Equine Lameness and External Coaptation Flashcards

Flashcards covering the key concepts of equine lameness evaluation and external coaptation techniques.

Lameness

A clinical sign, not a disease. (like colic)

Three reasons for lameness

Pain (inflammation), mechanical interference such as scar tissue (no pain), neurologic lameness

Five basic steps to a lameness exam

History, Observation, Palpation, Local Anesthesia (“Nerve blocks” or “joint blocks”), Special Diagnostics

History

• Signalment – age, breed, sex, use/sport

• Any previous lameness problems?

• How long has the horse been lame?

• Was the onset sudden or gradual?

• Does the lameness get better or worse with exercise?

• Is there known trauma or reason for lameness?

• Has any treatment or medication been intiated?

• Any pattern to the lameness? Associated with certain surfaces/gait?

• When was the last shoeing done?

• Response to medications?

• +-Blood panels

Observation AT REST:

• Obvious swelling or muscle atrophy; symmetry; obvious injury

• Conformation of the horse

• How the horse stands can give an idea of where the leg is hurting

• “Start at the bottom”- many lameness issues occur in the foot

Observation IN MOTION:

• Observe at walk and trot

• Usually observe moving directly away and then towards the clinician, and then from the side and from both directions

• Harder surfaces can exacerbate the lameness, making it easier to diagnose

• Removal of shoes may be necessary

• Smooth surfaces (avoid gravel, you try walking on it and not limping occasionally)

Observation- Flexion tests

• Joints isolated and flexed for 1-2 minutes, then horse is immediately trotted off in straight line

• Test both the suspect limb(s) and the sound limb(s)

• Using lunge line to accentuate lameness when on inside of circle.  Lameness of either front or rear legs is often more pronounced when the horse is circled via lunge

Palpation

• Palpation done in weight-bearing stance and with leg elevated; check all legs (use sound legs for comparison)

• Knowledge of normal anatomy is essential

• The wear pattern on the shoe or hoof wall can be helpful

• Thorough palpation of neck, back and hips is also essential

Local Anesthesia

Used to confirm the location of specific problem IF NEEDED. Can be used to localize the problem to a smaller region of a leg

•Lameness improved = source of pain found

•Lameness same = block higher on leg

Special Diagnostics

Radiographs, Diagnostic Ultrasound, Thermography, Nuclear scintigraphy, Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Arthrocentesis, Biopsy (muscle, bone, tendons)

Grading the Lameness

Relevant Anatomy of Distal Limb

Treatment for Lameness

• “Time heals all things”- stall rest, proper farrier care, and slowly returning to exercise can help many patients

• Anti-Inflammatories

• Corticosteroids- systemically or locally (joint injections)

• NSAID’s

  • phenylbutazone (“bute”)

  • firocoxib (Equioxx)

• Other modalities- nutritional/joint supplements, PT, therapy laser, massage, acupuncture, chiropractor?

Indications for External Coaptation

• Refers to the use of bandages, splints, and casts

• Apply pressure to control hemorrhage, reduce (compress) dead space during the treatment of surgical or traumatic wounds, reduce skin motion around wounds, minimize wound contamination, hold medications against a wound

Key to good bandages

Padding is the most important part of a bandage

Check bandage at least once daily for:

Tightness, Soiling, Strikethrough, Swelling-above or below

Neck cradles can be used (the large animal version of an E-collar)

What type of Bandage is Appropriate?

• Depends on several factors:

• Purpose of the bandage-injury, performance, transport, post-surgical, breeding/foaling

• Anatomical location of bandage- head, neck, abdomen, tail, extremities

• Patient factors- environment, temperament, training

• Available materials- sometimes have to be resourceful- diapers and duct tape!

Exercise Wraps (a.k.a. Polo Wraps)

• Usually only worn during exercise or turnout

• Based on horse’s profession and by horse’s tendency to strike its own legs accidentally

• Start Medial and Unroll Cranially

• Note that 1 inch of padding is exposed at the top and bottom of the bandage. Bell Boots can be added to protect the hoof and heel bulbs

Shipping Boots

• Subjected to sudden stops, starts, and turns. Thrown off balance and slip or step on themselves

• Some kick during transport or struggle when loading

• Proper protection should at minimum cover the lower leg completely

• Commercially shipping wraps available

Distal Limb Bandages

• Most common bandage for medical purposes

• Should include top of metacarpus/metatarsus to just below coronary band            (swelling of the fetlock will occur if just cover the cannon bone)

• Have proper patient restraint and all bandaging materials ready

• Clean and dry limb (wounds cleaned appropriately prior to wrap)

Primary Layer

If a wound present, this includes wound dressing and the layer to hold the wound dressing

Secondary Layer

Padding

Tertiary Layer

Securing layer – ONLY layer used to apply compression

Finishing Layer

Optional depending on the underlying condition, prevent bedding and other debris from entering the bandage

Unrolling bandage material

Primary Layer - NO compression

Wound dressing

• Choice of material depends on nature of wound exudate/bleeding expected, sutures present, need for granulation

• Also need a layer to keep wound dressing in place (elastic materials generally used to hold wound dressing in place)

• If no wound, then this layer can be eliminated

• Any bandage for large animals should use no less than 3 in width (4-6 preferred)

Secondary Layer (padding)

• Minimum 3 sheets of sheet cotton used

• (when folded over = 6 layers)

• Should cover the coronary band

Tertiary Layer – Securing Layer

• The securing layer must be “seated” before it can be pulled tight

• Circle the padding layer several times

• Start in the middle and proceed distally with minimal tension

• Brown gauze can be used to further conform padding so that the compression layer “bites” better

• Securing layer is seated by applying the material with minimal tension around the middle

• Then the material is applied distally

• 1 inch of padding visible above and below

• Compression is applied in a distal-to-proximal direction

• 50% overlap

• Proper tension is indicated when the waffle pattern is not visible

• Avoid bunching of padding

Finishing layer

• Prevent slippage

• Prevent bedding and debris from entering the bandage

• Finishing can be applied to top, bottom or both

• Elastic adhesive tape (Elastikon usually)

• Wrapped 2-3 times around the bandage, overlapping the bandage and adjacent skin or hoof wall

• Should NOT apply compression

Common error for full limb bandage – Trying to bandage upper leg without bandaging lower leg

• Can lead to edema/swelling of distal limb or slippage

• Doomed to slide down, even WITH adhesive

• To prevent this, the bandage is applied in two parts

"Double Decker" Bandage

• Distal limb is bandaged first, then upper bandage is applied in same manner

• Pressure sores are likely to form over the point of the accessory carpal bone and point of the calcaneus

Limb Splints

• Used to immobilize a joint after severe trauma

• Can be temporary (for transport) or used long term

• Standard distal limb support applied first

• Robert Jones Splint Bandage is the simplest

• Additional padding as needed

• Strut (wood, PVC, metal) is cut to the length of the bandage and smooth surfaces (immobilize a joint above and below if possible)

• Position strut on the cranial or caudal surface to prevent movement

• Secure with NON-ELASTIC TAPE (duct tape works great)

Limb Casts

• Foot cast, Lower limb cast, Full limb cast, Tube cast (sleeve cast)

• Normally applied under general anesthesia

Head and Face Bandages

• Use 6-inch stockinette for adult horses

• Cut twice as long as head

• Mark eye and ear hole locations with marker and remove to cut

• Secure with elastic tape

Tail Bandages and Wraps

• Protection during shipping, Protection from feces, urine, or fetal fluids, Prevention of contamination of the vulva or perineum during reproductive procedures

• Arterial supply to tail is a single major artery located on the ventral midline

• Avoid nonelastic materials on the living portion of the tail

• 6-inch roll gauze is a useful material for tail wrap and can then be passed around the neck and tied to remove the need for an assistant

• Commonly used for breeding/foaling

• Seat at base of tail

• Can place locking loops of tail hair to help prevent sliding

• Tie simple knot at base

• Use a quick-release knot to tie around the neck

• If left in place for more than few minutes, alleviate pressure on jugular by pulling tie away from the neck