Front
limb lameness:
The conditions to be discussed are
1.Shoulder
Slip: (Sweeny)
2.Bicipital
Bursitis
3.
Omarthritis: (arthritis of shoulder joint)
4.Capped
elbow: (Bursitis at the point of elbow, Olecranon bursitis/Shoe boil)
5.Radial
Paralysis
6.Carpitis
7.Bent-knee
and Knock-knee.
1.
Shoulder Slip: (Sweeny)
It is
paralysis of supra scapular nerve leading to atrophy of supraspinatus and
infraspinatus muscles.
Etiology:
Injury to suprascapular nerve by
a) Direct
blow to point of shulder
b) Stretch
of nerve in sudden backward thurst of the limb by collision/slipping.
Signs:
1. Supporting
limb lameness with abduction of the shoulder.
2. Atrophy
of the muscles, showing up sharp scapular spine.
Diagnosis:
Muscular dystrophy to be differentiated from muscular atrophy.
Treatment:
In the past by hydrotheraphy, applying antiphlogistic packs, ultrasound,heat in
acute cases, and injection of counter irritants in chronic cases to obtain scar
tissue to support the shoulder.
Surgical
Procedure:
1. Expose
the nerve and remove surrounding scar tissue.
2. Remove
a piece(2.5 cm long X 1.2 cm wide) of scapula under the nerve, to reduce the
nerve tension.
Three out of six horses will return to full form and
restoration of good muscle mass over scapula.
Surgery performed 2-4 months after signs appear and
after 4 months atrophy will occur. Incision is taken upto 15 cms from 4 cms
above distal end of scapular spine 1 cm cranial.
Surrounding scar tissue is removed around the nerve.
Distal cut in bone to prevent fracture of
supraglenoid tubercle.
Bone edges smoothened with curette and bone
roungers.
Post operative drain under supraspinatous muscle
removed in 24 hours.
Hand exercise after 5 days, sixweeks stall fed
withdaily hand exercise, after 6 months active exercise.
2.Bicipital
Bursitis:
Inflammation
of Bicipital bursa, which is between biceps brachii tendon and bicipital groove
of the humerus, cushioning tendon movement. Incidence of lameness due to
bicipital bursitis is very low.
Etiology:
1. Severe
trauma at the point of shoulder.
2. Fall/Slip
to flex shoulder and extend elbow.
3. Infection
by open wound/haematogenous like in B.Abortusor Equine influenza.
Signs:
1. Head
raising reflex.
2. Imperfect
flexon of the limb, slight lift off the ground.
3. Insufficient
foot clearance.
4. Fixation
of scapula-humeral joint.
5. Circumduction
of the limb.
6. Dropped
elbow if severe inflammation or radial nerve is involoved.
Diagnosis:
1. Swelling of the bursa at the point of
shoulder.
2. Fixation
of the scapula-humeral joint is diagnostic of shoulder lameness in motion.
3. Direct
pressure on the point of shoulder is painful.
4. Pain
by pulling leg upward/downward i.e., flexon test.
5. Definitive
diagnosis by intrasynovial anaesthesia of this bursa after removing sample of
synovial fluid.
6. Differential
diagnosis from a) Fracture of
supraglenoid tuberosity
b)Fracture
of proximal humerus
c)Ossification
of biceps tendon
d)Osteochondrosis
of the shoulder joint.
Treatment:
1. Rest
2. Counter
irritation by blisters, irritant injection and firing.
3. X-rays
radiation.
4. Inj.Corticosteroids
into bursa 4-5 injections every week and NSAID`s for non infectious bursitis.
5. In
Infective bursitis, lavage with antibiotics is used.
6. Surgical
debridement with lavage drainage in chronic cases.
3.Omarthritis:
(arthritis of shoulder joint)
Causes:
1. Fracture
of the joint.
2. Fracture
of supraglenoid tuberosity(tuber scapulae).
3. Fracture
of lateral tuberosity of humerus.
4. In
young osteochondrosis and in chronic osteoarthritis of joint.
5. In
foals naval infection extension-naval ill or joint ill by E.Coli.
Etiology:
1. Trauma,
kicks, running on to solid objects.
2. Septic
arthritis by bacteria like E.Coli from naval.
3. Insufficient
colostrums in take (Immunodeficiency in Arabian horses)
4. In
old horses by penetrating wounds/iatrogenic infection from arthrocentisis.
Signs:
1. Head
raising.
2. Circumduction
of the limb to avoid flexion of shoulder.
3. Standing
with foot beyond normal foot.
4. Obvious
swelling of the shoulder.
5. Fixing
of shoulder with small strides.
6. Flexion,
extension, abduction and adduction is painful.
7. Pain
on palpation of shoulder.
Diagnosis:
1. Nerve
block differentiation of distal limb, Medial and Ulnar nerves blocked to
eliminate lower limb lameness.
2. Radiograph.
3. Injection
of local anaesthetic into intra synovial joint of scapula-humeral joint.
4. Arthrocentesis
for analysis of fluid.
Treatment:
1. Remove
small chips fracture of lateral humeral tuberosity.
2. If
degenerative changes set in joint, there is no treatment.
3. Injection
of corticosteroids into shoulder joint gives temporaray relief.
4. If
bony changes occur prognosis is poor.
4.Capped
elbow: (Bursitis at the point of elbow, Olecranon bursitis/Shoe boil)
Elbow (point of olecranon tuberosity) bursitis
mostly in draft breeds, by trauma acquired subcutaneous bursa is formed. Rarely
small true bursa under triceps brachii muscle is involved.
Etiology: Trauma by shoe during motion (in exercise)
or when horse is lying down.
Signs/Diagnosis:
Prominent swelling at elbow point with fluid in
acute and fibrinous tissue in chronic cases. Mild lameness is seen. Radiograph
to rule out trauma or infection of olecranon process. Contrast radiograph
injection into draining tracts to identify course and foreign body.
Treatment:
In acute condition , remove shoe to prevent further
trauma . Injection of steroids after draining.
Chronic bursitis
is treated with
1. Inj.of irritant like Iodine.
2. Incision in the bursa and seton of Lugols
Iodine.
3. Insertion of penrose drive for 2 weeks to
remove fluid andhelp in fibrosis.
4.Surgical
excision.
Post operatively, varying degree of wound dehiscence
was observed by primary sutures, so tension sutures are applied, then stent
bandage application with cross tying to prevent sitting down.
5.Radial
Paralysis:
Etiology:
1. Trauma
to nerve at musculo spiral groove of humerus, mostly by fracture of humerus,
sometimes nerve severed.
2. Kick
or fall on lateral surface of humerus leading to paralysis of nerve.
3. Prolonged
lateral recumbency leading to radial paralysis like symptoms.
4. Overstretching
of nerve leading to paralysis.
5. Tension
of nerve by hyperentending the forelimb and adducting the shoulder.
Signs:
Signs will depend on the extent or degree and location of paralysis.
If
extensors of digits are affected, animal cannot advance the limb.
If
branch of nerve to triceps muscle is affected, dropped elbow and extended while
digits are flexed. Elbow muscles are relaxed with digital extension making limb
longer than normal.
If radial nerve paralysis is accompanied by
paralysis of entire brachial plexus, there is paralysis of flexor and extensor
muscles, animal unable to bear the weight.
In mild form of paralysis, there is little lameness
in slow walk, but stmbling and difficulty on uneven ground.
Diagnosis:
1. By
Clinical signs.
2. By
Electromyography (EMG) on extensor muscles of carpus and digits 5 days after
injury.
Treatment:
1. Horse
should be stalled.
2. Limb
in light cast or splint bandage to prevent contraction of flexors of the carpus
and digits, so that dorsal surface of fetlock is not damaged, change the cats
every 2-3 weeks.
3. If
there is fracture of humerus, surgical correction by which radial nerve freed
of bone chip fragments and dissect out scar tissue.
Prognosis:
Six months rest is allowed after corrective surgery,
and checked for further prognosis.
Surgery to correct paralysis should take place
between 8-12 weeks after injury.
6.Carpitis:
Acute or chronic inflammation of the carpal joint
that may involve fibrous joint capsule, synovial membrane,associated ligaments
and carpal bones progressing to degenerative joint disease.
1. Traumatic arthritis—Synovitis
and capsulitis with minimum ligament integrity lost.
2. Osselets—Traumatic
arthritis of metacarpophalangeal joint and
thickening with synovitis and capsulitis of fibrous joint capsule at
dorsal aspect of metacarpophalangeal joint , in chronic cases ossification
takes place.
Causes –1. Repeated trauma to joints in races.
2.In young race horses, conformational defects in carpel and
fetlock joints.
3.Joint distension with
synovial effusion leading to tearing of capsule.
4.Capsulitis develops secondary to synovial
membrane inflammation but primary
damage to fibrous capsule occurs at its attachment to the bone where
tears occur resulting in inflammation and subsequent bone formation.
Signs: 1.In
acute carpitis-short strides with decreased flexon at the carpus
2.Swelling of joint capsule and
flexed to reduce intra capsular pressure.
3.Digital pressure on joint elicits
pain and heat can be felt.
4.In chronic carpitis-carpal flexion
and increased lameness
5.Hard thickening at dorsal aspect
of joint.
Diagnosis: 1. Radiography—Relatively more amount
of fibrous or bony tissue is detected, and reveals exostosis on dorsal aspect
of carpal bones.
2.To eliminate intraarticular
fracture.
3. Periostitis causing new
bone growth.
4.Eliminate chip fractures of
proximal phalanx and osteochondrosis of articular surface of 3rd
matecarpal bone.
5.Synovial fluid analysis in
traumatic arthritis to know degree of inflammation and evaluate response to
therapy in septic joint.
6. In septic joint decreased
relative viscosity, increased protein content upto 5g/dl, WBC upto 10000/mm3.
7.Arthroscopic examination.
Treatment: 1. Rest and immobilization with
bandage support.
2.Physical therapy:
In acute
traumatic joint injury cold hydrotherapy which will decrease exudates, decrease
inflammation and decrease diapedisis.
In chronic inflammation (after
48 hrs), hot hydrotherapy which will decrease vasodialation, fluid resorption
and provide phagocytic cells.
3.Swimming: In convalescent
period water massage prevents fibrosis of joint capsule.
4.In chronic cases counter
irritation with vesicants and linaments with firing(cautery).
5.Diathermy and Ultrasound
will create deep heat in tissues to enhance vascularity and healing.
6.DMSO(Dimethylsulphoxide): It
is a polar chemical solvent, applied locally along with corticosteroids to soft
tissue swelling in acute trauma to reduce edema.It has got super oxide
dismutase activity which inactivates superoxide radicals and helps in the
penetration of various agents like steroids.
7.Joint lavage: To remove
cartilaginous debris from synovial cavity and 3 lts of electrolyte solution,
after that introduce hyaluronate.
8.Intra-articular
corticosteroids: Used in traumatic and degenerative arthritis in horses which
will reduce collagenase and prostaglandin release, decrease in migration of
leukocytes, decreased platelet aggregation, decreased leukocyte superoxide
production.
Side effects of cortisteroids-decreased
rate of healing in joint capsule, ligaments and bones. By systemic
corticosteroids osteoporosis and avascular necrosis of bone.
8.Intraarticular NSAIDS-Phenyl butazone,
Asiprin, Naproxen)
9.Superoxide
dismutase: Systemically, locally, intra articularly for arthritis for more
prolonged effect compared to NSAID.
10.Sodium hyaluronate: It is
nonsulphated glyscosamine glycan, used along with corticosteroid for equine
degenerative joint disease of carpal and fetlock joints.
11. Polysulphate
glycosaminoglycan: It will promote hyaluronic acid synthesis, used as boundary
lubricant of synovial membrane.
12.Synovectomy:It is removal
of hypertrophied,inflammation of synovial membrane for rheumatoid arthritis and
juvenile chronic arthritis. Alternate methods of synovectomy are irradiation,
intraarticular injection of osmictetroxide.
7.Bent-Knee:(Bow legs,Carpus Varus or
Bandy-legged conformation)
Lateral deviation of carpal joints, when
viewed from front of the horse.
Increased tension on lateral surface of
limb,particularly lateral collateral ligament of the carpus and increased
compression forces on the medial aspect of joint.
Knock-Knee:
(Carpus Valgus or Knee-narrow conformation)
Medial deviation of the
carpal joints.
Increased
tension on medial aspect and increased compression on lateral aspect, resulting
in varying degree of outward rotation of the cannon bone, fetlock and foot.
Medial angular
deviation of knees from abnormal growth plates and epiphysis of radius or from
abnormal development and alignment of carpal and metacarpal bones or from joint
laxity.
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