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Orthopedic Medicine > Equine Orthopedic Diseases > Flashcards

Equine Orthopedic Diseases Flashcards

1
Q

What are the major components of cartilage

A

Proteoglycans
Water (70-80%)

Dry Weight
50% type 2 collagen
35% proteoglycans

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2
Q

50% of the dry weight of cartilage is

A

type 2 collagen

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3
Q

35% of the dry weight of cartilage is

A

proteoglycans

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4
Q

What are we treating with equine osteoarthritis

A

1) Mechanical stress
2) Inflammation
3) Decreased SF viscosity
4) Cartilage breakdown

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5
Q

How does synovial fluid viscosity change with osteoarthritis

A

it becomes more fluid (decreased viscosity)

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6
Q

What is the pathogenesis of equine osteoarthritis

A

1) Synoviocytes are subjected to trauma and inflammation
2) Release IL-1, TNF-a, Metalloporteinases, Prostaglandins
3) Act on cartilage, more inflammatory mediators
4) Chondrocytes produce more mediators like PGE2 and Metalloproteinases leading to matrix degradation

Self-sustaining process

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7
Q

What inflammatory mediators are produced by synoviocytes during equine osteoarthritis

A

IL-1
TNF-a
Metalloproteinases
Prostaglandins

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8
Q

What inflammatory mediators are produced by chondrocytes during equine osteoarthritis

A

PGE2
Metalloproteinases: Stromelysin and Collagenase

-Leads to matrix degradation

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9
Q

What are the stages of equine joint disease

A

1) Synovitis: Synovial inflammation + deteriorating joint fluid
2) Degenerative Joint Disease: cartilage changes + joint capsule fibrosis
3) Osteoarthritis: bony changes

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10
Q

With equine joint disease, where is the stage of no return

A

Once synovitis begins to develop into degenerative joint disease (cartilage changes and joint capsule fibrosis)

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11
Q

Inflammation of synovial and deteriorating joint fluid (more watery)
early stage of joint disease

A

Synovitis

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12
Q

cartilage changes and joint capsule fibrosis,
past the point of no return

A

Degenerative joint disease

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13
Q

bony changes seen after degenerative joint disease

A

osteoarthritis

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14
Q

How do you diagnose equine osteoarthritis

A

1) Lameness exam first
2) Radiographs
3) Nuclear scintigraphy- turn over of bone (remodeling areas are darker)
4) Ultrasound
5) MRI- hoof and cartilage (only distal to carpus/tarsus)
6) Exploratory arthroscopy- see cartilage lesions well that radiographs might not pick up

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15
Q

How do you tell what areas are undergoing active remodeling in nuclear scintigraphy

A

darker areas

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16
Q

In horses, you can only use MRI if the lesion is

A

distal to the carpus/tarsus

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17
Q

You have a 5yo QH gelding presenting for a left forelimb lameness.
Positive to distal limb flexion, all other flexions negative
Lameness improved 80% with a basisesamoid block
What imaging modality would you perform first?

A

Radiographs to look for bony lesions

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18
Q

What are goals of equine OA therapy

A

1) Decrease inflammation- soft tissues and cartilage
2) Alleviate pan
3) Lubricate joint
4) Restore normal environment
5) Slow down disease progression
6) Remove inciting cause

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19
Q

What should you consider when chooding OA therapeutic choices

A

1) Is it joint involved
2) Stage of OA
3) Current and intended use
4) Age
5) Regulations
6) Cost
7) Response to therapy

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20
Q

What do chondroprotective agents do

A

Support joint structure and function

1) Normalize synthesis of matrix components

2) Decrease matrix degradation

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21
Q

A polysulfated glycoaminoglycan used IM to systemically treat OA in horses

A

Adequan

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22
Q

What are the different systemic therapies for OA in horses

A

1) NSAIDs
2) Polysulfated Glycosaminoglycan (Adequan)
3) Oral, slow acting agents like Cosequin and Glycoflex

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23
Q

What is the mechanism of action of NSAIDS

A

inhibits COX’s conversion of arachidonic acid to prostaglandin

COX-1: inflammation
COX-2: Homeostatic functions- GI tract, renal tract, platelet function, macrophage differentation

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24
Q

What COX is responsible for inflammation

A

COX-2 induced

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25
Q

What COX is responsible for Homeostatic functions- GI tract, renal tract, platelet function, macrophage differentation

A

COX-1 constitutive

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26
Q

What equine NSAIDs inhibit both COX-1 and COX-2

A

1) banamine (flunixin meglumine)
2) Bute (Phenylbutazone)

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27
Q

What equine NSAID inhibit primarily COX-2

A

Equioxx (Firocoxib)

COX-1 sparing NSAID

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28
Q

What is the COX-1 sparing NSAID used in horses

A

Equioxx (Firocoxib)

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29
Q

What NSAID is safest for use in horses

A

Equioxx (Firocoxib)

Safer but more expensive
-efficacy equivalent to phenylbutazone

Reduced risk of gastric ulceration

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30
Q

What NSAID in horses has a reduced risk of gastric ulceration

A

Equioxx (Firocoxib)

still has some risk, does inhibit some of COX-1 but it primarily on COX-2

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31
Q

What does Adequan do

A

it is composed of chondroitin sulfate- 1) stimulates the production of hyaluronic acid from synoviocytes
2) Increases synthesis of proteoglycans and collegen by chondrocytes
3) Inhibit metalloproteases, cathespins, and other degradative enzymes

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32
Q

What are the three effects of polysulfated glycosaminoglycan (Adequan)

A

1) stimulates the production of hyaluronic acid from synoviocytes
2) Increases synthesis of proteoglycans and collegen by chondrocytes
3) Inhibit metalloproteases, cathespins, and other degradative enzymes

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33
Q

What are the different intra-articular therapies you can use for OA in horses

A

1) Corticosteroids: Anti-inflammatory and chondroprotective
2) Hyaluronan: chondroprotective
3) Biological therapies

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34
Q

What is the mechanism of action of corticosteroids in equine OA tx

A

inhibits the phospholipase A2 conversion of phospholipids to arachidonic acid
this blocks both the cyclooxygenase pathway and the lipoxygenase pathway

*Works a step earlier than NSAIDs

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35
Q

What are the effects of giving corticosteroids for equine OA ?

A

1) Potent inhibitors of IL-1 and TNF-a (also inhibit IL-1 synthesis by synovial lining cells)
2) Reduce matrix MMP activity
3) Inhibit synthesis of MMP activators (plasminogen activator or plasmin)
4) Decrease WBC migration, fibrin deposition
5) Stabilize enzymes (Stromelysin)

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36
Q

What are the detrimental effects of corticosteroids on cartilage

A

1) GAG depletion
2) Suppressed collagen and hyaluronic acid synthesis
3) Laminitis
4) Steroid arthropathy

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37
Q

T/F: When doing joint injections in horses, the type of corticosteroids does not matter

A

False- it really matters

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38
Q

What are the three primary corticosteroids used for equine joint injections

A

1) Bethamethasone- potent, medium duration, 20-40 mg/joint, 100mg total

2) Triamcinolone acetonide (Vetalog) medium length of intra-articular half-life (1-5days), 6-9mg/joint (18mg total)

3) Methylprednisolone acetate (Depomedrol): long acting (intra-articular half life is one month), 40-60 mg/joint, 120 mg total, Synovial flare
NO healthy joints or high motion joints

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39
Q

Triamcinolone acetonide (Vetalog)

A

medium length of intra-articular half-life (1-5days), 6-9mg/joint (18mg total)

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40
Q

You should never put Methylprednisolone acetate (Depomedrol) in what joints *

A

1) Healthy joints
2) High motion joints
3) Never as a first line treatmnet

Severely detrimental affect
typically only SI

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41
Q

Methylprednisolone acetate (Depomedrol)

A

long acting (intra-articular half life is one month), 40-60 mg/joint, 120 mg total, Synovial flare
NO healthy joints or high motion joints

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42
Q

Betamethasone

A

potent, medium duration, 20-40 mg/joint, 100mg total

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43
Q

What corticosteroid formulation has the longest halflife when used in equine joint injections

A

Methylprednisolone acetate (Depomedrol)

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44
Q

A 15yo QH gelding has a right hindlimb lameness with marked tarsocrural joint effusion
Hx of repeated Intra-articular depomedrol injections
Has previously had radiographs and ultrasound of the RH, What do you do next

A

Diagnostic Arthroscopy

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45
Q

What are complications of corticosteroid IA injections

A

1) Joint “Flare” Acute inflammation to medication formulation
-Heat, pain, swelling, lameness
-8-24 hours after injections

2) Joint infection- signs not obvious immediately following injections
-Infections following steroid injections can be devastating

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46
Q

Do joint infections or joint “flare” inflamamtion occur sooner

A

Joint “Flare” is acute inflamamtion

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47
Q

Why are maintaining low doses of corticosteroids important

A

chondroprotective properties without marked effects on chondrocytes

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48
Q

You are seeing a 10yo warmblood sport horse for lameness
He is a grade 3/5 left hindlimb lame and you localize the lameness to the distal hock joint
The owner is keen to medicate with corticosteroids.
What do you recommend

A

inject each joint (4 in total) with 4mg triamcinolone

only comes out to 16mg total and you should be under 18mg total

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49
Q

What is the max dose of Triamcinolone Acetonide (Vetalog)

A

6-9mg/joint
18 mg total (but 20-30 mg ok)

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50
Q

What is the max dose of Depomedrol (Methylpredinisolone acetate)

A

120 total
40-60 mg/joint

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51
Q

What is the max dose of Betamethasone

A

20-40 mg/joint
100 mg total

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52
Q

non-sulfated GAG that is synthesized by Type B synoviocytes and chondrocytes
important component of the articular cartilage matrix
-backbone of the proteoglycan aggregate in the ECM
-Synovial fluid viscosity

A

Hyaluronan

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53
Q

Hyaluronan is produced by

A

Type B synoviocytes and chondrocytes

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54
Q

Sodium hyaluronan is best for what in horses

A

treatment of early OA
-acute synovitis

but corticosteroids still much better and work synergistically

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55
Q

Sodium hyaluronan has enhanced effects when combined with

A

low dose steroids

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56
Q

What is the mechanism of action of sodium hyaluronan

A

unclear
1) boundary lubrication
2) Steric exclusion of particles
3) Anti-inflammatory effects

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57
Q

For Sodium hyaluronan, how do you know what product to choose

A

it needs to be >500,000 Daltons

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58
Q

What are commonly used sodium hyaluronans used

A

1) Hylartin V (3.5,000,000)
2) Hyvisc (1,000,000)
3) Legend (500,000)

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59
Q

How is arthtroscopy both diagnostic and therapeutic

A

it can help identify cartilage defects that cannot be seen on radiographs
it can also be used to debride wounds

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60
Q

What are topical therapies used to treat equine OA

A

Liposomal NSAID cream: liposomes hold higher concentration at the site of inflammation
leads to significant improvement of lameness
disease modifying:
1) Improved gross cartilage staining
2) Improved total articular glycosaminoglycan content

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61
Q

T/F: Liposomal NSAID creams (diclofenac) have signficant improvement in lameness when used in horses with OA

A

True

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62
Q

Topical therapies like liposomal NSAID cream have what disease modifying effects in OA in horses

A

1) Improved gross cartilage staining
2) Improved total articular glycosaminoglycan content

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63
Q

Advanced therapies in equine OA

A

Il-1ra/APS (Prostride)
Stem cells
PRP

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64
Q

Most common devleopmental orthopedic disease in foals

A

Osteochondrosis dissecans

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65
Q

Common developmental orthopedic diseases in foals

A

1) Osteochondrosis - dissecans + subchondral bone cysts/cystic lesions
2) Physitis
3) Angular limb deformities
4) Flexural limb deformities
5) Some cervical vertebral malformation
6) Juvenille OA (hock and pastern)

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66
Q

conformational deviation of the limb in the frontal plane

A

angular limb deformities

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67
Q

conformational deviation of the limb in the sagittal plane

A

flexural limb deformities
-soft tissues holding limbs in position

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68
Q

What happens when the physis matures too quickly

A

contracted tendons- bones grow too fast and the soft tissues cant keep up

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69
Q

physis becomes inflamed

A

physitis

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70
Q

physis has abnormal mechanical pressure

A

angular limb deformity

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71
Q

epiphysis has abnormal ossification

A

Osteochondrosis dissecans

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72
Q

What factors lead to developmental orthopedic diseases in foals

A

1) Genetic predisposition/rapid growth
2) Nutritional factors (excesses or imbalances)
-High energy (High CHO)
-Mineral imbalances (high Ca, DE, & P)
-Trace minerals (Cu & Zn)
3) Endocrine imbalances (TH, insulin
4) Trauma

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73
Q

High levels of what mineral is correlated with OCD lesions in foals

A

phosphorus (like 4x the value)

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74
Q

the most significant skeletal disorder of growing horses

A

-OCD
-Subchondral bone cysts/cystic lesions (CBC/SCL)

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75
Q

What are the most common sites to see OCD lesions in foals

A

1) Fetlock joint

2) Tarsocrural joint
-distal intermediate ridge of tibia
-lateral trochlear ridge
-medial malleoulus of tibia

3) Femoral-Patellar joint
-Lateral trochlear ridge
-Medial femoral condyle (bone cyst)

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76
Q

What is the pathogenesis of osteocondrosis in foals

A

1) Disruption of nx endochondral ossification
A)Cleft formed in thickened cartilage (OCD)
OR
B) Entrapped cartilage leading to subchondral cyst formation

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77
Q

What are the most common sites for an OCD lesion of the tarsocrural joint in the foal

A

-distal intermediate ridge of tibia
-lateral trochlear ridge
-medial malleolus of tibia

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78
Q

What are the most common sites for OCD lesion of the femoropatellar joint in the foal

A

-Lateral trochlear ridge
-Medial femoral condyle (bone cyst)

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79
Q

What are the two fates when there is a defect in endochondral ossification

A

A) Cleft formed in thickened cartilage (OCD)
OR
B) Entrapped cartilage leading to subchondral cyst formation

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80
Q

What are the clinical signs of OCD in the stifle in horses

A

young horse, often fast growing
joint effusion
variable lameness present
often bilateral involvement
Lateral trochlear ridge ridge, medial trochlear ridge

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81
Q

Are OCD lesions of the equine stifle typically bilateral or unilateral

A

bilateral

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82
Q

How do you treat stifle OCD in horses

A

Preventative: nutrition evaluation if many cases are involved

Conservative: rest, re-radiograph

Surgical: Arthroscopy- debride, inject, pin lesion
Prognosis is favorable

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83
Q

You have a horse with a lateral trochlear ridge OCD lesion. What do you recommend for tx . Horse is 2yo

A

Arthroscopic removal

older horse, wont heal on its own

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84
Q

How do you treat Hock OCD lesions in the horse

A

Preventative: nutrition evaluation if many cases are involved

Conservative : Small lesions without effusion

Surgical: Arthroscopy to debride lesion
prognosis is favorable

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85
Q

T/F: Subchondral bone cysts have lots of effusion compared to OCD lesions

A

False- minimal effusion

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86
Q

Where in the equine stifle are subchondral bone cysts almost always located

A

almost always the medial femoral condyle

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87
Q

Subchondral bone cyst of equine stifle

A

minimal effusion
variable lameness
almost always medial femoral condyle

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88
Q

physitis

A

lameness
dx: radiographs
assess/change diet
rest/limit exercise

can lead to angular limb deformities

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89
Q

What causes congenital flexural deformities in foals

A

1) Teratogenic agents
2) Intrauterine positioning
3) Genetic predisposition - too rapid of growth

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90
Q

What causes acquired flexural deformities in horses

A

1) Nutritional - too rapid of growth
2) Trauma
3) Infectous polyarthritis

often involve the DIP of fetlock

all lead to pain and altered weight bearing thus causing the flexural deformity

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91
Q

Acquired flexural deformities are caused by nutrition, trauma, or infectious polyarthritis, they often involve which joints

A

1) DIP
2) Fetlock (MCP >MTP)

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92
Q

Flexural deformities of the DIP joint in horses typically develop between

A

Birth to 4 months of age

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93
Q

Flexural deformities of the MCP joint in horses typically develop

A

later, when they are yearlings ~18 months age

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94
Q

Flexural deformities is more common in the MCP or MTP?

A

MCP

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95
Q

How do you treat flexural limb deformities in horses

A

-Evaluate nutrition, control growth rate
-Control painful stimuli (NSAIDs)
-Medical treatment: Oxytetracycline and Splinting
-Surgical intervention (>180 degrees)

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96
Q

With flexural limb deformities in horses, when do you recommend immediate surgical intervention

A

the the angle is greater than >160 degrees, especially MCP

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97
Q

How do you medically treat flexural limb deformities

A

-Control painful stimuli (NSAIDs)
-Medical treatment: Oxytetracycline and Splinting

Oxytetracycline IV only helpful first few weeks of life (only 1-2 doses)

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98
Q

You are presented with a newborn foal with carpal contracture meaning it cannot stand without assistance
What are your initial treatments in regards to orthopedic disease?

A

Oxytetracycline and splint from ground to elbow

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99
Q

Oxytetracycline is only helpful in treating flexural limb deformities if

A

IV only helpful first few weeks of life (only 1-2 doses)

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100
Q

What is the most likely cause for a newborn foal’s contracted limbs?

A

Uterine malpositioning

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101
Q

deviation from the normal axis referred to as valgus or varus deformity

A

angular limb deformities

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102
Q

lateral deviation of the limb distal to the site of the deformity

A

valgus

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103
Q

medial deviation of the limb distal to the site of the deformity

A

varus

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104
Q

What might cause congenital angular limb deformities in horses

A

1) incomplete ossification of cuboidal bones or epiphyses
2) Ligament laxity- medial, lateral collateral ligaments of joints

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105
Q

What is important for normal physeal growth

A

load

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106
Q

delayed or defective physeal growth results in

A

ALD- most originate at the physis

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107
Q

incomplete ossification can lead to

A

crushing of the cuboidal bones and uneven growth
need to maintain equal weight bearing until ossified

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108
Q

in a foal angular limb deformities, why might you not want to cast hindlimbs

A

Although effective in making sure the foal bears weight evenly, they can luxate their capital femoral physis really easily

just use splints instead

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109
Q

Acquired Angular limb deformities in horses can be due to

A

1) Nutritional imbalance
2) Abnormal loading of the physis
3) Trauma

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110
Q

How do you rule out ligament laxity

A

move the limb deformity and if you can return it to normal position, it is soft tissue and not bone

of you cant, rule out ligament laxity

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111
Q

How do you diagnose ALD in horses

A

Radiographs are key

Normal = Angulation of 4 degrees

Radiographic examination of affected joints must be done early in the course of the disease

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112
Q

What is normal angulation of equine limb

A

4 degrees, ideally 5-6 degrees as a little of valgus is protective

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113
Q

Conservative treatment w ALD

A

-Exercise restriction/stall rest
-Correcting trimming +/- shoeing
-Minimize abnormal biomechanical forces- Splints if ligament laxity/delayed ossification

Re-evalaution needed in 2-3 weeks

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114
Q

How often should you re-evaluate foals with ALD *

A

2-3 weeks

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115
Q

Corrective trimming for valgus

A

put extension of medial side of foot

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116
Q

Corrective trimming for varus

A

put extension of lateral side of foot

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117
Q

surgical treatment of ALD must be done

A

before the physis close
-aim is to slow down growth
-contralateral growth acceleration procedures such as periosteal stripping rarely used- outcomes equivalent to stall rest
-Transphyseal screw
-Transphyseal bridge

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118
Q

What is the goal of ALD surgical treatment

A

Slow down growth
must be done before physis close

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119
Q

Surgical tx of ALD

A

-must be done before physis close
-aim is to slow down growth
-contralateral growth acceleration procedures such as periosteal stripping rarely used- outcomes equivalent to stall rest
-Transphyseal screw
-Transphyseal bridge

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120
Q

When does the distal radius/ tibia growth plate close

A

1-1.5 years = when little to no growth continues

Best therapeutic window within 4-6 months

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121
Q

When is the best therapeutic window for distal radius/tibia ALD

A

Best therapeutic window within 4-6 months

1-1.5 years = when little to no growth continues

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122
Q

When is the best therapeutic window for distal metacarpus/metatarsus ALD

A

within 3-4 weeks

12-14 weeks = when little to no growth continues

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123
Q

When does the the distal metacarpus/metatarsus growth plate occur

A

12-14 weeks

therapeutic window is within 3-4 weeks

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124
Q

What is a transphyseal bridge for ALD tx

A

a surgery to bridge the side that you want to slow down growth
allows the other side to catch up

For Valgus= turning laterally = medial side growing faster = bridge the medial physis

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125
Q

For valgus, what side do you want to do the transphyseal bridge on

A

For Valgus= turning laterally = medial side growing faster = bridge the medial physis

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126
Q

For varus, what side do you want to do the transphyseal bridge on

A

For varus = turning medially = lateral side growing faster = bridge the lateral physis

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127
Q

What are the differential diagnoses for severe lameness in horses

A

-Fracture
-Infection in a confined space (hoof abscess, septic synovial structure- joint, tendon sheath or cellulitis
-Laminitis
-Severe soft tissue injury (destabilizing tendon/ligament injury or joint luxations)

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128
Q

How does septic arthritis / tenosynvotis occur in horses

A

Foals- hematogenous
1) Failure of passive transfer
2) Patent urachus
Multiple limbs can be affected

Adults
1) Traumatic (wound)
2) iatrogenic - joint injection (0.4% incidence)

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129
Q

How might a foal get septic arthritis / tenosynvotis

A

1) Failure of passive transfer
2) Patent urachus

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130
Q

How might an adult horse get septic arthritis / tenosynvotis

A

1) Traumatic (wound)
2) iatrogenic - joint injection (0.4% incidence)

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131
Q

T/F: Adult horses with arthritis / tenosynvotis are febrile

A

False - only foals

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132
Q

T/F: arthritis / tenosynvotis only occurs in single joint in adult horses

A

True, unless injury occurs near multiple synovial structures

foals commonly have multiple limbs affected and can be febrile

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133
Q

Septic arthrtis risk factors in adult horses

A

recent intra-articular injection
recent joint sx
puncture wounds/ lacterations near joints

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134
Q

Septic arthritis risk factors in foals

A

1) Failure of passive transfer
2) Sepsis
3) Umbilical infection
4) Respiratory infection
5) Gastrointestinal (colitis)

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135
Q

What are exam findings of horses with septic arthritis

A

1) Moderate to severe peri-articular swelling/edema
2) Grade 4-5/5 lameness unless joint is open and draining
3) Pain
4) Heat
5) Fever (foals only)

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136
Q

How do you diagnose septic arthritis in horses **

A

1) Arthrocentesis - cytology (degenerative neutrophils +/- intracellular bacteria)
Fluid exits from wound after distension

2) Culture and sensitivity of synovial fluid and blood (foals)

3) Radiographs- lysis/erosion

4) Ultrasound- particles in fluid

5) Point of care analyzers of synovial fluid - Serum amyloid A and lactate

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137
Q

if you get a negative culture of synovial fluid, can you rule out joint infection in horses?

A

NO- bacterial likes to be in synovial membrane so sometimes they arent cultured within the fluid

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138
Q

What should normal equine synovial fluid look like

A

pale (straw colored) yellow

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139
Q

What does septic arthritis synovial fluid look like

A

yellow to orange

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140
Q

What is the viscosity of normal equine synovial fluid

A

high viscosity

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141
Q

What is the viscosity of septic equine synovial fluid

A

low- lost with OA and septic arthritis

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142
Q

What is the turbidity of normal equine synovial fluid

A

transparent /clear

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143
Q

What is the turbidity of septic equine synovial fluid

A

turbid, opaque

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144
Q

What is the total protein of normal equine synovial fluid

A

<2.5 g/dL

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145
Q

What is the total protein of septic equine synovial fluid

A

> 4g/dL

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146
Q

What is the nucleated cell count of normal equine synovial fluid

A

<1000 (x10^6/uL)

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147
Q

What is the nucleated cell count of septic equine synovial fluid

A

> 30,000 x 10^6 /uL

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148
Q

What is the WBC differential of normal equine synovial fluid

A

<10% neutrophils (mostly mononuclear cells)

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149
Q

What is the WBC differential of septic equine synovial fluid

A

> 90% neutrophils (degenerate of non-degenerate)

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150
Q

What are the characteristics of normal equine synovial fluid *

A

Pale (straw colored) yellow
Transparent/Clear
High Viscosity
<2.5g/dl protein
<1000x10^6 nucleated cell count
<10% neutrophils (mostly mononuclear cells)

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151
Q

What are the characteristics of septic equine synovial fluid *

A

Yellow to orange
turbid , opaque
low viscosity
>4g/dl protein
>30,000 (x10^6) nucleated cell count
>90% neutrophils (degenerative or non-degenerate)

152
Q

You have a 10yo QH mare with a sustained laceration to the left hind pastern from wire fence
upon arthrocentesis of coffin joint you get
TNCC: 18,200/uL
85% neutrophils
TP: 3.8 g/dL
Is it infected?

A

Yes

153
Q

How do you treat septic arthritis in horses **

A

1) LAVAGE
-Synovial irrigation +/- arthroscopy

2) Antimicrobials
-Intra-synovial
-Intra-osseous
-IV perfusions
-Systemic

3) Anti-inflammatory

4) Limb support- bandaging, splinting, casting

154
Q

In horses, why are systemic antimicrobials controversial w septic arthritis

A

they might not get good penetration into the joint

155
Q

acute infection of the dermis and SQ tissues with associated inflammation

A

cellulitis

156
Q

What are the clinical signs of cellulitis in horses

A

-Severe generalized swelling
-Heat
-Pain on palpation
-Lameness (4-5/5)
-Fever
-Extension of wounds/pastern dermatitis

157
Q

T/F: you see fever with cellulitis in horses

A

True

158
Q

How do you diagnose cellulitis in horses

A

1) Clinical signs
2) Ultrasound- thick SQ space or gas if anaerobe
3) Radiographs (to rule out fracture)
4) FNA or biopsy (not typically done)
5) Aerobic / anaerobic culture of drainage of SQ pockets
(Staphylococcus and Streptococcus spp are most common)

159
Q

What bacteria typically cause cellulitis in horses

A

(Staphylococcus and Streptococcus spp are most common)

if involves wound, external environment brings gram - bacteria within

160
Q

How do you treat cellulitis in horses

A

1) Systemic antibiotics (Enrofloxacin)
2) Regional limb perfusion
3) Anti-inflammatory medications
4) Analgesics
5) Bandaging
6) Hydrotherapy (+/- compression): game ready system

161
Q

What systemic antbiotic would you want to use to treat cellulitis in horses

A

Enrofloxacin

162
Q

rapidly progressing necrosis of muscle due to bacterial infection from penetrating wounds, IM injection, hematogenous spread

A

Bacterial myositis

163
Q

What typically causes bacterial myositis in horses

A

-penetrating wounds
-IM injection
-hematogenous spread

164
Q

What typical organisms cause bacterial myositis

A

Clostridium spp (anaerobic)
Streptococcal spp
Staphylococcal spp
Corynebacterium pseudotuberculosis
Salmonella

165
Q

IM injections of ________ can cause bacterial myositis in horses

A

Banamine

166
Q

In horses, banamine causes __________ when given IM

A

Bacterial myositis
rapidly progressing necrosis of muscle due to bacterial infection from penetrating wounds, IM injection, hematogenous spread

167
Q

How do you diagnose bacterial myositis in horses

A

Swollen horse
Ultrasound
Fluid aspirate (gram stain)
-Dont want to wait to get a culture back

168
Q

How do you treat bacterial myositis in horses

A

-Systemic antibiotics (ensure anaerobic coverage
-Anti-inflammatories/ pain management
-Surgical fenestration and debridement (wound management, maggots, hyperbaric oxygen therapy)
-Supportive care

169
Q

What is the purpose of exxternal coaptation (bandaging)

A

prevent further wound contamination
prevent edema formation
provide support to the limb

170
Q

types of bandaging (external coaptation)

A

robert jones- double /triple limb size
foot- enclose entire foot
distal limb - heel to just below carpus/tarsus
fill limb (stack)- heel to just below elbow/stifle

171
Q

What is the purpose of Robert Jone’s bandage in horses

A

Provide support
Limit joint mobility
Stop hemorrhage
Enable compression

172
Q

What supplies do you need for a Robert Jones bandage

A

Roll cotton / combine
Gauze
Vetwrap
Elastikon

173
Q

What is the purpose of bandaging a horse’s foot

A

Sole abscesses
Wounds
Protect bottom of foot

174
Q

How should you bandage a horse’s distal and full limb?

A

apply bandage tightly
ensure even distribution to avoid pressure sores/ bowed tendons
wrap in the same direction

175
Q

types of splints in horses

A

1) PVC
2) Kimsey (velcro)
3) Cast material (orthoglass)
-Planar support (lateral/medial or cranial/caudal)
4) Casts- circumferential support, most stable

176
Q

What is the difference between a splint and cast

A

cast you get circumferential support while splint you only get a couple of planes

177
Q

Types of casts in equine

A

1) full limb cast
2) Distal limb- below carpus and tarsus
3) Sleeve/tube cast - immobilized carpus but not the carpus and foot
4) Foot cast

178
Q

How often should you monitor equine casts *

A

twice a day at least

179
Q

What should you monitor in an equine casts *

A

1) Heat
2) Drainage (strike through)
3) Lameness
4) Fly accumulation
5) Unwilling to stand on it - pick up contralateral (uncasted limb)

180
Q

How often should you change an adult horse’s cast *

A

every 3-4 weeks

181
Q

How often should you change a foal’s cast *

A

every 1-2 weeks

they are growing frequently

182
Q

How often should you change a horse’s splint *

A

usually with bandage changes or every 1-2 weeks

183
Q

What are common sites for cast sores in horses *

A

-Proximal dorsal MC3/MT3
-Palmar / plantar fetlock
-Heel bulbs

184
Q

How do you control a horse’s anxiety with fracture stabilization

A

sedate but do not oversedate or they may forget they have a broken leg and step on it

185
Q

In horse’s with fractures, what should you give to provide analgesia

A

phenylbutazone

NSAIDs alone will not cause over loading on a fractured limb

186
Q

What should you do for sedating a horse with a fracture

A

Short acting sedation with xylazine / butorphanol

Don not oversedate- stabilizing the limb will reduce anxiety

avoid acepromazine with severe blood loss (hypotension)

187
Q

If you have a horse with an open fracture, what should you use

A

broad spectrum antibiotics

188
Q

If you have a horse with severe blood loss, what should you avoid when doing sedation

A

acepromazine

189
Q

What are the goals of fracture immobilization in horses *

A

1) Prevent further soft tissue damage
2) Minimize further none damage / fracture displacement
3) Stabilize limb to improve comfort and reduce anxiety
4) Determine best coaptation strategy (based on region)

190
Q

What do you do for fracture below the fetlock (hoof to distal MC3)?

A

bandage and apply DORSAL splint with leg non-weight bearing
Kimzey is useful

Aligns dorsal cortices of cannon bone/ phalanges

191
Q

What do you do for equine fractures of the distal metacarpus to distal radius
ex: MC3, carpal, distal radius

A

thick bandage and apply lateral AND caudal splint

function: prevents medial to lateral and dorsal to palmar instability, not good collateral support here

192
Q

What do you do for distal radius to elbow fractures in horse
ex: radius fractures

A

1) thick bandage
AND
2) apply caudal splint (ground to elbow)
AND
3) lateral splint (above shoulder)

function: prevents limb abduction and further injury in the medial aspect

193
Q

In horses with radius fractures, why do you need to apply a lateral splint that goes above the shoulder in additon to a caudal splint?

A

prevents limb abduction and further injury in the medial aspect

194
Q

What do you do for a horse with a fracture of the elbow to scapula
ex: humerus and scapula fractures

A

no coaptation is necessary
surrounding muscles provide support
splints cannot stabilize joint above
splinting adds weight and can create a fulcrum at fracture making it worse

195
Q

You shouldnt do coaptation in equine fractures that are above the elbow except if theres an

A

olencranon fracture- disrupt triceps apparatus causing dropped elbow inability to extend carpus

196
Q

What should you do for horses with an olecranon fracture

A

apply full limb bandage and place CAUDAL splint

function: prevents limb abduction and further injury to the medial aspect

197
Q

What do olecranon fractures lead to in horses

A

disrupt triceps apparatus causing dropped elbow inability to extend carpus

198
Q

What should you do for a horse with a fracture between the hoof and distal MT3?
ex: P1, P2, distal Mt3 fx

A

bandage and apply PLANTAR splint with leg non-weight bearing

function: aligns plantar cortices of cannon bone/phalanges

199
Q

How does tx of hoof to MC3 fractures from hoof to MT3 fractures

A

Front limb: apply dorsal splint

Hindleg: apply plantar splint

200
Q

What should you do for horses with a fracture of the tibia, mid tarsus

A

thick bandage and apply extended lateral splint to the hip

limb angle and reciprocal apparatus make splinitng challenging

function: prevents limb abduction and further injury to the medial aspect

201
Q

What should you do for a horse with a fracture from the stifle to the hip
ex: femur fractures

A

No coaptation is necessary
-surrouding muscles provude support
-splint cannot stabilize joint above
-splinting adds weight and can create a fulcrum at fracture

distal hindlimb musculature attachments enable more stbaility than upper forelimb fractures

202
Q

How do you transport horses with fractures

A

minimize how far the horse has to walk
bring trailer to horse

forelimb fracture- haul facing backwards
hindlimb fracture- haul facing forward

203
Q

How should you haul a horse with forelimb fx

A

haul facing backwards

204
Q

How should you haul a horse with a hindlimb fracture

A

haul facing forward

205
Q

What factors have a better prognosis for equine fracture repair **

A

1) young age (foals)
2) Small patient
3) Closed fracture
4) Simple / minimally displaced fracture
5) Early intervention
6) Non-articular
7) Good mental attitude

206
Q

What fractors have a worse prognosis for equine fracture repair? *

A

1) Older horse
2) Large patient
3) Open fracture
4) Comminuted fracture
5) Severe soft tissue disruption
6) Articular
8) Poor mental attitude

207
Q

What equine fractures are repairable

A

-Olecranon
-Phalangeal
-Metacarpal/Metatarsal
-Carpal/tarsal
-Radius (closed minimally displaced)
-Humerus, radius, femur, and tibia in foals

208
Q

What equine fractures are very difficult / non-repairable

A

-severely comminuted
-most radius fractures in adults
-humerus, femur and tibia in adults
-open radius and MC3/MT3 fractures

209
Q

equine fractures conservative management

A

-Non-displaced fractures
-Tie line to prevent laying down
-provide extra support with a cast or transfixation pin cast

210
Q

luxation requires

A

disruption of several of structures
-Collateral ligaments
-Muscles/tendons
-Osseous articulations
-Joint capsule
-Joint fluid (cohesion/adhesion)

additional fractures may occur during trauma

211
Q

How do you treat joint luxation in horses

A

-Splints
-Cast
-Internal fixation
-Arthrodesis

outcome: depends on joint involved/ amount of soft tissue trauma and stability of repair

complications: re-luxation, lameness, and osteoarthritis

212
Q

If just the fetlock is dropped down, what tendon is likely lacerated *

A

Just the superficial digital flexor tendon

213
Q

If the fetlock is dropped down and the patient’s toe flips up, what tendon(s) are likely lacerated *

A

Both the superficial and deep digital flexor tendons

214
Q

If the fetlock, P1, P2, and P3 are all on the ground, what tendons are likely lacerated? *

A

Superficial and Deep Digital flexor tendons and suspensory ligament

215
Q

How do you treat flexor tendon lacerations in horses

A

Suturing is rarely feasible
Tenoscopy if in digital flexor tendon or tarsal sheath
casting 6-8 weeks at least (cast in slight flexion)
shoe support- elevate heels or caudal extension

216
Q

What is the outcome with flexor tendon lacerations?

A

50% return to work

depends on structures involved- synovial fluid reduces ability of tendon to heal
-adhesion formation in tendon sheaths

217
Q

occur due to dorsal lacerations
unable to extend the fetlock

tx: bandage, splint and/or cast to prevent knuckling over
and stall rest 6-8 weeks

outcome: 75% return to full return, Stringhault (hindlimbs)

A

Extensor tendon lacerations

218
Q

Are flexor tendon or extensor tendon lacerations better prognosis in horses

A

Extensor tendon lacerations

219
Q

What should you consider about the other non-lame foot when treating a lame foot

A

laminitis can occur- once injured limb is stable, provide mechanical support to the contralateral limb

can have successful repair but lose a horse to laminitis, even 2-6 weeks post injur

220
Q

How do you support the limb to prevent laminitis

A

encourage early weight bearing on injured limb (if stable)
pain management
caudal epidural (hindlimbs)
encourage horse to lay down on heavy bedding

mechanical support- soft ride boot and Nanric Ultimate (releases tension on laminae and pulling from DDFT)

221
Q

What is a risk of any severe lameness

A

support limb laminitis

222
Q

most causes of lameness in the equine forelimb is in the

A

Fetlock region and distal (80% of lameness)

223
Q

When doing an equine orthopedic exam, what should you assess *

A

Abnormal?
-Swelling?
-Effusion?
-Limb alignment?

What anatomic structures are nearby
-Synovial structures
-nerves
-Blood supply
-Tendons/ligaments

224
Q

Once you notice the lame leg, how do you localize the source in a horse

A

Nerve/ synovial blocks
exceptions: severe lameness and instability (e.g fractures)

suggestive finidngs:
severe swelling
pain on palpation
abnormal anatomy
findings on diagnostic imaging

225
Q

When do you not want to use nerve/ synovial blocks to localize the source of the lameness

A

severe lameness and instability (e.g fractures)

226
Q

Ringbone is ____ *

A

osteoarthritis of the interphalangeal joints

Low= dDIP or coffin
High= PIP or pastern joint

227
Q

How do you treat ringbone?

A

Both low and high are challenging to manage medically
-Intra-articular injections (corticosteroids, hyaluronan)
-NSAIDs
-Extracorporeal shockwave (transient)

Arthrodesis: Surgical joint fusion
prognosis-
PIPJ- athletic use (90% hindlimbs) and (70% forelimb)
DIPJ- salvage

228
Q

What surgery is used to treat severe ringbone

A

Arthrodesis: surgical joint fuson making P1 and P2 a single bone

prognosis-
PIPJ- athletic use (90% hindlimbs) and (70% forelimb)
DIPJ- salvage

229
Q

How do you distinguish swelling of the fetlock vs tendon sheath

A

find the suspensory branch and see where it separates.
if dorsal = fetlock
if palmar = digital flexor tendon sheath

230
Q

How do you treat fetlock joint - synovitis and osteoarthritis

A

Intra-articular medications

when medical therapy fails do surgical
-arthroscopy if underlying structural damage
-Arthrodesis: salvage/breeding

231
Q

Dorsal proximal P1 fragments lead to

A

fetlock hyperextension

232
Q

Dorsal proximal P1 fragments are common in

A

racehorses

233
Q

How do you diagnose osteochondral dorsal proximal P1 fragments

A

variable lameness
joint effusion
intra-articular or low 4 point block
radiographs- can be small fragments, use oblique projections

234
Q

How do you treat fetlock joint osteochondral fragments

A

-Surgical (arthroscopic) removal is preferred
-Conservative management has been reports (Risk of progressive OA, no clinical effusion or lameness)

prognosis - generally good, unless concurrent injury to articular cartilage

235
Q

How do you diagnose subchondral bone cysts in horses

A

+/- effusion of fetlock
Intra-articular or low 4point perineural anesthesia
radiographs

236
Q

How do you treat subchondral bone cysts in horses

A

1) intra-cystic or intra-articular corticosteroids (not good for older)
2) Surgically (preferred)
-Arthroscopic debridement
-Lagscrew across the cyst

prognosis: variable (good to fair) based on cartilage damage/joint degeneration

237
Q

What are the 3 carpal joints in the horse *

A

Radiocarpal
Middle Carpal
Carpometacarpal joint

238
Q

What equine carpal joints always communicate

A

carpometacarpal joint and middle carpal joint

239
Q

T/F: the carpometacarpal joint and middle carpal joint always communicate in the horse

A

True

240
Q

T/F: the radiocarapl and middle carpal joint always communicate in the horse

A

False

241
Q

In horses with carpal osteochondral fragments, as dorsal fragments or palmar fragments more common

A

dorsal fragments

242
Q

What carpal joints are most commonly affected by osteochondral fragments in horses

A

Radiocarpal and middle carpal joints
-hyperextension injuries
-high motion joints, common in racehorses

243
Q

How do you treat carpal joint osteochondral fragments in horses

A

Arthroscopic removal

good prognosis if not a lot of articular cartilage is damaged

244
Q

What gait abnormality do horses with elbow OA and subchondral bone cysts have

A

decreased cranial stride/lameness

245
Q

How do you treat horses with elbow subchondral bone cysts

A

surgery: peri-articular curettage/drilling screw placement, biologic augmentation

elbow is much more difficult, not good fusion option *

246
Q

What gait abnormality do horses with shoulder OA

A

decreased cranial phase of stride- not pathognomonic for shoulder

247
Q

How do you diagnose shoulder OA in horses

A

1) Intra-articular anesthesia
2) Radiographs +/- contrast
3) Nuclear scintigraphy

248
Q

How do you treat shoulder OA in horses

A

intra-articular treatment
arthroscopy
arthrodesis - miniature horses

prognosis is variable- shoulder OA is difficult to manage

249
Q

What breed on horses can you do shoulder arthrodesis for shoulder OA

A

miniature horses - good prognosis, a lil of a gait abnormality

250
Q

If fractures involve the articular surface, what is likely to occur

A

-More likely to lead to OA
-More challenging to accurately reconstruct

251
Q

In the horse what phalangeal fractues are most common

A

P2>P1>P3

252
Q

How do you treat phalangeal fractures in horses

A

Internal fixation
external fixator (transfixation pin casts)
shoeing support (P3 only)

253
Q

transfixation pin cast

A

used for comminuted P1 fractures
always for transfer of weight out through pins and down the cast material

254
Q

How do you treat proximal phalangeal fractures in horses

A

Incomplete- lag screw fixation (possibly conservative management)

Complete- lag screw fixation

Comminuted- transfixation-pin cast +/- scres

prognosis: variable, depends on reconstruction of articular surfaces
simple and complete/ non displaced is good

255
Q

What does the prognosis of proximal sesamoid bone fractures in horses depend on

A

check the suspensory branches- attaches along abaxial margin

damge to distal sesamoidean ligaments

256
Q

How do you treat proximal sesamoid bone fractures in horses

A

if small and on margin- arthroscopic removal

if large, internal fixation

257
Q

Dorsal metacarpal disease in horses

A

Shin splints (Bucked shins)
common in young racehorses (2&3 year olds)
variable lameness
painful on palpation
thickening over the dorsal aspect of MC3
leads to stress fractures

258
Q

How do you diagnose Dorsal metacarpal disease in horses

A

physical examination- painful when palpating dorsal MC

Radiographs + Nuclear scintigraphy

259
Q

How do you treat Dorsal metacarpal disease in horses

A

modify training
extracorporeal shockwave
drill (osteostixis), place screw

260
Q

abnormal abaxial proliferation along the splint bones in horses
leads to variable lameness and palpable pain (can go on suspensory ligament)
might just be cosmetic problem

A

Splint bone exostosis

261
Q

Why might splint bone exostosis be painful

A

abnormal abaxial proliferation along the splint bones in horses
leads to variable lameness and palpable pain (can go on suspensory ligament)

262
Q

How might you diagnose splint bone exostosis

A

radiographs
Ultrasound- check suspensory ligament

263
Q

How do you treat splint bone exostosis

A

Usually conservative
Anti-inflammatories, rest, icing, bandaging
Surgical debulking if impinging on suspensory ligament

264
Q

What is the prognosis with splint bone exostosis

A

good

265
Q

Are medial or lateral splint bone fractures more common

A

lateral

266
Q

Are distal or proximal splint bone fractures most common

A

distal

267
Q

How do you diagnose splint bone fractures in horses

A

Radiographs

Ultrasound- check suspensory ligament- most common concurrent injury

268
Q

What soft tissue structure is often involved in splint bone fractures

A

suspensory ligament

269
Q

How do you treat splint bone fractures *

A

Primarily Conservative- rest, bandaging, anti-inflammatories

only surgical if:
1) causing lameness
2) If draining wound, the bone is a nidus for infection- only remove fractured portion (up to 2/3 removed safely)
3) Consider weight bearing or instability
Do internal fixation- proximal fractures/stabilize proximal articualr surface

270
Q

For splint bone fractures, you should primarily do conservative management but when should you consider surgical

A

1) causing lameness
2) If draining wound, the bone is a nidus for infection- only remove fractured portion (up to 2/3 removed safely)
3) Consider weight bearing or instability
Do internal fixation- proximal fractures/stabilize proximal articular surface

271
Q

Carpal slab fractures

A

commonly racehorses
3rd carpal bone is most affected (frontal and sagittal plane)

tx: internal fixation and arthroscopic guided

prognosis: fair to good

272
Q

Olecranon fractures on horses typically occur due to ____ *

A

kick injury

273
Q

What do you see with olecranon fractures in horses *

A

dropped elbow from disrupted triceps apparatus

274
Q

What are your 4 differentials for a horse with a dropped elbow *

A

1) Olecranon fracture
2) Radial nerve paralysis
3) Triceps myopathy
4) Humerus fracture

275
Q

What is the prognosis of horses with olecranon fractures *

A

good to fair

but can change with open vs closed and elbow osteoarthritis

276
Q

How do you treat olecranon fractures in horses *

A

internal fixation- tension band plating
-some can be treated conservatively (non-articular and not displaced)

277
Q

How do you identify palmar pastern soft tissue injuries

A

Ultrasound
MRI

278
Q

What is windpuffs

A

digital flexor tendon sheath tenosynovitis
-effusion there

279
Q

When is digital flexor tendon sheath tenosynovitis clinically significant in horses

A

if lameness is present with asymmetrical effusion

280
Q

fatigue, accumulation of repetitive microtrauma to the metacarpal tendon
commonly SDFT ?DDFT

A

Flexor tendoinits

281
Q

is SDF tendonitis more common in the forelimbs or hindlimbs

A

forelimbs

282
Q

Bowed tendon

A

SDF tendonitis

283
Q

How do you diagnose flexor tendonitis

A

mild to moderate lameness (1-3/5)
palpably thickened tendon that is painful on palpation
rounded profile
diagnostic: ultrasound or MRI

284
Q

what causes suspensory desmitis

A

repetitive strain or acute overstain injury (degenerative)

285
Q

Where can suspensory desmitis occur

A

anywhere along the suspensory ligament
1) Proximal at origin (proximal metacarpus)
2) Midbody
3) Branches (insert at abaxial sesamoid ligament)

286
Q

What block is used to diagnose suspensory desmitis

A

Perineural block
-Low 4 point -branches
-Lateral palmar (wheat) proximal
-Midbody

287
Q

How do you diagnose suspensory desmitis

A

1) Perineural block
-Low 4 point -branches
-Lateral palmar (wheat) proximal
-Midbody

2) Ultrasound
3) Radiographs
4) MRI

288
Q

How do you treat palmar soft tissue injury in horses

A

Acute: cryotherapy, bandaging, anti-inflammatories

Ultrasound guided intra-or peri-lesional injection of platelet rich plasma or mesenchymal stem cells

Shockwave

Rest and Rehabilitation (controlled exercise for 6+ months)

289
Q

Damage to the suprascapular nerve in horses leading to atrophy of the supra and infraspinatus muscles

A

shoulder sweeny

290
Q

In shoulder sweeny, what muscles are atrophies

A

supra and infraspinatus muscles

291
Q

What nerve is damaged with shoulder sweeny

A

suprascapular nerve

292
Q

How do you treat Shoulder sweeney

A

rest
surgery to decompress the suprascapular nerve

293
Q

What is the prognosis with shoulder sweeney

A

generally pretty good but it varies depending causes of damaged nerve (ie underlying fractures,etc) and chronicity

may take >1 year to heal

294
Q

70% of equine hindlimb lameness is localized to the _______*

A

hock region or above

295
Q

Where is most of the prevalence of equine forelimb conditions lameness *

A

most are below the fetlock

296
Q

With hindlimb lameness in horses, what can this cause *

A

lower back problems

hindlimb lameness is associated with back pain

297
Q

Is OCD more common in the forelimbs or hindlimbs in hroses

A

hindlimbs

298
Q

Is prognosis with high ringbone and P2 fractures better in the hindlimb or forelimb when doing surgical arthrodesis

A

hindlimb > forelimb (

299
Q

Suspensory branch desmitits

A

Degenerative (DSLD)
bilateral condition
hindlimb is most commonly affected
Predisposed breeds (Paso Fino and Peruvian Paso)
Horses with long pastern may be predisposed
difficult to treat if degenerative
traumatic desmitis is a better prognosis
entire suspensory

300
Q

Suspensory branch desmitits is commonly (unilateral/bilateral) and mostly affects (forelimbs/hindlimbs)

A

bilateral hindlimbs

301
Q

Proximal suspensory injury in the hind limb is most common in ____-*

A

jumping dressage and western performance horses

302
Q

What are the clinical signs of Proximal suspensory injury of the hindlimb *

A

grade 2-4/5 lameness
pain on palpation origin (plantar cannon and axial aspect of both cannon bones)
“compartment syndrome”

303
Q

How do you diagnose Proximal suspensory injury

A

assess the bone
deep branch of the lateral plantar nerve block
Ultrasound
MRI

304
Q

What block do you use to diagnose proximal suspensory injury

A

deep branch of the lateral plantar nerve block

305
Q

How do you treat proximal suspensory ligament injury *

A

Medical (forelimb + hindlimb)
-Shockwave (better at ligament/bone interface)
-Biologics (PRP, MSC)
-Rest/ Rehab

Surgical (hindlimb)
-neurectomy
-fasciotomy

306
Q

Surgical techniques such as neurectomy and fasciotomy are only useful in proximal suspensory injuries that are

A

hindlimb

307
Q

How many joints are in the equine tarsus

A

1) Tarsocrural joint
2) Tarsocalcaneal joint
3) Proximal intertarsal joint
4) Distal intertarsal joint
5) Tarsometatarsal joint

308
Q

What joints in the equine tarsus communicate

A

Tarsocrural and proximal intertarsal only communicate

Proximal and distal intertarsal sometimes communicate (least likely)

Distal intertarsal and tarsometatarsal only sometimes do

309
Q

In the horse, the tarsocrural joint always communicates with the _______ *

A

proximal intertarsal joint

310
Q

Sometimes, the distal intertarsal might comminucate with the

A

1) Proximal intertarsal joint
2) Tarsometatarsal joint

311
Q

What joint of the equine tarsus has the largest joint pouch

A

tarsocrural joint - has dorsal and plantar components to it
easy for you to see effusion there

312
Q

What is the only joint in the equine tarsus that sustains significant swelling from synvoial effusion

A

Tarsocrural joint

313
Q

What might cause synovial effusion of the equine tarsus

A

1) Tarsocrural joint (only joint in the tarsus to see swelling)
2) Tarsal sheath
3) Calcaneal bursa

314
Q

What does Bog spavin mean?

A

There is tarsocrural joint effusion

315
Q

What causes bog spavin

A

idiopathic
OCD (esp young horses)
trauma
Synovitis/capsulitis

316
Q

You see swelling of the tarsus in a horse, you want to evaluate if there is tarsocrural joint effusion. What do you do to confirm

A

Confirm if there is lameness with this
1) Radiographs for a cause,
2) Ultrasound
3) Arthrocentesis
4) CT/MRI
5) Arthroscopy

317
Q

What are the most common locations to see OCD lesions in the tarsus of a horse ***

A

1) Distal Intermediate Ridge of the Tibia (DIRT)
2) Lateral trochlear ridge of the talus
3) Medial malleolus

318
Q

Most common OCD sites of the equine tarsus ***
1) _________ Intermediate Ridge of the Tibia
2) ________ trochlear ridge of the talus
3) _________ malleolus

A

1) Distal Intermediate Ridge of the Tibia (DIRT)
2) Lateral trochlear ridge of the talus
3) Medial malleolus

319
Q

How do you treat OCD lesions in the equine tarsus *

A

Arthroscopic debridement

prognosis is good

320
Q

What does bone spavin mean *

A

there is distal tarsal joint osteoarthritis

321
Q

What joints are commonly involved with distal tarsal joint osteoarthritis in horses *

A

1) Tarsometatarsal (TMT)
2) Distal intertarsal (DIT)

322
Q

What causes distal tarsal joint osteoarthritis in horses *

A

-repetitive trauma
-poor confirmation
-incomplete ossification of cuboidal (tarsal) bones
-usually mature horses (juvenile OA can occur tho)

323
Q

distal tarsal joint osteoarthritis in horses *

A

“Bone spavin”
Commonly TMT and DIT joints
Usually mature horses (juvenile OA does occur)

Causes: repetitive trauma, poor conformation, incomplete ossification of cuboidal (tarsal) bones

324
Q

If a horse is having their hock injected for OA, what likely joints is it ? *

A

Tarsometatarsal and distal intertarsal joints as those are most commonly affected by tarsal OA

325
Q

What are the clinical signs of distal tarsal joint OA in horses *

A

-mild to moderate lameness
-positive spavin test (full limb flexion)
-Positive Churchill test
-boxy appearance to distal tarsus

326
Q

Churchill test

A

a test used to identify distal tarsal joint OA
pressure of dorsal medial tarsus (where horses are more likely to get osteophytes)

327
Q

How do you diagnose distal tarsal joint OA in horses

A

1) Regional anesthesia- TMT/DIT joint block
Peroneal-tibial perineural block
2) Radiographs
-Osteophytes
-Subchondral lysis
-Subchondral sclerosis
-Joint space narrowing
3) Nuclear scintigraphy

328
Q

How do you treat distal tarsal joint OA in horses

A

-IA corticosteroids +/- HA
-Systemic PSGAG or HA
-Oral joint supplements
-Shockwave
-Facilitated ankylosis (intra-articular drilling, laser facilitated, ethyl alcholol) to destroy articular cartilage and allow fusing

329
Q

What are common sites for fractures of the equine tarsus

A

-Malleolus fractures
-3rd and central tarsal slab
-calcaneous fractures

330
Q

How many patellar ligaments do horses have

A

3- medial, middle, and lateral

331
Q

Structures in the equine stifle

A

-Patellar ligaments (Med, Middle, Lat)
-Collateral ligaments (med and lat) -femorotibial ligaments
-Menisci (med and lat)
-Cruciate ligaments (cr + cd)
-Meniscotibial (4) and meniscofemoral (1) ligaments
-Articular cartilage
-Bone
-3 joint compartments

332
Q

How many stifle compartments are there in the equine stifle

A

3
1) Femoropatellar joint
2) Medial femorotibial joint
3) lateral femorotibial joint

333
Q

What two joints in the equine stifle always communicate

A

Femoropatellar joint and medial femorotibial joint

334
Q

T/F: the femoropatellar joint always communicates with the lateral femorotibial joint

A

False- Femoropatellar joint and medial femorotibial joint always ocmmunicate

335
Q

What joints in the equine stifle might communicate

A

ALWAYS: Femoropatellar joint and medial femorotibial joint

SOMETIMES: lateral femorotibial and medial femorotibial joint

336
Q

T/F: the femoropatellar joint always communicates with the medial femorotibial joint

A

True

337
Q

How do you test the stifle in your physical exam?

A

-Palpation
-Flexion tests
upper limb “Stifle” flexion
full limb flexion
attemp to discrimate tarsus from stifle

338
Q

What anatomic structure prevents complete isolation of tarsus and stifle flexion *

A

Reciprocal apparatus
1) SSDFT
2) Fibularis (peroneus) tertius

339
Q

If you are able to flex the stifle and extend the hock then what equine structure in broken

A

likely broke the fibularis tertius (cranial portion of the reciprocal apparatus)

340
Q

What is the most common site to see OCD lesions in the equine stifle *

A

Lateral trochlear ridge

341
Q

How do you diagnose OCD of the equine stifle *

A

-Moderate to severe effusion
-Usually low grade lameness
-Radiography (typically lateral trochlear ridge) see cartilage that failed to ossifty and some fragments

342
Q

How do you treat OCD of the stifle in horses *

A

-Surgical (arthroscopic) debridement
-Cartilage absorbable pin fixation

prognosis is generally good

343
Q

Is stifle OCD lesions in horses typically associated with a low grade lameness or high grade lameness **

A

Low grade lameness

344
Q

Where do you see subchondral cystic lesions in the stifle in horses

A

Medial femoral condyle

345
Q

What causes horses to have subchondral cystic lesions in the stifle (typically medial femoral condyle)

A

Osteochondrosis or traumatic (wt bearing surface)

346
Q

How do you treat subchondral cystic lesions in the stifle in horses

A

-Intralesional cyst injection- inflammatory lining (good for younger horses)

-Debridement of the cyst with biologic augmentation

-Screw across the cyst- biomechanical support

prognosis is good if not other concurrent damage to meniscus or cartilage

347
Q

Stifle synovitis/capsulitis or OA in horses

A

secondary to repetitive trauma, osteochondrosis or soft tissue injury
-Medial FTJ is most commonly affected
-Signs: variable lameness, usually low to mid grade, joint effusion, positive to flexion (upper and full limbs)

348
Q

How do you treat stifle synovitis/capsulitis or OA in horses

A

1) Conservative: intra-articular therapies (corticosteroids, HA, IRAP, stem cells)

2) Surgery-Arthroscopy to rule out other structural injuries
-large bore lavage

349
Q

When considering stifle synovitis/capsulitis or OA in horses, you shoould rule out other soft tissue injuries like

A

Menisci and associated ligamentous attachments
Collateral ligaments
Cruciate ligaments
Patellar ligaments

350
Q

What would you see with patella fractures in horses

A

-acute onset of moderate to severe lameness
-Femoropatellar joint effusion/swelling
-May hold leg in partial flexion

351
Q

The patella is not weight bearing so why might these fractures be a problem

A

disruption of the quadriceps apparatus

352
Q

How do you diagnose and tx patellar fractures in horses

A

Dx via radiographs

tx: arthroscopy -fragment removal or internal fixation if large
do conservative management

prognosis is good for small fragments
guarded for large/comminuted

353
Q

When does upward fixation of the patella occur in horses

A

when the medial patellar ligament remains locked on the trochlear of the femur
-horse has a really stiff gait to resolve it, cannot flex the stifle
-common in young horses into training

354
Q

Upward fixation of the patella is common in horses that

A

are young and going into training

355
Q

What are the clinical signs of upward fixation of the patella in horses

A

Mild- transition from extension to flexion is delayed and result in a popping

Severe- stifle locks and limb cant be advanced cranially

356
Q

How do you treat upward fixation of the patella in horses

A

1) Conservative- increased exercise and improve muscle development
NSAIDS

2) Surgical
a) medial patellar ligament fenestration AND improve muscle development
b) LAST RESORT: transection of the medial patellar ligament
dont like to do this because you get trochlear ridge damage

357
Q

You should only do transection of the medial patellar ligament to fix upward fixation of the patella if

A

it is the last resort

cutting it can lead to trochlear ridge damage

358
Q

What is thoroughpin in horses

A

tenosynovitis of the tarsal sheath
often considered a blemish unless associated with DDFT lesions or sepsis

359
Q

What is curb in horses

A

swelling or thickening of the long plantar ligament
see swelling below the plantar hock
usually chronic with no associated lameness

360
Q

Swelling or thickening of the long plantar ligament

A

CURB
see swelling below the hock on the plantar aspect
usually chornic with no assicated lameness

361
Q

What is Stringhault in horses?

A

exaggerated flexion of the tarsus during cranial phase of the stride (extensor tendons) , get better with trotting

usually unilateral

sequella of MT3 laceration

link to peripheral neuropahty: sweet pea/flat weed intoxication (bilaterally affected)

362
Q

What might cause a horse to have an exaggerated flexion of the tarsus during the cranial phase of the stride

A

Unilateral: Sequella to MT3 laceration (extensor tendons)

Bilateral: possible peripheral neuropathy (sweet pea/ flat weed intoxication) - Australia

363
Q

Stringhalt in horses is usually (unilateral or bilateral)

A

Unilateral

364
Q

How do you treat Stringhalt in horses

A

lateral digital extensor myotenectomy if damaged

may spontaneously resolve if not caused by a wound

365
Q

What results in overextension of the tarsus in horses

A

rupture of fibularis tertius

366
Q

What are the clinical signs of fibularis tertius rupture in horses

A

Stifle can flex while the tarsus is extended
horses can bear wieght but lower limb may appear limp

367
Q

How do you treat fibularis tertius rupture in horses

A

Conservative management for 4-6 months rest

good prognosis as scar tissue will readhere

368
Q

Fibrotic myopathy +/- ossifying in horses occurs due to

A

1) limited action of semitendinosus
2) secondary to muscle injury
form fibrous attachment

clinical signs: slapping down of the limb at the walk in the cranial to caudal direction

369
Q

What are the clinical signs of fibrotic myopathy +/- ossifying duie to limited action of the semitendinosus or muscle injury in horses

A

slapping down of the limb at the walk in the cranial to caudal direction
slaps back like a rubberband
goes away when the horse is in a trot

370
Q

How do you treat fibrotic myopathy +/- ossifying due to limited action of the semitendinosus

A

Conservative management and rehab exercises is very important for success

myotenotomy of semitendinosus

transection of fibrotic tissue

371
Q

What could cause the horses hindleg to slapping down of the limb at the walk in the cranial to caudal direction
slaps back like a rubberband

A

myopathy +/- ossifying due to limited action of the semitendinosus

372
Q

What are common sites of thoracolumbar back pain in horses

A

1) Sacroiliac
2) Lumbosacral
3) Thoracic/Lumbar vertebrae (articular facets)
4) Dorsal spinous processes

373
Q

T/F: horses with primary back pain can have lameness

A

True

374
Q

How do you diagnose back pain in horses

A

Muscular palpation (*)
Nuclear scinitigraphy (if you cant locate)
Ultrasound
Radiography

375
Q

How do you treat back pain in horses

A

1) Sacroiliac/lumbar facet injection
2) Extracorporeal shockwave
3) Chiropractic manipulations/ Rehab exercises
4) Medical management (NSAIDS, methocarbomol, gabapentin)
5) Desmotomy of interspinous ligament of impinging dirsal spinous processes so horses dont have the spnous processes rubbing on each other

376
Q
A

Orthopedic Medicine (8 decks)

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