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Equine > Eq 2 - midterm1 - lameness > Flashcards

Eq 2 - midterm1 - lameness Flashcards

1
Q

Definition of claudication

A

Structural or functional disorder in one or more limbs and related structures

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2
Q

Phases of the stride - Supporting phase

A

(on the ground)

  • Landing
  • Loading
  • Stance
  • Breakover (heel lift, toe pivot)
  • Swinging phase
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3
Q

Phases of the stride - Swinging phase

A

(in the air)

  • Flexion (caudal)
  • Extension (cranial)
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4
Q

Interference forms at the trot

A
  • frontlimb to frontlimb
  • ipsilateral front to hind
  • Pacer (diagonal limbs)
  • Ipsilateral hind to front

(see picture in ppt)

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5
Q

What can be the causes of lameness?

A
  • Trauma
  • Congenital
  • Acquired
  • Infection
  • Metabolic disturbances (e.g laminits)
  • Circulatory disorders (e.g thrombus in abd aorta caused by Strangylus vulgaris larvae) -
  • Nervous system
  • PAIN
  • Mechanical
  • paralytic disorders
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6
Q

Symptoms of Aortoiliac thrombosis

A
  • holds the hindpart up while trotting. When standing it holds one hindlimb up.
  • Can walk for 10 min, and then start to sweat. Showing colic symptoms due to hypoxia.
  • Can be that one leg is cold and one is warm, and that one saphenous vein is showing and the other is not.
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7
Q

Degree of lameness

A

1-5 or 1-10 (Europe), 0-5 (AAEP)

  • Grade 1: very mild
  • Grade 2: mild
  • Grade 3: moderate
  • Grade 4: severe
  • Grade 5: non weight bearing
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8
Q

Classification of lameness

A
  • Supporting limb lameness
  • Swinging limb lameness
  • Mixed lameness
  • Complementary lameness
  • Untipical lameness
  • Special lameness
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9
Q

Explain findings in Supporting limb lameness

A
  • Cranial phase is longer
  • Head and neck movement
  • The problem is usually lower
  • Worse in inside circle
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10
Q

Explain findings in Swinging limb lameness

A
  • Cranial phase is shortened (less hyperextension)
  • it is evident during motion
  • usually the problem is higher
  • worse in outside circle
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11
Q

Explain findings in Compensatory lameness

A

Uneven distribution of weigh on another limb

  • Lame on front limb –> other front limb
  • Navicular disease –> sole bruise
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12
Q

Untipical lameness?

A

When more than one limb is effected

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13
Q

Findings in Special lameness

A
  • E.g rupture of peroneus tertius
  • upword fixation of the patella
  • DDFT rupture
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14
Q

what belongs in a lameness examination

A
  • Anamnesis
  • Visual examination
  • Palpation
  • Provocating tests
  • Diagnostic analgesia (Perineural, intrasynovial, infiltration)
  • supplementary diagnostic aids (Puncture, lab evaluation, X-ray, UL, Scintigraphy, CT, MRI etc.)
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15
Q

What to look for in Visual examination at rest

A

At distance (in all directions):

  • conformation
  • body condition
  • positure
  • atrophy, assymetry

Close observation:

  • Hoof
  • swelling, distension etc.
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16
Q

What type of local anaesthetics should we use?

A

Best (less irritant):

  • Mepivacaine, Prilocain: fast acting and about 2 hr duration
  • Bupivacaine: Slower acting and about 4 hr duration

more irritant:

  • Lidocaine
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17
Q

Diagnostic analgesia sedation:

A
  • Small doses
  • Xylazine (0.1-0.2 mg/kg, 30 min duration)
  • Detomidine/butorphanol (0.005 mg-7kg, 1 hour duraton. Much safer, affect result in higher doses)
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18
Q

Diagnostic analgesia patient preparation

  • Perineural analgesia:
A
  • clean procedure
  • clip if hairy
  • antiseptic scrub until clean (iodine, chlorhexidine)
  • alcohol with swab then spray
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19
Q

Diagnostic analgesia patient preparation

  • Intrasynovial:
A
  • Aseptic procedure
  • Clip
  • 5 min antiseptic scrub
  • Alcohol wash
  • Sterile goves
  • Fresh bottle of anaesthetic
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20
Q

Diagnostic analgesia - fore limb strategy:

  • If there is no clinical suspicion as to site of pain, what is the procedure?
A
  • Block from distal to proximal
  • Use regional blocks
  • Differentiate with intrasynovial blocks later if necessary
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21
Q

Types of perineural analgesia in forelimb:

A
    1. Deep digital nerve block (TPA1)
  • (2. Prox palm digit block) (TPA 2)
    1. Abax. sesamoid block (MPA)
    1. Four point block
    1. High palmar block
    1. Subcarpal
    1. Lat. palmar block
    1. Ulnar block
    1. N. medianus et N.musculocutaneous block
22
Q

Deep digital nerve anesthesia:

  • procedure and structures anaesthetised
A
  • 23G, 1.5cm needle
  • 1.5 ml anaesthtic
  • At level of collateral cartilages

Structure anaesthetised:

  • palmar foot
  • toe
  • DIP joint
  • +/- distal DDFT lesions
  • Occasionally PIP joint
23
Q

Abax. Sesamoid block

  • procedure and structures anaesthetised:
A
  • 22-23G, 1.5 cm needle
  • 3ml loc anaesthetic
  • at level of prox sesamoidbones (proximal-distal direction of the needle)

Structures anaesthetised:

  • PDB (proximal pastern)
  • Distal DDFT lesions
  • Sometimes: Fetlock joint (MCP), sesamoid bone locally
24
Q

Distal interphalangeal joint analgesia

  • procedure and structures anaesthetised:
A
  • Aseptic procedure
  • 19G, 3cm needle
  • 6ml anaesthetic max!
  • Dorsal or palmar approach

Structures anaesthetised with 6ml:

  • DIP joint - Dorsal sole (toe)
  • (not the heel)

Structures anaesthetised with 10ml:

  • Blocks the heel as well!
25
Q

Navicular bursa analgesia - procedure and structures anaesthetised

A
  • aseptic procedure
  • radiographic control
  • 19G, 7cm needle
  • 3.5 ml anaesthetic
  • 0.5ml iohexol contrast solution

Structures anaesthetised:

  • Navicular bursa
  • Dorsal sole (toe)
  • Navicular bone
  • Navicular ligaments
  • (not the heel)
  • 30min: DIP joint
26
Q

Proximal interphalangeal joint (PIPJ)

  • procedure and structures anaesthetised:
A

Both Dorsal and palmar approach:

  • 21G, 2.5cm needle
  • 5 ml anaesthtic MAX

Strucures anaesthetised:

  • PIP joint
27
Q

4 point block (N.digit. palm., nn. metacarpales)

  • procedure and structures anaesthetised:
A
  • 23G, 1.5cm needle
  • 1.5-3 ml anaessthtics
  • palmar nerves (lat. med), palmar metacarpal nerves

Structures anaesthetised

  • PDB plus
  • metacarpophalangeal (MCP) region
  • PD nerve only: usefull for annular ligament analgesia
28
Q

Metacarpophalangeal joint anesthesia - procedure and structures anaesthetised

A

Dorsal and palmar apporaches:

  • 19-22G, 3-4 cm needle
  • 10 ml anaesthetic

Dorsal approach:

  • easier
  • articular cartilage easily traumatised

Palmar approach:

  • between suspensory lig and MC3
  • sometimes difficult to be sure of centesis

Structures anaesthetised:

  • MCP joint
  • Subchondral bone pain 30 min may anaesthetise:
  • distal suspensory branches
  • sesamoids
29
Q

Digital flexor tendon sheat (DFTS) analgesia

  • procedure and structures anaesthetised
A
  • 20G, 2.5cm needle
  • 10-15ml anaesthetic

Structures anaesthetised:

  • digital sheath
  • local structures with time
  • annular ligament
  • often only a partial improvement
30
Q

High palmar block

  • procedure and structures anaesthetised
A
  • 20G, 3cm needle
  • 5ml in each site
  • palmar nerves
31
Q

Subcarpal block

  • procedure and structures anaesthetised
A

Structures anaesthetised:

  • whole metacarpal region
  • 65% chance of penetrating carpometacarpal (CMC) joint
  • dorsal branches must be anaesthetised to block the skin dorsally
32
Q

Lateral palmar analgesia

A
  • more specific for suspensory lig. origin
  • 22G, 1.5cm needle
  • 5ml anaesthetic
  • less chance of blocking the CMC joint
33
Q

Suspensory lig origin infiltration

A
  • specific for suspensory lig. lesions
  • 19G, 5cm needle
  • 10ml anaesthetic
  • from lateral
  • include palmar metacarpal nerves
34
Q

Positive subcarpal analgesia

A
  • perform middle carpal joint analgesia
  • can diffuse around palmar nerves and block metacarpal structures
35
Q

Middle carpal and antebrachiocarpal analgesia

A
  • dorsal pouches
  • medial or lateral
  • 19G, 3cm needle
  • 5ml anaesthtic
  • check in 5-10 min
36
Q

N. ulnaris analgesia

A
  • 18G, 4cm needle
  • 10-15ml anaesthetic
  • 10cm prox from accessory carpal bone
37
Q

N. medianus analgesia

A
  • 5cm below elbow joint, medial side
  • caudomedial surface of radius
  • just cranial from m.flex.carpi radialis
  • 10 ml loc anaesthetics
  • A. and V. is located caudally from it
  • false positive response because of elbow joint
38
Q

N. musculocutaneous analgesia

A
  • branch for the skin
  • seldom necessary
  • 4x3 ml: V.cephalica cran. caud, V.ceph. access. cran.. caud
39
Q

Elbow analgesia - procedure and structures anaesthetised

A
  • 19G, 9cm needle
  • 25 ml anaesthetics
  • NB: radial nerve
  • lat ulnar bursa not adviced (communicates just in 37%)

Cranial approach:

  • signs of radialis paresis
  • in front of collat lit 2/3 distance between humerus apicondyle and tub. radii in cranial direction

Caudal method:

  • in front of olecranon caud from epicondyle long needle, may need skin loc. anaestheisa
40
Q

Shoulder joint analgesia: - procedure and structures anaesthetised

A
  • 19G, 9cm needle
  • 25ml anaesthtic
  • wait 30 min
  • inbetween tub majus pars cran et caud humeri
  • infront of intraspinatus insertion
41
Q

Bicipital bursa analgesia

A
  • 19G, 9cm needle
  • 20ml loc anaesthetics
  • Puncture under ultrasonographic controlled adviced
  • 4cm dist. and 6-7 cm caudal from tub. majus pars cranialis humeri
42
Q

Pastern ring block

A
  • include dorsal branches and dorsal metatarsal nerves
  • Blocks pastern and foot
43
Q

Low plantar six point

A
  • plantar digital nerve
  • plantar metatarsal nerve (important for subchondral bone of distal MCIII)
  • dorsal metatarsal nerve
  • blocks all tissues distal to block
  • Positive: return lator to block (Fetlock, digital sheat)
44
Q

Subtarsal (high plantar)

A
  • plantar and plantar metatarsal
  • blocks suspensory ligament
  • complete ring block to anaesthetise whole metatarsus
45
Q

Intra-articular Tarsometatarsal and Centrodistal

  • procedure and structures anaesthetised
A
  • they usually communicate
  • do TMT first from plantarolateral.
  • 21G, 4cm needle, 5-10ml
  • sometimes it can anaesthetise the suspensory lig. insertion
  • recheck subtarsal block if differential diagnosis in doubt
46
Q

Intra-articular Tarsocrural joint - procedure and structures anaesthetised

A
  • 19G, 4cm needle
  • 10-15 ml
  • Dorsomedial: axial to saphenous vein
  • communicates with proximal intertarsal joint
47
Q

Tarsal sheath - procedure and structures anaesthetised

A
  • differentiate if distended tarsal sheath is causing lameness
  • 19G, 4cm needle
  • 15-20ml
  • easier when distended, plantar to TC joint capsule
48
Q

Tibial and peroneal - procedure and structures anaesthetised

A

Superficial and deep peroneal:

  • hands breadth above point of hoch
  • between long and lat dig ext. muscles
  • 15ml, 4cm deep, 5ml under skin

Tibial: - 20ml, 1cm deep - from medial

49
Q

Intra-articular femorpatellar, medial and lateral femorotibial - procedure and structures anaesthetised

A
  • 19G, 6cm needle for all blocks
  • 20-35 ml
  • usually communicate, do all 3 together.
  • 50% improvement is significant
  • may not block bone cysts, pateller and collateral lig. injuries

Femoropatellar joint:

    • either side of middle patellar lig.
    • difficult to retrieve synovial fluid

Medial femorotibial:

  • pouch cranial to medial collateral lig.
  • fluid should be retrieved Lateral femorotibial joint
  • in extensor notch cranial or caudal to long digital extensor tendon
50
Q

Intra-articular coxofemoral

  • procedure and structures anaesthetised
A
  • 19G, 20cm needle, 30ml
  • find the caudal proc. of greater trochanter
  • rarely performed and difficult!
51
Q

Sacroiliac joint - procedure and structures anaesthetised

A
  • 20-25cm needle, 30 ml.
  • Avoid: sciatic nerve ventral to the S/I joint, cranial gluteal nerve caudal margin ileal wing.
  • medial approach preferred to avoid nerves
  • cranial to tuber sacrale, caudal to L6 dorsal spine, from contralaterally
  • usually block bilaterally
  • can use UL guidance
52
Q
A

Equine (8 decks)

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