Lameness in the Equine Athlete Flashcards
What main 3 types of athletes ?
Showjumper
Dressage Horse
Eventer
what mechanics in showjumping ?
More weight in HQs
- Brought forward and under the rider during locomotion
- Rq for engagement, collection & takeoff
- Inc stress of joint and ST
Stress on forelimbs inc during take off and landing?
- Considerable impact on landing
- Holds entire weight of H & R
Surfaces for showjumping?
- soft deep surfaces r MORE EFFORT
- Early fatigue of ST
- Hard surfaces may result in bone and joint related injury, distal limb foot problems
Studs use in showjumper?
- Placed to enhance traction - lat +/- medial
- Creates mediolat imbalance
- If ground hard - dorsopalmer balance altered
- Concentrates force -> deep bruising
- Stud girth -> protection
what are the main lameness issues of Showjumpers?
- Foot pain
- Distal hock joint pain
- Thoracolumbar region pain
Describe ‘Foot sore’ ?
- Approx. 60% of bodyweight on forelimbs
- Impact on landing greatly increases load and structural stresses on structures
within hoof capsule - Shoeing very important
Cause fo Foot Sore?
- Subsolar bruising
- Subsolar abscess
- Sheared heels
DIP Joint synovitis & osteoarthritis ?
Coffin joint OA - Frequently bilateral
+/- joint effusion
Forelimbs most commonly affected
Diagnostics for DIP synovitis/ OA?
- Radiographic changes may be absent or subtle periarticular osteophytes or enthesophytes
- US of the collateral lig of the DIP joint should be performed
What should we do for horses unresponsive to tx of DIP synovitis/OA ?
Evaluate for soft tissue damage within the foot
How do we evaluate collateral ligament injjury of the DIP?
- Medial and LAteral
- US may show disruption or enlargement
- MRI-gold standard in imaging
Tx for collateral injury of DIP?
– Corrective shoeing and prolonged rest
– Followed by a prolonged walking programme
– Shock wave or laser therapy
What to do if unresponsive to conservative tx for collateral DIP joint?
Palmar digital neurectomy?
Describe Navicular Syndrome
- Slow insidious onset
- early signs -> shortenign of stride, tripping or stumbling
- Presents as a unilat lameness but condition usually bilat
How can we diagnose navicular syndrome?
- Hoof testers
- Wedge test may accentuate lameness
What range of conditions does navicular syndrome incompass?
o Navicular Bone Pathology
o Navicular Bursitis
o Navicular suspensory desmitis ( collateral sesamoidean ligament)
o Impar Desmitis
o DDFT injury/tear or Adhesions of the DDFT
Radiography of Navicular Bone?
Pathology fo the navicular bone on radiography?
What is the most common hind limb lameness ?
Distal Tarsal OA
Distal Tarsal OA is usually due to which joints of the tarsus?
Tarsometatarsal (BLUE) and Distyal intertarsal joint (RED)
What can result in Distal tarsal OA?
- conformational defects
- developmental abnormalities
- torsional stresses placed on distal hock joints
Tarsal Oa often seen in combination with …?
lumbar pain & SUSPENSORY DESMITIS
Diagnosis of Distal Tarsal OA?
Hindlimb lameness - worse with limb on inside of circle and on hard ground
Positive to hindlimb flexion test
Positive to tarsometatarsal joint block
Radiographs
What radiographic changes with u see with distal tarsal OA?
varies: none-> severe (joint fusion) (changes don’t correlate with ° of lameness)
o Periarticular osteophytes/enthesophytes
o Joint space irregularities/narrowing
o Subchondral bone sclerosis
o Fusion of joint space
What often occurs 2ary to hindlimb lameness?
Back pain -> always perform lameness assessment as part of investigation og back pain
Most common causes of back pain?
- Muscular soreness / strain
- Impinging dorsal spinous processes
- Sacroilliac Pain
What are some less common back pain causes?
- Facet joint OA
- discospondylitis
How do we diagnose kissing spiness( impingement of dorsal spinous processes)
Back palpation
Radiography
nuclear scintigraphy (inc uptake)
Diagnostic analgesia
What can u see on radiography with kissing spines?
-impingement/overriding → narrowed/no space between dorsal spinous
processes
-sclerosis →increased bone opacity
-periosteal reaction →new bone formation
-Cyst formation →radiolucent defects
Describe conservative tx for kissing spine?
- SADDLE FITTING!!
- NSaids
- Medicate back -> Steroids +/- Mesotherapy
- Biphosphonates
- Other -> acupuncture; rehab
What Surgical tx for kissing spines?
- Interspinous Ligament Desmotomy
- Dorsal Spinous Process Resection or Subtotal Osteotomy
Aetiologies for Sacroiliac Joint pain?
- Oa
- Desmitis - dorsal sacroiliac lig
- Chronic joint instability
- Acute subluxation
what presentation of sacroiliac pain?
Poor performance
Refusal at jumps
Reduced hindlimb propulsion
Back soreness
Diagnosis fo sacroiliac pain?
– Clinical Examination
– Ultrasonography
– Scintigraphy
– Intra-articular/periarticular diagnostic analgesia
Often diagnosed by exclusion/positive response to treatment
Tx for sacroiliac pain?
- Intra-articular steroid injections
- Rest
- controlled exercised plan
Dressage horse - what issues why?
- Requires balance, suppleness and hind limb activity
- Centre of gravity is placed further caudally increasing degree of flexion
and loading on hindlimbs - Lateral movements apply specific unique
strains to different structures within skeleton - Training surfaces- artificial surface with a
high degree of cushioning
→consistent surface
What are the most common issues in dressage?
- Proximal suspensory desmitis (HL >FL)
- suspensory branch lesions
- Desmitis of the forelimb accessory ligament of the deep digital flexor tendon
Describe Proximal Suspensory Desmitis?
- More common in the hind limbs
- Commonly bilat this may delay diagnosis
- Repetitive strain injury
Diagnosis of Proximal sensory desmitis?
- Lameness -> worse on soft ground & affected leg worse on outside of circle
- Palpation - difficult due to deep location
- Diagnostic analgesia -> +ve to deep branch of lateral plantar nerve block & -vs to TMT block initially
Proximal sensory desmitis on US?
enlargement, fibre disruptionareas of reduced echogenicity
changes can be very subtle
always US both
Proximal suspensory desmitis on Xray?
Proximal metatarsal region
irregularities in proximal planter
cortex
Endosteal new bone
What other diagnostics might we do with proximal suspensory desmitis ?
Scintigraphy and MI
Tx for Proximal suspensory desmitis?
- Rest
- Rehab
- ACSWT
- Medication of tarsometatarsal joint with corticosteroid
- Core lesion -> intralesional injection with platelet rich plasma or stem cells
What surgical tx options for proximal suspensory desmitis?
- Neurectomy - deep branch of lateral plantar nerve
- Fasciotomy
Suspensory Branch Desmitis if often acute onset and accompnied by ….?
– Peri-ligamentous swelling
– Enlargement of ligament
– Often painful on palpation
Diagnosis of suspensory branch desmitis?
-> US
-enlargement of Branch
- Periligamentous fibrosis
- +/- core lesion
-> Radiography - sesamoid bones - may show enthesopathy, sesamoiditis & fragmentation
Tx for suspensory branch desmitis?
- Prolonged rest (4-6m)
- Shockwave therapy
- Controlled exercise 3-4 months
- Intralesional tx if core lesion present
Predisposing factors to correct in suspensory branch desmsitis?
- Mediolateral imbalance in feet
- Limb deviations
What is Desmitis of the Accessory Lig of DDFT (Check lig Desmitis)
- Acute injury-sudden onset lameness
- Heat pain swelling of proximal third of metacarpal region
- Cause -> overextension of the carpus
Diagnosis of Chekc lig desmitis?
US
- Enlargement
- Loss of definition of the margins
- Ares of reduced echogenicity
Tx of Desmitis of accessory lig ?
- controlled ascending walking programme better than complete box rest
- 3-6 months
- Risk of recurrence
-Good results with tx with intralesional PRP
What cross country injuries prone?
- Soft tissue
- OA also common
- Acute traumatic injuries
What. is super important. inthese Three day eventing horses?
conformation!n
Main issue in three day event horse?
Superficial digital flexor tendonitis
why do we tend to see this?
- Most commonly occurs from cyclical repetitive loading
- But can occur from a single-event injury ie fall or stumble
Tendons prone to development of accumulated microdamage during intense
training →Slight filling & heat in palmer metacarpal region
How do CLs develop with superficial digital flexor tendonitis?
Clinical signs of SDFT strain then develop acutely after training or competition
OR may be subclinical following competition but become evident when training resumes
How should we be monitoring these horses?
Ultrasound!!
What happens with Annular Ligament Syndrome?
thickening of the palmar or plantar annular ligament (PAL)
Who commonly gets ALS?
heavy breeds/warmblood and horse with foot pathology
Describe primary vs secondary ALS
-> Primary ALS
* Pathology of PAL itself
* Hypoechoic areas within the PAL
-> Secondary ALS
* Pathology of surrounding soft tissue
structures
* Digital tendon sheath
* Flexor tendons
What is manica flexoria?
- A band-like structure of the SDFT that wraps around the DDFT just above the
fetlock - Most commonly injuries occur in hindlimbs
Who is more susceptible to manica flexoria?
cob-types and ponies
Dx. &tx of manica flexoria
Diagnosis
* Digital flexor tendon sheath block
* U/S
* Contrast Study
Treatment
* Surgical resection -> Tenoscopy & resection
