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Equine BCM > OCD > Flashcards

OCD Flashcards

1
Q

What developmental process goes wrong to cause OCD?

A

endochondral ossification

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2
Q

Why is surgical removal of OCD lesions an important consideration in horses?

A

It can cause damage to the joint

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3
Q

What is endochondral ossification?

A

The process in epiphysis where the cartilage template has vascular in-growth leading to bone formation (subchondral bone)

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4
Q

What is the pathophysiology of why endochondral ossification fails in OCD cases?

A

Failure of vascular invasion leads to failure of ossification

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5
Q

What may exacerbate an osteochondrosis lesion?

A

Chondrocyte death, damage to extracellular matrix or trauma

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6
Q

Osteochondrosis latens definition

A

Focal cartilage necrosis which heals and is not clinically relevant

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7
Q

Osteochondrosis manifesta definition

A

Cartilage does not ossify to bone in a focal area
-aka theres cartilage where bone should be
-results in a weak spot (stress riser) which can result in fracture through the cartilage

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8
Q

If a stress riser results in a fracture through both cartilage and bone, what is this called?

A

Osteochondral fragment
-usually occurs due to shear forces

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9
Q

Osteochondrosis dissecans definition

A

Trauma causes shearing off of either cartilage or cartilage and bone

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10
Q

How does a subchondral bone cyst form?

A

Trauma on a weight bearing surface causes a crack in the cartilage allowing joint synovial fluid to flow in. Increased pressure in the bone then leads to inflammation and bone resorption
-enough trauma in a normal joint without OCD can still result in a cyst

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11
Q

When do you lose hope for an early OCD lesion healing?

A

Once a foal is over 18 months of age

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12
Q

Which is more difficult to treat- OCD or bone cysts?

A

Bone cysts - can end up with joint inflammation, arthritis, tears in meniscus, pain in the bone itself

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13
Q

What causes horses to be predisposed to OCD lesions?

A

High growth rate, high plane of nutrition, heritability, trauma (excess trauma on healthy cartilage, normal trauma on defective cartilage), overexercise

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14
Q

How does cartilage get nutrition?

A

From the movement of the joint/weight bearing (moves synovial fluid into the cartilage)

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15
Q

What about the diet can predispose to OCD?

A

Too much phosphorus or excess calcium + energy

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16
Q

Which trochlear ridge is thinner?

A

Lateral ridge

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17
Q

What are some radiographic signs of OCD lesions

A

Lucency, sclerosis, fragmentation, soft tissue swelling

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18
Q

What are the hallmark signs of OCD?

A

Joint effusion, lameness (worsens with flexion due to swelling of joint capsule)

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19
Q

T/F: A foal with a very swollen hock can be diagnosed with X-rays without blocking

A

True-not true for older horse (always block these)

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20
Q

T/F: Arthritis in joint decreases prognosis in OCD cases

A

True

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21
Q

How can you figure out if a cartilage flap exists because it cannot be seen on X-ray?

A

Ultrasonography, contrast radiography, CT, MRI, nuclear scintigraphy, PET scan

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22
Q

T/F- Arthroscopy is a diagnostic technique for OCD

A

True! Can diagnose and treat all at once

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23
Q

Why are subchondral bone cysts harder to diagnose?

A

Often wont see effusion unless fetlock is affected (as the bone is affected more than the joint)
-lameness can be delayed until stressed
-may not block or only partially block
-often have arthritis before these are diagnosed

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24
Q

T/F: Lateral femoral condyle has a more round surface

A

F- medial

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25
Q

What does the treatment and prognosis of OCD depend on?

A

The joint involved -if more accessible more likelihood of success
-age of horse- if younger much higher likelihood of success

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26
Q

How do you decide whether to bring a horse to surgery for OCD?

A

severity of signs, occupation of horse, potential for OA, age

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27
Q

Why do you preserve cartilage when possible?

A

As it increases the likelihood of post-op success due to preservation of hyaline cartilage (vs fibrocartilage)
-debrided ocd beds heal with fibrocartilage which does not have the same mechanical properties as hyaline (not as resilient)

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28
Q

What medical therapy options are available to treat OCD?

A

-reducing trauma vs exercise restriction, relieve synovitis through adequan, legend, hysvic, or steroids (use caution)

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29
Q

What are the goals of arthroscopy for ocd patients?

A

-fully explore the joint and assess for damage, joint lavage, remove loose and free osteochondral fragments, debride loose and diseased cartilage, do no harm to normal attached cartilage

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30
Q

What post-op protocol is usually used after arthroscopic surgery?

A

60 days minimum stall rest with a gradual return to exercise

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31
Q

What are the treatment options for SBCs?

A

Inject lining of cyst with corticosteroids
-place metal or bioabsorbable screw across the cyst (dont know why this works)
-curette the cyst and fill with bone substitute and cover with chondrocytes

32
Q

Why may a horse be more painful immediately post-op bone cyst surgery?

A

Because the area is weight bearing

33
Q

T/F: RDVM suture removal is critical following arthoscopy

A

True as everything has to remain extremely sterile
- infections post-op are most common 2 days post suture removal

34
Q

Describe the prognosis for OCD of distal intermediate ridge of tibia, lateral trochlear ridge of femur, medial femoral condyle cyst, or shoulder

A

Distal intermediate ridge of tibia: excellent
Lateral trochlear ridge of femur: fair to good
Medial femoral condyle (stifle): fair
Shoulder: poor

35
Q

What is the incidence of bilateral lesions with OCD patients?

A

50%- why you should always radiograph the contralateral joint

36
Q

If you see a horse with OCD in several joints and signs of neck pain what should you do?

A

Refer- need advise of radiologist especially for neck X-rays

37
Q

Are cysts or OCD lesions more common in the elbow region?

A

Cysts!

38
Q

Which is more common in the femoropatellar joint- cysts or ocd?

A

OCD- cysts very uncommon

39
Q

What are the common signs of OCD in the femoropatellar joint?

A

Prominent effusion
- more common to see changes at the lateral trochlear ridge

40
Q

Which radiographic view should you use to diagnose OCD in the lateral trochlear ridge?

A

lateral-medial and caudolateral to craniomedial oblique views
-should look for kissing lesion on patella

41
Q

Which is more common in the femortibial joint- SBC or OCD?

A

SBC

42
Q

What level of improvement can you expect through IA anesthesia with SBC in the femorotibial joint?

A

50%

43
Q

Where do you commonly see SBCs in the femorotibial joint?

A

Medial femoral condyle

44
Q

What views should you use to diagnose OCD of the medial femoral condyle?

A

Caudocranial view, caudolateral to craniomedial oblique
-marginal sclerosis may demonstrate maturity

45
Q

Describe the classifications of SBCs?

A

Type 1: dome shaped
Type 2: circular with narrow channel to the joint surface
Type 3: Dimple

46
Q

What occurs most commonly at the trochlear ridge of the tibio-tarsal joint?

A

OCD

47
Q

Where in the tarsus does OCD usually target?

A

Distal intermediate ridge of tibia most common, followed by medial malleolus, followed by medial trochlear ridge followed by distal lateral trochlear ridge of the tarsal bone

48
Q

What views should you take of tarsus when working up an OCD case localized to this area?

A

All of them

49
Q

When performing surgery on the tibiotarsal joint, what is important to remember?

A

Explore the whole joint! Easy to miss things on radiographs

50
Q

Fetlock joint OCD common locations:

A

Proximal sagittal ridge, proximal P1

51
Q

What views should you get of the fetlock joint to diagnose OCD?

A

4 orthogonal views plus flexed lateral

52
Q

What is the prognosis for fetlock OCD?

A

Good with surgery- non-weight bearing surface

53
Q

SBC of the fetlock- when is it observed?

A

Earlier than OCD

54
Q

What is seen on physical with horses with fetlock bone cysts?

A

Effusion in 50% of cases, positive to flexion tests

55
Q

Which area of the fetlock joint is usually affected by bone cysts?

A

Medial condyle

56
Q

What is the prognosis for fetlock bone cysts?

A

80% return to athletics with surgery

57
Q

What is the most common cause of elongated heel in horses?

A

Shoulder OCD

58
Q

What is frustrating about diagnosing OCD in shoulder?

A

Flexion tests don’t tell you much and its hard to take Xrays

59
Q

How to diagnose shoulder OCD?

A

IA blocks, scintigraphy, contrast study

60
Q

Why is arthroscopy so difficult in the shoulder joint?

A

Hard to get visualization and reach areas you need to

61
Q

What is unique about these lesions in shoulder joint?

A

SBCs often occur with the OCD

62
Q

Which is more commonly found in the pastern joint: OCD or cysts?

A

SBCs

63
Q

When do SBCs of pastern usually show up?

A

After horse has arthritis

64
Q

What will you see diagnostically with cysts of the pastern?

A

Positive flexion
-IA best for diagnosis

65
Q

What radiographic views should you take for SBCs of pastern joint?

A

DP and lateral

66
Q

What is the treatment for SBC of pastern joint?

A

Arthrodesis in most cases (debride, screw, and/or inject)

67
Q

Coffin joint- OCD or SBC more common?

A

SBC

68
Q

What is challenging diagnostically about SBC of coffin?

A

No swelling/effusion

69
Q

What radiographic views do you want to diagnose SBC of coffin joint?

A

DP60 and lateral

70
Q

How can you reach this joint for trt?

A

Cant reach through arthroscopy. Opt for steroid injections in many cases or open up hoof wall

71
Q

How to diagnose extensor process OCD

A

Confirm diagnosis through blocking the joint and operating arthoscopically

72
Q

What is most common at the radiohumeral joint?

A

SBC-but still uncommon

73
Q

Where in the radiohumeral joint is usually affected?

A

Medial proximal radial condyle

74
Q

How to treat radiohumeral cysts?

A

Steroids. Cant access through arthroscopy

75
Q

What is more common at carpus- OCD or cysts?

A

Cysts at the distal radius

76
Q

If cysts in the carpus do not communicate with the joint, can you still expect lameness?

A

NO

Equine BCM (13 decks)

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