Poor Performance Flashcards
Body systems to consider in the poor performance case
Musculoskeletal
Respiratory
Gastrointestinal
Reproductive
Cardiac
Possible musculoskeletal causes of poor performance
Mild, bilateral or quadrilateral lameness
Disease of axial skeleton
Muscle disease
Top respiratory causes of poor performance
Upper respiratory (recurrent laryngeal neuropathy, dorsal displacement of soft palate, pharyngeal collapse)
Lower respiratory (mild equine asthma)
Gastrointestinal cause of poor performance
Gastric disease
Reproductive cause of poor performance in male
Cryptorchid or rig
Reproductive cause of poor performance in female
Ovarian tumours
Normal ovarian cyclicity
Top cardiac cause of poor performance
Atrial fibrillation (horse with high athletic demand)
Steps of poor performance palpation
Neck palpation and baited stretches
Epaxial muscles of thoracic and lumbar spine (deep, sustained pressure and pulsatile to assess ability to ventral flex, muscle mass/tone/symmetry)
Sternal lift
Sacroiliac region (deep palpation either side of midline)
Lumbosacral dynamic flexion (pressure on skin either side of tail base)
Inspect limbs for signs of effusion, swelling and heat, especially in sites typical of bilateral lameness
Common sites of bilateral lameness in sport horses
Feet
Tarsus
Proximal suspensory
Common sites of bilateral lameness in racehorses
Carpus
Fetlock
Tarsus
How to identify bilateral/multilimb lameness
Lunging (more weight on inside limb)
Flexion tests (increased pressure of joint fluid)
What measurements do you get from objective gait analysis sensor based systems?
Asymmetry in millimeters
What measurements do you get from objective gait analysis sensor based systems?
Asymmetry in millimeters
Problem with anaesthesia of the proximal suspensory ligament or tarsometatarsal joint
Closely associated so anaesthesia of one can affect the other (but does mean medication of one can improve the other)
Treatment for refractory cases of proximal suspensory disease
Neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy
Contraindications for neurectomy and fasciotomy of the proximal suspensory
Horses with marked ligament degeneration (procedure can accelerate ligament degeneration)
Competition legality
Most mobile part of lumbosacral spine
L6-S1
Clinical signs of axial skeleton pain
Poor muscling
Pain on palpation
Abnormal dynamic responses
Resentment of ridden exercise
Poor quality canter (vs trot)
Most commonly acquired radiograph view used to image disease of dorsal spinous process
Laterolateral
What disease is this?
Dorsal spinous process impingement/’kissing spines’ in mid thoracic region with bony remodelling (halos of sclerosis)
What disease is this?
Dorsal spinous process impingement/’kissing spines’
Methods to increase suspicion of back pain alongside radiographic abnormalities
Gamma scintigraphy (combines physiology with anatomy as it identifies active inflammation)
Response to local anaesthesia (assess ridden before and after)
Response to local anti-inflammatories (‘long term block’)
Medical management for DSPs
Local injection of corticosteroids
Rehabilitation program to restore strength and function
(Can be curative, as back strengthens medication interval will increase)
Surgical procedures for DSP impingement
Interspinous ligament desmotomy
Subtotal (cranial wedge) ostectomy
Advantages of interspinous ligament desmotomy
Short rehabilitation period (back in work quickly e.g. young thoroughbred)
Disadvantages of DSP management
Doesn’t change underlying anatomy
Advantages of subtotal (cranial wedge) ostectomy
Permanent anatomy change (no impingement)
Better long term outcomes
Disadvantages of subtotal (cranial wedge) ostectomy
Invasive
Post-operative pain
Long rehabilitation period
Clinical signs of lumbarsacral/sacroiliac pain
Buck under saddle
Disunited at canter
Poor hind limb engagement
Occasionally overt lameness
Important consideration of sacroiliac nerve blocks
Ultrasound guided
Close to important structures (inadvertent blocking of cranial gluteal nerve = recumbent for 3-4 hours, ensure horse is in stable/recovery box)
Benefits of scintigraphy
Identify concurrent appendicular or axial pathology
Limitation of scintigraphy
Expensive
Radiation (= isolation 48-36 hours)
Diagnostic options for SI disease
Local anaesthetic block
Scintigraphy
Ultrasound per rectum
When you medicate the SI joint, is it a joint or regional medication?
Regional (3ml of synovial fluid, 10-20ml injectate)
Main goal of SI rehabilitation
Core stability (sternal lifts, LSI dorsiflexion, tail pull)
When is water treadmill exercise recommended?
Strength
Coordination
Stability
Postural control
Devices that encourage dorsiflexion and muscle recruitment
Pessoa systems
Equiband
