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CVNT2 > Equine Lameness and Orthopaedics > Flashcards

Equine Lameness and Orthopaedics Flashcards

1
Q

what background information is important to obtain when getting a history of a horse with a lameness issue?

A

signalment

use

duration of ownership (awareness of history)

recent management (work/exercise, feeding, housing, shoeing)

previous medical problems

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2
Q

what problem-specific information is important to obtain from the owner of a horse presenting with lameness?

A

limb/limbs affected

timing and nature of onset of signs
progression of signs since onset

associated events/incidents

any swelling/heat/pain

treatments/management employed

current state of problem

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3
Q

what are the aims of the initial lameness workup?

A 
decide if lame or sound 
identify limbs affected 
score the severity of lameness 
try to identify the source/cause 
implement treatment plan
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4
Q

what are the steps of the initial lameness workup?

A

physical examination

focused exam of musculoskeletal system

gait evaluation (walk/trot/lunge)

flexion tests

further examination of affected limb

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5
Q

what is involved in the physical examination of the horse? (5)

A

general clinical exam and body condition

conformation of body/limbs/feet

posture and weight bearing on the limbs

skeletal and soft tissue symmetry

localised swelling/thickenings

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6
Q

what is involved in a detailed evaluation of the limbs?

A

inspection, palpation and manipulation of the limbs/joints

palpating the soft tissue

applying pressure to see response

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7
Q

what do we want to establish with a gait evaluation?

A

is there a gait abnormality?

is this due to lameness or something else e.g.
neurological

degree of lameness, which limbs are affected

what exacerbates the lameness?

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8
Q

how do you perform a gait evaluation in a horse?

A

different surfaces - soft/hard
start with walk - if obviously lame at walk then won’t trot
trot up in a straight line
move on to lunging - soft and hard surface

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9
Q

what PPE should you wear in order to lead/trot up a horse?

A

hat
boots
gloves
overalls

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10
Q

what equipment is required for leading/trotting up a horse?

A

headcollar

lead rope

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11
Q

what are the considerations for trotting up?

A

appropriate PPE

location - safe, flat surface, weather
contained?

how lame - is it appropriate

temperament of the horse

restraint - headcollar +/- bridle

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12
Q

how can you assess forelimb lameness?

A

assess as the horse is walking/trotting towards you

will be a head nod if lame - head lifts UP as the LAME leg hits the ground

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13
Q

how can you assess hindlimb lameness?

A

assess as horse is walking away from you

“hip” of the lame limb will rise and fall through a greater range of motion than the sound side

hindquarters as a whole pushed up by sound limb and sink during stance phase of the lame limb

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14
Q

what are the other aspects of gait evaluation?

A

relative lengths of phases of stride
arc of foot flight
path of foot flight (medial/lateral)
foot placement

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15
Q

what is a lameness locator?

A

technology to aid lameness evaluation - sensors worn by horse (poll, foot and rump) - helps identify asymmetry in stride
not a replacement for standard evaluation

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16
Q

how is lameness graded? why grade it?

A

out of 10 (more common) or out of 5

useful for the individual clinician to assess improvement

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17
Q

what are the uses of provocative (flexion) tests?

A

to demonstrate occult lameness in a “sound” horse
to exacerbate mild lameness
to aid localisation of the source of lameness

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18
Q

how is a flexion test performed?

A

limb held in flexion for about 1 minute - horse trotted away as soon as limb released
allowed a few lame strides - does lameness continue longer than expected?
horse should be standing ready to trot away
attempt to only flex joints being tested

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19
Q

what are the limitations of flexion tests?

A

lack of specificity to site
inconsistency
lack of hard criteria for “positive” (allowed lame strides)
false positives and negatives

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20
Q

how does lunging help diagnose lameness?

A

lameness often exacerbated on a circle due to leaning in (suspected lame leg on inside)
hard ground more evident than soft usually

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21
Q

what PPE/equipment is required for performing lunging?

A

PPE - hat, steel toe capped boots, gloves, overalls

equipment - lunge line, lunge whip, bridle/lunging cavesson, boots for horse?

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22
Q

what are the other considerations when lunging a horse?

A

soft vs hard lunge (surfaces)
does the horse lunge well?
flat, large enough arena, appropriate surfaces

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23
Q

what are nerve/joint blocks?

A

perineural, intrasynovial or local infiltration of local anaesthetic - anaesthetises areas of the limb progressively to identify area of source of lameness

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24
Q

what LA is used for nerve blocks?

A

intra epicaine (mepivacaine)

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25
Q

how are nerve blocks perfomed?

A

start distally and work up
clean area with clorhex and spirit +/- clipping
usually unsedated (need to test movement)
left 10 mins then trot up to check for improvement

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26
Q

what are the common nerve block sites?

A
  1. palmar/plantar digital
  2. abaxial sesamoid
  3. low 4 point
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27
Q

what size needles/syringes are used for nerve blocks?

A

23-25G, 5/8” needles

2ml syringes

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28
Q

which nerve block site is this?

A

palmar/plantar digital

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29
Q

which nerve block site is this?

A

abaxial sesamoid

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30
Q

which nerve block site is this?

A

low 4 point - medial and lateral (4 needles)

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31
Q

how is a joint block performed?

A

intrasynovial administration - sterility is key
sterile skin prep - clorhex and spirit
evaluated at 10 mins and then later

32
Q

when is diagnostic imaging performed?

A

once an area of source of lameness has been identified

33
Q

what are radiographs useful for?

A

identifying bony change

34
Q

why are diagnostic ultrasounds useful?

A

distinguishes tendon/ligament injuries from peritendonous swelling

defines which tendon/ligament is injured

evaluates type and degree of damage

monitors healing

35
Q

how do you prep a limb for ultrasound?

A

clip if required
clean to remove dirt
apply gel to area
may require sedation to keep still

36
Q

what are we looking for during ultrasound?

A 
increase in tendon/ligament size 
change in internal architecture 
loss of longitudinal fibre alignment 
indistinct margination 
peritendinous fluid in tendon sheaths
37
Q

what are hyperechoic core lesions (US)?

A

black hole in tendon centre

38
Q

what is diagnostic arthroscopy?

A

direct visualisation of joint cavities, including articular cartilage, synovial membrane, intra-articular ligaments and menisci

39
Q

what are the limitations of diagnostic arthroscopy?

A

requires GA - risk and cost

inability to examine most joints in their entirety

40
Q

what is MRI useful for?

A

allows simultaneous demonstration of bone and soft tissue structures- good for hoof

41
Q

how is nuclear scintigraphy performed?

A

technetium 99m linked to methylene diphosphate
injected IV, taken up into mineral bone lattice
emits gamma radiation (6 hours) which is detected by gamma camera

42
Q

which lesions can be detected by nuclear scintigraphy?

A

stress fractures
arthropathies
enthesiopathies (connective tissue around joints)
(binds to increased metabolism/rapid turnover areas of bone)

43
Q

how can uptake be increased for nuclear scintigraphy?

A

lunge/exercise horse beforehand

44
Q

how must a horse be managed after nuclear scintigraphy?

A

will be radioactive - must be kept in isolation until no longer radioactive (no handling, mucking out etc)
urine will need to be collected during image acquisition

45
Q

what is synovial sepsis?

A

bacterial contamination of a synovial structure - causes septic arthritis and chronic lameness of not treated

46
Q

how can we investigate synovial sepsis?

A

synoviocentesis and analysis of synovial fluid
may inject sterile saline into joint and check for egress
contrast radiography?

47
Q

what does checking for egress with saline mean?

A

checking if fluid comes out of wound

shows communication between joint and wound

48
Q

what is the most important part of arthrocentesis?

A

maintaining sterility

49
Q

how do you prep for arthrocentesis?

A

sterile prep with clorhex 5 min minimum
wipe with surgical spirit
horse usually sedated

50
Q

what is the role of the nurse during arthrocentesis?

A

prepping site
non-sterile assistant during arthrocentesis
have equipment and spared ready (needles, syringes, sterile gloves, tubes/pots for collection)
monitoring for lameness/deterioration of lameness in post 48 hours (plus heat)

51
Q

how might an arthrocentesis sample be analysed?

A

cytology - TNCC and neutrophil %
protein concentration
lactate (slow to rise in first 24hrs)
may also take blood sample for serum amyloid A

52
Q

what is laminitis?

A

inflammation of the laminae/lamellae in the hoof

leads to dermal/epidermal separation and structural changes in the foot - rotation and sinking of P3

53
Q

what is the main issue with laminitis?

A

causes structural changes/failure in the foot (rotation/sinking of P3)

54
Q

what is the developmental phase of laminitis?

A

between the trigger and onset of clinical signs

55
Q

what are the phases of laminitis?

A

developmental
acute
subacute
chronic

56
Q

what is the acute phase of laminitis?

A

onset of clinical signs (72 hours)

may become chronic or subacute after this

57
Q

what is the subacute phase of laminitis?

A

from 72 hours

will require 2-3 months repair

58
Q

what is the chronic phase of laminitis?

A

structural failure

59
Q

what are the clinical signs of laminitis?

A 
stilted, pottery gait
increased, bounding digital pulses 
leaning back on heels 
recumbency 
worse on hard ground 
struggle to turn due to foot placement 
reluctance to pick up feet
60
Q

what are some of the causes of laminitis?

A 
endocrinopathies (PPID, EMS) 
excessive carbohydrates 
excessive weightbearing 
endotoxaemia/SIRS
corticosteroids (? anecdotal)
61
Q

what are the underlying endocrinopathies which can contribute to laminitis?

A

equine metabolic syndrome

pituitary pars intermedia dysfunction

62
Q

what is the pathophysiology of endocrinopathic laminitis?

A

not known but likely hyperinsulinaemia and insulin toxicity

63
Q

what are the other causes of laminitis?

A

hospital setting
supporting limb laminitis (excessive weightbearing, fractures, cellulitis)
endotoxaemia (secondary to colic/colitis/retained foetal membranes)

64
Q

what are the risk factors for laminitis?

A 
history of laminitis 
obesity 
endocrinopathies (PPID, EMS)
age 
insulin resistance 
season (pasture-related) 
heavy horses 
native ponies 
excessive weightbearing or carbohydrates
65
Q

how can we manage laminitis in the developmental stages?

A 
consider management for at-risk horses 
cold therapy - ice boots 
NSAIDs to reduce inflammation 
support for feet - frog supports, deep shavings bed 
treat underlying endocrinopathies
66
Q

how can we manage laminitis in the acute stage?

A

strict and complete box rest/restricted movement
deep shavings bed
frog supports/styrofoam pads
NSAIDs - analgesia and anti-inflammatory
increase perfusion - ACP?
treat underlying cause
address diet if endocrine related - care w/ colic
farriery once more comfortable

67
Q

how can we manage laminitis in the subacute phase?

A

gradually withdraw treatment as long as improving

keep on strict box rest

68
Q

how can farriery help laminitis?

A

shorten toe
needs doing over time
remedial shoeing - heart bars (support frog), silicone, glue on shoes

69
Q

what radiography considerations are there for laminitis patients?

A

lateromedial and dorsopalmar/plantar projections
measure rotation and sinking (prognostic indicators)
comfort - pick up feet and stand on blocks
metal marker on dorsal hoof wall for measurement

70
Q

how can we try and prevent laminitis occurring in those with endocrinopathies?

A

treat underlying endocrinopathy
weight loss/promote ideal BCS
exercise if possible to increase insulin sensitivity
diet - restrict carbohydrates, soaking hay
restricted grazing - muzzles, strip grazing

71
Q

what will change for the horse on box rest?

A

limited exercise
no turnout
behaviour - boredom, stable mates, lack of exercise
reduction in eating time

72
Q

what are the main concerns with a horse put on box rest?

A

colic
impaction
behaviour issues
gastric ulcers

73
Q

why might box rest increase the risk of gastric ulcers? how can this be avoided?

A

reduction in eating time due to boredom (eating faster)

omeprazole, smaller holed haynets/toys to keep occupied for longer
consider what is laminitis appropriate

74
Q

what nursing considerations are there for horse on box rest?

A

monitor faecal output, colic signs, appetite, signs of stress
consider mirrors, company
watch out for behaviour - may be more keen to escape, difficult to handle

75
Q

what considerations need to be made when a horse is coming off box rest?

A

gradual changes in management, gradual change in diet
behaviour when turned out - may require sedation/small field for gradual return
slow reintroduction to work

CVNT2 (47 decks)

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