Eq 2 - midterm1 - lameness Flashcards
Definition of claudication
Structural or functional disorder in one or more limbs and related structures
Phases of the stride - Supporting phase
(on the ground)
- Landing
- Loading
- Stance
- Breakover (heel lift, toe pivot)
- Swinging phase
Phases of the stride - Swinging phase
(in the air)
- Flexion (caudal)
- Extension (cranial)
Interference forms at the trot
- frontlimb to frontlimb
- ipsilateral front to hind
- Pacer (diagonal limbs)
- Ipsilateral hind to front
(see picture in ppt)
What can be the causes of lameness?
- 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
Symptoms of Aortoiliac thrombosis
- 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.
Degree of lameness
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
Classification of lameness
- Supporting limb lameness
- Swinging limb lameness
- Mixed lameness
- Complementary lameness
- Untipical lameness
- Special lameness
Explain findings in Supporting limb lameness
- Cranial phase is longer
- Head and neck movement
- The problem is usually lower
- Worse in inside circle
Explain findings in Swinging limb lameness
- Cranial phase is shortened (less hyperextension)
- it is evident during motion
- usually the problem is higher
- worse in outside circle
Explain findings in Compensatory lameness
Uneven distribution of weigh on another limb
- Lame on front limb –> other front limb
- Navicular disease –> sole bruise
Untipical lameness?
When more than one limb is effected
Findings in Special lameness
- E.g rupture of peroneus tertius
- upword fixation of the patella
- DDFT rupture
what belongs in a lameness examination
- Anamnesis
- Visual examination
- Palpation
- Provocating tests
- Diagnostic analgesia (Perineural, intrasynovial, infiltration)
- supplementary diagnostic aids (Puncture, lab evaluation, X-ray, UL, Scintigraphy, CT, MRI etc.)
What to look for in Visual examination at rest
At distance (in all directions):
- conformation
- body condition
- positure
- atrophy, assymetry
Close observation:
- Hoof
- swelling, distension etc.
What type of local anaesthetics should we use?
Best (less irritant):
- Mepivacaine, Prilocain: fast acting and about 2 hr duration
- Bupivacaine: Slower acting and about 4 hr duration
more irritant:
- Lidocaine
Diagnostic analgesia sedation:
- 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)
Diagnostic analgesia patient preparation
- Perineural analgesia:
- clean procedure
- clip if hairy
- antiseptic scrub until clean (iodine, chlorhexidine)
- alcohol with swab then spray
Diagnostic analgesia patient preparation
- Intrasynovial:
- Aseptic procedure
- Clip
- 5 min antiseptic scrub
- Alcohol wash
- Sterile goves
- Fresh bottle of anaesthetic
Diagnostic analgesia - fore limb strategy:
- If there is no clinical suspicion as to site of pain, what is the procedure?
- Block from distal to proximal
- Use regional blocks
- Differentiate with intrasynovial blocks later if necessary
Types of perineural analgesia in forelimb:
- Deep digital nerve block (TPA1)
- (2. Prox palm digit block) (TPA 2)
- Abax. sesamoid block (MPA)
- Four point block
- High palmar block
- Subcarpal
- Lat. palmar block
- Ulnar block
- N. medianus et N.musculocutaneous block
Deep digital nerve anesthesia:
- procedure and structures anaesthetised
- 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
Abax. Sesamoid block
- procedure and structures anaesthetised:
- 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
Distal interphalangeal joint analgesia
- procedure and structures anaesthetised:
- 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!
Navicular bursa analgesia - procedure and structures anaesthetised
- 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
Proximal interphalangeal joint (PIPJ)
- procedure and structures anaesthetised:
Both Dorsal and palmar approach:
- 21G, 2.5cm needle
- 5 ml anaesthtic MAX
Strucures anaesthetised:
- PIP joint
4 point block (N.digit. palm., nn. metacarpales)
- procedure and structures anaesthetised:
- 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
Metacarpophalangeal joint anesthesia - procedure and structures anaesthetised
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
Digital flexor tendon sheat (DFTS) analgesia
- procedure and structures anaesthetised
- 20G, 2.5cm needle
- 10-15ml anaesthetic
Structures anaesthetised:
- digital sheath
- local structures with time
- annular ligament
- often only a partial improvement
High palmar block
- procedure and structures anaesthetised
- 20G, 3cm needle
- 5ml in each site
- palmar nerves
Subcarpal block
- procedure and structures anaesthetised
Structures anaesthetised:
- whole metacarpal region
- 65% chance of penetrating carpometacarpal (CMC) joint
- dorsal branches must be anaesthetised to block the skin dorsally
Lateral palmar analgesia
- more specific for suspensory lig. origin
- 22G, 1.5cm needle
- 5ml anaesthetic
- less chance of blocking the CMC joint
Suspensory lig origin infiltration
- specific for suspensory lig. lesions
- 19G, 5cm needle
- 10ml anaesthetic
- from lateral
- include palmar metacarpal nerves
Positive subcarpal analgesia
- perform middle carpal joint analgesia
- can diffuse around palmar nerves and block metacarpal structures
Middle carpal and antebrachiocarpal analgesia
- dorsal pouches
- medial or lateral
- 19G, 3cm needle
- 5ml anaesthtic
- check in 5-10 min
N. ulnaris analgesia
- 18G, 4cm needle
- 10-15ml anaesthetic
- 10cm prox from accessory carpal bone
N. medianus analgesia
- 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
N. musculocutaneous analgesia
- branch for the skin
- seldom necessary
- 4x3 ml: V.cephalica cran. caud, V.ceph. access. cran.. caud
Elbow analgesia - procedure and structures anaesthetised
- 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
Shoulder joint analgesia: - procedure and structures anaesthetised
- 19G, 9cm needle
- 25ml anaesthtic
- wait 30 min
- inbetween tub majus pars cran et caud humeri
- infront of intraspinatus insertion
Bicipital bursa analgesia
- 19G, 9cm needle
- 20ml loc anaesthetics
- Puncture under ultrasonographic controlled adviced
- 4cm dist. and 6-7 cm caudal from tub. majus pars cranialis humeri
Pastern ring block
- include dorsal branches and dorsal metatarsal nerves
- Blocks pastern and foot
Low plantar six point
- 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)
Subtarsal (high plantar)
- plantar and plantar metatarsal
- blocks suspensory ligament
- complete ring block to anaesthetise whole metatarsus
Intra-articular Tarsometatarsal and Centrodistal
- procedure and structures anaesthetised
- 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
Intra-articular Tarsocrural joint - procedure and structures anaesthetised
- 19G, 4cm needle
- 10-15 ml
- Dorsomedial: axial to saphenous vein
- communicates with proximal intertarsal joint
Tarsal sheath - procedure and structures anaesthetised
- differentiate if distended tarsal sheath is causing lameness
- 19G, 4cm needle
- 15-20ml
- easier when distended, plantar to TC joint capsule
Tibial and peroneal - procedure and structures anaesthetised
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
Intra-articular femorpatellar, medial and lateral femorotibial - procedure and structures anaesthetised
- 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
Intra-articular coxofemoral
- procedure and structures anaesthetised
- 19G, 20cm needle, 30ml
- find the caudal proc. of greater trochanter
- rarely performed and difficult!
Sacroiliac joint - procedure and structures anaesthetised
- 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
