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Equine II > Proximal soft tissue injuries > Flashcards

Proximal soft tissue injuries Flashcards

1
Q

Carpal and tarsal sheath injuries

A

Usually present with lameness and effusion…

Ultrasound is the logical first line diagnostic tool, but don’t overlook the value of radiography!

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2
Q

Peroneus (or Fibularis) Tertius injuries

A

An important part of the reciprocal apparatus

Classic clinical signs – can extend tarsus without the stifle.

Usually do well but lengthy rehabilitation period

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3
Q

Injuries of the patellar ligaments

A

An unusual cause of primary lameness

Easily diagnosed with ultrasound

Good prognosis for return to exercise

Long (12 month) rehabilitation period

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4
Q

Delayed patellar release - “locking stifle”

A

Most commonly seen in miniatures

Sometimes associated with weakness/poor muscling

Rehab for mild cases

Medial PL desmotomy for severe cases

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5
Q

The medial (and lateral) meniscus

A

A fairly common cause of stifle lameness

Often seen with other pathologies

Severe disease can be diagnosed with ultrasound

Mild-moderate disease is an arthroscopic diagnosis

Less favourable prognosis

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6
Q

Cruciate ligament injuries

A

Associated with acute, severe lameness

Some descriptions of US diagnosis

Arthroscopy is best diagnostic

Not always associated with effusion

Cruciate ligaments are extra-synovial

Not always a satisfying blocking pattern

Often only partially improve

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7
Q

When is surgery indicated for proximal limb soft tissue injuries?

A

for synovial structures:
* Navicular bursa
* Digital flexor tendon sheath
* Carpal/Tarsal sheath
* Stifle joint

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8
Q

What can be achieved surgically in proximal limb soft tissue injuries?

A

Excellent diagnostic ability

Sound prognostication.

Debridement of torn soft tissues – improved outcomes

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9
Q

What are the most likely foci of disease in the tarsal region?

A

Proximal suspensory ligament

Tarsometatarsal joint

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10
Q

Imaging choices for the tarsal area

A

Can be helpful to block each structure in turn, but takes multiple visits

Compromise -> can acquire images of both

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11
Q

First line treatments for the tarsal region

A

We can use the proximity of the joint to the proximal suspensory ligament to deliver medications

Medication of the tarsometatrsal joint can successfully manage the condition in some cases

Has the added benefit of also managing any concurrent small tarsal joint disease

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12
Q

What is a Neurectomy of the Deep Branch of the Lateral Plantar Nerve and Plantar Fasciotomy used for?

A

For refractory cases

A specific treatment for the proximal suspensory ligament

A popular surgical procedure for a more “curative” therapy

Neurectomy -> permanent (usually) desensitisation of the ligament

Fasciotomy -> allows the ligament to swell outwards overcoming compartment syndrome

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13
Q

Indications for Neurectomy of the Deep Branch of the Lateral Plantar Nerve and Plantar Fasciotomy

A

Improves to block of DBLP but not TMT

Failed first line treatments – usually intra-articular corticosteroids in the TMT

Choose individuals with good conformation and ligament integrity

Discuss competition legality

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14
Q

Contraindications for Neurectomy of the Deep Branch of the Lateral Plantar Nerve and Plantar Fasciotomy

A

Horses with marked ligament degeneration -> the procedure can accelerate ligament degradation

Competition legality -> currently falls into same category as palmar digital neurectomy

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15
Q

Candidates for biological treatments of the proximal limb

A

Tendons with core lesions
Injuries within synovial structures

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16
Q

Aims of biological therapies in the proximal limb

A

Reduce inflammation,

improve extracellular matrix quality,

improve functionality of scar tissue,

Reduce healing time,

reduce re-injury

17
Q

Autologous stem cells

A

Bone marrow derived

Adipose tissue derived

Culture takes 2 weeks

18
Q

Allogenic stem cells

A

“off the shelf” products

Currently out of production

19
Q

PRP

A

Protein rich plasma

Autologous product:

Blood sample obtained

Centrifuged

Plasma removed

Filtration systems also exist

Quick to make

Some questionable evidence

20
Q

Controlled exercise programs for proximal limb rehab

A

Consistently improve outcomes

“best practice”

LOTS of variation in programs prescribed- needs to be tailored to the individual case and situation

21
Q

Pattern of increasing exercising intenstiy for controlled exercise rehab

A

Walking in hand or under saddle

Trotting under saddle in straight lines

Trotting under saddle on circles and bends

Canter work in straight lines

Canter work on circles and bends

22
Q

Rehab techniques

A

Exercise programs

Extracorporeal shockwave therapy (ESWT)

Laser (class 4)

Cold/heat treatment

Therapeutic ultrasound

Pulsed magnetic field therapy

23
Q

Shockwave therapy for rehab of proximal limb

A

Delivery of high-pressure waves to tissues - probably most focused at the junction between soft tissue and bone

Shockwave seems to temporarily improve lameness, but has limited effects on structure and function

24
Q

How many shocks are usually used for shockwave rehab therapy

A

1000-2000 per site

25
Q

Patient preparation for shockwave therapy

A

Restraint – sedation

Clipping long haired horses

Application of acoustic gel

Delivered when non-weightbearing

26
Q

Protocol of shockwave therapy

A

Often delivered weekly/fortnightly

Treatment period of 4-6 weeks

Not within 5d of FEI competition!

27
Q

Class IV laser therapy for proximal limb rehab

A

Reduce lesion size,

increase doppler signal,

change collagen deposition,

improve US fibre pattern

No evidence (yet!) that this leads to reduced re-injury rates!

28
Q

Contraindications for the use of high powered (class 4) lasers

A

Eye exposure,

neoplasia,

haemorrhage,

pregnancy?

sex glands?

29
Q

Methods to improve equine core stability

A

Water treadmill exercise

Swimming

Ridden or in-hand exercises

Whole body vibration (lacking evidence!)

30
Q

Benefits of water treadmill

A

Adds resistance to cranial phase of stride

Increases limb retraction (stride height)

Increases ROM of the axial skeleton

Buoyancy (if deep enough…)

31
Q

Clinical use of the water treadmill

A

Can be prescribed as an intensive course or incorporated into ongoing training

32
Q

When is swimming recommended?

A

Aerobic fitness

Brachiocephalicus tone

Reducing stress on joints and soft tissues

33
Q

Clinical use of swimming

A

Largely used in the training and rehabilitation of thoroughbred racehorses (improved fitness and reduced repetitive strain)

Less useful for sports horses as it encourages an extended neck and thoracolumbar spine – the opposite of what we hope to achieve!!

Consider implications for a fit horse with reduced bone stimulation…

34
Q

RIdden and non-ridden rehab

A

Lunging and long-lining devices

Hill work (trot up and walk down)

Pole exercises (raised)

Working on a range of surface types

“cross training”

Equine II (28 decks)

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