DL: HL lameness

Question 1

Describe the motion of the medial tarsal joints

Answer 1

low motion

Question 2

Define DLPMO

Answer 2

dorsolateral-palmaromedial oblique

Question 3

Define DMPLO

Answer 3

Dorsomedial-plantolateral oblique

Question 4

What is the high motion joint of the tarsus?

Answer 4

tarso-crucal joint

Question 5

What is the small tarsal joint prone to?

Answer 5

OA (spavin)

Question 6

What is present on dorsal aspect of hock?

Answer 6

tertius and tibialis cranialis

Question 7

How strng are tendon sutures?

Answer 7

very weak

Question 8

When is it better to use a 2x locking loop than a 3-loop pulley tendon suture?

Answer 8

better in tendons that are flatters

Question 9

What are the 2 most important things for tendon repair?

Answer 9

repair + protect

Question 10

Define/refine back pain in horses

Answer 10

can be primary or secondary to HL problem. only most severe cases show pain

Question 11

Define kissing spines

Answer 11

overriding dorsal spinous processes with a boney reaction b/w these

Question 12

Ddx - back pain in horse

Answer 12

Kissing spines
Intervertebral facet joint OA
Rib fracture

Question 13

How do you make a definitive diagnosis of kissing spines?

Answer 13

Radiographic appearance strongly suggestive of kissing spines
Diagnostic analgesia definitive
Gamma scintigraphy supportive

Question 14

Tx - kissing spines

Answer 14

Intra-spinous process steroid meds (test med as often not entirely sure)
Dorsal spinous resection – several techniques (when convinced of lesion location)
Interspinous ligament transection (new sx, controversial)

Question 15

What does a flexed stifle radiograph show?

Answer 15

trochlear groove

Question 16

Tx - patella luxation (canine)

Answer 16

• Sx correction (move patella back into correct position and ensure trochlear groove deep enough to hold it)
• tibial transposition
• trochlear sulcoplasty
• lateral soft tissue imbrication
• medial soft tissue release
• distal femoral osteotomy (straighten out bones themselves)

Question 17

Px - canine patella luxation

Answer 17

Good if sx succes and patella remains in trochlear groove

Question 18

Outline canine patella luxation grading.

Answer 18

1. ) manually patella can be pushed out but immediately reduces, no crepitus, stifle flexion/extension is in straight line with no abduction of the hock
2. ) patella spontaneously and frequently luxates at times but remains in trochlear groove predominantly, many live with this for years but chronic causes erosion of AC (patella and prox medial lip  crepitus)
3. ) patella resides out of trochlear groove predominantly, deviation of tibial crest between 30 and 50 degrees from cr/cd plane, trochlear flat/shallow
4. ) tibia twisted and tibial crest deviation of 50 to 90 degrees, patella permanently luxated, trochlea absent or even convex, limb carried or animal moves in a crouched position, with limb flexed

Question 19

Describe laterally luxating patella in horses

Answer 19

’normal’ in shetlands (can be secondary to hip has been displaced and mm not working properly)

Question 20

Describe upward fixation of patella

Answer 20

common, young animals, associated with mm weakness, best initial management = exercise, if persistent / permanent = medial patella ligament desmotomy (danger of apical patella fragmentation)
Contrast is that in dogs it will be MEDIAL

Question 21

Common causes of stifle swelling

Answer 21

• adult horse: meniscal tears

- young: osteochondrosis

Question 22

Outline meniscal tears in horses

Answer 22

Increasingly recognised cause of HL lameness in horse
Medial and lateral menisci, medial more frequently affected
Lameness – moderate to severe
Evaluation
Palpation - FT (and FP) joint distension. Palpate medial meniscus displacement
Imaging – radiograph, ultrasound, arthroscopy (combination of all 3)
Assess position of meniscus – prolapse important for stability and prognosis

Question 23

List orthobiologics that may be used in equine meniscal ligament damage

Answer 23

stems cells, PRP, bone marrow aspirate concentrate

Question 24

Px - equine meniscal injury

Answer 24

Over 50% horses with meniscal injury return to athletic use. With severe tears extending beneath femoral condyle + concurrent OA, px is considerably poorer

Question 25

Ddx - CCLR

Answer 25

• CCL dz/R +/- meniscal injury (a degenerative disease hence why at top of ddx list)
• Other ligament instability (collaterals)
• OCD of femoral condyle
• Patella luxation
• Septic arthritis
• Neoplasia

Question 26

Tx - CCLdz

Answer 26

SURGERY:
Extracapsular/ lateral fabellar suture
TPLO
Other types of tibial plateau levelling sx – cr closing wedge osteotomy/ CWO, TTO, TTA
Intracapsular stabilisation
CONSERVATIVE:
Most dogs will improve with time but it will take a long time
Reported that dogs under 15kg and cats do better with conservative managment