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Y4 EQ - Orthopaedics > Pastern and fetlock > Flashcards

Pastern and fetlock Flashcards

1
Q

Where is the pastern joint?

A

Between P1 and P2

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2
Q

Which ligaments/tendons lie at the palmar aspect of the pastern joint?

A

SDFT branch
Straight sesamoidean ligament
Oblique sesamoidean ligaments
Palmar scutum

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3
Q

Which ligament lies on the medial/lateral aspect of the pastern joint?

A

Collateral ligaments

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4
Q

Where does the distal sesamoidean ligament insert?

A

Onto the palmar/plantar scutum

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5
Q

Is the pastern joint a high or low motion joint?

A

Low

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6
Q

Is the pastern joint a high or low loading joint?

A

High

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7
Q

Where is the fetlock joint?

A

Between the 3rd metacarpal/tarsal bone and P1
Also proximal sesamoid bone

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8
Q

Which tendon is found at the dorsal aspect of the fetlock joint?

A

Common extensor tendon and extensor branch

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9
Q

Which tendons/ligaments are found at the palmar/plantar aspect of the fetlock joint?

A

Suspensory ligament
Collateral sesamoidean ligaments
Straight sesamoidean ligament
Oblique sesamoidean ligament

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10
Q

How is the fetlock joint stabilised?

A

Collateral/collateral sesamoidean ligaments

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11
Q

Is the fetlock joint a high or low motion joint?

A

High

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12
Q

The fetlock is primarily supported by which structure?

A

Suspensory ligament

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13
Q

Describe the initial investigation into pastern/fetlock problems

A

Clinical examination - Pain/lameness, swelling (synovial/soft tissue), heat, instability, ROM

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14
Q

Describe diagnostic analgesia of the pastern/fetlock

A

Perineural: ASNB (abaxial sesamoidean nerve block – blocks the foot and pastern); L4/6NB
Intra-synovial: PIPJ; MCPJ; (DFTS)

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15
Q

The L4 nerve block blocks which nerves?

A

Medial/lateral palmar and palmar metacarpal n.

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16
Q

The L6 nerve block blocks which nerves?

A

Medial/lateral plantar and plantar metatarsal n.
Dorsal metatarsal n. (med/lat)

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17
Q

Which radiographic views would you use for the pastern?

A

DP = front to back
LM = side to side
DMPLO = 45 degree angle dorsomedial
DLPMO = 45 degree angle dorsolateral

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18
Q

Which radiographic views would you use for the fetlock?

A

DP, LM, DMPLO, DLPMO, flexed LM

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19
Q

Which other imaging techniques can be used in the pastern/fetlock?

A

Ultrasonography
Advanced imaging e.g. nuclear scintigraphy, MRI or CT

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20
Q

Name 4 conditions of the equine pastern

A

Osteoarthritis
Osteochondrosis
Soft tissue injuries
Fractures/subluxation

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21
Q

What is a common term used to describe pastern osteoarthritis?

A

Articular ringbone

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22
Q

What is osteoarthritis?

A

Progressive destruction of articular cartilage with subchondral bone thickening and osteophyte production

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23
Q

What may severe cases of osteoarthritis have?

A

Cystic formation/joint collapse

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24
Q

How does arthritis occur?

A

Maybe insidious or secondary to other problem (e.g. trauma, sepsis, osteochondrosis)

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25
Q

What are the clinical signs of pastern osteoarthritis?

A

Lameness (mild to moderate)
Bony thickening over dorsal pastern

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26
Q

How is pastern osteoarthritis diagnosed?

A

Diagnostic anaesthesia: Perineural or intra-articular
Radiography
- Standard projections
- Changes often dorsal

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27
Q

How is pastern osteoarthritis managed?

A
  • Rest/light exercise
  • Intra-articular medication
  • Shoeing
  • NSAIDs
  • Arthrodesis (surgical, chemical)
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28
Q

What is sclerosis?

A

Subchondral bone formation - an abnormal increase in density and hardening of bone

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29
Q

How common are osteoarthritis and osteochondrosis in the pastern?

A

Osteoarthritis = common
Osteochondrosis = uncommon

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30
Q

How does osteochondrosis manifest?

A

Osseous cysts (P1 or P2) or palmar/plantar osteochondral fragmentation

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31
Q

How is osteochondrosis managed?

A

Management often palliative
Guarded prognosis

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32
Q

Name 2 common soft tissue injuries of the pastern joint

A

SDFT branch injury
Distal sesamoidean ligament injury - Oblique or straight sesamoidean ligament

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33
Q

How do horses with soft tissue injuries of the pastern joint present?

A

Usually present acutely lame following traumatic injury
Moderate lameness and soft tissue swelling

34
Q

What is the best method for diagnosing soft tissue injuries?

A

Ultrasonography

35
Q

How are soft tissue injuries managed?

A

Rest, NSAIDs, monitor healing by ultrasound

36
Q

Describe the main features of P1 fractures

A

Sagittal, frontal, comminuted
Often seen in racehorses

37
Q

Describe the pathway of P1 fractures

A

P1 fractures begin at sagittal groove at articular surface
- Extend distally (short <30mm; long>30mm)
- Complete fractures exit lateral cortex or through PIPJ

38
Q

Describe the features of P2 fractures

A

Palmar/plantar eminence, comminuted
Usually due to acute overload injury

39
Q

What are the common clinical findings of pastern fractures?

A

Usually acute onset severe lameness +/- instability +/- joint effusion

40
Q

How are pastern fractures diagnosed?

A

Radiography

41
Q

How are pastern fracture managed?

A
  • First aid stabilisation: Zone 1 external coaptation
  • Conservative = Short, incomplete fractures
  • Surgical = Internal fixation – most cases
  • Euthanasia = Comminuted, open, unstable
42
Q

What are the two main causes of pastern subluxation

A

Traumatic event (e.g. cattle grid/fence)
Fracture/subluxation common (e.g. avulsion fracture)

43
Q

How do cases of pastern subluxation present?

A

Acute lameness/instability
Marked soft tissue swelling

44
Q

How is pastern subluxation diagnosed?

A

Radiography +/- stress

45
Q

How is pastern subluxation managed?

A

Initially stabilise through external co-aptation (zone 1) but often require pastern arthrodesis

46
Q

List the main problems occurring at the equine fetlock

A
  • PSB fractures
  • Sesamoiditis
  • Osteochondral fragmentation of P1
  • Osteochondrosis
  • Osteoarthritis
  • Subchondral bone disease/POD
  • Chronic proliferative synovitis
  • Subluxation
47
Q

What types of fractures can occur in the proximal sesamoid bone?

A

Apical (<30% of bone), mid-body, axial, basilar and comminuted
may be unilateral or bilateral

48
Q

What are the causes of proximal sesamoid bone fractures?

A

Usually acute trauma but may be due to non-adaptive modelling

49
Q

How do cases of proximal sesamoid bone fractures present?

A

Clinical signs usually acute lameness with swelling and pain on palpation +/- joint effusion

50
Q

How are proximal sesamoid bone fractures diagnosed?

A
  • Standard radiographic projections but may need additional oblique views
  • Ultrasonography important as may also have concurrent SL injuries
51
Q

Describe when conservative management of proximal sesamoid bone fractures is indicated

A

Uniaxial PSB fractures in foals
Non-articular

52
Q

Describe when surgical management of proximal sesamoid bone fractures is indicated

A

Fragment removal (e.g. apical fracture removed arthroscopically)
Fracture repair (e.g.mid-body)

53
Q

Describe when euthanasia for proximal sesamoid bone fractures is indicated

A

Biaxial/comminuted fractures

54
Q

Define sesamoiditis

A

Inflammation around the soft tissues of the palmar fetlock
Increased size/no. vascular channels

55
Q

Sesamoiditis is most commonly seen in which horses?

A

Young performance horses

56
Q

Sesamoiditis may indicate which injury?

A

May be an indicator of SL branch/annular ligament injury

57
Q

How is sesamoiditis managed?

A

Rest/NSAIDs + local cold therapy
Shockwave therapy in refractory cases

58
Q

How is Osteochondral fragmentation of P1 managed?

A
  • May not be clinically relevant (or relevant at high speed) so need to prove significance (e.g. diagnostic analgesia)
  • Radiography: Check contralateral limb
  • Fragment removal frequently performed arthroscopically
59
Q

Name the clinical form of osteochondrosis

A

Osteochondritis dissecans

60
Q

Describe the main features of osteochondrosis of the fetlock region

A

Includes OCD of the sagittal ridge of Mc/MtIII and osseous cysts of distal McIII
OCD may be seen as flattening of the sagittal ridge to separate fragmentation
Usually seen in young horses (1-4 fetlocks involved) with joint effusion +/- lameness

61
Q

Describe management of osteochondrosis

A

Surgical removal of fragments (OCD) or curettage of the cyst

62
Q

Describe fetlock osteoarthritis

A

Degenerative joint disease resulting in joint effusion, cartilage loss, osteophyte production and loss of joint function
May be secondary to trauma, sepsis, osteochondrosis

63
Q

Describe the clinical findings of fetlock osteoarthritis

A

Lameness exacerbated by fetlock flexion; reduced ROM
Positive i/a anaesthesia

64
Q

What would be seen on radiography of a fetlock with osteoarthritis?

A

Periarticular osteophyte formation (particularly proximodorsal aspect of P1 and dorsoproximal and dorsodistal margins of PSBs), modelling of proximal aspects of the dorsal and palmar sagittal ridges, subchondral bone sclerosis and joint space reduction

65
Q

Describe management of mild/early cases of fetlock osteoarthritis

A

Intra-articular medication e.g. hyaluranon/ corticosteroids

66
Q

Describe management of moderate cases of fetlock osteoarthritis

A

NSAIDs, i/a corticosteroids, IRAP, polyacrylamide gel

67
Q

Describe management of severe cases of fetlock osteoarthritis

A

Arthrodesis (salvage)
Euthanasia

68
Q

What is Palmar/plantar osteochondral disease

A

Degenerative condition of the distal condyles of young racehorses

69
Q

How does palmar/plantar osteochondral disease occur in young racehorses?

A

Repetitive high strain on bone and articular tissues leading to cartilage loss with eventual collapse of the articular surface
Associated with repeated corticosteroid use?

70
Q

Describe the clinical signs of palmar/plantar osteochondral disease

A

Mild/moderate lameness in 1 or more limbs localised to the fetlock

71
Q

How does palmar/plantar osteochondral disease appear on radiography?

A

Minimal signs to focal increases in bone density (sclerosis) and change in contour of the subchondral bone
Advanced imaging include nuclear scintigraphy and MRI

72
Q

How is palmar/plantar osteochondral disease in young racehorses managed?

A

Alteration in exercise schedule

73
Q

Describe the aetiology of chronic proliferative synovitis

A
  • Usually forelimb
  • Chronic repetitive trauma to dorsal aspect of fetlock due to hyperextension
  • Can lead to supracondylar bone lysis
74
Q

What are the clinical signs of chronic proliferative synovitis?

A

Lameness, reduced range of motion, heat/pai

75
Q

How does chronic proliferative synovitis present on radiography?

A

Crescent shaped bone loss distal McIII
Soft tissue swelling

76
Q

How does chronic proliferative synovitis present on ultrasound?

A

Thickening of dorsal synovial pad

77
Q

How is chronic proliferative synovitis managed?

A

Intra-articular medication; surgical resection

78
Q

How does fetlock subluxation occur?

A

Often due to trauma
Disruption of the collateral ligaments +/- avulsion fracture

79
Q

How is fetlock subluxation diagnosed?

A

Acute, severe lameness +/- overt luxation
Radiography +/- stress

80
Q

How id fetlock subluxation treated?

A

Closed reduction + cast - Will fibrose but may end up with OA
Arthrodesis if unstable

Y4 EQ - Orthopaedics (14 decks)

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