Equine Lameness Investigation

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Questions and Answers

What is the primary goal of performing diagnostic analgesia in lameness investigation?

  • To guide further imaging based on pain source (correct)
  • To assess the efficacy of different local anaesthetics
  • To desensitize structures distal to the injection site
  • To completely eliminate pain before treatment

Which local anaesthetic is described as having the fastest onset and can irritate the skin?

  • Lidocaine (correct)
  • Bupivicaine
  • Mepivicaine
  • Procaine

When evaluating the success of a diagnostic analgesia procedure, what indicates a positive response?

  • A minimum of 50% improvement in lameness (correct)
  • Less than 50% improvement in lameness
  • No visible improvement in lameness
  • Complete abolition of lameness

Which sequence is recommended for the investigation of lameness using diagnostic analgesia?

<p>Begin distally and work proximally (C)</p> Signup and view all the answers

Which local anaesthetic is noted for being the least irritating to the skin?

<p>Mepivicaine (A)</p> Signup and view all the answers

What is the generally recommended duration for re-examination following a nerve block?

<p>Generally ~10 minutes (A)</p> Signup and view all the answers

What complications may arise from administering local anaesthesia?

<p>Soft tissue swelling and infection (A)</p> Signup and view all the answers

Which method should be used to ensure sterile preparation for intra-synovial analgesia?

<p>Scrubbing with antiseptic for at least 5 minutes (B)</p> Signup and view all the answers

What is a common result of injecting local anaesthetic too soon after placement?

<p>Insufficient time for the block to work (A)</p> Signup and view all the answers

What is a critical consideration when performing perineural analgesia?

<p>Employing clean technique and proper restraint (B)</p> Signup and view all the answers

What indicates a 'head nod' when assessing lameness?

<p>The horse lifts its head when the lame limb is weight bearing (A)</p> Signup and view all the answers

Which of the following describes a common sign of hindlimb lameness?

<p>Asymmetric movement of the pelvis (A)</p> Signup and view all the answers

What occurs during flexion tests for forelimbs?

<p>Carpal flexion or distal limb flexion is checked (D)</p> Signup and view all the answers

In the European Lameness Grading Scale, what does a score of 5 indicate?

<p>Severe lameness (A)</p> Signup and view all the answers

What does a positive flexion test indicate?

<p>Increased pain associated with the joints (A)</p> Signup and view all the answers

What is a key characteristic of bilateral lameness?

<p>Shortened or choppy stride length (B)</p> Signup and view all the answers

How can severe hindlimb lameness be mistaken for forelimb lameness?

<p>Contralateral forelimb assumes more weight (C)</p> Signup and view all the answers

What describes a subtle sign of mild lameness in a horse?

<p>A subtle head nod is observed when the lame forelimb strikes (A)</p> Signup and view all the answers

What is the first step when approaching a lame horse?

<p>Conduct a detailed history evaluation (D)</p> Signup and view all the answers

Which of the following factors should be included in the history taking of a lame horse?

<p>Recent changes in exercise or surface (D)</p> Signup and view all the answers

What does palpation focus on during a lameness evaluation?

<p>Assessing heat, pain, and swelling (B)</p> Signup and view all the answers

During a gait evaluation, which assessment can help determine the lameness severity?

<p>Flexion tests on affected limbs (C)</p> Signup and view all the answers

Why is it important to observe the horse walk in a straight line during a lameness evaluation?

<p>To identify irregularities in limb movement (B)</p> Signup and view all the answers

How does the surface on which the horse is lunged affect the assessment of lameness?

<p>Hard surfaces can worsen bone injuries and foot lameness (B)</p> Signup and view all the answers

In examining the horse, what does a faulty conformation indicate?

<p>Potential risk for future injuries (B)</p> Signup and view all the answers

What is the main purpose of incorporating nerve and joint blocks in a lameness investigation?

<p>To identify the specific area of pain or lameness (D)</p> Signup and view all the answers

What is the appropriate needle size and length for a Tarsometatarsal joint block?

<p>20 gauge 1” (A)</p> Signup and view all the answers

Which of the following is a common reason for performing a Tarsometatarsal joint block?

<p>Diagnosis of OA of the small tarsal joints (B)</p> Signup and view all the answers

What approach is used for a Digital Flexor Tendon Sheath block?

<p>Palmar axial sesamoidean approach (C)</p> Signup and view all the answers

How far should the needle be inserted for the deep branch of the lateral plantar nerve block?

<p>15mm distal to lateral splint bone (B)</p> Signup and view all the answers

What amount of local anesthetic is typically used for the deep branch of the lateral plantar nerve block?

<p>3ml (B)</p> Signup and view all the answers

What is a critical outcome to assess after performing a deep branch of the lateral plantar nerve block?

<p>Resentment to digital palpation (C)</p> Signup and view all the answers

Which joint compartments should be blocked to ensure proper diffusion of local anesthetic into the stifle?

<p>Medial femorotibial, lateral femorotibial, and femoropatellar (C)</p> Signup and view all the answers

Which option describes the technique of performing a Tarsometatarsal joint block?

<p>Needle inserted parallel to the ground in a dorsomedial direction (A)</p> Signup and view all the answers

Which of the following is a contraindication for performing perineural analgesia?

<p>Skin infection of injection site (C)</p> Signup and view all the answers

What is the main nerve blocked in a palmar digital nerve block?

<p>Medial and lateral palmar nerves (B)</p> Signup and view all the answers

What structures are desensitized by the abaxial sesamoid nerve block?

<p>Entire foot and middle phalanx (A)</p> Signup and view all the answers

During a low 4-point nerve block, which anatomical landmarks are primarily used?

<p>Palmar metacarpal nerves (B)</p> Signup and view all the answers

What is the correct needle size for performing an abaxial sesamoid nerve block?

<p>25 gauge 5/8 inch (B)</p> Signup and view all the answers

Which structure may be desensitized if the palmar digital nerve block is effective?

<p>Distal interphalangeal joint (C)</p> Signup and view all the answers

In a distal limb perineural analgesia, which block is used for desensitizing the fetlock joint?

<p>Low 4-point nerve block (A)</p> Signup and view all the answers

What is the volume of local anesthetic typically used for a palmar digital nerve block?

<p>1.5-2 ml (C)</p> Signup and view all the answers

Which location is NOT a site for intra-synovial diagnostic analgesia?

<p>Coxofemoral joint (C)</p> Signup and view all the answers

What is a risk when placing a low 4-point nerve block too high?

<p>Desensitization of proximal structures (A)</p> Signup and view all the answers

Which structure is NOT desensitized during a distal interphalangeal joint block?

<p>Palmar digital nerves (D)</p> Signup and view all the answers

What is the purpose of rechecking the site after administering a palmar digital nerve block?

<p>To assess skin sensitivity and effectiveness (C)</p> Signup and view all the answers

In which block is the needle inserted just proximal to the coronary band?

<p>Distal interphalangeal joint block (A)</p> Signup and view all the answers

Flashcards

Lameness Evaluation

The process of gathering information about a horse's history, physical condition, and gait to determine the cause of lameness.

Signalment

The age, breed, sex, and use of the horse. This information can help narrow down the potential causes of lameness.

Clinical Examination

A systematic examination of a horse's body, focusing on areas that may be affected by lameness, such as temperature, tenderness, swelling, and range of motion.

Observation

Observing how the horse moves, including its posture and stance.

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Palpation

Feeling the horse's body for temperature, tenderness, swelling, and effusion.

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Hoof Tester Examination

Using a hoof tester to apply pressure to the horse's hooves, determining if they are painful.

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Gait Evaluation

Evaluating a horse's gait by examining its movement at different speeds and on different surfaces.

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Flexion Tests

A test that involves bending a joint to assess its range of motion and potential pain.

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Diagnostic Analgesia

A method of diagnosing lameness based on the effect of local anesthetics on pain perception. Involves blocking specific nerves to relieve pain and assess the impact on lameness.

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Perineural Analgesia

Blocking nerves around a joint using local anesthetic, desensitizing the joint and structures served by that nerve.

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Intra-synovial Analgesia

Injecting local anesthetic directly into a joint to block pain receptors within the joint.

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Positive Diagnostic Analgesia

A positive diagnostic analgesia result occurs when the lameness improves by 50% or more after the block. A negative result indicates less than 50% improvement.

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Negative Diagnostic Analgesia

A negative diagnostic analgesia result occurs when the lameness improves less than 50% after the block. This suggests the blocked area is not the primary source of pain.

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Head nod

A gait where the horse lifts its head as the lame limb bears weight, often described as the horse lifting the head "down on the sound", indicating pain in the limb.

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Asymmetrical pelvis movement

A sign of hindlimb lameness where the pelvis moves up and down more on the lame side, often described as a 'hip hike' or 'hip drop'.

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Referred Lameness

The horse's lame hind limb hits the ground, causing the horse to shift weight forward and the opposite foreleg to bear weight simultaneously, mimicking a lame forelimb.

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Lameness Assessment on Hard Ground

Evaluating a horse's lameness on a walking surface that is less forgiving, highlighting lameness more easily.

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European Lameness Grading Scale

A standardized scale used to grade the severity of lameness, ranging from 0 (sound) to 10 (severe).

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AAEP Lameness Grading Scale

An alternative 5-point system, also used to assess lameness severity, with 0 being sound and 5 being the most severe.

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Ridden Assessment

Evaluating a horse's gait while it is being ridden, allowing observation of the horse's movement and reaction under weight.

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Bilateral Lameness

Bilateral lameness indicates that the horse is lame in both legs.

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Recommended Re-examination Time

The duration of time recommended for re-examining a horse after administering a nerve block depends on the type of block used and the desired outcome. Generally, waiting ~10 minutes is appropriate, as this allows sufficient time for the block to take effect. Waiting too short a time may mean the block hasn't had time to work, while waiting too long may lead to the local anesthetic diffusing and making the results less specific.

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Pain After Nerve Block

If pain persists after a nerve block wears off, it suggests that the source of the pain is in the joint or surrounding structures.

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Tarsometatarsal (TMT) Joint Block

A common procedure used to diagnose osteoarthritis (OA) in the small joints of the foot, often referred to as 'Bone Spavin'. It involves injecting local anesthetic into the joint space to temporarily block pain signals.

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Digital Flexor Tendon Sheath Block

This block targets the tendons responsible for flexing and extending the digits. It involves injecting local anesthetic near the tendons, which helps to isolate pain in this area.

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Deep Branch of the Lateral Plantar Nerve Block

This nerve block is used to diagnose problems with the proximal suspensory ligament, a crucial structure in the horse's leg. It involves injecting local anesthetic near the deep branch of the lateral plantar nerve, which supplies the suspensory ligament.

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Stifle Joint Block

This technique involves injecting local anesthetic into the stifle joint, a complex joint with several compartments. The aim is to block pain in all three compartments: medial femorotibial, lateral femorotibial, and femoropatellar.

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Suspected fracture

Refers to a suspected injury to a bone, usually found in a limb.

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Skin infection/dermatitis of injection site

Infection or inflammation of the skin at the injection site.

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Moderate – severe soft tissue injury

Significant damage or injury to soft tissues in a limb, usually apparent without further testing.

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Intra-synovial diagnostic analgesia

A method of administering pain relief by injecting medication directly into the joint space or a bursa.

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Palmar/Plantar digital nerve block

A type of perineural analgesia that targets specific nerves in the lower part of the limb.

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Abaxial sesamoid nerve block

This diagnostic procedure blocks the nerves around the sesamoid bones on the lower limb.

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Low 4-point nerve block

This block targets multiple nerves in the lower limb, helping to desensitize a large area.

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Distal interphalangeal (coffin) joint block

This block aims to relieve pain in the hoof, specifically the coffin joint.

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Navicular bursa block

This block directly targets the fluid sac around the navicular bone.

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MCP/MTP (fetlock) joint block

This block is used to diagnose pain or inflammation in the fetlock joint, using a variety of approaches.

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Fetlock joint block: Collateral sesamoidean ligament approach

This approach to a fetlock joint block targets the ligaments that support the sesamoid bones.

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Low 4-point nerve block

This block provides pain relief for the lower part of the limb, including the fetlock, pastern, and hoof.

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Abaxial sesamoid nerve block

A type of nerve block targeting nerves responsible for the area around the fetlock and hoof.

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Palmar digital nerve block

This block specifically targets the nerves that control feeling in the hoof and the pastern area.

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Study Notes

Approach to Equine Lameness Investigation

  • The presentation covers a comprehensive approach to investigating lameness in horses.
  • Key learning objectives include understanding how to approach a lame horse, describing lameness evaluation, and identifying the use and description of nerve and joint blocks.

History

  • Signalment (breed, age, sex) is crucial.
  • The horse's use and competition level provide context.
  • The perceived problem is vital, as is the onset, duration, and progression of the lameness.
  • Previous history, trauma, and medication use are relevant factors.
  • Changes in management and farriery practices are also important details.
  • The effects of exercise or surface type should be considered.

Clinical Examination

  • Observation of obvious clinical signs, posture, conformation, and symmetry is important.
  • Faulty conformation is a warning sign, not an unsoundness.
  • Palpation, assessing for heat, pain, swelling, effusion, and range of motion, is essential.
  • A hoof tester examination is a useful diagnostic tool.

Gait Evaluation

  • Gait evaluation involves observing the horse's walk (straight line), trot (straight line), and lunge (in a circle on both soft and hard surfaces).
  • Assessing lameness on inside/outside of circle during lunge is important.
  • Evaluating lameness through flexion tests and a ridden assessment further helps clarify the diagnosis.

Identifying Lameness

  • Lameness is assessed at the walk and trot, looking for distinguishing signs.
  • Forelimb lameness might manifest as a head nod or the horse putting less weight on the affected limb.
  • Hindlimb lameness can sometimes be identified by an asymmetrical movement of the pelvis ('hip hike' or 'hip drop').
  • Gait evaluation during lunging on both soft and hard surfaces is crucial for a thorough diagnosis.
  • Flexion tests and a ridden assessment provide more detailed insights into the nature of the lameness.

Identifying Lameness Continued

  • Assessing lameness during lunging can provide a better understanding of the specific movement causing the issue.
  • Determining if the lameness is worse on hard or soft surfaces helps differentiate between bone and soft tissue issues.
  • Flexion tests, identifying pain on specific limb movements, are critical diagnostic procedures.
  • The ridden assessment is a final diagnostic input.

Referred Lameness

  • Severe hindlimb lameness can sometimes be mistakenly diagnosed as forelimb lameness.
  • The horse adapts its weight distribution, mimicking forelimb lameness in its gait.
  • Differential diagnostics, including diagnostic analgesia, are necessary to correctly determine the source of the lameness.

Grading Lameness

  • The European Lameness Grading Scale (0-10) provides a standardized method to quantify lameness severity observed during a trot.
  • Gradations from sound (0) to severe (7-10) based on consistent observation of subtle or marked head/pelvic asymmetry, gait characteristics, and response to specific movements.
  • An additional alternative Grading Scale (0-5) defines lameness by factors such as difficulty observing lameness during a walk/trot, gait abnormalities, consistency, and marked movements.

Inertial Measurement Units

  • Inertial Measurement Units (IMUs) are increasingly used in equine lameness assessment, objectively measuring head and pelvic movements to quantify the extent of lameness.
  • Although helpful, IMUs are not a replacement for a skilled equine practitioner.

Principles of a Lameness Investigation

  • The investigation process, including consistent lameness assessment, diagnostic analgesia, diagnosis, and treatment are interwoven.
  • Performing these combined factors is crucial for an effective and thorough equine lameness assessment.

Diagnostic Analgesia

  • Local anesthetics, including lidocaine, mepivacaine, and bupivacaine, are used to desensitize nerves and block pain signals to pinpoint the painful area.
  • The process begins distally and moves proximally through affected areas to accurately identify the source of the pain and aid in imaging directions by the examiner.

Interpreting Diagnostic Analgesia

  • Determining if the block worked. Assessing skin sensation, and observing the horse's gait for signs of lameness relief are essential. Assessing any degree of lameness reduction following the block, from 50% to over 75%, is crucial.
  • Specific time duration for re-evaluation after a lameness block is important.
  • The re-evaluation criteria assist in a more accurate diagnosis.

Preparation for Diagnostic Analgesia

  • Thorough preparation is necessary. Adequate restraint, operator safety measures (equipment, like hard hats and sedation tools, short-acting sedation), and clean technique are essential.

Complications and Contraindications

  • Potential complications include soft tissue swelling, hematomas, and infections that could be caused by the procedure itself.
  • The presence of skin infections, suspected fractures, and moderate-severe tissue injuries are contraindications to diagnostic analgesia.

Perineural Analgesia

  • Several specific nerve blocks, including palmar digital, pastern ring, abaxial sesamoid, and low 4-point, are used in the forelimb and hindlimb.

Intra-Synovial Diagnostic Analgesia

  • Distal limb, involving joints like the distal interphalangeal, navicular bursa, and metacarpophalangeal, are treated with this technique.
  • Upper forelimb and hindlimb areas are similar targets.

Palmar/Plantar Digital Nerve Block

  • The site of this block is just proximal to the collateral cartilage, abaxially to the tendon.
  • The palpation and injection technique include detailed steps and precautions.

Abaxial Sesamoid Nerve Block

  • The site of this block is immediately palmar to the neurovascular bundle at the proximal sesamoid bones.
  • Specific techniques for vein artery nerve identification and injection volume are outlined.

Low 4-Point Nerve Block

  • The site is distal to the splint bone between the suspensory ligament and the deep digital flexor tendon.
  • The procedure, detailed technique, and care for placement near the deep digital flexor tendon sheath are discussed.

Distal Limb Perineural Analgesia Summary

  • Overview of the three procedures: Abaxial sesamoid nerve block, low 4-point nerve block, and palmar digital nerve block.

Distal Interphalangeal (Coffin) Joint Block

  • Procedure involves injection of local anesthetic targeting the collateral ligaments of the DIP (distal interphalangeal) joint.
  • It emphasizes the appropriate placement of the needle.
  • Correct radiographic alignment of the needle is crucial for effective treatment of navicular spurs.
  • Specific steps and considerations during this procedure are emphasized.

MCP/MTP (Fetlock) Joint Block

  • Three described approaches are available for the fetlock joint block.
  • Specific steps and considerations are emphasized.

Fetlock Joint Block: Collateral Sesamoidean Ligament Approach

  • Detailed descriptions of anatomical boundaries, targeting the proximal palmar process of P1, are given.
  • Specific directions for inserting the needle along the dorsal aspect and parallel to the ground are outlined.

Tarsometatarsal (TMT) Joint Block

  • Considerations for diagnosing Osteoarthritis (OA) of the tarsal joints are discussed.
  • Potential communication with the distal intertarsal joint is a factor in some cases.

Digital Flexor Tendon Sheath Block

  • Different approaches are described, including approaches targeting the proximal and distal sections of the tendon sheath, and variations in placement.

Deep Branch of the Lateral Plantar Nerve Block

  • The lateral approach technique, needle insertion technique, and appropriate volume of local anesthetic are detailed.

Stifle

  • The diffusion of local anesthetic between the three joint compartments is emphasized.
  • The necessity of specific blocking the three joint compartments is highlighted because diffusion is variable.
  • The method of blocking the three compartments is also noted.

Useful Resources and Further Reading

  • A list of relevant, credible resources in the field is presented (books, websites).

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