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Large Animal Surgery > Equine Lameness Exam > Flashcards

Equine Lameness Exam Flashcards

1
Q

What is the proper order of events for equine lameness exams?

A
  • history
  • PE + hoof testing
  • motion exam
  • flexion tests
  • localize lameness
  • diagnostic imaging
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2
Q

What are important aspects of a history to obtain during lameness exams?

A
  • signalment
  • use of horse (good for prognosis/treatment)
  • duration of lameness
  • worsened or improved with time or different circumstances
  • gradual or acute onset
  • history of trauma
  • management changes
  • medications administered
  • past lameness history
  • which leg owner believes is affected
  • when last trimmed or shod by farrier
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3
Q

How is the hoof in the attached picture?

A
  • angled out
  • overgrown hoof over shoe

(pictured is a nicely balanced hoof)

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4
Q

How is the symmetry of this horse?

A

right side seems more depressed, possibly due to disuse

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5
Q

Synovial effusion:

A
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6
Q

What is this joint?

A

coffin

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7
Q

What is this joint?

A

carpus

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8
Q

What is this joint?

A

fetlock

  • L = dorsal pouch
  • R = palmar/plantar pouch
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9
Q

What is this joint?

A

tibiotarsal

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10
Q

What are these joints?

A

L = femoropatellar

R = medial femorotibial

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11
Q

What is important to palpate for in the limbs on a lameness exam?

A
  • edema
  • cellulitis
  • pulses
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12
Q

Edema/cellulitis:

A

entirety of limb affected = NOT joint effusion

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13
Q

What bony proliferations may be palpated on lameness exams?

A

osteoarthritis

  • firm bulges from joints
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14
Q

In what conditions should tendon and ligament be palpated? What may be felt?

A
  • standing - taught when weight bearing
  • non-weight bearing - more freely mobile

enlargement, thickening, pain, lack of mobility

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15
Q

How do digital pulses normally feel? Where are they found? What is a significant finding?

A

faint - behind sesamoids and down the pastern

increase is indicative of increased hoof temperature —> laminitis, abscess

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16
Q

What is indicative of pain on back palpation? What are the most common causes of primary and secondary pain?

A

twitch, hollow back, move away from pressure

  • PRIMARY = saddle fit, arthropathies (Kissing Spine)
  • SECONDARY = hock pain, hind limb lameness
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17
Q

When should hoof testers be used? What is a positive?

A
  • before performing nerve blocks
  • before or after seeing the horse in movement

pulls limb away, muscle contraction

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18
Q

What are 3 basic conditions of evaluating the horse in motion? Advanced?

A
  1. walking in a straight line
  2. trotting in a straight line
  3. trotting in a circle (both ways) - weight distribution to inner limb, hard surface (boney tissue), soft surface (soft tissue issue)

canter, under saddle

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19
Q

What is the normal walking gait for a horse? What should be evaluated?

A

4 beat - each foot hits the ground separately

  • stride length
  • tracking up - hind feet should step into the prints left by the front feet
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20
Q

What is the normal trotting gait for a horse?

A

symmetric 2 beat —> limbs move in diagonal pairs

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21
Q

What is the best gait for seeing lameness?

A

trotting

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22
Q

What are the 6 grades of AAEP lameness grading?

A
  • 0 = lameness not perceptible under any circumstances
  • 1 = lameness difficult to observe and is not consistently apparent, regardless of circumstances
  • 2 = lameness is difficult to observe at a walk or when trotting in a straight line, but is consistently apparent under certain circumstances (weight-carrying, circling, inclines, hard surfaces, etc)
  • 3 = lameness is consistently observable at a trot under all circumstances
  • 4 = lameness is obvious at a walk
  • 5 = lameness produces minimal weight bearing in motion and/or at rest OR complete inability to move
23
Q

What is a “sound” leg?

A

the not lame leg(s)

24
Q

What is a head bob?

A

movement of the horse’s head and neck when lame in the front limb

25
Q

What is a hip hike? Fetlock drop?

A

lame limb has increased motion in the pelvis as the horse tries to bear less weight on the lame hindlimb

sound of fetlock drops further with increased weight bearing to compensate for lame limb (sound limb carries more weight)

26
Q

How is head movement used to evaluate lameness in the forelimbs?

A
  • head raises as lame limb hits the ground (trying to pull up and put on less pressure)
  • head lowers as sound limb hits the ground (trying to off-set pressure)
27
Q

What 2 things should happen as the sound limb hits the ground?

A
  1. fetlock drop (taking on more weight)
  2. head nod - head moves DOWN when horse bears more weight, which sounds louder (DOWN ON SOUND)
28
Q

What 3 things should happen as the lame limb hits the ground?

A
  1. head bob - head moves UP when lame leg hits the ground (trying to take weight off)
  2. hip hike - increased pelvic movement with lame hind limbs
  3. asymmetrical movement - shorter side
29
Q

What is indicative of a Grade 4 lame right front limb?

A
  • noticeable at a walk
  • head down the LF hits the ground
  • increased weight bearing on LF
  • LF fetlock drop
30
Q

What is indicative of a Grade 2 lame left front limb?

A
  • noticeable at a trot in special conditions
  • head node - head goes DOWN when RF hits the ground
  • throws weight to the right
31
Q

What is indicative of a Grade 3 lame right hind limb?

A
  • noticeable at a trot in all conditions
  • right hip moves up and down more
  • LH fetlock drops when weight-bearing
32
Q

What is indicative of a Grade 3 lame left hind limb?

A
  • noticeable at a trot in all conditions
  • left hip moves up and down more than the right
  • RH fetlock drops when weight-bearing
  • shortened cranial phase of stride on LH
  • RH comes further forward compared to LH (LH is NOT tracking up)
33
Q

When are flexion tests especially helpful? How is it performed?

A

Grades 1, 2, or 3 lameness to further locate lameness

put stress on a joint to see if it worsens the lameness —> if it worsens, it is positive to flexion

(mild/moderate/severe, +/++/+++, 1/2/3)

34
Q

What is seen in these radiographs?

A

OA of distal hock joints

35
Q

What 4 points of the forelimb are manipulated for flexion tests?

A
  1. distal limb - coffin, pastern, fetlock*
  2. carpus - will also flex elbow
  3. upper limb - shoulder, elbow
  4. coffin joint hyperextension - stress on navicular apparatus
36
Q

What does hindlimb flexion challenge? What 3 points are manipulated?

A

reciprocal apparatus

  1. distal limb - coffin, pastern, fetlock (will also flex hock)
  2. upper limb - hock, stifle, hip, will also flex fetlock
  3. caudal extension - stifle
37
Q

How long is the distal limb flexed? What also needs to be done?

A

coffin/pastern/fetlock ~ 30 seconds (be consistent!)

when testing one joint, minimize stress on other joints

38
Q

How long are the carpus and tarsus typically flexed?

A

45 seconds

39
Q

What joint is being flexed?

A

fetlock/coffin

40
Q

What joint is being flexed?

A

full limb

41
Q

What joint is being flexed?

A

carpus

42
Q

What joint is being flexed?

A

hock, upper limb

43
Q

What joint is being tested?

A

caudal extension of stifle

44
Q

How can lameness be localized? When does this work best?

A

nerve blocks - local anesthetic injected SQ over nerve to desensitize distally

consistent lameness - compare level of lameness post-block to pre-block, looking for 70% improvement (Grade 1 is difficult - hard to determine improvement)

45
Q

How are nerve blocks began? Joint blocks?

A

start distal and work proximally

intra-articular local anesthetic to desensitize joint - order not as important as nerves

46
Q

What 3 things affect the accuracy in interpreting blocks?

A
  1. timing - wait 5 minutes to allow migration
  2. volume - want least amount possible
  3. location - need to be accurate!
47
Q

What are the main 3 options of local anesthetics used for nerve blocks?

A
  1. Mepivacaine (Carbocaine-V)** - less tissue irritation, fast acting, lasts 2-3 hours
  2. Lidocaine - stings, fastest acting, lasts 1.5-3 hours
  3. Bupivicaine - intermediate onset, lasts 3-6 hours
48
Q

Where is the palmar digital nerve block placed?

A

insert needle over neurovascular bundle proximal to the collateral cartilages to block medial and lateral palmar digital nerves (not usually done in hindlimb)

(1-2 mL Carbocaine per site)

49
Q

What 3 structures are blocked by palmar digital nerve blocks?

A
  1. caudal 1/3 or foot
  2. sole
  3. navicular apparatus
50
Q

Where is the abaxial sesamoid block placed?

A

insert needle SQ over the neurovascular bundle at the abaxial surface of the sesamoid bones to block the medial and lateral palmar digital nerves

(1-3 mL Carbocaine per site)

51
Q

What 2 structures are blocked by abaxial sesamoid blocks?

A
  1. all structures below fetlock
  2. fetlock
52
Q

What are the 2 surfaces where a low 4-point block is placed? What is a common variation?

A
  1. under the button of the splint bone to block medial and lateral palmar metacarpal/metatarsal nerves
  2. over neurovascular bundle between DDF and suspensory ligament to block medial and lateral palmar nerves

6-point - inject across dorsum of cannon

53
Q

What structures are blocked by a low 4-point block? How does this block compare on forelimbs and hindlimbs?

A

fetlock joint and distal

inconsistent loss of skin sensation dorsally on hindlimb —> recommend 6-point to block dorsal canon

54
Q

What is the Equinosis?

A

lameness locator that uses inertial sensors to capture movements of head, pelvis, right front leg, and rider in real time

Large Animal Surgery (32 decks)

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