2. Ringbone
Ringbone is exostosis (bone growth) in the
pastern or coffin joint of a horse. In severe
cases, the growth can encircle the bones,
giving ringbone its name. whilst commonly
used, might be misleading and that it would
be better to refer to this condition as
osteoarthritis of the inter-phalangeal joints.
3. Ringbone
Ringbones are not very common but are
serious unsoundnesses. These bony
deposits usually appear just above the
coronary band on a hind foot, although front
feet also may be affected. The long and short
pastern bones may fuse together, causing
severe pain and lameness.
8. Ringbone can be classified by its location, with "high
ringbone" occurring on the lower part of the large
pastern bone or the upper part of the small pastern
bone. "Low ringbone" occurs on the lower part of the
small pastern bone or the upper part of the
coffin bone. High ringbone is easier seen than low
ringbone, as low ringbone occurs in the hoof of the
horse. However, low ringbone may be seen if it
becomes serious, as it creates a bony bump on the
coronet of the horse.
9.
10.
11. Causes of Ringbone
Excessive tension on the tendons, ligaments, and
joint capsules of the pastern area can strain the
periosteum. The body compensates by growing
bone at the stresspoint. Strain on the extensor
tendon, the superficial digital flexor tendon
branches, the collateral ligaments, and the distal
sesamoidean ligaments are all common factors. If
these tissues are stretched or torn, and the joint
is instabilized by the injury, new bone is produced
to help to stabilize the joint
12. Causes of Ringbone
Osteoarthritis (the endstage of degenerative
joint disease) of the pastern or coffin joint is a
very common cause of articular ringbone.
Bone is then produced to try to immobilize
the joint and to relieve the chronic
inflammation of the joint capsule. This
process may take years, and lameness will
continue until the joint is completely
immobilized
13. Causes of Ringbone
Trauma to the periosteum can cause bone
growth on the pastern bone.
Poor shoeing and conformation, such as long,
sloping pasterns, upright pasterns, long-toes
with low heels, pigeon toes, splay foot, or
unbalanced feet may predispose the horse to
ringbone, as they create uneven stress on
the pastern and coffin joint, unequal tension
on the soft tissues, or worsen the concussion
that is absorbed by the pastern area.
14. Signs of Ringbone
Ringbone usually occurs in the front legs, and is usually worse
in one leg than the other. Ringbone is most often found in
mature horses, especially those in intensive training.
High ringbone: The horse will have a bony growth around the
pastern area, and the pastern will have less mobility. The horse
will show pain when the pastern joint is moved or rotated. Early
cases will have a [[lameness (equine)|lameness score of 1-2
out of 5, with little or no bony swelling seen, although possibly
felt when compared to the opposite pastern. Lameness will
worsen to a grade 2-3 on a scale of 5 as the ringbone worsens.
17. Low ringbone: The horse will have
moderate lameness (grade 2-3), even in
early cases, because of the closeness of the
ringbone to the other structures in the hoof.
When severe or very advanced, the bony
growth will be able to be seen on the coronet
18. Pyramidal Disease
(Extensor process disease, Buttress foot(
Once classified as a type of low ringbone ( Ringbone),
pyramidal disease arises from a traumatically
induced periostitis or an avulsion fracture of the
extensor process of the third phalanx caused by
excess tension at the tendon insertion. The close
association of the extensor process with the distal
phalangeal joint means secondary arthritis is a likely
complication. In early cases, heat and pain on
pressure may be manifest. An enlargement of the
toe region just above the coronet is usually present,
which results in the “buttress foot” appearance.
Systemic anti-inflammatory medication may be
beneficial. Surgery has been successful for avulsion
fractures.
19. Prognosis for Ringbone
If the ringbone is close to a joint, the prognosis for
the horse's continued athletic use is not as good
than if the ringbone is not near a joint. Ringbone that
is progressing rapidly has a poorer prognosis as
well.
Horses that are not performing strenuous work, such
as jumping or working at speed, will probably be
usable for years to come. However, horses
competing in intense sports may not be able to
continue at their previous level, as their pastern
joints are constantly stressed.
20. Treatment of Ringbone
Ringbone is degenerative (unless it is
caused by direct trauma). Treatment
works to slow down the progress of the
bony changes and alleviate the horse's
pain, rather than working to cure it.
Shoeing: The farrier should balance the
hoof and apply a shoe that supports the
heels and allows for an easy
breakover.
21. NSAIDs: or non-steroidal anti-inflammatory
drugs help to alleviate the pain and reduce
inflammation within and around the joints.
Often NSAIDs make the horse comfortable
enough to continue ridden work, which is
good for the horse's overall health.
Joint injections: The pastern joint can be
injected directly, typically with a form of
corticosteroid and hyaluronic acid.
22. 1.Arthrodesis: the fusion of the two bones of the
pastern joints eliminates the instability of the joint,
and thus the inflammation. This procedure may
then eliminate the horse's lameness as well.
However, surgical alteration of the joint can
promote the growth of bone in the area, which is
cosmetically displeasing. Arthrodesis of the coffin
joint is usually not performed due to the location of
the joint (within the hoof) and because the coffin
joint needs some mobility for the horse to move
correctly unlike the pastern joint.
23. Extracorporeal Shockwave Therapy: A high
intensity specialized percussion device can
help to remodel new bone tissue and
decrease pain.
25. What is ESWT
?
ESWT, a new, non-invasive technology, has become a
popular treatment agent/tool for equine
musculoskeletal problems. Results include
accelerated healing, improved healing, and lessening
of pain. A shock wave is a high pressure ( acoustic )
wave with very high amplitude, rapid rise time, and
short pulse duration. These waves are generated
outside the body ( extracorporeal ) and can be focused
at a specific site within the body.
26. What is the origin of ESWT
Veterinarians have taken existing science in human
beings and applied it to horses and dogs. This type
of therapy was originally used to treat human beings
with kidney stones, by breaking up the stones
without the need for invasive surgery. This
technique has been around for years now, and in the
process of treating patients this way, it was
discovered that many of them had other unrelated
aches and pains disappear
27. Why is it important that shock waves are
“focused”?
The tighter the focus area, the more precisely
the shock waves can be delivered to specific
tissues. This means a greater concentration
of therapeutic energy on the specific injured
tissue as well as less trauma to the
surrounding tissues.
28. How does ESWT work
When the shock waves meet tissues of different densities, the energy contained
in the shock waves is released and interacts with the tissue.
-the shock wave exerts mechanical pressure and tension force on the
afflicted tissue. As a result, both localized circulation and metabolism are
increased in the treated tissue which promotes healing.
-secondary waves are created which break down pathological deposits of
calcification in the soft tissues.
-the shock wave appears to stimulate osteoblast cells which are responsible
for bone healing and new bone production.
-shock waves cause a decrease in pain perception
.
29. What conditions benefit from
shock wave therapy
The single largest cause of decreased performance in show and
pleasure horses is lameness originating from the musculoskeletal
system. The most widespread use of ESWT has been for proximal
suspensory desmitis (PSD). Currently, the use of ESWT is used
primarily on horses that have not responded to other therapies or
have injuries that typically heal slow or inconsistently.
suspensory ligament injury (PSD)
tissue calcification
back/neck pain
navicular disease
fractures or joint ankyloses
fatigue injury to bone
bucked shins
bone spavin
30. Before shock wave therapy can be used, a patient
needs a thorough examination to determine the
specific affected area. Examination usually includes
a general physical examination, a lameness
(orthopedic) examination, and radiography. It may
also be necessary to perform an ultrasound
examination or to perform nerve blocks. Shock wave
therapy appears to be an exciting and extremely
advantageous tool in the arsenal of lameness
treatment methods.
31. What is the treatment protocol
The area to be treated is clipped and thoroughly
cleaned, and a gel is applied to ensure good
transmission of the energy waves. The treatment
requires sedation and during treatment a local
analgesic effect may be induced. As a result,
horses usually tolerate the procedure well. The
exact treatment protocol is customized to each
horse and specific diagnosis. Some problems need
only a single treatment, while others may require 3
to 5 treatment sessions at intervals ranging from 10
to 30 days between sessions. After completion of
the course of treatment, horses are restricted to box
rest and controlled exercise between treatments.
32.
33. What are the advantages of using ESWT
as a therapeutic modality
non-invasive and surrounding tissues are unaffected by the
shock waves
accelerated healing
improved healing
positive results in previously non-responsive conditions,
injuries that usually are slow to heal, and injuries that heal
inconsistently
attenuation of pain
minimal aftercare, discomfort, and recovery time
no drug residues
34. What are the disadvantages of using
ESWT as a therapeutic modality
horses may be slightly sore after treatment
analgesic (decreased pain) period following
treatment so horses should not be subjected
to strenuous activities for at least 4 days after
ESWT where local analgesia might pre-
dispose the horse to injury
35. splint
On each side of the cannon bone is a small bone
known as the splint bone. The small splint bones are
thin and taper to become a small knob about two-
thirds of the way down the cannon bone. A ligament,
located between the cannon bone and the splint
bones, is quite elastic in young horses. As the horse
ages, the ligament ossifies; that is, the ligament is
replaced by bone and the three bones fuse. During
ossification, there may be inflammation and pain.
Jumping, running and working a horse during this
time produces further irritation
36.
37. Splints
Splints usually occur in horses 2 to 5 years old. Most often it is the
forelimbs which are affected. Splints rarely occur in the hind
limbs. In older horses, the splint bones are fused solidly to the
cannon bone.
The majority of splint problems occur on the medial side (inside) of
the forelimbs. The medial splint bone usually is the one
affected because it has a flat surface next to the knee. The
lateral (outer) splint bone has a more slanted surface. When
the weight is transmitted to these bones, the medial splint
bone probably bears more weight than the lateral splint bone.
Therefore, the ligament between the medial splint bone and
the cannon bone is subjected to more stress than the outer
ligament.
38. Splints
Lameness due to splints is most common in 2-year-old
horses undergoing training. The lameness is most
obvious while the horse is trotting or working or soon
thereafter. Lameness may come and go or be
present continuously for as long as a year. If you
probe up and down along the cannon bone, the
horse will flinch when the portion of the ligament
undergoing ossification is touched. A large swelling
or a number of smaller swellings due to ossification
may occur along the length of the splint bones. After
the ligament has ossified, the swelling and soreness
usually disappears
39. Sidebone
A Sidebone is a term that describes the
process where areas of cartilage in the foot
become hard and bony. When this happens it
may cause no problem at all, or it may
interfere with the way the soft tissues around
the area stretch and adjust during exercise.
This can cause pain and discomfort. Most
cases of sidebone do not result in pain.
40. cause:
The cause is unknown but it is most likely to be
due to poor conformation or improper
shoeing. This causes abnormal pressure and
impact on certain areas of the foot.
41. Is ossification of the lateral cartilages of the
foot, usually the fore foot. Its causes are
hereditary tendency
and shoeing with high calkins.
Remedy.—Bar shoe; cold applications. Rest,
blisters, firing, neurotomy
42. Sidebones. This is a common unsoundness
resulting from wear, injury or abuse. On each side of
the heel extending above the hoof are elastic
cartilages just under the skin that serve as part of the
shock-absorbing mechanism. They are commonly
termed lateral cartilages. When they ossify (turn to
bone) they are called sidebones. In the process of
ossification they may be firm but movable inward
and outward by the fingers. The horse is then
considered "hard at the heels." Sidebones are more
common to the front outside lateral cartilage than to
other locations.
44. Sidebone is ossification of the cartilages of the third
phalanx. It is most common in the forefeet of heavy
horses working on hard surfaces. It also is frequent
in hunters and jumpers but rare in racing
Thoroughbreds. Repeated concussion to the
quarters of the feet is probably the essential cause.
Predisposition may be inherited, but this has not
been confirmed. Improper shoeing that inhibits
normal physiologic movement of the quarters is also
predisposing. Some cases arise from direct trauma.
Loss of flexibility on digital palpation of either one or
both cartilages is indicative of sidebone.
45. Because the rigidity of the cartilages is accompanied by
ossification, the cartilages may protrude prominently above the
coronet. Lameness may be a sign, depending on the stage of
ossification, the amount of concussion sustained by the feet,
and the character of the terrain. Lameness is most likely when
sidebone is associated with a narrow or contracted foot or an
accompanying condition such as navicular disease. The stride
may be shortened, and walking the horse across a slope may
exaggerate the soreness. Mules often have prominent
sidebones, yet seldom show any lameness.
46. Sidebone may be suspected after palpation and
observation, but radiographic examination is
essential for confirmation. It should be remembered
that ossification of the cartilages commonly develops
without signs of lameness. When lameness is
present, corrective shoeing to promote expansion of
the quarters and to protect the foot from concussion
is often of value. Grooving the hooves, along with
applying a counterirritant (eg, tincture of iodine) to
the coronary region to promote hoof growth, also
may promote expansion of the wall.
49. Physitis
Physitis is the term applied to pain associated with the
abnormal activity in a growth plate (phsysis), usually the
lower growth plate of the radius, just above the knee the
condition may be related to osteochondrosis, the
condition occurs in rapidly growing young horses and
most commonly in yearlings, there is usually a slight
swelling and heat around the lower end of the radius just
above the knee, the horse is not always lame; it may be
lame if only one leg is affected or may show a stiff stilted
gait if both forelimbs are affected.
50. Treatment
The diet should be restricted and calcium-
phosphorus ratios checked to ensure that
there is not an imbalance. If the horse is
lame it should be confined to a small
paddock. The prognosis is favorable, given
time the swelling usually subsides
51. Sprain of the fetlock
There is enlargement of the fetlock joint it will have warm
soft tissue swelling round the joint. The horse is lame.
treatment aims to reduce pain and soft tissue inflammation,
cold hosing and water bandages help to reduce swelling.
pain killers are beneficial. , box rest should be continued
until all swelling has dissipated
The prognosis is favorable if there has been no major
damage to the collateral ligaments of the fetlock joint
resulting in instability of the joint.
52. Ringbone
Ringbone are bony exotosis affecting the interphalangeal joints of the horses foot or
any bony enlargment in that region
there is high ringbone where the pastern joint is the seat of the disease and low
ringbone where the deposits occur round the coffin bone
there is also false ringbone where the enlargement occurs upon the shaft of one of
the bones and does not involve the edges of the joint surface (although it might
do later). The term ringbone should be restricted to conditions in which a partial
or complete ring of bone is formed round one or other of the joints , and all
other bony enlargements affecting the shafts of the shafts of
the bones but not involeing the edges of the joint surfaces should be called
exotosis.
Injury, inflammation of the periosteum of the bone- sometimes following an
infection, also possibly a vitamin deficiency, are believed to cause ringbone
It is only in high ringbone that any lumps can be felt if lower ringbone there will be
no out ward visable signs at first but after a while the hoof alters shape with a
bulge at the coronet,
53. (1)Digital flexor tendon.
(2) Sesamoidean ligament.
(3) Digital extensor tendon.
(4) Long pastern bone.
(5) Short pastern bone.
(6) Coronary corium.
(7) Pedal bone.
(8) Laminar corium.
(2)9-Wall
(10) White line.
(11) Sole.
(12) Plantar cushion.
(13) Navicular bone.
54.
55. Bowed Tendon:
This condition can be mild or severe, yet all bowed tendons should
be treated as an emergency. Ligaments and tendons are
located at the back of the cannon bone and when the deep
flexor tendor and/or the superficial tendon becomes strained
or ruptured and the area becomes swollen this is known as a
bowed tendon. They are caused by excessive stretching,
training and fatigue of the tendons, external damage or long
pasterns. Often seen in race horses. Some horses with
bowed tendons will be become sound again, but the tendon
will be prone to re-injury. Chronic cases will have permanent
scar tissue.
Treatment: Lower leg treatments to relieve inflammation/pain and
rest for three - twelve monthes.
56. Bucked Shins:
This condition is seen often in race horses undergoing
intense training. Bucked shins is caused by strain
and excessive concussion (overtraining on hard
ground) and is usually seen in young horses. The
front of the cannon bone becomes sore and
inflamed. This is an acute coniditon that can
become chronic if not dealt with efficiently.
Treatment: Controlled exercise and lower leg
treatments to relieve the inflammation/pain.
57. Check Ligament Desmitis (sprain):
The check ligament is found behind the upper
part of the cannon bone sandwiched
between the bone and the deep flexor
tendon. The horse may or may not be lame.
This injury is caused by a strain or sprain to
the area is difficult to determine because of
the depth of the ligament.
Treatment: Lower leg treatment to relieve
pain/inflammation. Rest for a number of
monthes. Re-think the training regime.
58. Curb:
Curbs are common in young horses. It refers to a rupture or
strain of the plantar ligament which is located behind the
hock. The swelling is visible about four inches below the
hock joint and is usually firm when pressed. When
healed, the swelling may remain or reduce in size.
Initially the curb may be slightly warm and the horse
slightly lame, but more often the horse shows no signs
of lameness. Curbs can be caused by poor
conformation (sickle or cow hocks), kicking hard walls
or excessive bucking, jumping and galloping.
Treatment: Lower leg treatments to reduce
inflammation/pain and rest untill healed.
59. Osselets:
This refers to pain and inflammation that occurs
above or below the front of the fetlock. Osselets
is caused by strain and is seen often in young
racehorses. Pain is evident when the fetlock is
bent and hard swelling might be visible.
Treatment: Rest. Corrective shoeing, controlled
exercise and slow training regime. Lower leg
treatments to relieve inflammation/pain.
60. Ringbone: New bone growth occuring below the fetlock. Low ringbone
refers to calcification of the lower, short pastern bone or the coffin
bone (lower phalanx 2 and/or upper phalanx 3). High ringbone refers to
calcification of the long pastern bone or higher short pastern bone
(phalanx 1 and/or upper phalanx 3). Articular ringbone is calcification
within the joint itself. If the ringbone is below the coronary band it
cannot be seen, yet if it is above a bony growth will be evident. Some
horses with ringbone recover quite well and lead a usefull life. Initially
their will be heat, lameness and swelling. Ringbone is thought to be
caused by poor conformation (long or short pasterns), and repetative
concussion to the area. Treatment: Rest and lower leg treatments to
relieve inflammation/pain. Confirm that any calcium/phosphorus
imbalance in the diet is not a factor.
61. Sesamoiditis:
At the back of the fetlock is two sesamoid bones.
Sesamoiditis occurs when these bones are damaged
or inflamed. Acute lameness is generally present and
the fetlock will swell. Long pasterns and repetitive
concussion to the area is the usual cause. This is a
serious condition and the horse will need to be
immobilized.
Treatment: Long rest period (12 monthes). Pain relief
and lower leg treatments.
62. Splints:
Splints are very common and are usually not serious. A
splint is a hard and bony swelling on either side of
the cannon bone. Generally occurs in young horses.
Initially splints are warm and painful, but become
hard, cold and painless when healed (although they
do leave a blemish). Strenuous play or work on hard
ground/repetative concussion causes splints.
Treatment: Anti-inflammatory lotion, a little rest and
more conservative training.
63. Suspensory Ligament Desmitis (sprain(:
This injury is the same as a bowed tendon except that a
ligament is strained or ruptured--not a tendon.
Ligaments have less elasticity than tendons and can
therefore be injured easily. The suspensory ligament is
located behind the cannon bone beneath the flexor
tendons and connects to the sesamoid bones. This
condition is caused by excessive strain on the area
and can be aggravated by poor conformation.
Treatment: Lower leg treatments to relieve
inflammation/pain, and rest
64. Founder (Laminitis)
is an inflammation of the sensitive laminae which attach
the hoof to the fleshy portion of the foot. Its cause is
probably a sensitization (allergy). When horses gain
access to unlimited amounts of grain, founder often
results. Other conditions conducive to founder are
retained placenta after foaling and sometimes lush
grass. All feet may be affected, but front feet usually
suffer the most. Permanent damage usually can be
reduced or eliminated by immediate attention by a
competent veterinarian.
Permanent damage results from dropping of the hoof sole
and upturn of the toe walls when treatment is
neglected.
65.
66. Navicular Disease is an inflammation of
navicular bone and bursa. The condition
causes lingering lameness and should be
diagnosed and treated by a veterinarian.
67. Corns appear as reddish spots in the horny
sole, usually on the inside of the front feet,
near the bars. Advanced cases may ulcerate
and cause severe lameness. There are many
causes, but bruises, improper shoeing and
contracted feet are the most common.
Response to correct treatment and shoeing
is usually satisfactory.
68. Hoof cracks. When hoof cracks extend
upward to or near the hairline, lameness
often results. When well established, the
condition is difficult to arrest and cure. It can
be prevented in most hooves by proper
trimming and shoeing before it becomes
serious.
69. Contracted feet are a result of continued improper
shoeing, prolonged lameness or excessive dryness,
where the heels lose their ability to contract and
expand when the horse is in motion. Horses kept
shod, those with long feet and those with narrow
heels are susceptible to the condition. Close
trimming, going barefooted or corrective shoeing
usually produces sufficient cure to restore the horse
to service.
70. Thrush is a filth disease enhanced by
decomposition of stable manure around the
bars and frog of the foot. It may cause
lameness. Response to cleanliness and
treatment is usually prompt and complete.
71.
72. Wind or road puffs. Small swellings around the
ankles and lower cannons are common to horses
that are used heavily or trailered a lot, or to older
animals. Those with adequate flat bone, well-defined
joints and prominent veins usually have sufficient
substance and circulation to withstand wear better
than horses with coarse, round bone and meaty legs
with poorly defined joints and veins. Puffs are
blemishes.
73. Capped elbow or "shoe boil" is a blemish at
the point of the elbow. It is usually caused by
injury from the shoe when the front leg is
folded under the body while the horse is lying
down. Shoes with calks (heels) cause more
damage than plates.
74. Bowed tendons are apparent by a thickening of the
back surface of the leg immediately above the
fetlock. One or more tendons and ligaments may be
affected, but those commonly involved are the
superflexor tendon, deep flexor tendon and
suspensory ligament of one or both front legs.
Predisposing causes are severe strain, wear and
tear with age and relatively small tendons attached
to light, round bone. Bowed tendons usually cause
severe unsoundness.
75. Unsoundnesses and blemishes of the hind legs
The hock is the most vulnerable, therefore the most important, joint of the body. All of the power of a pulling horse is generated in the
hindquarters and transmitted to the collar by contact with the ground via the hocks. Working stock horses must bear most of the weight on
the hind legs by keeping their hocks well under them, if they are to attain maximum flexibility. Degree of finesse is determined with gaited
and parade horses by how well they "move" off their hocks.
Structurally sound hocks should be reasonably deep from top to bottom, well supported by fairly large, flat, straight bone, be characterized by
clean-cut, well-defined ligaments, tendons and veins, and should be free from induced unsoundnesses and blemishes.
Bone or jack spavin. Bone spavins are common unsoundnesses of light horses, especially those with sickle hocks or shallow hock joints
from top to bottom surmounting fine, round bone. Such conformation should be seriously faulted in a working stock horse.
A bony enlargement at the base and inside back border of the hock may be a bone spavin. Inspect the horse by bending or squatting in front
of it and looking between the front legs at the face of the hocks, or by standing near a front leg and looking under the belly at the opposite
hock. Before passing judgment, assume the same position and look at the opposite hock. If they are both alike, the horse is probably normal.
In the early stages, lameness may be apparent only when the horse has remained standing for a while. Bone spavins, like ringbones, may
fuse bones and render joints inarticulate.
Bog spavin and thoroughpin. Bog spavins are soft swellings on the inside-front area of the hocks that may result from the presence of
synovial fluid ("joint oil"). Blemishes of this type are more common to heavy horses than light ones, although individuals of low quality are
susceptible to the condition.
Thoroughpins are blemishes that appear as soft swellings above and back of the hock joint just in front of the large tendon. They can be
pressed from side to side, hence the name.
Curbs. Curbs can be seen best from a side view. They appear as swellings on the back border of the base of the hock. They result from
inflammation and thickening of the sheath of one of the important tendons. Shallow, sickle hocks predispose to development of curbs. They
may or may not cause lameness.
Capped hock. A thickening of the skin or large callus at the point of the hock is a common blemish. Many capped hocks result from bumping
the hocks when trailering in short trailers or with unpadded tail gates.
Stringhalt, or crampiness of the hind leg(s), is a disease of the nervous system resulting in spasmodic flexion of one or both hocks when the
horse is first moved after standing or when caused to back. The hock is raised abnormally high. It occurs more frequently in older animals
and may not render the animal unserviceable.
Stifled. When the patella of the stifle joint is displaced, the animal is stifled. If the patella is displaced outward, severe lameness results. If it
is displaced inward, lameness is less serious and sudden movement may replace it. However, the condition is likely to recur frequently.
76. Splints: A splint is a calcification or bony growth, usually occurring on the inside of the
cannon or splint bone area. Splints are a result of trauma but can also have many other
causes, such as slipping, running, and jumping, getting kicked, or receiving a concussion
from hard surfaces. Occasionally a fracture of the splint bones is possible.
Sore or Bucked Shins: A bucked shin is an enlargement on the front of the cannon
between the knee and the fetlock joints. This enlargement, which usually occurs in the
front limb, is due to trauma to the periosteum, most often caused by concussion.
Bowed Tendons or Tendonitis: A bowed tendon is an inflammation and enlargement of
the flexor tendons at the back of the front cannon. The general cause of bowed tendons is
severe strain.
Sidebones: These are calcifications of the lateral cartilages of the third phalanx or coffin
bone. Sidebones are considered an unsoundness in a young horse because the
premature ossification of the lateral cartilages will result in contracted heels and abnormal
foot growth.
77. Definitions
Splints: A splint is a calcification or bony growth, usually occurring on the inside of the cannon or splint bone area. Splints are a result of trauma but can also have many other causes, such as
slipping, running, and jumping, getting kicked, or receiving a concussion from hard surfaces. Occasionally a fracture of the splint bones is possible.
Sore or Bucked Shins: A bucked shin is an enlargement on the front of the cannon between the knee and the fetlock joints. This enlargement, which usually occurs in the front limb, is due to
trauma to the periosteum, most often caused by concussion.
Bowed Tendons or Tendonitis: A bowed tendon is an inflammation and enlargement of the flexor tendons at the back of the front cannon. The general cause of bowed tendons is severe strain.
Sidebones: These are calcifications of the lateral cartilages of the third phalanx or coffin bone. Sidebones are considered an unsoundness in a young horse because the premature ossification
of the lateral cartilages will result in contracted heels and abnormal foot growth.
Ringbone: Ringbone is an exostosis of the pastern bone in the form of a raised bony ridge usually parallel to the coronary band. The classification of ringbone as high or low describes the
location of the new bone growth, according to whether it occurs on the lower part of the first phalanx above the pastern joint (high) or the lower part of the second phalanx at the
coronary band (low).
Suspensory Ligament Unsoundness: This type of lameness is common in racehorses. The suspensory ligament attaches to the back of the cannon bone just below the knee, travels
downward, and splits above the sesamoid bones into two parts, each attaching to a sesamoid bone.
Wind Puffs or Wind Galls (Road Puffs or Road Galls): Wind puffs are soft, puffy, fluid-filled swellings that occur around a joint capsule, tendon sheath or bursa. They are the result of excess
synovia and can be found above the knee but usually are on the fetlock and pastern as a result of trauma.
Capped Elbow or Shoe Boil: A capped elbow is a bursitis or swelling at the point of the elbow and is usually caused when the horse irritates the elbow bursa with the shoe or hoof of the front
foot when lying down.
Sweeney: Atrophy of the muscles of the shoulder due to paralysis of the supracapsular nerve is called a Sweeney. The condition is usually caused by direct injury to the point of the shoulder
and subsequent damage to the nerve.
Stifled or Upward Fixation of the Patella: A particular type of stifle inflammation, in which the patella locks and causes the leg to remain in the extended position, is referred to as the stifled
condition. The stifle and the hock are unable to flex and the foot is dragged, but the patella can be released by manipulating the leg forward or backing the horse several steps.
Stringhalt: Stringhalt is an exaggerated lifting and forward motion of one or both hocks that is spasmodic and involuntary.
Capped Hock: A capped hock is one of the most common blemishes of the hind limbs. It is a firm enlargement at the point of the hock that reflects an inflammation of the bursa. Capped hock
is caused by trauma to the hock, usually as a result of kicking a wall, trailer gate, or some solid object.
Curb: A curb is a hard enlargement on the rear of the cannon immediately below the hock that develops in response to stress. It develops as an inflammation and subsequently thickening of
the plantar ligament on the posterior of the hock.
Thoroughpins: A thoroughpin is a soft, fluid-filled enlargement in the hollow on the outside of the hock. The swelling can be pushed freely from the outside to the inside of the hock by palpation
78. Bog Spavin: A soft distension on the inside front portion of the hock joint caused by an inflammation of the synovial membrane of the hock is known as a bog spavin. Faulty conformation (such
as straight hocks), strain (resulting from quick stops), and rickets (caused by a nutritional deficiency) may be predisposing causes that result in inflammation of the bursa and an
increased production of synovial fluid. It rarely interferes with the usefulness of the horse.
Bone Spavin or Jack Spavin: A bone spavin is a bony enlargement on the lower interior surface of the hock joint that may result in limited flexion of the hock. Faulty hock conformation,
excessive concussion, nutritional deficiencies, and hereditary predisposition are considered causes of the bone spavin, but a traumatic event, such as jumping or vigorous training, is
usually required to cause its development.
Quittor: A chronic, purulent, inflammatory swelling of the lateral cartilage resulting in intermittent subcoronary abscesses is called quitter. The condition may be caused by a trauma, puncture,
bruise, or laceration near the coronary band.
Seedy Toe: Another problem of the white line of the hoof is seedy toe, a condition where the hoof wall separates at the toe. Good hoof-trimming practices and proper first aid will usually correct
or control the condition.
Unsoundness: The majority of the unsoundnesses in the horse result in lameness.
Cracked Hooves or Sand Cracks: Cracked hooves, usually found on the feet of unshod horses, indicate neglect in the care of the foot. They may be called quarter crack, toe crack, or heel
crack, depending upon their location on the hoof. Hoof cracks vary in length and depth. When a crack reaches the coronet or the sensitive laminae, lameness usually results.
Contracted Heels: Contracted heels is a condition in which the frog is narrow and shrunken and the heels of the foot are pulled together. The foot may become smaller at the ground surface
than the coronary band.
Grease, Grease-heel, or Scratches: An inflammation of the back of the pastern is called grease, grease-heel, or scratches. It leads to a chronic dermatitis that results in scabs, skin cracks
and eventually granulation clusters. While the case is unknown, constant moisture, mud, manure and long coarse hair in the region all encourage its onset
Thrush: Thrush is an infection of the frog of the foot that is quite common in stabled horses. It is caused by an anaerobic organism that causes necrosis of the tissue of the frog and a foul,
blackish discharge. Extreme cases can lead to lameness and may require veterinary attention. Generally, when treated early and if proper sanitation is followed, the condition can be
easily controlled.
Gravel: Gravel is an infection that penetrates the white line of the sole and travels under the hoof wall between the sensitive and insensitive laminae until it abscesses at the coronet. The term
“gravel” arises because a piece of stone is sometimes the causative agent but any wound, crack, bruise, or infection to the area can have similar symptoms.
Navicular Disease: Navicular disease is any injury of the navicular bone of the front foot. Faulty conformation and injuries are the most important causes of navicular disease. A straight
pastern and shoulder or a small foot will increase the concussion on the navicular bone, thus forcing it against the flexor tendon and causing excess friction and possible damage.
Horses worked repeatedly on hard surfaces are predisposed to the disease, which often affects horses during their prime years (ages 6 to 10). The disease usually begins as an
inflammation of the navicular bursa. The term “navicular disease” is also applied to the chipping or fracture of the navicular bone which may or may not be caused by earlier navicular
disease damage. As a last resort, permanent relief from pain can be accomplished by a posterior digital neurectomy (nerving), but other complications can then arise. A horse that has
had a neurectomy is considered unsound even if there are no outward signs of pain or lameness.
79. Osselets
(Osslets, Periostitis and serous arthritis(
--------------------------------------------------------------------------------
Osselets refer to an inflammation, usually bilateral, of the periosteum on the dorsal distal epiphyseal
surface of the third metacarpal bone and the associated capsule of the fetlock joint. The proximal end of
the first phalanx may also be involved. Hence, osselets constitutes a form of periostitis and serous
arthritis that may progress to degenerative joint disease. The exciting cause is the strain and repeated
trauma of hard training in young horses and is recognized as an occupational hazard of the young
Thoroughbred.
The gait is short and choppy. Palpation and flexion of the fetlock joint produce pain, and examination
reveals a soft, warm, sensitive swelling over the front and sometimes the side of the joint. Radiography in
the initial stages may show no evidence of new bone formation, in which case the condition is called
“green osselets.” Later, enthesopathy may be seen in the area of attachment of the fetlock joint capsule to
the large metacarpal bone and first phalanx. New bone or spur formation may break off and appear as
“joint mice.”
Rest is very important and can be curative for early cases. The inflammation may be relieved by the
application of cold packs for several days. Systemic anti-inflammatory drugs such as phenylbutazone may
also be used. Corticosteroid can also be injected intra-articularly; however, this and other forms of anti-
inflammatory medication, if used along with continued training or racing, inevitably lead to destruction of
the joint surfaces. Intra-articular sodium hyaluronate is useful to reestablish normal synovial viscosity.
80.
81.
82. Hygroma
--------------------------------------------------------------------------------
A hygroma is inflammation of an acquired bursa (one that
develops as a result of trauma where normally there is no
bursa) over the dorsal aspect of the carpus. There is
accumulation of excessive bursal fluid and thickening of the
bursal wall by fibrous tissue. Lameness is not usually present.
The diagnosis is made by palpation and visualization.
Hygromas can be treated in the early stage with drainage,
steroid injections, and bandaging. Later, the implantation of
drains is required.
83. sesamoiditis
The sesamoid bones are maintained in position by the suspensory ligament proximally and
by a number of sesamoidean ligaments distally. Due to the great stress placed on the
fetlock during fast exercise, the insertion of some of these ligaments can tear, which
results in sesamoiditis.
The clinical signs are similar to, but less severe than, those resulting from sesamoid
fracture. Depending on the extent of the damage, there are varying degrees of lameness
and swelling. Reduced speed may be the only manifestation of lameness. Pain and heat
are evident on palpation and flexion of the fetlock joint. The radiographic features include
periosteal new bone proliferation or osteolytic lesions (or both), particularly on the abaxial
surface of the affected sesamoid, and radiolucent lines, which look similar to fracture lines
except there is no fragment distraction, running obliquely across the bone. These lines are
prominent vascular channels. Oblique radiographic views are essential for accurate
diagnosis and evaluation.
Despite various treatments, the prognosis is guarded or poor. Even after 9-12 mo rest,
many horses become lame 6-8 wk after resuming training. The recommended treatment is
a 2- to 3-wk course of phenylbutazone. For mild sesamoiditis, ≥6 mo rest is required; for
severe cases, 9-12 mo.
84.
85. Windgalls
(Windpuffs(
--------------------------------------------------------------------------------
These puffy, fluid-filled swellings around the fetlock joints (of
either or both fore- and hindlimbs) usually are not accompanied
by heat, pain, or lameness. They are said to be associated with
trauma and hard exercise, but the exact pathogenesis is
uncertain. Although usually benign, windgalls should be
regarded with suspicion in the presence of lameness. Some
horses, particularly heavy ones, seem to be more susceptible.
Treatment is problematic; in the absence of lameness, it is
unwarranted. Windgalls may disappear spontaneously or
respond to periods of rest, bandaging, and exercise.
Recurrence is common
86.
87. Desmitis or Sprain of the Inferior Check Ligament
-------------------------------------------------------------------------------
Inferior check ligament desmitis is a commonly made diagnosis and is
often confused with desmitis of the proximal suspensory ligament.
Before the use of diagnostic ultrasound, the differentiation was difficult.
The primary clinical sign is lameness that is alleviated by infiltration of
anesthetic behind the proximal aspect of the metacarpus. Anesthetic
injected in this area, however, may infiltrate outpouchings of the
carpometacarpal joint in >30% of horses, leading to analgesia of both
the carpometacarpal and intercarpal joints. Therefore, a local block of
the proximal aspect of the palmar metacarpal nerves is preferable.
This condition has been treated conservatively in the past, but
sectioning of the ligament has been performed more recently with good
results.
88.
89. Fractures of the Small Metacarpal and Metatarsal (Splint( Bones
--------------------------------------------------------------------------------
Fractures of the second and fourth metacarpal and metatarsal (splint) bones are not
uncommon. The cause may be from direct trauma, such as interference by the
contralateral leg, but splint fractures more often follow a suspensory desmitis (see
Suspensory Desmitis) and the resulting fibrous tissue buildup and encapsulation of the
distal, free end of the bone. The usual site of these fractures is through the distal end, ~2
in. (5 cm) from the tip. Immediately after the fracture occurs, acute inflammation is
present, usually involving the suspensory ligament. A supporting-leg lameness is noted,
which may recede after several days rest and recur only after work.
Chronic, longstanding fractures cause a supporting-leg lameness at speed. Thickening of
the suspensory ligament at and above the fracture site results. The fracture may show a
considerable buildup of callus at the fracture site but little tendency to heal.
Diagnosis is confirmed by an oblique radiograph. Surgical removal of the fractured tip and
callus is the treatment of choice. The prognosis is based on severity of the associated
suspensory desmitis, which has a greater bearing on future performance than the splint
fracture itself.
90.
91. Fracture of the Third Metacarpal (Cannon) Bone
A transverse fracture in the midmetacarpal region can result from direct trauma, usually
from a kick. The stress of racing on a hard surface may result in a longitudinally oblique
(ie, condylar) fracture that progresses up the metacarpal shaft from the fetlock and
sometimes also involves the proximal sesamoids. Incomplete fractures of the dorsal cortex
of the midmetacarpal region can occur as stress-type fractures. Diagnosis is confirmed by
radiography; the fissure fractures can be difficult to demonstrate, and a range of oblique
views may be necessary.
Midmetacarpal fractures may heal with just a cast, although prolonged immobilization may
be necessary because union is often delayed. Malunion and the encroachment of callus
on surrounding tendons and ligaments cause further problems. Internal fixation with
dynamic compression plates and screws is the treatment of choice. Condylar fractures can
be treated conservatively by casting, but such articular injuries are best managed by screw
fixation using interfragmentary compression if osteoarthritis is to be minimized or avoided.
Fissure fractures also may show delayed union unless a cortical bone screw is applied.
(See also bucked shins, Bucked Shins.)
92.
93. Osteoarthritis (Degenerative Joint Disease)
--------------------------------------------------------------------------------
In the carpus, osteoarthritis typically appears with chronic
thickening of the joint, usually associated with capsular fibrosis.
There is a decreased range of motion and sometimes a history
of treatment of an acute problem. Radiographic changes
develop slowly, and usually the degree of articular cartilage
compromise is severe. Cases that can possibly lead to
osteoarthritis should be treated aggressively and correctly.
Treatment of severe osteoarthritis is largely palliative, but
debridement and lavage, followed by intra-articular and
systemic therapy, may help. (See also osteoarthritis,
Osteoarthritis
94.
95. Rupture of the Common Digital Extensor Tendon
--------------------------------------------------------------------------------
This developmental problem is present at birth or is seen
shortly after. Foals usually show a carpal flexure deformity or a
fetlock flexural deformity. If the condition is not noticed
immediately, secondary contracture of the flexor muscle-tendon
unit develops. The condition is confirmed by palpation of the
swollen disrupted ends of the extensor tendon within the
tendon sheath over the carpus. Management involves
preventing secondary tendon contracture with the use of PVC
splints to prevent knuckling, if appropriate. Healing will occur.
96.
97. Splints
(Metacarpal exostosis)
--------------------------------------------------------------------------------
Splints primarily involve the interosseous ligament between the large (third) and small (second)
metacarpal (less frequently the metatarsal) bones. The reaction is a periostitis with production of new
bone (exostoses) along the involved splint bone. Trauma from concussion or injury, strain from excess
training (especially in the immature horse), faulty conformation, imbalanced or overnutrition, or improper
shoeing may be contributory factors.
Splints most commonly involve the medial rudimentary metacarpal bones. Lameness is seen only when
splints are forming and is seen most frequently in young horses. Lameness is more pronounced after the
horse has been worked. In the early stages, there is no visible enlargement, but deep palpation may
reveal local painful subperiosteal swelling. In the later stages, a calcified growth appears. After
ossification, lameness disappears, except in rare cases in which the growth encroaches on the
suspensory ligament or carpometacarpal articulation. Radiography is necessary to differentiate splints
from fractured splint bones.
Complete rest and anti-inflammatory therapy is indicated. Intralesional corticosteroids may reduce
inflammation and prevent excessive bone growth. Their use should be accompanied by counterpressure
bandaging. In Thoroughbreds, it has been traditional to point-fire a splint, the aim being to accelerate the
ossification of the interosseous ligament; however, in most cases, irritant treatments are contraindicated.
If the exostoses impinge against the suspensory ligament, surgical removal may be necessary.
98.
99. Synovial Hernia and Ganglion and Synovial Fistulae
--------------------------------------------------------------------------------
These conditions are relatively uncommon, but are important in
the differential diagnosis of fluid-filled swellings over the dorsal
aspect of the carpus. A synovial hernia is a cyst arising from
herniation of synovial membrane through a defect in the fibrous
joint capsule or fibrous sheath of a tendon. Diagnosis of these
conditions is confirmed with contrast radiography; if accessible,
the hernia or fistula is surgically repaired
100.
101.
102. Tenosynovitis of the Tendon Sheaths Associated with the Carpus
--------------------------------------------------------------------------------
There are several forms of tenosynovitis, including idiopathic, acute traumatic, chronic traumatic, and
septic. In the idiopathic form, there is no lameness and synovial effusion localized to the tendon sheath is
the only manifestation. It may be seen in the common digital extensor tendon sheath or the extensor carpi
radialis tendon sheath; these can be differentiated by knowledge of anatomy. Traumatic forms of
tenosynovitis are seen in older animals. In the acute stage, there is fluid distention; in the chronic stage,
fibrosis may be present as well. Treatment consists of systemic and local anti-inflammatory therapy (eg,
phenylbutazone therapy for 5-7 days). DMSO can be applied topically to the injured area for 7-10 days. In
chronic cases in jumpers, surgical debridement may be helpful. Septic tenosynovitis of the carpus is rare.
When it is seen, there are acute signs of lameness, heat, and swelling as seen in septic arthritis.
Traumatic Synovitis and Capsulitis
-------------------------------------------------------------------------------
Traumatic synovitis and capsulitis is inflammation of the synovial membrane and fibrous capsule with no
apparent radiographic involvement of bone or other structures. Soft tissues involved can include synovial
membrane, fibrous joint capsule, and intra-articular ligaments. Synovitis and capsulitis of the carpus is a
common primary clinical condition but also may be accompanied by radiographically unapparent
osteochondral damage. The cause is usually considered to be cyclic trauma.
103. Clinical signs include varying degrees of lameness with local
heat and swelling. In chronic synovitis and capsulitis,
radiographs may show enthesophytes or osteophytes, but in
many instances there are no significant radiographic changes.
Treatment is as described under osteoarthritis (see
Osteoarthritis (Degenerative Joint Disease)). The most
common treatments are intra-articular corticosteroids, alone or
in combination with hyaluronic acid, as well as systemic NSAID.
If carpal synovitis and capsulitis do not respond to intra-
articular therapy, diagnostic arthroscopy is indicated to
eliminate medial palmar intercarpal ligament tearing,
osteochondral fragmentation not visible on radiographs, or
osteochondral degenerative disease.
104. Arthritis of the Shoulder Joint
--------------------------------------------------------------------------------
Inflammation of the structures of the shoulder joint is uncommon. It is secondary to
changes in the joint capsule or, more frequently, to bony changes of the articular surfaces
of the humerus or scapula (such as might be caused by osteochondrosis). Occasionally,
fractures involving the articular surfaces are present. Trauma to the point of the shoulder is
a frequent cause. Bacterial infection of the joint from puncture wounds or of
hematogenous origin (pyosepticemia) in foals results in a purulent arthritis.
A swinging- and supporting-leg lameness are present in severe cases. In milder cases,
only the swinging-leg lameness may be noted. The forward phase is shortened, the toe
may be worn, and the leg is often circumducted to avoid flexion of the joint. Forced
extension of the leg, which pulls the shoulder forward, often causes pain. Radiographs of
the shoulder joint, preferably taken with the horse in lateral recumbency, may demonstrate
the arthritic changes.
Often, treatment is ineffective because of severe arthritic changes. Intra-articular injections
of a steroid may be of some benefit. Systemic steroids or phenylbutazone may relieve
signs of pain. Hyaluronic acid, because of its apparent benefit in cases of degenerative
disease in other joints, may be considered
105.
106.
107. Bicipital Bursitis
-------------------------------------------------------------------------------
Bicipital bursitis is an inflammation of the bursa between the tendon of the
biceps and the bicipital groove of the humerus. The usual cause is direct
trauma to the point of the shoulder.
Essentially, bicipital bursitis results in a swinging-leg lameness with the forward
phase being shortened. The horse may stumble because the toe is not being
lifted sufficiently to clear the ground. In severe cases, a supporting-leg
lameness is also present; the horse rests the limb in a characteristic semiflexed
position. Forced extension of the leg usually causes a pain reaction, as can
deep digital pressure over the bursa and the tendon of the biceps.
Ultrasonography can demonstrate the excess fluid and associated lesions of
the biceps tendon. In chronic cases, radiographs may show calcification of the
bursa, which is a common sequela.
Prolonged rest is indicated (>6 mo), particularly in acute cases. Intrabursal
injection of hyaluronic acid or steroids may be successful. Phenylbutazone and
oral steroids may also be helpful. The prognosis is guarded.
108.
109.
110.
111. Sweeney
(Shoulder atrophy, Slipped shoulder)
--------------------------------------------------------------------------------
Sweeney is disuse or neurogenic atrophy of the supraspinatus and infraspinatus muscles. Disuse atrophy, sometimes involving
the triceps also, follows any lesion of the limb or foot that leads to prolonged diminished use of the limb. Neurogenic atrophy is
due to damage to the suprascapular nerve, which supplies the supraspinatus and infraspinatus muscles. Polo ponies are
occasionally affected because of collision during competition.
If trauma is not evident, pain may be absent, and lameness may be difficult to detect until atrophy develops. If injury is evident,
there is usually some difficulty in extending the shoulder. As atrophy progresses, there is a noticeable hollowing on each side of
the spine of the scapula, especially in the infraspinous area, resulting in prominence of the spine. Because the tendons of
insertion of the two affected muscles act as lateral collateral ligaments to the humeroscapular joint, atrophy of the muscles leads
to a looseness in the shoulder joint. Abduction of the shoulder follows and, in severe cases, is sometimes erroneously
diagnosed as a dislocation. The affected limb, when advanced, takes a semicircular course and, as weight is borne by the limb,
the shoulder joint moves laterally (shoulder slip). At rest, along with abduction of the shoulder, there is an apparent abduction of
the lower part of the limb.
Treatment for disuse atrophy consists of removing the cause of the failure to use the limb. For neurogenic atrophy, massage
with stimulating liniments or by an electrical vibrator may be of benefit. Rhythmic muscular contractions by faradism have
maintained muscle bulk until the nerve regenerates. Surgical release of the suprascapular nerve from scar tissue impingement,
by “notching out” the rostral border of the scapula, has also been recommended. For best results, the surgery should be
performed before looseness and slipping of the shoulder joint are advanced.
The prognosis for cases of disuse atrophy depends on removal of the primary cause. In neurogenic atrophy, the prognosis is
guarded; mild cases should recover in 6-8 wk. When damage to the nerve has been severe, spontaneous recovery may take
many months, if it occurs at all. Such cases are candidates for surgical release. If the nerve has been severed, recovery is
unlikely
112.
113.
114. Hygroma: Introduction
A hygroma is a false bursa that develops over bony prominences and
pressure points, especially in large breeds of dogs. Repeated trauma
from lying on hard surfaces produces an inflammatory response, which
results in a dense-walled, fluid-filled cavity. A soft, fluctuant, fluid-filled,
painless swelling develops over pressure points, especially the
olecranon. If longstanding, severe inflammation may develop, and
ulceration, infection, abscesses, granulomas, and fistulas may occur.
The bursa contains a clear, yellow to red fluid.
If diagnosed early and if still small, hygromas can be managed
medically via aseptic needle aspiration, followed by corrective housing.
Soft bedding or padding over pressure points is imperative to prevent
further trauma. Surgical drainage, flushing, and placement of Penrose
drains are indicated for chronic hygromas. Areas with severe ulceration
may require extensive drainage, extirpation, or skin grafting
procedures. Use of intrahygromal corticosteroids is not recommended.
Editor's Notes
Main extensor attaches to the extensor process . Deep flexor attaches to the semi loner crest of coffin bone .
