Exam 2 Flashcards
Lameness Exam
o Walk
o Slow steady trot
o 2-beat symmetrical gait
o increased stress and concussion
o Smooth, flat, hard surface
o Straight line and small circles
o Examine moving toward and away, as well as from the side
o May need to see during activity where lameness identified
Features of a Lameness Gait
o Consistent- pain every time the limb is used
o Regularly irregular
o Decreased stride length
o Decreased concussion
o Occurs the same every stride
o May seem inconsistent when only seen during specific activity, but should be consistent within that activity
Features of a Mechanical Gait
o Consistent
o Repeated every stride
o More irregular
o Less subtle gait alteration than a lameness gait
Features of a Neurologic Gait
o Inconsistent
o Irregularly irregular
o Foot flight, stride length, and concussion may vary with every stride
o Very common
o Easy to confuse with lameness
o Neurologic and lame
Signs of Forelimb Lameness
o Head nod
o Unequal concussion
(louder on sound limb)
o Shoulder drop
(lower when weight on sound leg)
o Decreased stride length
Define: Unequal Concussion, Head Nod, Fetlock Drop
Unequal Concussion
* Landing heavier on the sound leg
Head nod
* up when lame leg hits, down on the sound leg
Fetlock drop
* lower on the sound leg
* Shortened cranial phase of stride
Why Work in a Circle
o Used to exacerbate mild lameness
o Usually makes lameness of inside leg more noticeable
o Increased strain on lateral side of inside leg and medial side of outside leg
o If pain is equal on both limbs no head nod
Signs of Rear Limb Lameness
o More difficult to recognize
o Cannot tell source by how horse travels
o Unequal concussion
o Hip hike
up when lame leg hits ground
o Fetlock drop lower on sound leg
o Swinging leg in or out
o Shortened stride
o Head nod down on forelimb diagonal to lame hind limb
Nerve Blocks for Lameness Localization
o carbocaine(best), lidocaine, bupivicaine -> wait 10 mins
o Can start with any suspect joint
o If no clues-start distally and work your way up
o May need to perform additional blocks on another day
o Localizes lameness to a smaller area
Common Causes for Forelimb Vs Rear Limb Lameness
Common Forelimb Lameness
o Sore feet
o Navicular Syndrome/ Palmar Heel Pain
o Carpal or fetlock arthritis
o Tendinitis
o Suspensory desmitis
o OCD
Common Rear Limb Lameness
o Distal tarsitis
o OCD
o Suspensory desmitis
o Sore feet
What do these look like? Fibrotic Myopathy, Stringhalt, Shivers, Upward Fixation of Patella, Rupture Peroneus Tertius
Fibrotic myopathy
o Fibrous band of tissue
o Horse brings foot forward and then slaps down
Stringhalt
o Hyperflexion of one leg when walking
Shivers
o Spastic “shivering” when trying to backup
Upward fixation of patella
* Dragging toe
Ruptured peroneus tertius
* Floppy leg
* Can extend hock while flexing stifle
Objectives of Fracture First Aid
o Relieve stress, pain, and anxiety
o Preserve nerves and blood vessels
o Protect soft tissue and prevent bone penetration of the skin
o Prevent further damage to bones
o FIRST THING STABILIZE
Sedation for Fractures
Acepromazine:
* Limit use to only animals without signs of shock!
* mares and geldings to decrease ataxia of other sedatives
Butorphanol:
* Good analgesia, may cause excitement if given alone
Xylazine:
* predictable and safer in animal with shock
Detomidine:
* longer duration of action than Xylazine
What to do if Bone is coming out of skin on Fx
o CLEAN
o Clip?
o Cover in water soluble dressing & sterile bandage
Ideal Splint for Fracture
o Stabilize joint above & below
o Neutralize damaging forces
o Minimally cumbersome
o Easy to apply
o Does NOT require general anesthesia
o Economical/accessible
o PVC, oak boards, etc
o metal is not usually a good choice
Things to Remember about Fractures of the Phalanges & Distal Metacarpus
o Biomechanically dominated by the angle of the Metacarpal joint
o Principal bending focus becomes the fracture site rather than the joint
o Splint must include neutralizing both the bending forces of the Metacarpal joint as well as the fracture site
How to: Splint a Fracture of the Phalanges or Distal Metacarpus
o Don’t put joint in normal anatomical position
o Dorsal cortices of the bones should be aligned in a straight line ->
o Apply a light bandage (~1/2 inch thick) to the distal limb ->
o Tape splint (PVC or board) to dorsal aspect of distal limb from carpus to toe ->
o Splint should align dorsal cortices of bones & neutralize suspensory apparatus ->
o Apply cast material over splint
Important things to know about Fractures of the Mid-Forelimb
o medial aspect of the radius is not protected by muscle
o the skin is easily penetrated by a fracture and must be protected
Splint Fractures of the Mid-Forelimb
o Apply a Robert Jones from elbow to ground (3x diameter of limb)->
o Apply a lateral splint extended up the lateral side of the shoulder
o Tape securely to the proximal forelimb at the level of the axilla (prevents the distal limb from abducting)
Important things to know about Fractures Proximal to Cubital Joint
o Scapula, humerus and ulna are well protected by muscle -> stabilize the fracture and protect the skin
o disarms the triceps apparatus -> impossible for horse to fix elbow for weight bearing
o splint carpus in extension so horse can use limb for balance & ambulation
Important things to know about Fractures of the Mid & Proximal Metatarsus (Hind Limb)
o Splints are placed caudally and laterally over a Robert Jones bandage
o Robert Jones should be less extensive than on the forelimb to help keep the splints in place
o splints extend from the calcaneal tuber to the ground
Important things to know about Fractures of the Tarsus & Tibia (Hind Limb)
o Very difficult to adequately stabilize
o Reciprocal apparatus causes tarsus to flex and extend each time the stifle flexes and extends
o Stifle flexion causes fractures of the tibia or tarsus to override
o Splinting can minimize lower limb abduction-adduction and trauma
o Use Robert Jones with a single extended lateral splint that extends over the angle of the hock
o in proximal fractures splint should extend to the point of the hip
Important things to know about Fractures of the Humerus
o Do not need external stabilization
Antibiotics & Analgesia for fractures
Antibiotics for Open Fractures
o Penicillin + Gentocin
o Cefazolin + Gentocin
Analgesia For Fractures
o Phenylbutazone
o Butorphanol
o IM Detomidine
Transporting Horse w/ Fracture
o hay net may be best for keeping horse calm
o Space minimized to support the animal on all sides
o Forelimbs should be transported backwards
o Hindlimbs transported forward
o Head and neck should be left free or loosely tied for balance
Sequestrum; Pathophysiology, Clinical Signs, Diagnosis, Treatment
Pathophysiology
* Piece of dead bone that has become separated during the process of necrosis from the sound bone
* Most secondary to trauma and are infected
* Or develop secondary to vascular compromise of the cortex (periosteum)
Clinical Signs
* +/-lameness
* Localized heat and swelling
* Persistent drainage with tract
Diagnosis
* Radiographs at 12 days usually demonstrate separated bone
* Bone usually is not completely separated until 3 weeks
Treatment
* Surgical removal
* May be done standing in selected cases
* Fragment should be removed and the granulation bed débrided to healthy tissue
* +/- Antibiotics
Septic Arthritis/Tenosynovitis; Risk factors, Clinical Signs, Diagnosis
Risk Factors
* More common in foals w/ bacteremia/septicemia
* Standardbred
* Intra-articular injections
* Failure of passive transfer
* Systemic sepsis
Clinical Signs
* Lameness
* Transient fever
* Joint effusion
Diagnosis
* Arthrocentesis
* Usually >30,000 WBCs w/ 80% degenerative
* TP > 3
* gram stain slides
* culture
* rads for rule out & determine prognosis
Septic Arthritis/Tenosynovitis; Common Bacteria, Treatment, Prognosis
Common Bacteria
* E. coli
* Strep
* Staph (post injection or sx)
* Anaerobes
Treatment
* Broad spectrum antibiotics 2-3 wks post infection
* Joint lavage
* Hyaluronana IV or IA to reduce inflammation & DJD
Prognosis
* Better in adults than foals
Joint Lavage
o Indicated in ALL cases of septic arthritis
o Use needle, arthroscopy, or arthrotomy
o Sterile balanced electrolyte solution
When/How to Use Open Drainage of Joints
o chronic sepsis or cases that do not respond to joint lavage
o 3-5 cm arthrotomy incisions
->
o Drain into sterile bandage which is changed 1-2x daily
o When upper joints are involved cross tie to prevent contamination
