Hind Limb Lameness

Term
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● Palpation - swelling, heat, pain, digital pulses, examine the joints
● Hoof testers
● Flexion tests
● Nerve/joint blocks
● Diagnostic imaging
● Severe hind lameness can produce a head nod and mimic forelimb lameness
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Terms in this set (40)
● Palpation - swelling, heat, pain, digital pulses, examine the joints
● Hoof testers
● Flexion tests
● Nerve/joint blocks
● Diagnostic imaging
● Severe hind lameness can produce a head nod and mimic forelimb lameness
How do we diagnose hind end lamness?
The fetlock will flex hard down on the good leg, because of the extra weight it's putting on it; fetlock/tail head will not drop much on the bad leg
What's a good indicator of hindlimb lameness when regarding the fetlock?
True
T/F: If there are OCD lesions in the femuro-patellar joint, you'd expect swelling.
(1) Secondary to improper ossification of growing articular cartilage

(2)May be related to rapid growth, copper deficiency, trauma
Osteochondrosis can occur due to....
(1) Lateral trochlear ridge of tibiotarsal bone (talus)

(2) Lateral trochlear ridge of the distal femur

(3) Distal intermediate ridge of the distal tibia

(4) Humeral head
What are the predilection sites for osteochondral fragmentation?
Fibroblasts will migrate in, surface will change to fibro-cartilaginous layer; will allow horse to be sound
What happens when you take out the OCD fragments?
-Medial femoral condyle
-Proximal radius
-Distal humeral condyle
-Distal MCIII
-Distal P1
What are the predilection sites for subchondral bone cysts?
True
T/F: bone cysts produce lameness without joint effusion generally.
Femoral nerve could get stretched out, ischemic and cause paralysis
If a horse has been in surgery with his legs held in extension, what could happen?
flexed
If stifle is flexed, hock should be...
Superficial digital flexor & peroneus tertius -Keeps hindlimb locked in extension when patella locks above medial trochlear ridge -Prevents hock extension when stifle is flexed -Forces hock to flex when stifle is flexed, and hock to extend when stifle is extendedWhat's in the reciprocal apparatus? What does it do?-Buckling of superficial digital flexor -Leg is straight behind horse when pull caudally -Favorable prognosis; stall rest for 3 months, gradual return to work; about 10 months until back to full work -Common injury during recover in horses with a full hindlimb castHow could you diagnose & treat a rupture of fibularis (peroneus) tertius?Superficial digital flexor/gastrocnemius rupture --> wrinkled up peroneus -Fair for injury in foals; grave for mature horses -Muscle shreds, doesn't hold sutures well -Can't keep him off leg enough, and get laminitis in the other foot -Massive pressure sores if cast used, where tibia jams into it, skin sloughs off; not helpfulWhat's the prognosis?*Prolonged fixation (more 'permanent')* -Patella locks unexpectedly, horse attempts to flex limb, causing patellar ligament loop to seat more firmly into trochlear notch -Patella remains locked in extension -Horse needs help to disengage *Intermittent fixation* -Limb briefly locks in extension as horse attempts to lift foot to advance it at the beginning of a stride. Strenuous attempt to flex locked limb often followed by explosive hyperflexion as patella suddenly releases -Limb briefly locks as foot is placed down near the end of a stride; slight jerk as patella releases, brief sinking of hindquartersWhat are the two clinical manifestations of upward fixation of the patella?Loss of tone to musculature causes looseness of patellar ligaments; doesn't have to extend stifle as much for middle and medial patellar ligaments slip over and lock -Straighter conformation (stifle angle) than average can also make it more proneHow could young horses that don't get much exercise get upward fixation of patella?135 degreesWhat's the normal stifle angle?Can back him up to extend stifle; leg drags out, loosens up patella, then you could pop the lateral patella so that it rotates off the medial trochlear ridgeHow can you help disengage the fixed patella in a prolonged fixation?Limb briefly locks in extension as horse attempts to lift foot to advance it at beginning of a stride If at the end of the stride, will see a slight jerk as it releases, and then sinking of hindquartersWhich type of intermittent fixation involves an explosive hyperflexion as patella suddenly releases?-Have horse lead forward at the walk -With limb in full extension, force patella upward and caudally -Attempt to hold patella in fixed position -If limb can be locked in extension, horse is affected -If horse can flex the leg, but patella shudders as limb is flexed, horse may be mildly affectedHow can you test for upward fixation?Counterirritant injection; 3mL of 2% iodine in oil -Causes irritant so that the ligaments thicken up, get a little shorter, and usually fixes it -Start horses back to work to overcome looseness -Another treatment would be a medial patellar desmoplasty (several longitudinal stab incisions) to thicken it upWhat can you inject patellar ligaments with to treat upward fixation?Stringhalt -Patellar fixation would be once it's been extendingWhen a horse hyperflexes the hind limb as soon as each stride is initiated, it's called _________?-May result from faulty input from stretch receptors in the lateral digital extensor or axonopathy of long myelinated nerves -May occur secondary to scarring of the lateral extensor tendon in its sheath or trauma to dorsal MTIII area; causes bad input to the brain about what's going on -If several horses seem affected, could be ingestion of Hypochoeris radicata, 'false dandelion, flatweed, or hair cats ear'What causes stringhalt?Lateral extensor tenectomyWhat could you resolve the problem of stringhalt if it's occurring due to trauma or scarring of lateral extensor tendon in its sheath?Stifle and hock not completely extended, in a Z shape; 'slaps' the foot down; stops forward motion of the foot abruptly just prior to placement -Hindlimb appears to hover briefly then slap the ground caudally as the foot is placedHow does fibrotic myopathy scarring of semitendinosus affect the horse?Cut tendon of insertion of the semitendinosus -Expose tendon insertion on medial aspect of cranial tibia -Incision parallel to tibia, caudal to saphenous vessels -Watch out for saphenous -Begin few minutes daily walking the day after surgeryHow could you treat fibrotic myopathy?-70% success -Minimal improvement for horses with extensive scarWhat's the prognosis of fibrotic myopathy treatment if it's mild? What if there's extensive scar formation?Fuse together usually; not much motion -Tibio tarsal joint won't want to fuse though because there's too much movement thereArthritis in the proximal interphalangeal joint causes the bones to...Bone spavin -Advanced stages produce bony swelling of the distal medial tarsusThe degenerative joint dz involving the distal intertarsal and tarsometatarsal joints is called __________-Chondroprotectives and anti-inflammatories used in the early stages -Potent long acting corticosteroids used after cartilage damage has progressed -Steroids relieve pain and promote fusionHow can you treat bone spavin?-Joint space narrowing -Periarticular osteophyte production -Subchondral bone sclerosis and irregularity -Joints may progress toward fusion (which can cause it to be sound)What are the radiographic findings for bone spavin?Lesion in the hock -So a fluid-y swelling in the lesion of a hock is 'bog spavin'What does spavin mean?Swelling: bog spavin fusion: bone spavinFlexion swelling is called _____, while the term for when two bones fuse is _______CurbInflammation of the long plantar ligament is called _________The tuber calcis to metatarsusWhat does the plantar ligament connect?Sickle hock conformation -They have slight tarsal flexion at rest and the point of the hock projects prominently caudalCurb is seen more commonly in horse with ________Thoroughpin -Circumscribed fluctuant swelling between Achilles tendon and tibiaEffusion of the tarsal sheath is __________-Bog spavin: fluid shifts to dorsal aspect of hock in tibiotarsal joint -Thoroughpin: fluid remains or shifts distally around DDFT distal to plantar ligamentHow can you differentiate thoroughpin from bog spavin by compressing the swelling?Often secondary to an injury to the sustentaculum -Rough surface of sustentaculum may damage DDFT May also be secondary to a stress injury to the DDFT in the area of the tarsal sheath -Horses in pulling contestsThoroughpin is caused by what things?Radiographs Ultrasound to evaluate DDFT for enlargement or evidence of fiber disruption Synoviocentesis useful to determine nature of effusion -Hemorrhage -Inflammation -InfectionHow can you diagnose thoroughpin?-If not involving DDFT, drain excess fluid from sheath and inject it with corticosteroid to minimize effusion; bandage and rest for 2 weeks -If secondary to DDF tendonitis injury, ice, rest, graduated exercise rehabilitation program -If secondary to sustentaculum lesion, surgical debridement of bony lesionHow do we treat throughpin?