Large Animal Surgery > Lameness > Flashcards

Lameness Flashcards

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1
Q

You suspect a horse is lame.

What are the 2 area’s of its body that you should watch closely to DX which area is causing the problem?

A
  • Poll
  • Hip

(front end vs. hind end)

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2
Q

What happens to the horse’s head

when a lame horse trots?

A

they raise their head when the lame front foot strikes the ground.

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3
Q

List the 3 clinical reasons for lameness.

A
  • Pain (majority)
  • Mechanical
  • Neurological defect
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4
Q

In what age group does OCD present?

A

Young horses that just started training

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5
Q

In what age group does OA more commonly present?

A

Older horses

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6
Q

What are 2-3 year old Throughbred racehorses are prone to?

A

Stress Fractures

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7
Q

What are Standardbred racehorses prone to?

A

Carpal lameness

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8
Q

What are 3 day Event horses prone to?

A

Back pain

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9
Q

What are Warmblood dressage horses prone to?

A
  • Distal tarsal joint arthritis
  • Proximal suspensory desmitis
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10
Q

What are Polo ponies prone to?

A

SDFT tendonitis

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11
Q

What one question you should be sure to ask when taking the HX of a lame horse?

A

When was the horse last shod?

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12
Q

Which angular limb deformity is this?

A

Varus

“Bow legged”

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13
Q

Which angular limb deformity is this?

A

Valgus

“knock kneed”

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14
Q

What 2 things do horses with broken back (hoof-pastern axis) often get?

A
  • Chronic heel soreness
  • Proximal suspensory desmistis
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15
Q

Severe carpal valgus will cause what 2 problems for horses?

A
  • Carpal lameness
  • Medial splints
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16
Q

List 3 things that this horse will be prone to

due to its poor hind end conformation

A
  • Upward fixation of the Patella
  • Suspensory desmitits
  • OA in the distal hock joints

(“straight through the hocks”)

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17
Q

What will this horse be prone to due to its poor confirmation?

A
  • OA of the distal hock joints
  • Desmitis of the long plantar ligament (curb)
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18
Q

You are performing a PE on a lame horse.

What is one area of the body that is every important, but often overlooked?

A

The mouth

Can be causing the horse pain & discomfort, which will throw off their natural balance

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19
Q

You find these while performing a PE on your client’s horse.

What should you tell the owner?

A
  • They are wind puffs → thickening of the tendon sheath
    • Non-pathogenic
    • Assocaited with heavy “work”
    • No need to worry about them
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20
Q

If a horse comes to you 3-legged lame, what are your top 3 concerns?

A
  • FX
  • Subsolar abscess
  • Septic synovial structure
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21
Q

Where does lameness almost always originate?

A

In the area distal to the carpus or hock

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22
Q

Which type of lamess gait is seen most frequently in lameness exams?

A

Supporting limb lamess

(lameness during weight bearing)

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23
Q

Swinging limb lamenesss is often due to a _______________.

A

Mechanical deficit

(i.e. fibrotic myopathy, stringhalt)

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24
Q

What grade would you give a horse if the lameness is consistently observable at a trot, under all circumstances?

A

Grade 3

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25
What grade do you give a horse with lameness that is obvious & has marked nodding, hitching &/o shortened stride?
Grade 4
26
What grade do you give a horse that is unable/refuses to move?
Grade 5
27
How do you evaluate the forelimb gait of a horse?
* Look for "head nod" * Listen to feet strike the ground * sound forelimb will be louder * Look at phase of stride/limb flight
28
What is the cause of 80-90% of lameness in horses?
* Palmar heel pain/Navicular syndrome * Solar bruising/abscess * DJD "in the foot"
29
How will a bilaterally lame horse appear to move?
They will have a short, shuffling gait
30
How do you best observed hind end lameness?
When the horse is being trotted away from you
31
What are signs of lameness in the hind end?
* increased displacement of coxae * decreased sound from shoe contact * Reduced cranial/caudal phase of stride
32
What will happen with the horse's head and neck if it suffers from hind end lameness?
The head and neck will shift forward and nod down at the same time ## Footnote (Horse is trying to shift its weight cranially away from the lame limb)
33
Why are Provocative Tests done on lame horses?
* to "tease-out" inconsistent lameness * to exacerbate a mild lameness * to help isolate the location of lameness
34
What is the primary disadvantage of Flexion Tests?
Unable to distinguish btwn an intraosseous and a soft tissue injury (just helps isolate the area)
35
What is the problem with performing Flexion Tests in the hind limbs?
Reciprocal apparatus does not allow for the stifle and hock to be flexed individually.
36
How is DX analgesia performed in lameness evaluations?
* Perineural anesthesia→ migrates & infiltrates * Intrasynovial anesthesia * Typically work distal to proximal
37
List the 3 commonly used LA in Equine Medicine.
* Lidocaine HCL * rapid onset, short action * Mepivicaine HCL * rapid onset, mid-duration * Bupivicane HCL * slower onset, longer duration
38
What are the limitations of nerve blocks?
* Best done W/O sedation → dangerous to the vet * Can't use if cellulitis or dermatitis is present * Interferes w/ other tests * nuclear scintigraphy (have to wait 2 wks)
39
If you are performing a nerve block on a synovial structure, what precautions are necessary?
* Aspetic technique * New bottle of LA * Sterile gloves
40
What are contraindications for performing nerve blocks?
* If you suspect a FX * Horse is being ridden or lunged
41
What is the most commonly performed regional nerve block of the forelimb? What areas does it block?
* Palmar digital nerve block * anesthetizes the entire foot, including the distal interphalangeal (coffin) joint.
42
What nerve blocks are done on the thoracic limbs?
* Palmar digital * Abxial sesmoid * Low 4 Point * High 4 Point → Lateral palmer & suspensory origin * Median & Ulnar → Musculocutaneous
43
List the nerve blocks used in the Pelvic limbs
* Plantar digital * Abaxial sesamoid * Low Plantar (6 point) * High Plantar (6 point) * Tibial & Peroneal
44
What is desensitized by the PD Block?
The palmar 1/3 & all of the sole
45
What region is NOT desensitized by a PD block?
Doroproximal * Coronet * dorsal laminae * DIP
46
What does improved lameness after a Palmar/Plantar Digital Nerve block indicate?
The pain is coming from th foot
47
What does the Abaxial Sesamoid block desensitize?
desensitizes the entire foot, the pastern joint, the short pastern bone and their associated soft tissues.
48
What nerves are blocked in the Low 4 Point block?
* Palmar Metacarpal n. * Palmar n.
49
What areas are desensitized by the **Low 4 Point** block?
* Navicular structures * Soft tissue structures of pastern and foot * Sole, Laminae * Three phalanges * Coffin and Pastern and Fetlock joint * Distal Digital tendon Sheath
50
What nerves are blocked in the **Low 4 Point on the hindlimb**?
* Palmar Metacarpal n. * Palmar n. * Dorsal Metatarsal n. * Digital Extensor tendons
51
What nerves are blocked in the **High 4 Point** block? What area of the leg gets anesthetized?
* Palmar Metacarpal n. * Palmar n. * Anesthetizes palmar metacarpus from distal carpus _+_ Carpo-metacarpal joint _+_ carpal sheath
52
What is accomplished by the **Tibial Peroneal Block**?
Anesthetizes deep pain from the distal tibia down
53
What are the disadvantages of the **Tibial & Peroneal block**?
* Difficult test to "read"→ only 50-80% effective * Peroneal: toe drag (extensors blocked) * Inconsistent skin sensation * Takes up to 1 hr. to reach full effect * Not good to rely on for distal limb lameness
54
What parts of the body is **Intra-synovial Anesthesia** used?
* Articular * Tendon sheaths * Bursae
55
What is digital radiography NOT good for in horses?
Cartilage damage
56
What is an Enthesiophyte?
Bone formation at a site of soft tissue attachment
57
What is U/S best used for in Equines?
* Soft tissue * Ligaments, cartilage, tendons, menisci * Helpful at bony sites * Abscess vs. Hematoma
58
What does increased uptake of Tc99 during Nuclear Scintigraphy indicate?
* Bony remodeling * Increased blood supply → acute inflammation
59
What is Nuclear Scintigraphy NOT good for?
Chronic issues such as arthritis
60
What is MRI useful for?
* Extremely sensitive for bone & soft tissue * Able to image areas difficult to image w/ other madalities (hoof capsule, skull)
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