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Musculoskeletal > LA MS 6: Angular Limb Deformities > Flashcards

LA MS 6: Angular Limb Deformities Flashcards

1
Q

Main Pediatric Conditions

A

Tendon laxity - weak flexor tendons
Flexural deformities - contracted tendons
Angular limb deformities - limb deviations

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2
Q

SDF Anatomy

A

Origin at the epicondyl of humerus

Inserts at P2

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3
Q

DDF Anatomy

A

Origin at epicondyl of humerus

Inserts at P3

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4
Q

SDF Check Ligament

A

Distal palmar aspect of radius

If you cut this, effectively lengthen musculotendinous unit of the SDF

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5
Q

DDF Check ligament

A

If cut this one, lengthen musculotendinous unit of DDFT

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6
Q

Tendon Laxity

A

Typically newborn foals
–congential&raquo_space;> acq’d
HL&raquo_space;> FL

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7
Q

Tendon Laxity CS

A

Not weight bearing on toes, walking on heel bulbs
Severe cases rest fetlocks on the ground
Animals get get concussion early forces, contusions - IFXs of heel bulbs or fetlocks

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8
Q

Congenital Tendon Laxity

A 
Etiology: musculotendinous weakened 
--prematurity 
--Primary systemic illness 
--lack of exercise 
Often will resolve on own
Restrict exercise - protect from hurting self
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9
Q

Acq’d Tendon Laxity

A

Etiology - induced weakness

  • -bandaging (avoid in foals!)
  • -splinting
  • -casting for extended periods
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10
Q

Tendon Laxity Tx

A

Trim heels flat –> elim rocker effect
Heel extension shoes (more severe cases)
–provide palmar/plantar support
–protect fetlocks and heel bulbs from trauma
–Just be careful about the coronary band: can induce damage if squeezed too tightly or glued on
Exercise
Prog - favorable
Be sure to protect fetlocks and heel bulbs from contusions!

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11
Q

Why Injuries/erosions on distal limb bad

A

Difficult to tx - no place to come to or contract in distal limb
Can turn sour very quickly: IFX of sesamoid bones, jt IFX

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12
Q

Flexural deformities

A

“Contracted tendons”
Persistent hyperflexion of jt
–tendons functionally too short compared to bone
FL > HL
–typically only 1 jt: coffin, fetlock or carpus
Congenital or acquired

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13
Q

Congential Flexural Deformities

A 
Etiology = multifactorial 
--Uterine malpositioning 
--Genetics 
--Idiopathic 
Fetlock and carpal deformities = most common 
--Fetlock: SDF, DDF
--Carpus: combination and carpal fascia 
(Club foot = acquired)
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14
Q

Congential Flexural Deformities Tx

A 
Increase exercise 
Oxytet 
NSAIDS 
Splints during the day 
Toe extension shoes 
Sx in severe cases 
***MUST BE ABLE TO STAND AND NURSE***
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15
Q

Congenital Flexural Deformities Prog

A

Better if shorter duration and the limb can be straightened manually

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16
Q

Acquired Flexural Deformities

A 
Uni or bilat 
Most common = fetlock, coffin jt 
Etiology
--chronic pain in affected limb 
--rapid growth --> nutrient imbalances, genetics
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17
Q

Acq’d flexural deformities coffin jt

A 
Contracture of DDFT "club foot"
Most developing btw 4 weeks and 4mo 
Stage 1: dorsal hoof wall less than vertical 
--can fix at this stage 
Stage 2: dorsal hoof wall over vertical 
--prog poor for athletic performance
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18
Q

Tx Acq’d Flexural Deformities of Coffin Jt

A 
Dietary changes 
Exercise 
Toe extension shoes 
NSAIDS, sometimes oxytet 
Sx: distal check ligament desmotomy, may need DDF tenotomy for stage 2
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19
Q

Sx for Acq’d Flexural Deformities - coffin jt

A

Be careful when doing this sx that doesn’t cut the wrong structure!!!

Check much bigger than SDF or DDF in live horse!
Prognosis guarded for stage 2 cases

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20
Q

Acq’d Flexural Deformities: fetlock

A

Contracture of SDF
Knuckle forward at fetlock with the hoof in normal alignment
Most develop btw 9mo and 2yr
Most often both SDFT and DDFT involved

21
Q

Acq’d Flexural Deformities: fetlock tx

A

Dietary changes
Exercise
Toe extension shoes
NSAIDS, sometimes oxytet
Sx: prox +/- distal check ligament desmotomy, rarely SDF tenotomy
Splinting of limb best in hospital setting

22
Q

Acq’d Flexural Deformities: fetlock Prog

A

Variable - jt capsule fibrosis

If do sx in show horses, will always have slight cosmetic defect

23
Q

Angular Limb Deformities

A

Lateral or medial deviation of the limb
–varus = medial deviation of limb below jt
–valgus = lateral
Congenital or acquired

24
Q

Acquired Angular Limb Deformities

A

Often will see in a horse with altered WB for so long that varus from increased WB on good leg

25
Q

Angular Limb Deformities - who

A 
Rare in ponies 
Age: foals, usually quite young 
Breed: all, esp those with rapid growth 
Limb: FL > HL
Sites: carpus, fetlock, tarsus
26
Q

Angular Limb Deformities Most Common Deformities?

A

Carpal valgus, fetlock varus

27
Q

Angular Limb Deformities Need to Know

A 
Is a deformity present?
Has the deformity changed over time?
What is the deformity? 
What jt(s) involved? 
What should you do - act or wait and see?
28
Q

How to Examine Foals

A

Look at foal from the front
Palpate limb - can you correct it?
Examine the foot
Watch the foal walk

29
Q

Looking at foal from the front

A

Align yourself with the toe of the foot
Ask where the knee is and the rest of the limb?
–look for wounds on medial aspect of carpus if very knock-kneed

30
Q

Palpate Limb

A

Joint Laxity
Can the deformity be manually corrected?
Heat, pain swelling?
–also check opposite limb

31
Q

Examine foot

A

Is hoof worn more on one side?
Rasp should be on your hand
Make it smooth and then watch it walk again

32
Q

Watch Foal Walk

A 
Don't forget to look at mom too!
Watch foal travel
Look for:
--multiple limb involvement 
--lameness in opposite limb 
--similar deformities in the mare
33
Q

Congenital Angular Limb Deformities

A

Present @ birth, may correct without tx
–foals start out a little carpus valgus
If severe (>15 degrees) or not improving within 5-7d, tx indicated

34
Q

Congenital Angular Limb Deformities Etiology

A

Intrauterine malposition
Joint laxity - prematurity
Incomplete ossification of cuboidal bones (normally 300d gestation)

35
Q

Congenital Angular Limb Deformities: different from windswept foals

A

Windswept foals have both HL curving in the same direction
–ligament and tendon laxity
–self correct in a few weeks
Tx: controlled exercise

36
Q

Acq’d Angular Limb Deformities

A

Born straight but go crooked within weeks or months of birth
Etiologies
–growth plate injury or physitis
–lame in CL limb
–Overnutrition that leads to rapid growth
–genetic predisposition to rapid growth

37
Q

Angular Limb Deformities Dx

A 
Visual and PE
--Lameness in opp limb 
--Mare's legs 
RADS 
--long plates 7x17
--DP (carpus), lateral (Tarsus)
--Determine degree and pivot pt
38
Q

Incomplete Ossification

A

Premature/dysmature foals
Usually severe deformity
–carpus valgus
–sickle hocked

39
Q

Incomplete Ossification tx

A

Sleeve (tube) casts
–ends at fetlock ie doesn’t include foot
–Max 14d
Early tx essential because abN ossification pattern occurs

40
Q

Angular Limb Deformities Tx - Conservative

A 
Mild cases (5-10degrees) or early in physeal growth 
--rest, trimming, shoes
41
Q

Angular Limb Deformities Tx - Sx

A

Moderate to severe cases or at end of physeal growth

Periosteal transaction, transphyseal bridging, single transphyseal screw, wedge osteotomy

42
Q

Other Angular Limb Deformities: Conservative Tx

A

Corrective trimming: lower the wall toward which hoof deviating
–ex: if turned out, trim outside wall
Shoeing: place extension on side of hoof that wearing out of most
–ex: if turned out, inside (medial) extension

43
Q

Other Angular Limb Deformities: Conservative tx - fetlock varus

A

Trim inside

Outside extension

44
Q

Angular Limb Deformities Sx: Periosteal Bridging

A

Performed to stimulate growth - on concave side, prox to physis
Radius - ulnar osteotomy
+/- transphyseal bridging on opposite side

45
Q

Angular Limb Deformities Sx: Transphyseal bridging

A 
Performed to slow growth 
--on convex side of deformity 
--screws prox and distal to physis 
--figure of 8 wires around screws 
Remove implants when straight!!!
46
Q

Angular Limb Deformities Sx: Transphyseal Screw

A 
Performed to slow growth
--convex side of deformity 
--single lag screw across physis 
--improved cosmetic appearance vs bridging 
Remove implants when straight
47
Q

Angular Limb Deformities Alpacas

A

Normally carpus valgus - sx if only a true deformity

48
Q

Angular Limb Deformities Prognosis - incomplete ossification

A

Good if treated early

Guarded if treated late or have crush injuries

49
Q

Angular Limb Deformities prognosis - other angular limb deformities

A

Severe (>15 degrees) = fair if early
Lower jt = fair if early, generally less success DT short time for correction
End of physeal growth = less success

Musculoskeletal (10 decks)

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