Splints –Metacarpal/Metatarsal
Exostosis.
Splints is a
disease of young horses most commonly found on proximal medial aspect of the limb between
second and third metacarpal bones.
Second and third
metacarpal bones are called splint bones, attached to third metacarpal by
interosseus ligament(dense fibrous tissue), thus splinting or supporting long
bone.
Second metacarpal
is more frequently involoved. Conformational stress on 2nd metacarpal which bears more weight.
Disease associated
with poor conformation, improper hoof care, malnutrition of young horses and
hard training.
The interosseous
ligament can tear with the strain applied during independent motion of the
splint bones and the cannon bone.
Initially
inflammatory desmititis ( inflammation of ligament) and periosteitis( by
superficial trauma to periosteum-proliferative periostitis) develops
subsequently new bone is produced that fuses the splints to the cannon bone and
stabilizes the source of irritation.
1.
A true splint refers to a sprain or
tear of the interosseous ligament. Result is enlargement 6-7 cm below carpals
on medial aspect at the junction of 2nd and 3rdmetacarpals.
2.
Blind splint refers to an
inflammatory process of the interosseous ligament, difficult to detect physically
as swelling is on inner aspect of splint between small metacarpal and
suspensory ligament. Diagnosed by radiograph as osteolysis between 2nd and 3rdmetacarpal.
3.
Knee splint refers to the enlargement
of the proximal portion of the splint bone may lead to osteoarthritis within
carpometacarpal joint.
Causes
1.Enlarged
splints-Proliferation of fibrous tissue and osteo perostitis.
2.Tearing of the
interosseous ligament by external trauma or healing of transverse or
longitudinal fracture.
3.The second metacarpal
bone is more frequently involved because of the difference in articulation with
the carpus.
4.Conformational
abnormalities that increase the stress on the small metacarpal bones.
5.Imbalanced
nutrition or over nutrition in young animals.
6.If inflammation
with periosteum is sufficient , it results in ossification of splints by time.
7.Chondroid
metaplasia of the collagen results by trauma.
8.Bent kee
conformation with toe out predisposes the problem.
9. Deficiency of
calcium and phosphorus.
10. Over weight.
11. Vigorously over
exercise.
12. Improper
shoeing and trimming.
Clinical signs
1.Lameness is
obvious in the trot.
2.Lameness more
marked with exercise on hard ground.
3.Heat, pain,
swelling over the affected region .
4.If new bone
growth occurs near the carpal joint, it may cause knee splints.
Diagnosis
1.Radiography –
osteomyelitis between second and third metacarpal bones, 2.Periostitis of the
splint bones observed from superficial
trauma to the periosteum, which causes a
proliferative periostitis
3.Ultrasound
examination can demonstrates injury to the suspensory ligament
4.Nuclear
scintigraphy may be needed to confirm a blind splints.
Treatment
1.In acute phase,
administration of NSAID’s coupled with hypothermia and pressure support wraps
beneficial to reduce inflammatory signs.
2. Hand massage,ice
application, application of DMSO/ furacin/ steroid sweat. 3.After inflammation
gone, mild liniment or hot application may be given.
4.Intra lesional
corticosteroid can reduce inflammation.
5.If splint is
from trauma, splint or shin boots may help to prevent trauma.
6.Corrective
trimming and shoeing
7.Pin firing, local
injection of sclerosing agents, topical application of blisters, radiation for
sub acute or chronic cases.
8.Surgery to remove
exostosis for medical or cosmetic reasons.
Prognosis
Good to excellent
except with large exostosis.
Sore shin
Osteoperiosteitis
of the front portion of the large metacarpal(more common in fore legs) and less
frequently of the metatarsal regions.
Common in young
race horses of one and half to three years old.
Etiology
Trauma
Severe concussion
Rigorous training
with exercise stress.
Clinical signs
Swelling over the
third metacarpal
Bilateral
shortening of the stride
Palpable callus
Absence of lameness
after exostosis
Diagnosis
Clinical signs
Radiography
Nuclear
scintigraphy
Treatment
Rest followed by
moderate exercise
Cold astringent
application
Blistering
Periosteotomy with
pressure bandage
Prognosis for
soundness
Favourable – in
early stages
Guarded – in
exostosis condition
SESAMOIDITIS
Observed frequently
in racing horses between the 2-5 years age.
The condition is characterized by pain
associated with proximal sesamoid bones and insertions of suspensory ligament,
resulting in lameness.
Causes
1.Any unusual
strain to the fetlock region may produce sesamoiditis.
2.Injury to the attachment
of the suspensory ligament to sesamoid bones.
Clinical signs
1.Swelling,
increased heat over the abaxial surface of the sesamoid bone.
2.Pain on palpation
and flexion of the fetlock.
3. Fetlock flexion
test exacerbates the lameness.
4.Lameness depends
on acuteness of the injury.
Diagnosis
1.Radiological
changes
2.Nuclear
scintigraphy
3.Ultrasound of sesamoid ligaments.
4.Perineural
anaesthesia or intra synovial anaesthesia.
Treatment
1.Cold or hot packs
should be used to reduce swelling.
2.Rest should be given.
3.In chronic stages firing and blistering.
4.Radiation, laser heat, shock wave therapy.
5. Balanced mineral
diet should be provided.
Prognosis
Guarded to unfavourable.
Wind puff/Wind gall
Distension of the
joint capsule of metacarpophalageal joint with over distension of joint capsule
between the suspensory ligament and third metacarpal bone.
Etiology
1.Full trained horse
with sudden rest.
2.Heavy parasitism
3.Inadequate
nutrition
Clinical sign
1.Joint capsule
distension
2.Lameness
Diagnosis
1.Clinical sign and
history
2.Radiography
3.Ultrsonography
Treatment
1.Application of
glycerine and alcohol with elastic wrap
2.Drainage of joint
capsule
3.Intra-articular
corticosteroid administration
Prognosis
Permanent correction
of condition is difficult.
Osselets
Inflammation of the
fibrous joint capsule of the metacarpophalangeal joint present bilaterally in
young horse – Two types.
1.Green osselets - No bony
proliferation.
2.True osselets - Bony proliferation
present.
Etiology
1.Frequent heavy
training.
2.Trauma.
Clinical signs
1.Metacarpophalangeal
joint enlargement.
2.Warm to touch.
3.Pain on palpation
4.Pits on digital
pressure
5.Shortened stride
6.Resistance on
extreme flexion and extension of joints
Diagnosis
1.Clinical sign and
history
2.Radiography
3.Ultrsonography
Treatment
1.Rest
2.Poultice
application with soft cotton bandage
3.Blistering of
joint after inflammation subside
4.Radiation therapy
5.Corticosteroids
administration
Prognosis - Good
Ring bone
Exostosis on the
Phalangeal bones – bony enlargements on the pastern or phalangeal bones.
A typical ring bone
is an osteoarthritis involving the inter-phalangeal joints.
Incidence – Common in both the fore and hind feet
Animal with ring bone is usually considered as unsound
Types – 6 types
1.True ring bone - Exostosis at the level of one of
the interphalangeal joints
2.High true ring bone - Exostosis involving the
suffragino-coronal joint (1st and 2nd)
3.Low true ring bone - Exostosis involving the
corono-pedal joint (2nd and 3rd)
4.False ring bone – Exostosis noticed on the shaft of the phalangeal bones
5.High false ring bone - Exostosis on the shaft of the
os-suffraginis (1st)
6.Low False ring bone - Exostosis on the shaft of the
os-corona (2rd)
Sub types -2 types
1.Articular ring bone – Exostosis associated arthritis at
the joint level
2.Periarticular ring bone – Exostosis periphery to the
joint with an intact articular surface.
Etiology
1.Young horse.
2.Heredity.
3.Defective shoeing
4.Poor conformation
of the limb
5.Pathological bone
diseases
6.Strain of the
articular ligaments
7.Fissured fracture
of the os- suffraginis or os corona
8.Uneven loading of
the limb
9.Direct external
trauma
10.Tearing of
common digital extensor tendon
Clinical signs
1.Moderate to
severe lameness.
2.Mechanical
interference of the contra lateral foot during progression .
3.Increased digital
pulse amplitude.
4.Increased pain at
the pastern .
Diagnosis
1.Clinical signs
2.Radiography
3.Palmar/Plantar
nerve block at abaxial sesamoid level
4.Intra-articular
analgesia
Treatment
1.Immobilisation of
the lower limb
2.Stall confinement
for 4 weeks
3.Controlled
exercise
4.Needle point
firing
5.Median and
external plantar neurectomy
Prognosis for
soundness
Considered as very serious if low
/articular ring bone condition noticed
Quittor/necrosis of the lateral cartilage
It is a localized
necrosis within a collateral cartilage of the 3rd phalanx.
Purulent discharge
and sinus formation above the coronary band.
Etiology
1.Lacerations
,punctures , bruises to the side of the foot above the coronary band.
2.Possible
extension of subsolar or submural abcess.
Clinical signs
1.Chronic ,
suppurative draining tracts above the coronet.
2.Localized pain ,
heat and swelling over collateral cartilage.
3.Lameness occurs
in the acute stages of infection.
4.Extensive
fibrosis and deformity of hoof wall in chronic cases.
Treatment
1.Surgical excision
of the necrotic core of the cartilage.
Prognosis
Not favourable, if collateral cartilage is involved extensively.
Side bone
Ossified lateral
cartilage of the foot
Etiology
1.Hereditary
predisposition in draft and heavier breed horses
2.Developmental
deformity – premature ossification
3.Incorrect
trimming and or shoeing
4.Improper conformation
of the foot
5.Increased loading
6.Concussion
7.Direct violence
Clinical signs
1.Usually absence
of lameness
2.If lameness
noticed, it is usually due to inflammation and ossification
3.Pain during
turning the animal to the direction of the affected foot
4.Absence of
flexibility of the cartilage
5.Upright foot
condition with bulging of coronary band region
Diagnosis
1.Clinical Signs
and shape of the foot
2.Radiography
3.Unilateral or
bilateral palmar digital nerve block
Treatment
1.Corrective
shoeing
2.Rest for 6-8
weeks
3.NSAIDs
4.Thinning of the
hoof wall at the quarters and the heel level
5.Digital
neurectomy
6.Partial removal
of lateral cartilage
Prognosis for
soundness
1.Good in early
stages
2.Guarded to poor
in extensive stages of ossification
Navicular bone
Chronic ostitis of
the navicular bone, usually with chronic synovitis of the navicular bursa and
inflammation of the plantar aponeurosis noticed commonly as bilateral in the
fore feets.
Commonly noticed in
the fore feet of light horses around seven years of age(old) than in young or
heavy horses.
Etiology
1.Hereditary
2.Defective shoeing
3.Fast work on hard
roads
4.Repetitive
concussion by overloading
5.Pressure from the
deep flexor tendon
6.Degeneration of
the fibrocartilage, flexor cartilage, synovial fluid of the navicular bursa
7.Thrombosis of the
arteriole supplying navicular bone
8.Abnormal foot
conformation
Clinical signs
1.Intermittent
forelimb lameness
2.Pottery or
stilted gait of forelimb
3.Groggy or
shuffling or boxy gait
4.Screwing of the
forelimb rather than lifting during turning
5.Wearing of the
toe of the shoe
6.Pointing of the
affected foot
7.Rocking horse
stance – with forelimb in the front and hind limb at the back
Diagnosis
1.Clinical signs
2.Radiography
3.Palmar digital
nerve block
Treatment
1.Correction of
foot abnormality or imbalance
2.Corrective
trimming and shoeing with wide webbed egg-bar shoe
3.Thinning and
grooving of the hoof wall
4.Administration of
vasoactive drugs isoxsuprine 0.6 – 1.2 mg/kg bid PO for 6-12 weeks
5.Warfarin – 0.018
mg/kg sid PO increased to 20% in every ten days until prothrombin time
increased by 2-4 seconds.
6.Plamar digital
neurectomy and medial and lateral suspensory ligament desmotomy
Prognosis for
soundness
Unfavourable
Pyramidal disease or buttress foot
Osteoperiosteitis, soft
tissue swelling and consequent exostosis of the pyramidal process of the
ospedis (3rd phalanx).
Due to new bone
growth in the region of the extensor process of the distal phalanx.
It is advanced form
of low ring bone.
Due to fracture or
periostitis of the extensor process.
Healing of the
pathological changes produces new bone growth causing enlargement at the
coronary band at the centre of the hoof.
Buttress foot –
Deformed foot condition due to oedema at the coronary band region
Incidence is more
common in the hind feet
Etiology
1.Strain of the
common or long digital extensor tendon and extensor branch of the suspensory
ligament as they insert on the extensor process of the distal phalanx,
resulting in periostitis and new bone growth.
2.Direct trauma
3.Fracture of the
extensor process of the distal phalanx that heals with excessive callus.
4.Defective
conformation of the hoof - upright or forward broken hoof –pastern axis-High
heels and short toes and horses that move with limbs lifted high in a short and
rapid manner(trappy gait).
5.Rapid angular
acceleration of the foot in high heeled horses, tears the insertion at the
extensor process.
Clinical signs
1.
Heat ,pain,swelling at the coronary
band in the centre of the coronary band.
2.
Arthritis
of the coffin joint becomes chronic.
3.
Varying degrees of lameness
4.
Shortened stride bearing of the
weight on heal
5.
Swelling on the dorsal coronary band
6.
V-shaped foot, by change in the shape
of front of hoof wall.
7.
Pain at the distal interphalangeal joint
on pressing
Diagnosis
1.Clinical signs
2.Radiography –variable
changes in middle and distal phalanges and coffin joint.
3.Abaxial
sesamoid/Palmar digital nerve block
Treatment
1.Pressure bandage
with cast application
2.Stall rest
3.Hoof trimming and
corrective shoeing
4.Palmar digital neurectomy
5.Firing and
blistering in olden days.
6.Injection of
corticosteroids
7.Radiation therapy
to reduce periostitis.
Prognosis for
soundness
Guarded in early
stages
Poor in advanced
stages
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