Upper hindlimb

Question 1

Where does osteochondritis dissecans occur in the upper hindlimb? CS? Dx?

Answer 1

• Young horses (warmbloods>thoroughbreds)
• Lateral trochlear ridge > Patella»> medial trochlear ridge
• CS = stifle effusion, lameness
• Dx = Radiography

Question 2

What is Treatment of osteochondritis dissecans

Answer 2

• Conservative = <12mo, dietary advice, exercise restriction + monitor lameness
• Surgery = >12mo, remove osteochondral fragments

Question 3

Why would you always take caudocranial x-rays of the stifle?

Answer 3

• Want the plate close as possible to the stifle

Question 4

What are osseous cyst like lesions? OCLL, CS? Dx?

Answer 4

• Subchondral bone cyst
  -present later than OCD (1-3yrs+)
  -usually medial femoral condyle
• CS = lameness, joint effusion
• Dx = radiography

Question 5

What are treatment options for Osseous cyst like lesions?

Answer 5

• Inject joint = intra-articular corticosteroids
• Inject cyst under GA = corticosteroids
• Debride cyst = may worsen, pack w bone graft
• Bone screw across cyst

Question 6

What are soft tissue injuries of the stifle?

Answer 6

• Meniscal + meniscotibial ligament injuries
  -Medial»»Lateral (poor prognosis if signs of OA)
• Cruciate ligament - poor prognosis if involved

Question 7

What can cause osteoarthritis in the stifle? Dx? Tx?

Answer 7

• Causes = trauma / soft tissue injury
  -Secondary to # / sepsis
  -OCD / OCLL
• Dx = Lameness, +ve response to analgesia
  -RADIOGRAPH
• Tx = Palliative - NSAIDs + Intra-articular meds

Question 8

What are different upper hindlimb fractures? Causes? What can be done? Dx?

Answer 8

• Causes = traumatic - hitting fence / kick, tibial stress in racehorses
• Dx = Radiograph
• Tibial tuberosity = conservative management
• Patella = Surgical removal (<1-3) or fixation
• Complete fracture of femur / Tibia = Euthanise
  -Foal = can repair but difficult + complications

Question 9

What are clinical signs of upward fixation of the patella? Tx?

Answer 9

• Weak quadriceps can’t lift patella from locked position
• CS = poorly muscled / rested / muscle loss, straight hind limb, dorsal toe wear
• To solve problem = make horse walk backwards / manually unlock by pulling leg
• Tx = build up muscle (walk up hills)
  -Splitting / injecting medial patellar ligament
  -Medial patellar desmotomy

Question 10

What are conditions of the coxofemoral joint?

Answer 10

• OA = v poor diagnosis = Euthanasia
• Subluxation = ponies - toggle + pin (doesn’t always work)
  -can get sign of upwards fixation of patella as no anchor for quadriceps

Question 11

What are different pelvic fractures? Causes?

Answer 11

– Tuber coxae (“knocked down” hip)
– Ilial wing
– Ilial shaft
– Pubis/ischium
– Acetabulum
* Causes = trauma, end stage bone fatigue (racehorses)

Question 12

What are clinical signs of pelvic fractures?

Answer 12

• Pain / swelling / asymmetry / muscle spasm
• Rectal palp = sharp discontinuity, haematoma, gentle rocking
• Signs of shock = severance of iliac arteries w ilial shaft fractures
• Nerve damage = muscle + anal tone
• Muscle atrophy + lameness

Question 13

What is Tx of pelvic fractures? What are complications of Tx?

Answer 13

• Pain relief = NSAIDs
• Box rest + cross tie for >1mo
• complications = pleuropneumonia - horse head up all the time
  -Colic = lack of movement

Question 14

What are presenting complaints of sacroiliac disease? Dx?

Answer 14

• Large-framed horses with long backs and weak quarter
• Lameness
• Poor performance – Lack of impulsion, Resisting jumps
• Pelvic asymmetry – Muscle atrophy
• Pain/swelling – Sacroiliac pain +/-thoracolumbar pain
• Dx = Exclude other HL causes (e.g. tarsus); diagnostic
  analgesia; scintigraphy; ultrasonography

Question 15

What is acute + chronic treatment of sacroiliac disease? (lower back pain)

Answer 15

• Acute =
  -4-8wks box rest
  -NSAIDs
  -Physiotherapy
• Chronic =
  -Work + NSAIDs
  -Build up limb / pelvic muslces
  -Perilesional injection - steroids
  -Physiotherapy + shockwave