DL: HL Lameness Flashcards
High motion joint of the hock?
Tarsocrural joint (cf. small tarsal joints more distally)
What is the spavin test?
Flexion of the limb worsens lamess with bone spavin (though not specific)
What is the centrodistal joint?
DITJ
Which hock joints communicate ? Clinical relevance?
- 30% horses TMT and DITJ communicate
- TCJ and PITJ
> inflam can spread between these joint spaces
How is TMTJ injected?
From plantar aspect
Which hock joints most commonly afected by OA?
DITJ and TMTJ
Which tendon overlies the area where bone spavin is commonly seen?
Cunean tendon and bursa
Initial method of arthrodesis in horses?
- injection of alcohol (less painful than MIA)
How are hock and stifle linked in the dog?
Similar to horse
- should not be abel to flex hock with stifle extended
Dxx for common calcaneal tendon in dogs?
Ultrasound too
WHich tendon sutures are best for cylindrical or flat tendons?
- locking loop : flat
- 3 pulley loop : cylindical
2 main tx principles for tendon rupture?
Repair and support
Where should the patella lie?
Trochlear groove of femur
Where does fibula lie wrt tibia?
laterally
What happens to bone shape when muscle alignment is out
Sigmoid shape develops d/t forces off centre line
eg. with quadriceps contraction and fibrosis
Which lameness is worsened on the inside of the circle?
Weight bearing lameness ie. NOT something to do with the swing phase (upper limb, elbow and shoulder or stifle)
What is seen with bone spavin?
bony/hard swelling over the small tarsal joints (medial distal tarsus)
What may be seen on radiographs with bone spavin?
- osteophytes
- periosteal reaction
- narrowed joint space / ankylosis
Which structure run over the dorsal aspect of tarsus?
- peroneus tertius (branches into lateral and medial
- tibialis cranialis with medial branch (cunean tendon and bursa)
Ddx for bone spavin?
- distal tarsal bone fx
- cunean bursitis (soft tissue injury)
Tx bone spavin
- medicate joints (corticosteroids)
- NSAIDs
- Tiludronate IV (tildren)
- Arthrodesis DITJ/TMTJ
> chemical (alcohol or MIA) or surgical (drilling, plates) or laser - farriery
- ?neurectomy ? cunean tenectomy
Px for bone spavin?
- fair - good for short term soundness
- guarded for long term
What is the flexor and extensor mechanism of the hind limb? How can damage to the common calcaneal tendon be identified?
- extensor = calcaneal tendon
- flexor = digital flexors (SDFT etc)
> if all tendons affected, will be able to flex the hock while extending the stifle, and the digits will not flex
> if only the gastroc tendon is affected, but SDFT remains, digits will be flexed
What types of damage may the common calcaneal tendon undergo?
- avulsion
- degenration
- rupture/tearing
- neoplasia
- previous trauma to calcaneous
Tx options for tendon rupture/
> repair surgically (conservative management is not effective)
- protect for >6 weeks to heal to 50% strength
calcaneotibial screw
- locks hock in extension
- risk of screw snapping
cast
- padded support dressing for 2-3 weeks after 6 weeks or orthoses
stem cells + custom orthoses?
Which tendon suture is quicker to place and more resistnat to gap formation?
3 loop pulley (but 2 locking sutures better for flat tendons)
Px for common calcaneal tendon rupture ina doberman?
- good as long as sz prompt and repair protected
- should regain normal function
> beware rupture may be d/t degneration of the tendon so may recur in opposite limb
Dxx for suspected back pain in the horse?
- scintigraphy
- excercise under saddle
- diagnostic analgesia
What radiographic view are dorsal spinous processes seen on?
laterolateral
Ddx for back pain equine
- impingeing spinous processes
- intervertebral facet joint OA
- rib fx
Tx kissing spine
- medicate intra-spinous regions
- dorsal spinous resection (either wedge or distal tips)
- interspinous ligament transection
Px kissing spine after tx?
fair
Presenting signs of patella luxation? Predisposing factors?
- bilaterally abnormal HL gait
- crouching posture
- no stifle extension
- internal tarsal rotation
- check patella trcking
- check tarsal alignment
> shallow trochlear groove of femur
> abnormal patella position (quads displaced to the same side)
Outline patella grading system
1 - can be pushed out but immediately reduces
2 - spontaneously luxtes but remain in trochlear groove predominantly
3 - patella resides out of trochlear groove predominantly but can still be reduced with manual pressure
4 - patella resides out of trochlear groove and cannot be reduced
Tx patella luxation?
> surgical correction
- tibial tuberosity transposition (lateral)
- trochlear sulcoplasty (wedge or block)
- lateral soft tissue imbrication
- medial soft tissue release
- distal femoral osteotomy
NOT conservative
Px patella luxation after tx>
- good
- if surgery successful and patella remains in trochlear groove
- but will develop DJD in the stifle so may suffer low grade lameness/stiffness
- risks: patellar relux, implant failure or bone fx
How do equine patellas differ to small animal?
- laterally luxating patellas normal in shetlands
- upward fixation of the patella common
- usually young animals d/t muscle weakeness
> best tx initially = excercise - if persistent = medial patellar ligament desmotomy (danger of apical patella fragmenetation)
Which stifle joints communicate? LOOK UP
- Anatomically, FPJ and MFTJ most, FPJ and LFTJ a little bit
- Functionally slightly less
- degenerative??
How would a medial meniscal tear appear on ultrasound?
Disruption of fibres between tibia and medial femoral condyle (ultrasound of medial aspect of the stifle)
How can menisci cause lameness in the horse?
- meniscal tears
- medial more frequently affected than lateral
- lameness can be mod-severe
- evaluation by palpation (FT and FP joint distnesion, palpate displacement directly)
> imaging - rads (new bone on MICET, best seen flexed lat-med)
- ultrasound (tears usually horizontal, assess position of meniscus - prolapse important for stability and Px)
- arthroscopy
Tx mensical tears in horses?
- arthroscopic debridement
+- Stem cells?
Px meniscal tears horses?
- Grade1 : 63%
- Grade2: 56%
- Grade3: 6%
> if visable ultrasonographically Px worse
What clinical and radiographic signs may be seen concurrentlly with CrCL dz? Ddx for these signs?
- muscle atrophy proximally
-joint effusion (cranial displacemet of infraptellar fat pad, caudal displacmeent of subgastrocnemial fascial plane) - periarticular osteophytosis (distal patella, prox trochlear ridge, fabellae, tibial plateua, remodelled popliteal sesamoids, stifle WNLs)
> Collateral damage -> instability
> OCD of femoral condyle
> patella luxation
> septic arthritis
> neoplasia
Tx CrCL Dz?
> surgery - extracapsular - TPLO/TTA - intracapsualr (Not advised naymore) > conservative - dogs under 15kg and cats better - takes a loooong time
Px CrCL Dz?
- fair (limb function should improve considerably)
- but DJD progressive and permenant
- dogs never recover 100% limb function despite doing well
- some stiffness/lamenss
