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RUSVM Large Animal Surgery 2017 > Lameness and Hoof Surgery > Flashcards

Lameness and Hoof Surgery Flashcards

1
Q

How long does it take for the entire hoof to grow?

A

1 year

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2
Q

How much hoof grows per month?

A

6mm

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3
Q

How much the hoof appear?

A

Perpendicular and parallel to the ground and symmetrical

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4
Q

How should the sole of the hoof appear?

A

Parallel and symmetrical

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5
Q

What instruments do you use to pull shoes?

A

Shoe puller
Clinch cutter
Hammer
Nail puller

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6
Q

What instruments do you use for Hoof trimming?

A

Hoof nippers
Hoof knife
Rasp

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7
Q

What breed is allowed to have a longer toe?

A

Standardbreds

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8
Q

Why do we leave the toe longer on Standardbreds?

A

Increase stride length and will allow the horse to pace faster

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9
Q

What is wrong with a horse that comes up lame after shoeing?

A

Nail bound

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10
Q

Sidebones

A

Calcified hoof cartilages seen in older or carriage horses due to microfractures created by each step causing concussion destabilizing the area

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11
Q

Why would you use a Full bar shoe?

A

Eliminate the hoof mechanism to allow for fracture healing

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12
Q

How do you shoe for Navicular disease?

A

Elevate the heel

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13
Q

Why do you elevate the heel in treating navicular disease?

A

Elevating the heel allows the deep flexor tendon to put minimal pressure on the navicular bone

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14
Q

Break over

A

the moment the toe touches the ground

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15
Q

How do you shoe a horse to facilitate break over?

A

Rocker toe shoe

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16
Q

How would you shoe for a Ruptured flexor tendon?

A

Shoe with elongated heels

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17
Q

What clinical sign do you see with superficial digital flexor tendon rupture?

A

Fetlock drops

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18
Q

What clinical sign do you see with deep digital flexor tendon rupture and superficial digital tendon rupture?

A

Fetlock drops and toe points up

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19
Q

What clinical sign do you see with all flexor tendon rupture?

A

Leg is on the ground

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20
Q

What are the clinical signs of Puncture wounds or Solar abscess?

A

Lameness
Thumping digital pulse
Draining tract at coronary band
Swelling

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21
Q

How do you diagnose Puncture wound or solar abscess?

A

Hoof testers
Sterile probe draining tract
Radiography

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22
Q

How do you treat Puncture wounds or solar abscess?

A

Establish drainage
Tetanus: toxoid/antitoxin
Antiseptic solution
Bandage

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23
Q

Keratoma

A

abnormal keratinization in response to chronic injury

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24
Q

What are the clinical signs of Keratoma?

A

Lameness
Fistulous tract at coronary band
Deviation of white line

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25
Q

How do you treat a Keratoma?

A

Use periosteal elevators to remove that section from the hoof

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26
Q

Necrosis of the Collateral Cartilage (Quittor)

A

Chronic purulent inflammation of collateral cartilage

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27
Q

What are the clinical signs of Necrosis of the Collateral Cartilage (Quittor)?

A

Lameness
Localized pain over cartilage
Chronic suppurative sinus tract

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28
Q

How do you treat Necrosis of the Collateral Cartilage (Quittor)?

A

Surgical excision of necrotic cartilage

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29
Q

Thrush

A

Degenerative condition of the frog

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30
Q

What are the clinical signs of Thrush?

A

Fetid odor
Undermined frog
Black discharge with sulci of frog
Draft horses

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31
Q

How do you treat Thrush?

A

Removal of all loose horn

Caustic agents: Copper sulfate

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32
Q

How do you treat Angular Limb Deformities?

A

Dalmer shoes

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33
Q

Laminitis

A

Inflammation of the laminae of the foot

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34
Q

Chronic Laminits

A

after 48 hours of continual pain or when rotation of the distal phalanx occurs

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35
Q

What are the clinical signs of Laminitis?

A 
Shifting weight to hind feet 
Unwilling to walk 
Sinking in at coronary band 
Non-parallel growth rings 
Sole abscess
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36
Q

What is a sign of several bouts of laminitis?

A

Non-parallel growth rings

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37
Q

Obel grade 1

A

No lameness at walk, short stilted gait at trot

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38
Q

Obel grade 2

A

Stilted gait at walk, foot can be lifted

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39
Q

Obel grade 3

A

Reluctant to walk, resists lifting foot

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40
Q

Obel grade 4

A

Refuses to move, may become recumbent

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41
Q

What do you see on radiographs with chronic laminits?

A 
Bone remodeling "ski-tips" 
Distal marginal fractures
Osteolysis 
Osteomyelitis
Rotation 
Sinking 
Radiolucent lines
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42
Q

What are risk factors for Laminitis?

A 
Pony 
Fat Horse
Late summer
High carbs
Non-weightbearing lameness
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43
Q

What are the treatment options for chronic laminitis?

A

Therapeutic shoeing: Dorsal hoof wall resection, Heart bar shoe, or Reversed horse shoe
Deep digital flexor tenotomy
Euthananasia

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44
Q

What causes tendon laceration?

A

Trauma
Overloading
Infection

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45
Q

What tendons in the Fore limb are prone to laceration?

A

Common digital extensor tendon

Lateral digital extensor tendon

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46
Q

What tendons in the Hind limb are prone to laceration?

A

Long digital extensor tendon

Lateral digital extensor tendon

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47
Q

How do you treat Tendon laceration?

A

Corrective shoeing
Bandage
Cast
Surgery

48
Q

What suture pattern is used to fix tendons?

A

Locking loop

49
Q

What do you observe during a lameness exam?

A 
Stride 
Foot flight arc 
Path of the foot flight 
Foot strike 
Joint angels 
Gluteal excursion
50
Q

What is the rule for fore limb lameness?

A

“Head Down on Sound”

Head Appears to rise when lame limb weight bearing

51
Q

Observing Hind Limb lameness

A

Head goes down with lame limb weight bearing

Increased gluteal excursion in lame limb - “Hip Hike” or “Hip Drop”

52
Q

Grade 1 Lameness

A

Difficult to observe, inconsistent

53
Q

Grade 2 Lameness

A

Difficult to observe in a straight line but consistently apparent under certain circumstances

54
Q

Grade 3 Lameness

A

Consistently observable or a trot under all circumstances

55
Q

Grade 4 Lameness

A

Obvious lameness with marked head, nod, hitching, shortened stride

56
Q

Grade 5 lameness

A

Minimal weight bearing/ non weight bearing and inability to move`

57
Q

What 5 pathognomonic lameness’ are diagnosed at the walk?

A 
Peroneus tertius rupture 
Upward fixation of patella 
Stringhalt 
Fibrotic myopathy 
Sweeney
58
Q

What is the clinical sign of Peroneum Tertius Rupture?

A

Simultaneous extension of the hock and flexion of the stifle

59
Q

How do you treat the Upward fixation of the patella?

A

Exercise

Medial Patellar Desmotomy

60
Q

What medication will cause a lameness to change?

61
Q

What are the different methods of Local Anesthesia?

A

Perineural block
Regional
Direct infiltration of site
IA

62
Q

What local anesthetics are used for Lameness exam?

A

2% Lidocaine
2% Mepivacaine
0.5% Bupivacaine

63
Q

When would you use Bupivacaine for lameness?

A

Shoeing manipulations/therapeutic effect

64
Q

What structures are anesthetized by the Palmar Digital Nerve Block?

A 
Entire Sole 
Navicular apparatus 
Soft tissues of heel 
Coffin joint 
Digital portion of DDFT
65
Q

What structures are anesthetized by the Abaxial Nerve Block?

A 
Foot P2
Distopalmar P1
Proximal and distal interphalangeal joints 
Distal SDFT and DDFT
Distal Sesamoidian ligament 
Digital annular ligament
66
Q

What nerves are blocked by Low 2-point nerve block?

A

L/M palmar metacarpal n.

L/M palmar n.

67
Q

Where do you perform the Low 4 point nerve block?

A

Between Palmar MCIII and MC II and IV

Between SL and DDFT

68
Q

What structures are anesthetized by the High 4-Point Nerve Block?

A

Suspensory ligament
Flexor tendons
MCIII and MCIV

69
Q

Where do you perform the High 4 point nerve block

A

Below carpus in groove between suspensory and DDFT

70
Q

What are the indications for Nuclear Scintigraphy?

A 
Lameness site cannot be determined 
Lameness is localized but not detectable with radiographs or US
Multiple limb lameness
Intermittent lameness
Upper limb/pelvic lameness
Suspect fracture not seen on rads
71
Q

What is important to know about Nuclear Scintigraphy?

A

The animals must be isolated because they are radioactive

Leave for 24-48 hours and detect radiation levels before handling the animal

72
Q

What is a disadvantage of Nuclear Scintigraphy?

A

Not very specific

poor anatomic detail

73
Q

What would you use if the lameness cannot be determined with radiographs or US?

74
Q

Crimp pattern of the tendon

A

Allows for “stretch” of tendon
Load applied, lose crimp
Followed by a linear phase of stretching

75
Q

How long can a tendon rupture?

A

can extend 12-20% before rupture

76
Q

Tendon Repair

A

Scar tissue formation resulting in less elastic tendon

77
Q

Tendonitis

A

Inflammation of a tendon most commonly from overuse but can be from infection or traumatic injury

78
Q

What causes tendon injuries?

A

Overstrain

Percutaneous Trauma

79
Q

Overstrain

A

Sudden overload or strain induced

80
Q

What causes strain induced Overstrain?

A

Repetitive microtrauma - a phase of molecular degeneration which progressively weakens the tendon

81
Q

where do you find the most serious percutaneous trauma?

A

Palmar aspect of the pastern/metacarpus

82
Q

Which tendons are most prone to injury?

83
Q

What are the predisposing factors for tendonitis?

A 
Increased stress on tendon/ligament 
Poor/deep ground surface 
Inadequate training and muscle fatigue 
Poor conformation 
Poor hoof care
Improper bandaging/boots
84
Q

What is the best tool for diagnosing tendonitis?

A

Ultrasound

85
Q

What type of probe should be used for diagnosing tendonitis?

A

7.5-12 MHz linear transducer

86
Q

What do you see on Ultrasound with Acute tendonitis?

A

Enlargement
hypoechogenicity
Reduce striated pattern
changes in shape, margin or position

87
Q

What so you see on ultrasound with chronic tendonitis?

A

variable enlargement
echogenicity
irregular striated pattern - fibrosis

88
Q

What is the treatment for tendonitis?

A

cold therapy, rest, and controlled exercise program
Compression and coaptation
NSAIDs

89
Q

What is the goal of treatment for Tendonitis?

A 
Restoration of the tensile strength of the tendon without peritendinous granulation tissue and adhesions
Reduce inflammation 
Speed healing/return to work 
Increase tensile strength 
Decrease risk of re-injury
90
Q

What are other non-surgical treatments for tendonitis?

A

Intra-lesional injections
Electro shock wave therapy
Therapeutic Ultrasound
Laser

91
Q

What is used for Intralesional injections?

A

Platelet Rich Plasma
Stem cells
Bone marrow

92
Q

How does Shock Wave Therapy help tendonitis?

A

Increases Vascularization

and growth factors in the area

93
Q

Surgical repair of tendonitis

A

Suturing tendon
Superior check desmotomy
Annular ligament desmotomy

94
Q

What are the two layers of the synovial membrane?

A

Subintimal

Intimal

95
Q

What is contained in the subintimal layer o the synovial membrane?

A

Blood supply and innervation

96
Q

What is contained in the intimal layer o the synovial membrane?

A

Synoviocytes

97
Q

Subchondral bone

A

“Shock absorber”

More deformable than cortical bone

98
Q

Articular Cartilage

A

specialized extracellular matrix that distributes compressive loads
Used to define the health of the joint and create a joint surface

99
Q

Aggregans

A

forms aggregates with HA

Protects collagens from damage

100
Q

What is the backbone of the cartilaginous matrix?

A

Hyaluronic acid

101
Q

What provides a sponge-like shock absorbing effect?

A

Glycosaminoglycans

102
Q

What are the gross cartilage changes associated with Osteoarthitis?

A 
Yellow
Fibrillate
Dull 
Ulcerated 
Pitted
103
Q

What are the changes associated with Joint disease?

A

Sclerosis
Osteophyte formation
Enthesiophyte formation

104
Q

What are the clinical signs of Osteoarthritis?

A

Lameness
Joint pain
Decreased range of motion
Joint effusion

105
Q

What are the goals of treatment of joint disease?

A

Reduce/ minimize inflammation
Slow progression of degeneration
Reduce/eliminate pain
Restore synovial fluid to normal

106
Q

What are the options to manage joint disease?

A 
Chondroprotectives 
Corticosteroids
NSAIDs
Blood based products
Cell based treatments
107
Q

What are the chondroprotective agents?

A

Hyaluronic acid
Polysulfated glycosaminoglycans
Polyglycan
Pentosin Gold plus Halo

108
Q

What does Sodium Hyaluronate/ Hyaluronic acid do?

A 
Provides viscoelasticity, boundary lubrication 
Modulates chemotactic response
Scavenges free radicals 
Increases production of endogenous HA
Decreases degradation of aggrecan
109
Q

What is the most efficacious way of administering HA?

A

Intra-articularly

110
Q

Polysulfated Glycosaminoglycans

A

inhibit degradative enzymes
Reduction of synovial effusion
Counteracts deleterious effects of IL-1

111
Q

How does Adequan work?

A

up regulation of glycosaminoglycans and collagen synthesis
Decrease in inflammatory mediators
Improvements in synovial membrane

112
Q

What should you add with Adequan?

A

Antimicrobial

113
Q

Polyglycan

A

Post surgical lavage

114
Q

What is the most effective for mild synovitis/capsulitis?

115
Q

What is the most effective for severe synovitis/capsulitis or chronic OA?

A

PSGAGs (Polysulfated Glycosaminoglycans)

116
Q

Why use Triamcinolone acetonide?

A

Chondroprotective effects

117
Q

What with wrong with using Methylprednisolone acetate?

A

deleterious effects on articular cartilage

RUSVM Large Animal Surgery 2017 (14 decks)

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