Joint Lameness Flashcards
What is idiopathic synovitis?
chronic synovial effusion of a joint
unknown cause
no lameness, tenderness, head, or radiograph changes
What are examples of idiopathic synovitis?
bog spavin of tarsocrural joint
windpuffs of fetlock
What are the causes of bog spavin?
poor tarsal conformation
strain and minor trauma
What are the signs of bog spavin?
distention of tarsocrural joint
no lameness
How do you diagnose bog spavin?
clinical signs
How do you treat bog spavin?
do nothing; drainage (will probably fill back up); intraarticular injection of corticosteroids (Depo-Medrol); bandaging
What is bog spavin?
a painful swelling in a horse’s hock joint that’s caused by inflammation and fluid buildup
What are windpuffs?
fluid-filled bumps that appear on the lower legs of horses
AKA windgalls
What are the causes of windpuffs?
straight fetlocks
heavy work
What are the signs of windpuffs?
distention of palmar/plantar pouch of fetlock joint
no lameness
How do you diagnose windpuffs?
clinical signs
How do you treat windpuffs?
do nothing, pressure wraps; osmotic agents
What are the causes of traumatic arthritis?
single or repetitive episodes of trauma
can progress to osteoarthritis (OA)
What might traumatic arthritis include?
synovitis - inflammation of synovial membrane
capsulitis - inflammation of joint capsule
sprain - injury of specific ligaments associated with joint
meniscal tears - femorotibial joints
intra-articular fracture
What are examples of traumatic synovitis and capsulitis?
carpitis
osselets - fetlock joint
What are signs of traumatic synovitis and capsulitis?
effusion, heat
pain on flexion
+/- lameness
How do you diagnose traumatic synovitis and capsulitis?
rads, CT or MRI to rule-out articular changes
synovial fluid analysis to rule-out infection
arthroscopy
How do you treat traumatic synovitis and capsulitis?
conservative: rest, immobilization, hydrotherapy, liminents, DMSO, NSAIDs, shoeing changes
more aggressive: IA medications, synovectomy (surgical excision of synovial membrane)
What are sprains?
stretching or tearing of supporting ligament(s) of joint by forced movement beyond normal range
What are signs of sprains?
swelling, pain
lameness
+/- avulsion fracture: piece of bone pulled loose
What are luxations?
dislocation of joint
may be complete or parietal (subluxation) - complete - pastern, fetlock, hip, hock joints
most involve ligaments (severe pain), capsule and tendons
How do you treat luxations?
casting, surgical arthrodesis, femoral head ostectomy (FHO) for hip
will get OA
What are the causes of meniscal tears?
primary or secondary to stifle problems
shifting or shear forces between femur and tibia
What are the signs of meniscal tears?
lameness worse with exercise
effusion
positive stifle flexion
How do you diagnose meniscal tears?
U/S, rads, arthroscopy
How do you treat meniscal tears?
stem cells
arthroscopic removal of torn portion
What is the prognosis of meniscal tears?
50% with surgery
What are the causes of intra-articular fractures?
traumatic injury (fetlock or carpus)
osteochondritis dissecans (OCD)
What is osteochondritis dissecans (OCD)?
failure of endochondral ossification
cartilage/bone fragments or flaps that develop along articular surfaces of joints
What is the most common form of developmental orthopedic disease in horses?
osteochondritis dissecans
Where is osteochondritis dissecans found?
often along non-weight bearing surfaces
most common - stifle, tarsus, fetlock, and shoulder
What are signs of osteochondritis dissecans?
joint effusion
mild to moderate lameness
often bilateral
How do you diagnose osteochondritis dissecans?
radiographs
exploratory surgery
arthroscopy or arthrotomy
How do you treat osteochondritis dissecans?
conservative - rest, joint supplements
surgery - arthroscopy or arthrotomy
What are subchondral bone cysts?
sac-like cavities in bone beneath cartilage surface
filled with fluid or soft material
Where are subchondral bone cysts found?
often bilateral
articular or non-articular
common locations - stifle (medial femoral condyle), fetlock, elbow
What are the causes of subchondral bone cysts?
defect of ossification (developmental)
IA subchondral bone trauma
How do you diagnose subchondral bone cysts?
rads
nuclear scintigraphy
How do you treat subchondral bone cysts?
conservative treatment: IA and systemic joint meds
surgical treatment: debridement, injection of corticosteroids in lining, grafting of debrided cyst (bone, chondrocytes, stem cells)
What is the prognosis of subchondral bone cysts?
good with surgery
What is osteoarthritis?
AKA degenerative joint disease
progressive deterioration of articular cartilage (with changes in bone and soft tissues of joint)
synovitis and effusion
pain and dysfunction
What are the primary types of OA?
acute: associated with high-motion joints (carpus and fetlock)
insidious: associated with low motion joints (pastern “ringbone” and tarsus “bone spavin)
What are the secondary types of OA?
secondary to other identified problems
intra-articular fractures
luxations/sprains
wounds -> septic arthritis
osteochondrosis (OCD or SBC)
What is the pathophysiology of primary OA?
repeated concussive forces -> thickening and fibrosis of synovial membrane and joint capsule -> breakdown of articular (hyaline) cartilage -> periosteal proliferation and bone formation (osteophytes) -> decreased flexion of joint (decreased range of motion)
What are the signs of OA?
slight to severe lameness
decreased range of motion
heat, pain, swelling
effusion
positive flexion
How do you diagnose OA?
radiographs (loss of joint space, periosteal proliferation, osteophytes, enthesophytes, sclerosis)
thermography
nuclear scintigraphy
regional and IA nerve block
How do you treat OA?
corrective shoeing
medications: NSAIDs, IM PSGAGs, IV hyaluronic acid (HA), IA hyaluronic acid, IA corticosteroids, IA IRAP
surgery: arthroscopic removal of osteophytes, arthrodesis
What is ringbone?
a degenerative joint disease in horses that affects the pastern (high ringbone) or coffin (low ringbone) joints
Where does high ringbone happen?
distal PI or proximal PII
Where does low ringbone happen?
distal PII or proximal PIII
What is bone spavin?
tarsal OA
common cause of hind limb lameness
involves distal intertarsal and tarsometatarsal joints (often affects dorsomedial surface first)
ankylosis can occur over time –> lameness resolves
What are some additional treatment for bone spavin?
cunean tenectomy (part of cunean tendon is removed)
surgical ankylosis (drilling)
non-surgical ankylosis (chemical injection)
What is sacroiliac disease?
involves SI joint and/or adjacent soft tissue structures
What are the causes of sacroiliac disease?
single event trauma (getting cast)
repetitive injury with performance
What are the signs of sacroiliac disease?
low grade lameness and poor performance
reduced stride length in one or both hindlimbs
reduced propulsion and engagement
refusal to jump or go downhill
bunny hop at canter
swapping leads or cross cantering
stiff/rigid with lack or lateral flexion in lumbosacral region
behavioral changes, especially when asked to canter
asymmetry of tuber sacrales
gluteal muscle atrophy
palpable pain over tuber sacrales
How do you diagnose sacroiliac disease?
pain on palpation
local anesthetic
nuclear scintigraphy
thermography
rectal examination
ultrasound (assess dorsal sacral ligaments)
How do you treat sacroiliac disease?
rest
NSAIDs
muscle relaxers
injection of SI joint/area (corticosteroids, antibiotics)
What is septic osteoarthritis?
EMERGENCY!
must be diagnosed and treated ASAP to minimize and prevent OA
can destroy joint quickly due to inflammatory mediators and toxins produced by bacteria
inflammatory response contribute to articular degeneration
What are the causes of septic OA?
adult - trauma allows bacteria into joint
foal - septicemia/hematogenous
What are the signs of septic OA?
lameness, effusion, swelling, cellulitis,
How do you diagnose septic OA?
synovial fluid analysis, radiography (lysis)
How do you treat septic OA?
sterilize joint - systemic and IA antibiotics, regional limb perfusions
allow drainage - lavage with saline and antibiotics, +/- arthroscopy and arthrotomy
restore normal joint environment - IA sodium hyaluronate
bog spavin
windpuffs
Describe the evolution of osteoarthritis
luxation
meniscal tears
intra-articular fracture
osteochondritis dissecans
top OCD
bottom normal
What does OCD look like on a radiograph
OCD
OCD
OCD
Describe what a subchondral bone cyst looks like on a radiograph
SBC
OA
What does a joint affected by osteoarthritis look like?
OA
OA
Describe what ringbone looks like
high ringbone
low ringbone
bone spavin
bone spavin
bone spavin
bone spur
lysis
