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
describe osteoarthritis/synovitis in the stifle
clinical signs:
1. lameness- pretty severe
2. effusion
3. bilateral or unilateral
4. common in western performance horses
5. MFT joint most common!/ medial side of joint!!!!
diagnostics:
1. IA anesthesia
2. radiographs
3. ultrasound
4. arthroscopy
5. CT
treatment: depends on how severe
1. NSAIDs
2. systemic joint health
3. IA therapy:
-corticosteroid (triamcinolone)
-HA
-orthobiologics
-polyacrylamides
4. arthroscopy
describe intra-articular fractures of the stifle
common when horses run into things!
clinical signs/history:
1. effusion
2. lameness (mild to severe depending on fx)
3. trauma in history is key!!
diagnostics:
1. radiographs
2. ultrasound (within or outside joint)
3. CT (if can get stifle in there)
4. common locations: patella, tibial crest, fractures CAN be extracapsular!!
treatment:
1. surgery
-arthroscopy: not helpful if extracapsular
-lag screw
2. rest and rehab:
-bone takes a while to heal (4-6 week range)
-patellar ligament injuries: add ECSWT, therapeutic laser, orthobiologics
what are 4 common intra/peri synovial soft tissue injuries of the stifle?
- meniscus! most common and msot serious! medial more common than lateral and its associated ligaments (cranial meniscotibial)
- patellar ligaments
- cranial and caudal cruciate
- collateral ligaments
*ONLY the meniscus is intra-articular
severe injury of any of these can lead to instability and OA
describe medial meniscus injuries
clinical signs:
1. effusion (MFT joint)
2. lameness: mild to severe
3. association with subchondral cyst (medial femoral condyle)
4. grade 1-3 (mild to severe); prognosis decreases as grade increases
diagnosis:
1. radiographs
2. ultrasound
3. arthroscopy: may not be able to access damaged region
4. CT (contrast)
treatment:
1. surgical debridement if can access area
2. rest and rehab is key!! even if do surgery; orthobiologics to treat inflam and provide growth factors for joint
describe patellar ligament injury
clinical signs/history:
1. lameness: mild to moderate
2. effusion: mild, of femeropatellar joint if present
3. pain on palpation and thickening of at pad on palpation
4. trauma: known or unknown
diagnostics:
1. radiographs to check for avulsed fragments
2. ultrasound
common sites:
1. intermediate/middle patellar ligament: has striations (help ID on ulstrasound)
2. insertion (likely due to trauma)
treatment:
1. rest and rehab: orthobiologics, ECSWT, therapeutic laser, cryotherapy/NSAIDs (steatis)
describe cruciate ligament injury
clinical signs/history:
1. lameness: mild to severe
2. effusion: mild to severe
3. trauma
diagnostics:
1. radiographs: check for avulsions
2. CT contrast
treatment:
1. arthroscopy
2. rest and rehab: orthobiologics
complete rupture is not as common in horses
describe trauma/hemorrhage/sepsis of the stifle
clinical signs:
1. lameness: mild to severe
2. effusion: single or multiple joint compartments
diagnostics:
1. radiographs
2. ultrasound
describe miscellaneous important conditions of the stifle (2)
- upward fixation of the patella:
-intermittent or fixed
-young horses with poor quadriceps tone
-medial trochlear ridge
-stuck in extension - peroneus tertius rupture: extended tarsus and flexed stifle
