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Locomotor > Investigation of Equine Lameness > Flashcards

Investigation of Equine Lameness Flashcards

1
Q

What is the appropriate approach to the lame horse?

A
  1. History
  2. Observation from a distance
    - Symmetry
    - Posture
    - Conformation
  3. Palpation
    - Inc hoof testers
  4. Gait observation
  5. Selected examination steps
    - Manipulation
    - Flexion tests
  6. Diagnostic analgesia
  7. Diagnostic imaging
  8. Treatment
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2
Q

What things should you ask in an equine lameness investigation?

A

History of trauma, duration of lameness, progession, effects of exercise, managment changes (shoeing, training, stable/turnout, housing, health diet, medications)

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3
Q

What is the purpose of a conformation assessment in terms of equine lameness?

A

determines shape, wear, flight of foot and weight distribution

faulty conformation is not an unsoundness, just a warning sign

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4
Q

What is meant by ‘referred lameness’?

A

When HL lameness is confused for FL lameness

Looks like ipsilateral FL lameness
When lame leg is WB the head is down (making it seem that the other limb is lame)
Associated with HL lameness grade 6+

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5
Q

Which local anaesthetics are used for diagnostic analgesia in equine lameness?

A

Mepivicaine or Lidocaine

  • Fast acting (mins)
  • Lasts 1.5-3 hrs
  • M is less irritant
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6
Q

What are the side effects of equine diagnostic analgesia and how are they dealt with?

A

ST swelling
- apply stable bandage overnight if several blocks have been performed
Haematoma (bruising)
- apply pressure immediately post-injection
Infection (rare)
Synovitis
Systemic side effects (rare)

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7
Q

List the nerve blocks of the forelimb.

A
  1. Palmar digital
  2. Abaxial sesamoid
  3. Low 4-point
  4. High 4-point
  5. Subcarpal
  6. Median & ulnar
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8
Q

List the nerve blocks of the hindlimb.

A
  1. Palmar digital
  2. Abaxial sesamoid
  3. Low 6-point
  4. High 6-point
  5. Deep branch
  6. Tibial & peroneal
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9
Q

Describe a palmar digital block

A

Blocks distal 2/3rds of the foot
Use a 25 gauge 5/8” needle
Inject 2ml Mepivicaine into the lateral and medial palmar digital nerve bundles @ the level of the distal pastern

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10
Q

Describe an abaxial sesamoid nerve block.

A

Block everything below the fetlock
Use 25 gauge 5/8” needle
Inject 2ml Mepivicaine @ into the lateral and medial palmar digital nerve at the level of the distal border of the proximal sesamoid bones

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11
Q

Describe a low 4-point nerve block.

A
  1. Palmar metacarpal/tarsal nerve [M+L branches]
    - 25 gauge 5/8” needle
    - 2ml Mepivicaine at each site
    - inj @ the distal aspect of the 2nd & 4th metacarpal/tarsal bones
  2. Palmar nerve [M + L branches]
    - 25 gauge 5/8” needle
    - 2ml Mepivicaine at each site
    - inj dorsal surface of DDFT [between DDFT and SL, hands breadth above fetlock]
    - insert needle perpendicular to limb
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12
Q

Describe a high 4-point nerve block of the forelimb…

A
  • Use 2-3ml Mepivicaine at each site
  • 25 gauge 5/8” needle
  • inj @ level just distal to carpus
  • desensitizes 2nd + 4th metacarpal bones, interosseous ligament, proximal suspensory ligament & accessory ligament of the DDFT
  1. Palmar metacarpal nerve [M+L branches]
    - inj @ b/w 2nd & 3rd metacarpal bones and 3rd & 4th metacarpal bones on the caudal aspect
  2. Palmar nerve [M + L branches]
    - inj dorsal surface of DDFT [between DDFT and SL]
    - insert needle perpendicular to limb
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13
Q

Describe a subcarpal nerve block.

A
  • 23 gauge 1” needle
  • inject 3ml of LA on inside of leg @ the level of the accessory carpal bone
  • desensitizes the origin of the suspensory ligament & proximal 2nd + 4th metacarpal bones
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14
Q

Describe a median & ulnar nerve block.

A

Median
Using a 20 gauge 2-2.5” needle inj 10-20mls LA at the caudomedial aspect of the radius just below the elbow joint where the ventral edge of the tranverse pectoral muscle inserts on the radius

Ulnar
Using a 20 gauge 1” needle inj 10mls of LA 10cm proximal to the accessory carpal bone in the groove b/w the ulnaris lateralis & the t ulnaris muscles

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15
Q

Describe a deep branch nerve block.

A

Also known as a suspensory block

Block deep branch of the lateral plantar nerve
Using a 21 gauge 1.5” needle inj 5ml of Intraepicaine 1.5cm below head of splint bone at the back of the cannon bone on the lateral aspect

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16
Q

Describe a high 6-point nerve block of the hindlimb.

A
  1. Plantar nerves
    inj 2ml LA at the dorsal surface of the DDFT 1cm below the TMT joint
    25 gauge 5/8” needle
  2. Plantar metatarsal nerves
    21 gauge 1.5” needle
    inj 2-3ml LA 1cm distal to the TMT joint b/w 2nd & 3rd metacarpal bones and 3rd & 4th metacarpal bones on the caudal aspect
  3. Dorsal metatarsal nerves
17
Q

Describe a tibial & peroneal nerve block.

A
  1. Peroneal
    inj 20ml Mepivicaine above the lateral aspect of the hock b/w the long & lateral digital extensor tendons
    20 gauge 1.5” needle
  2. Tibial
    inj 20ml Mepivicaine just cranial to the common calcaneal tendon (laterally or medially) (21 gauge 1.5” needle)
18
Q

Describe a distal interphalangeal joint block.

A
  • 20 gauge 1.5” needle
  • Inj 4-6ml of LA 1cm proximal to the coronary band at the midline perpendicular to the skin
  • Joint fluid will flow out of needle
  • Palmar digital nerves may be desensitised
19
Q

Describe a tarsometatarsal joint block.

A

20 gauge 1.5” needle

inj 5ml Mepivicaine at the head of the splint at the lateral aspect

20
Q

Describe a navicular bursa block.

A
  • use radiographic guidance
  • inj 3mls of LA 1cm proximal to the coronary band midway b/w the dorsal and palmar hoof walls
  • blocks out podotrochlear apparatus, solar toe & DDFT
21
Q

What are three common causes of equine lameness?

A

Osteochondrosis
Osteoarthritis
ST injury

22
Q

What is osteochondrosis?

A 
O = failure of endochondral ossification
OD = fragment of cartilage within the joint
23
Q

What are the clinical signs of osteochondrosis & how is it diagnosed?

A

CSs:
variable significance
not always lameness
synovitis

Dx:
radiographs

24
Q

How is osteochondrosis treated?

A

Arthroscopy

Intra-articular corticosteroid

25
Q

Explain osteoarthritis in the horse..

A

Caused by DJD
Affects distal intertarsal and tarsometatarsal joints
Most common cause of HL lameness

26
Q

What are the clinical signs of osteoarthritis in the horse?

A

+ve response to TMT joint block
Must compare to deep branch block
Radiographs

27
Q

How is osteoarthritis treated in the horse?

A 
Intra-articular corticosteroid
- Methylprednisolone
Surgical arthrodesis
NSAIDs
- Phenylbutazone
28
Q

What types of ST injuries occur in the horse?

A 
suspensory ligament desmitis
tendonitis
- SDFT
- DDFT
annular ligament desmitis
manica flexoria injury
check ligament desmitis (ALDDFT)
collateral ligament injury
distal interphalangeal joint
29
Q

How are ST injuries detected in the horse?

A

Should be palpable upon physical exam - heat, swelling + confirmed by US

30
Q

What are the treatment options for ST injury in the horse?

A 
Cold hosing in acute stage
NSAIDs
- Phenylbutazone
Box rest
Bandaging
Compagel
For suspensory ligament desmitis:
- Extracorpeal shockwave therapy
- Neurectomy + fasciotomy
31
Q

What are the 4 natural gaits?

A

Walk

  • even 4-beat rhythm
  • not suitable to recognise subtle lameness

Canter

  • 3-beat gait with lead preference
  • useful for back/rider/saddle associated - problems
  • difficult to recognise subtle lameness

Trot

  • 2-beat diagonal gait
  • steadiest and most rhythmic gait
  • preferred for lameness exam

Pace

  • 2-beat lateral gait
  • ipsilateral fore- and hindlimbs elevate alternatively
  • considered normal only in STB racehorses
32
Q

What is the goal of gait observation?

A

To localise the source of lameness in the limb(s) and determine severity to allow for targeted diagnostic imaging and treatment

33
Q

How is lameness quantified on the 10 point scale?

A

0/10: sound
2/10: lameness hard to detect at walk or trot
4/10: lameness barely detectable at walk, easy to see at trot
6/10: easily detectable lameness at walk
8/10: hobbling at walk, unwilling to trot
10/10: non weight bearing

34
Q

What aids recognition of lameness from the side view?

A 
Fetlock extension ('fetlock drop')
- more pronounced on sound limb (usually)
Changes in limb flight characteristics
35
Q

What aids recognition of forelimb lameness?

A

Head nod/elevation
- head down when sound forelimb hits ground
- head up when lame forelimb hits ground
Asymmetrical contraction of pectoral muscles

Louder noise when landing on the sound limb

36
Q

What aids recognition of hindlimb lameness?

A

Pelvic hike/drop
- pelvis hikes up and drops down with a larger range of motion on the lame limb

Elevation of tuber calcis
- higher on sound side

Drifting
horse moves away from lame limb (lame limb tracks under the body or is posted out)

Noise
- harder landing on sound limb = louder noise

37
Q

What different conditions should be used/considered during a lameness examination?

A 
Different surfaces: soft vs hard
Circle vs straight 
Different gaits 
Under saddle (owner vs other rider)
High-speed treadmill

Locomotor (16 decks)

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