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Y4 EQ - Orthopaedics > Upper forelimb > Flashcards

Upper forelimb Flashcards

1
Q

Which bones make up the carpus from proximal to distal

A

Radius proximally
2 rows of carpal bones:
- Proximal row from medial to lateral = radial CB, intermediate CB, ulnar CB and on the palmarolateral aspect, the accessory carpal bone
- Distal row from medial to lateral = 2nd CB, 3rd CB, 4th CB. The 1st CB may also be present in some horses and can misleadingly appear like a small fracture
2nd, 3rd and 4th metacarpal bones distally

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2
Q

Name and describe the joints of the carpal region, from proximal to distal

A

Top joint = radiocarpal joint also known as the antebrachial carpal joint
Intercarpal joint = between the proximal and distal row of carpal bone
Carpometacarpal joint = not a hinge joint unlike the other two. This joint communicates with the intercarpal joint so pathology in one can affect the other

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3
Q

Name the ligaments and tendons of the carpal region

A

Common digital extensor – insets on P3 – extensor of carpus and digital
Lateral digital extensor – inserts on P2 – extensor of carpus and digital
Extensor carpi radialis – inserts on the proximal metacarpus
Medial and lateral collateral ligaments to stabilise the carpus – restricts it to flexion and extension

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4
Q

How can problems of the carpus be investigated using a clinical exam

A
  • Pain/heat/soft tissue swelling
  • Reduced ROM, crepitus
  • Joint effusion (differentiate from extensor tendon sheath effusion dorsally)
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5
Q

How can problems of the carpus be investigated using diagnostic analgesia

A

Carpal joint anaesthesia (RC and MC)
Median/ulnar nerve block

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6
Q

How can problems of the carpus be investigated using radiography - which views?

A

DP, LM, DMPLO, DLPMO, flexed LM
Additional views to skyline carpal bones

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7
Q

How can problems of the carpus be investigated using ultrasonography - which structures can be assessed?

A

Carpal and digital extensors and sheaths dorsally
Carpal sheath (SDFT/DDFT, ALSDFT) palmarly

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8
Q

What is carpal osteoarthritis

A

Degenerative joint disease affecting one or more of the carpal joints

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9
Q

What are the causes of carpal osteoarthritis?

A
  1. Secondary to joint trauma, sepsis, fracture or soft-tissue injury (e.g. intercarpal ligament injury)
  2. Poor conformation may predispose to carpal OA
  3. Arabs predisposed to CMC (carpometacarpal joint) OA – this can then lead to middle carpal joint disease due to communication of these joints
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10
Q

What are the clinical signs of carpal osteoarthritis?

A

Lameness
Joint effusion
Fibrosis
Reduced ROM
Positive to carpal flexion
Crepitus

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11
Q

New bone formation linked to joints = ?

A

Osteophytes

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12
Q

New bone formation linked to the joint capsule = ?

A

Enthesiophytes

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13
Q

How is carpal osteoarthritis diagnosed?

A

Clinical signs
Intra-articular anaesthesia
Radiography - Soft tissue swelling and new bone formation dorsally

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14
Q

How is carpal osteoarthritis managed?

A

Intra-articular medication; NSAIDs
Arthrodesis in advanced cases (drilling of CMC)

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15
Q

A carpal chip fracture is also known as?

A

Osteochondral fragmentation

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16
Q

What is Osteochondral fragmentation?

A

May be fragmentation of an osteophyte (in OA) or fragmentation of the dorsal articular margin with training (racing breeds)

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17
Q

How does osteochondral fragmentation occur?

A
  • Sclerosis of subchondral bone may predispose pathology
  • Can be due to excessive loading on the dorsal aspect of the carpal joint: bone becomes more dense and brittle -> fragmentation
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18
Q

How is Osteochondral fragmentation managed?

A

Management usually involved arthroscopic removal of the fragment(s)

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19
Q

How do carpal bone fractures usually present?

A
  • Include slab, frontal and comminuted fractures
  • Often present as acute single overload but may result from stress maladaptation (e.g. sclerosis from repetitive loading)
  • Present as acute lameness + joint effusion with pain/crepitus on palpation
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20
Q

How are carpal bone fractures diagnosed?

A

Radiography (inc. skyline views)

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21
Q

How are carpal bone fractures managed?

A

Conservative - Incomplete f#
Surgical
- Usually internal fixation via arthroscopy
- Incomplete or complete f#

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22
Q

What is the main cause of accessory carpal bone fractures?

A

Trauma/single impact overload

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23
Q

How do horses with accessory carpal bone fractures present?

A
  • Acute lameness with swelling/pain over the palmar carpus
  • Horse may stand with carpus semi-flexed
  • Antebrachiocarpal joint effusion and/or carpal sheath effusion
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24
Q

Describe management of horses with Accessory carpal bone fractures

A

Conservative - Most cases heal by fibrosis
Surgical
- Repair difficult (shallow/curved bone)
- Remove any fragments in joint

25
Q

What is the carpal canal?

A

Carpal canal = synovial structure – tendon sheath – where tendons form from muscle

26
Q

Which structure inserts on the SDFT in the carpal canal?

A

Accessory ligament of the SDFT – superior check ligament
(remember the accessory ligament of the DDFT aka inferior check ligament, is in the metacarpus)

27
Q

List some causes of carpal canal syndrome

A
  1. Idiopathic tenosynovitis - haemorrhage or secondary to other cause
  2. Septic tenosynovitis - may or may not have a wound; seen secondary to elective tenoscopy
  3. Tendinitis of the SDFT/DDFT (or muscle tears)
  4. AL-SDFT (SCL) desmitis
  5. Radial physeal exostosis
  6. Osteochondroma of the distal radius: discrete separate centres of cartilage ossification
  7. Accessory carpal bone (ACB) fracture: ACB forms lateral boundary of carpal sheath through carpus
28
Q

List the clinical signs of carpal canal syndrome

A

Carpal sheath effusion
Lameness/pain - Flexion often exacerbates lameness/pain
Puncture wound with sepsis

29
Q

How is carpal canal syndrome diagnosed?

A
  1. Diagnostic anaesthesia (median/ulnar nerve block or carpal sheath anaesthesia)
  2. Synoviocentesis
  3. Radiography
  4. Ultrasonography
30
Q

How can the underlying causes of carpal canal syndrome be treated?

A
  • Tenoscopic lavage (e.g. sepsis)
  • Removal of exostosis/osteochondroma via tenoscopy
  • Debridement of damaged tendon/ligament
  • Local anti-inflammatories into the carpal sheath
31
Q

What is the main cause of carpal subluxation?

A

Usually trauma (e.g. high speed fall)
- Often have additional carpal bone fractures

32
Q

How does a horse with carpal subluxation present?

A

Horse is severely lame with marked swelling, carpal instability and overt anatomical derangement
Radiograph to determine level of luxation and presence of fractures

33
Q

How should a horse with carpal subluxation be managed?

A
  • Stabilise with full limb bandage plus splints (zone 3 external coaptation)
  • Euthanasia in many cases esp with fractures/carpal bone collapse
  • Surgical partial or complete arthrodesis possible
34
Q

What is the most common cause of radial fractures?

A

Usually due to external trauma (e.g. kick) esp. distomedial radius

35
Q

How do horses with radial fractures present?

A

Moderate swelling and lameness but can weight-bear (incomplete fractures) - Check for wounds!
Open/complete fractures in adult horses usually euthanased

36
Q

Describe conservative management of radial fractures?

A
  • Most closed, incomplete fractures in adults managed conservatively
  • Full limb bandage plus caudal and lateral splint - Cross-tie but head down for feeding
  • Regular monitoring – can still displace!
37
Q

Which is surgical treatment indicated for radial fractures?

A

Internal fixation in foals

38
Q

What is the most common cause of ulnar fractures?

A

Trauma/kick leading to the fracture of the proximal ulna (olecranon)

39
Q

How do horses with ulnar fractures present?

A

Acute lameness +/- wound with swelling/pain around elbow
Dropped elbow stance (ddx radial nerve paralysis, triceps myopathy)

40
Q

Describe first air for ulnar fractures

A

Splint carpus as lost stay apparatus

41
Q

Describe conservative management of ulnar fractures

A

Tend to get a non-union or delayed union of the fracture in this area due to the pull of the triceps muscle so generally advise against

42
Q

Describe surgical management of ulnar fractures

A
  1. Tension-band principal by converting distractive forces of triceps to compression
  2. Plate fixation in adults (plate or wire/pins in foals) generally do well
43
Q

What are the main causes of Fractures of the humerus and scapula?

A

Usually acute trauma (kick, impact); also stress f# in racehorses

44
Q

Describe the presenting signs of Fractures of the humerus and scapula

A
  • Moderate to severe lameness with loss of limb function with complete fracture
  • Radiography can be difficult in this region
45
Q

Describe the management of Fractures of the humerus and scapula

A
  • Complete humeral fractures = euthanasia
  • Conservative e.g. deltoid tuberosity, scapula spine
  • Sporadic reports of surgical repair but difficult!!
46
Q

How would Osteochondrosis of the elbow appear on radiography?

A

Osseous cyst-like lesions in proximal radius

47
Q

How would Osteochondrosis of the shoulder appear on radiography?

A

Osseous cyst-like lesions in the distal scapula (also proximal humerus)
OCD of the glenoid cavity

48
Q

Describe management of Osteochondrosis of the elbow

A

Conservative (intra-articular medication) or surgical (extra-articular drilling)

49
Q

Shoulder dysplasia and subluxation is most commonly seen in which horses?

A

Shetland/Miniature breeds

50
Q

How does shoulder dysplasia and subluxation present?

A

Malalignment results in pain/instability
Subluxation can occur without dysplasia secondary to trauma
Moderate/severe lameness with pain on shoulder extension/abduction

51
Q

How does shoulder dysplasia and subluxation present on radiography?

A

Abnormal alignment of scapulohumeral joint
Often secondary OA present

52
Q

Describe management of shoulder dysplasia and subluxation

A
  • Reduction under GA possible but often recurs
  • Secondary OA managed conservatively
  • Shoulder arthrodesis a possibility but most cases euthanased
53
Q

Describe the typical presentation of shoulder osteoarthritis

A
  • Seen infrequently
  • Shetland ponies /Miniature breeds predisposed
  • Affected horses/ponies generally moderately to severely lame
54
Q

Shoulder osteoarthritis occurs secondary to?

A

Trauma, intra-articular fracture, osteochondrosis , sepsis

55
Q

How is shoulder osteoarthritis managed?

A

Palliative treatment; prognosis guarded

56
Q

Describe the main features of elbow osteoarthritis

A

Unusual to get OA in the elbow in horses
Secondary to trauma, sepsis, OCLL

57
Q

Describe diagnosis of elbow osteoarthritis

A

Can be difficult to diagnose
Diagnostic anaesthesia of the elbow joint difficult!
Radiography

58
Q

Describe management of elbow osteoarthritis

A

Intra-articular medication, NSAIDs
Guarded prognosis

Y4 EQ - Orthopaedics (14 decks)

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