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Y4 Equine - Lameness & Orthopaedics > Overview > Flashcards

Overview Flashcards

1
Q

Components of a physical exam

A
  • observation from a distance
  • direct palpation
  • ancillary tests
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2
Q

Components of a lameness exam

A
  • basic examination
  • additional movements/surfaces
  • evocative tests
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3
Q

What is lameness?

A

= a clinical sign, [manifesting] signs of inflammation including pain, or a mechanical defect that results in a gait abnormality

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4
Q

5 ‘types’ of lameness

A
  • supporting limb (stance phase) lameness
  • swinging limb lameness
  • mixed lameness
  • compensatory lameness
  • induced/artefactual lameness
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5
Q

Hind limb lameness

A
  • limb with greatest movement when trotting
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6
Q

Is forelimb or hindlimb lameness more common?

A
  • forelimb
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7
Q

Are forelimb lamenesses above the carpus common?

A
  • no, extremely uncommon in all groups of horses
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8
Q

History - signalment: age

A

Specific age groups often suffer from specific conditions:
* foals: haematological septic arthritis, lateral luxation of the patella
* young, skeletally immature animals: developmental orthopaedic diseases including OCD, stress related injuries (esp TB horses)
* older horses: chronic progressive OA, navicular disease

but these are not necessarily exclusive

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9
Q

History - signalment: sex

A
  • There are very few sex related conditions; however, breeding potential may be important for treatment
  • may also see behavioural changes associated with oestrus
  • RER has been shown to be more common in female TB and
    event horses
  • anecdotally lameness has been implicated in cryptorchid animals
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10
Q

History - signalment: discipline

A
  • certain disciplines will place unique strains on animals
  • some manifestations of lameness are seen in all groups of animals
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11
Q

Top 3 causes of lameness in a flat-racing TB

A
  1. foot-related lameness
  2. suspensory desmitis
  3. middle carpal joint dz
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12
Q

Top 3 causes of lameness in a National hunt TB

A
  1. SDFT injury
  2. suspensory desmitis
  3. carpal dz
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13
Q

Top 3 causes of lameness in a show jumper

A
  1. palmar foot pain
  2. distal tarsal pain
  3. DIPJ OA
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14
Q

Top 3 causes of lameness in an event horse

A
  1. back.neck pain
  2. foot related lameness
  3. traumatic OA
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15
Q

Top 3 causes of lameness in a dressage horse

A
  1. PSD
  2. suspensory branch injury
  3. DIPJ OA
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16
Q

Top 3 causes of lameness in a draft horse

A
  1. foot-related lameness
  2. tarsal lameness
  3. ‘splints’
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17
Q

Top 3 causes of lameness in a pony

A
  1. laminitis
  2. distal tarsal pain
  3. ALDDFT desmitis
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18
Q

What is the most common cause of lameness in the horse?

A
  • hoof abscess
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19
Q

History

A
  • When did the owner first notice the problem? Is there a history of trauma?
  • Have any treatments been attempted?
  • What is the nature of the lameness?
  • Does it improve with exercise? Is it worse on different surfaces/with different tack?
  • Have there been any recent changes in management/exercise level/paraprofessional involvement?
  • Is there any previous history of lameness?
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20
Q

Conformation

A
  • severe conformational abnormalities are easy to appreciate
  • asymmetry of conformation is often particularly important
  • there may be important breed characteristics that lead to lameness e.g.
    long toe/low heeled TBs
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21
Q

Hock conformation

A
  • Hock conformation has a very significant effect on the prognosis for hind limb suspensory desmopathy (Dyson and Murray, 2011)
    – 77.8% (70/90) of horses with primary PSD and normal hock conformation returned to full soundness for >1yr following surgery
    – 0% of horses with primary PSD and straight hock conformation and/or hyperextension of the MTPJ returned to exercise
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22
Q

Posture

A
  • Careful observation from a distance is extremely important
  • laminitis or severe skeletal injuries might be readily obvious
  • pointing or reduced weight-bearing
  • “dropped elbow” indicates failure of the triceps apparatus
  • cervical pain
  • upward fixation of the patella
  • (neurological conditions)
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23
Q

Symmetry

A
  • Asymmetry is often very important in lameness evaluation
  • muscle atrophy (disuse or neurogenic)
  • foot size
  • fetlock height/angle
  • localised swelling (synovitis, cellulitis, exostosis/callus formation)
  • bony asymmetry (e.g. scapular height, tuber coxae/sacrale)
24
Q

Palpation

A
  • examine limbs during
    weight-bearing and
    elevated from the ground
  • ideally perform static examination before dynamic examination

Should include assessment of:
* asymmetry
* signs of inflammation
* pain (by both deep palpation and induced movement)
* loss of function e.g. range of movement
* crepitus
* peripheral pulses

25
Q

Cervical region examination

A
  • Examination of the poll including wings of the atlas * Palpation of the para-spinal musculature
  • Palpation of the brachiocephalicus muscle
  • If indicated assessment of the range of cervical movement using food
26
Q

Forelimb examination

A
  • Shoulder and bicipital region
  • Elbow and antebrachium
  • Carpus
  • Metacarpal region
  • Fetlock
  • Pastern
  • Foot
    – should include use of hoof testers
27
Q

Thoracolumbar spine examination

A
  • Use digital pressure to assess dorsal contour
  • Deep digital pressure of the epaxial muscles is resented by many horses and is not pathognomomic for back pain
    – pressure over the thoracic and cranial lumbar region usually results on lordosis
    – pressure over the caudal lumbar and sacral region results in kyphosis
    – often lack of these actions more indicative of back pain
  • Often back pain is secondary to hindlimb lameness
28
Q

Hindlimb examination

A
  • Femoral region
  • Stifle
  • Tibia
  • Tarsus
    – capped hock, bog spavin, bone spavin, curb and thoroughpin
  • Metatarsophalangeal region
  • Fetlock
  • Pastern
  • Foot
29
Q

Pelvic exam

A
  • Often externally palpable abnormalities of the pelvis appreciated during observation
  • include gentle rocking of the pelvis to detect crepitus
  • generally performed last due to inherent risks
  • include basic neurological assessment (tail tone, lower motor neurone function)
30
Q

General physical examination

A
  • This should not be overlooked
    – pyrexia may be concurrent with septic arthritis especially in
    the foal
  • Lameness and gait abnormalities may also result from other conditions
    – peritonitis/pleuritis, abscessation, genito-urinary disease
31
Q

Dynamic examination

A
  • Select an appropriate environment and surface
  • safety of the horse and handler are paramount
  • select an even, straight, firm surface free from distractions; however, alternate surfaces can be useful
  • explain to inexperienced handlers exactly what you require
32
Q

Lameness characteristics - examination should attempt to assess

A
  • baseline lameness (i.e. before provocative tests) or
    lamenesses
    – attempt to identify multiple limb lameness, and also establish whether these are primary or secondary problems, or if they are artefactual
  • any lameness identified should be graded and immediately recorded to attempt to create a degree of objectivity
33
Q

Lameness grading - AAEP Grade 1

A
  • Lameness difficult to observe and not consistently apparent regardless of circumstances (such as weight carrying, circling, inclines, hard surfaces)
34
Q

Lameness grading - AAEP Grade 2

A
  • Lameness difficult to observe at a walk or trotting a straight line but is consistently apparent under certain circumstances (such as weight carrying, circling, inclines, hard surfaces)
35
Q

Lameness grading - AAEP Grade 3

A
  • Lameness consistently observable at a trot under all circumstances
36
Q

Lameness grading - AAEP Grade 4

A
  • Obvious lameness with marked nodding, hitching, or shortened stride
37
Q

Lameness grading - AAEP Grade 5

A
  • Lameness characterized by minimal weight bearing in motion or at rest and the inability to move
38
Q

Assessment at walk

A
  • The horse should be walked at a steady pace away from and towards the observer
    – observe horses carefully during the turn
  • Careful attention should be placed upon
    – foot placement
    – gait abnormalities (e.g. “dishing”, “plaiting”)
  • Include lateral observation to assess:
    – foot flight
    – “tracking up”
    – cranial and caudal phases of the stride
39
Q

Alternative/mechanical causes of lameness

A
  • “stringhalt”
  • fibrotic myopathy
  • upward fixation of the patella
  • “shivers” syndrome
40
Q

Which age of horse is it important to assess neurological function when it comes to lameness?

A
  • young horses
41
Q

Examination at trot

A
  • Horse should again be moved at a steady pace away from and towards the observer
  • ensure that the handler does not constrain the horse’s natural movement
  • pace can sometimes mask or complicate assessment so different speeds can be useful
  • assessment now focuses less on the foot placement and more on other alterations in gait
42
Q

Head nodding

A
  • head elevation begins just before the stance phase of the lame limb
  • results in reduced ground reaction force (GRF) due to upwards acceleration of the head and neck, and caudal movement of the centre of gravity
  • consequently the horse appears to nod when the “good” leg is in contact with the ground
43
Q

Hindlimb lameness

A
  • Relative excursion of the tuber coxae is generally the accepted visual method of assessing hindlimb lameness
    – often given terms like hip or pelvic “hike”
    – the limb with the greater degree of movement is the lame limb
    – visual cues can be improved by placing tape on each hindlimb running between the tuber coxae and tuber sacrale
  • Hind limb lameness is harder to appreciate than forelimb lameness
44
Q

Artefactual lameness

A
  • Hindlimb lameness can mimic forelimb lameness at trot
    – when the lame limb hits the ground the horse moves it centre of gravity cranially to help unload the limb
    – the two-beat gait means that there will be a head nod during the stance phase of the contralateral forelimb
    – therefore the horse appears to be lame on the ipsilateral forelimb to the lame hindlimb
  • This is generally apparent only if moderate lameness is present
45
Q

Additional assessments - sound

A
    • excluding all visual clues and listening to syncopation can be extremely useful (remembering the beats of the four standard gaits)
46
Q

Additional assessments - fetlock drop

A
  • at trot because there is a higher GRF (ground reaction force) in the sound (less lame limb) the fetlock will drop further
  • structural disruption of the suspensory apparatus and flexor tendons will typically result in over-extension of the affected limb at walk
47
Q

Duration of stance phase

A
  • Most lameness results from pain during limb loading
  • therefore horses will attempt to reduce the duration of the
    stance phase
  • can be especially useful in the assessment of hindlimb lameness during lunging exercise
48
Q

Lunging exercise

A
  • Helpful in ascertaining there might be a bilateral component to lameness
  • Lunging on different surfaces can also be extremely useful
  • Beware of over interpretation
    – “soft tissue lameness is worse with the limb on the
    outside/when lunged on soft ground”
    – very tight circles on hard ground can evoke forelimb lameness of questionable significance, especially in heavier horses
49
Q

Lunging at canter

A
  • Three beat gait
  • L lead: LF, RF and LH, RH
    – although RH contacts the ground on its own, stance phase, GRF and degree of flexion in the proximal joints is greater in the LH
    – therefore a horse with a RH lameness may possibly prefer to canter on a left lead
  • R lead: RF, LF and RH, LH
50
Q

Ridden exercise

A
  • The additional weight of the rider can elicit lameness in either the forelimbs or the hindlimbs
  • subtle changes in weight can also mask signs of lameness
  • having an experienced rider can be extremely useful especially when evaluating subtle poor performance issues
51
Q

Flexion tests

A
  • Important to remember that these are not specific to one particular structure
  • Different clinicians will also apply different forces
    – consequently you need to be familiar with the normal
    – it is possible to induce lameness
    – studies show that 100-150N is optimal (????)
    – aim to flex the limb to a point slightly before a withdrawal response is elicited
  • No clear guidelines as to how long flexion should be applied
    – most clinicians use 60 seconds
    – however, it has been shown that 5 seconds of flexion generally produces similar results to 60 seconds in many cases
52
Q

Evocative tests

A
  • Extension tests
  • Direct palpation and pressure
  • Wedge tests
    – often overlooked
    – limb should be placed on the block whilst the contralateral limb is held
    – wedge can be placed to evoke lateromedial or dorsopalmar forces
53
Q

Horse temperament

A
  • Safety of the horse and handler should be the first consideration
  • acepromazine can be useful in calming fractious horses without providing analgesia
  • some clinicians advocate low doses of xylazine; however, this will be analgesic and may result in ataxia
  • more frequently xylazine is used to facilitate local anaesthesia in which case it is important to allow sufficient time for the effects to wear off
54
Q

Kinetics vs kinematics

A
  • kinetics describes motion (e.g. examines the forces applied)
  • kinematics explains motion (e.g. a geometric description of motion without considering causal forces)
55
Q

Objective lameness recording

A

Equinosis, took 20 years of development
* Use three wireless sensors which transmit data to a computer
* algorithms then identify the severity of the lameness and which limbs are involved

  • Other systems now available some with up to 8 sensors

Y4 Equine - Lameness & Orthopaedics (34 decks)

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