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Equine Final Year > Ultrasonography Of The Equine Distal Limb > Flashcards

Ultrasonography Of The Equine Distal Limb Flashcards

1
Q

What four things does ultrasound provide information on?

A

–Structures involved

–Degree and extent of injury

–Acute or chronic injury

–Healing / response to treatment

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2
Q

What is the examination technique of using ultrasound?

A
  • Quiet, dark environmen with suitable facilities
  • Allow sufficient time for an examination
  • Sedation / analgesics for painful lesions
  • Clip and scrub affected area
  • Use plenty of coupling gel
  • Move limb during musculoskeletal examination (dynamic studies)
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3
Q

What is the depth of imaging for SDFT and DDFT?

A

2-4cm

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4
Q

What is the depth of suspensory ligament?

A

4-6cm

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5
Q

What angle does the ultrasound probe need to be to the area imaged?

A

90 degrees

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6
Q

What 2 views do we need with an ultrasound?

A

Transverse and longitudinal

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7
Q

What images are needed from lateral and medial aspect for suspensory branches?

A

Transverse images

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8
Q

Name 12 of the normal structures proximal to fetlock seen on ultrasound (15)

A
  • Superficial digital flexor tendon (SDFT)
  • Deep digital flexor tendon (DDFT)
  • Accessory ligament of DDFT / check ligament (ALDDFT)
  • Suspensory ligament (SL)
  • Digital extensor tendon
  • Intersesamoidean ligaments
  • Proximal annular ligament
  • Tendon sheath
  • Cannon bone
  • Splint bones
  • Sesamoid bones
  • Fetlock joint
  • Fetlock collateral ligaments
  • Skin and subcut. tissues
  • Neurovascular structures
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9
Q

What is the origin of flexor tendons?

A

Caudomedial humerus

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10
Q

Where does the SDFT insert?

A

P1 and P2

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11
Q

Where does the DDFT insert?

A

P3

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12
Q

Where do suspensory ligament arise from?

A

Palmar carpal ligament and metacarpal bone

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13
Q

Where do the suspensory ligaments insert?

A

On sesamoid bone (exensor branches)

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14
Q

What are the regions and technique to ultrasound the metacarpus?

A

7 zones from accessory carpal bone to ergot (1A, 1B, 2A, 2B, 3A, 3B, 3C)

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15
Q

What are the regions and techniues to ultrasound the metatarsus?

A

•9 zones from base of hock to ergot (1A, 1B, 2A, 2B, 3A, 3B, 4A, 4B, 4C)

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16
Q

Look at this

A
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17
Q

Name 10 normal structures distal to fetlock (12)

A
  • SDFT and DDFT
  • Extensor branches of SL
  • Tendon sheath
  • Digital extensor tendon
  • Distal annular ligament
  • P1, P2 and P3
  • Pastern joint
  • Coffin joint
  • Collateral ligaments
  • Navicular bone, impar ligament and bursa
  • Collateral cartilages
  • Skin and subcut. tissue
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18
Q

Look at this

A
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19
Q

What changes can be seen with disease?

A
  • Position, size, shape, structure and echogenicity
  • Changes in position
  • Changes in cross sectional area
  • Changes in margins
  • Changes in fibre pattern
  • Changes in echogenicity
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20
Q

What do you describe lesions in terms of?

A

–Location: which structures are affected, distance from anatomical landmarks (accessory carpal bone or base of hock, where is the lesion

–Size: measure CSA, extent of defect and compare to other limb or known normals

–Shape: margins and outline

–Changes in echogenicity

–Changes in normal architecture

–Anomalies

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21
Q

What are tendon fibres held together by?

A

Endootenon

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22
Q

What are fasicles held together by?

A

Paratenon

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23
Q

What is a whole tendon surrounded by?

A

Epitenon

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24
Q

What does this show?

A
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25
Q

How do you grade tendon changes in echogenicity?

A

Type 1: slightly less echogenic than normal

Type 2: half echogenic and half anechoic

Type 3: mostly anechoic

Type 4: completely anechoic

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26
Q

What is fibre pattern/allignment socring?

A

0: >75% fibres aligned parallel to target path
1: 50-75% fibres aligned parallel to target path
2: 25-50% fibres aligned parallel to target path
3: <25% fibres aligned parallel to target path

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27
Q

What is this?

A

SDFT

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28
Q

What is the normal appearance of SDFT?

A

–Homogenic and echogenic.

–Slightly less echogenic than DDFT (TGC).

–Normal CSA for UK and US thoroughbreds and other breeds

–Training can cause a 10% increase in CSA and mild decrease in echogenicity

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29
Q

What is this?

A

DDFT

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30
Q

What is the normal appearance of DDFT on ultrasound?

A

–Homogenic and echogenic

–Increased echogenicity cf SDFT

–Hypoechoic region in hindlimb at insertion of ALDDFT

–Bilobed appearance in pastern

–Normal CSA for UK and US thoroughbreds and other breeds

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31
Q

What is the normal appearance of the ALDDFT?

A

Homoegneous and echogenic

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32
Q

What thickness do we measure with ALDDFT?

A

Dorsopalmar or lateromedial

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33
Q

What is this?

A

Suspensry ligament

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34
Q

What is the normal appearance of the suspensory ligament?

A

–Heterogeneous - muscle, connective tissue, fat + ligament fibres

–Can contain hypoechoic areas check contralateral limb

–Branches are homogenous and echogenic

–Normal CSA published for body and branch.

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35
Q

What is a 3.5.MHz transducer good for?

A

Echocardiography and ultrasonography of late pregnancy in large / medium sized dogs

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36
Q

What is a 5MHz transducer used for?

A

Abdominal ultrasound in large dogs, abdominal and cardiac ultrasound in medium and small dogs, pelvic and pregnancy ultrasound in all dogs

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37
Q

What is a 7.5 MHz transducer used for?

A

Abdominal and cardiac ultrasound in small dogs and cats, pelvic and pregnancy ultrasound in medium and small dogs and cats, cervical ultrasound in large dogs, puppies and kittens

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38
Q

What is a 10MHz transducer used for?

A

Ultrasound of cervical structures (salivary glands, thyroid), superficial structures (skin, mammary glands) and musculoskeletal

39
Q

Name 2 advantages of a linear array transducer (3)

A
  • High near field resolution
  • Parallel beams
  • No moving parts
40
Q

Name the disadvantage of using a linear array transducer

A

Large contact area

41
Q

Name 3 uses of linear array transducers (4)

A
  • Muscles
  • Mammary glands
  • Joints
  • Tendons
42
Q

What is the purpose of the stand off pads?

A

Increase distance between transducer and superficial structures

43
Q

How does an ultrasound machine work?

A

•When sound strikes a boundary (between two tissues of different acoustic impedance) the beam is split into four

–Transmitted beam

–Reflected beam

–Refracted beam

–Scattered beam

•This reflected beam is received by the ultrasound machine and converted into an image

44
Q

What are the structures labelled a, b, c and d?

A

a – superficial digital flexor tendon

b – deep digital flexor tendon

c – straight sesamoidean ligament

d – oblique sesamoidean ligament

45
Q

What are the structures labelled a, b, c and d?

A

a – superficial digital flexor tendon

b – deep digital flexor tendon

c – accessory ligament of deep digital flexor tendon (check ligament)

d – suspensory (interosseus) ligament

46
Q

List the criteria used to assess an ultrasound image (6)

A
  • Position, size, shape, structure and echogenicity
  • Changes in position
  • Changes in cross sectional area
  • Changes in margins
  • Changes in fibre pattern
  • Changes in echogenicity
47
Q

List the different features of a lesion that you should describe when interpreting an ultrasound (6)

A
  • Location: which structures are affected, distance from anatomical landmarks (accessory carpal bone or base of hock, where is the lesion
  • Size: measure CSA, extent of defect and compare to other limb or known normals
  • Shape: margins and outline
  • Changes in echogenicity
  • Changes in normal architecture
  • Anomalies
48
Q

Identify the different structures in this ultrasound image of the proximal palmar metcarpal region

A
49
Q

Describe the abnormalities in the ALDDFT in this image

A

Increased in size
Irregular outline, assymmetrical shape
Heterogenous pattern
Loss of fibre pattern

This was a chronic healing lesion in this horse, so lacks the hypoechoic regions you would associate with acute lesions, but remains grossly enlarged with variable healing

50
Q

What is the structure and function of tendons?

A
  • Tendons connect muscle to bone
  • They originate from the connective tissue of muscle
  • They insert in bones
  • They have great tensile strength
  • They function to store elastic energy
  • Tendons occur at the origin and insertion of muscles
  • ORIGIN: Muscles originate from bone by tendons (proximal region)
  • INSERTION: Muscles are attached to bone by tendons (distal region)
51
Q

Label these blue boxes

A
52
Q

What is apoenurosis?

A

a sheet of pearly white fibrous tissue which takes the place of a tendon in sheet-like muscles having a wide area of attachment.

55
Q

How are the tendons fibres structured?

A
  • String or steel cable consists of several strands of material interwoven
  • Tendon structure uses a similar principle except the fibres remain in parallel (to allow elastic movement)
56
Q

What is the origin and insertion of tendons?

A
  • Tendons occur at the origin and insertion of muscles
  • ORIGIN: Muscles originate from bone by tendons (proximal region)
  • INSERTION: Muscles are attached to bone by tendons (distal region)
57
Q

Label these arrows

A
58
Q

Label this

A
59
Q

What are tendons and ligaments designed to give?

A

Maximum biomechanical strength

60
Q

Label 1, 2 and 3 of the tendon

A

Endotenon (1) holds fibres together to form fasicles

Peritenon (2) holds fasicles together

Epitenon (3) surrounds whole tendon

61
Q

Label this picture

A
62
Q

Label this image of transition from tendon to bone

but don’t label 5 or 6 cause there isn’t an answer and i cbfa to figure it out for myself

A
  1. Tendon
  2. Fibrous cartilage
  3. Mineralised cartilage
  4. Bone
63
Q

Label the blue squares as part of an image from tendon transitioning to bone

A
65
Q

Give 2 examples of where ligaments can stabilise and support axial skeleton

A
66
Q

What is tendon composed of? How is it organised?

A
  • Tendon is composed of connective tissue
  • Type of connective tissue is collagen fibrils
  • Collagen fibrils are organised into fibres
  • Fibres are arranged in parallel bundles

•Hierarchical organisation
into primary bundles (fibres) & secondary bundles (fasicles)

69
Q

What is the structure of tendon maintained by?

A

•Structure of tendon (primary and secondary bundles) is maintained by loose connective tissue

  • Endotenon (endotendineum)
  • Peritenon (peritendineum)
  • Epitenon (epitendineum)
70
Q

Label the blue squares

A
75
Q

What do ligaments do?

A

•Ligaments link bone to bone

  • Tendons link muscle to bone
  • Do not have same capacity for elastic storage of energy
  • Key component of joints providing stability
  • Collateral ligaments present in most joints
77
Q

What are the functions of the patellar ligaments of equine stifle?

A

Function is to lock the stifle and maintain the limb in a weight-bearing position with the minimum muscular effort

78
Q

What is the function of the cruciate ligaments of stifle?

A

Resist cranio-caudal movement of stifle. Injury is most common cause of lameness in the dog

79
Q

Which ligaments function is to lock the stifle and maintain the limb in a weight-bearing position with the minimum muscular effort?

A

Patellar ligaments of equine stifle:

80
Q

Label this image with regards to tendon sheaths and bursae

A
81
Q

Label the blue squares in this image

A
82
Q

Which ligaments function is to resist cranio-caudal movement of stifle. Injury is most common cause of lameness in the dog?

A

Cruciate ligaments of stifle:

84
Q

FIll in the question mark with the anatomical structure that should be there based on the anatomy

A

Flushing the flexor tendon sheath in a horse with an infection following a pastern injury

85
Q

What is the innervation and vasculature for tendons and ligaments? What does this mean?

A
  • Tendons and ligaments have low metabolic function
  • Poorly vascularised and innervated
  • This affects their ability to heal
86
Q

What are some ways you can get failure of tendons and ligaments?

A
  • Biomechanically very strong
    • Failure often within the muscle or within the bone at the site of attachment
  • Fibres arranged in parallel bundles
    • When some fibres are damaged, remainder take the additional load / strain
  • Tendons and ligaments poorly innervated
    • Damage may be significant before pain and lameness is evident
  • Tendons and ligaments have poor vascular supply
    • Ability to heal is poor
  • Tendons and ligaments can be damaged by excessive pressure and friction
    • Where they run over joints, bony prominences or where there a marked change in direction
87
Q

Fill in the blue squares with regards to the tendon bursae

A
88
Q

How many bursae are under the nuchal ligament?

A

3

89
Q

What is happening in this radiograph?

A

Radiograph of contrast being injected in navicular bursa

90
Q

Tendons and ligaments are biomechanically very strong. What does this mean in terms of failure?

A

Failure often within the muscle or within the bone at the site of attachment

91
Q

What are these images of?

A

Acquired bursae in cattle

92
Q

Tendon and ligaments fibres are arranged in parallel bundles. What does this mean with regards to failure?

A

When some fibres are damaged, remainder take the additional load / strain

93
Q

Tendons and ligaments are poorly innervated. What does this mean with regards to failure?

A

Damage may be significant before pain and lameness is evident

94
Q

Tendons and ligaments have poor vascular supply. What does this mean with regards to failure?

A

Ability to heal is poor

95
Q

Tendons and ligaments can be damaged by excessive pressure and friction. What does this mean with regards to failure?

A

–Where they run over joints, bony prominences or where there a marked change in direction

96
Q

This picture is an ultrasound of the superficial digital flexor tendon in a horse. Which is normal and which shows pathology? What pathology?

A

Left - normal

Right - tendonitis

97
Q

What are tendon sheaths and bursae?

A

Tendon sheaths and bursae are fluid-filled structures that protect tendons at pressure / friction points

  • Tendon sheaths wrap completely around tendon
  • Bursae are present on only one side (like a cushion)

A tendon sheath is a layer of synovial membrane around a tendon. It permits thetendon to stretch and not adhere to the surrounding fascia

100
Q

Where do tendon sheaths occur?

What is their function?

A

Occur at the point of friction

Occur wherever tendons cross high motion joints

Surorund and protect tendon and enable it to glide smoothly

101
Q

Common digital synovial sheaths:

  • Where do they reach from?
  • What do they enclose?
  • Where is swelling of this sheath visible?
A

Common digital synovial sheaths

  • Reaches from the distal cannon to the middle phalanx
  • Palmar: 9 pouches
  • Enclosed the superficial and deep flexor tendons
  • Swelling of this sheath is most easily visible proximal and palmar to the fetlock joint (also know as windgalls)
103
Q

What are tendon bursae?

Where are they present?

A
  • Fluid-filled sacs that facilitate sliding
  • Synovial structures with a synovial membrane and synovial fluid
  • Present at major pressure points
  • Between bones and muscle, tendons or ligaments, or between skin and bones, muscle, tendons or ligaments
104
Q

What is bursae existence dependent on?

What can trauma lead to?

A
  • Their existence is inconstant depending on mechanical challenges, age, body condition
  • Trauma can lead to ‘acquired` bursae
108
Q

What are the bursae of the equine hindlimb?

A
  • Patella bursae
  • Calcaneal bursae
  • Navicular bursa
110
Q

What is the difference between a tendon and a ligament?

A
  • Tendons originate from the connective tissue of muscle and insert in bones
  • They function to store elastic energy
  • Ligaments link bone to bone
  • Do not have same capacity for elastic storage of energy
  • Key component of joints providing stability
111
Q

What is the difference between a tendon sheath and a bursa?

A
  • Tendon sheaths wrap completely around tendon
  • Bursae are present on only one side

Equine Final Year (102 decks)

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