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Locomotor > Intro and investigation of lameness > Flashcards

Intro and investigation of lameness Flashcards

1
Q

Outline approach to the lame horse

A 
History	(Anamnesis)	
• Observation	from	a	distance:		
– Symmetry		
– Posture	
– Conformation	
• Palpation	
– Incl. hoof	testers	
• Gait Observauion	/	Movement	
– Baseline	
– Addiyional	Movement	
• Selected	Examination	Steps	
– Manipulations	
– Flexion	Tests	
• Diagnostic	Analgesia	
• Diagnostic	Imaging	
• Treatment
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2
Q

Name 2 objective tests

A
  • kinetics

- kinematics (motion of points, bodies and systems/ groups of bodies without consideration of the causes of motion)

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3
Q

What are the 2 types of observation?

A
  • subjective

- objective (kinetic and kinematic)

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4
Q

What basic info is important in the hx?

A

• SIGNALMENT – Sex, Breed, Age*, Use
• CURRENT LAMENESS: What is the problem?
– hx of trauma
– Duration of lameness
– Deterioration or improvement, circumstances
– Effects of exercise
– Management Changes
• Changes in shoeing or related changes
• Changes in training or performance intensity
• Changes in stable/working/turn-out surface
• Changes in housing
• Changes in health & diet
• Current medication and response, response to rest
• Past Lameness Problems

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5
Q

Specifc aspects of hx that are important in a lameness work up

A 
TYPE OF SPORTING ACTIVITY	
– Level	of	Competition	(past,	current,	intended)	
• ADDITIONAL SOURCES	
– Images	/	Video	tapes	
– Records	
– Diagnostic	Imaging	
– Discussion	with	others
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6
Q

Where might chronic porgressive OA affect the older horse? 8

A 
– PIP joint
– DIP joint	
– MCP	joint	
– Carpometacarpal	joint	
– Coxofemoral	joint	
– FemoroRbial	joints	
– Tarsus	
– Previous	injury	(retired	racehorses)
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7
Q

What should you observe from a distance?

A
  • symmetry, posture and conformation
  • poor conformation doesn’t necessarily mean lameness
  • significant variations usually obvious
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8
Q

What should you palpate?

A
  • SDFT origin and insertion
  • distal sesamoidean ligaments
  • digital pulses
  • hoof testers
  • tendons (loaded and unloaded)
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9
Q

What are you looking for when palpating joints?

A
  • distension
  • temperature
  • pain
  • ROM
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10
Q

What should you palpate along equine back?

A
  • back

- pelvis (tuber coxae adn tuber ischii)

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11
Q

What is limb movement composed of? 2

A

horse’s travel and action

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12
Q

Define a horse’s ‘travel’

A
  • flight of a single hoof in relation to other limbs

- often viewed from side or behind

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13
Q

Define a horse’s ‘action’

A

– Overall description of gait characterisyics
– Takes into account joint flexion, stride length, suspension and other qualities – Variation between different types and breeds

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14
Q

What are the phases of an equine stride?

A
  • landing
  • slide
  • loading
  • stance
  • breakover (heel lift and toe pivot)
  • swing
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15
Q

Describe gait - walk

A
  • Even rhythm four-beat gait

* Not very suitable to recognise subtle lameness

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16
Q

Describe gait - pace

A
  • Two-beat lateral gait
    – Ipsilateral fore- and hindlimbs elevate alternatively
    – Viable gait for STB racehorses and some other breeds
    – Considered an impure gait for most “normal” horses
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17
Q

Describe canter

A
  • Three-beat gait with lead preference
    – Difficult to identify subtle lameness
    – Useful for back/rider/saddle associated problems
18
Q

Describe trot

A
  • Two-beat diagonal gait

• Steadiest and most rhythmic gait in most horses

19
Q

Which gait is preferred for a lameness exam?

A

trot

20
Q

If you are in doubt as to the location of a lameness, what can you do?

A
  • palpation

- nerve and joint blocks

21
Q

What should you determine with gait observation/ movement?

A
  1. is the animal lame? which legs?

2. How lame (grading system, will i be able to appreciate a difference with diagnostic analgesia)

22
Q

Goal - lameness exam

A

localise the source of lameness in the limb(s) to allow for targeted diagnostic imaging and tx (helps cost and specificity)

23
Q

Name 2 lameness grading scales

A
  • American Association of Equine Practitioners (AAEP, scale 0-5)
  • Wyn-Jones scale (0-10)
  • doesn’t matter which scale you use so long as you use one scale consistently
24
Q

Outline the AAEP lameness grading scale

A

0:Lameness not perceptible under any circumstances
1:Lameness difficult to observe and not consistently
apparent, regardless of circumstances (e.g. weight
carrying, surface, circling, inclines, hard surface etc.)
2:Lameness is difficult to observe at a walk or when
troqng in a straight line but consistently apparent
under certain circumstances (e.g. weight carrying,
surface, circling, inclines, hard surface etc.)
3:Lameness consistently observable at a trot under all
circumstances
4:Lameness is obvious at a walk
5:Lameness produces minimal weight-bearing in moRon
and/or at rest or a complete inability to move

25
Q

Outline the Wyn-Jones lameness grading scale

A

Grade 0: Sound.
Grade 2/10: Lameness hard to detect at walk or trot.
Grade 4/10: Lameness barely detectable at walk, easy to see
at trot.
Grade 6/10: Easily detectable lameness at walk.
Grade 8/10: Hobbling at walk. Unable/unwilling to trot.
Grade 10/10: Non weight-bearing

26
Q

What does a fetlock drop suggest? Exception?

A

Usually more on opposite (sound) fore- or hind
limb
• Exception: Tendon or Suspensory Ligament damage

27
Q

When might changes in limb stride be noted?

A

cranial and caudal phase of stride

28
Q

Is it easier to recognise TL or HL lameness?

A

forelimb

29
Q

Signs of forelimb lameness - 3

A

• HEAD NOD/ HEAD ELEVATION
– Head down when opposite forelimb hits ground
– Head up when lame forelimb hits ground
• ASYMMETRICAL contraction pectoral mm.
• SOUND/CONCUSSION
– Harder landing on sound limb → louder noise

30
Q

How can HL lameness be recognised? 4

A

• PELVIC HIKE
– Affected side down when lame HL hits ground
– Affected side up when opposite HL hits ground
– Greater excursion on lame HL
• ELEVATION OF TUBER CALCIS
– Higher on sound side
• DRIFTING
– Horse moves away from lame limb
– Lame limb tracks under body (most often) or is posted out
• SOUND
– Harder landing on sound limb → louder noise

31
Q

What additional factors need considering when assessing lameness? 5

A 
• SURFACE	
– Soft	vs.	hard	
• CIRCLE	
• Different	GAITS	
– Severe	lameness/Suspected	Fracture	(walk)	
– Gallop	(rarely)	
• UNDER SADDLE	
– Owner&	separate	rider	(?)	
• HIGH-SPEED TREADMILL
– STB	Pacers	&	Trolers
32
Q

How does a slow motion video affect grading score?

A

tends to increase grading score as it looks more severe than normal speed

33
Q

T/F: radiographic signs of change on fetlock and stifle can cause lameness

A

True

34
Q

How reliable is the tuber calcis elevation for evaluating HL lameness?

A

not so reliable

35
Q

What is meant by drifting?

A

horse runs obliquely (e.g. L HL brought b/w front limb tracks)

36
Q

What can a short stride length indicate?

A
  • either TL or HL lameness, easier to appreciate when HL lame as a greater distance b/w the toe of the HL and the toe of the TL when the lame HL is weight-bearing
37
Q

What can reduced fetlock drop be a sign of?

A
  • TL or HL lameness
  • observe how close the fetlock drops towards the ground
  • reduced fetlock drop is associated with the lame limb d/t reduced loading
  • easiest to observe at walk
38
Q

What parts of the history do you need? (SA)

A
  • signalment (including use)
  • current lameness (hx of trauma, duration of lameness, deterioration or improvement, circumstances, effects of exercise, management changes
  • past lameness problems
39
Q

How should you observe gait? (SA)

A
  • patient moving towards, away and across you
  • circling and turning (exaggerate abnormalities)
  • which limb is problem, concentrate on this (characterise and score)
40
Q

What manipulation should be done? (SA)

A

Move joint and limb in a controlled fashion to determine:

  • ROM/ abnormal mvt
  • pain related to mvt
  • load or unload specific structures in limb
41
Q

What is your overall assessment/ future decisions based on? (SA)

A
  • add up findings from exam
  • does patient have locomotor abnormality?
  • is it a problem to patient/ owner?
  • anatomical location known?
  • how to investigate further
42
Q

What are the objective parts of the lameness exam?

A
  • observation at rest
  • observe gait
  • palpate to recognise anatomical abnormalities
  • manipulate to locate functional abnormality

Locomotor (31 decks)

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