Equine Hindlimb Lameness - Hock and Stifle Flashcards
- Tibial nerve block.
- Deep and superficial peroneal nerve block.
- Proximal to point of hock on medial aspect dorsal to DDFT (palpable).
- Lateral gaskin at similar level between long and lateral digital extensor muscles - the superficial nerve palpable here.
– may induce stumbling and toe drag.
Synovial structures in and around the hock.
Many sheaths and bursae as well as hock joints themselves.
Distal intertarsal joint accessed on dorsomedial hock.
Tarsocrural joint would be another common site to block w/ 4 potential portals, the most commonly used being dorsolateral one.
- note the saphenous vein on the dorsomedial portal.
Calcaneum bursa over point of hock - wraps around SDFT.
Gastrocnemius just deep to calcaneum bursa.
Cunean tendon on dorsomedial hock.
Tarsal sheath wraps around DDFT.
- effusion may be hard to determine between effusion in the palmar pouches of the tarsocrural joint.
*All these structures are vulnerable w/ wounds if close to surface.
Stifle.
Medial femorotibial and femoropatellar joints usually communicate.
Lateral femorotibial joint usually independent.
Can desensitise lower limb in 1/3 cases - check!
- 4 standard views for hock radiography?
- Additional views for hock radiography.
- Lateromedial, DLPMO, dorsoplantar, DMPLO.
- Flexed lateral.
Skyline calcaneous.
- Standard views for stifle radiography?
- Additional view for stifle radiography?
- Lateromedial, caudocranial, caudolatero-dorsomedial oblique.
- Patellar skyline.
* Remember medial trochlear ridge much larger than lateral trochlear ridge.
Stifle ultrasound.
Gives good assessment of:
- effusion.
- fat pad.
- meniscus (not all).
- patellar tendons.
- collateral ligaments.
OA of the small hock joints (Bone Spavin).
Often bilateral.
Various presentations.
- lame/poor performance/loss of action/back issues.
- swelling on medial distal hock.
Shortened cranial phase, limb carried medially and then stamps laterally to the ground.
Positive to hock flexion.
Radiographic signs of OA of small hock joints.
Irregularity of joint margin.
- marginal demineralisation.
- perarticular new bone.
Irregular joint space:
- subchondral bone erosion.
- partial fusion.
Sclerosis of subchondral.
May have partial fusion.
Hock (TMT/DIT) OA tx options.
NSAIDs.
As all joint med options.
Shoeing (rolled toe, lateral extensions).
Arthrodesis.
- surgical – drill across joint.
- chemical – MIA (monoiodoacetate), ethanol.
– welfare and pain.
- then 6m rest.
*Radiographic change significance does not correlate with pain.
OA of stifle.
Associated w/ new bone formation around the lateral surface of the femorotibial joint.
Osteohondritis dissecans (tarsus).
Presentation:
- tarsocrural joint effusion.
- ?variable lameness.
Increased incidence in:
- warmbloods.
- standardbreds.
- ?shires?
Location:
- distal intermediate ridge of the tibia (most commonly).
- lateral trochlear ridge of the tibial tarsal bone.
- medial trochlear ridge of the tibial tarsal bone.
- medial tibial malleolus.
OCD in stifle.
Lateral trochlear ridge of the distal femur (most commonly).
Patella.
Medial trochlear ridge.
Joint effusion.
Variable lameness.
Osseous cyst like lesions aka subchondral bone cysts.
Persistent mild-moderate lameness.
Few localising signs.
Usually medial condyle.
Communicate with joint.
Sclerotic rim.
May not block convincingly.
“Curb”.
Plantar ligament desmitis.
- strain / trauma.
Occasionally SDFT injury.
Firm swelling above chestnut and below point of hock.
Lameness at onset later incidental.
Rest:
- poor cosmesis.
- sound in a few months.
“Bog Spavin”.
Tarsocrural effusion.
Clinical sign.
OCD.
Trauma.
Sprain injury.
Idiopathic.
