VSR-511 Class 6 and 7

Crural paralysis (Femoral nerve paralysis)

·  The crural nerve or femoral nerve supplies the quadriceps extensor cruris muscle (quadriceps femoris muscle) situated in front of the femur, which covers front and sides of the femur and inserts onto the patella. This quadriceps femoris muscle, actually consists of four muscles, viz., vastus lateralis,vastus medialis, rectus femoris and vastus internus muscles.

Etiology:

               1. Trauma

               2.  Azoturia

               3.Overstretching of limb during exertion, kicking and slipping.

Signs:

                1.No weight bearing on the affected limb.

 2.In standing position all joints of the affected limb will be flexed.

 3.The stifle remains “dropped”.

 4.The atrophy of the quadriceps femoris muscle occurs and it becomes tendinous.

Diagnosis:

1.      Clinical signs

2.      Differential diagnosis from true lateral luxation of patella,rupture of quadriceps femoris muscle,avulsion of tibial crust, and distal luxation of patella.

3.      Electromyography of the quadriceps femoris muscle is definitive diagnosis.

·  Treatment

1.If the paralysis is due to a callus or tumor pressing on the nerve, it is desirable to remove the same.

2.When the paralysis is due to a minor injury and is of a temporary nature, application of counter-irritants locally may accelerate recovery. Pot. Iod may be given internally to promote absorption of inflammatory exudates pressing on the nerve.

3.Nerve tonics like vitamin-B1 (Thiamine), Phospholectin , Vit E and Selenium etc. and mild exercise are advisable, if due to azoturia.

4.Administration of calcium.

5.For muscular atrophy, mild exercises, massage and application of liniments or blisters are indicated.

6.Electro-therapy prevents muscular atrophy.

7.Infra-red rays favour hyperaemia.

8.If paralysis is due to rheumatism, sodium salicylates  is indicated.

9.Corticosteroid preparations may be effective in some cases to quicken the recovery.

 Prognosis: Guarded to unfavourable.

 

Subluxation of sacroiliac joint(sacroiliac strain)

ANATOMY

·  The sacroiliac joint is a diarthrosis between sacrum and ilium.

·  The pelvis consists of two symmetrical sets of bones that are fused together to form a solid bone. The pelvis is attached to the lower part of the spine, called the sacrum, by a left and right sacroiliac joints. Unlike the hip, knee, elbow and other joints, the sacroiliac joints have limited movement.

·  The sacrum consists of five spinal bones that are fused together

·  The sciatic nerve runs immediately below the sacroiliac joint, thus this nerve is susceptible to damage

SIGNS

·  Sacroiliac luxation ( partial displacement) usually is caused by a very traumatic blow to the hind end of an animal.

·  Varying degrees of lameness.

·  Pain is noted.

·  The pelvis may feel crunchy.

·  If the sciatic nerve was also injured, decreased sensation to the outside toe.

DIAGNOSIS

·  Prior to surgery the following tests are usually performed:

o Bloodwork such as CBP.

o Radiographs (x-rays) of the chest to rule out trauma to the lungs or ribs

o Radiographs or ultrasound of the abdomen to rule out internal organ damage and internal bleeding

o Radiographs of the pelvis for  unfractured pelvis.

TREATMENT

·  There are three options for treatment of a sacroiliac luxation

o Conservative treatment is rest.

o Traditional surgery involves making  incision along the side of the pelvis and screws are used.

o Minimally invasive surgery is by making a small incision (about 1 to 1.5 cm) on sacroiliac joint and securing the sacroiliac joint in place with screws with the aide of fluoroscopy or digital radiography.

 

POST OPERATIVE CARE

• Limit activity until the fractures have healed
• Provide a soft bed to prevent bed sores
• Turn the animal from side to side
• Check the incision for infection
• Use slings

POTENTIAL COMPLICATIONS

·  Sciatic nerve damage

·  Nonhealing of the fractures

·  Breakage of the screws

·  Infection

·  Anesthetic death

·  Chronic constipation if a lot of callus or scar tissue develops in the pelvic canal

·  Entrapment of the urethra (tube from the bladder for urination) by fracture fragments

PROGNOSIS

·  Most patients heal well following surgical repair.

·  Patients that have sciatic nerve injury frequently will regain normal function.

RUPTURE OF PERONEUS TERTIUS, ROUND LIGAMENT AND ACHILLES TENDON Rupture of peroneus tertius Peroneus tertius is a muscular band lies between long digital extensor and tibialis cranialis muscles of rear limb. Origin: Extensor fossa of distal lateral femur. Insertion: third metatarsal bone and laterally on 4th metatarsal bone. Causes Due to over extension of hock Exertion of fast jumping After application of full limb cast to the rear limb Symptoms Stifle joint flexes as the limb advances, and the hock is carried forward with little flexion. Portion of the limb below hock tends to hang limp, giving the appearance of being fractured as it is carried forward. Treatment Complete rest. Rupture of round ligament A partial tear or rupture of round ligament or accessory ligament of coxo-femoral joint. Causes Trauma, the same injury that can cause luxation of coxo-femoral joint can cause injury to the accessory ligament without resulting in joint luxation. Symptoms History of trauma. Similar to those of luxation. The characteristic signs include toe out, stifle out, and hock-in appearance of the affected limb. In chronic cases, atrophy of the gluteal muscles. Direct pressure on  greater trochanter shows pain. Flexion of hip is painful. Crepitation over the joint. Diagnosis Complete rupture – based on signs like stifle-out, toe-out, and hock-in with equal length of limbs. Radiograph of the joint – severe DJD(Degerative joint disease) in chronic cases. Treatment No effective treatment. Arthroscopy to perform synovectomy. Rupture of achilles tendon Rupture of the gastrocnemius muscle or its tendon (tendo-achilis). Etiology Excessive strain on the tendon during jumping or while pulling heavy draft. External violence. Due to malicious injury. Malicious cutting of the tendon is called hamstringing. Symptoms The hock and all joints below it are flexed. The affected limb is not able to bear weight. Treatment In small animals like dogs and cats suturing may be tried. Keep the hock extended by putting plaster of paris bandage. Healing and re-union of the tendon takes four to six weeks and will depend on whether the hock has been properly immobilized in the extended position. Prognosis In small animals like dogs and cats recovery  takes place.  In large animals healing is difficult .

TROCHANTERIC BURSITIS(T.Lameness, Whorlbone Lameness)

·  Inflammation of bursa below the tendon of middle gluteus muscle as it passes over the cartilage of greater trochanter of femur.

·  Trochanteric bursitis is characterized by painful inflammation.

·  The term greater trochanteric pain syndrome (GTPS) is now being commonly substituted for trochanteric bursitis, because the inflammatory etiology of the pain.

History

·  The  pain at the greater trochanteric region.

·  Pain may radiate down the lateral region of thigh.

·  The symptoms are worse when the animal lies on the affected bursa.

·  Hip movements increase  the symptoms.

·  Onset may be slow or acute.

Causes

·  Acute trauma, such as a fall results in trochanteric bursitis, or direct kick.

·  More commonly, repetitive trauma.

·  Distemper attack.

·  Bone spavin.

·  Hock lameness.

Symptoms

·  Symptoms are often related to exercise.

·  Palpation produces pain that radiates down the thigh.

·  Bursal swelling is present.

·  Lateral hip pain,seen with flexion.

·  Short strides on affected limb.

·  Atrophy of gluteal muscles.

Differential diagnosis

·         Inflammation of coxofemoral joint.

·         Fracture of acetabulum.

·         Injection of local anaesthetic into bursa.

Treatment

·  Rest.

·  Apply ice.

·  A NSAID.

·  A steroid injection into inflammation.

·  Physical therapy to strengthen the hip muscles.

·  Inj.of lugols iodine into bursa.

·  Surgical removal of bursa. The procedure is known as bursectomy.

Prognosis:

Guarded to unfavourable.

 

 

 

 

 

 

 

 

 

 

UPWARD FIXATION OF PATELLA It occurs on medial trochlea of the femur between middle and medial patellar ligaments, which prevents flexion of hind limbs. Impaired patellar function is characterized by jerky movements.  Since the animal fixes its limb in extension while the patella glides up over the trochlea, this condition called as recurrent or permanent upward fixation of patella. Anatomy Stifle joint consists of two separate joints, femoro patellar and femoro tibial. Trochlea bounded by  medial and lateral ridges, medial ridge is longer and wider. The patella is a sesamoid bone which is connected to the cranial tuberosity by three patellar ligaments, medial, middle and lateral. The middle patellar ligament is thick and strong. The medial one is widely separated from the middle ligament at both the ends. The lateral ligament is flat and lies close to the middle one. Causes Heredity-Laxity of patellar ligaments predisposes the upward fixation of patella. This would lead to complete extension of the limb. Straight hind limb. Debility and poor nutrition. Occupational trauma, age of the animal or climatic conditions . The condition may be unilateral or bilateral. Signs are more severe during winter. In draught purpose animals. Clinical signs  Jerky flexions during movement or drags the affected limb with flexed pastern. The signs disappear after few steps but reappear after prolonged rest.  Toes are worn out and blood may ooze out. Animal sit, keeping the affected limb stretched. Treatment Sub cutaneous division of medial patellar ligament is common. The animal is cast with affected limb lower most and other three legs are tied together. The affected limb drawn slightly backward. The site is prepared aseptically and infiltrated with local anaesthetic solution. The index finger is moved upward along the cranial border of the tibia till the cranial tibial tuberosity is reached. The finger is slipped inwards at the level of medial condyle of the tibia into the groove between cranial and medial ligaments. Medial one is felt as a prominent cord. In closed method, a stab incision is made into the akin immediately infront of the medial tibial tuberosity. Grooved knife is passed between medial and middle ligaments and the sharp edge of the instrument is directed towards the ligament. It is transected by withdrawing the knife. A small quantity of tincture iodine is instilled into the wound which is left unsutured. Some animals may show recurrence after successful surgery or counter irritant injection. In bovines a piece of ligament is removed to prevent the reunion of cut edges of the ligaments.

STRINGHALT/SPRINGHALT

·  It is an involuntary overflexion and lifting of the limb during progression by degeration of peroneal or sciatic nerve.

·  It occurs in two form- ordinary or classic stringhalt.

·  Etiology

o The cause is obscure.

o  Articular lesions of hock or stifle.

o  Irritation in the flexor muscles of the hock.

o Toxin factors like mycotoxins.

o Cold weather.

·  Symptoms

o The characteristic flexion of the limb  during progression.

o All degrees of hyperflexion are seen.

o In mild form, spasmodic lifting  then struck violently on the ground.

·  Diagnosis

o Diagnosis can be made from clinical signs and electromyography.

·  Treatment

o Rest.

o  Peroneal tenotomy gives relief in certain cases.

o The tendon of the peroneus muscle is cut below the hock on the lateral aspect of the metatarsus.

 

 

GONITIS

• Gonitis is an inflammation of the stifle joint.

·  It is degenerative joint disease and more common in bullocks.

·  The factors includes- osteochondosis, persistent upward fixation of the patella, injuries to the medial or lateral collateral ligaments, injuries to the cruciate ligaments or the menisci, erosion of the articular cartilage or bacterial infection.

·  Two types of gonitis- acute and chronic gonitis.

Acute gonitis

·  Acute gonits is found in working bullocks and breeding bulls.

·   Trauma  by overextension of the stifle joint e.g. accidental slipping.

·  Symptoms

o Clinical signs.

o Synovitis and arthritis

o Painful and swollen joint

o Incomplete flexion and stiffness of the joint during progression

o Shortening of the stride

o Dragging of the toe

• Diagnosis

o By history,

o Clinical findings and radiograph.

o Ultrasonograph.

• Treatment
• General treatment for acute inflammation

Chronic gonitis

·  More incidences in bullocks, heavy draft horsed and breeding bulls

·  Causes

o Excessive strain on the joint.

o  May  be due to rheumatism or toxins.

·  Symptoms

o Symptoms appear gradually.

o During rest repeatedly flexes the stifle.

o Dragging of the toe during progression

o Distension of the joint capsule

o Pain on palpation

o Erosion of articular surfaces and crepitation.

• Prognosis: Incurable
• Treatment

o Treatment is not effective.

o  However, following measures should be taken

§ Prolonged rest.

§ Repeated intra-articular injections of steroids or hyaluronic acid.

§ Firing and blistering.

CHONDROMALACIA OF THE PATELLA

·  It is a degenerative change in  patella by inflammation and local pressure

·   Osteochondrosis of patella.

Etiology:

·  Repetitive trauma to  patellar

·  Upward fixation of patella.

·  Alteration of the articular cartilage of the apex of the patella.

·  Lateral displacement of the patella.

·  Clinical signs

o  Pain.

o  Synovial effusion and crepitation of the patella.

·  Diagnosis

o History of trauma.

o Clinical findings and

o Radiography

·  Treatment

·  No treatment except rest and injections of hyaluronic acid or glycosaminoglycan.

·  Prognosis: Guarded

FIBROTIC AND OSSIFYING MYOPATHY

Fibrotic myopathy

·  Fibrotic myopathy is a chronic, progressive, degenerative disorder affecting the semitendinosus, semimembranosus, and biceps femoris muscles as a result of trauma.

·   Normal tissues are replaced by dense collagenous connective tissues.

·  Etiology: Unknown

·  Clinical sings:

·  Nonpainful.

·   Neurologic function is normal.

·  Treatment: Tenotomy, Z-plasty, or complete resection.

·  Prognosis: Guarded.

Ossifying myopathy

·  Ossifying myopathy results from fibrotic myopathy.

·   The affected muscles eventually ossify.

• Clinical signs
• Characteristic gait- the forward phase of the stride is jerky.
• The hardening of the muscles can be palpable.
• Diagnosis
•  History
• Clinical findings
• Radiography
• Ultrasonography
• Treatment

o Incise the medial ligament of semitendinosus at the stifle.

• Prognosis: poor.