Ruminant Upper Limb & Joint Lameness

Question 1

What are the 6 major etiologic agents of septic arthritis?

Answer 1

1. Trueperella pyogenes
2. fusbacteria
3. streptococcus
4. staphylococcus
5. coliforms
6. mycoplasma

culture to determine antimicrobial of choice

Question 2

What are the 3 major ways microbes can infect joints?

Answer 2

1. hematogenous - common in calves with navel infections or failure of passive transfer, affects multiple joints
2. puncture - affects one joints
3. periarticular penetration - sequel to a cast sore, abscess outside of joint capsule

Question 3

How do most cases of septic arthritis present? Why should all joints be evaluated, especially in calves?

Answer 3

3-legged severe lameness

• often multiple joints involved
• mature cattle arthritis is usually affecting a single joint

Question 4

What are 5 major factors that contribute to prognosis and treatment of septic arthritis?

Answer 4

1. number of joints involved
2. how long it has been going on
3. response to previous therapy
4. size/weight
5. financial constraints

Question 5

Why is sterile prep important for performing joint taps? Where should a joint tap be taken?

Answer 5

• swelling may not be septic
• culture and sensitivity

soft spot in the swelling (palpate for bone and avoid)

Question 6

What bore needle is recommended for joint taps? Why?

Answer 6

14-18

14g preferred so it is large enough to flush antibiotics and clumps of fibrin or purulent material without becoming clogged

Question 7

What does normal joint fluid look like? How can normal viscosity be tested?

Answer 7

clear to slightly yellow with no turbidity, few WBCs or neutrophils, and low protein

string test - more purulent material = less stringy; should be at least 2 cm

Question 8

What conservative treatment is commonly used to treat septic joints? What is a more advance option? What is treatment is not worth it?

Answer 8

antibiotics and anti-inflammatories for a few days (good for cases of one joint is affected and found quickly)

systemic and intra-articular antibiotics, anti-inflammatories, and flushing of the joint with saline**

slaughter, euthanasia

Question 9

What clinical signs are most commonly associated with septic arthritis?

Answer 9

acute onset of a swollen, hot, and painful joint that the cattle is reluctant to move

• 3-legged lame!

Question 10

How are chronic cases of septic arthritis like?

Answer 10

treatment likely not worth it due to poor prognosis —> euthanasia/slaughter

Question 11

How are radiographs used for diagnosing septic arthritis?

Answer 11

give an idea of how long infection has been present —> arthritic changes take at least 2 weeks to appear

Question 12

What is wrong with this joint tap?

Answer 12

no sterile prep!

Question 13

What NSAID and antibiotics are recommended for septic arthritis? How should the joint be flushed?

Answer 13

Meloxicam + Procaine Penicillin G (Naxcel not able to be used in an off-label manner) —> good option for T. pyogenes, as it is G+, but it’s not broad-spectrum

flush as long as it is productive to do so and the fluid is clear

Question 14

Is method of administering antibiotics as important in treating septic arthritis?

Answer 14

most drugs given systemically achieve therapeutic tissue levels in synovial membrane and synovia

Question 15

What is a red flag for septic arthritis caused by Mycoplasma?

Answer 15

feedlot beef calf with arthritis and pneumonia (can cause an outbreak!)

• no good treatment or control
• vaccination is the principle focus on control, but they are lacking

Question 16

What is the only drug approved for treating septic arthritis caused by Mycoplasma? What are some other options?

Answer 16

Tulathromycin (Draxxin)

• Florfenicol (Nuflor)
• Spectinomycin (Adspec)
• Enrofloxacin (Baytril)
• Oxytetracycline has mixed results

Question 17

How do most bovines present with degenerative joint disease?

Answer 17

• chronic progressively severe lameness with a rolling gait
• prefers recumbency, reluctant to mount
• can be acute with ligament rupture

Question 18

What are 3 possible causes of bovine degenerative joint disease?

Answer 18

1. conformation defects - post-leggedness (straight hock and stifle)
2. trauma, arthritis, ligament tears
3. nutrition deficiencies - aphosphorosis

+/- heritable, older and overweight cattle

Question 19

What are 4 common findings in cattle with degenerative joint disease? How is it diagnosed?

Answer 19

1. resist flexion of affected joints
2. joint capsule usually not distended, painful, or hot, but can be unstable
3. soft tissue thickening around joint
4. crepitation

radiographs +/- arthroscopy

Question 20

What are common findings in the joint fluid of cattle with degenerative joint disease?

Answer 20

• yellow tinged +/- debris, but no clot
• 200-1000 WBCs
• 10-15% neutrophils
• <3 g/dL protein

Question 21

What is the preferred treatment of degenerative joint disease? What palliative care is an option?

Answer 21

slaughter —> no good therapy available

• intra-articular corticosteroids
• rest
• NSAIDs
• intra-articular hyaluronic acid
• acupuncture

Question 22

What surgeries are available for cattle with degenerative joint disease?

Answer 22

• curettage and removal of joint mice
• surgical arthrodesis

Question 23

How do cattle with coxofemoral luxation present? What if it’s bilateral?

Answer 23

• usually sternally recumbent and unable to rise with affected limb abducted excessively
• standing - extended and shortened limb craniodorsally
• asymmetric gluteal region

always recumbent in a frog-legged position

Question 24

What are 4 common etiologies associated with coxofemoral luxation? In calves?

Answer 24

1. estrus - large bull mounts smaller female on a slippery floor or with improper leg position
2. parturition/dystocia - obturator nerve trauma
3. trauma
4. slick footing

improper traction at birth

Question 25

What coxofemoral luxations are most common in the US and Australia?

Answer 25

US = craniodorsal (not palpable) AUSTRALIA = caudoventral

Question 26

What are the 6 best cases for coxofemoral luxation reduction?

Answer 26

1. able to stand 2. < 3 y/o 3. < 800 lbs 4. < 12 hr duration 5. lack of concurrent metabolic disorders 6. no nerve paralysis

Question 27

What are the 2 most common clinical signs associated with coxofemoral luxation? What can be observed on rectal palpation?

Answer 27

1. abnormal posture of affected limb(s) 2. limb splayed perpendicularly ot the lateral body wall unable to palpate femoral head in its normal position in the obturator foramen

Question 28

How will a luxated coxofemoral luxation appear on palpation?

Answer 28

place thumbs on tuber ischia and pointer fingers on the greater trochanter ---> length differnce between sides is a good means of diagnosis +/- swelling, crepitation, sudden onset swinging leg lameness

Question 29

How should a downer cow be manipulated to test for hip luxation?

Answer 29

must get up ---> use hip lifters and place in a floater tank

Question 30

What is the preferred option for coxofemoral luxation treatment? What else can be done?

Answer 30

slaughter - prognosis is poor and reluxations are common - nothing if able to ambulate, can develop pseudoarthrosis - reduce luxation if within 24 hr and craniodorsal - open reduction can be performed after 24 hrs in valuable cattle

Question 31

What can make coxofemoral luxation reduction difficult in cattle?

Answer 31

- muscle contraction - blood clots can form within a few hours of luxation

Question 32

What are 2 indications of a successful coxofemoral luxation reduction? How can reluxations be avoided?

Answer 32

1. "clunk" sound hear upon traction (constant traction can fatigue muscles!) 2. greater trochanter in normal position and leg can be flexed easily

Question 33

What treatment of coxofemoral is available for calves?

Answer 33

femoral head osteotomy = salvage

Question 34

In what 2 ways can coxofemoral reluxations be prevented?

Answer 34

1. confinement to a location with excellent footing 2. hobbles

Question 35

In what large animals is osteochondrosis dissecans most common? What are 4 predisposing factors?

Answer 35

rapidly growing, young cattle and hogs (6-18 months) ---> outgrow cartilage 1. hard floors 2. minimal excercise 3. "hot" nutritional rations (grain!) 4. genetics (seen anywhere - humeral head, distal radius, femoral trochlear ridges, femoral condyles, tarsal joints)

Question 36

How is osteochondrosis dissecans diagnosed?

Answer 36

- joint tap = ~2000 WBCs, no bacteria - radiography - arthroscopy

Question 37

How do most patients with osteochondrosis dissecans present? Treated?

Answer 37

chronic, intermittent, less severe lameness - stall rest - correct diet with less grains - arthroscopy with curettage if above fails (good prognosis with no complicating factors, like DJD)

Question 38

What is a hygroma? Where are they most commonly found?

Answer 38

cystic swelling containing serous fluid due to chronic irritation of joints (epidermis, dermis, subcutis), commonly lacking lameness tarsus and carpus (periarthrosis), not commonly involving the actual articular surface

Question 39

Hygroma:

Answer 39

Question 40

What is the most common cause of hygroma development?

Answer 40

repeated trauma (rubbing), most common in free stalls with concrete edges (hocks!) or insufficient bedding

Question 41

What are common differentials for hygromas? How do they differ? What is commonly used to differentiate?

Answer 41

- septic arthritis - periarticular abscess hygroma = much less obvious lameness and pain associated U/S, sterile tap

Question 42

What is a unique cause of hygromas in buffalo?

Answer 42

Brucellosis

Question 43

What treatment is recommended for hygromas?

Answer 43

most commonly - NOTHING - more appropriate bedding ---> pasture! - antibiotics/anti-inflammatories may not be necessary - lance and flush if abscessed - bandaging and surgical removal is tough ---> complications of entering joint that is not infected or incomplete removal

Question 44

How can hygroma development be avoided?

Answer 44

provide excellent bedding and housing

Question 45

How do cases of contracted tendons present?

Answer 45

walking on pastern joints (splints for correction!)

Question 46

What congenital causes can contribute to developing contracted tendons? How can size affect development?

Answer 46

arthrogryposis or lupine toxicity (crooked calf disease) more common in smaller calves ---> may have tendons shorter than bones

Question 47

How are contracted tendons treated? What does not work in calves?

Answer 47

- splint and stretch to speed up recovery - extreme case + valuable calf = surgery to transect superficial flexor tendon with cast application **may grow out of it - provide good footing** IV oxytetracycline

Question 48

How do patients with spastic paresis (Elso Heel) present?

Answer 48

tripod - one leg hovering and not weight bearing, commonly a hind leg

Question 49

What ultimate genetic cause has been linked to spastic paresis? When are signs seen?

Answer 49

Elso II (bull) clinical between 2-9 months ---> occurs in both hindlimbs, but one is commonly worse than the other

Question 50

What treatment is available for spastic paresis?

Answer 50

- slaughter as soon as possible - tibial nerve transection - not as helpful, other leg will the become stiff

Question 51

What is the most common cause of extremity cellulitis? What sign is indicative?

Answer 51

unsanitary injections - extensive cellulitis and abscess tracking - extremely swollen limb - lameness due to pain and swelling

Question 52

What treatment is recommended for extremity cellulitis?

Answer 52

- drain - flush - antibiotics - repeat

Question 53

How do patients with syringomyelia present?

Answer 53

calves with hopping gait

Question 54

What is indicative of perosomus elumbis?

Answer 54

agenesis of lumbosacral spine and vertebra causes rear leg arthrogryposis (front legs normal!)

Question 55

What is indicative of spinal dysraphism?

Answer 55

arrested development of spinal cord with cavitations results in a hopping gait similar to syringomyelia