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MSK II > LA Axial Skeleton: Cervical/Thoracolumbar/Pelvis > Flashcards

LA Axial Skeleton: Cervical/Thoracolumbar/Pelvis Flashcards

1
Q

describe the common history with axial skeleton pathology

A
  1. lameness: asymmetry
  2. poor performance
  3. change in behavior: abnormal/dangerous behaviors, ridden and non-ridden
  4. neurologic signs/weakness
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2
Q

describe the poor performance observed in horses with axial skeleton pathology

A
  1. lack of push (won’t move forward)
  2. collection, contact with bit
  3. wont bend in one direction or sometimes both
  4. bucking, rearing
  5. lateral movement
  6. difficulty with hills
  7. giving out- stifle weakness (client tells you this)
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3
Q

describe the diagnostic approach to the axial skeleton

A
  1. static:
    -musculoskeletal palpation
    -functional exam
  2. lameness exam
    -flexion tests
    -+/- ridden exam
  3. neurologic exam! lost of overlat between neuro and painful
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4
Q

describe the functional exam of the axial skeleton

A
  1. sternal lift: belly tickles, normal horses should lift through back; if horse tries to kick or bite = problem maybe in back
  2. lumbosacral tuck: scratch at lumbosacral region and see if can lift butt through that region of their back
  3. hindlimb circles: more specific SI test: pick hindlimb up and circle it around to see if can hold in that position or make the circles
  4. cervical spine:
    -baited stretches (cookie stretches): to evaluate neck movement; but if see snacks horses will override pain to get snak so also
    -palpate individual facet joints
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5
Q

what are commonly affected structures in the cervical spine?

A
  1. articular facet joints!! first is between C2-C3
  2. intervertebral discs (live in facet joints)
  3. spinal cord
  4. nerve roots!!
  5. nuchal bursa
  6. muscles
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6
Q

what are 5 common cervical disease processes?

A
  1. cervical facet OA
    -nerve root impingement
  2. compressive myelopathy (Wobblers)
  3. nuchal bursitis
  4. subluxations/luxations/fractures
  5. intervertebral disc disease
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7
Q

describe cervical facet OA

A

clinical signs/history:
1. neck stiffness and pain
2. won’t move neck normally
3. forelimb lameness: decreased cranial phase of stride
-esp if OA further down in neck
4. explosive behavior if sudden pain
5. difficulty with collection, bit contact (dressage)
6. neurologic deficits

diagnostics:
1. radiographs: myelogram
2. nuclear scintigraphy
3. CT: +/- contrast to see if involvement of structures on spinal cord itself
4. ultrasound: can look at surface of joint

treatment:
1. medical:
-IA injections (facet joints; steroids or biologics)
-nerve root injections
-complementary therapie (acupunture, chiropractic, laser ECSWT)
-medications: gabapentin, CBD
2. surgical:
-vertebral fusion
-foraminotomy

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8
Q

describe nuchal bursitis

A

clinical signs:
1. swelling behind poll
- +/- drainage tract
2. pain on palpation
3. poor performance
4. change in head carriage

diagnostics:
1. radiographs
2. ultrasound
3. CT
4. other (sample drainage)

treatment:
infectious:
1. debridement/lavage
2. anti-inflam: NSAIDs, cryotherapy
3. antimicrobials: systemic or local

non-infectious:
1. debridement/lavage
2. anti-inflam: NSAIDs, corticosteroids (local), cryotherapy
3. ECSWT

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9
Q

describe subluxations/luxations/fractures

A

clinical signs/history:
1. trauma
2. juvenile: born abnormal, or baby got head stuck somewhere
3. neck pain
4. abnormal head/neck carriage
5. ataxia that develops to paresis that develops to paralysis

diagnostics:
1. radiographs: limited with what views can have; more options in babies bc smaller
2. CT

treatment:
1. surgical stabilization
2. conservative: NSAIDs, stall rest
3. euthanasia

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10
Q

describe intervertebral disc disease

A

can be cervical, thoracolumbar, or lumbosacral

probs underdiagnosed due to imaging limitations in horses, CT helps ID

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11
Q

describe pathology of the thoracolumbar spine

A

clinical signs/history:
1. poor performance
2. ridden behavior changes

diagnostics: even more limited!
can only rads and ultrasound unless minihorse bc can’t fit in CT

affected structures:
1. dorsal spinous processes
2. articular facet oints
3. IV discs
4. nerve roots
5. muscles: multifidus muscle atrophies with thoracolumbar pain!!!! ON EXAM!!

fractures/sublux can have pretty severe clinical signs in this region

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12
Q

describe dorsal impingement of spinous processes (kissing spine) treatments

A

medical:
1. methocarbamol
2. local injections: corticosteroid
3. alternative therapies: acupuncture, chiropractics, ECSWT
4. core strengthening exercises

surgical:
1. intraspinous ligament desmotomy
2. ostectomy

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13
Q

describe treatment of thoracolumbar facet OA

A
  1. methocarbamol
  2. IA injections: corticosteroids, orthobiologics
  3. alternative
  4. core strengthening
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14
Q

describe thoracolumbar fractures

A
  1. traumatic: cranial thoracic
  2. maladaptive remodeling: common in quarter horse racehorses in the caudal lumbar region
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15
Q

describe pathology of the sacroiliac region (pelvis)

A

clinical signs/history:
1. poor performance
2. difficulty cantering, maintaining lead
3. gluteal pain
4. difficulty holding up hind feet

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16
Q

what 3 joints are associated with the SI region?

A
  1. SI joint
  2. inter-transverse joint (IT joint): wing of sacrum interacts with last transverse process of lumbar vertebrae
  3. lumbosacral (LS) joints: articular facets and LS disc

these joints get OA changes like osteophytes!

17
Q

describe diagnostics of the sacroiliac region

A

hard! giant glutes get in the way and lack of abnormalities on imaging does not mean horse not have pain! eliminate other causes and use functional exam

  1. nuclear scintigraphy: so much muscle can = false negative though
  2. ultrasound: transrectally, but can only see a little bit; transcutaneous very limited
18
Q

describe treatment of pathology in the sacroiliac region

A
  1. methocarbamol
  2. periarticular injections: corticosteroids and orthobiologics
  3. alternative therapies
  4. exercise/core exercises/turnout
19
Q

describe coccygeal vertebral fractures

A

clinical signs/history:
1. trauma
2. swelling
3. loss of function

diagnostics:
1. palpation
2. radiographs
3. ultrasound

20
Q

describe degenerative conditions

A

only post mortem findings currently

  1. dorsal root ganglioneuritis: axial skeleton pain, progressive
  2. equine degenerative myeloencephalopathy: progressive ataxia and behavioral changes

MSK II (40 decks)

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