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    Lecture 2 Unit VI

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    Riya Adhangle

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    Lecture 2 Unit VI

    Uploaded by

    Riya Adhangle
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    6 views53 pages

    Lecture 2 Unit VI

    Uploaded by

    Riya Adhangle

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 53

    Department of Veterinary Surgery and Radiology

    Mumbai Veterinary College, Parel, Mumbai


    MAFSU, Nagpur

    Lecture No.: 02

    Subject Title: Veterinary Surgery


    Unit: VI (Veterinary Orthopaedic and Lameness)
    Lecture Title: Lameness: Its definition classification and diagnosis. General methods
    of therapy for lameness. Body and limb conformation in relation to lameness in
    equine
    ORTHOPAEDICS

    • Branch of surgery concerned with conditions involving


    musculoskeletal system

    • Use of surgical and non-surgical means to treat musculoskeletal


    trauma, spine diseases, sports injuries, degenerative diseases,
    infections, tumours and congenital disorders
    Lameness

    • Indication of a structural or functional disorder in one or more limbs


    or the back that is evident while the horse is standing or at
    movement

    • Only a symptom not a diagnosis


    Etiology

    • Lameness can be caused by


    • Trauma
    • Congenital or acquired anomalies
    • Infection
    • Metabolic disturbances
    • Circulatory and nervous disorders
    • Or combination of any of these.
    Classification:-

    • Supporting limb lameness (most common)


    1. Apparent when the foot first contacts the ground or
    2. Evidenced while supporting
    3. Injury to bones, joints, collateral ligaments, motor nerves and foot

    • Swinging limb lameness


    • Evident while in motion.
    • Pathologic changes involving joint capsule, muscles, tendons, tendon sheaths & bursas
    • Mostly noted in upper limbs or axial skeleton
    Cont.….

    • Mixed lameness:
    -EVIDENT IN MOTION AND AT REST

    • Primary or baseline lameness:


    • Most obvious lameness or gait abnormality noted before flexion and manipulative tests

    • Compensatory or Complementary Lameness:


    -Uneven distribution of weight due to pain in a limb, produces lameness in a sound
    limb
    AAEP (American Association of Equine
    Practitioners) Lameness scale
    NUMBER EXPLANATION

    0. Lameness not perceptible under any circumstances


    1. Lameness is difficult to observe and is not consistently apparent, regardless of circumstances (e.g.
    under saddle, circling, inclines, hard surface, etc.)
    2. Lameness is difficult to observe at a walk or when trotting in a straight line but consistently
    apparent under certain circumstances (e.g. weight carrying, circling, inclines, hard surface, etc.)
    3. Lameness is consistently observable at a trot under all circumstances

    4. Lameness is obvious at a walk

    5. Lameness produces minimal weight bearing in motion and/or at rest or a complete inability to
    move
    DIAGNOSIS

    • Observation of Gait and stride, consideration of the signalment


    and use (work) of the horses, age and shodding

    • Majority of lameness in horses-Forelimb (60-65% weight bearing)


    • 95% of lameness in the forelimb occurs distal to carpus
    • 80% of the hindlimb lameness involve hock or stifle
    • 3) Path of the foot in flight

    • 4) How the foot lands

    • 5) Joint flexion angles

    • 6) symmetry and duration of gluteal rise


    Cont.….
    • History (Anamnesis)
    • Lameness examination
    • Kinetics : Measurement of ground reaction forces
    (stationary force plate, force measuring treadmill,
    force measuring devices attached to the bottom of
    the hoof and pressure sensitive mats)
    • Kinematics: Measurement and study of movement
    (EquuSense motion capture and analysis system)
    Cont.…..

    • Perineural and Intrasynovial Anaesthesia (Low and


    High palmar 4-point block etc.)
    • Equine Diagnostic Acupuncture Examination (DAPE)
    • Radiology ( Computed Radiography/Digital
    Radiography
    • Ultrasound
    • Nuclear Medicine (Scintigraphy)
    Cont.…..
    • MRI

    • Computed Tomography

    • Arthroscopy/Endoscopy/Bursoscopy

    • Thermography (Pictorial Representation of the


    surface temperature of an object)
    ANAMNESIS

    • History and signalment


    • How long the horse been lame?
    • Has the horse been rested or exercised during this
    lameness period?
    • What caused the lameness?
    • Does the horse warm out of the lameness?
    • Does he stumble?
    • What treatment has been done and was it helpful?
    • When was the horse shod?
    Consideration before Examination

    • Before systemic examination the clinician should have good idea


    about
    • Anatomical and physiological knowledge of bone, ligament, tendon and
    muscles.
    • Phase of stride
    • Path of foot flight.
    • Landing of foot.
    • Flexion of joint.
    • Head movement with the affected limb.
    Examination of the bottom of the
    foot
    • Determine whether there is contraction
    of the heel . At this time the sole and
    frog should be examined with a hoof
    tester to determine any areas of
    sensitivity .
    • If the entire sole shows pain upon pressure
    of a hoof tester you should consider
    laminitis, fracture of the third phalanx.
    • If the area of sensitivity in localized you
    should check for sole bruising, puncture
    wounds and separation of the white line.
    Examination of the hoof wall
    • excessive dryness

    • Contraction

    • cracks

    • and evenness of wear


    Examination of coronary band
    • palpated for increase
    in heat Increase in
    heat and roughning of
    the hoof at anterior
    portion of the
    coronary band, might
    indicate a developing
    low ringbone
    • Drainage at the heel
    area of the coronary
    band would indicate a
    punctured wound in
    the feet
    Examination of the lateral cartilage

    • with the foot on


    the ground and
    with the foot off
    the ground to
    determine if
    calcification has
    occurred ( side
    bone-ossification
    of collateral
    cartilage
    Examination of the pastern area

    • examined in change in temperature


    and swelling that might indicate
    ringbone-New bone growth on 1st, 2nd,
    or 3rd phalanx due to periostitis
    Examination of the fetlock joint

    • examined for areas of pain on pressure ,


    specially on sesamoid bones

    • Swelling on the anterior surface may


    indicate osselets ( Tr. Arthritis of
    metacarpophalangeal joint) or chip
    fracture of the 1st phalanx
    Examination of the cannon bone
    areas
    • checked on the lateral and
    medial side for the presence
    of splints.
    Examination of the suspensory ligament

    • examined in standing and with the limb flexed


    • Pain on pressure or scar tissue in this structure
    indicates pathology
    Examination of the flexor tendon both superficial and deep

    • examined for
    tenosynovitis, pain on
    pressure and fibrosis
    Examination of the carpus
    • carefully examined for swelling on the
    posterior or anterior aspect

    • Swelling of the tendon sheath, joint


    capsule, and bursa in this area are
    commonly called as hygroma

    • Firm swelling over the anterior


    surface of the carpus indicates fibrosis
    and exostosis that might be caused by
    carpitis (popped knee)
    Examination of the soft tissues between the carpus
    and the elbow.

    • examined carefully for swelling ,


    pain and punctured wounds
    Examination of the elbow and shoulder joints

    • carefully palpated for the presence


    of pain and Crepitation on
    movement

    • The bursa at the point of the


    shoulder should be checked for
    bicipital bursitis

    • The fore arm, Shoulder and Scapular


    areas should be examined for
    muscular atrophy indicating a long
    standing lameness or Sweeney.
    Hind
    Limbs
    • checked in the same manner as
    are the fore limb up to the hock
    joints

    • presence of bog spavin, bone


    spavin, occult spavin, curb,
    thorough spavin and capped
    hock
    • stifle joint should be examined carefully for the
    presence of upward fixation of the patella and for
    gonitis

    • soft tissues over the stifle and hip areas should be


    examined for pathological changes including atrophy

    • Atrophy of the gluteal and quadriceps musculature


    will be present in chronic lameness of the hip and
    chronic painful stifle lameness
    Hip joint
    • examined by palpation and by observation of the gait

    • Involvement of this joint produces a supporting leg


    lameness and often an accompanying swinging leg
    lameness

    • When the round ligament of the hip joint has


    ruptured the stifle joint and toe will point outward ,
    while the hock goes inward. This same appearance
    will be present in complete luxation of the joint
    • Pelvis should be
    examined by rectal
    examination for the
    presence of fracture
    Special consideration
    • Hyperthermia

    • Crepitation

    • Sedation
    Conditions which may be observed on
    clinical examination
    Calf or Buck Knee
    Broken back or Broken Forward pastern
    Base wide or Base narrow
    conformation
    Toe out or toe in
    condition
    Winging due to Base narrow
    toe out toe in
    Bow legs Knock Knee
    Normal Hindlimb Sickle Hock

    Standing Under
    BUTTRESS
    FOOT
    Forging at the trot
    Lameness Treatment
    • intraarticular injection of corticosteroids and/or hyaluronic acid
    • Steroid injections are the oldest and most common-can help the horse in the short term (6months-1year) but prolonged
    use of steroid injections can have a negative effect on the quality of the joint, causing further problems down the road
    • stem cells
    • plasma
    • interleukin-1 receptor antagonist proteins (made individually for each horse by drawing blood and extracting the plasma
    by putting it in a centrifuge, once the plasma is separated, it is placed in a syringe that “stimulates production of the
    antagonist protein”, work by “preventing IL-1 from binding to IL-1 receptors on tissues within the joint, and therefore
    blocks the action of and stops the damage caused by the IL-1 in the joint”
    • Arthroscopy - in the case of a tear in the meniscus or abnormal bone growth, the vet can clear the area to eliminate the
    source of pain
    • alternative practices like chiropractic and acupuncture
    • vibrating plates
    • magnetic therapy have (little peer reviewed evidence)
    • Similarly, oral joint supplements have little scientific evidence supporting their effectiveness in treating or maintaining
    comfort in sport horses
    • Extracorporeal shockwave therapy
    • Tenectomies/Neurectomies
    • Shodding

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