Ortho (EQ) Flashcards
Tendonitis of which tendon causes fetlock sinking and carpal sheath effusion?
SDFT
How do we treat SDFT tendonitis?
Cold hose + NSAID
Box rest for few days
Controlled exercise
Promote angiogenesis - PrP/Stem cells/US
What are the 2 Ddx for a swelling deep to the DDFT in the proximal metacarpus?
ALDDFT desmitis
DDFT desmitis
What is the Px for ALDDFT desmitis?
Guarded - likely recurrence
Which US features are diagnostic for suspensory desmitis?
Enlargement
Poor margination
Hypoechogenicity
What are the 2 approaches to Tx suspensory ligament desmitis?
Conservative: rest and shockwave therapy
Surgery: splitting, Neurectomy/fasciotomy
Is PAL desmitis painful on flexion or extension?
Flexion
What are the visible signs of PAL desmitis?
Notching of limb
DFTS effusion
+ response to DFTS analgesia
What are the 2 approaches to Tx PAL syndrome?
Conservative: Cold, NSAID, rest
Surgery: Tenoscopy and PAL desmotomy
Describe the aetiology of upward patellar fixation in the horse.
Medial pole of patellar hooked over medial trochlear ridge of femur
How is patellar fixation treated?
Exercise = build up muscle.
Can perform desmotomy as back up.
Following trauma, where may the SDFT luxate to?
Lateral Side
How is SDFT luxation treated?
Conservatively 3-6m!
Which muscular disease of horses presents like colic - how do you differentiate?
Acute Exertional Rhabdomyolysis
Urine - myoglobin
Pain over gluteals and biceps.
How is Acute Exertional Rhabdomyolysis treated?
IVFT
ACP
NSAIDs
How is Chronic Exertional Rhabdomyolysis managed?
Minimise stress, warm-up, avoid high-energy feeds
Which 3 breeds are predisposed to Polysaccharide Storage Myopathy?
Draft Horses
Warmblood
Quarter Horse
Give high fibre, low carb diet!
Where does the common calcaneal tendon insert?
Calcaneus
Where does the SDFT insert?
calcaneus
What occurs to the flight of the lame limb?
Reduced - may drag
In which direction do hoof cracks commonly run?
Proximo-distal
What causes hoof cracks?
Poor balance
Low horn quality
Trauma
What are transverse hoof crack associated with?
Coronary Band injury
How are hoof crack treated?
Debride necrotic tissue
stabilise with filler
Trim foot and unload crack (bar shoe/quarter clips best)
Treat cause
Give Local/systemic ABs
Describe the severity of lameness associated with Coronary Band injury
Moderate to severe
Which other structures may be involved with Coronary band injury?
DIP/PIP/NB/DFTS
Tendons/ligs: SDFT/DDFT/Extensors/collateral ligaments
How are Coronary Band injuries treated?
PRESERVE Coronary Band - suture it. Stabilise hoof wall Flush synovial structures Antibiotics NSAIDs
What is the best way to stabilise a Coronary Band injury?
CAST
What is the difference between Nail Bind and Nail Prick?
Bind - Nail close to sensitive structures
Prick - Nail into sensitive structures, may develop into abscess.
What are the signs of subsolar abscessation?
acute severe lameness
sensitive to hoof testers
Inc Digital Pulse and hoof temp
How are subsolar abscesses treated?
DRAINAGE remove shoe and nail pare foot remove all necrotic/underrun horn Poultice 1-2x daily Bandage to protect food
+ NSAID/AB and Tet
When should a foot with a subsolar abscess be re-shod?
Once dry/hardened
A penetration in which part of the foot may involve synovial structures?
Middle 3rd of frog
What are the signs of a synovial foot penetration?
severe lameness \+/- FB in foot (or wound) Distal limb swelling Inc digital pulse Sensitive to hoof testers over tract
What is the best way to diagnose foot penetration injuries?
Rx +/- probe/contrast
Synoviocentesis
MRI
How are synovial foot penetrations treated?
Debride infected tissue
Flush synovial structures - bursoscopy
ABs: systemic/IVRA/Intra-synovial/PPMA beads
How should a synovial foot penetration be dressed following surgery?
Bandage
Plate to raise heel
NSAIDs
What is the prognosis for synovial foot penetration?
Fair survival to disch (56%)
Guarded return to function (36%)
What are 5 potential causes of chronic hoof abscessation?
Imm. comp (Cushing’s) Keratoma Laminitis Bone sequestrum Collateral cartilage infection Infective (pedal) osteitis
What is Quittor?
Infection of the collateral cartilages following wound
How does quittor present?
Swelling or discharge from coronary band
How is quittor treated?
Surgical debridement - with care to avoid DIPJ
What is a keratoma?
Benign hoof/solar horn tumour
How do equine keratomas present?
Intermittent lameness/discharge
Circular keratinisation abnormality w/disch tract
How can we diagnose keratomas?
Rx = smooth radiolucent defect in P3
How are keratomas treated?
Surgical resection (GA)
What is canker?
Hypertrophy of frog epithelium - hyperkeratotic w/fronds of unconnected horn
Fusobacterium/bacteroides involved
How is canker treated?
Early: environment, debride, metronidazole bandage + systemic ABs + astringents
Late: aggressive surgery + bandaging
What is white line Dz?
Prog crumbling hoof wall w/white line separation +/-lameness
What causes white line Dz?
Warm, wet weather
Biotin/Zn/Se deficiency
What are the 3 steps in treating white line Dz?
- Remove abnormal horn
- Support remaining horn
- Prevent progression
What is the onset/DOA of mepivicaine?
1-2m
45m-1h
What is the onset/DOA of bupivicaine?
4-5mm
1-2h
What are 3 CIs for diagnostic analgesia?
Suspect fracture
Cellulitis
Uncooperative horse
What radiographs are involved in a standard foto series?
ML
DP
DPr-PaDiO
PaPr-PaDiO
Where should the beam be aimed for an LM Rx of the foot?
1-2cm below CB
1/2way between dorsal hoof wall and heel
Where should the beam be aimed for a DP Rx of the foot?
Horizontal beam centred 2cm below coronary band, perpendicular to limb
What are the 2 versions of a DoPr-PaDiO
Upright (hickman block needed)
High Coronary
Which Rx view of the foot is known as the “skyline view”?
PaPr-PaDi Oblique
What are the signs of DIPJ Dz?
Uni or Bi-lateral lameness
DIPJ effusion
What is the best imaging technique to assess foot pain?
Rx
How is Synovitis/OA/OC frag of the DIPJ treated?
IA medication - hyaluranon/CS/IRAP
NSAIDs
Remove frag if present
How is DIPJ trauma treated?
Rest NSAIDs
How is collateral ligament desmitis diagnosed/treated?
MRI
Rest
Farrier (rolled toe)
Shockwave/IA meds
How are DIPJ OCLLs treated?
IA meds
What are the signs of pedal bone fractures?
Acute pain
inc digital pulse
Hoof tester +, percussion +
+/- DiPJ effusion
WITH Hx of trauma!!
Where are pedal bone fractures commonly located?
Wings of P3 - need obliques and may need advanced imaging
How are pedal bone #s diagnosed?
Partial response to local anaesthesia
Rx!
How are pedal bone fractures managed?
Immobilisation - bar shoe and hoof cast.
Extensor process: remove frag surgically
Articular: internal fixation
Non-healing wing #: PD neurectomy
How is pedal osteitis diagnosed?
Chronic foot soreness.
Rx: demineralisation and wide vasc channels
How is pedal osteitis treated?
Correct foot imbalance to reduce abnormal stresses
Traumatic # of which bonecauses a moderate lameness, localised by LA to the foot?
Navicular bone
What is the best Tx for navicular bone #s?
Conservative
What exacerbates navicular Dz?
hard surface
circle
Low heel/long toe conformation
What may an O notice in a horse w/navicular dz?
Bilateral FL lameness
Unwilling to go forward
Stumbling
Refusing Jumps
What histopath changes are seen in the fibrocartilage of horses with navicular dz?
Thin fibrocartilage w/ palmar cortex erosion and medullary lysis
What histopath changes are seen in the DDFT of horses with navicular dz?
surface fibrillation
core lesions
adhesions
What bony histopath changes are seen in horses with navicular dz?
palmar cortical bone medulla replaced w/vascular CT
Degeneration of DIP/NB articulation
What histopath changes are seen in the sesamoidean lig of horses with navicular dz?
New bone formation
Where may a horse with Navicular Dz be + on hoof tester?
Over frog (inconsistent)
Describe the gait of a horse with navicular Dz?
Toe First
Which nerve blocks will resolve navicular Dz?
PD, DIP, NB
What Rx abnormalities are seen in navicular dz?
Medullary cyst formation Flexor Cortex erosion Loss of corticomedullary definition Fragmentation of distal border Enthesophytes (L/M border)
What is the most important Tx for navicular Dz?
Farriery! Engage frog w/ground and improve heel support
What should be given in addition to correcting navicular Dz?
NSAIDs
IA hyaluranon/CS
Bisphosphonates
can perform neurectomy but complications occur!
How are 1e DDFT lesions diagnosed?
MRI - proximal to navicular bone
How do 1e DDFT lesions present?
Mild-severe acute unilateral lameness
+ve to PDNB and NB
How are 1e DDFT lesions treated?
Conservative good
Surgery if debridement indicated
Which perineural blocks can be used in the pastern/fetlock?
ASNB
L4/6NB
Which intra-synovial blocks can be used in the pastern/fetlock?
PIPJ, MCPJ
Which ligaments support the pastern/fetlock area?
sesamoidean
What is the medical name for “articular ringbone”?
Pastern OA - prog destruction articular cartilage w/ subchondral thickening and osteophyte production
What are the clinical signs of pastern OA?
Lameness
Bony thickening on dorsal aspect
How is pastern OA diagnosed?
Analgesia: Perineural or articular
Rx: standard angles, dorsal changes
How is pastern OA managed?
Rest
IA meds
Shoeing and NSAIDs
Can perform arthrodesis
Where is osteochondrosis most common?
Tarsus/Stifle
Can occur in pastern
How does pastern OC present on Rx?
osseous cysts on P1/2 and osteochrondral fragments
What is the Px/Tx for Pastern OC?
guarded Px, palliative care!