Upper limb lameness 1 + 2 Flashcards
Compare a swinging vs weightbearing lameness
Swinging lameness – animal is painful as they try to bring the leg forwards. Shortened stride on the affected leg.
Weightbearing lameness – pain as weight is put on the affected limb. Shortened stride on the sound leg.
Describe how head position in weightbearing lameness can be used to identify which limb is lame
Head position at the point of weightbearing:
- Head up if front leg (at the point the painful limb hits the ground)
- Head down if back leg (shifts weight forwards)
How can accessory digits be used to identify painful limbs?
Compare left and right accessory digit heights.
E.g. if the RHS accessory digits are lower than on the left.
This indicates that the left is the painful one as less weight is being put onto it.
Describe the use of flexion tests in farm animals
Can be done but not as refined as in the horse
E.g. Flex fetlock for 2 minutes and then get to trot off – puts stress on the joint to try and localize lameness.
Do one joint at a time and move up the leg.
Cows may lean on you and can be hard to ‘trot off’ – worth a go but keep your own safety in mind
How can asymmetry be used in lame cows?
Assess cow from directly behind, compare left and right sides -
Atrophy:
- Disuse, e.g. pain-induced
- Neurological
Swelling:
- Haematoma
- Inflammation
- Effusion
Why should dirty areas on limbs always be inspected?
May be covering up a wound
Describe the diagnostic tools that can be used to investigate upper limb lameness
- Ultrasound
- Radiography
- MRI
- Scintigraphy
- Thermography
Describe the use of nerve blocks in farm animal species
Same as in horses regarding principles
Challenge in cattle is having two digits – complex branching of the different nerves
Easier to do it on a broader level e.g., fetlock and below, carpus/hock and anything below
Be aware of thick skin in cattle – easier to perform a ring block
Describe the condition that may cause calves to ‘walk’ on their fetlocks
Contracted tendons
- Animal is not able to place its foot with the sole on the ground
- Affects front legs
Describe the conservative treatment options for contracted tendons in calves
- Casting
- If the limb can be manually extended for the calf to walk on their toe, then a cast should be efficient
- Helps the leg to extend and the tendons to stretch
- Be aware of causing ulcers – lots of padding needed
- Cast 2-4 weeks → change after 10-14d & re-apply as half-cast - Metal splint
How is contracted tendons in calves managed surgically?
Tendonectomy
- If you can’t extent into ‘tippy-toe’ stance
- Cut superficial flexor tendon first – see if this is enough to allow joint extension
- If not then cut the deep digital flexor tendon too
- Can do in the field under LA
What are the causes of gastrocnemius rupture?
Rotational force
Sudden weight bearing
Trauma
Weakening
? Hypophosphataemia
Describe the typical stance of an animal with gastrocnemius rupture
Hock is much lower than expected
Hyperflexion of the fetlock so the foot can still touch the ground
Which condition shows a similar stance to gastrocnemius rupture?
Tibial nerve paralysis?
How can you differentiate gastrocnemius rupture with tibial nerve paralysis?
In tibial nerve paralysis sensation will be lost (on the plantar aspect)
What is the most common cause of a flexor tendon injury?
Trauma
Spontaneous/infection less common
Describe the steps in treating a flexor tendon injury?
Treated as a wound
- Lavage
- Debride
- Antibiotics if infected
- Cast alone? need to get infection under control first
- Confinement +/- Block to raise heel and release pressure off the wound
How can you decided if a wound has joint involvement?
- Position – is the wound near the joint capsule?
- Synovial fluid present - Viscosity
- Explore with sterile probe
- Radiography +/- contrast
- Expand synovial compartment
- Sterile saline
- Entry AWAY from wound
- If saline exits at wound -> lavage
How would you investigate/diagnose the following case:
- acute onset working bull, swelling cranio-ventral to stifle
- Rule out foot / lower limb
- Clicking sound
- Joint effusion
- Pain
- Crepitus (popping, clicking or crackling sound in a joint)
- Cranial drawer
- Radiography
- Ultrasound
Describe how cattle with patellar fixation present
Adult steers more commonly affected?
BCS no difference
Leg fixed in full extension
Can be intermittent initially
How is patellar fixation treated?
Cut medial patellar ligament
Under LA
Both legs - very likely that this one will develop fixation too
Describe the condition caused by over lifting the leg during food trimming
Peroneus tertius rupture → normal reciprocity of stifle & hock is lost
Can fully extend the hock while the stifle remains flexed – cannot do this in a normal animal
Serratus ventralis rupture = ‘flying scapula’
Describe how osteodystrophy affected younger and older animals differently
Ricketts = young, growing animal
Osteoporosis & osteomalacia = adult
What are the causes of osteodystrophy?
Mineral/Vitamin-Deficiency: Ca, P, Cu, D
Combined with: Rapid growth, gender (males), housing (on concrete), genetics (beef cattle)
-> Affects calcification & bone tissue formation
List the clinical signs of osteodystrophy
- Stiffness / recumbency
- Bone distortion
- Long bone fractures
- Swelling joints / epiphysis
How is osteodystrophy diagnosed?
- Joint fluid sample
- Bloods: decreased Ca2+, increased AlkPhos
- PME & histopathology
- Bone ash concentrations
Describe the presentation and trigger of white muscle disease
Vitamin E & Selenium deficiency
Rising 1-yo
Trigger: increased activity – calved turned out in spring
Describe the serum levels seen in animals with white muscle disease
- Decreased levels of vitamin E and selenium
- Increased levels of AST and CK
Describe the presentation of hip dysplasia in cattle
- 3mo - 2yo
- Bilaterally affected limbs
- Dorsal acetabulum & femoral head
- Males
- Sporadic condition but many may be affected so can appear to be an outbreak
How can hip dysplasia be identified just by looking at the leg
- Normal leg goes straight down
- In hip dysplasia: stifle is rotated outwards; the hock is inwards and the fetlock is outwards
What is osteochondrosis?
Focal necrosis of cartilage vessels
O. dissecans
O. latens
O. manifesta
Which joints are most commonly affected by osteochondrosis?
Atlanto-occipital & femoro-patellar joints
How is osteochondrosis disgnosed?
Young animals
Little lameness until OCD
Joint tap: mild inflammation, mild ↑ protein
Describe the features of degenerative joint disease in cattle
Severe, progressive lameness
Diffuse cartilage lesions
Associated with osteochondrosis
Where does degenerative joint disease affect
1. calves
2. older animals
Distal interphalangeal joint in calves
Fetlock, carpus, tarsus in older animals
How does a cow with hip dislocation present?
- Freshly calved?
- Present with decreased anterior phase when walking & swelling greater trochanter
- Asymmetry
- Stifle in normal position
- Hock and fetlock move outwards
What is the main DDx of hip dysplasia?
fracture of the proximal femur – hard to distinguish
Describe the two common directions that hip dysplasia can go and how each will present
Cranio-dorsally - still walking
Caudo-ventrally - recumbent
How is hip dysplasia treated?
Treatment by closed reduction - using rope to pop it back in
- Prognosis 40-75%
- Walking normal in 3-4 d
How would you investigate a suspected hip haematoma/abscess?
Ultrasound and FNA useful
Describe the 3 main causes of fractures
- Direct trauma
- Spontaneous - Hypophophataemia
- Pathological - Pre-existing infection / necrosis has weakened the area
What is the most common cause of metacarpal/metatarsal fractures?
Injuries from calving ropes/chains – over-forceful
In most cases will heal due to calves age
What are the uses of radiography in fracture cases?
Diagnosis
Allows realignment planning
Describe the first aid protocol for a cow with a fracture
Restrain
Splint
If recumbent, consider cross tying and blindfolding them to help stop them getting up
Describe how splinting should be used for different fracture locations
- Just above carpus or below = splint whole of front leg on medial and lateral aspects
- Below hock = splint lower half of back leg on medial and lateral aspects
- If between elbow and carpus/stifle and hock = lateral splint only
- If above the elbow or stifle = no splint
What needs to be considered when transporting an animal with a fracture
Good legs FORWARD
Care & aid loading
Pad out trailer
Pain:
- Avoid sedation (more wobbly and unstable)
- NSAID (& Butorphanol)
List the positive prognostic indicators for a fracture
- Young animal
- Distal fracture
- Closed
- Simple
- Ambulatory
List the negative prognostic indicators for a fracture
Older animal
Proximal limb
Open
Comminuted
Recumbent
When is box rest advised for a fracture?
Humerus/Femur fractures
No displacement or joint involvement
Animal is ambulatory
Will take months to heal
Pain relief needed
- rare to just use this method
Describe the indications and considerations for casting limbs with fractures
Not indicated for spiral or open fractures
Needs to be above and below the joint of the fracture site
Length
Analgesia!
Padding
Alignment
Strength
Claws
Aftercare
Describe using a hanging pin cast for fracture repair
Trans-cortical pins
ABOVE fracture only
Full leg cast
Important: Include foot
Describe the steps/features of good nursing and monitoring of cows/calfs treated for fractures
- Aid to stand up
- Easy access food & water
- Safe from others
Monitor for: - Smell
- Local temperature
- Weightbearing
List the main complications of fractures
Osteomyelitis
Dislocation / Non-union
Decreased Long-bone development
Ischaemic necrosis
Nerve damage
Disuse atrophy
Describe support removal post-fracture removal
Not all at once - gradual
Patient growth
- Calves: change at 2 w (max. 3 w)
- Adults: can leave 6-8 w
Disuse atrophy / osteodystrophy
E.g. if 4 pins in place, remove one at a time
How is septic arthritis spread?
Haematogenous spread
- Umbilicus, intestines
- Check other organs
or Traumatic
Which pathogens cause septic arthritis?
T pyogenes - most common
Strep/Staph/E.coli/Salmonella H.somnus, M.bovis
How is septic arthritis diagnosed?
Arthrocentesis
Describe the arthrocentesis procedure
Scrupulous asepsis
Not through wounds
18-20g, 1” needle
Plain & EDTA pot
Once diagnosed, how is septic arthritis treated?
Aggressive antibiosis, anti-inflammatory - high dose
Surgical: single joint affected
- GA or IVRA (intra-venous regional)
- Lavage
- Arthroscopy
- Arthrotomy
