Equine lameness and orthopaedics

Question 1

history questions

Answer 1

• signalment
• use
• duration of ownership
• recent management (work, feed, shoeing, housing
• previous medical problems

Question 2

specific history

Answer 2

• limb affected
• timing and nature of onset of signs
• associated events or incidents
• details of any swelling, heat, pain
• progression of signs
• treatments employed

Question 3

aims of a lameness workup

Answer 3

• identify limb affected
• score severity
• identify source/cause
• implement training plan

Question 4

steps of a lameness work up

Answer 4

• physical exam
• gait evaluation
• flexion tests

Question 5

gait evaluation

Answer 5

• different surfaces (soft/hard)
• start with walk
• trot in line
• lunge

Question 6

forelimb lameness

Answer 6

head goes up as lame limb hits ground

Question 7

hindlimb lameness

Answer 7

hindquarters raised by sound limb and sink during stance phase of lame limb

Question 8

provocative (flexion) test

Answer 8

• limb flexed for 1 min
• horse trotted away as soon as limb released
• only flex the joint being assessed

Question 9

limitation of flexion test

Answer 9

• lack of specificity to site
• inconsistency
• false positives and negatives

Question 10

lunging

Answer 10

usually exacerbates lameness on inside leg

Question 11

nerve block

Answer 11

• perineural, intrasynovial or local infiltration of local anaesthetic

Question 12

nerve block steps

Answer 12

• start distally and work up
• clean area with chlorhex/spirit
• leave for 10 mins then trot up

Question 13

sites of nerve block injection

Answer 13

• palmar/plantar digital (medial and lateral)
• abaxial sesamoid (site of digital pulse)
• low 4 point (medial and lateral)

Question 14

joint blocks

Answer 14

• intrasynovial admin
• sterility a must
• evaluate at 10mins and then later

Question 15

diagnostic imaging of lameness

Answer 15

• performed once a narrow area source of lameness identified
• allows interpretation of significance of findings

Question 16

ultrasound for lameness

Answer 16

• distinguishes tendon/ligament injury from peritendinous swelling

Question 17

signs signalling injury in ultrasound for lameness

Answer 17

• increase in tendon/ligament size
• change in internal architecture
• indistinct margination

Question 18

diagnostic arthroscopy

Answer 18

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

Question 19

limitations of diagnostic arthroscopy

Answer 19

• need GA
• inability to examine most joints in their entirety

Question 20

CT and MRI for lameness

Answer 20

• allows bone and soft tissue visualisation

Question 21

nuclear scintigraphy (bone scan)

Answer 21

• injected IV
• taken up into bone mineral lattice
• emits gamma radiation

Question 22

lesions detected by nuclear scintigraphy

Answer 22

• stress fractures
• arthropathies
• enthesiopathies

Question 23

nuclear scintigraphy steps

Answer 23

• lunge to increase uptake if poss
• IV catheter placed
• horse radioactive after (isolation)
• urine collected during image acquisition

Question 24

synovial sepsis

Answer 24

• bacterial contamination of synovial structure
• wounds in adults
• causes septic arthritis and chronic lameness if not treated

Question 25

synovial sepsis investigation

Answer 25

• synoviocentesis and analysis
• may inject sterile saline into joint to check for egress
• contrast radiography

Question 26

arthrocentesis

Answer 26

• sterility a must
• sedation

Question 27

roles of nurse in arthrocentesis

Answer 27

• prep site
• non-sterile assistant
• equipment and spares ready

Question 28

arthrocentesis samples

Answer 28

analysis:
- cytology
- protein conc
- lactate

Question 29

laminitis definition

Answer 29

• inflammation of laminae/lamellae in hoof
• dermal/epidermal separation
• can lead to rotation or sinking of p3

Question 30

phases of laminitis

Answer 30

1. developmental= before onset of clin signs
2. acute= onset of clin signs
   - can become chronic or subacute
3. subacute= 2-3 months repair
4. chronic= structural failure

Question 31

clinical signs of laminitis

Answer 31

• stilted, pottery gait
• bounding digital pulses
• leaning back on heels
• recumbency
• worse on hard ground (increased pressure)
• struggle to turn
• reluctance to pick up feet

Question 32

causes of laminitis

Answer 32

• endocrinopathies (PPID= cushings, EMS= eq metabolic syndrome)
• excessive carbs
• excessive weightbearing
• endotoxaemia/SIRS
• corticosteroids?
• potentially multiple mechanisms

Question 33

endocrinopathic laminitis

Answer 33

• most cases
• majority of pasture associated cases
• pituitary pars intermedia dysfunction
• equine metabolic syndrome

Question 34

risk factors of laminitis

Answer 34

• history of laminitis
• obesity
• endocrinopathies (insulin resistance, PPID, EMS)
• season (spring + frost)

Question 35

management of developmental phase

Answer 35

• Cold therapy
• NSAIDs to reduce swelling
• frog supports, deep shavings bed
• treat underlying disease

Question 36

management of acute phase

Answer 36

• strict box rest, deep shavings
• frog supports
• NSAIDs
• treat underlying cause

Question 37

management of subacute laminitis

Answer 37

• gradually withdraw treatment
• strict box rest
  subacute and chronic:
• radiograph and farriery
  
  • shorten toe over time, remedial shoeing

Question 38

radiography for laminitis

Answer 38

• measure rotations and sinking
• metal marker on dorsal hoof wall
  
  • coronary band -> dorsal hoof wall

Question 39

effects of box rest

Answer 39

• limited exercise
• diet change
• behaviour (boredom)
• reduction in eating time (gastric ulcers)

Question 40

nursing considerations for box rest

Answer 40

• monitor faecal output, colic signs. appetite, stress
• company