Poor performance exam Flashcards
What respiratory conditionscan contribute to poor perfromance?
Upper respiratory conditions:
* Recurrent laryngeal neuropathy
* Dorsal displacement of the soft palate
* Pharyngeal collapse
Lower respiratory diseases:
* Mild equine asthma
what reproductive conditionscan causepoor performance?
In the male:
* Cryptorchid or rig
In the female:
* Ovarian tumours
* Normal ovarian cyclicity (is the behaviouroccuring at a certain time)
What cardiology disease can cause poor performace?
Atrial fibrillation
Cause of poor performance in horses with high athletic demand
Racehorses, event horses
How does palpation differ during a poor performance exam vs lameness exam?
As with a standard lameness examination we will inspect the limbs for signs of effusion, swelling and heat with a focus on likely foci of bilateral lameness.
We will spend more time examining and manipulating the axial skeleton to identify signs of pain or dysfunction.
Breifly describe how you will examin the axial skeleton during poor performace exam
- neck palpation and baited stretches (with food)
- Deep, sustained pressure onto the epaxial muscles of the thoracic and lumbar spine. (Can apply pulsatile pressure to assess ability to ventral flex.)
- Assess – muscle mass, muscle tone, symmetry and pain on palpation (be careful!)
- Sternal lift –> sustained pressure applied to the sternum to encourage dorsiflexion of the cranial thoracic spine
- Palpate the sacroiliac region with deep palpation either side of midline – not a very specific test
- Pressure is applied to the skin either side of the tail base - dorsiflex lumbar spine and lumbosacral joint
- limb palpation
Where is of bilateral limb disease normaly found in sports horses vs race horses?
what are the advantages anddisagvantages of palpaltion for identifying disease in the limbs?
Effusions and passive range of motion can be helpful for high motion joints:
* Distal interphalangeal joint
* Metacarpo/tarsophalangeal joints
* Radiocarpal and middle carpal joint
Less helpful for low motion joints:
* Tarsometatarsal joint
* Distal intertarsal joint
* Proximal interphalangeal joint
Palpation is challenging for some soft tissues:
* Proximal suspensory ligament
What ‘tests’ can you do to help you differentiate symetrial lamneses?
Lunging: More weight and more torsion on the inside limb
* Would make our DIPJ case lame on the inside leg of both circles
Flexion tests: Increased pressures of joint fluid
* Our DIPJ horse would be moderately positive to flexion of both limbs
Should a ridden exam be part of a poor perfromance exam?
yes, always include a ridden assesment?
Adds lots of benefits:
* Some lameness cases become more obvious or more consistent when ridden
* Allows better understanding of the presenting complaints of the rider
* Important to investigate diseases of the axial skeleton
* Can offer another (slightly biased!) opinion to the outcome of diagnostic analgesia
How can objective gait analysis be used for poor performance?
Sensor based systems allow you to detect even more subtle asymmetries - to detect lameness
* Measures asymmetry in millimeters and gives a predominantly limb
* Can suggest a starting point for diagnostic analgesia
When performing diagnostic anaesthesia for susspected bilateral lamenes, what often occurs?
A significant response is usually the appearance of a lameness in the contralateral limb!
What is the issue with diagnostic anaesthesia of the tarsal region?
The proximal suspensory ligament and tarsometatarsal joint are the most likely foci
They are also very closely associated:
- **Anaesthesia of one can improve the other **- hard to differentiate the two after blocking, best to the US the SDFT and xray the tarsal joint
(but also Medication injected in one can help the other!)
Discribe what you can see here (lateral view of the DDFT and suspensory ligament) and what it is suggestive of?
unorganised, overly hypoechoic, heterogenous suspensory ligament, suggestive of a proximal suspensory issue where it inserts on the metatarsal
What is the first line treatment for proximal suspensory ligament pain?
We can use the proximity of the tarsal joint to the proximal suspensory ligament to deliver medications
* Medication of the tarsometatarsal joint can successfully manage the condition in some cases
* Has the added benefit of also managing any concurrent small tarsal joint disease.
What is the secondary treatment for pain attributed to the proximal suspensory ligament?
Neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy
Some contraindications:
Horses with marked ligament degeneration the procedure can accelerate ligament degradation
Competition legality currently falls into same category as palmar digital neurectomy
Neurectomy –> permanent (usually) desensitisation of the ligament
Fasciotomy –> allows the ligament to swell outwards overcoming compartment syndrome
