Musculoskeletal Flashcards
MSK01-06; MSK08 (07 is in Miscellaneous); MSK09-11
name the 7 steps of investigation of a lame horse
- Take History
- Examine at rest
- Palpate and manipulate limbs
- Observe horse moving
- Flexion tests
- Diagnostic nerve and/or joint blocks
- Diagnostic Imaging
this is a clinical sign of musculoskeletal pain
lameness
what is the best gait for determining which limb(s) is lame?
the trot
what is the main sign that is key to recognising forelimb lameness
head nod
what is the cardinal sign of hindlimb lameness?
asymmetric movement of the gluteal regions/tubercoxae
with unilateral forelimb lameness, what direction with the horse’s head nod with the SOUND limb and with the LAME leg?
DOWN with the SOUND limb
UP on the LAME limb
a horse with unilateral hindlimb lameness will show increased excursion of gluteal region on which side?
(sound or lame)
LAME
(the ‘hip hike’)
name the lameness grading scale
graded from 1-5;
an overarching grade when looking at the horse on various surfaces and gaits;
easier to utilise but does not allow for more subtle changes, particularly when performing diognostic anaesthesia
AAEP
name the lameness grading scale
graded from 1-10;
sliding scale that can be used for each trot up
Wyn-Jones
name the AAEP lameness grade
Lameness not perceptible under any
circumstance
0
name the AAEP lameness grade
lameness that is difficult to observe and is not consistently apparent, regardless of circumstances
1
name the AAEP lameness grade
lameness that is difficult to observe at a walk or when trotting in a straight line, but is consistently apparent under certain circumstances
2
name the AAEP lameness grade
lameness is consistently observable at a trot under ALL circumstances
3
name the AAEP lameness grade
lameness is obvious at a walk
4
name the AAEP lameness grade
non-weightbearing
5
name the Wyn-Jones lameness grade
sound
0
name the Wyn-Jones lameness grade
minimal degree of lameness is detectable, which may be inconsistent
1
name the Wyn-Jones lameness grade
a consistent, but mild, degree of lameness - detectable and consistent subtle head nod
2
name the Wyn-Jones lameness grade
consistent and obvious head nod/pelvic asymmetry
3
name the Wyn-Jones lameness grade
pronounced head nod / pelvic asymmetry
4
name the Wyn-Jones lameness grade
marked head nod/pelvic asymmetry
5
name the Wyn-Jones lameness grade
very marked head nod/pelvic asymmetry
6
name the Wyn-Jones lameness grade
difficulty trotting;
only just able to place heels to ground
7
name the Wyn-Jones lameness grade
minimal weight-bearing, heels not placed on the ground
8
name the Wyn-Jones lameness grade
only able to touch the limb to the ground
9
name the Wyn-Jones lameness grade
unable to put limb on ground
10
what is the most commonly used local anaesthetics for perineural anaesthesia?
nerve blocks used for assessing lameness
Mepivicaine
(onset 5-10min; duration 2-3h)
name the nerve block for assessing lameness
1-2mL;
limb position: limb held up, digit in partial flexion;
landmark: axial to the neurovascular bundle at the level of the ungular cartilages (NOT in the mid-pastern region)
palmar/plantar digital nerve block
name the nerve block for assessing lameness
1-2mL;
forelimb position: limb held in partial flexion;
hindlimb position: limb weight bearing or held up;
landmarks: palmar to the medial and lateral neurovascular bundle at the level of the distal aspect of the proximal sesamoid bones
abaxial sesamoid nerve block
name 3 landmarks blocked by the abaxial sesamoid nerve block
- all of the hoof capsule
- proximal interphalangeal joint
- palmar pastern region
name 5 parts of the palmar pastern region blocked by the abaxial sesamoid nerve block
- sesamoidean ligaments
- DDFT
- SDFT
- distal part of tendon sheath
- part of metacarpophalangeal joint
name the nerve block to assess lameness
1-2mL;
forelimb position: limb held up in partial flexion;
hindlimb position: limb weight bearing or held up;
landmarks: distal to button of the splint, 1-2” proximal to DFTS, subcutaneously between suspensory ligament and flexor tendons, at level of the button of the splint, adjacent to the abaxial margin of the extensor tendon
low 4-6 pt nerve block
name 3 areas blocked by the low 4-6 pt nerve block
- everything the abaxial blocks
- DFTS
- fetlock region (incl. suspensory branches)
name 4 advantages of ultrasound for diagnosing lameness
- non-invasive
- readily available
- relatively cheap
- horse side
name 4 disadvantages of ultrasound for diagnosing lameness
- fast learning curve
- can be tricky to interpret
- anatomy knowledge essential
- false/artefacts
name 5 advantages of radiography for diagnosing lameness
- relatively cheap
- readily available
- easier to interpret than u/s
- useful for bone pathology
- horse side
name 3 disadvantages of radiography for diagnosing lameness
- health and safety implications
- radiographic changes often historical
- difficult to image proximal limbs/pelvis
name 4 advantages of scintigraphy for diagnosing lameness
- good for ‘active’ bone pathology
- occasionally useful for enthesopathy
- proximal limb/trunk injuries
- concerns over fractures
name 4 disadvantages of scintigraphy for diagnosing lameness
- referral hospital
- take 10-14d before a fracture is ‘active’
- expensive (1400-2000)
- requires min of 48h hospitalisation
name 3 advantages of MRI for diagnosing lameness
- soft tissue and bone
- particularly within the foot and pastern region
- standing
name 5 disadvantages of MRI for diagnosing lameness
- referral hospital
- expensive
- not good at cartilage
- susceptible to movement
- can’t go more proximal than carpus/tarsus
.
name the characteristic lameness gait
shortened cranial phase, with an abrupt catching of the forward swing, followed by a slapping of the foot onto the ground ;
occurs on EVERY step of the effected leg;
single leg usually;
scar tissue of semitendinosus muscle
Fibrotic Myopathy
name the characteristic lameness gait
subluxation of scapulohumeral (shoulder) joint ;
muscle atrophy (supraspinatous mm and/or infraspinatous mm);
suprascapular nerver neuropraxia due to blunt trauma
Sweeney
what is the 4 treatments for Sweeney
- anti-inflammatories
- electrostimulation
- physiotherapy
- vit E and selenium supplements
name the characteristic lameness gait
exaggerated upward flexion of a hindlimb or both hindlimbs;
every stride;
affected limb is brought up, underneath the horse, frequently to the ventral abdomen
Stringhalt - neuropathy
name the characteristic lameness gait
draft breed and warmbloods;
early or mild disease can resemble stringhalt or upward fixation of the patella;
EPISODIC hyperflexion and abduction of the hindlimb (for several seconds), before placing foot on ground ;
exacerbated by picking up of the limb
Shiverer
what treatment can be tried for shiverer gait?
change to a high fat, low starch and low sugar diet
name the characteristic lameness gait
decreased force of muscle contractions (biceps femoris and quadriceps);
episodically unable to flex the stife, and drag extended limb behind them on the toe;
unilateral > bilateral
upward fixation of the patella
(‘locking patella’)
how to treat upward fixation of the patella
exercise
(conditioning, work on hills)
what surgery can be done for upward fixation of the patella?
medial patella ligament desmoplasty / desmotomy
name the characteristic lameness gait
often trauma related, resulting in hyperextension of the limb or laceration;
allows hock to extend while stifle is flexed;
characteristic dimple in the contour of the distal aspect of the crus
ruptured peroneus tertius
how long should a horse with ruptured peroneus tertius be box rested?
3 months
name the characteristic lameness gait
dropped elbow;
inability to lock out the carpus;
often associated with trauma, young horses turned out together
radial nerve paralysis
name 5 differentials for a ‘drop elbow’
- radial nerve paralysis
- olecranon fracture
- triceps myopathy
- shoulder fracture
- humerus fracture
name 5 treatments for radial nerve paralysis
- time
- anti-inflammatories
- electrostimulation
- physiotherapy
- vit E and selenium supplements
start of MSK02
name the 7 structures making up the Podotrochlear apparatus of the foot
- deep digital flexor tendon (DDFT)
- suspensory ligament of navicular bone
- collateral sesamoidean ligament
- distal interphalangeal joint
- distal sesmoidean impar ligament (DSIL)
- navicular bursa
- navicular bone
name the foot pathology
due to single episode of trauma or repetitive overloading (foot imbalance);
diagnose with inspection and hoof testers
bruising
name 3 parts of treatment for bruising of the foot
- rest
- NSAIDs
- solar pads or glue on shoes
name the foot pathology
a specific bruise at the angle of the bar;
more common medial than lateral;
usually due to presure from heel of shoe (either shod too short or shoe left on too long)
corns
name the foot pathology
very common cause of lameness;
acute, severe lamness or intermittent;
incr prevalence in winter/wet;
variable clinical signs;
any insult to sole can create ideal inflamm medium for bacterial growth
foot abscess
name the foot pathology
a nail is driven close to the sensitive laminae during shoeing, resulting in compression and pain
nail bind
name 3 clinical signs of nail bind
- lameness
- incr digital pulses and heat
- pain on hoof testers over location of nail
where do foot abscesses most commonly occur?
around the white line
what can be used to soften to hoof to help find the foot abscess for diagnossi
warm poultice
name the 3 parts of treatment for a foot abscess
- release infection & adequate drainage
- poultice until infection is controlled
- warm bath with povidone and magnesium salt (5-10min)
name the foot pathology
benign, hyperplasticity mass made of keratin;
originate from epidermal cells of the coronary band;
between sensitive laminae and hoof wall (stratum internum/medium;
usually dorsal half of foot
keratoma
name the foot pathology
inflammation of the distal phalanx;
demineralisation of the solar margin
pedal osteitis
name 5 parts of treatment for aseptic or concussive pedal osteitis
- corrective farriery (with shoes)
- improve solar palmar angle
- correct mediolateral imbalance
- avoid work on hard ground
- may require 6mo paddock rest
name the foot pathology
recurring foot abscess in the same site;
+ve hoof testers;
+ve PDNB/ABNB;
x-ray or MRI in combo with history to diagnose
septic pedal osteitis
name the 3 parts of treatment for septic pedial osteitis
- surgical debridement
- abx + NSAIDs
- hospital plate
name the foot pathology
infection of the ungular/collateral cartilages;
result of a hoof wall crack, puncture wound, or chronic abscess;
chronic abscessation, with intermittent purulent discharge above the coronary band
quittor
name the 2 parts of treatment of quittor
- surgical excision of infected cartilage and surrounding tissue
- opening of ventral drainage portal
name the foot pathology
pododermatitis of the frog;
bacterial: Fusobacterium necrophorum;
foul smelling, black discharge and degeneration of the frog
thrush
name 3 predispositions to thrush
- damp environment and poor stable sanitation
- poor hoof health/care
- sheared heels
name 5 parts of treatment for thrush
- debride frog
- move to dry clean environment
- daily hoof cleaning
- foot baths
- regular exercise
name the foot pathology
hypertrophic, moist dermatitis of the frog and bulbs of the heel;
gram neg bacterial infection (F. necrophorum) and chronic pododermatitis;
results in abnormal keratin production
canker
name the 3 parts of treatment for canker
- repeat radical debridement
- topical abx (metronidazole and chloramphenicol)
- caustic agents
(difficult!)
start of MSK03
name the foot pathology:
combo of bacteria and fungi produce separation of the white line;
occasionally will cause lameness, but often an incidental finding during trimming;
white line often has a grey/black chalky appearance
seedy toe/white line disease
which part of the sole does seedy toe/white line disease start at?
stratum medium and junction of stratum internum
name the foot pathology
vertical cracks in hoof wall from coronary distally
sand cracks
name the foot pathology
vertical cracks in hoof wall from ground proximally
grass cracks
name 5 causes of hoof wall cracks
- chronic foot imbalance
- lack of trimming
- trauma
- nutrition
- poor hoof quality
which radiographic view allows you to see the upright navicular bone
dorsoproximal-palmarodistal oblique (upright navicular)
which radiographic view allows you to see the navicular skyline
palmaroproximal-palmarodistal oblique
name the 3 types of treatment options for navicular disease
- farriery
- surgical
- medical
name the 3 ways to treat navicular disease with farriery
- shorten toe
- aid break-over
- elevate heels
name the 4 medical treatments for navicular disease
- intra-thecal anti-inflammatories
- intra-articular (DIPj)
- Biphosphates
- NSAIDs
name 3 intra-thecal anti-inflammatories that can be used to treat navicular disease
- corticosteroids
- hyaluronic acid
- polyacrylamide gel
name 2 surgical treatments for navicular disease
- buroscopy
- palmar digital neurectomy
name the foot pathology
mineralisation of the ungular cartilages - normal part of the ageing process;
often an incidental finding ;
BUT extensive ossification has been associated with lameness
sidebone
name the 3 characteristics of remedial farriery to treat fracture of ungular cartilage
- bar shoe with extra clips
- wide bar on fractured side
- groove hoof wall, proximal to fracture site
how long should a horse with fractured ungular cartilage be on box rest?
3-4mo
name 2 treatments for distal phalanx fractures
- external coaptation
- internal fixation
name the type of distal phalanx fracture
abaxial fracture WITHOUT joint involvement
type 1
name the type of distal phalanx fracture
axial, periaxial and abaxial fractures INVOLVING the joint
type 2 & 3
name 2 parts of treatment of type 1 distal phalanx fracture
- cast or bar rim shoe for 2mo
- box rest 2-4mo
name the 2 parts of treatment of type 2 & 3 distal phalanx fractures
- surgery (lag screw)
- box rest 2mo, then hand walking 2mo
name the type of distal phalanx fracture
extensor process fragments
type 4
name the type of distal phalanx fracture
multifragment fractures
type 5
name the type of distal phalanx fracture
solar margin fractures
type 6
name the treatment for type 4 distal phalanx fractures
remove small fragments,
lag screw large fragments
name the conservative treatment for type 5 distal phalanx fractures
rim shoe / cast
name the surgical treatment for type 5 distal phalanx fractures
articular joint reconstruction
name the treatment for type 6 distal phalanx fractures
usually heal by bony union
name the 3 synovial structures present in the middle of the foot that can be damaged by solar penetration
- DFTS
- NB
- DIPj
what is the treatment for coronary band laceration
debridement and primary closure
start of MSK05
which part of the long bone is ossified at birth and which part remains partly cartilaginous?
diaphysis ossified at birth;
epiphysis remain partly cartilaginous
name th 4 steps of endochondral ossification
- cartilage proliferation and hypertrophy
- calcification of cartilage
- deposition of primary bone
- remodelling into bony trabeculae
this is a focal disturbance in the process of endochondral ossification
osteochondrosis (OC)
cartilage superficial to an osteochondrosis lesion can fracture, giving rise to fragments in joints known as these
osteochondrosis dissecans (OCD)
name the 3 osteochondrosis stages
- Osteochondrosis latens
- osteochondrosis manifesta
- osteochondrosis dissecans
name the osteochondrosis stage
characterised by a focal area of necrotic cartilage (chondronecrosis), within the epiphyseal cartilage (visible histologically)
osteochondrosis latens
name the osteochondrosis stage
necrotic cartilage results in focal failure of endochondral ossification - visible macroscopically (similar to a bone cyst)
osteochondrosis manifesta
name the osteochondrosis stage
fissure originating from the necrotic cartilage, extends to the articular cartilage, creating a chondral or osteochondral flap;
likely secondary to trauma
osteochondrosis dissecans
name 4 things that cause clinical OC (osteochondrosis) progression
- biomechanical trauma
- exercise
- nutrition, hormonal factors and growth rate
- genetics
which mineral is important in the repair of lesions?
collagen and elastin crosslinks
copper
what joint in warmbloods is the most common site for osteochondrosis (OC)
tarsocrural
what joint in thoroughbreds is most common site for osteochondrosis (OC)
femoropatella
which pouch has the most obvious soft, fluctuant swelling in tarsocrural osteochondrosis (OC)
dorsomedial pouch
name 3 signs of stifle osteochondrosis (OC) appreciated on clinical exam
- effusion of femoropatellar joint and medial femorotibial joint
- soft fluctuant swelling cranial to medial collateral ligament of femorotibial joint
- soft fluctuant swelling cranial to patella
name 3 parts of the fetlock that can be affected by osteochondrosis (OC)
- dorsal end of sagittal ridge
- dorsoproximal first phalanx
- plantar osteochondral fragments (POF)
what is the most common part of the fetlock to be affected by osteochondrosis (OC)
dorsoproximal first phalanx
name 3 parts of the stifle that are affected by osteochondrosis (OC)
- lateral trochlear ridge
- medial femoral condyle subchondral bone cysts
- distal apex of patella
name 4 parts of the tarsus affected by osteochondrosis (OC)
- distal intermediate ridge of tibia (DIRT)
- lateral trochlear ridge of talus (LTR)
- medial malleolus of tibia (MM)
- medial trochlear ridge of talus (rare!)
what is the treatment of choice for most cases of OCD (osteochondrosis dissecans)
arthroscopy
what is the most common location in the stifle for a subchondral bone cyst
medial femoral condyle
name 4 treatment options for stifle subchondral bone cysts (SBC)
- arthroscopic debridement
- intra-cyst injection (corticosteroids, mesenchymal stem cells)
- bone graft
- transcortical screw
start of MSK04
name the type of dermis (corium):
vascular, dense connective tissue;
extends elongated distally directed papillae
coronary corium
name the type of dermis (corium):
series of laminae that interdigitate with epidermal laminae
laminar corium
name the type of dermis (corium):
shorter papillae
perioplic, solar, cuneate corium
this part of the foot provides sensation, nourishment and attachment for overlying epidermis
dermis (corium)
name the type of epidermis of the foot
single layer proliferating columnar keratinocytes;
lie on and between long dermal papillae;
proliferation forces cells distal intol stratum medium
stratum basale
name the 3 types of epidermis that make up the wall
- stratum internum
- stratum medium
- stratum externum
name the part of the hoof wall
epidermal laminae interleave with dermal laminae (550-600);
secondary laminae (150-200);
0.8m^2
stratum internum
name the part of the hoof wall
horn tubules and intertubular horn;
provides strength in every direction
stratum medium
name the part of the hoof wall
thin from perioplic region
stratum externum
name the 3 valveless venous plexus - digital veins of the foot
- dorsal
- palmar/plantar
- coronary
name 4 causes of failure of dermal/epidermal junction in the foot
- carb overload
- septicaemia
- equine metabolic syndrome/insulin resistance
- mechanical overload
name the theory of laminitis
older;
endotoxin causes peripheral vasoconstriction;
decr laminar perfusion and necrosis
vascular
name the theory of laminitis
newer and now more accepted;
proteolytic enzymes damage collagen allowing laminar separation
inflammatory
name 4 clinical signs of laminitis
- incr digital pulses
- if ‘sinker’ then there is a palpable dip at dorsal coronary band
- rotation results in pedal bone tip pressing on sole dorsal to frog = convex
- separation of white line
name the radiographic evidence of laminitis being assessed
angle between dorsal surface hoof wall and dorsal surface P3;
sole thickness at P3 tip
rotation
name the radiographic evidence of laminitis being assessed
founder distance (extensor process P3 to top of coronary band);
sole thickness
sinking
name 5 ways to reduce stress on laminae for treatment of acute laminitis
- remove shoes
- deep supportive bed
- cryotherapy
- small box confinement
- even weight bearing/heel support
.
name 5 pain relief options for acute laminitis treatment
- non-steroidals
- morphine IM q4h
- acepromazine IM + morphine
- lignocaine + morphine as CRI + acepromazine IM
- ketamine CRI
.
name 3 advantages of glue on shoes for laminitis
- atraumatic
- mouldable
- good for re-intro of exercise
name 2 disadvantages of glue on shoes for laminitis
- poor grip
- pressure!!
name 3 goals of trimming & shoeing as treatment of chronic laminitis
- hoof capsule realigned to P3
- frog support
- reduce breakover
start of MSK06
which angular limb deformity (ALD) is when the leg deviates inwards
varus
which angular limb deformity (ALD) is when the leg deviates outwards
valgus
which angular limb deformity (ALD) is more of a problem?
varus
name 3 congenital causes of angular limb deformities (ALD)
- incomplete cuboidal bone ossification
- laxity of the periarticular stuctures ‘windswept’
- aberrant intrauterine ossification
name 7 developmental factors for acquired angular limb deformities (ALD)
- genetic predisposition
- dietary imbalances
- trauma
- exercise
- physeal dysplasia
- physeal overload
- heavy birth rate
name the rapid growth phase (mo) for the growth plate
proximal P1
0-2mo
name the rapid growth phase (mo) for the growth plate
distal MC3/MT3
0-2mo
name the rapid growth phase (mo) for the growth plate
distal radius
0-6mo
name the rapid growth phase (mo) for the growth plate
distal tibia
0-4mo
name the time of radiographic physis closure (mo) for the growth plate
proximal P1
12mo
name the time of radiographic physis closure (mo) for the growth plate
distal MC3/MT3
6mo
name the time of radiographic physis closure (mo) for the growth plate
distal radius
22-36mo
name the time of radiographic physis closure (mo) for the growth plate
distal tibia
17-24mo
up to what degree of angular limb deviation is considered normal
up to 4 degrees
which side grows FASTER in an angular limb deformity?
the concave or the convex side?
concave side grows faster
(convex side grows slower)
at what points should the fetlock be assessed for angular limb deformities (ALD)
at birth/1d old
and again at 30d
(or q1-2wks)
when must an angular limb deformity (ALD) of the fetlock be resolved by?
by 12wks of age
(3mo)
at what age are angular limb deformities (ALD) of the fetlock usually surgically treated at?
4-6wks of age
at what age should you consider surgery for angular limb deformities (ALD) of the carpus
~6 mo
name the 2 steps of hoof manipulation to correct valgus (toe out)
- outside half of hoof wall is rasped (at the sole)
- extension placed medial
name the 2 steps of hoof manipulation to correct varus (toe in)
- inside half of hood wall is rasped (at the sole)
- extension placed lateral
name 3 risks of hoof manipulation to correct valgus and varus angular limb deformities (ALD)
- risk of P3 fractures
- joint stress (distal limb)
- exothermic reaction (aseptic pedal osteitis, foot abscess)
name the 2 surgical options for correction of angular limb deformities (ALD)
- growth acceleration
- growth retardation
what is the surgical option for growth acceleration to correct angular limb deformities (ALD)
hemicircumferential periosteal elevations
(aka periosteal strip)
what is the surgical option for growth retardation to correct angular limb deformities (ALD)
transphyseal bridge
(transphyseal screw OR screw and wires)
name 4 angular limb deformities (ALD) that cause problems
- offset knees, ‘bench knees’
- fetlock varus
- long pasterns
- mild carpal valgus
what is meant by the angular limb deformity (ALD) called offset knees or ‘bench knees’
carpal valgus & fetlock varus
this is a limb deformity in the saggital plane
flexural limb deformity
name the flexural limb deformity
flaccidity of flexor muscles;
commonly seen in newborns or premature foals;
often self-corrects within a few weeks
digital hyperextension
name the flexural limb deformity
congenital;
limb in permanent flexion;
can be a cause of dystocia;
physically unable to manipulate them straight
contracture
name 2 aetiologies for congenital contracture
(flexural limb deformity)
- uterine malposition
- toxic/viral insult in utero
name 4 treatments for congenital contracture (flexural limb deformity)
(early aggressive treatment required!)
- IV oxytet (3g SID for 3d)
- corrective farriery
- bandaging/splints/casts
- analgesia (metacam/fentanyl)
name 3 aetiologies for acquired flexural limb deformities
- rapid growth
- nutrition
- pain (reduced weight bearing)
name 4 clinical signs of acquired flexural limb deformities
- 6wks-6mo old
- boxy, upright foot
- broken forwards HPA
- raised heel, walking on toe
name the type of DIPj acquired flexural limb deformity
dorsal hoof wall does not pass beyond vertical
type 1 (A)
name the type of DIPj acquired flexural limb deformity
dorsal hoof wall passes beyond vertical
type 2 (B)
name 4 conservative treatments for acquired DIPj flexural limb deformity
- dietary changes
- NSAIDs
- exercise
- hoof trimming, bandaging +/- toe extension
name 2 surgical treatments for acquired DIPj flexural limb deformity
- desmotomy of ALDDFT (accessory ligament of deep digital flexor tendon)
- DDF tenotomy
(salvage procedures)
name the stage of acquired MCPj flexural limb deformity
straight fetlock, that is palmar to the foot
mild
name the stage of acquired MCPj flexural limb deformity
fetlock is dorsal to the foot, but when weight bearing, fetlock becomes palmar to foot
moderate
name the stage of acquired MCPj flexural limb deformity
fetlock is always dorsal to the foot
severe
name 3 treatments for acquired MCPj flexural limb deformities
- remedial farriery
- analgesia
- surgery
name the 2 surgical options for correction of acquired MCPj flexural limb deformity
- ALDDFT tenotomy
- ALSDFT tenotomy
this is inflammtion and disruption of the physis
physitis
name 3 aetiologies for physitis
- overload
- over exercise
- rapid growth
name 5 clinical signs of physitis
- 4-8mo old
- pain on palpation
- hard swelling over physis
- distal radius, tibia, MC3 and MT3
- variable lameness
name 2 signs of physitis seen on radiographs
- metaphyseal flaring
- hourglass shape to bone
name the 3 treatments for physitis
- reduction in BW or growth rate
- box rest
- NSAIDs 2-4wks at low doses
name the grade of cuboidal bone abnormality
some cuboidal bones of the carpus and tarsus have no evidence of ossification
grade 1
name the grade of cuboidal bone abnormality
all cuboidal bones have some form of ossification
grade 2
name the grade of cuboidal bone abnormality
all cuboidal bones (carpus and tarsus) are ossified, but small and rounded edges are present;
joint spaces are wide and lateral styloid process and malleoli are distinctly visible;
prox physes MC3/MT3 are closed
grade 3
name the grade of cuboidal bone abnormality
all criteria of grade 3 are met;
cuboidal bones are shaped like corresponding adult bones and joint spaces have expected width
grade 4
what is the treatment for cuboidal bone abnormalities
- box rest
- repeat radiographs q2wks
start of MSK08
name 4 aetiologies for synovial sepsis in the adult horse
- traumatic
- iatrogenic (joint medication)
- extension from overlying/adjacent structure
- very rarely haematogenous
name 7 clinical signs of synovial sepsis in adult horse
- trauma/wound overlying synovial structure
- visible penetration
- severe lameness
- heat/swelling
- rectal temp usually normal
- history of joint medication
- history of cellulitis
name 4 ways to diagnose synovial sepsis
- obvious clinical findings (palpate and u/s)
- synovial fluid analysis
- joint distension
- advanced imaging
what tube should be used for cytology of synovial fluid
EDTA
what tube should be used for bacteriology of synovial fluid
plain
name 4 things to assess in synovial fluid
- appearance
- total WCC, % neutrophils
- total protein
- lactate/serum amyloid A
what volume should be used for joint distension/pressure test in fetlock and carpus joints?
30 mL
what volume should be used for joint distension/pressure test in tarsocrural joint
120mL
name the 4 parts of treatment for synovial sepsis
- remove source of infection
- lavage joint
- antimicrobials
- anti-inflammatories
name 4 uses of arthroscopy for treating synovial sepsis
- remove foreign material
- remove pannus
- debride tissue
- assess damage and prognosticate
name 4 advantages of needle lavage over arthroscopy for treating synovial sepsis
- cheap and easy
- good for acute infection in foals
- first litre most important
- multiple widely spaced needles
name 3 disadvantages of needle lavage over arthroscopy for treatment of synovial sepsis
- no visualisation
- no pannus removal
- limited FB removal
name the 3 steps of intra-venous regional perfusion (IVRP)
- tourniquet proximal to joint
- catheter/needle in peripheral vein
- large volume
what is the highest risk factor for foals developing septic arthritis and osteomyelitis
failure of passive transfer
name the type of septic arthritis and osteomyelitis in foals
synovial membrane and fluids
S-type
name the type of septic arthritis and osteomyelitis in foals
articular epiphyseal complex
E-type
name the type of septic arthritis and osteomyelitis in foals
primary infection of physis
P-type
name 4 treatments for synovial sepsis in foals
- abx
- needle joint lavage if no evidence of osseous involvement
- anti-inflammatory meds
- treat concurrent disease
what is the characeristic radiological appearance of sequestrum formation
sequestrum surrounded by radiolucent involucrum
start of MSK09
name the 3 general causes of fractures in horses
- acute trauma
- pathologic fracture
- repetitive stress over short intervals of time
what is the most common general cause of fractures in horses
repetitive stress over short intervals of time
name 6 clinical signs of limb fracture
- acute, severe lameness
- local heat, pain on palpation, swelling
- abnormal angulation or mobility of limb
- limb shortening
- crepitus
- loss of function
list 7 differential diagnoses for a patient presenting with acute, severe lameness
- subsolar abscess
- fracture
- septic arthritis, tenosynovitis or bursitis
- tendon or ligament injury
- cellulitis or lymphangitis
- laminitis
- rhabdomyolysis
what 4 limb fractures would have a hopeless prognosis in majority of cases
proximal humerus, radius, tibia and femur
in adult horses (>300kg)
what range can the cost for repair of fractures cost?
2,000-10,000
(can exceed 15,000)
name 5 criteria for humane destruction (euthanasia) in a fracture case
- large open fractures
- significant comminution
- proximal long bone fracture
- recumbency
- owner request (finances, etc)
what should be used as sedation for an adult horse with a fracture
alpha-2 and opiod
xylazine or detomodone +/- butorphanol or morphine
what should be used as sedation for a young foal with a fracture
diazepam
what should be used as sedation for an older foal with a fracture
butorphanol
name 3 reasons accurate stable reduction is required ASAP with a fracture, before moving the patient, attempting radiography or transporting the patient
- provides pain relief
- allows horse to regain control of limb
- minimises further soft tossue injury or further injury to fractured bone
name the 3 steps of fracture stabilisation
- address wounds
- apply bandage
- place splint(s) based on biomechanical divisions or type of fracture present
name the type of bandage for stabilisation of fracture
1x diameter on distal limb
3x diameter for higher fractures
Robert Jones
name the type of bandage for stabilisation of fracture
3 layers of cotton wool
better stabilisation
modified Robert Jones + splint
name 5 options for splinting material
- Polyvinylchloride (PVC) pipe splints
- pine board
- aluminium or flat steel
- bandage cast
- commercial splints
name 4 splinting options for a level 1 P1 sagittal/parasaggital fracture
- Robert Jones bandage
- modified Robert Jones and lateral and medial splints from ground to proximal metacarpus/tarsus
- bandage cast
- compression boot
name 2 splinting options for a level 1 P1 frontal fracture
- bandage cast
- compression boot
name the type of splinting for level 1 palmar (forelimb) process fractures of P1 and P2
apply splint dorsal from ground to proximal metacarpus with fetlock in flexion
(use of Kimzey leg saver)
name the type of splinting for level 1 plantar (hindlimb) process fractures of P1 and P2
apply splint on plantar aspect of limb from ground to top of calcaneus with fetlock in flexion
(use of Kimzey leg saver)
name 3 splint options for a level 2 lateral or medial condylar fracture
- splinted Robert Jones bandage (lateral and medial splints)
- bandage cast
- compression boot
name the splinting method for level 2 sesamoid bone fractures of the forelimb
apply splint dorsal from ground to proximal metacarpus with fetlock in flexion
(use of kimzey leg saver)
name the splinting method for level 2 sesamoid bone fractures of the hindlimb
apply splint on plantar aspect of limb from ground to top of calcaneus with fetlock in flexion
(use of Kimzey leg saver)
where should the splint be placed for level 2 fractures of the forelimb to prevent abduction of the limb
- from ground to elbow
- on caudal and lateral aspect of limb
where should the splint be placed for level 2 fractures of the hindlimb to prevent abduction of the limb
- from ground to top of tuber calcis
- on caudal and lateral aspect of limb
what 2 splints should be placed for a level three fracture of the forelimb to prevent abduction of limb
- caudal - elbow to ground
- lateral - ground to withers
what splint should be placed for a level three fracture of the hindlimb to prevent abduction of limb
one splint lateral to level of tuber coxae
fractures of what 4 bones are considered level 4 fractures
- humerus
- scapula
- femur
- pelvis
can you place a splint for a level 4 fracture?
no
name 3 situations where splinting is NOT required for transport
- fractures of humerus, scapula, femur and pelvis (level 4)
- pedal bone fractures
- fractures where limb stability is preserved
why should nerve blocks NOT be performed prior to radiographs of a fracture
to encourage weight-bearing
name the type of fracture
courses completely through the bones and divides bone into 2 or more separate fragments
complete fracture
name the type of fracture
does not course completely through the bone nor divide bone into 2 or more separate fragments
incomplete fracture
name the type of fracture
occur when fracture fragments are separated, angulated, or overriding and no longer in anatomic apposition
displaced fractures
name the type of fracture
fracture remains in anatomic apposition
non-displaced fracture
name the type of fracture
skin has a wound over fracture that introduces contamination and increases risk for infection
open fractures
name the type of fracture
skin overlying fractured bone is intact and not penetrated by injury
closed fractures
name the type of fracture
course through the articular surface of a bone
articular fractures
name the type of fracture
do not extend through an articular surface
non-articular fractures
name the type of fracture
involve the end of a long bone
epiphyseal fracture
name the type of fracture
involve an open physis
physeal fracture
name the type of fracture
involve a region of bone adjacent to growth plate on the side closer to the centre of the long bone
metaphyseal fracture
name the type of fracture
involve the central region of a long bone
diaphyseal fracture
name the type of fracture
course approximately perpendicular to the longitudinal access of the bone
transverse fractures
name the type of fracture
course along a flat plane but obliquely through the bone
oblique fractures
name the type of fracture
have a spiral fracture component through a bone
spiral fractures
name the type of fracture
have transverse and oblique components
butterfly fractures
name the type of fracture
divide bone into only 2 fragments
simple fracture
name the type of fracture
divide bone into 2 major fragments with small bone fragments, usually along the major fracture line
mildly comminuted fractures
name the type of fracture
divide bone into 3 or more major fragments
comminuted fractures
name 2 types of stress fractures
- kick injuries of distal medial radius
- tibial stress fractures or pelvic fractures in high-level performance horses
what is the treatment for stress fractures
min 6wks box rest depending on severity
name 5 clinical signs of pelvic fractures
- overt lameness
- external swelling or palpable symmetry
- pain with palpation
- possible haemorrhagic shock if artery involved
- muscle atrophy in chronic cases
what is the typical treatment for pelvic fractures
conservative with stall rest
how can displaced iliac shaft fractures in foals be repaired
internal fixation
how can displaced tuber coxae fractures that are draining be treated?
surgically by removing fracture fragment(s)
start of MSK10
name 2 proteoglycans found in tendons
- lecticans
- SLRPs
name the component of tendons
fibril forming;
tensile strength
type 1 collagen
name 5 risk factors for tendinopathy
- speed
- surface
- weight of horse
- fatigue
- shoeing
name 3 theories for how fibril damage occurs
- overstimulation
- understimulation
- aberrant differentiation of resident progenitor cells
name the cause of fibril damage/tendinopathy
repetitive subthreshold mechanical strain;
hyperthermia;
ischaemia - reperfusion injury;
imbalance between synthesis and degradation;
ECM and cellular damage
overstimulation
name the cause of fibril damage/tendinopathy
loss of local homeostatic strain results in activation of catabolic cascade;
collagenase upregulated in stress deprived tendons leading to breakdown of the extracellular matrix
understimulation
name the tendon injury
acute onset lameness;
heat, soft painful swelling;
classically in the mid-cannon area;
lameness often resolved quickly for non-severe injuries BUT tendon remains weak
superficial digital flexor (SDFT) injury
how long after injury should u/s be used to confirm extent of fibre damage in superficial digital flexor injuries
10-14 d
what is the aim of superficial digital flexor tendinopathy treatment
promote longitudinal organisation of collagen fibrils
name 4 treatments available for tendinopathy of superficial digital flexor tendon
- controlled exercise alone
- stem cells
- platelet rich plasma (PRP)
- desmotomy ALSDFT
how long should a horse with superficial digital flexor tendinopathy be on box rest and 30min in hand walking
8wks
how long after superficial digital flexor injury before a horse should resume full race/competition training
52 wks
name 5 locations for deep digital flexor tendinopathy
- within the foot
- within digital flexor tendon sheath
- assoc with osteochondroma in carpal canal
- assoc with ALDDFT desmitis
- assoc with injury to sustentaculum tali
how to treat deep digital flexor tendinopathy within the digital flexor tendon sheath
tenoscopic debridement
what is the most useful way to diagnose deep digital flexor tendinopathy within the foot
MRI
(sagittal split, core lesions, dorsal fibrillation)
name 5 treatments for deep digital flexor tendinopathy within the foot
- NSAIDs
- box rest and controlled exercise
- farriery (elevated heels)
- bursal medication
- bursoscopy
this extends from the distal 1/3 metacarpus to the T ligament
digital flexor tendon sheath (DFTS)
name 3 first aid treatments for complete breakdown of suspensory apparatus
- Kimzey leg saver splint
- NSAIDs
- abx if surgery indicated
name 3 treatments for forelimb proximal suspensory desmitis
- 3mo box rest and controlled exercise
- shockwave
- platelet rich plasma intra-lesional
what is another name for the accessory ligament of the deep digital flexor tendon (ALDDFT)?
inferior check ligament
start of MSK11
this is the articulation between vertebral column and pelvis;
synovial joint between two flat surfaces
sacro-iliac joint
name the 3 ligaments required to provide stability to sacro-iliac joint
- dorsal
- ventral
- interosseus
name 4 things to examine the back and pelvis for
- range of motion
- pain
- lameness
- symmetry
name the radiograph projection of the neck
neutral position;
multiple overlapping views;
position of the neck has some but not massive impact
lateral-lateral
name the radiograph projection of the neck
separates out articular process joints;
taken from both sides
oblique projections
(lateral 45-55° ventral-dorsal oblique)
name 4 clinical presentations of neck pain
- weak, tripping, reduced neck movement
- resents contact
- unwilling to move neck
- hopping like lameness
name 3 indications for nuclear scintigraphy of neck, back and pelvis
- screening tool for investigation of poor performance
- investigation of undiagnosed lameness
- undiagnosed but suspicion of severe pathology - fracture
name 4 clinical signs of impingement of the nerve root at the intervertebral foramen caused by degenerative arthropathy
- localised sweating, pain
- reluctance to bend the neck
- stiffness
- forelimb lameness
name 3 clinical signs of type 2 CVCM caused by degenerative arthropathy
- reduced performance
- subtle hindlimb gait abnormalities
- ataxia
name 4 medications that can be used to manage impingement of dorsal spinous processes and back pain in general
- corticosteroids (interspinous space)
- NSAIDs
- muscle relaxants
- biphosphonates
name 3 surgical resection options for treatment of impingement of the dorsal spinous processes
- subtotal ostectomy
- cranial wedge ostectomy
- interspinous ligament desmotomy
name 4 causes of sacro-iliac joint disease
- arthrosis and microscopic instability
- desmitis of the sacro-iliac ligaments or lumbosacral ligaments
- osteoarthritis of the lumbosacral joint
- acute sacroiliac injury
