Large Animal Tarsus and Stifle Flashcards
identify common clinical signs in horses with tarsal disease
- tarsal effusion: bog spavin (effusive tarsocrural joint), thoroughpin (effusion within tarsal sheath), swelling within calcaneal bursa
- tarsal enlargement: bone spavin (OA), capped hock (effusion or bony prominence in the area of the hock)
(not tested on above, for NAVLE)
lameness, swelling/effusion, pain, decreased ROM
spavin = tarsus/hock
what are 6 differentials for tarsal effusion?
- OCD (dissecans)
- collateral ligament desmitis
- fracture (IA)
- trauma (hemarthrosis)
- septic arthritis
- idiopathic synovitis
how prioritize?
-history of trauma, age of animal, lameness grade
diagnostic tests:
radiographs, nerve blocks, ultrasound, synoviocentesis, CT, MRI
what are clinical signs/history of OCD? diagnosis? treatment?
- tarsocrural (tibiotarsal) joint effusion!!!
- young horses: onset of training
- bilateral (multiple joints)
- mild lameness
- could be incidental funding on PPE
diagnosis: radiographs!
top 3 locations for lesions:
1. DIRT lesion: distal intermediate ridge of tibia (in 75% of horses!)
2. lateral trochlear ridge of talus
3. medial malleolus of tibia
treatment: often depends on how clinically affected the horse is; may not need to do anything if incidental finding and no clinical signs
1. surgical removal (arthroscopy); loose fragment could cause inflammation and lead to OA
2. if see ongoing joint effusion, could lead to stretch of joint capsule so treat!
describe collateral ligament (of tarsus) desmitis; include clinical signs/history, diagnostics, and treatment
clinical signs/history:
1. synovial effusion, acute
2. any age horse
3. initially lame (moderate to severe) but improves within 1-2 weeks unless damage all collateral ligaments (rare)
4. flexion test can make a not super lame horse crippled
diagnostics:
1. radiographs: rule out OCD lesions; check for avulsion fragments at ligament attachment
2. ultrasound: difficult when joint is effusive, but look for ligaments and if not sure
3. MRI
treatment: lameness usually resolves on own but ligament must heal!
1. IA treatment: reduce effusion and aid in ligament healing: orthobiologics (pro-stride, IRAP, HA)
2. rest and rehab: ligament healing
-intra-ligament injections: PRP, stem cells
-ECSWT
-therapeutic laser (class IV)
describe tarsocrural joint fractures
clinical signs/history:
1. effusion, hella
2. hella lame
3. +/- instability on palpation
4. trauma
diagnostics:
1. radiographs
2. CT: to figure out repair
3. synoviocentesis: look for hemorrhage, increased WBC, TP initially (hard to dif fx from septic joint initially)
treatment:
1. fracture repair: screws, or fragment removal if too many tiny pieces
2. cast immobilization: full limb
3. euthanasia
describe septic arthritis
clinical signs/history:
1. marked to severe lameness
2. effusion (closed)
3. wound/puncture: foals are different!
-if wound, may not be effusive bc fluid leaked out
4. lame at walk or non weight bearing
diagnostics:
1. radiographs: rule out fracture
2. ultrasound
3. synoviocentesis!!!
4. arthroscopy: can also be part of treatment
more in septic arthritis lecture
describe distal tarsal joint osteoarthritis
also called bone spavin; most common disorder of the tarsus
joints affected: TMT and DIT!!
-can be unilateral or bilateral; one leg more affected but bilateral common
age: mature or juvenile onset
why happen?
1. conformation
2. trauma/repetitive use
3. incomplete ossification (juvenile onset)
describe diagnostics of distal tarsal joint OA
- lameness eval, flexion tests
- local anesthesia: intra-articular, tibial/peroneal nerve block
- radiographs: findings don’t always correlate with degree of lameness/pain
- advanced imaging:
-MRI, CT, nuclear scintigraphy
important!! thew proximal suspensory ligament is really close to this region! there can be overlap; need to determine: is it proximal suspensory or is it distal tarsal joint?
describe treatment of distal tarsal joint OA
mild cases:
1. shoeing
2. NSAIDs
3. modified exercise
moderate to severe cases:
1. IA treatments
2. bisphosphonates
3. arthrodedis/ankylosis
describe distal tarsal joint fractures
clinical signs: mild to severe lameness
diagnostics: radiographs, advanced imaging (C, MRI, NS)
treatment:
conservative based on fiances or severity: rest and rehav
surgery: lag screw
describe tarsal sepsis and synovitis
sepsis: in tarsal sheath, calcaneal bursa (distal tarsal joints)
synovitis: idiopathic
describe tarsal tendon/ligament injuries
- curb: desmitis of plantat ligament: blemish
- SDFT, DDFT, gastrocnemius tendon injuries: synovial effusion at the location of the injury
clinical signs of a horse with stifle disease?
swelling/effusion, lameness, pain, decreased ROM
stifle effusion and lameness often go together! unlike the tarsus
what are 6 differentials for stifle effusion?
- OCD dissecans
- OA/synovitis
- fractures
- soft tissue injuries (intra or periarticular)
- trauma/hemorrhage
- sepsis
describe OCD dissecans in the stifle
clinical signs:
1. juveniles
2. effusion: most commonly mediofemorotibial joint or front of stifle
3. lameness
4. multiple joints
diagnosis: radiographs
common locations:
1. trochlear ridges of femur (med and lateral)- femeropatellar effusion
2. medial femoral condyle: could be OCD OR traumatic lesions; think of age of horse (if 5 years old could be traumatic, but treat same way)
treatment:
1. trochlear ridge OCD: arthroscopic debridement, pretty good prognosis
2. subchondral cyst:
-if not super lame, treat conservatively (rest, etc.)
-arthroscopic debridement + graft
-injection-corticosteroid to kill lining of cyst
-transcondylar screw
