Equine Orthopoedics Flashcards
How would you identify acute and chronic tendon injury on US?
Acute: hypoechoic (darker) areas
Chronic: heterogenous pattern of variable amounts of hypoechogenicity and hyperechogenicity
What is an exostosis?
Benign outgrowth of cartilaginous tissue on a bone
How do you treat exostosis on the distal radius?
If impinging on tendons: tenoscopic exam
If not impinging: look for another source of lameness. If none found but still positive to carpal sheath block: do tenoscopy
What would you suspect if you saw acoustic shadowing on an US of a tendon sheath?
Foreign body
Why is it so important to treat incomplete radial fractures?
Radius is a weight-bearing bone so is at high risk of propagating leading to a complete fracture (commonly fatal)
How do you treat radial fractures?
Stabilisation (need to stabilise joint above and below)
Bandage from foot to as high as possible
Ideally 2 splints (caudal and lateral):
Caudal: foot to olecranon
Lateral: foot to withers
Box rest and cross-tie to prevent lying down
Repeat rads in 2-4 weeks
What should you do in a case of suspected radial fracture with no obvious fracture line on x-ray?
Treat as if it’s fractured and re-radiograph in 2 weeks- fracture will be more obvious then
What would make you suspect an ulna fracture?
Horse can’t extend carpus (failure of passive stay apparatus)
How would you stabilise an ulna fracture for referral?
Splint at the palmar aspect to lock carpus in extension
Give some differentials for a positive response to carpal sheath anaesthesia
Tendinitis of the DDFT or SDFT
Osteochondroma/ exostosis
Should you splint a humeral fracture?
NO!
It will act as a fulcrum and make things worse
Poor prognosis
How do you treat deltoid tuberosity fractures of the humerus?
If radius is not involved:
Clean and debride wound and remove bone fragments
Treat conservatively, let wound heal by 2nd intention
Good prognosis
How do you treat a bicipital tendon injury?
Controlled exercise
Intra-lesional therapies
Shock wave for insertional injuries
Bicipital bursoscopy
Which is the best radiographic view to diagnose a humeral tubercle fracture?
Skyline (cranioproximal-craniodistal oblique)
How do you treat osseous cyst-like lesions of the shoulder?
Arthroscopic surgery
Joint medication: corticosteroids, IRAP
How do you treat osteoarthritis?
Arthroscopic evaluation Intra-articular corticosteroids IRAP NSAIDs Weight management Dietary modification (eg adding omega 3 fatty acids)
What are the 3 compartments of the stifle?
Femoropatellar
Medial and lateral femorotibial (divided by an intact septum)
In the stifle, does the femoropatellar compartment communicate more with the medial or lateral femorotibial compartment?
Medial
Give some clinical signs of OCD of the stifle
Stifle effusion
Lameness
Which part of the stifle is most affected by OCD?
Lateral trochlear ridge of (distal) femur
Give the treatment options for OCD
Conservative: if <8-12 months old. Dietary advice, exercise restriction.
Surgery: if >12 months old. Removal of osteochondral fragments. Curettage to healthy subchondral bone.
How old are horses when they present with osseous cyst-like lesions?
1-3 years +
Which femoral condyle is usually affected by osseous cyst-like lesions?
Medial
Give some clinical signs of an osseous cyst-like lesion
Lameness ++
+/- joint effusion
Give the treatment options for an osseous cyst-like lesion
Inject joint with intra-articular corticosteroids
Inject cyst under GA (with corticosteroids)
Debride cyst (may worsen it)
Bone screw across cyst
How can you treat a patellar fracture?
Surgical removal if <1/3, or fixation
What are the treatment options for a complete fracture of the femur/tibia?
If adult/ >250kg/ comminuted/open: euthanasia
If foal or weanling: possible to repair but requires high expertise
How do you treat tibial stress fractures?
Rest/alteration to exercise regime
Give some clinical signs of pelvic fractures
Pain/swelling/muscle spasm
Lameness
Signs of shock (if iliac arteries are severed)
Muscle atrophy
Nerve damage (decreased muscle/anal tone)
Sharp discontinuity on rectal exam
Give the treatment options for pelvic fractures
NSAIDs Box rest (cross tie for >1 month if major fracture), 2 months box rest with daily walking out, then 2 months field rest
Give some clinical signs of sacroiliac disease
Lameness
Poor performance
Pelvic asymmetry (muscle atrophy)
Pain/swelling
Give the treatment options for sacroiliac disease
Acute: 4-8 weeks box rest, NSAIDs, physio
Chronic: work + NSAIDs, aim to build up limb/pelvic muscles, peri-lesional injections of corticosteroids, physio, shockwave analgesia
Give the clinical signs of aortoiliac thrombosis
Poor performance to severe/acute onset lameness
Distressed/kicking out
Affected limbs feel cool/reduced saphenous filling time
Rectal exam: reduced pulse amplitude
What is the treatment for aortoiliac thrombosis?
NSAIDs
Platelet inhibitors eg aspirin
Guarded prognosis
How do you treat incomplete mineralisation of the carpal bones?
Restricted exercise
Bandage with a light splint (don’t include digit)
Repeat radiographs every 2 weeks
Balanced nutrition
How do you treat peri-articular laxity causing angular limb deformities in foals?
Controlled exercises to strengthen peri-articular soft tissues
Exercise in pool
Be careful with bandaging
Give the causes of angular limb deformities
Congenital: incomplete mineralisation of carpal bones, peri-articular laxity
Acquired: imbalanced nutrition, trauma, genetics (rapid growth)
What are the treatment options for angular limb deformities in foals?
Limited exercise Bandages, splints Corrective hoof trimming Limit mare and foal nutrition Surgery (growth acceleration/retardation)
How do you ‘accelerate growth’ when treating ALD?
Periosteal elevation on the concave side, just proximal to physis
Does not over-correct
Always combine with hoof trimming
How do you ‘retard growth’ when treating ALD?
Use implants to bridge the physis on the convex side (side that is growing fastest)
Risk of over-correction- remove the implants once straightened!
Always combine with hoof balancing
How do you treat digital hyperextension in neonates and what causes it?
Caused by laxity of flexor tendons
Tx: laxity reduces with exercise, corrects in 1-2 weeks
If severe, protect the heel bulbs (palmar/plantar extensions)
What are the treatment options for flexural limb deformities?
Conservative: physio, splints, farriery if DIP joint (to extend the toe), analgesia
Medical: oxytetracycline (diluted in saline)
Surgical: desmotomy
How do you surgically treat a FLD of the DIP joint?
Desmotomy of the AL-DDFT (accessory ligament of DDFT)
Combine with conservative tx
How would you treat a FLD of the carpal joint?
Palmar/plantar splint
Oxytetracycline
Analgesia
Surgery: palpate which tendons are most affected when extension is forced:
-If SDFT: proximal check lig desmotomy
-If DDFT: distal +/- proximal check lig desmotomy
-Severe cases: both proximal and distal
Give some clinical signs of septic arthritis in foals
May be reluctant to stand Joint effusion Peri-articular swelling Lameness Filling of mare's udder
How would you identify septic physitis on a radiograph?
Irregular/widened physis
Radiolucency
Soft tissue swelling
How do you diagnose septic synovitis?
Synoviocentesis into an EDTA tube: Turbid, serosanguinous, reduced viscosity >20x10^9/L cells >80% neutrophils Total protein >30g/L
Can also do culture and sensitivity
How do you treat septic synovitis?
Lavage synovial structure
Antimicrobials
NSAIDs
How would you recognise stress-related dorsal metacarpal/tarsal disease on a radiograph?
Increased cortex thickness (due to modelling in response to loading)
How do you treat dorsal metacarpal/tarsal disease?
Rest
Stimulate remodelling and healing by drilling/placement of a screw
How do you treat diaphysial fractures of MC3/MT3?
Internal fixation
What are ‘splints’?
Periostitis between 3rd metacarpal/tarsal bones and splint bones (periosteal new bone formation)
Secondary to damage to suspensory ligament
Most commonly between MC3 and MC2, and MT3 and MT4
Are ‘splints’ clinically relevant?
If so, how do you treat them?
Many are of no clinical significance, but if extensive, can impinge on suspensory ligament: infiltrate with corticosteroids, removal in some cases
How do you treat fractured splint bones based on their location?
Proximal: need healing/fixing
Mid: most can be removed
Distal: can be removed
Which diagnostic procedure could you use in a lameness without clinical signs, or inconclusive radiographs?
Scintigraphy
Which carpal bone is more at risk of slab/bi-articular fractures?
Third carpal bone
How do you treat slab/bi-articular fractures of the carpal bones?
If incomplete and non-displaced: 6 months rest
Surgery:
Thin fractures: surgically remove
Internal fixation
What is the function of the palmar intercarpal ligaments?
Prevent dorsal displacement of intercarpal joint
What is the only treatment option for multiple palmar fragmentation?
Arthrodesis
How do you treat OA of the tarsal joint?
Intra-articular steroids
Intra-articular ethanol
Surgical arthrodesis
How does the prognosis for suspensory desmitis differ between the FL and HL?
Why does it differ?
FL: usually favourable prognosis without surgery
HL: usually unfavourable prognosis without surgery
Due to risk of compartment syndrome in the HL: close proximity of suspensory ligament to MT3 and thick fascia -> pressure on plantar metatarsal nerves
Can transect fascia to relieve pressure or transect nerves innervating the suspensory ligament (lateral plantar nerve)
What is the treatment for suspensory ligament desmitis of the FL?
Controlled exercise for 3-4 months Shock wave (analgesia, stimulates healing) If recurrent/non-responsive: intra-lesional PRP, stem cells, neurectomy
What is the treatment for suspensory ligament desmitis of the HL?
Surgery:
Can transect fascia to relieve pressure and prevent compartment syndrome
Can also transect nerves that innervate the suspensory ligament (lateral plantar nerve)
How do you identify C6 on a radiograph?
It is shorter than C5
Has a transverse process split into a cranial, caudal and ventral part
Ventral process= how we recognise it on radiographs
How do you identify C7 on a radiograph?
Shorter than C6
Has a small dorsal spinous process
How do you identify T1 on a radiograph?
Has a large dorsal spinous process
Give some presenting signs of neck pain
Neck stiffness/pain/’locking’
Acute trauma
Poor performance/ problems performing specific manouvres
Ataxia (usually low-grade)
Why are disc problems rare in horses?
No nucleus pulposus (only fibrous intervertebal discs)
Give some presenting signs back pain
Poor performance Behavioural changes Uncomfortable when ridden Stiffness in the back Back spasms Difficulty in being tacked up Bucking/rearing
How do you treat fractures of the withers?
2-3 months box rest
NSAIDs
How would you recognise saddle-induced trauma?
Dry spot under saddle after riding
Indicates excessive pressure
Often see hair loss/swelling/increased sensitivity
How do you treat saddle-induced trauma?
Rest/ice
US therapy
Low-powered laser for indolent wounds
Correct inciting cause
What are the clinical signs of supraspinous ligament damage?
Rigid gait/elevated head/reduced stride
Heat/pain/swelling (acute)
Thickening of ligament (chronic)
How do you diagnose supraspinous ligament damage?
US
How do you treat supraspinous ligament damage?
Acute: cold compress, NSAIDs, rest
Chronic: physio, shockwave analgesia?
What is ‘kissing spine’?
Impingement of the dorsal spinous processes
Not always significant
How do you diagnose ‘kissing spine’?
Confirm significance
Intra-lesional LA
Exclude other causes of pain first
What are the treatment options for impinging dorsal spinous processes?
Medical/conservative: PBz, shockwave therapy, phyio
Surgical: removal of all/part of the affected dorsal spinous processes
How can you treat dorsal articular facet arthropathy (spine arthritis)?
Light plane of work +/- NSAIDs Oral supplements? Phyio Shockwave therapy US-guided periarticular injections
