Is Your Horse Off Behind?? Common Hindlimb Lameness Hindlimb

3/21/2012
Is Your Horse Off Behind??
Nathaniel A. White II DVM MS DACVS
Jean Ellen Shehan Professor and Director
Common Hindlimb Lameness
Sacroiliac joint
pain
Hock Arthritis
Hip Lameness
Suspensory
Ligament
Stifle Lameness
Tenosynovitis
Stress Fractures
Hock
Fetlock
Diagnostic Techniques
Observation
Palpation
Heatt
H
Swelling
Pain
Flexion
Lower limb
Upper limb
Nerve/Joint
blocks
Hindlimb Facts
Muscles used for
propulsion
40% of weight
Feet have a higher
hoof angle
No stay apparatus
Hock and stifle are
connected so they can
lock the limb for
support
Gait
Analysis
Imaging
Radiographs
Ultrasound
Scintigraphy
MRI
Thermography
Observe the
lameness:
Which leg?
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Gait Analysis
Where is the Lameness?
Joint Flexion
Gait Analysis
Where is the lameness?
Radiography
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Scintigraphy
Thermography Camera
Detects infrared (heat energy)
from skin
High Field MRI
Back Injuries
Pain is often soreness due to lameness
in the front or rear limbs
Arthritis
Dorsal spine interference
High Field MRI
Sacroiliac Pain
Pain from the joints which attach
the back bone to the pelvis
Fibrous joint
j
Bone and ligament pain
Uneven gait and stiffness
increased with horse under saddle.
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Sacroiliac Pain
Jumpers Bump
Sacroiliac Joints
Hip Lameness
Arthritis
Rare and usually due to a fracture or
luxation
RX IIntra-articular
RX:
l treatments
Luxation (dislocation)
Treatment includes injection of corticosteroids
into and around the joint
Rare
Dislocation goes up shortening the leg
Difficult to treat
Pelvic
Fractures
Hip Luxation
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3/21/2012
Stifle Lameness
Patella Fracture
Osteochondritis dessicans (OCD)
Femoral bone cysts
Meniscus damage
Cartilage/subchondral bone injury
Cruciate/collateral ligament
rupture
Femoral OCD
Femoral OCD
Defect in cartilage
development under
the patella
Cartilage clefts and
bone fragments
Develop early 4-6
months but may
not cause lameness
until horse is placed
in work
Femoral Trochlear OCD
Treatment
Early cases rest
with possible
h li
healing
Surgery to remove
defective cartilage
Surgery should be
delayed until after
10 months of age
Bone Cysts
Medial femoral
condyle
Fluid pressure
expands
d a cartilage
l
cleft
Lining of the cyst is
inflammatory
causing lameness
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3/21/2012
Bone Cysts
Subchondral
Bone/Cartilage
Injury
RX- Cortisone
j
injections
Hardening of the
subchondral bone
Surgery to
remove the cyst
lining
Lack of spongy bone
allows cracks form in
the cartilage
Subchondral bone
pain
Cartilage Defects
Mensical Injuries
• Greater meniscus movement in extension
• More compression in the medial meniscus
during extension of the legs
Cartilage
Damage
Stifle Meniscal
Injury
Lameness
Stifle effusion
No radiographic
g p
changes
Ultrasound
examination may
indicate a mensical
tear
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Ultrasound Diagnosis of Stifle
Injury
Meniscal Tear
Medial Meniscal Tears
Grade 2 Meniscal Tear
Three grades of tears
When the meniscal ligament is torn,
the prognosis is poor
Treatment
Surgery
Regenerative medicine
Hock OCD
Tibia Fractures
Stress fractures
Most common in
race horses
Malleolar fractures
in the hock
Lameness with
hock enlargement
Associated with
trauma to limb
Genetic
tendency for
OCD
Lameness
Fluid distention
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Distal Tibial Ossicle
Distal Tibial OCD
Treatment
Surgery
Prognosis is excellent
May retain some joint swelling
Hock Arthritis (spavin)
Inflammation of the
lower hock joints
Lower joints have
minimum movement
Arthritis can lead to
bone proliferation and
joint fusion
Hock Inflammation: RX
Hock Inflammation
Soreness or
lameness
Hip hiking-toe
touching lameness
Increased lameness
after flexion
Commonly in
both hocks
Degenerative Joint Disease
NSAIDs
Phenylbutazone
Firocoxib (Equioxx)
Hock injections
Corticosteroids (Vetalog, Depomedrol)
Hyaluronic acid
Autogenous conditioned serum (IRAP)
Adequan (Polysulfated Proteoglycan)
Oral supplements
Glucosamine
Chondroitin Sulfate
Avocado/Soybean Unsaponifiables
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3/21/2012
Hock Degenerative Joint
Disease
Hock Joint Fusion (Arthrodesis)
Hock Joint Fusion
Septic Arthritis
Surgical fusion
Drilling with bone graft
Chemical fusion
90% ethyl alcohol
Direct injection
Stall rest
Fusion takes several months
Pain may be improved before fusion
Septic Arthritis
Hock and stifle of
foals are frequently
involved
A
Associated
i d with
ih
infection of the
umbilicus
Bone infection is
common and the
source of bacteria
Suspensory Desmopathy
(Injury)
Lameness onset is often acute or
intermittent
Lame iin one lleg; both
L
b h involved.
i l d
Localization with nerve blocks or
scintigraphy
Diagnosis made with ultrasound or
MRI
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3/21/2012
Suspensory Desmitis
Suspensory Desmitis
Proximal Suspensory Desmitis:
Bone response
Rear Limb Suspensory
Desmoplasty
Ultrasound Guided
Desmoplasty
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Neurectomy Surgical
Technique
Custom fasciotome
Dr.Fritz
PreOP
3 months PostOP
Andy Bathe- ACVS presentation; 2006
Proximal Suspensory Release
What is the Lesion?
Acute edema and fiber disruption
Histocyte and fibroblastic response
Collagen necrosis (necrobiosis)
Ultrasonogram vs.
Histology
Proximal Suspensory Desmitis:
Trichrome Stain
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3/21/2012
Suspensory Insertional
Desmitis
11 months post operatively
Suspensory Support
Suspensory Support
Maintain
support for 1-2
months
Can be
combined with
surgery or
regenerative
medicine
Tenosynovitis
Sheath Anatomy
Tarsal or digital
sheath
Excess fluid in the
tendon sheath (wind
puff)
Tendon injury
causes excess fluid
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3/21/2012
Tenosynovitis
due to tendon
tearing
Extensor Tendon Laceration
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