Limb Exams Flashcards
What are you feeling for on limb palpation
Heat
Swelling
Pain
Bony changes
What is the most proximal carpal join called
Antebrachiocarpal
What is the proper name for the check ligament
Accessory ligament of the deep digital flexor tendon
What should you look for on your distant exam
Both sides
Confirmation
Asymmetry
Muscle wastage
Swelling
What are the correct terms for swayback and roachback
Spondylosis and lordosis
Where does tendon sheath effusion stay
Behind the suspensory branch
What is a bone spavin
Boney swelling at distal tarsal joint
What is a big spavin
Effusion in tibial tarsal joint
What nerve do you block with a DP
palmar distal
What is the physiology of a bounding digital pulse
Injury to foot leading to inflammation and swelling/increased blood flow
As the hoof can’t expand the BP in the digital artery increases causing a bounding pulse
Where do you find the digital pulse
The abaxial margin of the lateral and medial sesamoid bones with finger and thumb on either side
What is normal for the digital pulse
Faint and hard to feel
What is important to do with hoof testers
Use with two hands and work systematically around the hoof and across the heals
How can you further examine the hoof
Remove shoe, repeat hoof testing, par the food
Assess discolouration, discharge and white line deviation
How should you manage a suspected fracture
Appropriate stabilisation - RJ/cast
AO principles of fracture repair
Fracture reduction and fixation to restore anatomical
Fracture fixation providing absolute/relative stability
Preservation of blood supply to soft tissue
Early/safe mobilisation of injured part and patient
What do lag screws do
Bridge 2 bone parts into compression, cartilage contour returned as close as possible to normal
Lag screws technique
Drill through chip with bit the same size as screw place drill sleeve
Counter sink the screw
Reach far cortex and measure length
Screw into the tapped area in the bone
Position screws
Hole drilled to core diameter then screw inserted and thread cuts in
What are the types of plate screw
DCP - dynamic compression plates
LC-DCP - limited contact dynamic compression plates
LCP - locking compression plates (screw locks into bone and plate)
Preparation for emergency radiography
Restraint
Analgesia
Sedation
Remove bandages
Tail bandage out the way
Find appropriate radiography location - stable area you can guard
Complications of fracture repair
Osteomyelitis
Screw loosening
Implant failure
Delayed/non union
Ring sequestrum
Support limb laminitis
First aid of tendon/ligament injuries
Reduce inflammation
Provide stability
Reduce tendon loading
First aid for the inflammatory phase of tendon injury
Nsaids
Steroids
External support
Cold therapy
Confinement
When can you use intralesional therapies
Only when a hole/space is present to improve speed)quality of healing
How is stem cell therapy used in tendon injury
Autologous graft of mesenchymal stem cells cultured in laboratory and differentiate into tenocytes to promote healing
What is platelet rich plasma
Autologous graft of platelets in plasma stimulates angiogenesis and proliferation of tissues
What is bone marrow aspirate concentrate (BMAC)
Autologous graft of fluid and cells from bone marrow. Centrifuged to concentrate cells injected under ultrasound guidance
Single cell procedure
Surgery of tendons
Exposed fibres treated by arthroscopic removal
Few lesions amenable to surgical treatment
Palmar/plantar annular ligament desmitis - PAL desmotomy
SDFT tendonitis - superior check ligament desmotomy
Manica flexoria tear - removal
DDFT tear - DDFT debridement
When should you start exercise after tendon injury
End of inflammatory/start of proliferative phase
What is the use of shockwave therapy
Treatment of the junction between bone and soft tissue
Temporary lameness improvement with no effects in structure or function
Clinical application of shockwave
Variables - number and intensity of shocks - no evidence basis
Protocol - weekly/fortnightly for 4-6 weeks
Delivered non weight bearing
Use of laser
Class 4
Reduces lesions size, increases Doppler signal, changes collagen deposition and improves US fibre pattern
No evidence yet of reduced reinjury
Contraindications for laser use
Eye exposure
Neoplasia
Haemorrhage
Pregnancy/sec glands
Whole body rehab
Water treadmill
Swimming
Ridden/in hand work with poles etc
What are the sections of tendon loading curves
Straightening of crimp
Elastic deformation
Non-elastic deformation
Failure/rupture
What is comp
Cartilage oligometric metrix peptide
Correlates with tendon elasticity - vary within a tendon
What are GAGS
Glycosaminoglycans
Components of the extracellular matrix linking collagen fibrils
What happens to comp with age
Metacarpal comp decreases with age - up to 5
Metacarpophalangeal comp increases - up to 5
Where are inferior check lesion injuries normally most palpable
Lateral side of the proximal third of the forelimb metacarpus
What symptom is characteristic of SDFT injury
Palmar bow
Clinical signs of tendon injury (inflammatory phase)
Lameness
Pain on palpation
Heat
Swelling
Pathology
Haemorrhage/inflammation/neutrophils/increased blood flow/oedema
Clinical signs/pathology of reparative phase
Reduction of lameness
Resolution of inflammation
Palpable enlargement
Pathology - angiogenesis, fibroplasia, fibroblasts, type 3 collagen, small fibril formation
Remodelling/maturation phase signs
Size decreases, tendon less pliable, contracture
Collagen transforms 3-1
Cross linking and collagen fibrils
Where is strain likely to occur when a tendon has been previously injured
Proximal and distal to the previous injury
Cross links are very strained
Synoviocenthesis of DIP
Proximal edge of DIP 2cm lateral or medial of midline needles inserted distally
Synoviocenthesis of PIP
Difficult
1cm distal to line of medial and lateral eminences for attachment of collateral ligaments
Digital flexor tendon sheath synoviocenthesis
Enter on palmar aspect of the pasterns between proximal and distal annular ligaments
Metacarpophalangeal/metatarsophalangeal synoviocenthesis dorsal approach
Insert needle under lateral edge of the common digital extensor at or slightly above palpable joint space directed medially parallel to frontal plane of the joint
Metacarpophalangeal/metatarsophalangeal synoviocenthesis palmar approach
Needles must be dorsal to suspensory branch distal end of forth metacarpal/metatarsal bone
Carpus synoviocenthesis
Must be flexed sample either side of extensor carpal radialis either into radiocarpal or intercarpal joint
Synoviocenthesis of tarsocural
Distal to the medial malleolus of the tibia just medial or lateral to the saphenous vein 45° toward joint
Tarsometatarsal synoviocenthesis
Planterolateral approach inserted above the head of the 4th metatarsal directed dorsomedial
Femoropatella compartment of stifle
Between the middle and medial patella ligaments between the middle and lateral patella ligaments proximal to the palpable aspect of the tibial tuberosity
Medial femorotibial synoviocenthesis
Needle inserted in to indentation between medial patella ligament and the tendon of the sartorius muscle proximal to the tibial plateau parallel to the ground
Lateral femorotibial synoviocenthesis
Immediately cranially, caudally or through the long digital extensor muscles proximal to tibial plateau
