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Equine I > Lameness > Flashcards

Lameness Flashcards

1
Q

What does tension of the brachiocephalicus muscle often reflect?

A

Pain in the distal limb

(Will be interpreted as shoulder pain by owner)

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2
Q

Aspects of a static clinical exam in a lameness workup

A

Look at the horse:
○ Feet- hoof quality, foot imbalances
○ Legs- conformation, obvious swellings, wounds, or effusions
○ Pelvic region and shoulders- symmetry (atrophy, swellings)
○ Note if the horse is resting any legs or shifting their weight

Put your hand all over the horse and palpate:
○ The musculature for signs of atrophy and pain response
○ The legs for any wounds, swellings, effusions
○ Digital pulses- bounding?

Pick up the legs to test the range of motion (ROM) of the joints
○ Also important to note the horses response to flexing the joints

Use a hoof testers and assess the horse’s response

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3
Q

Using hoof testers

A

Hold horse’s leg between your legs so both hands are free to use hoof testers

Work your way around the sole, then put pressure on the backs of the heels and frog

Assess for pain response (snatching foot away, shuffling, etc.)

Also note any ‘sponginess’ of the sole (may indicate area of bruising)

Note- it is not a massive amount of pressure on the hoof testers, gentle pressure is sufficient to elicit a response

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4
Q

Spotting forelimb lamaness

A

Head nod (down on sound)

Stride length (shorter cranial phase)

Rhythm (irregularity can be heard)

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5
Q

Spotting hindlimb lameness

A

Pelvic tilt/hip movement (hip hike is sacral rise on lame leg)

Assess from side as well to assess stride length (will not track up well)

Rhythm (irregularity can be heard)

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6
Q

Horse with pelvic hike AND a head nod?

A

May be two separate primary issues or ‘compensatory’ lameness

Compensatory lameness: in a case of hind limb lameness the weight is redistributed onto the opposite hind limb and also the contralateral fore limb. This weight distribution presents as a ipsilateral forelimb lameness.

‘hind limb lameness can cause compensatory load redistribution evidenced as ipsilateral forelimb lameness’

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7
Q

Forelimb flexion tests

A

The entire leg can be flexed (usually utilised in a pre-purchase exam setting) or individual joints can be flexed

The amount of time the limb is flexed for and the pressure used should be consistent between both forelimbs

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8
Q

Hindlimb flexion tests

A

Due to the stay apparatus of the hindlimb one cannot flex the individual joints of the hindlimb- the entire limb is flexed at once

Again consistency between the legs is important

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9
Q

Diagnostic analgesia for lameness

A

Used to localise the source of pain to a region within the limb

This allows for more targeted further diagnostics to be performed in this area

Also guides treatment

The horse should be consistently and sufficiently lame so that any improvement in gait can be detected e.g. The lameness should be ‘blockable’

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10
Q

Further diagnostics available for lamaness

A

Radiography

Ultrasonography

MRI of distal limb

Arthroscopy (stifle, tarsus, fetlock, carpus)

Tenoscopy (flexor tendon sheath)

Scintigraphy (‘bone scan’)

CT of distal limb (less commonly performed)

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11
Q

Common lameness presentations in racehorses

A

P1 fractures

Carpal slab fractures

SDFT injuries

Overreach injury

Stifle OC/OCD

Osteoarthritis of carpus

DSP impingement (‘kissing spines’)

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12
Q

Common lameness presentations in sport horses

A

OA of Tarsus/coffin/fetlock

DDFT injury with foot (showjumpers)

Navicular syndrome (warmbloods and showjumpers)

Proximal suspensory desmitis (dressage horses)

Back pain

Sacro-iliac issues (showjumpers)

OCD of the tarsus/stifle/fetlock (warmbloods)

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13
Q

Diagnostic analgesia step-by step

A
  1. Assess the lameness
  2. Prepare the site for blocking in an appropriate manner
  3. Select an appropriate local analgesia
  4. Perform the block
  5. Test the block
  6. Reassess lameness
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14
Q

Preparation for perineural blocks

A

Clean not sterile

+/- clipping

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15
Q

Preparation for joint blocks

A

Sterile preparation

Betadine, Hibiscrub, Surgical spirit

+/- clipping

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16
Q

Most popular LA choice for diagnostic analgesia

A

Mepivicaine

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17
Q

Why should you not use lidocaine with adrenaline as a nerve block in horses?

A

White hair formation

Dehiscence

Tissue ischaemia and necrosis

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18
Q

Risks of nerve blocks

A

Haematoma

Needle trauma resulting in soft tissue swelling

Cellulitis

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19
Q

Risks of joint blocks

A

Joint flare (non-septic)

Septic

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20
Q

Common nerve blocks used in diagnostic analgesia

A

Palamar digital nerve block

Abaxial sesamoid nerve block

Low 4-/6- point block

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21
Q

Nerves blocked with a palmar digital nerve block

A

Medial and lateral palmar/plantar digital nerves

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22
Q

Technique for a palmardigital nerve block

A

In a conscious horse, elevate the leg and palpate the neurovascular bundle beneath the skin about 1 cm proximal to the collateral cartilage of the foot (Medial and lateral)

Insert a 25 gauge 5/8 needle in a distal direction with the tip of the needle ending at roughly the level of the pastern joint

Inject 1-2ml of local anaesthetic agent at each site

23
Q

Areas desensitised with a palmar digital nerve block

A

all of the sole,

navicular apparatus,

soft tissues of the heel,

distal interphalangeal joint (coffin joint),

deep digital flexor tendon,

distal sesamoid ligaments.

Pastern may be partially desensitised

24
Q

How to test palmar digital nerve block

A

Loss of skin sensation to coronary band of the heel

25
Q

When should you assess a palmar digital nerve block?

A

10 minutes post block

26
Q

Nerves blocked by an abaxial sesamoid nerve block

A

medial and lateral palmar/plantar digital nerves

27
Q

Technique for an abaxial sesamoid nerve block

A

In a conscious horse, elevate the leg and palpate the neurovascular bundle beneath the skin at the abaxial aspect of the proximal sesamoid bones of the fetlock joint (palmar-/plantar-medial and palmar-/plantar-lateral)

Insert a 25 gauge 5/8 needle in a distal direction with the tip of the needle ending at the level of the base of the sesamoids

Inject 1-2ml of local anaesthetic agent at each site

28
Q

Areas desensitised by an abaxial sesamoid nerve block

A

the foot,

P2,

PIP joint,

distopalmar/distoplantar aspect of P1,

distal SDFT and DDFT,

distal sesamoidean ligaments,

digital annular ligaments.

Distal aspect of fetlock joint maybe partially desensitised

29
Q

Testing abaxial sesamoid nerve block

A

Loss of skin sensation to the coronary band of the heel and the toe

30
Q

When should you reassess lameness after an abaxial sesamoid nerve block?

A

10 minutes post block

31
Q

When would you do a low 4-point block?

A

When assessing lameness in a forelimb that has not blocked to lower blocks

32
Q

When would you do a low 6-point block?

A

When assessing lameness in a hindlimb that has not blocked to lower blocks

33
Q

Which nerves are blocked in a low 4-/6- point block?

A

medial and lateral palmar/plantar metacarpal/metatarsal nerves, medial and lateral palmar/plantar nerves, lateral and medial dorsal metatarsal nerve in hindlimb

34
Q

Technique for low 4-/6- point block

A

In a standing leg horse use a 25 gauge 1 inch needle to inject 2-5 ml of local anaesthetic agent at each nerve site

Medial and lateral palmar/plantar metacarpal/metatarsal nerves: insert needle just distal to the button of the splint (N.B. Caution-close to the fetlock joint!)

Medial and lateral palmar/plantar nerves: insert needle between suspensory ligament and DDFT 3-5cm proximal to button of the splint (N.B. Caution- close to digital tendon sheath)

Medial and lateral dorsal metatarsal nerves: insert needle either side of the common digital extensor tendon and perform a subcutaneous ring at the level of plantar metatarsal nerves

35
Q

Areas desensitised by a low 4-/6- point block

A

fetlock joint,

proximal sesamoid bones,

flexor tendons distal to block,

digital flexor tendon sheath,

limb distal to block

36
Q

How to test a low 4-/6- point block

A

Loss of skin sensation to dorsal and palmer/plantar aspects of fetlock

37
Q

Considerations for joint/synovial blocks

A

Use the smallest gauge needle possible but make sure it’s big enough not to break

Subchondral bone pain will not necessarily be blocked

Know which joints communicate with each other

38
Q

What are the three approaches to a distal interphalangeal/coffin joint block?

A

dorsal perpendicular approach, dorsal parallel/inclined approach, lateral approach

39
Q

Dorsal parallel/inclined approach for diatal interphalangeal/coffin joint block

A

In a conscious standing animal palpate the dorsal pouch of the DIP joint just proximal to the coronary band

Insert a 1.5 inch 20-22 gauge needle abaxial to the extensor tendon 1cm dorsal to the coronary band at a 45 degree angle OR horizontal to the ground just above the coronary band midline

Inject 5-10ml of local anaesthetic agent

40
Q

Areas desensitised by a distal interphalangeal/coffin joint block

A

DIP joint,

navicular bursa,

DDFT insertion and sole may also be blocked

41
Q

When to reassess lameness after a distal interphalangeal/coffin joint block

A

At 5 minutes then again at 20 minutes post blocking

42
Q

What are the 4 approaches to a fetlock joint block?

A

proximopalmar, dorsal, distopalmar, palmar

43
Q

Proximopalmar approach to fetlock joint block

A

Either in a flexed or standing leg insert a 21 ga 1.5 inch needle in a dorsal-distal direction distal to the button of the splint, dorsal to suspensory ligament, palmar/plantar to the cannon and proximal to the sesamoids

Inject 10ml of local anaesthetic agent

44
Q

Areas desensitised by a fetlock joint block

A

Proximal sesamoid bones, suspensory branches and digital flexor tendon sheath may also be blocked

45
Q

When to resassess lameness after a fetlock joint block

A

10 mins post blocking

46
Q

Technique for a tarsometatarsal joint block

A

Use a 21 gauge 1.5 inch needle to inject 3-5ml of local anaesthetic agent into the palpable depression just proximal to the lateral splint (MT IV) and distal to the 4th tarsal bone

Insert the needle at a roughly 45 degree angle in a craniomedial direction i.e. Aim to the forelimb fetlock of the contralateral side

47
Q

Areas desensitised by a tarsometatarsal joint block

A

Tarsometatarsal joint.

Distal intertarsal joint will be blocked by diffusion in 76% of cases.

The proximal portion of the suspensory ligament and MT III may also be blocked.

48
Q

When to reassess lameness after tarsometatarsal joint block

A

10mins post blocking

49
Q

Technique for tarsocrural joint block

A

Use a 21 gauge 1.5 inch needle to inject 10-20ml of local anaesthetic agent on either the lateral or medial side of the saphenous vein

The saphenous vein traverses joint approx. 1-1.5 inch distal to the medial malleolus of the tibia

The joint pouch is easily palpable and the joint capsule is thin

50
Q

Areas desensitised by a tarsocrural joint block

A

tarsocrural joint.

Proximal intertarsal joint directly communicates with the TC joint

51
Q

Needle and volume to inject in a stifle block

A

Use an 18 gauge 1.5/2 inch needle to inject 20-30ml of local anaesthetic into each compartment

52
Q

Three compartments of the stilfe joint capsule for blocking

A

Medial femorotibial: insert needle between medial patellar ligament and medial collateral ligament proximal to tibial tuberosity

Femoropatellar: insert needle between medial and middle patellar ligament proximal to tibial tuberosity

Lateral femorotibial: insert needle caudal to lateral collateral ligament proximal to proximal-lateral edge of tibia

53
Q

Communications between compartments of the stifle joint

A

The medial femorotibial compartment normally communicates with the femoropatallar compartment.

The lateral femorotibial compartment communicates with the femoropatellar compartment in a small proportion of horses.

Important to note that LFT and MFT never communicate

Equine I (21 decks)

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