse is landing on the normal/sound front limb. Conversely it will come up on the lam front limb.

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17
Q

What are you watching for mostly when assessing the hind end of lameness?

A

A “hip hike” or increased gluteal excursion.

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18
Q

What structure should you never put your hoof testers on?

A

The coronary band.

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19
Q

What is a Grade 1 lameness on the AAEP Lameness scale?

A

Difficult to observe, inconsistent

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20
Q

What is a Grade 2 lameness on the AAEP Lameness scale?

A

Difficult to see in a straight line, but consistently seen under certain circumstances.

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21
Q

What is a Grade 3 lameness on the AAEP Lameness scale?

A

Consistently seen at a trot under all circumstances.

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22
Q

What is a Grade 4 lameness on the AAEP Lameness scale?

A

Obvious with marked head nod, hitching and shortened stride.

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23
Q

What is a Grade 5 lameness on the AAEP Lameness scale?

A

Minimal/non-weight bearing. Can’t move.

24
Q

What are 5 pathognomonic lameness’ diagnose at the walk?

A 
Peronius tertius rupture
Upward fixation of the patella
Stringhalt
Fibrotic myopathy
Sweeny
25
Q

What will you see in a peroneus tertius rupture?

A

Can extend the hock while the stifle is flexed, and you may see an “S” curve below the SMST (this is the ruptured muscle, ouchie!)

26
Q

What is stringhalt?

A

Hyperflexion of the hind limb.

27
Q

What is fibrotic myopathy?

A

Fibrosus of the SMST

28
Q

What is Sweeny?

A

Nerve damage resulting in the atrophy of the supra-and infraspinatus muscles.

29
Q

When do you perform your flexion tests?

A

AFTER palpation, observation at exercise and using hoof testers.

30
Q

What is a positive flexion test?

A

Exacerbated lameness.

31
Q

How do you perform a flexion test?

A

Flex the joint of interest and trot off in a straight line immediately after.

32
Q

When performing a flexion test on a distal forelimb, which joint are you flexing and for how long?

A

Just trying to flex at the carpus for 30 seconds.

33
Q

When performing a flexion test on the proximal forelimb, which joint are you flexing and for how long?

A

Carpal joint for 60 seconds.

NOTE: You end up flexing the carpus, elbow and shoulder.

34
Q

When performing a flexion test on a distal hindlimb, which joint are you flexing and for how long?

A

Just trying to flex at the carpus for 30 seconds.

35
Q

When performing a flexion test on the proximal hindlimb, which joint are you flexing and for how long?

A

The hock, stifle and hip for 90 seconds.

NOTE: This test is NOT hock specific.

36
Q

Why do you perform nerve blocks?

A

To localize the lameness.

37
Q

When performing nerve blocks, where do you begin?

A

Distally and work proximally.

38
Q

When performing nerve blocks, why do you not want to use sedation?

A

Sedation makes it more challenging to watch them go.

NOTE: If they’re being jerks, you can use a little Ace.

39
Q

What 4 different methods can you use when performing nerve blocks?

A

Perineural (nerve block)
Regional
Direct infiltration (ie. if you have a big mass)
Intraarticular

40
Q

What is a reason NOT to perform a nerve block?

A

Severe lameness.

41
Q

What agents might you use in a nerve block?

A

Lidocaine
Mepivacaine
Bupivacaine

42
Q

What kind of volume should you use with perineural anesthesia?

A

The smallest volume possible

43
Q

When doing a skin test (to test your nerve block), what do you use first?

A

A blunt instrument.

44
Q

From distal to proximal, what 6 nerve blocks can you perform?

A 
Palmar digital
Basi-sesamoid
Abaxial sesamoid
Low and high 4 point
MUN (forelimb)
Peroneal/tibial (hindlimb)
45
Q

What at the landmarks for the palmar digital nerve block?

A

Groove between the flexors and the ergot medially and laterally.

46
Q

What does the palmar digital nerve block anesthetize?

A

Essentially the whole foot.

47
Q

What are 3 main reasons why the palmar digital nerve block might fail?

A

Adhesions between the navicular bone and the DDFT
Osteoarthritis
Improper/incomplete anesthesia

48
Q

What 6 structures does the abaxial (basisesamoid) nerve block anesthetize?

A 
Foot, P2
Distopalmar P1
Proxiaml and distal interphalangeal joints
Distal SDFT and DDFT
Distal sesamoidean ligament
Distal annular ligament
49
Q

What nerves does the low 4-point block?

A

Lateral and medial palmar metacarpal nerve

Lateral and medial palmar nerve

50
Q

What volume should you use in the low 4-point block?

A

3mL per palmar nerve and 1mL per palmar metacarpal nerve

51
Q

What structures does the low 4-point block?

A

Everything from the fetlock down.

52
Q

What risk is there when using a high 4-point?

A

Could enter synovial structures.

53
Q

What block can you used instead of a high 4-point?

A

Lateral palmar nerve block

54
Q

What structures are anesthetized with a high 4-point block?

A

Suspensory ligament
Some flexor tendons
Some of metacarpal III and metacarpal IV

55
Q

What does the lateral palmar nerve block block?

A

The origin of the suspensory ligament.

56
Q

If you’re doing joint blocks, can you start high and go low?

A

Yes, because it should be intraarticular.

Large Animal Surgery (30 decks)

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