Upper hindlimb (Yr 4)

Question 1

what are the three compartments of the stifle?

Answer 1

femoropatellar
medial femorotibial
lateral femorotibial

Question 2

what compartments of the stifle communicate?

Answer 2

femoropatellar and medial femorotibial

Question 3

what are the bones that make up the stifle?

Answer 3

distal femur
proximal tibia
patella

Question 4

what are the patellar ligaments?

Answer 4

medial, middle, lateral

Question 5

what are the soft tissue structures of the stifle?

Answer 5

medial, middle, lateral patellar ligaments
medial and lateral femoropatellar ligaments
medial and lateral collateral ligaments
cranial and caudal cruciate ligaments
medial and lateral menisci

Question 6

why is it difficult to image the stifle?

Answer 6

lots of soft tissue structure around it (top of leg)

Question 7

what radiographic views can we take of the stifle?

Answer 7

caudocranial
lateromedial
caudolateral-craniomedial oblique

Question 8

what is highlighted on a caudolateral-craniomedial oblique view of the stifle?

Answer 8

caudomedial (medial femoral condyle)
craniolateral (lateral trochlear ridge)

Question 9

why should you always image both stifles?

Answer 9

lesions are often developmental

Question 10

what is the main site of osteochondritis dissecans (OCD) in the stifle?

Answer 10

lateral trochlear ridge

Question 11

what is OCD?

Answer 11

osteochondritis dissecans

Question 12

what horses usually present with OCD?

Answer 12

young horses (6 months - 4 years)

Question 13

what is the number one site for OCD?

Answer 13

lateral trochlear ridge

Question 14

how does stifle OCD present?

Answer 14

joint effusion
variable lameness (depends on where fragments sit)

Question 15

how is stifle OCD diagnosed?

Answer 15

radiograph and ultrasound

Question 16

how can stifle OCD be treated conservatively?

Answer 16

if <12 months old
dietary control and restrict exercise
monitor lameness

Question 17

how can stifle OCD be treated surgically?

Answer 17

if >12 months old
removal of fragment
curettage of healthy subchondral bone (until it bleeds)

Question 18

when should you do surgery of stifle OCD?

Answer 18

only if older than 12 months (fragments can reattach before this)

Question 19

where are osseous cyst-like lesions found in the stifle?

Answer 19

medial femoral condyle

Question 20

what are osseous cyst-like lesions also called?

Answer 20

subchondral bone cyst

Question 21

when do horses present with osseous cyst-like lesions?

Answer 21

1-3 years old (and older) - later than OCD lesions

Question 22

what are the clinical signs of osseous cyst-like lesions?

Answer 22

intermittent/severe lameness
joint effusions (medial femorotibial joint)

Question 23

what is the main way osseous cyst-like lesions are diagnosed?

Answer 23

radiography

Question 23

what are the treatment options for osseous cyst-like lesions?

Answer 23

intra-articular corticosteroids
inject cyst with corticosteroids
debride cyst and pack with bone graft
bone screw across cyst

Question 24

what does prognosis of osseous cyst-like lesions depend on?

Answer 24

age of horse (much better in younger horses)

Question 25

what is the best treatment for osseous cyst-like lesions?

Answer 25

injection of corticosteroids into cyst (still not that great)

Question 26

what are some possible soft tissue stifle injuries?

Answer 26

meniscal and meniscotibial ligament injuries cruciate ligament injuries (uncommon)

Question 27

what can cause osteoarthritis of the stifle?

Answer 27

trauma/soft tissue injury secondary to fracture sequelae to sepsis OCD/osseous cyst-like lesions

Question 28

why is osteoarthritis of the stifle not good?

Answer 28

it is a very high motion joint

Question 29

what are common clinical signs of stifle osteoarthritis?

Answer 29

moderate lameness sore to flexion test respond to diagnostic analgesia

Question 30

what imaging is used for stifle osteoarthritis?

Answer 30

radiography

Question 31

what is the prognosis for stifle osteoarthritis?

Answer 31

poor

Question 32

what is the prognosis for complete femur or tibial fractures?

Answer 32

euthanasia required

Question 33

what are common sites for upper hindlimb fractures?

Answer 33

tibial tuberosity patella

Question 34

what muscle inserts onto the tibial tuberosity?

Answer 34

patella ligaments

Question 35

why does care need to be taken with possible tibial tuberosity fractures in foals?

Answer 35

tibial tuberosity has a separate centre of ossification so growth plates can look like fractures (radiograph the other leg!!)

Question 36

how can we treat patella fractures?

Answer 36

repair them remove if less than 1/3

Question 37

what is the aetiology of upward fixation of the patella?

Answer 37

medial pole of the patella hooks over the medial trochlear ridge of the femur (normal part of stay apparatus) but then can't unlock itself from this position

Question 38

what are the two possible reasons for upward fixation of the patella?

Answer 38

patella ligaments too tight quadriceps are too weak

Question 39

what are the clinical signs of upward fixation of the patella?

Answer 39

poorly muscled or muscle loss limb locked in extension and dragged (entire leg is rigid due to stay apparatus) can be intermittent or persistant

Question 40

how can upward fixation of the patella be treated?

Answer 40

exercise to build up quadriceps muscle desmoplasty of medial patella ligament

Question 41

how can you unlock an upward fixed patella?

Answer 41

walk horse backwards manually move patella laterally

Question 42

how common is coxofemoral joint pathology?

Answer 42

relatively uncommon

Question 43

what are two possible conditions of the coxofemoral joint?

Answer 43

osteoarthritis subluxation

Question 44

what is the prognosis for osteoarthritis of the coxofemoral joint?

Answer 44

euthanasia (crippling lameness) - also very difficult to medicate the joint

Question 45

what breeds is coxofemoral joint subluxation associated with?

Answer 45

miniature breeds

Question 46

what are the common sites for pelvic fractures?

Answer 46

tuber coxae (traumatic) ilial wing ilial shaft (life threatening) pubis/ischium acetabulum

Question 47

why are ilial shaft fractures life threatening?

Answer 47

iliac artery can be severed (usually require euthanasia)

Question 48

what are the clinical signs of pelvic fractures?

Answer 48

pain/swelling/muscle spasms lameness (variable) signs of shock (haemorrhage) nerve damage muscle atrophy (if chronic)

Question 49

how are pelvic fractures treated?

Answer 49

pain relief (NSAIDs) box rest (cross-tie) - at least a month

Question 50

what is the prognosis for pelvic fracture?

Answer 50

good for minimally displaced poor for acetabular or ilial shaft fractures

Question 51

what is sacroiliac disease?

Answer 51

ligaments of sacroiliac joint become strained/stressed leading to poor performance and lameness

Question 52

what are the clinical signs of sacroiliac disease?

Answer 52

lameness (variable) poor performance pain on palpation pelvic asymmetry (muscle wastage)