Forelimb Lameness

Question 1

What major condition of joints can result in lameness? What kind of Dx tools can we use?

Answer 1

OA!!

Arthroscopy
Rads
US

Question 2

What is Ringbone? What are the two types?

Answer 2

OA of interphalangeal joints (new bone added around joints)

"Low" = DIP (coffin) 
"High" = PIP (pastern) 

*look up pics to differentiate

Question 3

How can we manage/tx Ringbone?

Answer 3

Both low and high can be difficult to manage medically

• Intra-articular injections (TA + HA)
• NSAIDs
• Shoeing changes

Arthrodesis

• DIPJ (low) = salvage
• PIPJ (high) = athletic use

Question 4

How do we Dx MCP Jt (Fetlock): Synovitis and OA? How do we Tx?

Answer 4

Dx:

• Effusion of fetlock jt
• IA anesthesia
• Rads

Tx:

• Medical = IA medication
• Surgical = if severe, arthrodesis (salvage)

Question 5

What traumatic fragments (of the fetlock) are common in racehorses? why?

Answer 5

Dorsal P1 fragments

Due to hyperextension

Question 6

How do we diagnose OC fragments of the Fetlock? Tx? Prognosis?

Answer 6

Dx: 
- variable lameness 
- effusion of fetlock jt 
IA or low 4-pt nerve block
- rads 

Tx:
- Sx = arthroscopic removal if IA

Px:
- fair to good

Question 7

What is a subchondral cyst? How do we dx? tx? Px?

Answer 7

Cysts in bone underneath the cartilage - caused by trauma or OC

Dx: 
- variable lameness 
- effusion of fetlock jt 
IA or low 4-pt nerve block
- rads 

Tx:
- Sx = arthroscopic removal if IA

Px:
- variable

Question 8

Carpal Synovitis, Capsulitis, OA

Dx? Tx? Px?

Answer 8

Variable lameness

Effusion, capsular thickening, bony proliferation

Dx: Rads

Tx: IA meds; arthrodesis - severe (salvage)

Px: variable

Question 9

OC fragments of the Carpus

The ____ and middle _____ joints affected

Common in ______ due to hyperextension

______ fragments&raquo_space;»» ______ fragments

Answer 9

Radiocarpal

Carpal

Racehorses

Dorsal&raquo_space;> Palmar

Question 10

OC fragments of the Carpus….

Dx? Tx? Px?

Answer 10

mild lameness and carpal effusion

Dx:

• IA anesthesia
• Rads (multiple views)

Tx:
- arthroscopy

Px:
- good if not much cartilage damaged

Question 11

Elbow OA

Dx, Tx, Subchondral cyst, Px

Answer 11

Decreased CRANIAL phase of stride

Dx:

• IA anesthesia
• rads

Tx:
- IA injection

Subchondral cyst

• medial radius
• traumatic or OC
• Sx = curette, screw, pack

Px: variable

Question 12

Shoulder OA

Dx, Tx, Px

Answer 12

Decreased CRANIAL phase of stride; Secondary to OCD, traumatic

Dx:

• IA block
• Rads
• Nuclear scintigraphy

Tx:

• IA injection
• arthroscopy

Px:
- depends on extent of damage

Question 13

Which phalangeal fracture is most common? How can P3 be fractured? Tx?

Answer 13

P2 > P1 > P3

P3 - kick wall, step hard on rock

Tx: internal or external fixation, shoeing support

Question 14

Proximal sesamoid bone fx…

Dx, tx, px

Answer 14

Dx:
variable lameness, effusion of fetlock jt, Rads

Tx:
surgical - removal, internal fixation

Px: variable… check suspensory branches!!

Question 15

MC3 condylar fractures…

Dx, Tx, Px

Answer 15

Dx: Rads

Tx:
surgical - lagscrew fixation + arthroscopy

Px:
good for non-displaced
guarded for displaced

Question 16

What is Dorsal MC dz? who gets these most? what CS do we see?

Answer 16

Shin splints! (bucked shins)… “stress fracture”

Often in young racehorses (2 and 3 yo)

Lameness is variable

• painful on palpation
• thickening over dorsal aspect of MC3

Question 17

Dorsal MC Dz…

Dx, Tx, Px

Answer 17

Dx: PE, imaging

Tx: alter training (REST!!!), extracorpeal shockwave, drill/place screw

Px: good, may take time

Question 18

(KNOW)

Splint Exostosis

Answer 18

MC2 most common

• cosmetic
• abaxial proliferation
• typically mid or proximal sections
• variable lameness (palpable pain, acute)

Question 19

(KNOW)
Splint Exostosis….

Dx, Tx, Px

Answer 19

Dx: rads, US (susp lig)

Tx:

• usually treat conservatively (esp acute cases_ –> NSAIDs, rest, ice, bandaging
• Sx removal/debridement (susp lig)

Px: generally good

Question 20

Conditions of the Foot and Phalanges

Answer 20

“Low” and “High” Ringbone

Palmar soft tissue injury

Phalangeal fractures

Question 21

Conditions of the Fetlock Jt

Answer 21

1. Synovitis and/or capsulitis
2. OSTEOARTHRITIS
3. OC fragments - Dorsal P1 “chips”
4. Osteochondrosis
   - MC3 cyst
   - palmar P1 fragments

Question 22

Conditions of the MC region

Answer 22

1. MC3 condylar fractures
2. Dorsal MC dz
3. **Splint bone exostosis
4. Splint bone fractures - distal vs proximal
5. Flexor tendonitis
6. Suspensory ligament desmitis

Question 23

Conditions of the Carpus

Answer 23

1. Carpal synovitis, capsulitis, OA
2. Osteochondral fragments - slab fractures of carpal bones
3. Carpal fractures and luxations

Question 24

Conditions of the Upper Limb

Answer 24

1. *Elbow and shoulder OA
2. Radius and humeral fractures
3. *Olecranon fractures
4. Shoulder fractures
5. *Shoulder Sweeney

Question 25

Shoulder Sweeney

Damage to the ______ nerve

Atrophy of the ____ and ______ mm

Tx?

Answer 25

Suprascapular nerve

Supra and infraspinanous mm

Tx: rest, sx - decompress nerve

Question 26

Olecranon Fracture - how do they occur? what do we see in the horse?

Answer 26

Kick injury

Lameness grade 4-5

Dropped elbow - triceps apparatus

Question 27

Olecranon Fractures

Dx, Tx, Px

Answer 27

Dx: rads

Tx: internal fixation - tension band plating

Px: fair to good, open vs closed, OA in elbow?