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MSK2 > Equine MSK disease 4 > Flashcards

Equine MSK disease 4 Flashcards

1
Q

How may sepsis or synovitis of the tarsal joint commonly occur in horses?

A

Kick to plantar/medial aspect of the hock

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2
Q

List the synovial structures in the hock that may be affected by trauma in the horse, and where relevant, state what they contain

A
  • Calcaneal bursa: superficial part of SDFT
  • Tarsal sheath: surrounds DDFT
  • Tarsocrural joint
  • Proximal intertarsal joint
  • Distal intertarsal joint
  • Tarsometatarsal joint
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3
Q

List the causes of stifle lameness in the horse

A
  • DJD
  • OCD
  • Bone cysts
  • Fractures
  • Joint effusion
  • Septic arthritis
  • Meniscal injuries
  • Cruciate injuries
  • Collateral ligament injuries
  • Patellar ligament injuries
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4
Q

Outline the clinical signs of stifle lameness in the horse

A
  • Proximal limb lameness exacerbated by soft ground
  • Abduction when avoiding flexion of joint
  • Reduced ROM
  • Pain on flexion
  • Joint effusion in one or more of the 3 compartments
  • Pain on palpation (should be able to palpate all 3 patellar ligaments, and medial and lateral menisci)
  • Crepitus if fractures
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5
Q

What are the 3 joint compartments of the stifle in the horse? Which are usually implicated in joint effusion?

A
  • Femoropatella (most common)
  • Medial femorotibial (meniscal disease)
  • Lateral femorotibial
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6
Q

What would indicate a rupture of the peroneus tertius in the horse?

A

Ability to flex stifle and extend hock - should usually flex together

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7
Q

Describe the joint communications in the stifle horses, and explain the importance of this

A
  • Femoropatellar joint usually communicates with medial femorotibial joint
  • Communicates with the lateral FT joint in 25% of horses
  • The FT joints do not communicate with each other
  • Need to block each one individual if performing intra-articular anaesthesia
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8
Q

Explain how pain is localised in the equine stifle

A
  • Intra-articular anaesthesia, block each joint individually
  • No perineural anaesthesia!
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9
Q

What is the most common soft tissue injury of the equine stifle?

A

Medial meniscal injury

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10
Q

Outline the diagnosis of medial meniscus injury the horse

A
  • Medial femorotibial (+/- femoropatella) effusion
  • Radiography: presence of changes = poor prognosis
  • Ultrasonography: evaluation of soft tissues e.g. medial and lateral meniscus, collateral ligaments, patella ligaments, components of cruciate ligament
  • Arthroscopy (soft tissues and cartilage)
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11
Q

Describe the ultrasonographic features that may be present in a medial meniscal injury in the horse

A
  • May have signs of DJD
  • Bony remodelling
  • Meniscus bulging out of joint
  • Irregular shape of meniscus
  • Differences in echogenicity
  • May see tear
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12
Q

Explain the usefulness of radiography for establishing a prognosis for stifle injuries in the horse

A
  • Many are soft tissue injuries, but can be used to indicate degree and treatment required
  • Signs of DJD indicate for return to athletic function
  • Identification of bony lesions e.g. OCD, subchondral bone cysts, DJD, fractures
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13
Q

Describe the normal ultrasonographic appearance of the equine meniscus

A
  • Triangular and flush with the bone
  • Collateral ligaments run over the top
  • Should be homogenous
  • May have blood vessels present that cause shadowing
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14
Q

Discuss the use of arthroscopy in the diagnosis of meniscal injury in the horse

A
  • Can combine diagnosis and treatment
  • But costly and requires GA
  • Cannot facilitate complete evaluation of the menisci or cruciate ligaments
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15
Q

Outline the treatment options for meniscal injuries in the horse

A
  • Rest and NSAIDs

- Arthroscopic debridement

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16
Q

Discuss the prognosis for meniscal injuries in the horse

A
  • Return to function 50-60%
  • Poorer prognosis if radiographic changes present (arthroscopy unlikely to be useful)
  • Degree of lameness reflects prognosis
  • Older horses = poorer prognosis
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17
Q

Briefly outline cruciate injuries in the horse (which cruciate, associated pathology, diagnosis, treatment, prognosis)

A
  • Cranial cruciate
  • AP: menisci, collateral ligaments, articular cartilage
  • Dx: radigraphy, arthroscopy
  • Tx: arthroscopic
  • Px: depends on severity and presence of radiographic changes
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18
Q

Which collateral ligament is most commonly injured in the horse?

A

Medial collateral

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19
Q

In which horses are patellar ligament injuries most likely to occur, and what often occurs concurrently?

A
  • Jumping horses

- Commonly see patellar fractures/pathology

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20
Q

Discuss the aetiology of subchondral bone cysts in the horse

A
  • Unclear

- May be developmental or traumatic

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21
Q

Where are bone cysts commonly seen in the equine hindlimb and how are these diagnosed?

A
  • Medial femoral condyle
  • Latero-medial radiograph, palmar-dorsal radiograph (caudo-15-proximal to cranio-distal oblique projection may be better)
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22
Q

Outline the treatment of subchondral bone cysts in the stifle of the horse

A
  • Debridement of cyst

- Arhtroscopic injection of steroid into cyst cavity

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23
Q

Discuss the prognosis for subchondral bone cysts in the equine stifle

A
  • Approx. 60% come sound
  • Older horses have worse prognosis
  • Radiographic changes of DJD indicate worse prognosis
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24
Q

What structures in the equine forelimb are commonly affected by kick wounds?

A

Bony prominences e.g. splint bones, olecranon

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25
Q

Which structures in the equine forelimb are commonly affected by trauma/concussion

A
  • Pastern

- Metacarpus

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26
Q

Which structures in the equine forelimb are commonly affected by stress fractures?

A
  • Metacarpus
  • Radius
  • Humerus
  • Scapula
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27
Q

Discuss the management of open fractures of the splint bones in horses

A
  • Rest, bandaging, anti-inflammatories
  • Antibiotics
  • Surgical removal possible, can be done standing
  • If proximal, risk of involvement of joint, need more aggressive approach
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28
Q

What is a serious complication of kick wounds to the area of splint bones that may not be noted on radiography?

A
  • Non-displaced fractures of the cannon bone

- Displace catastrophically during recovery from anaesthesia

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29
Q

Describe the appearance of ulnar/olecranon fractures in the horse

A
  • Dropped elbow

- Similar to radial paralysis

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30
Q

Discuss the management and prognosis of ulnar/olecranon fractures in the horse

A
  • Consider referral for surgical repair

- Usually good prognosis with repair

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31
Q

Describe the clinical signs of stress fractures in the horse

A
  • lameness (single/multiple limbs possible)
  • Variable presentation and duration
  • Absence of clinical signs in affected limb possible
  • Localised inflammation
  • regional pain response to palpation/manipulation
  • Specific tests e.g. tibial torsion test
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32
Q

Where are stress fractures commonly found in the equine hindlimb?

A
  • Sacrum
  • Pelvis
  • Tibia
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33
Q

Identify the methods that can be used in the diagnosis of stress fractures in the horse

A
  • Clinical signs and history (intense exercise, lameness associated with work)
  • Diagnostic anaesthesia
  • Scintigraphy
  • Radiography
  • Ultrasonography
  • MRI, CT
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34
Q

Outline the management of equine stress fractures

A
  • Modify exercise patterns
  • Change intensity, level and/or type of exercise
  • Ensure balanced nutrition (calcium 23g/day, phosphorous 23g/day)
  • Extracorporeal shock wave therapy and pulsed electromagnetic fields anecdotal evidence
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35
Q

In which horses, and in which joints are articular fractures most common?

A
  • Racehorses
  • Fetlock
  • Sesamoid bones
  • Carpus
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36
Q

Outline the treatment of articular fractures in horses

A
  • Remove small fragments (arthroscopically, or arthrotomy)
  • Stabilise larger fragments using screws
  • Treat joint inflammation
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37
Q

Which horses are predisposed to fracture of the second phalanx and in which limb does this most commonly occur?

A

Quarter horses, in the HLs

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38
Q

What types of fracture most commonly occur in the second phalanx?

A
  • Palmar/plantar eminence fractures of proximal P2

- Or comminuted fractures

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39
Q

Outline the treatment of fracture of the second phalanx in horses, and discuss the prognosis

A
  • Internal fixation using plates and screws and/or transfixation pin cast
  • Lameness usually present after, depends on degree of OA that develops in dip and PIP
  • Prognosis depends on comfort of horse after fracture stabilisation and contralateral laminitis development
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40
Q

In which horses is fracture of the first phalanx more common

A

Any horse used for performance

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41
Q

Outline the clinical signs of fracture of P1 in the horse

A
  • Usually traumatic, hyperextension of fetlock
  • Acute lameness, effusion of fetlock
  • Sensitive to firm flexion of fetlock
  • Lameness at speed
42
Q

Outline your diagnostic approach for a suspected P1 fracture in the horse

A
  • Radiography

- May need intra-articular diagnostic analgesia to implicate as cause of lameness

43
Q

Outline the radiographic appearance of P1 fracture in the horse

A
  • Osteochondral fragment fracture along dorsal margin of proximal joint surface (chip fracture)
  • Sagittal fracture (complete/incomplete)
  • Or Comminute fracture
44
Q

In which horses does chip fracture of P1 more commonly occur?

A

Racing breeds, horses exercising at speed

45
Q

What is meant by type I and type II P1 fractures in the horse?

A
  • Type I: axial fractures, generally articular

- Type II: abaxial, minimal articular cartilage present

46
Q

Outline the treatment of chip P1 fractures in the horse

A

Remove arthroscopically, excellent prognosis if no other joint abnormalities

47
Q

Outline the treatment of routine, non-displaced sagittal P1 fractures in the horse

A

internal fixation with lag screws placed via stab incisions

48
Q

Outline the treatment for complex fractures of P1 in the horse

A

Open reduction with placement of lag screws

49
Q

Outline the treatment of comminuted P1 fractures in the horse

A
  • Immobilise with plaster/fibreglass cast for up to 12 weeks

- With or without use of transfixation pins through third metacarpal/tarsal bone

50
Q

Describe the common fractures of the metacarpus in the horse

A
  • Most common is lateral condyle
  • Lateral condylar: mid to midaxial, traverse toward lateral cortex, rarely spiral
  • Medial condylar fractures: extend towards axial aspect of cannon bone
  • Vertical fracture in sagittal plane of distal metacarpal bone in young racehorses
51
Q

What is the most common major long bone fracture in horses and how does it commonly occur?

A
  • Fracture of diaphyseal cannon bone (metacarpal bone)

- Usually trauma while pastured with other horses

52
Q

Give and explain the preferred treatment for a diaphyseal metacarpal bone fracture in the horse

A
  • Open reduction and internal fixation

- Little soft tissue coverage, cast/coaptation would not provide enough support

53
Q

What radiographic views are required for the diagnosis of metacarpal fractures in the horse?

A
  • Full series
  • Fetlock
  • Flexed dorsopalmar views
54
Q

Outline the treatment for condylar fractures of the metacarpus

A
  • Lateral: can be treated conservatively with splinting, treatment of choice is compression with lag screws (minimises OA)
  • Medial: lag screw fixation distally, plate placed up remaining metacarpus
55
Q

Where sesamoid fractures of Standardbreds and TBs most commonly occur and how do these occur?

A
  • Most are apical

- Caused by overextension and often associated with suspensory ligament damage

56
Q

How do lateral proximal sesamoid fractures in the HL of Standardbreds commonly occur?

A

Torque forces induced by shoeing with trailer-type shoe

57
Q

List the types of sesamoid fractures that may occur in the horse

A
  • Apical
  • Mid-body
  • Basilar
  • Abaxial
  • Axial
  • Comminuted
    (NB most common in the lateral proximal sesamoid)
58
Q

Outline the clinical signs of sesamoid fractures in the horse

A
  • Heat
  • Pain
  • Acute lameness, exacerbated by flexion of fetlock
  • Haemarthrosis
  • Synovial effusion of metacarpal/tarsophalangeal joint
59
Q

Outline the treatment of different types of sesamoid fractures

A
  • Apical sesamoid fractures: remove fragments arthroscopically
  • Mid body fractures: reduction using lag screws
  • Surgical arthrodesis of fetlock if have complete disruption of suspensory appratus, including both sesamoids bones in order to salvage for breeding
60
Q

In which horses do osteochondral fractures of the carpal bones occur and why?

A
  • Race horses

- Trauma associated with fast exercise

61
Q

What are the main clinical signs of carpal bone fracture in the horse?

A
  • Synovitis

- Capsulitis

62
Q

Where are carpal chip fractures in the middle carpal joint usually located?

A
  • Dorsal aspect

- Middle carpal: distal radial carpal bone, proximal third carpal bone, distal intermediate carpal bone

63
Q

Where are carpal chip fractures in the radiocarpal joint usually located?

A
  • Proximal intermediate carpal bone
  • Distal lateral radius,
  • Proximal radial carpal bone
  • Distal medial radius
64
Q

Outline slab fractures of the third carpal bone in the horse

A
  • One articular surface to another
  • Can be in frontal or sagittal planes
  • Most common: frontal slab fracture of radial facet of third carpal bone
  • Less common: fractures of intermediate facet and both facets of the third carpal bone
65
Q

Outline accessory carpal bone fractures in the horse (incl. treatment and prognosis)

A
  • Less common
  • Acute lameness, severe, may see synovial effusion in carpal sheath and radiocarpal joint
  • Radiographs confirm diagnosis
  • Treat conservatively
  • If articular and fragmented, remove fragments
  • Fibrous unions may enable horse to return to normal activity
66
Q

Outline the treatment and prognosis of carpal chip fractures in the horse

A
  • Arthroscopic surgery to remove fragments

- Prognosis depends on degree of articular cartilage damage

67
Q

Outline the treatment of carpal slab fractures in the horse

A
  • Lag screw for fractures >10mm

- Removal of fragments if thin/not amenable to lag screw fixation

68
Q

List the sites of fracture of the shoulder in the horse

A
  • Supraglenoid tuberosity of scapula
  • Mid to distal scapula
  • Proximal humeral metaphysis
69
Q

Outline the clinical signs of shoulder fracture in the horse

A
  • Dropped shoulder in supraglenoid fractures
  • Mid to distal scapular fractures often trauma related
  • Sudden onset lameness with stress fractures, often with exercise
70
Q

Outline the diagnostic tools that can be used for shoulder fracture in the horse

A
  • Radiography (rarely helpful due to region, good for periosteal and endosteal new bone at site of proximal humeral fractures)
  • Ultrasonography
  • Scintigraphy
71
Q

Outline the treatment and prognosis for supraglenoid fracture in the horse

A
  • Large: repair surgically
  • Remove smaller fragments
  • Resect biceps tendon of origin
  • Prognosis guarded, depends on size, displacement, articular involvement, degree of biceps disruption, intended use -
72
Q

Outline the treatment of mid to distal scapular fractures in the horse

A

Simple, non/minimally displaced fractures usually heal with rest alone

73
Q

Outline the treatment of deltoid tuberosity fractures in the horse

A
  • Usually recover with rest alone

- Surgical debridement of infected bone in rare cases

74
Q

Outline the treatment of proximal humeral fractures in the horse

A
  • Confinement counterproductive

- Light exercise (walk only) once lameness subsided

75
Q

What are the most common sites for synovial sepsis in the equine forelimb and how is this diagnosed?

A
  • Distal limb: flexor tendon sheath, pastern joint, fetlock joint
  • Diagnosed with synoviocentesis
76
Q

How do luxations of the fetlock (FL or HL) occur in the horse?

A
  • Rupture of medial or lateral collateral ligaments or avulsion fracture
  • Usually caused by trapping distal limb in hole, trailer/transport injury, high speed exercise
77
Q

Outline the clinical signs of fetlock luxation in the horse

A
  • Sudden onset non-weight bearing lameness
  • Angular limb deformity of distal limb
  • History of injury/trauma
  • Excessive movement in fetlock joint
  • Variable soft tissue trauma, often little swelling initially
78
Q

Outline your approach to the diagnosis of fetlock luxation in the horse

A
  • Confirmed on radiography
  • Also identified any complicating bone injury
  • Ultrasonography to assess collateral ligaments
79
Q

Outline your treatment approach to simple luxation of the fetlock in a horse and the prognosis

A

Reduction and cast immobilisation to achieve pasture soundness

80
Q

What are the possible causes of proximal interphalangeal joint luxation in the horse?

A
  • Traumatic tearing of collateral ligament
  • Fracture of P1 or 2
  • Loss of suspensory or palmar support structures
81
Q

What may cause dorsal subluxation of the DIP in the horse?

A
  • Loss of fetlock support
  • Contraction of straight sesamoidean ligament
  • Flexural deformity of DIP
  • Suspensory ligament desmotomy with DDF tenotomy
82
Q

What may cause palmar subluxation of the DIP in the horse?

A

Tearing of palmar support structures e.g. jump from height, landing on FLs

83
Q

Outline the clinical signs of proximal interphalangeal joint luxation in the horse

A
  • Acute, non-weight bearing lameness
  • Acute swelling over site of luxation, local heat
  • Pain on manipulation
  • Firm swelling in chronic cases
  • Malalignment of metacarpus/metatarsus , proximal phalanx and middle phalanx
  • Dorsal sublux: dorsal pastern swelling, dropped fetlock
  • Palmar sublux: concave dorsal pastern, sinking pastern at wall, heels contact ground
84
Q

Outline the radiographic positioning and appearance of proximal interphalangeal joint luxation in the horse

A
  • Standard and stressed views
  • See uneven joint space
  • May see middle phalanx fracture, minor avulsion fractures
  • Displacement of proximal phalanx
85
Q

Outline the treatment of proximal interphalangeal joint luxation in the horse

A
  • Depends on cause and time since injury
  • Treat concurrent fractures specifically
  • Surgical arthrodesis usually best option
  • NSAIDs
86
Q

Outline the prognosis of proximal interphalangeal joint luxation in the horse

A
  • Depends on cause and time of treatment
  • Generally good for salvage purposes
  • Arthrodesis guarded prognosis for performance processes
87
Q

Outline the signs of scapulohumeral joint luxation in the horse

A
  • Non-weight bearing
  • Shoulder atrophy if chronic
  • Humeral head palpated lateral, or cranial to the scapula
88
Q

Outline the diagnosis of scapulohumeral joint luxation

A
  • Best demonstrated on standing caudolateral to craniomedial oblique views
  • Look for fractures of humeral head to scapula, esp. rim of glenoid
89
Q

Discuss the treatment of scapulohumeral joint luxation

A
  • Closed reduction followed by scapulohumeral joint arthroscopy to evaluate articular surfaces and remove cartilage debris
  • Must be within 24 hours, and before open approach performed
90
Q

Discuss the prognosis of scapulohumeral joint luxation

A
  • Eventually OA and severe lameness, resulting in euthanasia

- Arthrodesis an option, but rare

91
Q

Describe the pathophysiology and appearance of suprascapular nerve damage in the horse

A
  • Damaged by blunt trauma to point of shoulder
  • Innervates supraspinatus and infraspinatus muscles
  • Causes muscle atrophy and lateral luxation of shoulder joint
92
Q

Describe the pathophysiology and appearance of radial nerve neuropathy in the horse

A
  • Post-anaesthetic neuropathy, or trauma
  • Animal unable to protract limb
  • Dropped elbow
93
Q

What condition may present similarly to radial nerve neuropathy in the horse?

A

Ulna fractures can present similarly due to disruption of triceps brachii insertion

94
Q

List the conditions of the equine hindlimb that are critical

A
  • Joint infection
  • Fracture
  • Tendon ruptures
  • Luxations
95
Q

List the nerve and joint blocks using in diagnosis of hindlimb lameness

A
  • Palmar digital
  • Abaxial sesamoid
  • Femoropatella and both femorotibial joints
  • Tibial and peroneal nerve blocks
  • PIT, DIT, TMT
96
Q

What is innervated by the tibial nerve in the horse?

A
  • Extensors of hock
  • Flexors of digit
  • Skin on caudomedial aspect of limb and plantar and dorsal aspect of foot
97
Q

What is innervated by the peroneal nerve in the horse?

A
  • Flexors of hock and extensors of digit

- Skin on craniolateral aspect of limb

98
Q

What should we aim for when performing radiography in the horse?

A
  • Minimal exposure/risk to staff
  • Diagnostic films of region of interest
  • Minimal repetition of views (minimum number of exposures possible)
99
Q

Outline the safety precautions that should be taken when performing radiography of a horse’s limb

A
  • Have maximum distance between other animals/people and the x-rays
  • Minimum number of staff (>18, not pregnant) (3 should be enough)
  • Use markers to centre beam and reduce no. of exposures
  • Ensure good restraint of horse using stocks, ties, sedation, head rests
  • Careful measuring of film focal distance
100
Q

What skeletal conditions could cause cystic lesions within bones of the horse’s limb?

A
  • Osteochondrosis

- Subchondral bone cyst

MSK2 (29 decks)

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