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Lameness – Part 2: Specific Diseases INAG 120 – Equine Health Management November 2, 2011.

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Presentation on theme: "Lameness – Part 2: Specific Diseases INAG 120 – Equine Health Management November 2, 2011."— Presentation transcript:

1 Lameness – Part 2: Specific Diseases INAG 120 – Equine Health Management November 2, 2011

2 Common Lameness Disorders  FRONT LIMB Shoulder Shoulder Knee Knee Fetlock Fetlock Pastern Pastern Navicular Navicular  HIND LIMB Stifle Hock Fetlock Pastern

3 Front Limb - Shoulder Signs of shoulder lameness: Signs of shoulder lameness: Head lifts when limb moves forward Head lifts when limb moves forward Little flexion of limb (low foot arc) Little flexion of limb (low foot arc) Swinging out of limb to avoid flexion Swinging out of limb to avoid flexion Failure to reach out (shortened cranial phase) Failure to reach out (shortened cranial phase)  Fixation of shoulder joint  inability to move Hard or soft ground often has same effect if level (may be slightly worse on soft ground) Hard or soft ground often has same effect if level (may be slightly worse on soft ground)

4 Lameness in the Shoulder Arthritis – Arthritis – Usually caused by trauma Usually caused by trauma Persistent lameness Persistent lameness In foals, other joints also involved In foals, other joints also involved Tx: injections with steroid (usually cortisone) followed by hyaluronic acid Tx: injections with steroid (usually cortisone) followed by hyaluronic acid

5 Lameness in the Shoulder Sweeny – Sweeny – Atrophy of muscles around shoulder Atrophy of muscles around shoulder Paralysis of suprascapular nerve Paralysis of suprascapular nerve “Popping” of the shoulder when horse walked toward examiner “Popping” of the shoulder when horse walked toward examiner

6 Sweeny

7 Front Limb - Knee Site of many developmental orthopedic diseases Site of many developmental orthopedic diseases Signs: Signs: Stand with knee flexed Stand with knee flexed Failure to reach out in stride Failure to reach out in stride Lower foot arc Lower foot arc Stiff-legged paddling gait Stiff-legged paddling gait Carpal flexion test, joint blocks good tools for diagnosis Carpal flexion test, joint blocks good tools for diagnosis

8 Front Limb - Knee Fractures Fractures Common in race horses, jumpers, hunters Common in race horses, jumpers, hunters Factors = speed, immaturity, long limb length, position of rider, distances run, firm surface Factors = speed, immaturity, long limb length, position of rider, distances run, firm surface Most common is chip fracture (also slab or fragmented fractures – less common) Most common is chip fracture (also slab or fragmented fractures – less common) Involves only one joint surface Involves only one joint surface © Clark Equine Clinic

9 Lameness in the Knee Anatomy of the knee: Anatomy of the knee: Two stacked rows of cuboidal bones (6) Two stacked rows of cuboidal bones (6) Three joint spaces Three joint spaces All held together by intercarpal ligaments All held together by intercarpal ligaments Radius above, cannon below  compressive force! Radius above, cannon below  compressive force! Faulty conformation (back at the knee)  predisposed Faulty conformation (back at the knee)  predisposed Decreased incidence in European racehorses as opposed to American  why? Decreased incidence in European racehorses as opposed to American  why?

10 The Knee Joint

11 Front Limb - Fetlock Bones of the Fetlock Joint: Cannon, Proximal Sesamoid Bones (2), Long Pastern Bone Bones of the Fetlock Joint: Cannon, Proximal Sesamoid Bones (2), Long Pastern Bone Fractures Fractures Fairly common! Fairly common! Usually on the medial side of the long pastern bone, less often on end of cannon Usually on the medial side of the long pastern bone, less often on end of cannon Former seen in race horses on hard surfaces, latter when training begins Former seen in race horses on hard surfaces, latter when training begins Lameness most obvious at trot Gets worse with work Usually can’t produce pain with palpation, but can feel heat Use opposite limb as comparison Lameness most obvious at trot Gets worse with work Usually can’t produce pain with palpation, but can feel heat Use opposite limb as comparison

12 Lameness – Fetlock Fracture of sesamoid bones: Fracture of sesamoid bones: Common in racing Thoroughbreds, Standardbreds and Quarter Horses Common in racing Thoroughbreds, Standardbreds and Quarter Horses Forelimbs most commonly affected in TB and QH, hindlimbs in STB Forelimbs most commonly affected in TB and QH, hindlimbs in STB Lameness is very pronounced – often non-weightbearing Swelling, heat, pain Fetlock held rigid during movement Lameness is very pronounced – often non-weightbearing Swelling, heat, pain Fetlock held rigid during movement

13 Front Limb – Pastern Joints TWO joints (Long pastern-short pastern and short pastern-coffin bone) TWO joints (Long pastern-short pastern and short pastern-coffin bone) Ringbone Ringbone New bone growth on bones of pastern joint(s) leading to arthritis and fusion of joints New bone growth on bones of pastern joint(s) leading to arthritis and fusion of joints High = top joint High = top joint Low = bottom joint Low = bottom joint

14 Pastern Joint - Ringbone Articular vs. Non-articular Articular vs. Non-articular Non-articular due to inflammation of the periosteum Non-articular due to inflammation of the periosteum Most common in non-speed horses with coarse boxy pasterns Most common in non-speed horses with coarse boxy pasterns Horses with high heels and short toes with trappy gaits Horses with high heels and short toes with trappy gaits

15 Pastern Joint – Ringbone Articular High ringbone Articular High ringbone Horse used for high speed that make quick stops, short turns or rapid twisting movements Horse used for high speed that make quick stops, short turns or rapid twisting movements Overly upright pasterns  increased concussion on joint Overly upright pasterns  increased concussion on joint Signs of lameness are not specific Signs of lameness are not specific Fusion of pastern joint common Fusion of pastern joint common

16

17 Ringbone

18 Front Limb – Navicular Bone “Navicular Syndrome” aka Podotrochleosis “Navicular Syndrome” aka Podotrochleosis Most common cause of intermittent, shifting forelimb lameness Most common cause of intermittent, shifting forelimb lameness Most common in horses 4-15 years old Most common in horses 4-15 years old Most common lameness of horses between 4 and 9 yo Most common lameness of horses between 4 and 9 yo Hereditary (small feet, faulty conformation) Hereditary (small feet, faulty conformation) Highest incidences in Quarter Horses and Standardbreds Highest incidences in Quarter Horses and Standardbreds Geldings > Stallions > Mares Geldings > Stallions > Mares Lameness exhibits as heel pain Lameness exhibits as heel pain

19 Navicular Syndrome Predisposing factors: Predisposing factors: Poor conformation Poor conformation Upright pasterns Upright pasterns Inappropriate exercise Inappropriate exercise Resilient surfaces Resilient surfaces Improper/irregular trimming Improper/irregular trimming Long toe-low heel (broken-back axis) Long toe-low heel (broken-back walk and walk and trot Lands toe first  excessive wear of the toe, bruising Lands toe first  excessive wear of the toe, bruising Lower limb flexion test  aggravates 80% of horses Lower limb flexion test  aggravates 80% of horses Stiff shuffling gait with high head and rigid neck Stiff shuffling gait with high head and rigid neck When circled, limb on inside will be worse, head held to outside of circle When circled, limb on inside will be worse, head held to outside of circle

20 Hind Limb – Stifle Bones involved: femur, tibia, patella (knee cap) Bones involved: femur, tibia, patella (knee cap) Most commonly mis-diagnosed lameness area (overdiagnosed) Most commonly mis-diagnosed lameness area (overdiagnosed) Hard to discern differences due to stifle vs. hock Hard to discern differences due to stifle vs. hock Common Problems: Common Problems: DOD … DOD … Upward Fixation of the Patella Upward Fixation of the Patella Arthritis and inflammation (gonitis) Arthritis and inflammation (gonitis)

21 Upward Fixation of the Patella Locked Stifles Locked Stifles Middle and medial patellar ligaments get “caught” on the femur Middle and medial patellar ligaments get “caught” on the femur Patella should be able to slide during movement, if ligaments stuck, patella can’t move Patella should be able to slide during movement, if ligaments stuck, patella can’t move May be intermittent or complete May be intermittent or complete Acute = hindlimb locked in extension Acute = hindlimb locked in extension Stifle and hock can’t flex (but fetlock can) Stifle and hock can’t flex (but fetlock can) Catching (not complete locking) also possible Catching (not complete locking) also possible

22 Upward Fixation of the Patella Diagnosis: Diagnosis: Catching most noticeable when horse is turned in a tight circle towards affected limb Catching most noticeable when horse is turned in a tight circle towards affected limb Walk up and down slope – crouched position going up, jerky gait down Walk up and down slope – crouched position going up, jerky gait down Toe drag if limb locked Toe drag if limb locked Palpation – patella locked in extension Palpation – patella locked in extension Treatment: Treatment: Training to improve muscle tone Training to improve muscle tone Avoid exercise in soft areas Avoid exercise in soft areas Surgery as last resort Surgery as last resort

23 Locked Stifles NORMAL LOCKED

24 Stifle – Arthritis and Gonitis Gonitis = inflammation Gonitis = inflammation Many causes Many causes Distension of the stifle joint Distension of the stifle joint Gluteal muscles may be atrophied Gluteal muscles may be atrophied Wearing of toes in the hind end (toe drag) Wearing of toes in the hind end (toe drag) More lame when ligaments or cartilage involved More lame when ligaments or cartilage involved Shortened stride (failure to reach forward) Shortened stride (failure to reach forward) Hip hike Hip hike Arthritis = bony changes Arthritis = bony changes

25 Hind Limb – Hock Bone spavin Bone spavin Bog spavin Bog spavin Fractures Fractures Curb Curb Stringhalt Stringhalt Shivers Shivers Capped Hock Capped Hock Soft Tissue Soft Tissue DOD (Nutrition Course) DOD (Nutrition Course) When the stifle flexes the hock also flexes and vice versa!

26 The Hock Joint 6 cuboidal bones, tibia, cannon, 4 joints 6 cuboidal bones, tibia, cannon, 4 joints Hock works as a hinge Hock works as a hinge Most movement occurs between the tibia and the tibial tarsal bone Most movement occurs between the tibia and the tibial tarsal bone Hock is the pivotal hind limb joint – all equine exercise disciplines rely on it for performance Hock is the pivotal hind limb joint – all equine exercise disciplines rely on it for performance The hock absorbs most concussive forces The hock absorbs most concussive forces Most common site of stress related injuries! Most common site of stress related injuries!

27 Hock Lameness First noticeable sign is stiffness/soreness in lumbar region of back First noticeable sign is stiffness/soreness in lumbar region of back Poorly trained chiropractors may “adjust” a horse that really has a primary hock problem! Poorly trained chiropractors may “adjust” a horse that really has a primary hock problem! Pain around inside splint bone Pain around inside splint bone Swelling and pain in the joint itself Swelling and pain in the joint itself

28 Specific Conditions Bone Spavin: Bone Spavin: General term for degenerative joint disease or osteoarthritis in the hock joint General term for degenerative joint disease or osteoarthritis in the hock joint Often in both hocks Often in both hocks History = back stiffness/soreness with lameness that may go away with exercise History = back stiffness/soreness with lameness that may go away with exercise Excessive wear on the outside of the shoe/hoof Excessive wear on the outside of the shoe/hoof Bony enlargement just below and behind the chestnut Bony enlargement just below and behind the chestnut Flexion test! Flexion test!

29 Specific Conditions Bog Spavin: Bog Spavin: General term for distension of joint capsule General term for distension of joint capsule Present on inside front of the hock! Present on inside front of the hock! Usually representative of an underlying hock problem! Usually representative of an underlying hock problem! Curbed Hock Curbed Hock Sprain of the ligament that runs down the back of the hock Sprain of the ligament that runs down the back of the hock Common in horses with sickle- hocked conformation Common in horses with sickle- hocked conformation

30 Specific Conditions Capped Hock Capped Hock Hematoma at the point of the hock Hematoma at the point of the hock Often due to trauma (kicking walls, etc.) Often due to trauma (kicking walls, etc.) Avoid drainage due to potential for infection Avoid drainage due to potential for infection Stringhalt Stringhalt Excessive involuntary flexion of the hock joint Excessive involuntary flexion of the hock joint Usually isolated Usually isolated Causes unknown Causes unknown

31 Specific Conditions Stringhalt Study in Australia: Stringhalt Study in Australia: Appears in Late Summer  peaking in February Appears in Late Summer  peaking in February Associated with droughty summers Associated with droughty summers All breeds affected but TBs more, ponies less All breeds affected but TBs more, ponies less Recover when removed from paddocks containing catsear or dandelion Recover when removed from paddocks containing catsear or dandelion

32 Specific Conditions Shivers Shivers Involuntary muscle movements of limbs and tail Involuntary muscle movements of limbs and tail May be caused by EPSM – most other causes unknown May be caused by EPSM – most other causes unknown Usually most visible when trying to back a horse Usually most visible when trying to back a horse Jerks foot and holds it above the ground in flexed position Jerks foot and holds it above the ground in flexed position

33 Treatment Terminology Rest with Controlled Exercise: Rest with Controlled Exercise: Out of work (time off!); moderate controlled exercise such as daily hand-walking Out of work (time off!); moderate controlled exercise such as daily hand-walking Physiotherapy: Physiotherapy: Hydrotherapy Hydrotherapy COLD – up to 48 hours post-injury to reduce inflammation COLD – up to 48 hours post-injury to reduce inflammation HOT – 48 hours after injury to reduce tension, relieve pain HOT – 48 hours after injury to reduce tension, relieve pain

34 Treatment Terminology Joint Lavage: Joint Lavage: Washing dead tissue out of joint with large amounts of sterile fluid Washing dead tissue out of joint with large amounts of sterile fluid DMSO (dimethyl sulfoxide): DMSO (dimethyl sulfoxide): Topical application can reduce joint inflammation Topical application can reduce joint inflammation Wear gloves! Wear gloves! Corticosteroids: Corticosteroids: Anti-inflammatory – helps reduce harmful enzymes in synovial fluid Anti-inflammatory – helps reduce harmful enzymes in synovial fluid Usually directly injected into joint Usually directly injected into joint

35 Treatment Terminology NSAIDs: NSAIDs: Non-steroidal anti-inflammatory  pain relief for soft tissue injuries (Bute, Banamine, Aspirin) Non-steroidal anti-inflammatory  pain relief for soft tissue injuries (Bute, Banamine, Aspirin) Hyaluronic Acid (HA): Hyaluronic Acid (HA): Natural part of synovial fluid used to treat synovitis injected directly into joint (after steroids) Natural part of synovial fluid used to treat synovitis injected directly into joint (after steroids) Horses often show immediate, long-lasting relief Horses often show immediate, long-lasting relief Joint Fusion: Joint Fusion: Surgical repair of arthritis Surgical repair of arthritis

36 Treatment Terminology Counterirritation: Counterirritation: Blistering, firing, ultrasound to speed healing Blistering, firing, ultrasound to speed healing


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