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Title: Lameness of the Horse
Veterinary Practitioners' Series, No. 1
Author: John Victor Lacroix
Release Date: July 27, 2005 [eBook #16370]
Language: English
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Transcriber's Note:
The original text was inconsistent in the use of accents and
hyphenation. These variants and a small number of typographical
errors were maintained in this transcription. A complete list
of the variant spellings is found at the end of the book along
with the list of typographical errors.
The Table of Contents lists the Authorities Cited section as
preceding the Index, but it was printed following the Index.
This order has been retained in this transcription.
Veterinary Practitioners' Series
No. 1
LAMENESS OF THE HORSE
by
J. V. Lacroix, D.V.S.
Professor of Surgery, The Kansas City Veterinary College
Author of "Animal Castration"
Illustrated
Chicago
American Journal Of Veterinary Medicine
1916
PREFACE
All that can be known on the subject of lameness, is founded on a
knowledge of anatomy and of the physiology of locomotion. Without such
knowledge, no one can master the principles of the diagnosis of
lameness. However, it must be assumed that the readers are informed on
these subjects, as it is impossible to include this fundamental
instruction in a work so brief as this one.
The technic of certain operative or corrective procedures, has been
described at length only where such methods are not generally employed.
Where there is no departure from the usual methods, treatment that is
essentially within the domain of surgery or practice is not given in
specific detail.
Realizing the need for a treatise in the English language dealing with
diagnosis and treatment of lameness, the author undertook the
preparation of this manuscript. That the difficulties of depicting by
means of word-pictures, the symptoms evinced in baffling cases of
lameness, presented themselves in due course of writing, it is needless
to say.
It is hoped that this volume will serve its readers to the end that the
handling of cases of lameness will become a more satisfactory and
successful part of their work; that both the practitioner and his
clients may profit thereby; and last but by no means least, that the
horse, which has given such incalculable service to mankind and is
deserving of a more concrete reward, will be benefited by the
application of the principles herein outlined.
In addition to the consultation of standard works bearing on various
phases of the subject of lameness, the author wishes to thankfully
acknowledge helpful advice and assistance received from the publisher,
Dr. D.M. Campbell; to appreciatively credit Drs. L.A. Merillat, A.
Trickett and F.F. Brown for valuable suggestions given from time to
time. Particular acknowledgment is made to Dr. Septimus Sisson, author,
and W.B. Saunders & Co., publishers of The Anatomy of Domestic Animals,
for permission to use a number of illustrations from that work.
J.V.L.
Chicago, Illinois, October, 1916.
_Justice shows a triumphant face at the works of humane practitioners,
who give serious thought and expend honest effort, for the alleviation
of animal suffering._
TABLE OF CONTENTS
Page
Illustrations 7
Introduction 11
SECTION I
Etiology and Occurrence 15
Affections of Bones 15
Rarefying Osteitis, or Degenerative Changes 16
Fractures 16
Affections of Ligaments 20
Luxations--Dislocations 21
Arthritis 22
Affections of Bursae and Thecae 27
Affections of Muscles and Tendons 28
Affections of Nerves 30
Affections of Blood Vessels 31
Affections of Lymph Vessels and Glands 32
Affections of the Feet 34
SECTION II
Diagnostic Principles 37
Anamnesis 38
Visual Examination 39
Attitude of the Subject 41
Examination by Palpation 43
Passive Movements 47
Observing the Character of the Gait 48
Special Methods of Examination 53
SECTION III
Lameness in the Fore Leg
Anatomo-Physiological Review of Parts of the Fore Leg 55
Shoulder Lameness 61
Fracture of the Scapula 62
Scapulohumeral Arthritis 65
Infectious Arthritis 66
Injuries 66
Wounds 67
Luxation of the Scapulohumeral Joint 67
Inflammation of the Bicipital Bursa 68
Contusions of the Triceps Brachii 71
Shoulder Atrophy (Sweeny) 73
Paralysis of the Suprascapular Nerve 75
Radial Paralysis 77
Thrombosis of the Brachial Artery 81
Fracture of the Humerus 82
Inflammation of the Elbow 84
Fracture of the Ulna 86
Fracture of the Radius 87
Wounds of the Anterior Brachial Region 90
Inflammation and Contraction of the Carpal Flexors 93
Fracture and Luxation of the Carpal Bones 96
Carpitis 98
Open Carpal Joint 100
Thecitis and Bursitis 104
Fracture of the Metacarpus 106
Splints 107
Open Fetlock Joint 110
Phalangeal Exostosis (Ringbone) 118
Open Sheath of the Flexors of the Phalanges 124
Luxation of the Fetlock Joint 125
Sesamoiditis 127
Fracture of the Proximal Sesamoids 128
Inflammation of the Posterior Ligaments of the Pastern
Proximal Interphalangeal Joint 129
Fracture of the First and Second Phalanges 131
Tendinitis (Inflammation of the Flexor Tendons) 135
Chronic Tendinitis and Contraction of the Flexor Tendons 137
Contracted Tendons of Foals 143
Rupture of the Flexor Tendons and Suspensory Ligament 146
Thecitis and Bursitis in the Fetlock Region 150
Arthritis of the Fetlock Joint 152
Ossification of the Cartilages of the Third Phalanx 155
Navicular Disease 157
Laminitis 160
Calk Wounds (Paronychia) 170
Corns 172
Quittor 174
Nail Punctures 178
SECTION IV
Lameness in the Hind Leg
Anatomo-Physiological Consideration of the Pelvic Limbs 185
Hip Lameness 195
Fractures of the Pelvic Bones 196
Fractures of the Femur 199
Luxation of the Femur 201
Gluteal Tendo-Synovitis 203
Paralysis of the Hind Leg 204
Paralysis of the Femoral (Crural) Nerve 204
Paralysis of the Obturator Nerve 206
Paralysis of the Sciatic Nerve 208
Iliac Thrombosis 209
Fracture of the Patella 212
Luxation of the Patella 213
Chronic Gonitis 217
Open Stifle Joint 220
Fracture of the Tibia 222
Rupture and Wounds of the Tendo Achillis 224
Spring-Halt (String-Halt) 225
Open Tarsal Joint 229
Fracture of the Fibular Tarsal Bone (Calcaneum) 230
Tarsal Sprains 232
Curb 233
Spavin (Bone Spavin) 235
Distension of the Tarsal Joint Capsule (Bog Spavin) 242
Distension of the Tarsal Sheath of the Deep Digital Flexor
(Thoroughpin) 246
Capped Hock 251
Rupture and Division of the Long Digital Extensor (Extensor
Pedis) 253
Wounds from Interfering 255
Lymphangitis 257
Authorities Cited 265
Index 267
ILLUSTRATIONS
Page
Fig. 1--Hoof Testers 53
Fig. 2--Muscles of Left Thoracic Limb, Lateral View 56
Fig. 3--Muscles of Left Thoracic Limb, Medial View 57
Fig. 4--Sagital Section of Digit and Distal Part of
Metacarpus 59
Fig. 5--Ordinary Type of Heavy Sling 62
Fig. 6--A Sling Made in Two Parts 63
Fig. 7--Paralysis of the Suprascapular Nerve of Left
Shoulder 76
Fig. 8--Radial Paralysis 78
Fig. 9--Merillat's Method of Fixing Carpus in Radial
Paralysis 79
Fig. 10--Contraction of Carpal Flexors, "Knee Sprung" 95
Fig. 11--Pericarpal Inflammation and Enlargement Due to
Injury 99
Fig. 12--Hygromatous Condition of the Right Carpus 100
Fig. 13--Carpal Exostosis in Aged Horse 101
Fig. 14--Exostosis of Carpus Resultant from Carpitis 102
Fig. 15--Distal End of Radius, Illustrating Effects of
Carpitis 102
Fig. 16--Posterior View of Radius, Illustrating Effects of
Splint 108
Fig. 17--Phalangeal Exosteses 120
Fig. 18--Rarefying Osteitis in Chronic Ringbone 121
Fig. 19--Phalangeal Exostoses in Chronic Ringbone 122
Fig. 20--Contraction of Superficial Digital Flexor Tendon
Due to Tendinitis 138
Fig. 21--Contraction of Deep Flexor Tendon Due to
Tendinitis 139
Fig. 22--Chronic Case of Contraction of Both Flexor Tendons
of the Phalanges 140
Fig. 23--Contraction of Superficial and Deep Flexor
Tendons 141
Fig. 24--Contraction of Superficial Digital Flexor and
Slight Contraction of Deep Flexor Tendon 142
Fig. 25--"Fish Knees" 145
Fig. 26--Extreme Dorsal Flexion 146
Fig. 27--A Good Style of Shoe for Bracing the Fetlock 148
Fig. 28--The Roberts Brace in Operation 149
Fig. 29--Distension of Theca of Extensor of the Digit 151
Fig. 30--Rarefying Osteitis Wherein Articular Cartilage
Was Destroyed 153
Fig. 31--Ringbone and Sidebone 156
Fig. 32--Position Assumed by Horse Having Unilateral
Navicular Disease 159
Fig. 33--The Hoof in Chronic Laminitis 165
Fig. 34--Effects of Laminitis 166
Fig. 35--Cochran Shoe, Inferior Surface 168
Fig. 36--Cochran Shoe, Superior Surface 169
Fig. 37--Hyperplasia of Eight Forefoot Due to Chronic
Quittor 176
Fig. 38--Chronic Quittor, Left Hind Foot 177
Fig. 39--Skiagraph of Foot 179
Fig. 40--Sagital Section of Eight Hock 186
Fig. 41--Muscles of Right Leg; Front View 187
Fig. 42--Muscles of Lower Part of Thigh, Leg and Foot 189
Fig. 43--Right Stifle Joint; Lateral View 190
Fig. 44--Left Stifle Joint; Medial View 191
Fig. 45--Left Stifle Joint; Front View 193
Fig. 46--Oblique Fracture of the Femur 200
Fig. 47--Fracture of Femur After Six Months' Treatment 201
Fig. 48--Aorta and Its Branches Showing Location of
Thrombi 210
Fig. 49--Thrombosis of the Aorta, Iliacs and Branches 211
Fig. 50--Chronic Gonitis 218
Fig. 51--Position Assumed in Gonitis 219
Fig. 52--Spring-halt 226
Fig. 53--Lateral View of Tarsus Showing Effects of Tarsitis 228
Fig. 54--Right Hock Joint 231
Fig. 55--Spavin 235
Fig. 56--Bog Spavin 243
Fig. 57--Thoroughpin 247
Fig. 58--Fibrosity of Tarsus in Chronic Thoroughpin 248
Fig. 59--Another View of Case Shown in Fig. 58 249
Fig. 60--"Capped Hock" 252
Fig. 61--Chronic Lymphangitis 258
Fig. 62--Elephantiasis 259
INTRODUCTION
Lameness is a symptom of an ailment or affection and is not to be
considered in itself as an anomalous condition. It is the manifestation
of a structural or functional disorder of some part of the locomotory
apparatus, characterized by a limping or halting gait. Therefore, any
affection causing a sensation and sign of pain which is increased by the
bearing of weight upon the affected member, or by the moving of such a
distressed part, results in an irregularity in locomotion, which is
known as lameness or claudication. A halting gait may also be produced
by the abnormal development of a member, or by the shortening of the leg
occasioned by the loss of a shoe.
For descriptive purposes lameness may be classified as _true_ and
_false_. _True lameness_ is such as is occasioned by structural or
functional defects of some part of the apparatus of locomotion, such as
would be caused by spavin, ring-bone, or tendinitis. _False lameness_ is
an impediment in the gait not caused by structural or functional
disturbances, but is brought on by conditions such as may result from
the too rapid driving of an unbridle-wise colt over an irregular road
surface, or by urging a horse to trot at a pace exceeding the normal
gait of the animal's capacity, causing it to "crow-hop" or to lose
balance in the stride. The latter manifestation might, to the
inexperienced eye, simulate _true lameness_ of the hind legs, but in
reality, is merely the result of the animal having been forced to assume
an abnormal pace and a lack of balance in locomotion is the consequence.
The degree of lameness, though variable in different instances, is in
most cases proportionate to the causative factor, and this fact serves
as a helpful indicator in the matter of establishing a diagnosis and
giving the prognosis, especially in cases of somewhat unusual character.
An animal may be slightly lame and the exhibition of lameness be such as
to render the cause bafflingly obscure. Cases of this nature are
sometimes quite difficult to classify and in occasional instances a
positive diagnosis is impossible. Subjects of this kind may not be
sufficiently inconvenienced to warrant their being taken out of
service, yet a lame horse, no matter how slightly affected, should not
be continued in service unless it can be positively established that the
degree of discomfort occasioned by the claudication is small and the
work to be done by the animal, of the sort that will not aggravate the
condition.
Subjects that are very lame--so lame that little weight is borne by the
affected member--are, of course, unfit for service and as a rule are not
difficult of diagnosis. For instance, a fracture of the second phalanx
would cause much more lameness than an injury to the lateral ligament of
the coronary joint wherein there had occurred only a slight sprain, and
though crepitation is not recognized, the diagnostician is not justified
in excluding the possibility of fracture, if the lameness seems
disproportionate to the apparent first cause.
The course taken by cases of lameness is as variable as the degree of
its manifestation, and no one can definitely predict the duration of any
given cause of claudication.
Because of the fact that horses are not often good self-nurses at best,
and that it is difficult to enforce proper care for the parts affected,
one can not wisely state that resolution will promptly follow in an
acute involvement, nor can he predict that the case will or will not
become chronic. Experience has proved that complete or partial recovery
may result, or again, that no change may occur in any given case, and
that in some instances even where rational treatment is early
administered, a decided aggravation of the condition may follow
unaccountably.
However, because of the economic element to be reckoned with, it is of
some value to be able to give a fairly accurate prognosis in the
handling of cases of lameness, as in the majority of instances the
treatment and manner of after-care are determined largely by the expense
that any prescribed line of attention will occasion.
A case of acute bone spavin in a horse of little value is not generally
treated in a manner that will incur an expense equivalent to one-half
the value of the subject. The fact is always to be considered in such
cases, that even where ideal conditions favor proper treatment, the
outcome is uncertain. Where less than six weeks of rest can be allowed
the animal, one affected with bone spavin would therefore not be treated
with the expectation of obtaining good results, as six weeks' time, at
least, is necessary for a successful outcome. If the cost attending the
enforced idleness of an animal of this kind is considered prohibitive
for the employment of proper measures to affect a cure, and if lameness
is slight, the animal should be given suitable work, but in cases of
articular spavin in aged subjects, they should be humanely destroyed and
not subjected to prolonged misery.
A thorough knowledge of the structure and functions of the affected
parts is necessary to proceed in cases of lameness; likewise, the age,
conformation and temperament of the subject need to be taken into
consideration; the presence or absence of complications demand the
attention; the kind of care the subject will probably receive directly
influences the outcome; and the character of service expected of the
subject, too, needs to be carefully considered before the ultimate
outcome may reasonably be foretold.
The practitioner is often confronted with the problem of how best to
handle certain cases. Will they do better under conditions where
absolute quiet is enforced, or is it preferable to allow exercise at
will? The temperament of the animal must be considered in such cases,
and if a lame horse is too active and playful when given his freedom,
exercise must be restricted or prevented, as the case may require. In
cases of strains of tendons, during the acute stage, immobilization of
the affected parts is in order. In certain sub-acute inflammatory
processes or in instances of paralytic disturbance where convalescence
is in progress, moderate exercise is highly beneficial.
Consequently, each case in itself presents an individual problem to be
judged and handled in the manner experience has taught to be most
effective, appropriate and practical, and the veterinarian should give
due consideration to the comfort and welfare of the crippled animal as
well as to the interests of the owner.
SECTION I.
ETIOLOGY AND OCCURRENCE.
In discussions of pathological conditions contributing to lameness in
the horse, cause is generally classified under two heads--_predisposing_
and _exciting_. It becomes necessary, however, to adopt a more general
and comprehensive method of classification, herein, which will enable
the reader to obtain a better conception of the subject and to more
clearly associate the parts so grouped descriptively.
Though _predisposing_ factors, such as faulty conformation, are often to
be reckoned with, _exciting_ causes predominate more frequently in any
given number of cases. The noble tendency of the horse to serve its
master under the stress of pain, even to the point of complete
exhaustion and sudden death, should win for these willing servants a
deeper consideration of their welfare. Too frequently are their
manifestations of discomfort allowed to pass unheeded by careless,
incompetent drivers lacking in a sense of compassion. Symptoms of
malaise should never be ignored in any case; the humane and economic
features should be realized by any owner of animals.
In the consideration of group causes, lameness may be said to originate
from affections of bones, ligaments, thecae and bursae, muscles and
tendons, nerves, lymph vessels and glands, and blood vessels, and may
also result from an involvement of one or several of the aforementioned
tissues, caused by rheumatism. Further, affections of the feet merit
separate consideration, and, finally, a miscellaneous grouping of
various dissimilar ailments, which for the most part, do not directly
involve the locomotory apparatus but do, by their nature, impede normal
movement.
AFFECTIONS OF BONES.
The bony column serving as the framework and support of the legs,
probably constitutes the most vital element having to do with weight
bearing and locomotion, and therefore during the acute and painful stage
of bone affections, the pain becomes more intense in the process and
pressure of standing than when the member is swung or advanced.
Certain bones are so well protected by muscular structures that they are
not frequently injured except as a result of violence which may produce
fracture. However, there are certain bones which receive the constant
shock of concussion when the animal is subjected to daily, rapid work on
hard road surfaces. Splints, ringbones and spavins are the most general
examples produced by these conditions.
Varying pathological developments often result from concussion,
contusion or other violent shocks to the bony structures. In such cases
there either follows a simple periostitis which may resolve
spontaneously with no obvious outward symptom, or osteitis, which may
occur with tissue changes, as in exostosis; or the case may produce any
degree of reaction between these two possible extremes.
Rarefying Osteitis, or Degenerative Changes.
Certain bone affections, such as osteomalacia or osteoporosis, are in
the main, responsible for distortions and morphological changes of bone,
causing lameness, permanent blemish and even resulting in death of the
affected animal. The climatic conditions in some localities favor these
occurrences but they may also be ascribed to improper food constituents
and to possible infective agencies.
Rarefying degenerative changes manifested by exostosis involving the
phalanges of the young, causing ringbone, are fairly common in
occurrence throughout this country. This is due, supposedly, to a lack
of mineral substance in the bony structure of the affected animals, and
is known as rachitis--commonly called rickets. Since the affected
subjects suffer involvement of several of the extremities at the same
time, the theory of rachitic origin seems well supported.
Fractures.
Fractures of bones constitute serious conditions and are always
manifested by lameness. A sub-classification is essential here for the
student of veterinary medicine who would comprehend the technic of
reduction and subsequent treatment in such cases.
Fractures are classified by many authorities as being _simple_,
_compound_, and _comminuted_. This method is practical because it
separates dissimilar conditions. There are also grouped fractures, the
pathologic anatomy of which is similar. Classification on an etiological
basis would attempt to associate conditions, the morbid anatomy and
gravity of which would justly preclude their being combined.
Simple Fracture is a condition where the continuity of the bone has
been broken without serious destruction of the soft structures adjacent,
and where no opening has been made to the surface of the flesh. Such
fractures do not reduce the bone to fragments. Long bones are frequently
subjected to simple fracture, while short thick bones, such as the
second phalanx, may suffer multiple or comminuted fractures.
Compound Fracture designates a break of bone with the destruction of
the soft tissues covering it, making an open wound to the surface of the
skin. This form of fracture is serious because of the attendant danger
of infection, and in treatment, necessitates special precaution being
taken in the application of splints that the wound may be cared for
without infection of the tissues. These fractures generally occur as a
result of some forceful impact through the flesh to the bone, or where
the bones are driven outward by the blow. Common examples are in
fractures of the metacarpus and metatarsus of the first phalanx. This
kind of injury in mature horses usually produces an irreparable
condition, and viewed economically, is generally considered fatal.
Comminuted Fractures, as the term implies, are those cases wherein the
bone is reduced to a number of small pieces. This kind of break may be
classified as simple-comminuted fracture when the skin is unbroken, and
when the bone is exposed as a result of the injury, it is known as a
compound-comminuted fracture. Such fractures are caused by violent
contusion or where the member is caught between two objects and
crushed.
Multiple Fractures.
Fractures are called _multiple_ when the bone is reduced to a number of
pieces of large size. This condition differs from a comminuted fracture
in that the multiple fracture may break the bone into several pieces
without the pieces being ground or crushed, and the affected bone may
still retain its normal shape.
Further classification is of value in describing fractures of bone with
respect to the manner in which the bone is broken--the direction of the
fissure or fissures in relation to its long axis.
A fracture is _transverse_ when the bone is broken at a right angle from
its long axis. Such breaks when simple, are the least trouble to care
for because there is little likelihood that the broken ends of bone will
become so displaced that they will not remain in apposition. _Simple
transverse_ fracture of the metacarpus, for instance, constitutes a
favorable case for treatment if other conditions are favorable.
_Oblique fractures_, as may be surmised, are solutions of continuity of
bone in such manner that the fissure crosses the long axis of a bone at
an acute or obtuse angle. These fractures are prone to injure the soft
structures adjacent, and are frequently compound, as well. Moreover,
because of the fact that the apposing pieces of bone are beveled, the
broken ends of bone are likely to pass one another in such a way as to
shorten the distance between the extremities of the injured member.
Contraction of muscles also tends to exert traction upon a bone so
fractured, resulting in a lateral approximation of the diaphysis and
thus preventing union because the broken surfaces are not in proper
contact.
Fractures are _longitudinal_ when the fissure is parallel with the long
axis of the bone. This variety of break is not infrequent in the first
phalanx; and a vertical fracture of the second phalanx is also said to
be longitudinal, however, there is little difference (if any, in some
subjects) between the vertical and transverse diameters of this
particular bone.
_Green stick fractures_ are essentially those resulting from falls to
young animals. They are usually sub-periosteal and when the periosteum
is left intact or nearly so, no crepitation is discernible. If this
fracture is _simple_, prompt recovery may be expected. Bones of young
animals, because they do not contain proportionately as much mineral
substance as do bones of adults, are more resilient and less apt to
become completely fractured. They are, however, subject to what is known
as green stick fracture.
_Impacted fractures_ are usually occasioned by falls. When the weight of
the body is suddenly caught by a member in such manner as to forcefully
drive the epiphyseal portions of bone into and against the diaphysis,
_multiple longitudinal_ fractures occur at the point of least
resistance. Parts so affected undergo a fibrillary separation,
increasing the transverse diameter of the bone; or if the impact has
been sufficiently violent, the portion becomes an amorphous mass.
In a treatise on the subject of lameness, the bones chiefly concerned
and most often affected must be especially considered. The shape and
size of a bone when injured, determines in a measure, the course and
probable outcome in most cases, but of first and greater importance is
the function of the bone. A fracture of the fibula in the horse need not
incapacitate the subject, but a tibial fracture is serious and generally
proves cause for fatal termination. The body of the scapula may be
completely fractured and recovery will probably result in most cases
without much attention being given to the subject, yet a fracture of the
neck of this same bone constitutes an injury of serious consequence. The
difference in the function of different parts of this same bone, as well
as its shape and mode of attachment, determine the gravity of the case;
so it is in fractures of other bones with respect to the course and
prognosis of the case--function is the important factor to be
considered.
Next in importance is the age of the animal suffering fracture of the
bone. Capacity for regeneration is naturally greater in a vigorous,
young animal than in aged or even middle-aged subjects. A healthy
condition of the bone and the body favor the process of repair in case
of fracture, and prognosis may be favorable or unfavorable, depending
upon these factors mentioned for consideration. Individuals of the same
species, differing in temperament, may comport themselves in a manner
that is conductive to prompt recovery, or to early destruction. This
feature cannot be overestimated in importance, as it is sometimes a
decisive element, regardless of other conditions. A horse suffering from
an otherwise remediable pelvic fracture may be so worried and tortured
by being confined in a sling that the case calls for special attention
and care because of the animal's temperament. Sometimes, the constant
presence of a kind attendant will so reassure the subject that it will
become resigned to unnatural confinement, in a day or two. This
precaution may, in itself, determine the outcome, and the wise
veterinarian will not overlook this feature or fail to deviate from the
usual rote in the handling of average cases. Recovery may be brought
about in irritable subjects by this concession to the individual
idiosyncrasies of such animals.
AFFECTIONS OF LIGAMENTS.
Ligaments which have to do with the locomotory apparatus are, for the
most part, inelastic structures which are composed of white fibrous
tissue and serve to join together the articular ends of bones; to bind
down tendons; and to act as sheathes or grooves through which tendons
pass, and as capsular membranes for retention of synovia in contact with
articular surfaces of bones.
Ligaments are injured less frequently than are bones. Because of their
flexibility they escape fracture in the manner that bones suffer. They
are, however, completely severed by being cut or ruptured, though
fibrillary fracture the result of constant or intermittent tensile
strain is of more frequent occurrence.
Simple inflammation of ligaments is of occasional occurrence but, unless
considerable injury is done this tissue, no perceptible manifestation of
injury results. No doubt many cases wherein fibrillary fracture of
ligaments (sprain) takes place some lameness is caused, but because of
the dense, comparatively nonvascular nature of these structures, little
if any manifestation, except lameness, is evident. And such cases, if
recognized are usually diagnosed by excluding the existence of other
possible causes and conditions which might also cause lameness.
Certain ligaments are subjected to strain more than are others and
therefore, when so involved, frequently cause lameness. Examples of this
kind are affections of the collateral (lateral) ligaments of the
phalanges. Because of the leverage afforded by the transverse diameter
of the foot, when an animal is made to travel over uneven road surfaces,
considerable strain is brought to bear on the collateral ligaments of
the phalanges. A sequel to this form of injury is a circumscribed
periostitis at the site of attachment of the ligaments and frequently
the formation of an exostosis--ringbone--results.
Where sudden and violent strain is placed upon a ligament and rupture
occurs, the division is usually effected by the ligament being torn from
its attachment to the bone. In such cases, a portion of periosteum and
bone is usually detached and the condition may then properly be called
one of fracture. In some cases of this kind recovery is tardy, because
of the difficulty in maintaining perfect apposition of the divided
structures, and reactionary inflammation is not of sufficient extent to
enhance prompt repair. In fact, some cases of this kind seem to progress
more favorably, when no attempt at immobilization of the affected member
is attempted.
If some freedom of movement is allowed, acute inflammation resulting in
nature's provisional swelling soon develops and repair is hastened
because of increased vascularity. But where luxation of phalanges
accompanies sprain, reposition and immobilization are necessary--that is
if cases are thought likely to benefit by any treatment.
Luxations--Dislocations.
Luxation or dislocation is a condition where the normal relation between
articular ends of bones has been deranged to the extent that partial or
complete loss of function results. When a bone is luxated (out of
joint), there has occurred a partial or complete rupture of certain
ligaments or tendons; or a bone may be luxated when an abnormal or
unusual elasticity of inhibitory ligaments or tendons obtains.
Luxations may be practically classified as _temporary_ and _fixed_. In
temporary luxations, disarticulation is but momentary and spontaneous
reposition always results; while a fixed luxation does not reduce
spontaneously but remains luxated until reposition is effected by proper
manipulation and treatment. Fixed luxation may be of such character as
to be practically irreducible because of extensive damage done to
ligaments or cartilage. Where a complete luxation of the
metacarpophalangeal joint exists, it is probable that in most cases
sufficient injury to collateral and capsular ligaments has been done to
render complete recovery improbable, if not impossible.
Temporary luxation of the patella is a common affection of the horse and
fixed luxation of this bone also occurs. As a matter of fact, in the
horse, patellar luxation is the one frequent affection of this kind.
As a rule, complete disarticulation immobilizes the affected joint and
in most instances there is noticeable an abnormal prominence in the
immediate vicinity--in patellar luxation, the whole bone. In other
instances the articular portion only, of the affected bone is
malpositioned. Usually, luxation and fracture may be differentiated in
that there is no crepitation in luxation and more or less crepitation
exists in fracture.
It is evident, when one considers the symptomatology and nature of the
affection, that fixed luxation is usually caused by undue strain or
violent and abnormal movement of a part. Joints having the greater
freedom of movement are apt to suffer luxation more frequently.
Arthritis.
The study of arthritis in the horse is limited to a consideration of
joint inflammations which, for the most part, are of traumatic origin.
Unlike the human, the horse is not subject to many forms of specific
arthritis--tubercular, gonorrheal, syphilitic, etc.
A practical manner of classification of arthritis is _traumatic_ and
_metastatic_.
_Traumatic arthritis_ may result from all sorts of accidents wherein
joints are contused. Such cases may be considered as being caused by
direct injuries. Instances of this kind, depending on the degree of
insult, manifest evidence of injury which ranges from a simple
synovitis to the most active inflammatory involvement of the entire
structure and adjacent tissues.
The reactionary inflammation which attends a case of tarsitis caused by
a horse being kicked is a good example of the result of direct injury.
Such cases, if the contusion is of sufficient violence, result in
arthritis and periarthritis. In inactive farm horses, during cold
weather, this condition becomes chronic, swelling remains for weeks
after all lameness and pain have subsided and occasionally hyperthrophy
is permanent.
Arthritis occasioned by indirect injury, such as characterizes joint
inflammation from continuous concussion, is seen in horses that are
worked at a rapid pace on city streets or other hard road surfaces. Such
affections may be acute, as in some cases of spavin, but are usually
inflammatory conditions that do not occasion serious disturbance when
these affections become chronic. If the involvement persists with
sufficient active inflammation, there may follow erosion of cartilage
and incurable lameness. If extensive necrosis of cartilage takes place,
the attendant pain will be sufficient to cause the animal to favor the
diseased part and such immobilization enhances early ankylosis--nature's
substitute for resolution in this disease.
Wounds invading the tissues adjacent to joints, when these wounds are of
considerable extent, cause inflammation of such articulations by
contiguous extension of inflammation. As long as an injury remains
practically aseptic, or if infected and the septic process does not
involve the joint proper by direct extension, no more serious
disturbance than a simple synovitis will result. If, instead, a
periarthritic inflammation is serious or destructive in character, the
type of arthritis will be grave--even though due to an indirect cause.
Where a vulnerant body penetrates all structures and invades the
interior of the joint capsule the result is that a more or less active
disturbance is incited. The introduction of a sterile instrument into a
joint cavity, under strict asepsis, where a perfect technic is executed,
does not cause perceptible manifestation of the injury, if the opening
so made is small--such as a suitable exploratory trocar makes. But a
puncture made in a similar manner and with the same instrument without
due regard to asepsis is likely to cause an infectious synovitis and
arthritis usually follows.
A larger opening than is produced by means of an exploratory trochar may
be made into a joint cavity, causing escape of synovia as it is secreted
for days and even for weeks and no serious or permanent trouble is
experienced in some cases. If the synovitis or arthritis remains
non-infected and the wound, traumatic or surgical, is not too large,
healing by granulation occurs, and the discharge of synovia ceases.
However, if synovial discharge persists too long because of tardy
closure of an open joint, there is great danger of infection gaining
entrance into the synovial cavity, or in some instances, desiccation of
endothelial cells of the articulation occurs, in areas, and the
reactionary inflammation eventually results in ankylosis.
A small puncture which introduces into the synovial cavity infectious
material of active virulence will cause an arthritis that is more
serious, much more painful and more difficult to handle than is
occasioned by a wound of moderate size, that affords ready escape of
synovia even through the virulence of the infection be the same.
Synovia is a good culture medium and the environment is ideal for
multiplication of bacteria; consequently, the grave disturbances which
may attend the introduction of pathogenic organisms into a synovial
cavity as the result of a puncture wound are not to be forgotten. The
veterinarian is in no position to estimate the virulency of organisms so
introduced; neither can he determine the exact degree of resistance
possessed by the subject in any given case. Therefore, he is uncertain
as to the best method of handling such cases where an injury has been
recently inflicted and positive evidence of the existence of an
infectious synovitis is not present. If one could determine in advance
the degree of infection and injury that is to follow small penetrant
wounds of joint capsules, it would then be possible to select certain
cases and immediately drain away all synovia and fill the cavity by
injection with suitable antiseptic solutions.
This offers a broad field for experimentation which will in time be
productive of a radical change in the manner of treating such cases.
_Metastatic arthritis_ is seen more frequently in colts or young animals
than in mature horses and we here take the liberty of classifying with
the arthritis of omphalophlebitis and strangles the so-called rheumatic
variety.
A specific polyarthritis or synovitis which attends navel infection of
foals is perhaps the most frequent form of arthritis that is to be
considered metastatic. This condition is truly a disease of young
animals and, while it is a specific arthritis, the cause is yet to be
attributed to any definite pathogenic organism with certainty. This
condition is well defined by Bollinger as quoted by Hoare,[1] when he
calls it a purulent omphalophlebitis due to local infection of the
umbilicus and umbilical vessels, by pyogenic organisms, causing a
metastatic pyemia.
This affection is grave; its course is comparatively brief; the
prognosis is usually unfavorable; and omphalophlebitis occasions a form
of lameness which at once impresses the practitioner that serious
constitutional disturbance exists. Its consideration properly belongs to
discussions on practice or obstetrics and diseases of the new born, and
it has received careful attention and is discussed at length in these
works.
A second form of metastatic arthritis is met with in strangles.
Strangles occurs in the young principally and is not a frequent cause of
synovitis or arthritis in the adult animal.
Strangles or distemper is, according to most pathologists, due to the
Streptococcus equi. Hoare[2] states that in this type of specific
arthritis the contagium is probably carried by the blood. He gives it as
his opinion that even laminitis has occurred as a result of the
streptococcus-equi. This, indeed, would point toward probable extension
by the blood as well as by way of lymph vessels.
Septic synovitis and infectious arthritis are always serious affections
even in young animals and much depends upon individual resistance and
early rational treatment in such cases, if recovery is to follow.
The same general plan of treatment is indicated in this kind of septic
synovitis as is employed in all cases of infective synovitis and septic
infection in open joints. There is to be considered, however, the fact
that the young animal is more agile, a better self-nurse, and in a
general way more apt to recover than is the adult, under similar
conditions.
_Rheumatic arthritis_, if one is justified in classifying rheumatic
inflammation of joints as a metastatic form of arthritis, is not a
common condition, though seen in mature and aged animals. Cases that may
be diagnosed with certainty are usually advanced affections wherein
dependable history is obtainable and the symptoms are well marked.
Rheumatism may be thought of, with respect to arthritic inflammation
caused thereby, as a sort of pyemia. Undoubtedly, exposure to wet and
cold weather is an active factor, but probably a predisposing one only.
Likewise a member that suffers from chronic inflammation due to
recurrent injury or to constant or repeated strain is less able to
resist the vicissitudes of climate and work.
Consequently, rheumatic arthritis is to be seen affecting horses that
are in service, more often at heavy draft work where they are exposed to
severe straining of joints; where stabling is insanitary; and where they
are obliged to lie down (if they do not remain standing) upon cold and
wet ground or upon hard unbedded floors or paving.
Where such inhumane and cruel treatment is given animals those
responsible ought to be impressed with the unfairness to the animal as
well as the economic loss occasioned by inflicting such unnecessary and
merciless treatment upon their helpless and uncomplaining subjects. The
very nature of the veterinarian's work affords him constant and frequent
opportunity to convince those who are responsible for keeping animals in
this manner, that it is inhumane and unprofitable.
Cases of this kind are not uncommon about some grading and lumbering
camps and in contract work where, often, shelter for animals is given
little thought; the result is a cruel waste of horseflesh.
Chronic articular rheumatism is occasionally observed in young animals
that have never been in service. In these cases it seems that there
exists an individual susceptibility and in some instances the condition
is recurrent. Each attack is of longer duration, and eventually death
results from continued suffering, emaciation and intoxication.
AFFECTIONS OF BURSAE AND THECAE.
Acute bursitis and thecitis is of frequent occurrence in horses because
of direct injury from contusion, punctures and other forms of
traumatism. These synovial membranes, with few exceptions, when inflamed
occasion a synovitis that may be very acute, yet there is less
manifestation of pain than in arthritis.
It is only in structures such as the bursa intertubercularis or in the
sheath of the deep digital flexor that an inflammation causes much pain
and is apt to result in permanent lameness. This is due to the peculiar
character of the function of such structures.
An acute inflammation of a small bursa may even result in the
destruction of such synovial apparatus without serious inconvenience to
the subject, either at the time of destruction or thereafter.
Obliteration of the superficial bursa over the summit of the os calcis
is not likely to cause serious inconvenience or distress to the subject
unless it be due to an infected wound. Even then, with reasonably good
care given the animal, recovery is almost certain. Complete return of
function of the member and cessation of lameness takes place within a
few weeks in the average case.
Where an infectious synovitis involves a structure such as the sheath of
the tendon of the deep digital flexor (perforans) the condition is grave
and because of the location of this theca the prognosis is not much more
favorable than in an articular synovitis.
Inflammation of bursae and thecae may be classified on a chronological
basis with propriety because the duration of such affections, in many
cases, materially modifies the result. A chronic inflammatory
involvement of a theca through which an important tendon plays may cause
adhesions to form. Or there may occur erosions of the parts with
eventual hypertrophy and loss of function, partial or complete.
However, in general practice a classification on an etiological basis
is probably more practical and we shall consider inflammation of bursae
and thecae as _infectious_ and _noninfectious_.
_Infectious_ bursitis and thecitis is usually the result of direct
introduction of septic material into the synovial structure by means of
injuries. Infection by contiguous extension occurs and also metastatic
involvement is met with occasionally.
The noninfectious inflammation of bursae and thecae usually result from
contusions or strains and generally run their course without becoming
infective in character, where vitality and resistance of the subject are
normal.
In a general way, inflammation and other affections of bursae and thecae
are considered very similar to like affections of joints.
AFFECTIONS OF MUSCLES AND TENDONS.
Muscles and tendons having to do with locomotion are more frequently
injured than are any of the other structures whose function is to propel
the body or sustain weight. This is due in part to the exposed position
of muscles and tendons. They serve as a protection to the underlying
structures and in this manner receive many blows the force and violence
of which are spent before injury extends beyond these tissues.
Muscles of the breast, shoulder and rump are most frequently the
recipient of injuries of various kinds. The abductors of the thigh are
subjected to bruising when horses are thrown astride of wagon poles or
similar objects. Thus in one way or another muscle injuries are
occasioned and cause lameness.
Traumatic affection of muscles of locomotion may be surface or
subsurface--subsurface with little injury done the skin and fascia, but
with subsurface extravasation of blood and masceration of tissue.
Puncture wounds wherein the vulnerant body is of small diameter, are
observed, and they occasion deep seated infectious inflammation of the
parts affected, with surface wounds that are often unnoticeable. Such
injuries--puncture wounds--are always serious, and because of the fact
that, there exists little evidence of injury at the time of their
infliction, treatment is usually deferred several days and often
infection has become quite extensive when the practitioner is consulted.
Where infective wounds of muscles of locomotion occur, the course and
gravity of the affection are directly influenced by the proximity of the
injury to lymph plexuses. For instance, injuries causing an infectious
inflammatory involvement of the adductors of the thigh may result in a
generalization of the infection by way of the inguinal lymph glands.
Large open wounds that extend deep into muscles, render inactive such
structures, and even where division is not complete, the pain occasioned
causes the subject to favor the part in every way possible. Contraction
of muscular fibers of such parts increases pain and because of this fact
groups of muscles are at times disabled because of injury done to one
muscle. Instances of this kind are frequently seen where shoulder
injuries, which affect but one muscle, exist; yet because of such injury
a marked swinging-leg lameness is present.
Tendons, because of their inelasticity, are subjected to injuries
peculiar to themselves. In addition to being affected as are muscles,
wounds of many kinds are found to affect tendons--contusions,
interference wounds, penetrant wounds, incised wounds and lacerations.
However, the commoner form of injury done tendons, is strain or sprain.
Because of the sudden tensile strain brought to bear upon tendons in the
shocks of concussion, as well as in propulsion of the body, there
frequently occurs a rupture of fibers and this we know as sprain.
Sprains may be considered as fibrillary fractures of soft structures and
since this form of injury is subsurface, and limited to fractional
portions of tendons, the inflammation occasioned usually remains an
aseptic one. Reaction to this form of injury is characterized by
inflammation, the course of which is erratic and variable. In chronic
inflammation of tendons, where animals are continued in service, the
usual sequel is contraction, or shortening of these structures.
The degree of contraction as well as its import varies in different
subjects and in the various tendons which may be affected. Contraction
is a slow-going process that is progressive, gradually causing a
decrease in the length of the affected structure and eventually
rendering the animal useless.
The practice of applying shoes with extended toe-calks for the purpose
of "stretching" contracted deep digital flexor tendons (flexor pedis
perforans) cannot be too strongly condemned. While the addition of an
extension such as is ordinarily employed to the toe of a shoe of this
kind, prevents for a time, frequent stumbling in such cases, the
increased tensile strain which is thus occasioned hastens further
contraction and subjects animals so shod to much unnecessary pain.
AFFECTIONS OF NERVES.
Because of their being protected by other structures, nerve trunks,
which supply muscles of locomotion, are not subjected to frequent
injuries such as contusions. However, they do become injured at times
and the result is lameness, more or less severe.
Lameness originating from nerve affection, may involve central
structures as, for example, the spinal cord, medulla oblongata or parts
of the brain. In making an examination of some lame animals it is
necessary to distinguish between cases of lameness that are of central
origin and marked by incoördination of movement, and disturbances caused
by other affections. Tetanus in its incipiency should not be confused
with laminitis involving all four feet, or with certain forms of
pleuritis, when careful examination is made, yet, in a way, to one not
trained, the clinical symptoms are similar.
Disturbances of nerve function are caused in a variety of ways. It is
not within the scope of this work to discuss central nervous
disturbances caused by ingestion of mouldy provender, or disturbances of
the brain or cord occasioned by infectious diseases, but mention of the
existence of such conditions is appropriate.
By direct injury the result of blows, certain nerves are injured and
muscles supplied by such nerves are rendered inactive. Depending upon
the nature and extent of an injury thus inflicted, so the manner in
which the affection is manifested varies. The suprascapular nerve is
rather frequently injured causing partial or complete loss of function
of the structures supplied by this nerve, and abduction of the
scapulohumeral joint naturally results.
In some cases of dystocia the obturator nerve, (or nerves, if the
involvement is bilateral), becomes injured by being caught between the
maternal pelvis and some dense part of the fetus. This results in
paralysis of the adductors of the thigh if sufficient injury is done.
It is said that nerves become over-stretched and held tense, in certain
positions in which animals are obliged to remain while cast in
confinement such as in some instances where unusual methods of restraint
are employed. When the fore feet are drawn backward in such manner that
great strain is put upon the radial nerve, it suffers more or less
injury, and this is followed by partial or complete paralysis which may
be temporary or permanent.
Degenerative changes affecting nerves, as in other tissues, occur and
more or less locomotory impediment will follow--this depending upon the
nerve or nerves affected and the nature of such involvement. Tumors may
surround nerves and eventually the nerve so exposed becomes implicated
in the destructive process. Before degenerative changes take place in
the nerve substance, in such cases, pressure may completely paralyze a
nerve when it is so situated. Melanotic tumors in the paraproctal tissue
in some cases, because of the large size of the new-growths, cause
paralysis of the sciatic nerve. The author has seen one case of brachial
paralysis occasioned by an enormous development of fibrous tissue
involving the structures about the ulna.
AFFECTIONS OF BLOOD VESSELS.
Lameness caused by disturbances of circulation may be due to structural
affection of vessels, or functional disorders of the heart, and in some
instances, a combination of these causes may be active.
Direct involvement of vessels is the commoner form of circulatory
disturbance which occasions lameness, and the most frequent cause is of
parasitic origin. Sclerostomiasis with attendant arteritis, thrombus
formation and subsequent lodgement of emboli in the iliac, femoral, or
other arteries, causes sufficient obstruction to prevent free
circulation of blood, and the characteristic lameness of thrombosis
results.
Indirect injury to vessels may occur because of contused wounds and
subsequent inflammation of tissues supplied by such vessels. If the
injury be of sufficient extent, considerable extravasation of blood will
take place and the painfully swollen parts necessarily impair
locomotion. In such instances lymph vessels participate in the
disturbance, and the condition then becomes one wherein lymphangitis is
the predominant disturbing element.
Angiomatous tumors are occasionally found affecting horses'
legs--usually the result of some injury; and because of their size or
position, they mechanically interfere with function. Furthermore, when
such tumors are located on the inner or flexor side of joints, enough
pain is occasioned that affected animals show evidence of distress,
usually by intermittent lameness.
Horses do not suffer from distension of veins as does man, that is,
there is rarely to be seen a case wherein much disturbance from this
source exists.
AFFECTIONS OF LYMPH VESSELS AND GLANDS.
Inflamed lymph vessels and glands, the result of various causes, is a
rather common source of lameness of horses. When one considers the
proportion of tissue that is composed of lymph vessels and glands, it is
then obvious that inflammation of these structures should cause a
painful affection of members, when so affected, and that marked lameness
and, in some instances, general constitutional disturbance such as
anorexia, hyperthermia and general circulatory disorder are to follow.
Lymphangitis is most frequently occasioned by the introduction of septic
material into the tissues; consequently, infectious lymphangitis is more
frequently observed than the non-infectious type.
Specific infectious forms of lymphangitis are seen in glanders and in
strangles; infectious types of this disturbance are found in many
instances where, initially, a localized or circumscribed infection has
occurred--the contagium having been introduced by way of an injury. An
example of this kind is to be seen in a wound perforating the tibial
fascia, where the injury is inflicted by means of a horse being kicked
by another animal shod with sharp shoe-calks. Cases of this kind
invariably result in a septic lymphangitis, and frequently lymphadenitis
also occurs, for the inguinal lymph glands are so situated that their
becoming contaminated is almost certain.
The trite phrase that "the tissues are bathed in lymph" should make
clear the reason for the frequent occurrence of infectious lymphangitis
and lymphadenitis. Foreign substances, bacteria and their products,
inorganic material and in fact, anything that is introduced into the
tissues, if soluble or miscible, will be taken up and conveyed by the
afferent lymph vessels and disseminated throughout the system--hence the
constitutional disturbances so frequently thus caused.
A non-infectious type of lymphangitis is frequently seen in the heavy
draft breeds of horses and in such cases one or both hind legs are
involved--it is very seldom that the thoracic limbs become so affected.
Law[3] refers to this ailment as "Acute Lymphangitis of Plethora in
Horse." When one takes into consideration that these cases so frequently
occur in heavy draft animals that are not worked regularly, that the
pelvic limbs are the ones involved, and that the disorder often runs a
short course (recovery often taking place within two or three days, with
no treatment given other than a purge, circulatory stimulants and
walking exercise) it is plausible to ascribe the condition to idiopathic
factors.
Admitting the frequency of non-infectious lymphangitis, the practitioner
must not confuse this type with similar lymphatic inflammation
occasioned by nail punctures of the foot. It is very embarrassing indeed
to make a diagnosis of lymphangitis--expecting that the disturbance will
terminate favorably and uneventually--and later to discover a sub-solar
abscess caused by a nail prick in the region of the heel.
Recurrent attacks of this disturbance cause hypertrophy of the lymph
vessels and in some cases lymphangiectasis. In old subjects used for
dissection or surgical purposes, it is very evident that in the ones
which have suffered from chronic lymphangitis there exists an excessive
amount of sub-facial connective tissue, making subcutaneous neurectomies
quite difficult in some instances.
A sequel of chronic lymphangitis is a condition known as elephantiasis.
In such cases there occurs a hyperplasia of the skin and subcutaneous
tissues, resulting in some instances, in the affected member attaining
an enormous size. Sporadic cases of this kind are to be seen
occasionally, and are apparently caused by repeated attacks of
lymphangitis. The affection is not benefited by treatment, and while a
horse's leg may become so heavy and cumbersome as to mechanically impede
its gait, as well as to fatigue the subject when made to do service even
at a slow pace, elephantiasis causes no constitutional derangement. The
hind legs, in elephantiasis, are affected and a unilateral involvement
is more often seen than a bilateral one. The legs may be enlarged from
the extremity to the body, but ordinarily the affection does not extend
higher than the hock or the mid-tibial region.
A chronic, progressive, hyperplastic-degeneration exists in some cases
and the subjects are in time rendered unserviceable because of the
burden of getting about encumbered by the affected extremity. In other
animals hyperplasia progresses for a time--until the parts become
greatly enlarged and conditions apparently attain an immutable state.
Nevertheless animals so affected may continue in service for years
without being distressed.
AFFECTIONS OF THE FEET.
Lameness is very often due to affections of the feet, and in all foot
diseases probably the most constant cause is injury inflicted in some
manner. Resultant from injury, there frequently develops complications
and the one most often seen is infection.
Because of the fact that the feet are constantly exposed to germ-laden
soil and filth, if not actually bathed in such infectious materials, it
naturally follows that septic infection of some part of the feet must be
of frequent occurrence.
Subsequent to being obliged to stand in mud and other damp or wet media,
exposure to desiccating influences such as stabling upon dry floors, or
at service on hot and dry road surfaces causes the insensitive parts of
the feet to become dry, hard and brittle. This favors "checking" of the
protecting structures and it frequently results in the formation of
large fissures which expose the underlying sensitive parts of the feet
and lameness is the inevitable outcome.
The function of the feet--bearing the weight of the animal at all times
when the subject is not recumbent, and in addition to this, the
increased strain put upon them at heavy draft work, together with the
concussion and buffeting occasioned by locomotion, make the feet
susceptible to frequent affections of various kinds.
Being almost completely encased by a somewhat inexpansible and
insensitive wall and sole, renders the foot subject to pathologic
changes peculiar to itself. The very nature of the structure of the foot
together with the function of the sensitive lamina is sufficient cause
for an affection unlike that seen involving other tissues--laminitis.
An exhaustive consideration of foot affections is a study in itself and
one that comes within the realm of pathologic shoeing; nevertheless, a
practical knowledge of diseases of the foot is indispensable in the
diagnosis of lameness wherein the foot may be at fault.
The peculiar nature of foot affections renders them difficult of
classification on any sort of basis that is helpful in the consideration
of this subject. Injuries are the most constant cause of foot lameness,
yet one must admit that there results complications because of infection
in most instances; and that in some cases the injury is slight--just
enough to permit the introduction of vulnerant organisms into the
tissues. Therefore, one might well classify affections of the feet as
infectious and non-infectious. There can be grouped in the class of
infectious affections such conditions as nail pricks, calk wounds and
canker. In the class of non-infectious affections one may consider
conditions such as laminitis, strain and fractures.
FOOTNOTES:
[Footnote 1: A System of Veterinary Medicine by E. Wallis Hoare,
F.R.C.V.S., Vol. I, page 519.]
[Footnote 2: Ibid, page 807.]
[Footnote 3: Vol. I, page 534, Veterinary Medicine, by James Law,
F.R.C.V.S.]
SECTION II.
DIAGNOSTIC PRINCIPLES.
_To observe attentively is to remember distinctly._--_Poe_.
Before treatment is administered in constitutional disturbances
resulting in disease, _cause_ is logically sought; so, in order to
handle effectively any case of lameness, it is necessary first to
discover the source of the trouble and contributing conditions affecting
the structures. Hence, diagnostic ability is the prime requisite; and a
thorough knowledge of pathologic anatomy or of surgical technic is of
little value if this knowledge is not applied with the insight of the
trained diagnostician.
The cruel and unnecessary methods employed by those untrained for
diagnostics, cannot be too vigorously condemned. For instance, the
application of an active and depilating vesicant upon a large area on
the gluteal or crural region, in a case where the practitioner "guesses"
the condition to be one of "hip lameness," constitutes an exposition of
gross ignorance, and at once stamps the perpetrator as a crude bungler
without scientific insight whose works are no credit to his profession.
How much better it would be, if the practitioner does not see fit to
call in a competent consultant, to prescribe a suitable agent to be
given internally, and to recommend complete rest for the subject.
In establishing a diagnosis in such cases, the student or practitioner
seldom has recourse to laboratory assistance, and his work is done by
means of physical examination; therefore, a thorough knowledge and a
clear conception of the physiology of locomotion are essential.
Memorizing nosological facts without an understanding of underlying
principles is of no more practical benefit for qualification as a
diagnostician in cases of lameness, than is the employment of similar
methods in the study of theory and practice. A knowledge of the dosage
of drugs does not in itself qualify one as being competent to administer
such therapeutic agents to a proper effect. How much is a practitioner
benefited by the knowledge that a high temperature is usually present in
septic intoxication, if he is not possessed of a scientific
understanding of anatomy, physiology, bacteriology and pathology, as
well as the principles of clinical diagnosis?
In order to determine the reasons for certain symptoms manifested by the
subject, an analysis of these symptoms is the proper method of
procedure, insofar as this is possible. If one may reason that an animal
assumes a certain position while at rest to allow relaxation of an
inflamed tendon or ligament, such a fact enables the diagnostician to
recall that this is indicative of some specific ailment. In acute
tendinitis, the subject while at rest, maintains the affected member in
volar flexion because this position permits relaxation of the inhibitory
apparatus, including the inflamed tendon. Likewise, the various abnormal
positions assumed,--adduction, abduction, undue flexion or
pointing--have their own significance and are taken into account by the
trained diagnostician in the course of an examination.
In the examination of lame subjects, where the cause is not obvious, a
systematic method of diagnosis is pursued even by the most expert
practitioners. In all obscure cases of lameness a methodical and
thoroughly practical examination of the animal according to an
established procedure is necessary to determine the nature and source of
the affliction.
Anamnesis.
The first thing to be given consideration in diagnosis is the fact that
related history of the case is not always dependable, because of lack of
accurate observation or wilful deceit on the part of the owner or
attendant. The successful veterinarian soon acquires the faculty of
obtaining information in a manner best adapted to his client,--either by
direct interrogation or by subtle means of suggestion, and in this way
he draws out evaded facts essential to his diagnosis. In time he learns
to make allowance for misstatements made to shield the owner or driver
and to hide the facts of apparent neglect or abuse that the subject may
have experienced. A suppurating cartilaginous quittor, complicated by
the presence of a large amount of hyperplastic tissue, cannot be
successfully represented to be an acute and recently developed
affection, where a trained practitioner is left to judge the validity of
the statement.
In complicated conditions, where there is evident a chronic disturbance
which could not be conceived as sufficient cause for a marked
manifestation of lameness, accurate history of the case may be of great
aid in arriving at a diagnosis. An aged animal, having recently become
very lame, showing a small exostosis on the first phalanx, and with the
history given that the osseous deposit was of long standing, should at
once lead the veterinarian to seek the source of trouble elsewhere.
Visual Examination.
As in all diagnostic work, a careful visual examination of the subject
should be made before it is approached. The novice is given to hasty
examination by palpation, not realizing how much may be revealed by a
careful scrutiny of the subject. In this way he is led to erroneous
conclusions which the skilled diagnostician has learned from experience
to avoid. _Too much emphasis cannot be placed on the importance of
making a thoughtful visual examination in every instance before the
subject is approached._ In this examination, type, conformation and
temperament are taken into account at once, for each of these qualities
is in itself, a determining factor in predisposing a subject to certain
ailments or inherent attributes, which may exert a favorable or
unfavorable influence upon existing conditions and thus make recovery
probable or otherwise.
Draft animals are less likely to be permanently incapacitated as a
result of tendinitis, than are thoroughbreds. Likewise, one would not
expect to find this affection present in heavy harness horses as
frequently as in light harness animals.
Mal-formation of a part, or an asymmetrical development of the body as a
whole, may render an animal susceptible to certain affections which
cause lameness. A "tied in" hock predisposes the subject to curb, and an
animal having powerful and well-developed hips and imperfectly formed
hocks, will, if subjected to heavy work, be a favorable subject for bone
spavin.
The matter of temperament cannot be disregarded in diagnosis, for in
some instances, it is the chief determining factor which materially
influences the outcome of the case. A nervous, excitable animal, that is
kept at hard work, may, under some conditions, be expected to experience
disturbances which more lethargic subjects escape. Nervous subjects, it
is known, are more prone to azoturia than are those of lymphatic
temperament. Furthermore, the lymphatic subject often recovers from
certain bone fractures which are successfully treated only when the
animal is sufficiently resigned by nature to remain confined in a sling
for weeks without resistance.
The physiognomy of a subject is often indicative of the gravity of its
condition. The facial expression of an animal suffering the throes of
tetanus, azoturia, or acute synovitis, is readily recognized by the
experienced eye, and upon physiognomy alone, in many instances, may the
opinions regarding prognosis be based. Particularly is this true where
death is a matter of minutes, or at most is only a few hours distant.
Due allowance should be made for restiveness manifested by some more
nervous animals when the surroundings are strange and unusual. In such
instances, even pathognomic symptoms may be masked to the extent that
little, if any, sign of pain or malaise is evinced. In these cases the
subject should be given sufficient time to adjust itself to the new
environment, or it should be removed to a more suitable place for
examination. Animals quickly detect the note of friendly reassurance in
the human voice and can very often be calmed by being spoken to.
By visual examination one may detect the presence of various swellings
or enlargements, such as characterize bruises and strains of tendons
where inflammation is acute. Inflammation of the plantar
(calcaneocuboid) ligament in curb is readily detected when the affected
member is viewed in profile. Spavin, ringbone, splints, quittor and many
other anomalous conditions may all be observed from certain proper
angles.
The fact that the skins of most animals are pigmented and covered with
hair, precludes the easy detection of erythema by visual examination,
consequently this indicator of possible inflammation is not often made
use of in the examination of equine subjects.
Attitude of the Subject.
The position assumed while the subject is in repose, is often
characteristic of certain affections and this, of course, is noted at
once. The manner in which the weight is borne by the animal at rest,
should attract the attention of the diagnostician and if the attitude of
the subject is abnormal or peculiar, the examiner tries to determine the
reason for it. If weight-bearing causes symptoms of pain, the affected
member will invariably be favored and held in some one of a number of
positions. The foot may contact the ground squarely and yet the leg may
remain relaxed and free from pressure; volar flexion, in such cases, is
indicative of inflammation of a part of the flexor apparatus. If the
condition be very painful, position of the afflicted member is
frequently shifted, but in all cases where the pain is not so keenly
felt, the inflamed member is held in a state of relaxation. There is
need then, for a knowledge of anatomy and certain principles in physics
to enable the observer to determine just which structures are purposely
eased in this manner. Where palpation of parts is possible, one does not
need to depend on visual examination alone, and it is always wise to
take into consideration every factor that may influence conditions.
Manipulation or palpation of the structures thought to be involved,
should not be resorted to until a careful and thorough observation of
the subject has revealed all that it can reveal to the diagnostician.
In all conditions where extreme pain is manifested by the constant
desire of the animal to keep its foot in motion off the ground,
examination should be made for local cause. This is seen in certain
septic inflammations of the feet such as those caused by nail punctures
invading the navicular joint, or in newly made wounds where nerves have
been divided and the proximal end of such a nerve is exposed to pressure
or irritation.
"Pointing" affords a comfortable position in some cases of navicular
disease, and in a unilateral affection, one may observe the subject
bearing weight with one sound member, while the affected foot is planted
well ahead of the sound one. In a bilateral involvement of this kind,
weight may be frequently shifted from one foot to the other, or in
chronic cases, where no marked pain is experienced, the subject stands
squarely upon both front feet and no peculiar shifting of weight or
pointing is evident.
In some cases of hip or shoulder involvement, complete relaxation of all
parts of the affected member may be noticed. In brachial paralysis, the
pectoral member is held limply; if the patient is made to move, it is
evident there is lack of innervation to the afflicted part. In some
cases where contusion has caused acute inflammation of the member, the
subject instinctively tries to keep it inactive to relieve the pain
which movement occasions.
Where there is an active and painful inflammation of the prescapular
lymph glands and contiguous structures, in some cases of "levator-humeri
abscess," the scapulohumeral joint is extended. This is brought about by
flexion of the elbow and carpal joints.
There are some cases of bi-lateral affections which occasion such pain
during weight-bearing that the subject shifts its weight from one
affected leg to the other; an example of this condition may be observed
in any acute case of gonitis which affects both patellar regions, making
it equally painful to bear the weight on either member.
A peculiar characteristic position is assumed in acute laminitis of the
fore feet. In such instances, the hind feet are brought forward under
the body sufficiently to relieve the front feet of the weight, insofar
as is possible by the abnormal position taken in cases of acute
laminitis.
So in each position that is abnormal to any degree, assumed by a
suffering animal, there may be deduced, the fact that the subject is
attempting to relieve the affected structures, and in each clinical
picture of this kind, the trained diagnostician sees some index to the
nature and source of the trouble. Further examination is rendered more
effective because of this preliminary visual examination which has
precluded the unnecessary annoyance of the animal by manipulating
unaffected structures.
It has been presupposed in the foregoing, that the one making visual
examination of a lame animal for diagnostic purposes, will remember that
with the normal animal the weight is borne equally well with both fore
legs; and that this is done without shifting from one to the other; and
that the pelvic limbs do not support the body in this manner. Normal
subjects shift their weight from one hind leg to the other and the one
relaxed, rests in a state of flexion with the toe on the ground and the
heel raised.
Examination by Palpation.
In nearly every case where lameness exists an examination of the
affected parts, by palpation or by digital manipulation, is necessary
before an accurate conclusion may be drawn; but in making this kind of
an examination one needs to exercise good judgment lest he fail to
acquire a correct impression of the actual existent conditions. There is
need for the diagnostician, here, as well as in other conditions where
physical examination is made, to approach the subject in a manner that
will not excite or disturb to the extent that the animal will, in one
way or another, resist or object to the approach of the diagnostician,
thereby masking the symptoms sought. The practitioner would best acquire
skill as a horseman--if he is not possessed of such--and handle each
individual subject in the manner calculated to best suit the temperament
of the animal examined. The unbroken subject is not handled as
satisfactorily as is the intelligent family horse; in the former, in
some cases, little dependence is placed upon digital examination.
By palpation one is enabled to recognize hyperthermia and this, _in
lieu_ of dependable history, is at times sufficient evidence upon which
to determine the duration of any given inflammatory affection.
By comparison of different parts of the same member or with an analogous
portion of another member any marked increase in the apparently normal
temperature of a part at once signalizes inflammation. In this manner,
in examining a case where laminitis or other inflammation of the feet is
suspected, one may arrive at a fairly accurate conclusion without the
employment of other means. Throbbing vessels are not always easily
recognized if the subject is a victim of chronic lymphangitis.
In some instances, where a moderate degree of lameness exists and cause
is apparently obscure, the recognition of hyperthermia may be the
deciding factor in establishing a diagnosis. In cases of sprained
ligaments in the phalangeal region, because of the dense character of
the structures involved, little if any evidence of the cause of
lameness, other than local heat, may be found twenty-four hours after
the injury has been inflicted.
In order to determine the amount or extent of hyperthermia with a fair
degree of accuracy in any given case, one must make due allowance for
external conditions affecting temperature; also the effect of a
considerable amount of hair covering an area, as well as any possible
dirt contacting the surface of the skin must be taken into account. All
dirt should be removed if practicable, so that the diagnostician's palms
may come as nearly in contact with the inflamed structures as possible.
Then, too, the sense of touch if the operator's hands are chilled, is
not dependable. In such instances the novice will need to be deliberate
as to his findings--whether or not hyperthermia really exists. Such an
examination is of little value where the subject's feet are wet and an
examination is hurriedly made, as in cases of suspected laminitis.
Often, before being able to distinguish the presence of a hyperthermic
condition, one is impressed with the fact that an animal manifests
evidence of being supersensitive. In fact, some animals in the
anticipation of pain at the touch of an injured part, will instinctively
withdraw--in self-protection--such an ailing member or resist the
approach of the practitioner. This sensitiveness is more apparent in
animals that have been subjected to previous manipulation or treatment
which has occasioned pain, and consequently, allowance must be made for
this exhibition of fear. No better example of this condition can be
imagined than is present in cases of "shoe boil," where there exists an
extensive area of acute inflammation of the elbow. There is always more
or less surface disturbance wherever vesication has been produced, and
in cases where irritants of any kind have been employed for several days
or a week previous to an examination, more or less supersensitiveness is
to be expected.
One must not lose sight of the fact that unscrupulous
dealers,--"traders"--make use of their knowledge of this principle in
various way usually for the purpose of attracting attention to a part,
which, presumably might have been blistered in order to intentionally
produce inflammation of tissues, in this way, causing lameness which is
not manifested until an animal has been kept by its new owner for
twenty-four hours or more. This, to be sure, usually makes a
dissatisfied purchaser who is willing to dispose of his newly acquired
animal at a sacrifice, thus enabling the original owner or his agent to
regain possession of the victimized animal at less than its real value.
Some nervous animals, because of the manner of approach of the
practitioner, are wont to flinch, and there is manifested a
pseudo-supersensitiveness. Young animals not accustomed to being handled
are likely to be timorous, and one must not hastily conclude that a part
is painful to the touch because the subject resents even gentle digital
manipulation of such parts. In instances of this kind, one needs to
compare sensibility by manipulation of different parts of the subject's
body in a careful and gentle manner; and by exercising patience and good
judgment in such work, it is possible to actually distinguish between
normal sensibility and abnormal sensitiveness, in most cases. Here,
again, the diagnostician needs to possess skill as a horseman and good
judgment as to individual temperament of different animals, under any
condition which may exist at the time he makes his examination.
By palpation alone, one can recognize the presence of fluctuating
enlargements; one may not only recognize such conditions, but
distinguish between a fluctuating mass such as exists in
non-strangulated hernia and a large fibrous tumor. By palpation, for the
recognition of density and for determining the presence or absence of
hyperthermia, one may decide that there exists an abscess and not a
tumor. Edematous swellings are recognized by palpation,--the
characteristic indentations which may be made in dropsical swellings are
pathognomonic indicators. In this manner it is easy to differentiate
post-operative or post-traumatic edemas which may or may not cause
lameness. At any rate, it is essential to take into account all
determinate conditions that may assist in the prognosis of any given
case, for the purpose of being able to outline rational remedial
measures. To be able to distinguish between the generalization of a
septic infection in its incipiency, and a more or less benign edema, is
largely possible by digital manipulation alone. An extremity may be
greatly swollen because of the existence of chronic lymphangitis,
influenza, or an acute septic infection occasioned by the introduction
of pathogenic and aerogenic organisms. Since the effect produced by
these dissimilar ailments are productive of conditions that may
terminate favorably or unfavorably, it becomes necessary for the
diagnostician to develop a trained, discriminating, tactile-digital
sense, in order to correctly interpret existing conditions, and handle
cases in a rational and skillful manner.
In order to ascertain the extent and exact location of a tumor, an
exostosis, or other enlargements, the diagnostician, here also, needs to
be in possession of a trained tactile sense and in addition if he be
fortified with an accurate knowledge of normal anatomy and pathology, he
is able to arrive at proper conclusions, when digital manipulations have
been employed. Fibrous tumors are sometimes located in the inferior part
of the medial side of the tarsus--exactly over the seat of bone-spavin.
Such tumors, when the affected member is supporting weight, are not to
be distinguished from exostoses; but as soon as the affected leg ceases
to bear weight, it may be passively flexed and the nature of the
enlargement recognized because it may be slightly displaced by digital
manipulation. Displacement, of course, is not possible with an
exostosis.
A necessary qualification, which the diagnostician must possess, is that
of being able to judge carefully the nearness of any given exostosis to
articular structures. Also, the extent or area of the base of an
exostosis as well as its exact position, needs be determined before one
may estimate the probable outcome in any case,--whether treatment should
be encouraged or discouraged by the practitioner. Periarticular ringbone
may, because of the size and location of the exostosis, constitute a
condition which cannot be relieved in any way in one case, and in
another, because of the manner of distribution of such osseous
deposits, the condition may be such that prompt recovery will follow
proper treatment. In the examination of an exostosis of the tarsus, it
is particularly important to determine the exact location of the
exostosis--whether or not the spavin involves the tibial tarsal
(astragulus) bone very near its tibial articular portions. Obviously, if
articular surfaces of joints are involved, complete recovery cannot
result despite the most skillful attention given the subject.
Passive Movements.
Wherever it is possible to gain the confidence of a tractable animal to
the extent that it will relax the structures sufficiently to make
possible passive movement of affected parts, much is to be learned as a
result of such manipulation. By this method one may differentiate true
crepitation, false crepitation, luxation and inflammation of ligaments
that have been injured, as in sprains of such structures in the
phalangeal region.
_True crepitation_ is recognizable by the characteristic vibration which
is interpreted by tactile sense. It is possible to recognize fracture by
the use of other methods--auscultation, tuning fork tests, etc., but in
ordinary veterinary practice one must rely upon the sense of touch for
recognition of crepitation.
Where pain is not so great that relaxation of parts does not occur, one
can, by gently moving an extremity in various directions--as in flexion,
extension and lateral motion as well as by rotation--cause to be
manifested this peculiar grating,--the friction of newly broken bone.
This is known as _true crepitation_. Where the subject, suffering
phalangeal fracture, manifests evidence of pain due to tensing the
structures about a fractured part, one may anesthetize the parts by
using about two cubic centimeters of a two per cent. solution of cocain
upon the plantar nerves, proximal to the fracture. It is perhaps best to
deposit the cocain solution by means of two hypodermic punctures at
different points along the course of each nerve, though closely situated
to one another, thereby making more sure of the solution actually
contacting the nerve. In some multiple fractures of the first or second
phalanx this is quite necessary; otherwise, pain produced by passive
manipulation causes the subject to keep the tendons so tense that
crepitation may not be detected. The unnecessary infliction of pain is
always to be avoided.
We know as _false crepitation_ a vibrating impulse occasioned by normal
contact of articular portions of bones such as in the metacarpophalangeal
joint when this structure is passively moved, where the subject permits
the parts to remain in a state of complete relaxation.
Attempts to recognize supersensitiveness or inflammation by means of
passive movement of the shoulder or hip, whether gently or forcefully,
is not productive of good, in any case, in large animals. Because of the
bulk and weight of parts so manipulated, as well as the resistance the
subject offers even in normal cases, no accurate conclusion is to be
arrived at in this manner in the average instance. Animals nearly always
resist the placing of members in any position that is so unusual and
uncomfortable as that which is required to materially displace the
component tissues of the shoulder or hip; therefore, such practice is
useless because one can not distinguish between normal resistance and
flinching caused by painful sensations in injured parts. Such
manipulations are practical in small animals.
Observing the Character of the Gait.
In order to determine the degree of lameness as well as its character,
it is necessary to cause the subject which is being examined, to move in
some manner. The degree of inconvenience or distress experienced by a
lame animal that is being so examined is manifested by the character of
the claudication; and where much pain is occasioned in locomotion there
is disturbance of respiration; perspiration may be noticeable and in
some instances manifestation of nervous shock are very evident--this in
timid, nervous animals that anticipate being punished when approached
and, consequently, make every effort possible to move when urged to do
so. An animal, then, should be moved only sufficiently to cause it to
exhibit the degree of lameness present in any given case, and if a
marked impediment is manifested it is not necessary to cause the subject
to be exerted to the extent of inflicting, in such manner, unnecessary
punishment. Further or conclusive examination is made by palpation. To
cause the subject to move, an assistant may simply lead the animal with
a halter and compel it to walk a few steps. In this way, lameness,
whether manifested during the weight-bearing period of an affected
member, or when such a member is being advanced, or whether a
combination of the two conditions exists, is made apparent. In the words
of Dollar, one is thus enabled to recognize the existence of
"supporting-leg-lameness," "swinging-leg-lameness" or "mixed lameness."
When the cause of lameness is not strikingly apparent it becomes
necessary to have the subject moved farther than a few steps and at
different paces. Depending then, upon the character of lameness
manifested, as well as upon its degree of intensity, one needs to
exercise the subject in various ways, but this should not be overdone.
The first thing apparent in the lame subject in action, is the lame leg.
If this is not readily determinable, as in some complicated cases, the
leg or legs which are at fault are to be discovered by further
examination, and to do this,--word-pictures convey little that is
helpful in difficult cases,--long practice is the one route by which one
may become efficient; that is, by experience gained after fundamental
principles in the diagnosis of lameness have been mastered.
For a careful study of supporting-leg-lameness involving a fore limb,
the subject is driven or led _toward_ the one making such examination.
If a hind leg is to be observed, the animal is made to travel _away
from_ the examiner. Where there exists swinging-leg-lameness, the
subject should be caused to move past the diagnostician, so that he may
get a side view of the subject while it is in motion.
In every case such examinations are made to the best advantage if the
practitioner can view his patient from a little distance. Here, again, a
visual examination is made but this cannot be successfully executed, in
difficult cases, if the practitioner is stationed at too close range.
The average subject is best observed by being led, rather than being
ridden, and in so doing the animal should be given moderately free
rein. A close grasp on the lead may interfere somewhat with head
movements. Nodding of the head with the catching up of weight by a sound
member in supporting-leg-lameness of a fore leg, constitutes the chief
symptom considered in detecting the lame leg.
Where supporting-leg-lameness affects a hind limb the head is raised at
the time weight is caught by the sound member--here the long axis of the
subject's body may be likened unto a lever of the first class. The
posterior part of the body, at the time weight is taken upon the sound
leg, is as the long arm: the fore limbs the fulcrum, and the subject's
head the weight, which is lifted. The head movements of a horse at a
trot, in supporting-leg-lameness of a front leg, synchronize with the
discharge of weight from a lame leg to the opposite one if sound; but in
pelvic limb affections, the head is thrown or jerked upward as weight is
caught by the sound member,--this peculiar nodding movement is
_opposite_ in the two instances.
In pacing horses, since front and hind legs of the same side are
advanced at the same time, there occurs in supporting-leg-lameness, a
nodding of the head with discharge of weight from the lame leg, and a
dropping of the hip as weight is caught by the sound pelvic member. In
observing animals that are limping, (as in supporting-leg-lameness) one
notices particularly the sacro-iliac region in hind leg affections and
the occipital region in lameness of the front legs.
Where there exists a bilateral affection, (such as characterizes some cases
of navicular disease or other affections causing supporting-leg-lameness)
there occurs no nodding of the head; weight is supported for an equal
length of time upon each one of the two legs, but the stride[4] is
shortened. The gait, in such cases, is peculiar, animals appearing stiff
and they are said, by horsemen, to have a "choppy" gait.
It is desirable, in some cases, to cause an animal to move from side to
side; in other instances the subject is best made to walk or trot in a
circle, and if the circle be very small the animal then particularly
employs the inner fore leg as a pivotal supporting member. To augment
the manifestation of certain affections, it is necessary to cause the
patient to walk backward, and each one of these tests of locomotion
serves to point out in a more or less characteristic manner, the site of
the affection which is causing lameness in different cases.
Sprains or injuries of lateral ligaments of the extremities, ringbone
and certain foot affections, are made manifest by a side to side
movement or a pivotal movement. In fact, wherever it is possible to
cause undue or unusual tension to be exerted upon an inflamed structure,
manifestation of pain is the response. In an inflamed condition of the
lateral side of the phalanges, unequal weight-bearing such as a rough
road surface will, by virtue of the leverage which the solar surface of
the foot affords, cause undue strain upon such inflamed parts, and
increased lameness is evident.
When an animal is made to travel in a circle, when a member affected
with supporting-leg-lameness is on the inner side of the circle,
lameness is accentuated because weight is borne by the lame leg for a
greater length of time, the result of such circuitous manner of
locomotion. In swinging-leg-lameness, on the other hand, because pain is
increased at the time an affected member is being advanced, lameness is
increased when the subject is made to travel in a circle, with the lame
leg on the outside of a circle thus described.
In supporting-leg-lameness, the transientness of the weight-bearing
period upon the affected member is the determining factor in the
production of lameness. This unequal period of weight-bearing upon the
front legs, for instance, causes an acceleration in the advancement of
the sound member, in order to relieve the diseased one which is bearing
weight. In other words, when an animal that is affected with
supporting-leg-lameness travels in a straight line, since weight is
borne by the diseased leg for an abnormally short period of time, the
sound member needs be in the act of advancement a correspondingly short
period. The result is then, an unequal division of stride; a nodding of
the head with the catching up of weight by the sound leg,--in front leg
affections--and this is termed _limping_.
With continuous exertion as in travel for a considerable distance, in
some cases, lameness becomes less evident--as in spavin. This "warming
out" process is due in a measure to the parts becoming less sensitive
upon exertion, and is to be seen, to a limited extent, in all
inflammatory affections that are not too severe; consequently, in some
cases, examination of a lame animal should begin in the stall, for in
instances where the impediment is not marked, there may be no evidence
of lameness after the subject has walked a few steps. In other cases,
lameness increases as the subject continues to travel, and often to the
extent that the impediment becomes too severe to allow the animal being
serviceable. Therefore, one can not, in every case of lameness observed,
positively determine the gravity of the situation, without having seen
the affected animal in action for a sufficient length of time to
understand the nature of the condition existing. This necessitates
driving the animal for several miles in certain cases.
Sometimes it is impossible to arrive at any definite conclusion, as the
result of a single examination, and it then becomes necessary to see the
subject again at a later date, or under more favorable circumstances.
This is to be expected in some conditions where there exists rheumatic
affections, and also in some foot diseases.
In the examination of young animals, unused to harness and to other
strange incumbrances, one is obliged to make allowance for impediments
of gait, which are not occasioned by diseased conditions. Such
affections have been termed "false lameness." Young mules that are not
well broken to harness, are difficult subjects for examination and in
some cases it is necessary to have them led or driven for a considerable
distance before one can definitely interpret the nature of the
impediment in the gait when lameness is not pronounced. It is especially
difficult to satisfactorily examine such subjects, for the reason that
their normal rebellious temperaments cause resistance whenever a strange
person approaches them, as it is necessary to do for an examination by
palpation. In such cases--if an examination does not reveal the cause of
trouble, rest must be recommended and further examination made at a
later date, whereupon any new developments may be noted, if such changes
exist.
Special Methods of Examination.
After having completed a general examination of a lame animal--obtaining
the history of the case, noting its temperament, type, size,
conformation, position assumed while at repose, swellings or
enlargements if present, causing the subject to move to note the degree
and character of lameness manifested; palpating and manipulating the
parts affected to acquire a fairly definite notion of the nature of an
inflammation or to recognize crepitation it becomes necessary in some
cases to employ peculiar means of examination in singular instances.
This may be done by making use of cocain in solution for the production
of local anesthesia as in lameness of the phalanges. Such means are not,
in themselves, dependable but are valuable when used in conjunction with
all other available and practical methods.
Trial use of various shoes in order to shift the weight from one part of
the foot to another or to cause an animal to "break over" in a different
manner so that the gait may be changed, constitutes a special test
procedure. The use of hoof testers or of a hammer to note the degree or
presence of supersensitiveness is another means that is of practical
service. No examination, in any case of lameness, is complete without
having removed the shoe and scrutinized the solar surface of the foot.
[Illustration: Fig. 1--Hoof testers with special jaws of sufficient size
to grasp the largest foot.]
Diagnosis by exclusion, finally, is resorted to, and, as in any other
case where the recognition of cause is difficult, exclusion of the
existence of conditions,--one at a time, by an analysis of
symptoms--generally enables the practictioner to eliminate all but the
disturbing element.
FOOTNOTES:
[Footnote 4: By stride is meant the distance between two successive
imprints of the same foot. The term is not used in this work as being
synonymous with step.]
SECTION III.
LAMENESS IN THE FORE LEG.
Anatomo-Physiological Review of parts of the Fore Leg.
For supporting weight, whether the subject is at rest or in motion, the
bony column of the leg, together with attached ligaments, tendons and
muscles, is wonderfully well adapted by nature for the function which
they perform. The several bones which go to make up the supportive
portion of the leg, are so joined at their points of articulation, that
a minimum degree of strain is put upon each attachment.
The upper third of the scapula, with its cartilage of prolongation, is
sufficiently broad and flattened that it fits snugly against the thorax
without necessity for a complicated method of attachment--the clavicle
being absent, attachment is muscular.
Smith[5] has very aptly stated that:
"It seems quite legitimate to regard the muscular union between the
thorax and forelimb as a joint. There are no bones resting on each
other, no synovia; but where the scapula has its largest range of
movement there is a remarkable amount of areolar tissue, which renders
movement easy. The whole central area beneath the scapula and humerus
not occupied by muscular attachment, is filled with this easy-moving,
apparently gaseously distended, crepitant, areolar tissue over which the
fore legs glide on the chest wall as freely as if the parts were a
large, well lubricated joint."
The scapulohumeral articulation (shoulder joint) is an enarthrodial
(ball and socket) joint but because of its being held more or less
firmly against the thoracic wall by muscular and tendinous attachment,
and because a part of this attachment affords a means of support for the
body itself, there is no need for binding ligaments and movement is
possible in all directions even though restricted as to extent.
[Illustration: Fig. 2--Muscles of Left Thoracic Limb from Elbow
Downward; Lateral (External) View.
a, Extensor carpi radialis; g, brachialis; g', anterior superficial
pectoral; c, common digital extensor; e, ulnaris lateralis. (After
Ellenberger-Baum, Anat. für Künstler.) (From Sisson's "Anatomy of the
Domestic Animals").]
[Illustration: Fig. 3--Muscles of Left Thoracic Limb from Elbow
Downward; Medial (Internal) View.
The fascia and the ulnar head of the flexor carpi ulnaris have been
removed. 1, Distal end of humerus; 2, median vessels and nerve. (From
Sisson's "Anatomy of the Domestic Animals").]
Undue extension, (by extension is meant such movement as will cause the
long axis of two articulating bones to assume a position which
approaches or forms a straight line--opposite to flexion), of the
scapulohumeral joint is impossible while weight is borne, because of the
normally flexed position of the humerus on the scapula; whereas flexion,
beyond desirable limits, is inhibited by the biceps brachii (flexor
brachii or coracoradialis) muscle.
The distal end of the humerus, however, articulating with the radius and
ulna in a fashion that no support is lent by any sort of contact with
the body, is a ginglymus (hinge) joint and lateral motion, because of
the long transverse diameter of its articular portions, is easily
prevented by the medial and lateral ligaments (internal and external
ligaments). Flexion of this, the humeroradioulnar joint (elbow), is
restrained by the triceps brachii and extension is checked by the biceps
brachii (flexor brachii).
The carpal joint (erroneously called the knee joint), is composed of the
several carpal bones which interarticulate and, when taken as a group,
serve as a means of attachment and articulation for the radius and
metacarpal bones.
The transverse diameter of this joint is long, thus giving it contacting
surfaces that are sufficiently extensive to minimize the strain upon the
mesial and lateral ligaments (internal and external lateral common
ligaments). Motion is that of flexion and extension; slight rotation is
possible when the position is that of flexion. While supporting weight
the carpus is fixed in position by a slight dorsal flexion, but undue
dorsal flexion is prevented by the flexor muscles and tendons and
volar-carpal or annular ligament, together with the superior check
ligament.
The metacarpophalangeal articulation (fetlock joint), is a hinge joint
and its articular surfaces contact one another, with respect to their
having a long bearing surface from side to side, as do all ginglymus
(hinge) joints. Two common lateral ligaments bind the bones together.
While bearing weight, there is assumed a position of slight dorsal
flexion, undue flexion being checked by the inhibitory apparatus of the
joint--check ligaments, and their tendons and the suspensory ligament.
The inhibitory apparatus of the fetlock joint is materially reinforced
by the proximal sesamoid bones. Situated as they are, between the
bifurcating portions of the suspensory ligament and the posterior part
of the distal end of the metacarpus--with which they articulate--the
sesamoid bones serve to change the course of the branches of the
suspensory ligament in a manner that they give firm support to this
joint. Volar flexion is limited by the extensors of the phalanges.
[Illustration: Fig. 4--Sagital Section of Digit and Distal Part of
Metacarpus.
A, Metacarpal bone; B, first phalanx; C, second phalanx, D, third
phalanx; E, distal sesamoid bone; 1, volar pouch of capsule of fetlock
joint; 2, inter-sesamoidean ligament; 3, 4, proximal end of digital
synovial sheath; 5, ring formed by superficial flexor tendon; 6, fibrous
tissue underlying ergot; 7, ergot; 8, 9, 9', branches of digital
vessels; 10, distal ligament of distal sesamoid bone; 11, suspensory
ligament of distal sesamoid bone; 12, 12', proximal and distal ends of
bursa podotrochlearis. (From Sisson's "Anatomy of the Domestic
Animals").]
The first phalanx (os suffraginis) normally sets at an angle of about
50 to 55 degrees from a horizontal plane while weight is being
supported. Its distal end articulates with the second or median phalanx
(os corona) and forms the proximal interphalangeal (pastern or
suffraginocoronary) joint. This also, is a ginglymus joint, having but
slight lateral motion, and that only when it is in a state of flexion. A
rather broad articular surface--from side to side--exists here,
lessening the strain on the collateral ligaments somewhat. Dorsal
flexion is checked by the flexor tendons and dorsal ligaments. Volar
flexion is restrained by the extensor tendons.
The distal end of the second phalanx (os corona) has but slight lateral
motion and this is manifested principally when it is in a state of volar
flexion. Undue dorsal flexion is prevented by the deep flexor tendon
(perforans) and volar flexion is inhibited by the extensor of the digit
(extensor pedis). Thus it is seen, that when the leg is a weight-bearing
member, weight is supported by the bony framework whose constituent
parts are joined together by ligaments and tendons and each one of the
several bones articulates in such manner that the joint is locked. The
articular parts of bones rest upon or against an inhibitory apparatus,
and are slightly flexed, as in the carpus, or considerably flexed such
as in the fetlock joint when weight is being supported. In the first
instance, for example, the flexors of the carpus and the superior check
ligament assisted by the flexors of the phalanges constitute the
inhibitory apparatus.
It will be noted that provision for weight bearing is so arranged that
muscular energy is not required except in the matter of suspension of
the body between the scapulae and here tonic impulses only are necessary
to maintain an equilibrium[6], yet in every instance where weight is not
supported by bones, inelastic ligaments or tendinous structures relieve
the musculature of this constant strain. This explains the fact that
some horses do not lie in the stall, yet in spite of their constant
standing position, they are able to rest and sleep.
The student of lameness is interested in the function of the legs in the
rôle of supporting weight and as propelling parts, and not particularly
in the capacity of these members for inflicting offense or as weapons
of defense. Yet, in the exercise of their functions other than that of
locomotive appliances, injury often results, but usually it is the
recipient of a blow that suffers the injury, such as an animal may
receive upon being kicked. Therefore, we do not often concern ourselves
with strains or other injuries that the subject experiences as the
result of efforts put forth in kicking or striking. Where such injuries
occur, however, a diagnosis is established by making use of the
principles heretofore discussed.
As propelling members the front legs bear weight and are advanced
alternately when the horse is walking or trotting--in cantering this is
not so. When the normal subject travels in a straight line, at a walk or
a trot, the length of the stride is the same with the right and left
members. The stride of the right foot then, for example, is equally
divided by the imprint of the left foot, in the normal horse, when
traveling at a walk and in a straight line.
Shoulder Lameness.
This enigmatical term is frequently employed by the diagnostician when
he is baffled in the matter of definitely locating the cause of
lameness; when he has by exclusion and otherwise arrived at a decision
that lameness is "high up." Shoulder lameness may be caused by any one
or several of a number of conditions, e.g., fractures of the scapula or
humerus; arthritis of the shoulder or elbow joint; luxation of the
shoulder or elbow joint (rarely); injuries of muscles and tendons of the
region due to strains, contusions or penetrant wounds; paralysis of the
brachial plexus or of the prescapular nerve; involvement of lymph
glands; arterial thrombosis; metastatic infections; rheumatic
disturbances; and as the result of inflammation, infectious or
non-infectious occasioned by collar bruises. In some instances such
inflammation is due to the manner of treatment of collar injuries.
Therefore, when one considers the numerous and dissimilar possible
causes of shoulder lameness, it behooves the practitioner to become
proficient in diagnostic principles.
A principle which is elemental in the diagnosis of locomotory
impediment, is that lameness of the shoulder or hip is usually
manifested by more or less difficulty in swinging the affected member.
Swinging-leg-lameness, then, is usually present in shoulder affections.
In some instances lameness is mixed as in joint ailments, involvement of
the bicipital bursa (bursa intertubercularis), etc. In affections of the
extremity there exists supporting leg lameness. Consequently, we employ
this elemental principle, and, by a visual examination of the subject,
which is being made to travel suitably, one may decide that lameness is
either "high up"--shoulder lameness or, "low down"--of the extremity.
[Illustration: Fig. 5--Ordinary type of heavy sling.]
To make practical use of this principle, the examiner must be thoroughly
familiar with the anatomy of the various structures concerned in
advancing the leg--those which support weight as well as those concerned
both in weight bearing and swinging the member.
Fracture of the Scapula.
Etiology and Occurrence.--Fractures of the body of the scapula are of
infrequent occurrence in horses for the reason that protection is
afforded this bone because of its position. Its function, too, is such
that very unusual conditions are necessary to subject it to fracture.
The spine is occasionally broken due to blows such as kicks, etc., and
here frequently a compound fracture exists.
[Illustration: Fig. 6--A sling made in two parts so that horses may be
supported without use of central part or bodice. This sling is more
comfortable than is the ordinary style and is particularly useful in
cases that require a long period of this manner of confinement.]
Where fractures of the body of the scapula occur, heavy contusions have
been the cause as a rule, and serious injury is done the subject;
consequently, treatment of fracture of the body of the scapula is seldom
successfully practised. Fractures of the body of this bone resulting
from accidents not involving internal injury or other disturbances and
which would not seriously interfere with the vitality of the subject,
are not necessarily serious unless compound.
Fractures of the neck of the scapula are serious because of the fact
that there occurs displacement of the broken parts and perfect
apposition of the fractured ends is difficult, if not impossible.
Fractures that extend to the articular surface are very serious, and
complete recovery in such instances is practically impossible. The
cartilage of prolongation of the scapula is sometimes seriously involved
in certain cases of fistulous withers, and in some instances it has been
separated from its attachment to the rhomboidea muscles, and lameness
has resulted. In such instances, the upper portion of the scapula is
disjoined from all attachment, and with every movement the animal makes,
the scapula is moved back and forth. Complete recovery in such cases
does not occur.
Symptomatology.--Fractures of the scapular spine are ordinarily
readily recognized because there is usually visible displacement of the
broken part. Crepitation is also detected without difficulty.
In fractures of the body of the scapula where an examination may be made
before much swelling has taken place, and in subjects that are not
heavily muscled, one should have no difficulty in recognizing the
crepitation.
Fractures of the neck of the scapula are recognized by crepitation, by
passively moving the leg, but it is necessary to exclude fractures of
the humerus when one depends upon the finding of crepitation by this
means. However, unless undue swelling exists, the exact location of the
crepitation is recognized without serious difficulty.
Treatment.--The treatment of compound fractures of the scapular spine
consists in the removal of the broken piece of bone by way of a
cutaneous incision so situated that good drainage of the wound will
follow.
Simple fractures of the body of the scapula are best treated by placing
the subject in a sling, if the animal is halter broken, and enforcing
absolute quiet for a period of from three to six weeks. Splints or
similar appliances are not of practical value in scapular fractures.
Compound fractures of the scapula usually result from violence, which at
the same time does serious injury to adjacent structures, and it then
becomes necessary to administer an expectant treatment, observing
general surgical principles and providing in so far as possible for the
comfort of the patient.
Scapulohumeral Arthritis.
Anatomy.--The scapulohumeral joint is an enarthrodial (ball and
socket) joint wherein the ball or humeral articulating head greatly
exceeds in size the socket or glenoid cavity of the scapula. The
capsular ligament surrounding this joint is very large and admits of
free and extensive movement of the articulation. There exist no lateral
or common ligaments jointing the scapula and humerus as in other joints,
but instead the tendinous portions of muscles perform this function. The
principal ones which are attached to the scapula and humerus that act as
ligaments are the supraspinatus (antea-spinatus), infraspinatus
(postea-spinatus) biceps-brachii (flexor brachii) and subscapularis
muscles.
Etiology and Occurrence.--Inflammation of the scapulohumeral
articulation results from injuries of various kinds, including punctures
which perforate the joint capsule, bruises from collars, metastatic
infections and involvement as a result of direct extension of infectious
conditions situated near the joint.
Classification.--Acute arthritis may be septic or aseptic, and there
seems to be a remarkable tendency for recovery in cases of septic
arthritis involving this joint in the horse.
Chronic arthritis with destruction of articular surfaces and ankylosis,
is seldom observed. It is only in cases of severe injury, where the
articular portions of the bones are damaged at the time of infliction of
the injury, and where the articulation remains exposed for weeks at a
time, together with immobility of the parts because of attending pain,
that permanent ankylosis results.
Scapulohumeral arthritis may result then from _infections_, local or
metastatic; from _injuries_, such as contusions of various kinds; from
_wounds_, which break the surface structure or perforate the joint
capsule; or from _luxations_.
Infectious Arthritis.
Infectious arthritis of the scapulohumeral joint the result of local
causes other than produced by septic wounds, seldom causes serious
inconvenience to the subject. Where such occurs, however, there is
manifested mixed lameness and complete extension of the extremity is
impossible. Local swelling is present and manifestations of pain are
evident upon palpation of the affected area.
Treatment.--During the first stage of the infection, local
applications, hot or cold, are indicated. A hot poultice of bran or
other suitable material contained within a muslin sack, may be supported
by means of cords or tapes which are passed over the withers and tied
around the opposite fore leg. Such an appliance may be held in position
more securely by attaching it to the affected member. Following the
acute stage of such an infection, any local counter-irritating
application or even a vesicant is in order.
Where abatement of the infectious process does not take place, and
suppuration of the structures in the vicinity of the joint occurs, it is
necessary to provide drainage for pus. In some cases of strangles, for
instance, large pus cavities are formed and drainage is imperative.
However, metastatic inflammation of this joint is seldom observed except
in cases of strangles. The animal should be kept perfectly quiet until
recovery has taken place.
Injuries.
Injuries to the scapulohumeral joint may be the result of kicks, runaway
accidents or bruises from the collar, and there may result, because of
such injuries, reactionary inflammation which will vary in intensity
from the mildest synovitis to the most severe arthritis, causing more or
less lameness.
Treatment.--The general plan of treatment in this form of arthritis is
the same as has been outlined under the head of infectious arthritis,
with the exception that there is seldom occasion to provide for drainage
of pus.
Wounds.
Wounds which cause a break of the skin and fascia overlying the
scapulohumeral joint are usually of little consequence, unless the blow
is of sufficient force to directly injure the articulation, and in such
cases, the treatment of the injury along general surgical principles,
such as cleansing the area, providing drainage for wound secretion, and
the administration of suitable dressing materials such as antiseptic
dusting powder, is all that is required for the wound. The symptoms
manifested by the subject in such cases are the same as have been
discussed heretofore and merit no special consideration.
Prognosis.--Unless very serious injury be done the articular portions
of the scapula or the humerus, resulting in the destruction of the
capsular ligament, prognosis is entirely favorable.
Open Joint.--Where the capsular ligament is perforated and the
condition becomes one of open joint, then a special wound treatment
becomes necessary. The surface of the skin is first freed from all hair
and filth in the vicinity of the wound. The wound proper is cleared of
all foreign material either by clipping with the scissors, curetting or
mopping with cotton or gauze pledgets. The whole exposed wound surface
as well as the interior of the joint cavity, if much exposed, is
moistened with tincture of iodin. Subsequent treatment consists in a
local application of a desiccant dusting powder, which should be applied
five or six times daily. The composition of the powder should be such as
to permit of its liberal use, thereby affording mechanical protection to
the wound as well as exerting a desiccative effect. Equal parts of boric
acid and exsiccated alum serve very well in such cases.
Animals suffering from open joints of this kind should be confined in a
standing position, preferably in slings, and kept so confined for three
or four weeks. Since they usually bear weight upon the affected member,
there is no danger of laminitis resulting.
Luxation of the Scapulohumeral Joint.
Because of the large humeral head articulating as it does with a
glenoid cavity, scapulohumeral luxations are very rare in the horse.
According to Moller[7], luxation is generally due to excessive flexion
of the scapulohumeral joint. In such cases the head of the humerus is
displaced anterior to the articular portion of the scapula and remains
so fixed.
Symptoms.--Complete luxation of the scapula is recognized because of
immobility of the scapulohumeral joint and of the abnormal position of
the head of the humerus, which can be recognized by palpation, unless
the swelling be excessive. Immobility of the scapulohumeral joint is
noticeable when one attempts to passively move the parts.
Treatment.--Reduction of the luxation is effected by making use of the
same general principles that are employed in the reduction of all
luxations, and they are--the control of the animal so that the
manipulations of the operator are not antagonized by muscular
contraction, which is best accomplished by anesthesia; placing the
luxated bones in the position which they have taken to become unjointed;
and then making use of force which is directed in a manner opposite to
that which has effected the luxation.
In a forward luxation of this kind, the operator should further flex the
humerus, and while it is in this flexed position, force is exerted upon
the articular head of this bone, and it is pushed downward and backward
into its normal position.
After-care consists in restriction of exercise and, if necessary,
confining the subject in a sling and the application of a vesicant over
the scapulohumeral region.
Inflammation of the Bicipital Bursa.
(Bursitis Intertubercularis.)
Anatomy.--There is interposed between the tendon of the biceps brachii
(flexor brachii) and the intertubercular or bicipital groove a heavy
cartilaginous pad, which is a part of the bursa of the biceps brachii.
This synovial bursa forms a smooth groove through which the biceps
brachii glides in the anterior scapulohumeral region. Great strain is
put upon these parts because the biceps brachii is the chief inhibiting
structure of the scapulohumeral articulation--the one which prevents
further flexion of the humerus during weight bearing. Passing, as it
does, over two articulations, the biceps brachii has a somewhat
complicated function, being a flexor of the radius and an extensor of
the humerus. Thus it is seen, the biceps brachii is a weight bearing
structure, as well as one that has to do with swinging the leg.
Etiology and Occurrence.--Because of the exposed position of the
bicipital bursa (bursa-intertubercularis) it is occasionally injured.
Blows and injuries received in runaway accidents do serious injury to
the bursa and because of the peculiar and important part it plays during
locomotion, serious injuries are not likely to resolve, and too often
chronic lameness results. It is to be noted that the tendon of the
biceps brachii (flexor brachii) is always involved in cases of
inflammation of the bicipital bursa, and according to the late Dr.
Bell[8] strain of the biceps brachii is a frequent cause of lameness in
city horses, more frequent than is generally supposed.
Pathological Anatomy.--More or less destruction of the cartilaginous
portion of the bursa, sometimes involving the tendinous portion of the
biceps, takes place and, according to Moller, in some instances there
occurs ossification of the tendon. Autopsies in some old horses reveal
the presence of erosions of cartilage and hyperthrophy of the inflamed
parts.
Symptoms.--In acute inflammations, there is always marked lameness.
This is manifested to a greater degree when the subject advances the
affected leg. There is incomplete advancement of the member; the toe is
dragged when the horse is made to walk and the foot kept in a position
posterior to the opposite or weight bearing foot while the subject is at
rest. Lameness is disproportionate to the amount of local manifestation
in the way of heat, swelling and pain that is to be recognized on
palpation. In fact, in some cases so much pain attends the condition
that no weight is borne by the affected member, and when compelled to
walk, the subject hops on the sound leg.
Chronic inflammation of the bicipital bursa is occasionally met with
wherein both members are affected. Because of the nature of the
structures involved, when inflamed, chronic inflammation is a more
frequent termination than is complete recovery. Bilateral affections are
seen in horses that are driven for years, regularly at a fast pace on
paved streets. In such cases, the gait is stilted, that is, there is
incomplete advancement of both members and, of course, the period of
weight bearing is correspondingly shortened; hence the short strides.
In chronic cases, little if any evidence of inflammation is to be
detected by digital manipulation of the parts. If flinching occurs, one
is often unable to interpret the manifestation as to whether it is due
to inflammation or not.
There is no marked "warming out" in this condition, and animals are
nearly as lame after having been driven a considerable distance as when
started, although the lameness is not as a rule very great.
Treatment.--In very painful cases acute inflammation is treated by
employing cold applications during the initial stage. Cracked ice when
contained in a suitable sack may be held in contact with the affected
part and the pack is supported by means of cords or tapes as suggested
in the discussion on treatment of scapulohumeral arthritis on page 66.
Later, hot applications may be employed to good advantage.
In the course of ten days or two weeks, if the acute painful condition
has entirely subsided, vesication is indicated. The ordinary mercury and
cantharides combination does very well. Depending upon the course taken
in any given case, one is guided in the treatment employed. If prompt
resolution comes to pass, the subject may be given free run at pasture
after three or four weeks confinement in a box stall. If, however, the
case does not progress in a prompt and satisfactory manner, absolute
quiet must be enforced for six weeks or more. Repeated blistering is
beneficial, although it is doubtful if firing is of sufficient benefit
in the average chronic case of intertubercular bursitis to justify the
punishment which this form of treatment inflicts, unless infliction of
pain is the thing sought, to enforce repose in restless subjects.
Patients are best given a long rest at pasture and returned to work for
two or three months after an acute attack of inflammation of the bursa,
lest the condition become chronic. When due consideration is given the
pathology of such cases, the frequent unsatisfactory termination under
the most careful treatment, is readily understood.
Contusions of the Triceps Brachii.
(Triceps Extensor Brachii: Caput Muscles.)
Anatomy.--The triceps brachii is the principal structure which fills
the space between the posterior border of the scapula and the humerus.
The several heads originate for the most part on the border of the
scapula, the deltoid tuberosity of the humerus and the shaft of the
humerus. Insertion of this large muscular mass is effected by means of
several tendons to the olecranon. A synovial bursa is situated
underneath the tendinous attachment of the posterior portion of the
triceps brachii--the long head or caput magnum.
The function of the triceps as a whole is to flex the shoulder joint and
extend the forearm. The triceps brachii is the chief antagonist of the
biceps brachii.
Etiology and Occurrence.--Owing to the exposed position of this
structure, it is not infrequently contused, the result of falls, kicks
and other injuries. The function of the triceps is such that it becomes
strained upon rare occasions when a horse resists confinement of
restraint in such manner that the parts are unduly tensed in
contraction. This sort of resistance may stretch the radial nerve or its
branches in a way that paralysis results. A condition known as "dropped
elbow" is described by Henry Taylor, F.R.C.V.S., in the Veterinary
Record[9], wherein a two-year-old colt while resisting confinement was
so injured.
The triceps group because of its convenient location, constitutes the
site for hypodermic injection of drugs and biologic agents, with some
practitioners; and as a result, more or less inflammation may occur. The
author has observed and treated some twenty cases where an intensely
painful infectious inflammation of the triceps brachii was caused by
the intramuscular injection of a caustic solution by a cruel and
unscrupulous empiric, whose object was to increase his practice.
Symptomatology.--As the triceps brachii is not particularly taxed
during weight bearing in the subject at rest, there may be no unnatural
position assumed during inflammation of the triceps. More or less
swelling and supersensitiveness is always present, however, and great
care and discrimination must be exercised in digital manipulation of the
triceps region because many animals are normally sensitive to palpation
of these parts. It is sometimes difficult to correctly interpret the
true state of conditions because of this peculiarity.
There is always swinging-leg-lameness, which is accentuated when the
subject is urged to trot. Where symptoms are pronounced, it is
unnecessary to cause the subject to move at a faster pace than at a walk
to recognize the condition. The forward stride is shortened and in
extremley painful conditions, no attempt is made to extend the leg. It
is simply carried _en une piéce_--flexion of the shoulder and elbow
joints is carefully avoided.
Treatment.--During the early stage of inflammation, hot or cold
applications are beneficial. Long continued use of moist
heat--fomentations--allays pain and stimulates resolution. Keeping in
contact with the painfully swollen parts a suitable bag filled with
bran, which can be moistened at intervals with warm water, constitutes a
practical and easy means of treatment. By employing this method, one is
more likely to succeed in having his patient properly cared for, in that
less work is entailed than if hot fomentations are prescribed.
After the acute and painful stage has subsided, a stimulating liniment
is of benefit. The subject should be kept within a comfortable and roomy
box stall for a sufficient length of time to favor prompt resolution.
Wild and nervous subjects, if not so confined, will probably overexert
the affected parts if allowed the freedom of a paddock or pasture.
Where the inflammation becomes infective, surgical interference is
necessary. The prompt evacuation of pus, with adequate provision for
wound discharge, should be attended to before extensive destruction of
tissue takes place. Resolution is prompt as a rule in such cases because
of the vascularity of the structures and the ease with which proper
drainage may be effected. No special after-care is necessary if drainage
is perfect, except that one should avoid injecting the wound cavity with
aqueous solutions unless it be absolutely necessary to cleanse such
cavity, and then it is best to swab the wound rather than to irrigate it
freely.
Shoulder Atrophy.
(Sweeny or Swinney)
No satisfactory consideration of the pathogeny of this condition is
recorded, but practitioners have long distinguished between muscular
atrophies which are apparently caused without doing serious injury to
nerves and muscular atrophy which seems to be due to nerve affection. In
the first instance, recovery when proper attention is given, is prompt;
whereas, in the latter, regeneration of the wasted tissues requires
months in spite of the best sort of treatment.
The parts more frequently affected are the supra- and infrascapularis
(antea- and posteaspinatus) muscles. But in some cases the triceps group
is involved; however, this occurs in unusual and chronic affections. No
doubt, these chronic cases are due to suspended innervation and are not
to be classed with the ordinary case of atrophy of the abductor muscles
of the humerus (supra- and infraspinatus) as in the usual case of
"sweeny."
Occurrence.--Shoulder atrophy such as the general practitioner
commonly meets with, is an affection, more often seen in young animals
and it seems to be due to injuries of various kinds which contuse the
muscles of the shoulder. Ill-fitting collars and pulling in a manner
that there occurs side draft with unusual strain on the muscles of one
side of the neck and shoulder, seem to be the more frequent causes of
this trouble. Blows such as are occasioned by kicks and falls frequently
result in atrophy of shoulder muscles.
Course.--In some cases a rapidly progressive atrophy characterizes the
case and lameness and atrophy appear at about the same time. The
affection in such instances does not recover spontaneously but
constitutes a condition which requires prompt and rational treatment so
that function may be fully restored to the parts involved.
Occasionally one may observe cases where there is but slight atrophy;
where the disease progresses slowly and atrophy is not extensive or
marked. In vigorous young animals that are left to run at pasture when
so mildly affected, spontaneous recovery occurs.
Symptomatology.--Lameness is the first manifestation of shoulder
atrophy, and in many cases where lameness is slight, the veterinarian
may fail to discover the exact nature of the trouble if he is not very
proficient as a diagnostician of lameness or if he is careless in taking
into consideration obtainable history, age of the subject, etc. Because
of the fact that the average layman believes that practically every case
of fore-leg lameness wherein it is not obvious that the cause is
elsewhere, is due to a shoulder affection of some kind, we may be too
hasty in giving the client assurance that no "sweeny" exists. In some of
these cases where a diagnosis of "shoulder lameness" has been made and
the client has been assured that no sweeny exists, the patient is
returned in about a week and there is then marked atrophy of one or both
of the spinatus muscles.
A mixed type of lameness characterizes this affection, and in the
average case there exists little evidence of local pain. The salient
points in recognizing the condition are a consideration of history if
obtainable; age of the subject; finding slight local soreness, by
carefully manipulating the muscles which are usually involved; noting
the character of the lameness if any is present; and where atrophy is
evident, of course, the true condition is obvious.
Treatment.--Subcutaneous injections of equal parts of refined oil of
turpentine and alcohol, with a suitable hypodermic syringe, is a
practical and ordinarily effective treatment. From five to fifteen cubic
centimeters (the quantity varies with the size of the animal), of this
mixture is injected into the atrophied parts at different points, taking
care to introduce only about one to two cubic centimeters at each point
of injection. The syringe should be sterile and, needless to say, the
site of injections must be surgically clean.
Other agents, such as tincture of iodin, solutions of silver nitrate,
saline solutions and various more or less irritating preparations have
been employed; but in the use of these preparations one may either fail
to stimulate sufficient inflammation to cause regeneration to take
place, or infection is apt to occur. Where suppuration results, surgical
evacuation of pus must be promptly effected else large suppurating
cavities form.
The employment of setons constitutes a dependable method of treatment of
shoulder atrophy, but because of the attendant suppurative process which
inevitably results, this method is not popular with modern surgeons and
is a last resort procedure.
After-care.--Regular exercise such as the horse usually takes when at
pasture, is very helpful in treating atrophy, and in some cases it has
been found that no reasonable amount of irritation would stimulate
muscular regeneration; but by later allowing patients to exercise at
will, recovery took place in a satisfactory manner. No special attention
is ordinarily necessary.
Paralysis of the Suprascapular Nerve.
Anatomy.--The suprascapular (anterior scapular) nerve, a small branch
of the brachial plexus, is given off from the anterior portion of this
plexus. The nerve rounds the anterior border of the neck of the scapula,
passing upward and backward under the supraspinatus (antea-spinatus)
muscle and terminating in the infraspinatus (postea-spinatus) muscle.
Etiology and Occurrence.--As the result of direct injury to this nerve
by contusion such as may be received in runaway accidents, collar
bruises, especially collar bruises in young horses that are not
accustomed to pulling and that walk in a manner to cause side draft,
injury to the nerve occurs, and partial or complete paralysis
supervenes. Some writers state that it may be produced by confining an
animal in recumbency, with the casting harness. The common cause of
paralysis or paresis of this nerve in cases such as one observes in
country practice, is bruises from the collar in colts that are put to
heavy farm work or where ill fitting collars are used.
Symptomatology.--With partial or complete suspension of function of
the suprascapular nerve there results enervation of the supraspinatus
and infraspinatus muscles. Since these muscles act as external lateral
ligaments of the scapulohumeral joint, when they are incapacitated,
there naturally follows more or less abduction of the shoulder when
weight is borne.
In extreme cases, as soon as the ailing animal is caused to support
weight with the affected member, the joint is suddenly thrown outward in
a manner that the average layman at once concludes that there must be
scapulohumeral luxation, and the veterinarian receives a call to see a
case wherein the "shoulder is out of place." There exists, however, no
luxation in such cases.
If serious injury is done the nerve so that it undergoes degenerative
changes, there will result atrophy of the muscles that derive their
nerve supply from the suprascapular nerve.
[Illustration: Fig. 7--Paralysis of the suprascapular nerve of the left
shoulder]
Treatment.--During the first few days following injuries which result
in this form of paralysis, it is well to keep the subject inactive, and
if much inflammation of the injured structures contiguous to the nerve
exists, the application of cold packs is beneficial. Later, as soon as
acute inflammation has subsided, vesication of a liberal area around the
anteroexternal part of the scapulohumeral joint and over the course of
the suprascapular nerve, will stimulate recovery in favorable cases. As
a rule, in mild cases, the subject is in a condition to return to work
in two or three weeks.
Radial Paralysis.
Described under the titles of "Radial Paralysis" and "Brachial
Paralysis," there is to be found in veterinary literature a discussion
of conditions which vary in character from the almost insignificant form
of paresis to the incurably affected conditions wherein the whole
shoulder is completely paralyzed.
When one considers the anatomy of the brachial nerve plexus and the
distribution of its various branches, the location of this plexus and
its proximity to the first rib, and the inevitable injury it must suffer
in fracture of this bone, together with the inaccessibility of the
plexus, it is not strange that a correct diagnosis of the various
affections of the brachial plexus and the radial nerve is often
impossible until several days or weeks have passed. And, in some
instances, diagnosis is not established until an autopsy has been
performed. Here, too, we fail to find cause for paralysis in some rare
instances.
Anatomy.--The radial nerve is a large branch of the brachial plexus
and is chiefly derived from the first thoracic root of the plexus and is
here situated posterior to the deep brachial artery. It is directed
downward and backward under the subscapularis and teres major muscles,
rounding the posterior part of the humerus, and passing to the anterior
and distal end of the humerus, it finally terminates in the anterior
carpal region. The radial nerve supplies branches to the three heads of
the triceps brachii, to the common and lateral extensors of the digit
and also to the skin covering the forearm.
Etiology and Occurrence.--Nothing definite is known about the cause of
some forms of radial paralysis. However, radial paralysis is encountered
following injury to the nerve occasioned by its being stretched, as in
cases where the triceps brachii is unduly extended in restraining
subjects by means of a casting harness. Berns[10] states that in
confining horses on an old operating table where it was necessary to
draw the affected foot forward twenty-four to thirty-six inches in
advance of its fellow, which was secured in a natural vertical
position, radial paralysis of a mild form was of frequent occurrence.
Country practitioners, in restraining colts by casting with harness or
ropes, occasionally observe a form of paresis wherein the radial nerve
suffers sufficient injury that there is caused a temporary loss of
function of the triceps brachii. Such cases recover within three or four
days and are not a true paralysis, but nevertheless constitute
conditions wherein normal nerve function is temporarily suspended.
[Illustration: Fig. 8--Radial paralysis.]
Symptoms.--Immediately subsequent to injuries which involve the radial
nerve, there is manifested more or less impairment of function.
Remembering the structures supplied by the radial nerve and its
branches, one can readily understand that there should occur as
Cadiot[11] has stated:
In complete paralysis, the joints of the affected limb with the
exception of the shoulder are usually flexed when the horse is
resting. In consequence of loss of power in the triceps and
anterior brachial muscles, the arm is extended and straightened on
the shoulder, the scapulohumeral angle is open, and the elbow
depressed. The forearm is flexed on the arm by the contraction of
the coracoradialis (biceps brachii), while the metacarpus and
phalanges are bent by the action of the posterior antibrachial
muscles. The knee is carried in advance, level with, or in front
of, a vertical line dropped from the point of the shoulder. The
hoof is usually rested on the toe, but when advanced beyond the
above mentioned vertical line, it may be placed flat on the ground,
the joints then being less markedly bent. When the limb as a whole
is flexed, it may be brought into normal position by thrusting back
the knee with sufficient force to counteract the action of the
flexor muscles.
[Illustration: Fig. 9--Merillat's method of fixing carpus in radial
paralysis. Courtesy, Alex. Eger.]
When made to walk, the animal being unable to exert muscular action with
the paralyzed structures, limply carries the member as a whole, and
there is shortening of the anterior portion of the stride. There being
loss of function of the triceps brachii, it is impossible for the
subject to straighten the leg in the normal position for supporting
weight; therefore, any attempt to bear weight results in further
flexion of the affected member and the animal will fall if the body is
not suddenly caught up with the sound leg.
Differential Diagnosis.--In making examination of these cases, one can
exclude fracture by absence of crepitation and usually, also, swelling
is absent in radial paralysis. In a typical case of radial paralysis,
the affected leg can sustain its normal share of weight if placed in
position, that is, if the carpal joint is extended in such manner that
the leg is positioned as in its normal weight-bearing attitude. In
brachial paralysis, whether due to fracture of the first rib or to other
serious injury, it is impossible for the subject to support weight with
the affected member even when it is passively placed in position.
No difficulty is ordinarily experienced in differentiating radial
paralysis from muscular injuries to the triceps; yet, in some cases of
"dropped elbow," it is necessary to observe the progress of the case for
ten days or two weeks before one can positively establish a diagnosis.
Quoting Merillat[12]: "When, after four weeks, there is no
amelioration of the paralysis, the muscles have atrophied, and the
patient has become emaciated from pain and discomfort, the
diagnosis of brachial paralysis with fracture of the first rib may
then be announced."
Prognosis.--When no complete paralysis of the brachial plexus or no
fracture of the first rib exists, the majority of cases recover
completely in from ten days to six weeks. Some writers claim that
recoveries occur in ninety per cent of cases when conditions are
favorable.
Treatment.--When incomplete radial paralysis exists, little needs be
done except to allow the subject moderate exercise and to provide for
its comfort. Local applications, stimulative in character, are
beneficial, and the internal administration of strychnin is indicated.
In the cases where weight is not supported without the affected leg
being passively placed in position, it is necessary to provide for the
subject's comfort in several ways.
Mechanical appliances such as braces of some kind in order to keep the
affected leg in a position of carpal extension, constitute the essential
part of treatment. The leg is supported in such a manner that flexion of
the carpus is impossible. Due regard is given to prevent chafing or
pressure necrosis by contact of the skin with the braces--this may be
done by bandaging with cotton. The supportive appliance is kept in
position for ten days or two weeks. At the end of this time the brace
may be removed and the subject given a chance to walk, and improvement,
if any exists, will be evident. When there is manifested an amelioration
of the condition, moderate daily exercise and massage of the affected
parts are helpful.
Should the subject be seriously inconvenienced by the application of a
brace or other supportive appliances, it is necessary to employ slings.
Further, if weight is supported entirely by the unaffected member,
laminitis may supervene if a sling is not used.
Thrombosis of the Brachial Artery.
Thrombosis of the brachial artery or of its principal branches is of
very rare occurrence in horses.
Etiology.--Partial or complete obstruction of arteries (brachial or
others) occurs as the result of direct injury to the vessel wall from
compression and tension of muscles and resultant arteritis; lodging of
emboli; and parasitic invasion of vessel walls causing internal
arteritis.
Symptomatology.--If sufficient collateral circulation exists to supply
the parts with blood, no inconvenience is manifested while the subject
is at rest. Where the lumen of the affected vessel is not completely
occluded, there may be no manifestation of lameness when the ailing
animal is moderately exercised. Consequently, the degree of lameness
depends upon the extent of the obstruction to circulation; and,
likewise, the course and prognosis depend upon the character and extent
of such obstruction.
In severe cases, lameness is markedly increased by causing the animal to
travel at a fast pace for only a short distance. There are evinced
symptoms of pain, muscular tremors and sudation, but the affected member
remains dry and there is a marked difference of temperature between the
normal areas and the cool anemic parts. When the subject is allowed to
rest, circulation is not taxed, and there is a return to the original
and apparently normal condition, only to recur again with exertion. This
condition characterizes thrombosis.
Treatment.--In these cases, little if any good directly results from
any sort of treatment in the way of medication. Absolute rest is thought
to be helpful. Potassium iodid, alkaline agents such as ammonium
carbonate and potassium carbonate, have been administered. Circulatory
stimulants also have been given, but it is doubtful if any good has come
from medication.
Fracture of Humerus.
The shaft of the humerus, protected as it is by heavy muscles, is not
frequently fractured; and fractures of its less protected parts, as for
example, the head, are complicated in such manner that resultant
arthritis soon constitutes the more serious condition.
As a result of falls on frozen ground, kicks or any other form of heavy
contusion, the humerus is occasionally broken. It is rarely fractured
otherwise. Because of the force of contusions usually required to effect
humeral fracture, the manner in which the bone is broken, with respect
to direction, is variable. Often oblique fractures exist and
occasionally there occurs multiple fracture. In addition to the
ordinarily serious nature of the fracture itself, there is always much
injury done the adjoining structures.
Symptomatology.--Mixed lameness and manifestation of severe pain
characterize this affection. Considerable swelling which increases, in
some cases for a week or more, is to be observed. Crepitation is readily
detected, if pain and swelling is not too great to prevent passive
movement of the member. Where intense pain is not manifested, because of
manipulation, one may abduct the extremity and thereby occasion distinct
crepitation; but when it is possible to recognize crepitation by holding
the hand in contact with the olecranon while the animal is made to walk,
this method is to be preferred, if the subject can move without serious
difficulty. The pathognomonic symptom here is recognition of
crepitation, but this may be very difficult to recognize in fracture of
condyles, and in such instances, a careful examination is necessary.
Gentle manipulation in a manner that pain is not aggravated will tend to
inspire confidence on the part of the subject and relaxation of muscles
will enable the operator to detect crepitation.
Course and Prognosis.--Because of the direction of the long axis of
the humerus, with relation to the bony column of the extremity, it is
obvious that any lateral movement of the leg tends to rotate the shaft
of this bone. In fractures of the shaft of the humerus, then, it is
apparent that immobilization is very difficult if at all possible.
The proximity to the axillary lymph glands makes for easy dissemination
of infection when the contused musculature becomes infected. The
adjacent brachial nerve plexus is so very apt to become involved, if not
actually injured at the time fracture occurs, that paralysis is a
probable complication. Consequently, it is logical to reason that
because of the many possible serious complications, such as shock,
occasioned by the injury and the distress and pain which this accident
produces, recovery must be the exception in fracture of the humerus.
However, recoveries do take place and in addition to the reported
recoveries by Liautard, Moller, Stockfleth, Lafosse, Frohner and others,
we have instances cited by American practitioners where cases resulted
in recovery. Thompson[13] reports a good recovery in a 1600-pound mare
where there existed an oblique fracture of the humerus. This mare was
kept in slings for eight weeks. Walters[14] reports complete recovery in
humeral fracture in a foal three days old. The only treatment given was
the application of a pitch plaster from the top of the scapula to the
radius. The colt was kept in a comfortable box stall and in about four
weeks regained use of the leg. Complete recovery eventually resulted. In
the experience of the author, recovery has not occurred in humeral
fractures.
Treatment.--When animals are not aged and of sufficient value to
justify treatment, they are best supported in a sling, if halter broken.
If subjects are nervous, wild and unbroken, it is possible to employ the
sling, if care is given to train the animal to this manner of restraint.
The presence of an attendant for a day or two will reassure such
subjects so that even in these cases it may be practicable to employ the
sling.
Braces and other mechanical appliances intended to immobilize the parts
are not of practical benefit in the horse. Unlike the dog, the horse as
yet has not been successfully subjected to tolerating rigid braces for
the shoulder and hip.
Everything possible must be done that will make for the patient's
comfort. If the subject turns out to be a good self nurse, and the
nature of the fracture is such that practical apposition of the broken
ends of bone may be maintained, recovery will occur in some cases.
Inflammation of the Elbow.
(Arthritis.)
Affections of this articulation other than those which are produced by
traumatism are rare. This joint has wide articular surfaces, and
securely joined as they are by the heavy medial and lateral ligaments
(internal and external lateral ligaments), luxation is practically
impossible. When luxation does occur, irreparable injury is usually
done. Castagné as quoted by Liautard[15], reports a case of true
luxation of the elbow joint in a horse where reduction was effected and
complete recovery took place at the end of twenty-five days. This is an
unusual case. The average practitioner does not meet with such
instances.
Anatomy.--The condyles of the humerus articulate with the glenoid
cavities of the radius and a portion of the ulna. Two strong collateral
ligaments pass from the distal end of the humerus to the head of the
radius. The capsular ligament is a large, loose membrane which encloses
the articular portion of the humerus with the radius and ulna and also
the radioulnar articulation. It is attached anteriorly to the tendon of
the biceps brachii (flexor brachii). The capsule extends downward
beneath the origin of these digital flexors. This fact should be
remembered in dealing with puncture wounds in the region, lest an error
be made in estimating their extent and an open joint be overlooked at
the initial examination.
Etiology and Occurrence.--Exclusive of specific or metastatic
arthritis, which is seldom observed except in young animals,
inflammation of the elbow joint is usually caused by injury. This
articulation is not subject to pathologic changes due to concussion or
sprains as occasioned by ordinary service, but is frequently injured by
contusion from falls, blows from the wagon-pole and kicks. Wounds which
affect the elbow joint, then, may be thought of in most cases, as
resultant from external violence. They may be contused wounds or
penetrant wounds. Sharp shoe-calks afford a means of infliction of
penetrant wounds which may occasion open joint and infectious arthritis.
Classification.--A practical manner of classifying inflammation of the
elbow is on an etiological basis. Eliminating the forms of elbow
inflammation, such as are caused by metastatic infection and other
conditions which properly belong to the domain of theory of practice, we
may consider this affection under the classification of _contusive
wounds_ and _penetrative wounds_.
Symptomatology.--Any injury which is of sufficient violence to
occasion inflammation of the elbow causes marked lameness and
manifestation of pain. The degree of lameness and distress manifested by
the subject, depends upon the nature and extent of the involvement. A
contusion suffered as the result of a fall, which occasions a
circumscribed inflammation of the structures covering this joint and
where little inflammation of the articulating parts exists, marked
evidence of pain and lameness might be absent. On the other hand, if a
true arthritis is incited, there will be evident distress manifested,
such as hurried respiration, accelerated pulse, inappetence, mixed
lameness, local evidence of inflammation and particularly marked
supersensitiveness of the affected parts. Considering these two extremes
of manifested distress and injury, one may readily conclude that in the
frequently seen case, wherein contusion has occasioned a moderate
degree of injury, prognosis is favorable and recovery ordinarily
follows in the course of a few weeks' treatment.
In cases of arthritis due to penetrative wounds (because of the
important function of this joint and its large capsule, which when
inflamed discharges synovia in a manner that closure of such an open
joint is seldom possible) a very grave condition results.
Treatment.--Inflammation of the elbow, such as is frequently seen in
general practice where horses are turned out together and exposed to
kicks and other injuries, yields to treatment readily, if an open joint
does not exist.
Hot packs supported in contact with the elbow and kept around the
inflamed articulation for a few days, materially decrease pain and tend
to reduce inflammation. The subject must be kept quiet in a comfortable
stall and, if necessary, a sling used. Where it is impossible for the
animal to support much weight with the injured member the sling should
be employed.
As inflammation abates, which it does in the course of from one to three
weeks in uncomplicated cases, the subject may be allowed the freedom of
a comfortable box stall. Vesication of the parts is in order, and this
may be repeated in the course of two weeks, if it is deemed necessary.
Penetrative wounds resulting in open joint are not treated with success
as a rule, and because of the handicap under which veterinarians labor,
methods of handling such cases, where large, important articulations are
affected, are not being rapidly improved. Prognosis is usually
unfavorable, and for humane and economic reasons, animals so affected
should be destroyed.
Ordinary wounds of the region of the elbow are treated along general
lines usually employed. They merit no special consideration, except that
it may be mentioned that with such injuries concomitant contusion of the
parts occasions injury that does not recover quickly.
Fracture of the Ulna.
Etiology and Occurrence.--Fractures of the ulna in the horse are not
common in spite of the exposed position of the olecranon. This bone when
broken, is usually fractured by heavy blows and any form of ulnar
fracture is serious because of its function and position in relation to
the joint capsule. Transverse fractures do not readily unite because of
the tension of the triceps muscles, which prevent close approximation of
the broken ends of the bone.
Thompson[16], however, reports a case of transverse simple fracture of
the ulna in a mare, the result of a kick, in which complete recovery
took place. He kept the subject in a sling for six weeks and then
allowed six months rest.
Symptomatology.--The position assumed by a horse suffering from a
transverse fracture of the ulna, is similar to that in radial paralysis.
Crepitation may be detected by manipulating the parts, and in some
instances of fracture of the olecranon, there occurs marked displacement
of the broken portions of the bone. Lameness is intense and the parts
are swollen and supersensitive. The capsular ligament of the elbow joint
is usually involved in the injury because fracture of the ulna may
directly extend within the capsular ligament. In such cases, there is
synovitis, and later arthritis causes a fatal termination.
Treatment.--The impossibility of applying a bandage in any way to
practically immobilize these parts in fracture of the ulna, prevents our
employing bandages and splints. Therefore, one can do little else than
to put the patient in a sling and try to keep it quiet and as nearly
comfortable as circumstances allow.
Fracture of the Radius.
Etiology and Occurrence.--From heavy blows received such as kicks,
collision with trees or in falls in runaway accidents, the radius is
occasionally fractured. In very young foals, fracture of the radius, as
well as of the tibia and other bones, results from their being trampled
upon by the mother.
Symptomatology.--Excepting in some cases of radial fracture of foals
where considerable swelling has taken place, there is no difficulty in
readily recognizing this condition. The heavy brachial fascia materially
contributes to the support of the radius, and in cases where swelling
is marked, crepitation may not be readily detected. In fact, a
sub-periosteal fracture may exist for several days or a week or more and
then, with subsequent fracture of the periosteum, crepitation and
abnormal mobility of the member are to be recognized. In such cases, the
subject will bear some weight upon the affected member, but this causes
much distress. In one instance the author observed a transverse fracture
of the lower third of the radius which was not positively diagnosed
until about ten days after injury was inflicted. In this case, without
doubt, the subject originally suffered a sub-periosteal fracture of the
bone and because the animal was a good self nurse, the brachial fascia
supported the radius until the periosteum gave way and the leg dangled.
In this instance infection took place and suppuration resulted. It was
deemed advisable to destroy this animal.
Prognosis.--In adult animals, radial fracture constitutes a grave
condition; generally speaking, prognosis, in such cases, is unfavorable.
Because of the leverage afforded by the extremity, immobilization of the
radius is difficult. Any sort of mechanical appliance, which will
immobilize these parts, is likely to produce pressure-necrosis of the
soft structures so contacted. There is occasioned thereby much pain and
the subject becomes restive, unmanageable and sometimes the splints are
completely deranged because of the animal's struggles, and much
additional injury to the leg is done. Occasionally, an otherwise
favorable case is thus rendered hopelessly impossible to handle, and the
subject must be destroyed several days after treatment has been
instituted.
Consequently, unless all conditions are good, and the affected animal a
favorable subject, young, of good disposition, and the fracture a simple
transverse one, complete recovery is not likely to result from any
practical means of handling.
Treatment.--Mature subjects ought to be put in slings and kept so
restrained throughout the entire time of treatment. Immobilization of
the broken parts of the bone is the object sought. This is attempted by
practitioners who employ various methods, and each method has its
advocates.
Casts are used by some and serve very well in many cases; but because of
their bulk and unyielding and rigid nature, they are not well adapted to
use on fractures of bones proximal to the carpus and tarsus. This is in
reference to plaster-of-paris casts or those of any similar material.
Appliances which depend on glue or other adhesive substances combined
with leather, wood or fiber for their support, are efficacious but not
comfortable.
The use of heavy leather when the member has been suitably padded with
cotton and bandages, constitutes a very good manner of reducing fracture
of the radius or of the tibia. Leather when cut to fit both the medial
and lateral sides of a leg, and firmly held with bandages, will form a
firm support that yields slightly to changes of position, thus making
for comfort of the subject.
Such a splint or support should extend from the fetlock region to the
elbow, but the cotton and bandages are to reach to the foot. When one
considers that, with the supportive appliance placed on each side of the
affected member, rigidity is accomplished as much from tensile strain
put upon the leather as from its own stiffness, it is seen that the
leather need not be of the heaviest--sole leather is unnecessary.
Because of the more comfortable immobilizing appliance, the subject is
less restive, and chances for a successful outcome are materially
increased thereby.
In the mature subject, six or eight weeks' time is required for union of
the parts to occur sufficiently so that splints may be dispensed with.
Rearrangement of the supportive apparatus, however, is possible and
usually necessary during the first few weeks of treatment. By employing
care in handling the parts, the subject will be unlikely to do itself
injury at the time readjustment of splints is being effected.
In foals, it is best to give them the run of a box stall with the
mother. Being agile, they get up and lie at will without doing injury to
the fractured member. The splints (leather is preferable in these cases
also) are looked after and readjusted as necessity demands.
Three or four weeks time is all that is required for the average young
colt to be kept in splints when suffering from simple transverse
fracture of the radius.
Compound fractures are necessarily more difficult to treat than are the
simple variety, but even in such cases recovery results sometimes, and
the practitioner is justified in attempting treatment after having
explained the situation to his client.
Oblique fractures, even when simple, do not completely recover. Muscular
and tendinous contraction, together with the natural tendency for the
beveled contacting parts of the broken bone to pass one another in
oblique fracture, results in shortening of the leg and, if union
results, a large callus usually forms. Where shortening of bones occur,
necessarily, permanent lameness follows.
Wounds of the Anterior Brachial Region.
Etiology and Occurrence.--Contusions and lacerations of the forearm
are of frequent occurrence in horses and are troublesome cases to
handle; particularly is this noticeable where extensive laceration of
the parts occurs. These injuries are caused by animals being kicked; by
striking the forearm against bars in jumping; and in sections of the
country where barbed wire is used to enclose pastures, extensive
lacerated wounds are met with when horses jump into such fences.
Symptomatology.--Any wound which causes inflammation of the structures
of the anterior half of the forearm, is characterized by
swinging-leg-lameness. Depending upon the nature and extent of the
injury, manifestation varies. In cases where laceration has practically
divided all of the substance of the extensor tendons, it is, of course,
impossible for the subject to advance the leg; but where lacerated
wounds involve only a part of the extensor apparatus of the foreleg, not
so much inconvenience is evident, unless the wound is seriously infected
and inflammation involves contiguous structures. Therefore, in many
instances, lameness is more pronounced in contusions of the anterior
brachial region than where tissues have been divided more or less
keenly.
In every instance diagnosis is easily established. The injury is quite
evident, and the manner of locomotion is not in itself an essential
feature to be considered in a discussion of symptoms. Where a contusion
of the anterior brachial structures occurs, there is, in addition to
lameness, swelling which is painful because of the pressure occasioned
by the heavy non-yielding brachial fascia. And where suppuration occurs,
there is then an intensely painful condition which is not relieved until
pus has been evacuated. Rather frequently, drainage for wound secretions
is a difficult problem, and approximation of the divided ends of muscles
is always difficult to maintain.
Treatment.--Contused wounds of the anterior brachial region are
treated along usual lines; that is, attempt is made to stimulate prompt
resolution. Hot or cold applications are employed throughout the acute
stage of the affection. Complete rest is provided for until all pain has
subsided. Later, stimulating liniments are beneficial.
Where no injury is done the periosteum or bone, complete resorption of
all products of inflammation usually occurs, though in many instances,
this is tardy--six weeks or more are sometimes required for recovery to
take place.
If suppuration occurs, it is necessary to provide for drainage as soon
as it is possible to distinguish the presence of pus. Due regard is
given the manner of establishing drainage because of the usual existence
of sub-fascial fistulae. In these cases, one avoids injecting solutions
of aqueous antiseptics. By gently compressing the parts, pus is caused
to drain out and in enforcing a moderate amount of exercise at a walk,
when lameness is not intense, drainage is maintained. Cotton packs,
moistened with hot antiseptic solutions, and kept around the forearm for
several hours daily, are helpful because drainage is facilitated, and
resolution is stimulated by the increase of blood thus attracted to the
parts, and pain materially diminishes.
In lacerated wounds of the anterior brachial region, after having
controlled hemorrhage, an area around the wound margin is freed of hair
by clipping or shaving. The wound is carefully examined, and the best
site for drainage is selected and a suitable opening for wound discharge
is provided for. Where the extensor carpiradialis (metacarpi magnus)
with other structures, is divided and the distal portion is torn
downward, as frequently is the case in barbed wire cuts, it is
necessary to make careful provision for drainage. The wound is
thoroughly cleansed by means of ablutions if necessary; but preferably
by swabbing with pledgets of cotton or gauze which are moistened in
antiseptic solutions. All shreds of macerated tissue are clipped with
scissors and finally the whole wound surface is painted with tincture of
iodin.
If drainage is made by cutting through the tissues in the median portion
of the structures that have been displaced, the opening should be packed
with gauze so that it may remain patent after swelling has occurred.
Such packing is left _in situ_ for twenty-four hours.
The pendant muscular portions of tissues are sutured up by means of
tapes and, while perfect apposition is not ordinarily possible, it is
very essential to train the pendant tissues in their normal position
even if they require resuturing within a week. This minimizes
granulation of tissue, and there results less scar if the detached
portions are kept near, even if not in contact with the proximal wound
margins. The skin together with subcutaneous fascia is sutured on either
side unless drainage is to be provided for on one side, and the
lowermost part of that side is left unsutured.
After-care.--Where extensive suturing of tissues has been necessary,
subjects must be kept quiet. They are best confined in box stalls and
not taken out for several weeks. Particularly is this true where
transverse division of extensors has taken place. Sutures are removed at
the end of from ten days to three weeks as cases permit. Drainage of
wound secretions, which usually become infected, is necessary, because
with obstructed drainage in an infected wound of this kind, there will
result an early destruction of tissue at some point sutured. Daily
irrigation done in a manner that practical asepsis is carried out, is
necessary for about a week. All irrigation is done by way of the
drainage opening, and this with warm aqueous solutions of suitable
antiseptics. After a week or ten days' time, the wound should not be
dressed more frequently than twice weekly.
If it is necessary to leave a portion of the wound uncovered, as in
cases where skin is destroyed, the frequent (three or four daily)
application of a suitable antiseptic powder is necessary to check
exuberant granulation. This may be directly effected by the use of an
astringent or desiccant preparation, and such dressing serves as a
mechanical protection as well.
When such wounds are kept clean, where drainage is properly maintained,
and the subject kept quiet, no particular attention other than the local
application of an astringent lotion (such as the zinc and lead lotion)
is necessary after the first three or four weeks. Usually, if the animal
gnaws at the parts or otherwise manifests evidence of discomfort, it is
an indication that new areas of infection are being established because
of obstructed drainage or retained eschars. A thorough cleansing of the
wound with a two per cent solution of Liquor Cresolis Compositus and
this followed by moistening every part of the wound with tincture of
iodin, will check all such disturbance if done promptly.
Where practically all of the anterior surface of the radius has been
denuded, recovery is tardy and there is in some cases imperfect
extension of the leg for months after the wound has healed. But in such
instances, animals gradually regain complete use of the affected member
and in the course of a year function is fully restored.
Inflammation and Contraction of the Carpal Flexors.
Anatomy.--The structures which are usually considered as true flexors
of the carpus are a group of three muscles, which have separate heads of
origin and different points of tendinous insertion.
The _flexor carpiradialis_ (flexor metacarpi internus) originates from
the medial epicondyle of the humerus. It is inserted to the proximal end
of the medial metacarpal (inner metacarpal or splint) bone. This muscle
is the smaller of the three and is not usually divided in doing carpal
tenotomy.
The _flexor carpiulnaris_ (flexor metacarpi medius) has two heads of
origin; one, the larger, originates from the epicondyle of the humerus
and the other from the posterior surface of the olecranon. The two
heads unite at the upper third of the radius and the muscle, becoming
tendinous, as is the case with the other carpal flexors, is attached by
one point of insertion to the accessory carpal bone (trapezum). The
other blends with the posterior annular ligament of the carpus.
The _ulnaris lateralis_ (flexor metacarpi externus) has its origin from
the lateral epicondyle of the humerus and inserts to the proximal
extremity of the fourth metacarpal (outer splint) bone and by another
attachment to the accessory carpal bone (trapezium) with the tendon of
the flexor carpiulnaris (flexor metacarpi medius).
Acting together, these muscles flex the carpus or extend the elbow and
this action is antagonized by the biceps brachii (flexor brachii) and
extensors of the carpus and phalanges.
Etiology and Occurrence.--Inflammation of the muscular or tendinous
parts of the carpal flexors, does not occur as frequently as does
inflammation of the flexors of the extremity. They are subject to injury
such as is occasioned by hard work and concussion and contract as a
result; but, more frequently a congenital malformation of the leg is
responsible for undue strain upon these parts. Horses that are "knee
sprung" or that have a congenital condition where in the anterior line,
as formed by the radius, carpal and metacarpal bones, is bent forward at
the carpus, are subject to inflammation and contraction of the carpal
flexors. When these flexors are contracted, the condition is commonly
known among horsemen as "buck knee." In itself, inflammation of the
carpal flexors is not a condition which is likely to prove troublesome,
but because of carpal involvement (which is often present) the cause of
the trouble remains, and inflammation of the carpal flexors recurs or
becomes chronic and contraction of tendons results.
Symptomatology.--Inflammation of the carpal flexors, when acute and
uncomplicated, is characterized by a painfully swollen condition of the
affected tendons. No weight is borne upon the affected leg and the
carpal joint is flexed. Mixed lameness is present. There is no
difficulty encountered in arriving at a diagnosis because of the very
noticeably inflamed parts.
Many fully developed cases of contraction of the tendons of the carpal
flexors are observed where the condition has become established
gradually and no lameness has resulted from tendinitis or carpitis. In
some of these cases, subjects are stumblers and when they are carelessly
handled or kept at fast work over irregular or hard roads, chronic
carpitis with hyperplasia of the structures of the anterior carpal
region results, owing to frequent bruising from falls.
[Illustration: Fig. 10--Contraction of carpal flexors, "knee sprung."]
Where inflammation is caused by a puncture wound and subfascial
infection occurs, there is evident manifestation of pain. No weight is
supported by the affected member and because of the pressure, occasioned
by the swollen muscles confined within the non-yielding brachial fascia,
there exists marked supersensitiveness of the affected parts. Flexion of
the elbow is avoided because contraction of the biceps brachii (flexor
brachii) or the extensors, which are antagonists of the flexors of the
carpus, tenses the carpal flexors and pain is thereby increased.
However, in most instances, the practitioner's attention is not directed
to typical and uncomplicated cases, but to subacute or chronic
inflammations which are often attended with contraction of the tendinous
parts of the carpal flexors, and in such cases carpitis is present.
Animals so affected have lost the rigidity which characterizes the
normal carpal joint when the leg is a weight bearing member, and because
of its sprung condition, the leg trembles when supporting weight.
Treatment.--Acute inflammation is treated by means of local
application of cold or hot packs until the pain and acute stage of
inflammation has subsided and later stimulating liniments are indicated.
Absolute quiet must be enforced. Especially where the carpus is involved
must the subject be kept quiet until all evidence of inflammation has
subsided.
The application of vesicants or line-firing is beneficial in subacute
inflammation of the tendons of the carpal flexors. Where contraction of
tendons exists and no osseous or ligamentous change prevents correction
of the condition, tenotomy is necessary. The reader is referred to
Merillat's "Veterinary Surgery"[17] for a good description of the
technic of this operation.
In all serious cases of inflammation of the carpal flexors, whether
tenotomy has been performed or not, the subject needs a long period of
rest subsequent to treatment. In fact, three or four months at pasture
is necessary to permit of recovery and this where no congenital
deformity has predisposed the subject to such affection of the flexors.
Return to work must be gradual and the character of the work such as to
enable the animal to become inured to service without a recurrence of
the trouble if possible.
It follows then, that tenotomy, here as in other cases, is not practical
from an economic viewpoint, unless the animal be of sufficient value to
justify the long period of rest for recovery. Tenotomy is not of
practical benefit unless ample time is allowed for regeneration of
divided tendinous tissue.
Fracture and Luxation of the Carpal Bones.
Etiology and Occurrence.--Fracture of the carpal bones is of
infrequent occurrence in horses and, when it does occur, it is usually
due to injuries, and because of their nature (resulting as they
generally do from heavy falls or in being run over by street cars or
wagons), a comminuted fracture of one or more bones exists. The
accessory carpal bone (trapezium) is said to be fractured at times
without being subjected to blows or like injuries, but this is
exceptional.
Luxations of the carpal joint are of rare occurrence, and very few cases
of this kind are on record. Walters[18] reports a case of
carpometacarpal luxation in a pony wherein reduction was spontaneous and
an uneventful recovery followed. His reason for reporting the case, as
he states, is its rarity.
Symptomatology.--Fractures of the carpal bones as they usually take
place are diagnosed without difficulty. Because of their usually being
comminuted, abnormal movement of the joint is possible. Such movement is
not restricted and flexion of the leg at the carpus in any direction is
possible. Crepitation is readily detected and frequently these fractures
are of the compound-comminuted variety.
In fracture of the accessory carpal bone (trapezium) or in fracture of
any other single bone when such exists, there is no increase in the
movement of the joint. The accessory carpal bone may be readily
manipulated and when fractured, its parts are more or less displaced.
Recognition of fracture of any other single carpal bone must be done by
detecting crepitation unless it be a compound fracture, whereupon
probing is of aid in establishing a diagnosis.
Carpal luxation when present is to be recognized by finding the apposing
carpal bones joined in an abnormal manner--that is, out of position.
There is restricted or suspended function of the joint, and in the cases
recorded, no difficulty has been experienced in making a diagnosis. The
carpometacarpal portion of the articulation is the part which is usually
affected.
Prognosis and Treatment.--There is no chance for complete recovery in
the usual case of carpal fracture because of the fact that there results
sufficient arthritis to destroy articular cartilage beyond repair. In
the average instance, because of arthritis which persists for a
considerable length of time, more or less ankylosis results. At best,
one can only hope for partial recovery, that is to say, the member may
regain its usefulness as a weight-supporting part, but because of
restricted or abolished joint function, locomotion is more or less
difficult. Exostoses, articular and periarticular, occur and the carpus
usually becomes a large immobile articulation. There is danger of
infection resulting in simple carpal fractures and, needless to say, in
a compound-comminuted fracture of the carpus, infection usually occurs
and a fatal outcome is probable.
When treatment is instituted, antiseptic precautions are taken in
handling the compound fractures, and in any case immobilization of the
parts is sought. Here, as has been previously pointed out, it is best to
employ leather splints, so that a maximum degree of rigidity with a
minimum of distress and inconvenience to the patient will result. The
leg must be bandaged from the hoof upward, making use of a sufficient
amount of cotton to ensure against pressure-necrosis. The leather
splints are placed mesially and laterally and, of course, need to extend
as high as the proximal end of the radius. Subjects must be kept in
slings until union of bones has become established, and as a rule there
will then exist marked ankylosis.
There is no particular difference in the handling of carpal luxation and
dislocation of other bones. Where ligaments have not been destroyed to
the extent that reduction is of no practical use, the parts are kept
immobilized, if thought necessary. Later, vesication of the whole
pericarpal region is done and the subject allowed exercise at will.
Carpitis.
Etiology and Occurrence.--Inflammation of the carpus is caused by
contusions, such as are occasioned in falling, by kicks by striking the
carpus against objects in jumping and sometimes by striking it against
the manger in pawing. The condition is of rather frequent occurrence.
Symptomatology.--Evident symptoms of inflammation in carpitis are
always present--hyperthermia, supersensitiveness and swelling. Also,
there exists lameness which is characterized by an apparent inability to
flex the leg, and there is circumduction of the leg as it is advanced
because in this way little if any flexion of the carpus (which increases
pain) is necessary.
Depending upon the nature of the cause, there occurs a marked difference
in the character and amount of swelling.
[Illustration: Fig. 11--Pericarpal inflammation and enlargement due to
injury.]
Naturally, when much extravasation of serum and blood takes place, there
is occasioned a fluctuating swelling which is usually less painful to
the subject upon manipulation than is a dense inflammatory change
without marked extravasation.
In acute carpitis, there is present, then, a very painful condition
which involves the articulation, causing marked lameness, disturbance of
appetite and some elevation of temperature.
Chronic cases do not occasion serious pain or constitutional
disturbances, but do interfere with locomotion in direct proportion to
the existing articular inflammation and periarticular hypertrophy of
ligamentous and tendinous structures.
Treatment.--If possible, keep the subject absolutely quiet, employing
the sling if necessary. During the first stages of inflammation, the
application of ice packs to the affected parts, is of marked benefit.
At the end of forty-eight hours, hot applications may be used and this
treatment continued throughout several days. Anodyne liniments are of
service and should be employed throughout the acute stage of
inflammation during intervals between the hydrotherapeutic treatments.
As inflammation subsides, a counterirritating application such as a
suitable liniment and later blistering or line-firing is helpful in
stimulating resolution.
[Illustration: Fig. 12--Hygromatous condition of the right carpus, also
distension of sheaths of extensor tendons of both fore legs.]
Open Carpal Joint.
Anatomy.--The carpal bones as they articulate with one another and
with the radius and metacarpal bones, as classed by anatomists, form
three distinct articular parts of the joint as a whole and are known as
radiocarpal, intercarpal and carpometacarpal. These three pairs of
articulating surfaces are all enclosed within one capsular ligament. On
the anterior face of the bones, the capsular ligament is attached to the
carpal bones in such manner that an imperfect partitioning of the three
joint compartments is formed. Posteriorly, the capsule is very heavy and
forms a sort of padding over the irregular surfaces of the bones, and
also its reflexions constitute the sheaths of the flexor tendons. The
anterior portion of the capsular ligament forms sheaths for the extensor
tendons, and both portions of the joint have an attachment around the
distal end of the radius and another at the proximal end of the
metacarpal bones.
[Illustration: Fig. 13--Carpal exostosis in aged horse.]
Etiology and Occurrence.--Puncture wounds of any kind may serve to
perforate the joint capsule and such traumatisms are occasioned by
falls, kicks and in various ways in runaway accidents, and open carpal
joint may follow.
Symptomatology.--The pathognomonic symptoms of the existence of an
open joint is the exposure to view of articular surfaces of bones or
noting the escape of synovia from the joint capsule. As has been
previously referred to, there always exists a peculiar suspension of
carpal flexion in all cases of carpitis.
Non-infective wounds which may cause open joint are not necessarily
productive of an active carpitis--a synovitis may be the extent of the
disturbance. Unlike synovitis, which may characterize a non-infectious
penetrative wound of the capsular ligament, septic arthritis which may
supervene is a very painful inflammatory disturbance. It is
characterized by all of the symptoms which attend the case of open joint
and synovitis plus the obvious manifestation of great pain. There is an
elevation of temperature of from two to five degrees above normal;
circulation is accelerated; the pulse is bounding; respiration is
hurried; there is an expression of pain as indicated by the physiognomy;
and because of rapid erosive changes of cartilages which take place,
there is soon so much of the articulation destroyed that death is
inevitable. Death is usually due to generalization of the arthritic
infection.
[Illustration: Fig. 14--Exostosis of carpus resultant from carpitis.]
[Illustration: Fig. 15--Distal end of radius. Illustrating the effects
of chronic carpitis.]
In the meanwhile, if the character of the infectious material is not so
virulent, the disease will take on a slower course and the subject may
experience laminitis from supporting weight upon the sound member, or
because of continued recumbency, decubital gangrene and emaciation
sometimes cause death. If the subject does not soon succumb, it is
compelled to undergo days or even weeks of unnecessary suffering, and
too often in such cases, it is later deemed advisable to destroy the
animal because of the cost of continuing treatment until the horse is
serviceable. Therefore, it is evident that when such joints as the
carpus or tarsus are open and infection exists, if they are not promptly
treated and the infectious process checked, it is neither humane nor
practical to prolong treatment.
Distinction must be made between the different joints when infected as
the condition is much more serious in some cases than in others. All
things considered, perhaps open joints rank, with respect to being
serious cases as follows: elbow, navicular, stifle, tarsus, carpus,
fetlock and pastern. This, of course, is restricted to articulations of
the locomotory apparatus.
Treatment.--Preliminary care in the treatment of an open carpal joint,
is the same as has been described in this condition as it affects the
scapulohumeral articulation described on page 65. Likewise the further
treatment of such cases is along the same lines except that where it is
possible, the parts are kept covered with cotton and bandages. However,
in some cases, animals have been successfully treated without bandaging
and by keeping the patient in a standing position and on pillar reins
until recovery resulted. Such cases were of the non-infectious type and
recovery was possible within three or four weeks. Further, the condition
is not sufficiently painful in such instances as to prevent the subjects
bearing weight with the affected member; hence, no danger of resulting
laminitis is incurred. And finally, where bandages are not employed, the
frequent use of antiseptic dusting powders is substituted for cotton as
a protector.
When bandaged, such wounds need dressing more or less frequently, as
individual instances demand. The purulent infective inflammation of a
carpal joint will require daily dressing; whereas, in other cases
(non-infective), semi-weekly change of bandages is sufficient. Equal
parts of boric acid and exsiccated alum constitute a suitable
combination for the treatment of these cases, and this powder should be
liberally employed. Tincture of iodin may be injected into the joint
capsule where there is provision for its ready evacuation, as
conditions seem to require. Daily injections for three, four or five
days, are not harmful and will control infection in many instances.
Thecitis and Bursitis.
Etiology and Occurrence.--The thecae and bursae of the leg are several
in number. In the carpal region, the flexors of the phalanges are
contained together in the carpal sheath, and this is the principal theca
in the carpal region. Each of the tendons is provided with synovial
sheaths which are subject to inflammation and occasionally synovitis and
distension of these synovial sheaths occur.
Because of faulty conformation, some animals are subject to inflammation
of these sheaths, and all forms of strenuous work which taxes the
tendons greatly is apt to result in synovitis. Direct injury such as
blows may be the cause of synovial distension of thecae and the
affection is to be seen in all horses that have done much fast work on
hard road surfaces or pavements.
The usual case as it occurs in practice is a non-infective synovitis,
but where puncture wounds cause the trouble, an infectious inflammation
obtains.
Symptomatology.--No trouble is experienced in diagnosing distension of
tendon sheaths, for the affection is very palpable. During acute
inflammatory stages of this affection, some lameness is present--in
infectious inflammation lameness is intense. Local heat and pain upon
manipulation are readily discernible in all acute cases. And finally,
where there is reason for doubt, an aseptic exploratory puncture of the
wall of the fluctuating enlargement may be made with a suitable trocar,
and the discharging synovia will be proof of the existence of synovial
distension.
After the affection becomes subacute or chronic, no lameness or
inconvenience is manifested, and the condition is undesirable only
because of its being a blemish.
Treatment.--Acute non-infectious synovial distension of tendon sheaths
is treated by aspirating as much synovia as possible from the affected
theca (this is, of course, done under strict asepsis) and by means of
bandages, a uniform degree of pressure is kept over the parts for ten
days or two weeks. The patient is kept quiet and in the course of two
weeks an active blistering agent is employed over the region affected.
Usually, at the end of a month's time, complete recovery has taken place
and the subject may be gradually returned to work.
When synovial distensions are of long standing, it is necessary to take
special precautions to check excessive secretion of synovial fluid, and,
also because of the atonic condition of the tissues affected, resolution
is tardy. In addition to aspirating synovia, the introduction of equal
parts of alcohol and tincture of iodin into the theca is necessary. The
quantity of this combination injected, depends upon the size of the
sheath affected and the amount of synovia retained at the time injection
is made. Experience is necessary to judge as to this part of the work,
but one may consider that a quantity between three and ten cubic
centimeters of equal parts of tincture of iodin and alcohol constitutes
the proper amount to employ. Where much synovia is contained within the
sheath at the time of injection, there occurs great dilution of the
agent injected and consequently less irritation results.
The object of such injections is to check synovial secretion, and this
is sought by the local effect of iodin in contact with the secreting
cells together with the reactionary swelling which occasions pressure.
An increase in the local blood supply also follows. In all cases where
it is possible to employ suitable bandages, this should be done. The
ordinary derby bandages serve well and if their use is continued for a
sufficient length of time, good results follow.
There are other methods of treating these affections, and each has its
advantages and disadvantages. Line-firing, instead of the vesicant is
made use of by some, but the object desired is the same and results
obtained are similar.
Sheaths may be opened surgically by means of a knife, and the removal of
a portion of the wall of distended and atonic tendon sheaths is
possible. These operations belong to the realm of surgery and are not
properly a part of this treatise. However, in passing, it may be said
that if a perfect technic is possible in doing the last named
operation, a permanent recovery is the outcome.
Fracture of the Metacarpus.
Etiology and Occurrence.--As the result of all sorts of violence, such
as falls and injuries in accidents of various kinds wherein the
metacarpals are subjected to contusions, fractures may result. In the
horse it is unusual for fracture of one of the small metacarpal bones to
take place without there being at the same time a fracture of the third
(large) metacarpal bone.
Classification.--Fractures of the metacarpal bones as they occur, are
as likely to be compound as simple, and the multiple and comminuted
varieties are occasionally observed. The manner in which the third
(large) metacarpus is fractured, largely determines the outcome in any
given case.
Symptomatology.--Abnormal mobility of the broken parts of bone and
crepitation mark fracture of the metacarpus, and the condition is easily
diagnosed. In many instances, when compound fracture exists, broken ends
of bone are protruding through the skin. No weight is borne upon the
fractured member ordinarily, although during the excitement occasioned
by runaways, horses are sometimes seen to support weight with a broken
leg even when the protruding bone is sunk into the ground in so doing.
Prognosis.--Generally speaking, fractures other than the
simple-transverse in young animals, are considered unfavorable cases.
With the metacarpus, however, there are instances where compound
fracture occurs in colts that justify treatment. But in all cases of
compound fracture, the element of infection in addition to the increased
difficulty in maintaining immobility of the broken bone, creates almost
insuperable difficulties in the average instance. And unless the
practitioner distinctly explains to his client the various reasons which
make treatment an economic impracticability, dissatisfaction is likely
to follow if treatment is instituted without such an understanding.
Treatment.--Perfect apposition of the broken ends of bone is easily
effected and less difficulty is encountered in maintaining such
relations in metacarpal fractures than in fractures of the radius.
However, reduction and immobilization of this as in all fractures, must
be done without delay. In simple fracture, the metacarpus is covered
with enough cotton to pad the parts, and this is retained in position by
bandages. Splints of heavy leather or of thin pieces of tough flexible
wood are placed on each side of the leg and firmly held in position with
bandages. Bandages may be put on in layers and a coating of glue applied
over each layer if this is thought necessary. The advantage gained in
using glue or other adhesive materials is that the cast thus formed is
more rigid than where such material is not employed. On the other hand,
all elasticity is lost as soon as the cast adapts itself to the contour
of the extremity, and because of this rigidity, it is doubtful if
anything is gained by the incorporation of glue, except in the way of
added strength of the cast. Since the animal does not walk upon the
broken leg, it is possible to employ splints of suitable materials which
are retained in position without glue and frequent readjustment of a
part of the immobilizing apparatus is possible. This is impossible with
casts.
In compound fractures, provision ought to be made for dressing the wound
of the soft structures. This entails adjusting the splints in such
manner that one splint may be retained and others removed for dressing
the wound and readjusted as often as wound dressing is necessary.
Splints.
By this term is meant a condition where there exists an exostosis which
involves usually the second (inner small) and third (large) metacarpal
bones. While an exostosis involving any one of the splint bones, even
when directly caused by an injury, is called a "splint," the term is
employed here, in reference to exostoses not due to direct injury such
as in contusions.
Etiology and Occurrence.--This condition is one wherein there is
osseous formation following a periostitis and the region of the upper
portion of the second (inner small) metacarpal bone is the usual site of
the exostosis. There is incited an inflammation of the periosteum at
the site of the interosseous ligament which attaches the small to the
large metacarpal bone. This ligament is involved in the inflammatory
process, and according to Havemann, whose view is supported by Moller,
this inflammation is the origin of the trouble.
Various theories attempting an explanation of the frequent affection of
this one certain part so regularly involved have been offered, but no
proof of the correctness of any exists. It follows, however, that
splints occur in young animals; that the affection seldom starts in
subjects that are ten years of age or older, and that when the exostosis
has formed, lameness usually subsides. Anything which will cause undue
strain or irritation of the metacarpal bones in young animals, is quite
apt to result in a splint being formed. Concussion such as is caused by
fast work on hard roads, or work on rough or irregular road surfaces
which cause unequal distribution of weight, will cause splint lameness
and exostosis follows.
[Illustration: Fig. 16--Posterior view of radius (right) illustrative of
effects of splint. Note the extent of exostosis.]
Course.--Because of the peculiar manner in which the second and third
metacarpal bones articulate in young animals, until the bones become
ossified and permanently joined, the inflammation which attends the
acute stage of this affection, causes lameness. Later, unless an
unusually large exostosis is formed, which may cause a constant
irritation due to its size and juxtaposition to the carpus, lameness is
discontinued.
Symptomatology.--Lameness is usually the first manifestation of this
disorder, and the thing which characterizes splint lameness is its
peculiar intermittence. There is a mixed form of lameness which may not
be in evidence when an affected animal is started on a drive, but which
is marked after the subject has gone some distance. The animal may,
however, go lame throughout the whole of a drive and continue to be lame
for several days or weeks in some cases. It is noticeable that lameness
is augmented or produced when the subject travels on rough road surfaces
and that little or no difficulty is encountered when roads are smooth.
The heavy brachial fascia is inserted in part to the head of the second
metacarpal (inner small) bone together with the oblique digital extensor
(extensor metacarpi obliquus) and this explains the reason for pain
being manifested during extension of the member.
Before there is a visible exostosis, supersensitiveness is readily
recognized upon palpation of the parts, if careful comparison is made
between the sound and unsound members. However, frequently splints occur
on both forelegs at the same time and in some instances exostoses are
several in number upon each member affected. In some instances, the
affection involves the outer splint bone and no evident involvement of
the inner one exists.
Treatment.--At the onset complete rest should be provided and the
local application of some good cataplasm is in order. A stimulating
liniment is beneficial when employed several times daily and massage is
also quite helpful. Later, the application of a blistering ointment is
good treatment. The use of the actual cautery stimulates prompt
resolution, but there is seldom any resorption of products of
inflammation following firing. Whereas, in cases where other treatment
is begun early, there usually follows considerable diminution in the
size of the exostosis. A rest of four or five weeks is necessary and
very young animals should not be put to work too soon, if the character
of the work is such as to induce a recurrence of the trouble.
Many cases are treated successfully in draft types of animals (where the
subjects are not kept at work that occasions serious irritation to the
affected parts) by blistering the exostosis repeatedly and allowing the
animals to continue in service. In such cases, it is unreasonable to
expect to check the size of the exostosis and, of course, such methods
are not employed where lameness causes distress to the subject.
Firing usually causes prompt recovery from lameness and is a dependable
manner of treating such cases but there remains more blemish following
cauterization than where vesication is done.
OPEN FETLOCK JOINT.
This condition, because of the frequency with which it occurs may be
taken as typal, from the standpoint of treatment and results obtained
therefrom. While it serves to constitute a basis from which other
joints, when open, are to be considered, due allowance must be made for
the fact that, as has been previously mentioned, some articulations when
open constitute cause for grave consequences; while with others an open
capsule, even when infected, does not cause disturbance enough to be
classed as difficult to handle. Moreover, the fetlock joint is admirably
suited, anatomically, to bandaging; and when wounded, is easily kept
protected by means of surgical dressings. This fact is of great
importance in influencing the course and termination in any given case
of open fetlock joint and should not be forgotten.
There is no logical reason for comparing the pedal joint with the
pastern on the basis that it may also be completely and securely
bandaged. Open navicular joint does not occur, as a rule, except by way
of the solar surface of the foot, and the introduction of active and
virulent contagium is certain to happen; consequently, an acute
synovitis quickly resulting in an intensely septic and progressively
destructive arthritis soon follows in perforation of the capsule of the
distal interphalangeal articulation.
Etiology and Occurrence.--Wounds of the fetlock region resulting in
perforation or destruction of a part of the capsular ligament are caused
by all sorts of accidents, such as wire cuts, incised wounds occasioned
by plowshares, disc harrows, stalk cutters and other farming implements.
In runaways the joint capsule is sometimes punctured by sharp pieces of
wood or other objects. In horses driven on unpaved country roads the
fetlock is occasionally wounded by being struck against the sharp end of
some object, the other end of which is firmly embedded in the ground. In
one instance the author treated a case wherein the fetlock joint was
perforated by the sickle-guard of a self-binder. In this case there
occurred complete perforation causing two openings through the
_cul-de-sac_ of the joint. Such wounds are produced by implements which
are, to say the least, non-sterile, and this perforation of the
uncleansed skin conveys infectious material into the joint capsule. Yet
in many instances, especially in country practice, no infectious
arthritis results where cases are promptly cared for.
Symptomatology.--A difference in the character of symptoms is
evidenced when dissimilar causes exist. Small penetrant wounds which
infect the synovial membranes cause infectious arthritis in some cases,
whereas a wound of sufficient size to produce evacuation of all synovia
will, in many instances, cause no serious distress to the subject, even
when not treated for several days. If it is not evident that an open
joint exists and the articular cavity is not exposed to view a positive
diagnosis may be early established by carefully probing the wound. In
some cases where a small wound has perforated the joint capsule,
swelling and slight change of relation of the overlying tissues may
preclude all successful exploratory probing. In such instances it is
necessary to await development of symptoms. Twenty-four hours after
injury has been inflicted, there is noticeable discharge of synovia
which coagulates about the margin of the orifice, where synovial
discharge is possible. Particularly evident is this accumulation of
coagulated synovia where wounds have been bandaged--there is no
mistaking the characteristic straw-colored coagulum which, in such
cases, is somewhat tenacious.
No difference exists between other symptoms in infectious arthritis
caused by punctures, and non-infectious arthritis, excepting the
intensity of the pain occasioned, the rise in temperature, circulatory
disturbances, etc.; all of which have been previously mentioned.
Treatment.--Just as has been stated in discussions on the subject of
open joint, probing or other instrumentation is to be avoided until the
exterior of the wound and a liberal area surrounding has been thoroughly
cleansed--too much importance can not be placed on this preliminary
measure. In cases of open joint where ragged wound margins exist and the
interior of the joint capsule is contaminated, much time is required to
thoroughly cleanse all soiled parts. In some instances an hour's time is
required for this cleansing process after the subject has been
restrained and prepared. In order to thoroughly cleanse these delicate
structures without doing them serious injury, one ought to be skillful
and careful in all manipulations of the exposed parts of the joint
capsule.
The general plan of treatment, after preliminary cleansing has been
accomplished, has been outlined on page 66 in the consideration of
scapulohumeral joint affections. The injection of undiluted tincture of
iodin in ounce quantities, it must be remembered, is not to be done
unless there is provision for its free exit. Where good drainage from
the joint cavity exists all infected wounds should be thus treated, and
this treatment may be repeated as conditions seem to require--until
infection is checked.
If daily injections are necessary, dilution of the tincture of iodin
with an equal amount of alcohol is advisable in order to avoid doing
irreparable damage to the articular cartilages and synovial membranes.
An antiseptic powder composed of equal parts of boric acid and
exsiccated alum is employed to protect the wound surfaces and the
margins, and the parts are then bandaged. In bandaging wounds of this
kind a liberal amount of cotton should be employed, and after a large
surface surrounding the wound has been thoroughly cleansed, it must be
so kept thereafter. This is impossible, if one uses a small amount of
cotton, particularly if such meager quantity of dressing material is
carelessly wrapped in position with an insufficient amount of bandage
material. Mention, without description of the elemental problem of
applying cotton and bandages to a wound, would be sufficient, were it
not that this is a very important part of the handling of such cases,
and many practitioners are not only thoughtless in this part of their
work, but also apparently careless. What does it profit to prepare a
part and cleanse a wound with painstaking care and then neglect to take
every possible precaution to prevent its subsequent contamination?
In the handling of open joint capsules where the perforation of the
capsular ligament is small and discharge of synovia does not immediately
follow, there is presented a problem which is difficult to decide upon
and that is the manner in which such wounds are to be handled. One
hesitates to enlarge such openings to drain or irrigate the capsule when
there is no proof that serious trouble will follow because of infectious
material which has probably been introduced at the time the wound was
inflicted. It is especially difficult to decide upon the manner of
handling such cases where the tarsal joint is wounded, although one
hesitates to invade any joint to the extent of incising its capsule,
unless there is urgent need of so doing.
Frost[19] offers the following suggestion in such instances:
The treatment recommended by us for open joints, in which we wish
to prevent ankylosis, is, first, to shave all hair from the area
surrounding the wound, following with a thorough cleansing of the
skin and disinfection of the wound, and then to inject a twenty per
cent Lugol's solution in glycerin into the wound. This should be
repeated two or three times a day, each time enough of the solution
being injected to fill the joint capsule, thereby securing the
flushing effect. As this solution does not cause irritation to the
tissue and yet is a strong antiseptic, it serves to shorten the
period of congestion and inflammation and to overcome the infection
without causing a destruction of the secreting membrane until the
external wound has had time to heal. The injection of this solution
seems to retard the excessive secretion of synovia. The larger the
joint capsule and the smaller the external wound, the longer our
antiseptic will remain in contact with the inflamed tissues as the
glycerin, being thick, does not flow through a small opening.
After-care.--Following the initial cleansing and treatment of open
joint, subsequent dressing is necessary as frequently as conditions
demand. If the parts are badly infected and profuse discharge of pus
exists a daily change of dressings is necessary. In the average
instance, however, semi-weekly treatments are sufficient. And in many
instances where one is obliged to travel a considerable distance to
handle the affected animal one weekly dressing of the wound will suffice
after the second treatment.
The same general plan of treatment concerning the subject's comfort that
has been previously mentioned in arthritis, is carried out here. A
further and detailed consideration of the subject of handling of open
joints follows.[20]
* * * Such wounds may be classified in two general groups as
follows: First, wounds in which the trauma has exposed the
articulation to view, and second, those the result of punctures, in
which the external wound is small and free drainage is lacking.
Wounds in which the articulation is exposed to view have drainage
either all ready provided for, or it is established without
hesitancy surgically. With free drainage thus established there is
little or no chance for the adjacent tissues to become infiltrated
with infected wound discharge. This prevents an extension of the
injury and the establishment of a good field for the growth of
anaerobic bacteria.
Open joints caused by punctures, unless the puncture is aseptic,
produce a swelling which is more painful than is the open wound
which exposes the joint to view. Especially is this true if the
puncture is of small diameter, allowing the tissues to partially
close the opening immediately after the wound has been made. Where
drainage is lacking there follows an exudation which congests the
tissues surrounding the injury and all factors favoring germ growth
are present. It is perhaps advisable to establish good drainage in
such cases as soon as a diagnosis is made.
It is not always an easy matter to recognize an open-joint, when
first made, but twelve to twenty-four hours later there is no cause
for doubt. The condition is then a very painful one; lameness is
excessive; there is rise in temperature; acceleration of the pulse
and manipulation or palpation of the region affected, occasions
great pain.
The treatment of open joints must be varied to suit the disposition
of the animal, the nature and location of the injury, the length of
time intervening between the infliction of the wound and the first
attention given, and the surroundings in which the patient is kept.
In each and every case in which there exists an open wound the
surface surrounding the wound is cleansed thoroughly, the hair is
shaved if possible, and the margin of the wound is curretted and
cleansed thoroughly with antiseptic solutions.
If there is evidence that the articulation contains infective
material, it is washed out with copious quantities of peroxide of
hydrogen--usually as much as six or eight ounces. This is followed
by injection of an ounce or two of tincture of iodin. Even though
the joint appears to be clean some tincture of iodin is used, as it
checks the secretion of synovia and is, in every way, beneficial.
Care is taken to apply the iodin also to the surface immediately
surrounding the wound. The entire wound is then covered with a
dusting powder composed of zinc oxide, boric acid, exsiccated alum,
phenol and camphor.
This powder is used in abundance and the wound is then covered with
a heavy layer of absorbent cotton and well bandaged. This bandage
is not disturbed for at least three days and may be left in place
for a week. In cases in which it is necessary to keep the dressing
on for a week, or in cases where the patient is, through necessity,
kept in quarters that are wet or unclean, the first bandage is
covered with a layer of oakum which has been saturated in oil of
tar and this in turn is held in place by means of several layers of
bandages. The bandages are also saturated with oil of tar.
In from one to two months wounds so treated, unless they are
foot-wounds, will be ready to dress without being bandaged. It is
ordinarily unnecessary to dress foot-wounds oftener than every
second week after the discharge of synovia has ceased. When the
wound has filled with granulation, a protective dressing is applied
which is rendered water proof by the use of bandages covered with
oil of tar. The patient can now be turned out for a month or six
weeks without disturbing the dressing. After the removal of the
bandages, the only treatment necessary is an occasional application
of some mildly antiseptic ointment.
Except in nail pricks of the foot, occasioned by punctures, a five
per cent tincture of iodin is injected into open joints, if the
wound remains sufficiently open, and this treatment is continued so
long as there is a discharge of synovia. Surgical drainage is
established if it is considered practicable and the remainder of
the treatment is about the same as for wounds which are open.
Open joints occur in horses at pasture and are sometimes not
discovered until several days or a week after the injury, and in
some instances the wounds are filled with maggots. The only
difference in the treatment of these cases is that more time and
care is taken in cleansing the wound, more curetting is necessary,
and after cleansing the wound with peroxide of hydrogen, the joint
is thoroughly washed out with equal parts of tincture of iodin and
chloroform. This is followed by the injection of a quantity of
seventy-five percent alcohol and the wound is dressed and bandaged
as already described. At each subsequent dressing of infected
wounds so treated less suppuration is noticed and the synovial
discharge usually ceases in from one to two months.
About _ninety percent of all cases of open joint make complete
recoveries_, about four per cent partially recover and six per cent
are fatal. Among the fatal cases are the open joints with
complications as severed tendons, those occasioned by calk wounds
in horses that are stabled, and nail punctures of the feet. The
following report of twelve favorable cases is taken from a record
of sixty-two cases. The favorable ones are reported, chiefly
because there are now enough reports on record of such cases which
have terminated fatally.
Case 1.--A gray gelding used as a saddle pony received a
horizontal wire cut laying completely bare the scapulohumeral
articulation. The margins of the wound were cleansed as heretofore
described, a drainage was provided surgically, tincture of iodin
was injected and the wound was covered with equal parts of boric
acid and exsiccated alum. The horse was kept tied and a diluted
tincture of iodin was injected into the wound once daily and the
powder applied often enough to keep the wound covered. The case
made a complete recovery and the pony was again in service within
sixty days.
Case 2.--A twelve-hundred-pound bay mare with an open carpal
joint. The wound was an open one about two and one-half inches in
length, and made transversely and when the member was flexed the
articular surface of the carpal bones were presented to view. An
ounce of tincture of iodin was injected into this joint after
having cleansed the margin of the wound and the mare was cross-tied
in a single stall to keep her from lying down. The owner was
instructed to keep the outside of the wound powdered with air
slaked lime and a very unfavorable prognosis was given.
I heard nothing further from this case until fifty-nine days from
the date of the injury, when I met the owner driving this mare to a
buggy. The wound had healed by first intention and at that time so
little cicatrix remained that it was difficult to find it.
Case 3.--A brown mare with an open fetlock joint due to a
spike-nail puncture. Lameness was excessive, and joint greatly
swollen. Tincture of iodin was injected into the wound and towels
dipped in hot antiseptic solutions were applied for several hours
daily until the acute stage had passed. Later the mare was turned
out to pasture and a vesicant was applied once or twice a month
until recovery was complete which was in about six months.
Case 4.--A four-year-old bay mare having a wire-cut which opened
the tarsus joint was treated as heretofore described. The wound was
kept bandaged for about two weeks and later it was dressed without
being bandaged. In ninety days she had completely recovered.
Case 5.--A twelve-year-old mare with an open fetlock joint due to
a puncture wound. The margins of the wound were cleansed and the
external wound enlarged to facilitate drainage. Tincture of iodin
was injected; the wound was bandaged and dressed for a month in the
manner heretofore described, when all discharge had stopped. A
vesicant was applied; the mare was put to pasture and within sixty
days from the date of the injury she was being driven on short
trips.
Case 6.--A two-year-old brown gelding with a wire-cut on the left
front foot. The wound extended down through the sole and opened the
navicular joint. This colt was very wild and it was necessary to
tie it down each time the wound was dressed. The wound was dressed
weekly for a month and less frequently thereafter. It was handled
eight times; the last dressing was left in place until worn out.
Six months later the colt was practically well, a very little
lameness being shown when walking on frozen ground.
Case 7.--A seven-year-old saddle-horse weighing eleven hundred
and fifty pounds received a wound of the tarsus, laying bare the
articular surfaces of a part of the joint. It was impossible to
keep this wound bandaged because of the restless disposition of the
subject. Injections of a dilute tincture of iodin were employed
every second or third day for a month and the wound was kept
covered with the antiseptic dusting powder referred to heretofore.
In five months complete recovery had taken place, with the
exception of a stubborn skin disturbance which was successfully
treated six months after the wound was inflicted. The horse is
still in use and is absolutely free from lameness.
Case 8.--A two-year-old brown gelding with a wire-wound opening
the scapulohumeral joint. This wound was large enough to expose to
view the articular portion of the humerus. The same treatment as
that given case No. one was instituted and in ninety days the colt
was practically well.
Case 9.--A three-year-old bay filly was found at pasture with one
fore foot badly injured. The owner intended to destroy her, but a
neighbor prevailed upon him to have her treated. Apparently the
wound was of about a week's standing and in a very bad condition,
filled with maggots and dirt. Both the navicular and coronary
articulations were open. This wound was cleansed in the usual
manner and the owner cared for the case the balance of the time
because the distance from my office was too great to give her
personal attention. She made an almost complete recovery in five
months.
Case 10.--At two-year-old mule with an open navicular joint due
to a barbed wire wound. Usual care was given this case and in five
months recovery was complete and little scar is to be seen. This
case received seven treatments.
Case 11.--An eighteen-months-old colt at pasture was found down
and unable to rise without help. In addition to several wounds of
lesser importance there was a large wound on the inner side of the
elbow, the joint was open and the entire leg was greatly swollen
and in a state of acute infectious inflammation. The colt could not
walk, its temperature was 105°, pulse was rapid and respiration was
a little hurried. After advising the owner to put the poor animal
out of its misery I left the place. Four days later the owner came
to my office and asked if he could borrow some old shears to "trim
off some loose hide from that colt." He left the colt in the
pasture and all the care it received was the regular application of
a proprietary dusting powder. It made a complete recovery.
Case 12.--A family mare, heavy in foal, received a vertical wound
of the fetlock joint inflicted by a disc-harrow. The _cul-de-sac_
of the ligament of this joint was opened freely. The wound was
dressed in the usual manner and again three days later when no
suppuration had taken place. Four days later the patient gave birth
to a colt and suckled it right along through her convalescence.
This wound healed by first intention and seventy-nine days from the
date of the injury the mare was driven to town, two and one-half
miles distant, and showed but little lameness.
Phalangeal Exostosis (Ringbone)
This term is applied to exostoses involving the first and second
phalanges (suffraginis and corona), regardless of their size, extent or
location. It is a misnomer, in a sense, and the veterinarian is
frequently obliged to spend considerable time with his clients in order
to convince them that a spherodial exostosis of the proximal phalanx, in
certain cases, is in reality "ringbone," even though there exists no
exostosis which completely encircles the affected bone.
Etiology and Occurrence.--Exostosis of the first and second phalanges
is usually due to some form of injury, whether it be a contusion, a
lacerated wound which damages the periosteum, or periostititis and
osteitis incited by concussions of locomotion, or ligamentous strain.
Practically the only exception is in the rachitic form of ringbone which
affects young animals.
There are predisposing causes that merit consideration, chief among
which is the normal conformation of the coronet joint. This proclivity
is constant; the normal interphalangeal articulation is an incomplete
ginglymoid joint and while its dorso-volar diameter is great, this in no
wise compensates for its disproportionately narrow transverse diameter.
The pivotal strain which is sometimes thrown upon this articulation when
an animal turns on one foot, as well as the tension which is put on the
collateral ligaments when the inner or the outer quarter of the foot
rests in a depression of the road surface, tends to detach the insertion
of these ligaments or to cause fibrillary fractures of their substance.
Short, upright, pasterns receive greater concussion during fast travel
on hard roads than do the longer more sloping and well formed
extremities. Those who are advocates of the theory that this type of
osteitis with its complications has its origin in the articular portion
of the joint, claim that the upright pastern constitutes an important
tendency toward ringbone. Howbeit, ringbone is an active, serious and
frequent cause of lameness and it affects animals of all ages and occurs
under various conditions. Horses having good conformation and kept at
work wherein no great amount of strain is put upon these parts, are
occasionally victims of this affection.
Classification.--The arrangement employed by Moller[21] is intensely
practical and logical. He considers ringbone as _articular_,
_periarticular_, _rachitic_ and _traumatic_. A mode of classification
that is common and in a practical way, good, is, high and low ringbone.
When prognosis is considered, for instance, it is very convenient to
state that the chances for recovery are much better in high ringbone
than in low ringbone. The classification of Möller will be followed
here.
[Illustration: Fig. 17--Phalangeal exostoses.]
Symptomatology.--In all forms of incipient ringbone except rachitic,
the first manifestation of its existence, or of injury to the ligaments
in the region of the pastern joint which causes periostitis, or
affections of the articular portions of the proximal inter-phalangeal
joint, is lameness. Lameness which typifies ringbone is of the
supporting-leg variety and by compelling the subject to step from side
to side, marked flinching is observed, especially in periarticular
ringbone; causing the affected animal to turn abruptly on the diseased
member, using it as a pivot, likewise accentuates the manifestation. In
fact, many subjects that exhibit no evidence of locomotory impediment
while walking or trotting in a straight line on a smooth road surface,
will manifest the characteristic form of lameness from ringbone when the
aforementioned side to side movement is performed.
When the manner in which pain is occasioned is considered, it will be
understood why lameness is intermittent in the early stages of this
affection and may even be unnoticed by the driver. An animal may travel
on a smooth road without giving evidence of any inconvenience, but as
soon as a rough and irregular pavement or road surface is reached, will
limp. As the subject is driven farther on level streets the lameness may
disappear. This intermittent type of lameness may continue until there
is developed a large exostosis, or until articular involvement causes so
much distress during locomotion that lameness is constant. On the other
hand, resolution may occur during the stage of periosteal inflammation,
or, an exostosis forms which causes no interference with function.
[Illustration: Fig. 18--Rarefying osteitis in chronic ringbone and
ossification of lateral cartilages.]
Before there is evidence of an exostosis, diagnosis of ringbone is not
easy, for it is then a problem of detecting the presence of a
ligamentous sprain, periostitis, or osteitis. The diagnostician should
take note of local manifestations of hypersensitiveness, or heat if such
exist, and, in addition, other conditions must be excluded before
definite conclusions are possible.
In _articular_ ringbone as soon as there is developed an exostosis, it
occupies a position on the dorsal (anterior) part of the articulation
and extends around the sides of the joint.
_Periarticular_ ringbone is characterized by exostoses which are
situated on the sides of the phalanges and not extending around to the
anterior part of the joint. This type of ringbone as well as the
articular may occur "high" or "low."
[Illustration: Fig. 19--Phalangeal exostoses in chronic ringbone. Museum
specimen of the Kansas City Veterinary College.]
With the _traumatic_ form of ringbone, all consequences, as to the size
and form the exostosis is to assume, depend upon the nature and extent
of the injury.
_Rachitic_ ringbone is frequently observed in some sections of the
country and does not ordinarily cause much if any lameness. It is a
disease of colts and may affect one or all of the phalanges at the same
time. As the subject advances in age there is more or less diminution in
the size of the enlargements.
Treatment.--Rest is essential in the treatment of ringbone. If
diagnosed during its incipiency, remedial measures such as are usually
employed to treat sprains, are indicated and later the parts should be
blistered. When an exostosis has developed puncture firing is the remedy
_par excellence_. Not that this method of treatment is infallible, for
to any thinking one who takes into consideration the pathological
anatomy of this condition, it is evident that no manner of treatment is
beneficial in some cases. If the exostosis is so situated that it does
not mechanically interfere with function, and is not so large that it
may inhibit flexion and extension, and where the articular portions of
the joint are not eroded, good results attend the use of the actual
cautery.
In firing, after having anesthetized the extremity, and prepared the
surgical area, the cautery is deeply inserted in numerous places, taking
care, however, not to open the joint. The parts are immediately covered
with aseptic absorbent cotton and this dressing is left in position for
forty-eight hours and if perchance there is evidence of synovial
discharge, the parts are again aseptically dressed in order to prevent
infection of the articulation. If, as is the case usually, no
perforation of the joint capsule exists, the openings made by the
cautery have been closed by the coagulation of serum and there is then
little chance of infection causing trouble, even though the member is
left unbandaged.
In several instances, the author has treated ringbone by this method
where the periarticular type existed and lameness was marked, and in
three weeks the subjects were in service and not lame--this, in one
instance in a valuable polo pony where the subject continued in service
for more than a year without any evidence of recurrence of the lameness.
The production of a deep-seated and acute inflammation with the actual
cautery is preferable to any sort of counter-irritation which may be
produced by vesicants.
There is no occasion for any difference in the treatment of either of
the first three classes of ringbone, but in the rachitic type where
treatment is given, the application of a vesicant is all that is
required. In most instances treatment is not necessary.
The affected animals require a month to three months' time for recovery
to take place in the average favorable cases of ringbone.
Median neurectomy is of service in many instances where lameness is not
completely relieved by the use of the actual cautery and no bad results
attend the performance of this operation even though no benefit is
derived thereby. Plantar neurectomy is contraindicated in all cases
where there exists much lameness. If lameness is due to acute
inflammation bad results such as sloughing and loss of the hoof may
follow; and if large exostoses mechanically interfere with function of
the joint, or where articular erosions exist, no possible good can come
from neurectomy. Careful discrimination should be employed in selecting
cases for neurectomy for this operation; otherwise, it is very likely to
prove disappointing.
Open Sheath of the Flexors of the Phalanges.
This condition does not differ from a like affection involving other
tendons except that the function of these tendons is such that large
synovial sheaths are necessary, and when synovitis exists, the condition
then becomes more serious.
Infectious synovitis involving these tendons in the fetlock region is of
more frequent occurrence than a like affection of carpal or tarsal
sheaths. With the exception of the extent of the involvement and
distress occasioned thereby, synovitis the result of open tendon
sheaths, is similar wherever it occurs.
Etiology.--The same conditions which are responsible for open fetlock
joint and other wounds of the pastern region, cause open tendon sheaths
of the flexor tendons.
Symptomatology.--Because of the size and extent of this sheath and the
different manner in which it is opened, there is manifested dissimilar
symptoms in different cases. A nail puncture which perforates the sheath
in the pastern region and at the same time produces an infectious
synovitis, will cause a markedly different manifestation than will a
wound which freely opens the sheath above the fetlock. In the first
instance, the condition is much more painful; swelling is intense in
some cases; and if the subject does not possess sufficient resistance so
that spontaneous resolution promptly occurs, surgical evacuation of pus
is usually necessary. When these tendon sheaths are opened, there
follows a reaction which is quite analogous to that which exists in
arthritic synovitis, but instead of ankylosis, adhesions with thecal
obliteration occur. Rarely there result cartilaginous and osseous
formations.
The constitutional disturbances which characterize this condition vary
with the degree of distress occasioned. As the infection is virulent and
causes serious destruction of the affected parts, so does evidence of
malaise and finally distress appear. Detailed discussions of
symptomatology in similar conditions have heretofore been given, and
further repetition is unnecessary.
Treatment.--The same general plan of treatment which is employed for
handling open joint is put in practice in these cases. Following the
preoperative cleansing of the external wound and adjacent surfaces,
where liberal drainage exists, tincture of iodin is injected into the
sheath, the parts covered with a suitable dressing powder, and the
entire member is carefully dressed with cotton and bandages.
Subsequent treatment is the same as has been outlined in the discussion
of open fetlock joint on page 112. The same general plan of after-care
is necessary. Recovery, however, does not require so much time
ordinarily, yet punctures of the sheath occasioned by nails or other
small implements make for long drawn out cases of infective synovitis.
Luxation of the Fetlock Joint.
Etiology and Occurrence.--The manner of construction of the fetlock
joint is such that disarticulation without irreparable injury resulting,
is practically impossible. Logically, this joint in the fore legs (not
so in the pelvic limbs) should disarticulate in such manner that either
all of the inhibitory apparatus (flexor tendons and suspensory ligament)
must rupture or a lateral luxation is necessary. Lateral disarticulation
must necessarily sever the attachment of one of the common collateral
ligaments. Because of the width (transverse diameter) of the
articulating surfaces of this joint, lateral luxation requires a great
strain; and a force that is sufficient to occasion this trauma usually
causes serious additional injury. Therefore, the condition is considered
one wherein prognosis is always unfavorable in so far as practical
methods of treatment are concerned.
Mr. A. Barbier[22] reports a case of bilateral luxation of the fetlock
joints of the hind legs in a horse. This was done in jumping, and the
extensor tendon of each leg was ruptured and the anterior portion of the
metatarsus was protruding through the skin. Profuse hemorrhage had taken
place due to tearing of the blood vessels.
Symptomatology.--Entire luxation of this joint when present is so
evident that one cannot fail to recognize the condition. Complete
disarrangement of normal relation occurs and there is either a breaking
down of the inhibitory apparatus, or if a lateral disarticulation
exists, the normally straight line formed by the bones of the front leg,
as viewed from the front or rear, is broken at the fetlock.
Often fracture of bones are concomitant and then, of course, mobility is
increased and not decreased as is the case in uncomplicated luxation.
Such violence occurs at times, when this joint is disarticulated, that
the joint capsule is also completely ruptured and the articular portion
of the bones is exposed to view.
Treatment.--The condition being practically a hopeless one,
destruction of the subject is the thing which should be promptly done.
In valuable breeding animals, owners may prefer that treatment be
attempted when a lateral luxation and detachment of but one common
ligament have permitted luxation without complete disarticulation and
rupture of the joint capsule. In such cases, by immobilizing the
affected parts as in fracture, and confining the subject in a sling for
about sixty days, partial recovery may occur in some instances.
Experience has shown that where luxation with detachment of a
collateral ligament occurs, recovery is slow and incomplete--there
always results considerable exostosis at the site of injury.
Sesamoiditis.
Etiology and Occurrence.--Inflammation of the proximal sesamoid bones
is caused by any kind of irritation which may involve this part of the
inhibitory apparatus. Positioned as they are, between the bifurcations
of the suspensory ligament and the pastern joint, they serve as fulcra
and effectively assist in minimizing concussion which is received by the
suspensory ligament. The flexor tendons also, in contracting, exert
strain upon the inter-sesamoidean ligament, which has a similar effect
upon the sesamoid bones as that which is produced by the suspensory
ligament.
The condition occurs quite frequently, and because of the important
function performed by these bones, active inflammation of the sesamoids
constitutes a serious affection. Because of the fact that these bones
have proportionately large articular surfaces, when they are inflamed to
the extent that degenerative changes affect the articular cartilage,
complete recovery seldom results.
The same pathological changes occur here that are to be seen in any case
of arthritis. No special pathological condition characterizes
sesamoiditis but this condition causes incurable lameness when the
sesamoid bones are much inflamed.
Symptomatology.--In acute inflammation, there exist all the symptoms
which portray any arthritic inflammation of like character. The parts
are readily palpable and are found to be hot, supersensitive, and more
or less infiltration of the tissues contiguous to the joint causes
swelling. There is volar flexion of the phalanges when the subject is at
rest. Lameness is intense; in some acute inflammatory disturbances the
subject is unable to bear weight on the affected member.
In chronic sesamoiditis, constant lameness is the one salient feature
which marks the condition. While it is possible for one sesamoid bone to
become involved without its fellow being affected, this is not usual.
Considerable organization of tissue surrounding the joint is present and
no particular evidence of supersensitiveness exists. However,
supporting weight brings sufficient pressure to bear upon the inflamed
and more or less eroded bones so that pain is occasioned and lameness
results.
Treatment.--During acute inflammation, absolute quiet is, of course,
of first consideration. Cold packs are to be kept in contact with the
parts until acute inflammatory symptoms subside. The fetlock region is
then enveloped with a poultice or an iodin and glycerin combination
(iodin one part to seven parts of glycerin) is applied and a dressing of
cotton is kept in contact with the inflamed region. Following this, a
vesicant is employed and the subject is allowed a month's rest.
In sub-acute cases, the entire region surrounding the pastern is
blistered or the actual cautery is used. Line-firing is preferable. The
subject is given a month or six weeks rest and one may be guided by the
presence or absence of lameness as to whether improvement or recovery is
taking place.
Old chronic cases, and particularly those where there are considerable
induration and fibrous organization of tissue surrounding the joint, are
not to be benefited by treatment.
The chief consideration in handling sesamoiditis is checking
inflammation as early as possible and preventing, if this can be done,
the erosion of articular surfaces. If destruction of any part of the
articular surfaces can be prevented and the patient allowed ample time
for complete resolution of the affected parts to occur, permanent relief
is possible.
Fracture of the Proximal Sesamoids.
Etiology and Occurrence.--Fracture of the proximal sesamoid bones is
caused by violent strain when there exists _fragilitas osseum_, or by
contusions. The author treated a case where fracture of one sesamoid was
occasioned by a horse receiving a puncture wound wherein the sharp end
of a steel bar was protruding from the ground where it was firmly
embedded. The subject in this case was injured while being driven along
a country road. Frost[23] reports simultaneous fracture of all of the
proximal sesamoids occurring in a sixteen-year-old pony. The condition
is of rather common occurrence in some countries because of the fragile
condition of horses' bones.
Symptomatology.--If the parts can be examined before extravasation of
blood and swelling mask the condition, crepitation may be detected. In
other instances, it is possible to note a displacement of parts of the
sesamoid bones--this in horizontal fracture. There occurs more or less
descent of the fetlock which must not be attributed to rupture of the
superficial flexor tendon (perforatus). By outlining the course of this
tendon with the fingers, when it is passively tensed sufficiently to
follow its course, one may exclude rupture of the superficial flexor.
Finding the suspensory ligament intact from its origin to the sesamoid
attachments, one may also eliminate rupture of this structure as a cause
of the trouble. Needless to say, marked lameness and swelling of the
fetlock soon take place. The condition is painful, and ordinarily,
recovery is impossible.
Treatment.--Where treatment is attempted, immobilization as in
luxation is in order. The patient's comfort is sought, and if the
fractured parts can be kept in close proximity, their union may occur in
time. However, chances for partial recovery (which is the best to be
hoped for) are so remote that early destruction of the subject is the
humane and economical thing to do.
Where treatment is instituted, it is found that there is required a long
time for union of the fractured bones to occur (where union does take
place) and the cost of treatment together with the uncertainty of even
partial recovery, makes for an unfavorable outcome. When the best
possible results succeed treatment, a large callosity is formed and
movement of the pastern joint is restricted. Lameness, though not
intense, in the case referred to, where one bone was broken, was
permanent and the subject was out of service for nearly a year.
Inflammation of the Posterior Ligaments of the Pastern (Proximal
Interphalangeal) Joint.
Anatomy.--The ligaments here involved are the four volar ligaments
described by Sisson[24] as follows: "The _volar ligaments_ (Ligg
Volaria) consist of a central pair and a lateral and medial bands which
are attached below to the posterior margin of the proximal end of the
second phalanx and its complementary fibro-cartilage. The lateral and
medial ligaments are attached above to the middle of the borders of the
first phalanx, the central pair lower down and on the margin of the
triangular rough area."
This portion of the inhibitory apparatus is described by Strangeways'
Anatomy as two posterior ligaments which run each from three points on
the sides of the os suffraginis to a piece of fibro cartilage, described
as the glenoid cartilage, and attached to the postero-superior edge of
the os coronae; between them is the insertion of the inferior
sesamoidean ligament.
Etiology and Occurrence.--Everything tending to increase strain upon
these ligaments is contributory to possible fibrillary fracture of these
structures. Excessive leverage as furnished by long toes, long toe-calks
and low heels increases the normal tension on the posterior ligaments of
the pastern joint. Faulty conformation, which throws an abnormal strain
on these ligaments, is a predisposing cause of inflammation of these
structures. Hard pulling upon slippery and rough or frozen roads is a
common exciting cause of this injury. The condition is of comparatively
frequent occurrence and is seen affecting draft horses frequently, in
the hind legs.
Symptomatology.--Lameness is the first manifestation of this affection
and weight bearing is painful in direct proportion to the extent of
injury present. Volar flexion of the phalanges relieves tension on the
parts; therefore, this position is assumed while the subject is at rest.
When considerable tissue has been ruptured, and the condition is very
painful, the foot is held off the ground as in all painful affections of
the extremity.
By palpation evidence of pain is discernible, though very little
swelling occurs. Pain is increased by manual tension of the parts which
is done by grasping the toe of the foot and exerting traction on the
flexor apparatus. Care must be taken in executing such manipulations,
and it is only by comparison of the affected member with the sound one
and noting the difference in the manifestations of discomfort that we
may arrive at the proper conclusion.
Some hyperthermia is to be recognized in acute inflammation, by
comparing the extremities. In the fore legs, navicular disease is
differentiated by noting absence of contraction at the heel. By use of
the hoof testers one may recognize evidence of inflammation of the
navicular apparatus. In inflammation of the posterior ligaments of the
pastern joint, there is also absence of the characteristic stumbling
which is seen in navicular disease.
Treatment.--Rest is the first requisite, and in addition every
mechanical means possible to change the center of gravity in the
phalangeal region, is to be employed. This is best accomplished by
shortening the toe and paring the sole at the toe as much as conditions
will permit. The heel is raised by means of a shoe with moderately high
heel calks.
The iodin-glycerin combination heretofore mentioned may be applied and
the parts covered with cotton and bandage. Subjects require from three
weeks to several months' rest and must be returned to work carefully,
lest the incompletely regenerated tissues suffer injury.
Regeneration of tissue in such cases, as has been pointed out, is slow
and sufficient time for complete recovery must be allowed or relapses
will occur.
Fracture of the First and Second Phalanges.
Etiology and Occurrence.--Fractures of the first phalanx (suffraginis)
occur with respect to frequency, second to pelvic fractures. Often,
almost insignificant injuries cause phalangeal fractures. On city
streets, horses shod with shoes having long calks get caught in frogs of
street railways or by slipping on rails, and phalangeal bones are often
broken. The author observed a case of comminuted fracture of both the
first and second phalanges (suffraginis and corona) in a polo pony
caused by making a sudden turn while in action in a contest on the turf.
Symptomatology.--Fracture of the phalanges is nearly always signalized
by lameness, and this is marked during the period of weight bearing.
Lameness is usually intense and where the pathognomonic symptom
(crepitation) is not recognized, the intensity of the claudication, when
other causes are absent, is indicative of fracture. The subject does not
bear weight upon the affected member and where pain is intense, the foot
is held in an elevated position and swung back and forth. In hind legs
the member is often flexed in abduction and held in this position for
several minutes, being rested on the ground only during short intervals.
When compelled to walk, if pain is excruciating, the animal hops with
the sound leg, no weight being supported by the fractured member.
When an examination of the subject is possible before the extremity is
swollen, crepitation is usually found without great difficulty, except
in a subperiosteal break or in some cases of vertical or oblique
fracture. Great care is necessary in handling the injured extremity in
these cases, and particularly in nervous subjects or in excited animals
that have been recently injured in runaways, is it necessary to be
gentle in manipulating the extremity, if definite deductions are to be
made. As has been mentioned in the chapter on diagnostic principles, if
the condition is so painful that the subject does not relax the parts
and crepitation is masked, local anesthesia is necessary. An anesthetic
solution of cocain or novocain may be applied to the metacarpal or
metatarsal nerves and an entirely satisfactory examination is then
possible.
Passive movement of the phalanges in all directions is practised in
order to produce crepitation. When rotation of the parts does not
occasion crepitation, gentle flexion and extension may do so. And in
many instances, considerable manipulation of the phalanges is necessary
before the pathognomonic symptom is to be recognized.
In cases where crepitation is not found and lameness is pronounced, out
of proportion with other possible existing causes, one may by exclusion
of other causes establish a diagnosis of fracture in the course of
forty-eight hours. In the meanwhile, support is given the affected
member by applying an effective leather splint, so that pain may be
diminished. To combat inflammation, a suitable cataplasm may be applied
directly to the skin, the extremity bandaged, and the temporary
immobilizing appliance may be secured over all. In this manner one may
make repeated examinations of the subject, and if slings are used and
every other necessary precaution taken to promote comfort for the
subject, no harm will result in delaying for several days the
application of permanent immobilization--bandages and splints or casts.
In fact, where much swelling exists at the time one is called to treat
such cases, it is advisable to delay the application of a permanent
dressing or cast until inflammation has somewhat subsided.
Course and Prognosis.--Where conditions are favorable, the nature of
the fracture one that will yield to treatment, the subject not aged, and
facilities for giving good attention to the affected animal are ample,
fractures of the first and second phalanges recover completely in from
six weeks to four months. Only simple fractures are considered curable
from a practical and economical point of view, excepting in foals, where
compound, and even comminuted, fractures may be so handled that animals
may eventually become serviceable though blemished.
Age retards the process of osseous regeneration, but in one instance at
the Kansas City Veterinary College, a very aged mare suffering from a
multiple fracture of the first phalanx was treated and at the end of
sixty days was able to walk into an ambulance. Large exostoses had
developed and the subject remained lame, but union of the broken bone
took place in a surprisingly prompt and effective manner, when age of
the subject and nature of the fracture are considered.
As a rule, one is loath to recommend treatment, even in a simple
transverse fracture of the first phalanx, in animals ten years of age or
older. The conditions which exist in any given locality that regulate
the expense of caring for an animal during the period of treatment,
especially influence the course to be pursued in treating fractures.
Treatment.--For permanent immobilization of the phalanges in fracture,
materials which might adapt themselves to the irregular contour of the
member and at the same time contribute sufficient rigidity to the parts
without doing injury to the soft structures, would constitute ideal
means of treatment; but no such materials have yet been devised, and
opinions are various as to the most efficient and practical method to
employ.
After the fetlock has been shorn of hair and the ergot trimmed, the skin
is thoroughly cleansed and allowed to dry. Several thin layers of long
fiber cotton are then wrapped around the extremity--enough to pad well
the member--and this is retained in position with a wide bandage. Gauze
bandages are preferable to heavier bandages of cotton fabric because
they are somewhat more elastic and yield to the irregular contour of the
parts to a better advantage. Layers of three inch gauze bandages, which
are soaked with a cold starch paste are wound about the extremity.
Strips of leather that are flexible and not more than an inch in width
are placed in a vertical position around the leg and these are also
covered with the starch and securely held in position with the bandages.
In this way, one is able to provide a sufficient degree of rigidity and
at the same time, where the cast is carefully applied, little if any
injury is done the skin. Such a cast is not difficult to remove and is
so inexpensive that it may be removed and reapplied at any time it
should be thought preferable to do so. Of course, this does not
constitute an effective means of support if the parts are to be
frequently and thoroughly soaked with water, but animals undergoing this
sort of treatment are usually kept sheltered.
The same after-care is necessary in such cases as is given in fractures
of other bones. Two months after the injury has been done, the
application of a blistering ointment to the entire region is of benefit.
Results.--Much depends on the nature of fractures as to the success
one may attain in approximating the parts of a broken bone, and in some
cases of oblique fracture for instance, complete recovery is impossible,
despite the most skillful and painstaking attention given. On the other
hand, cases of simple transverse fractures make perfect recoveries in
some instances. All fractures are serious, and in every instance the
practitioner would best be careful to impress his client with the many
difficulties which usually attend the treatment of fracture in horses.
Tendinitis.
Inflammation of the Flexor Tendons.
One of the most common causes of lameness in light harness and saddle
horses is tendinitis, and because of the character of the structure of
tendons and because of their function, an active inflammation of these
parts is always serious.
Being almost inelastic and not well supplied with blood, tendinous
tissue is slowly regenerated, and so much time is required for complete
recovery to take place in tendinitis, that affected animals seldom fully
recover before they are in service or vigorously exercising at will. As
a result, complete recovery is delayed or prevented.
The extensor tendons, because of the nature of their function, are very
seldom strained; they are often bruised and occasionally divided, but
unlike this condition in the flexors, tendinitis of the extensors is of
rare occurrence.
For a concise discussion of this subject the most practical
classification is one made on a chronological basis and we may then
consider tendinitis as _acute_ and _chronic_.
ACUTE TENDINITIS.
Etiology and Occurrence.--Causes of tendinitis, as in almost all
diseases, may be considered under the heads of predisposing and
exciting. Among the predisposing causes of tendinitis may be mentioned,
faulty conformation. Everything which has to do with increasing the
strain upon tendons adds to the probability of their being over-taxed.
Long, sloping, pastern bones; disproportionate development of parts,
such as a heavy body and small, weak tendons and long hoofs, are the
principal factors which usually predispose to tendinous sprains.
Degenerative changes which take place in tendons following
constitutional diseases such as influenza may also be classed as a
predisposing cause.
Excessive strain when put upon tendons in any possible manner, such as
is occasioned in running and jumping; making missteps and catching up
the weight of the body with one foot, when the force thus thrown upon
the supporting structure is great because of momentum gained at a rapid
pace, are exciting causes of tendinitis.
Symptomatology.--In all cases of acute tendinitis there is presented a
characteristic attitude by the subject. Volar flexion in a sufficient
degree to relax the inflamed structures is always evident. The foot may
be rested on the toe or placed slightly in advance of the one supporting
weight, but the fetlock is always thrown forward. More or less swelling
of the inflamed tendons is present. Where the deep flexor (perforans) is
involved swelling is marked and with swelling there is present the other
symptoms of inflammation--heat and supersensitiveness.
In manipulating tendons for the purpose of detecting supersensitiveness,
care must be taken so that no false conclusion be drawn, because of the
aversion many horses have to submitting to palpation of the tendons even
when they are in a normal condition.
Supporting-leg-lameness is present and varies in degree with the
intensity of the pain caused by weight bearing. In many instances, as
soon as the subject has traveled a considerable distance, lameness
diminishes or discontinues. As soon as the affected animal is permitted
to stand long enough to "cool out" there is a return of the lameness,
which is then marked.
No difficulty is encountered in making a practical diagnosis in
tendinitis; that is, one may fail to readily recognize the extent of the
involvement as it affects the superficial flexor tendon, for instance,
but this has no practical bearing on the prognosis and treatment, when
existing inflammation of the deep flexor is recognized.
The course of each tendon is readily outlined by palpation; all parts
are easily manipulated; and with experience one may readily recognize
the extent and degree of the inflammation.
Treatment.--In some cases of acute tendinitis, pain is intense and the
application of cold packs during this stage is very beneficial in that
pain is controlled and inflammation subsides. The extremity may be
bandaged with a liberal quantity of absorbent cotton or with woolen
material. Ice water is then poured around the bandaged member every
fifteen minutes and this should be continued for about forty-eight
hours. In some cases this treatment is not necessary for more than
twelve hours; at the end of this length of time, pain has subsided and
the acute stage of inflammation has passed or its intensity has been
diminished.
Following the application of cold packs, the use of a poultice such as
some of the sterile, medicated muds, is of marked benefit. The author
has made use of tincture of iodin and glycerin in the proportion of one
part of iodin to seven parts glycerin, with very satisfactory results.
This combination is hygroscopic, anodyne and antiseptic and is easily
applied. A liberal quantity is directly applied all around the affected
tendons and the leg covered with a heavy layer of cotton, and this is
snugly held in position with bandages. The application may be used once
or twice daily, or if it is thought necessary, an attendant may pour a
quantity of the iodized-glycerin around the leg and under the bandage
once daily without removing the cotton and bandage. Needless to say,
absolute rest is imperative.
When all evidence of acute inflammation has subsided vesication is
indicated. At this stage walking exercise is beneficial and the subject
may be allowed the freedom of a paddock.
Some practitioners are partial to the use of the actual cautery in these
cases, but it is doubtful if it is necessary to produce such a great
degree of counter-irritation in cases where the subject is suffering the
first attack of tendinitis.
As has been indicated, ample time should be allowed for recovery and
depending upon conditions, it takes from three weeks to six months for
complete recovery to become established.
Chronic Tendinitis and Contraction of the Flexor Tendons.
Etiology and Occurrence.--Acute inflammation of the flexor tendons may
result in chronic tendinitis. Recurrent attacks in cases where
insufficient time is allowed for complete recovery to result, is
followed by chronic inflammation and hypertrophy of the tendons. Again,
in subjects where conformation is faulty, no amount of care will be
sufficient to prevent a recurrence of the inflammation and the condition
must become chronic.
Symptomatology.--On visual examination of the subject at rest, one may
note the hypertrophied condition of the affected tendons. Their
transverse diameter is usually perceptibly increased and in many cases,
there is an increase in the antero-posterior diameter. The latter
condition causes a bulging of the tendon that is so noticeable, because
of the convexity thus formed, it is commonly known as "bowed tendon."
[Illustration: Fig. 20--Contraction of the superficial digital flexor
tendon (perforatus) of the right hind leg, due to tendinitis.]
In chronic tendinitis there occurs repeated attacks of inflammation
wherein lameness is pronounced and there exists in reality, at such
times, acute inflammation of a hypertrophic structure, where at no time
does inflammation completely subside. Therefore, in chronic tendinitis
there is to be found at times the same conditions which characterize
acute inflammation, except that there is usually a variance of symptoms
because of the difference in the degree of inflammation and pain.
The diagnosis of contraction of tendons is an easy matter because of the
fact that relations between the phalanges are constantly changed with
tendinous contraction. If one bears in mind the attachments and function
of the digital flexors, no difficulty is encountered in recognizing
contraction of either tendon.
Contraction of the superficial digital flexor (perforatus), when
uncomplicated, is characterized by volar flexion of the pastern joint.
The foot is flat on the ground and the heel is not raised because the
superficial flexor tendon does not have its insertion to the distal
phalanx (os pedis) and therefore can not affect the position of the
foot.
By causing the subject to stand on the affected member, one may outline
the course of the flexor tendons by palpation, and in this way recognize
any lack of tenseness or contraction of tendons or of the suspensory
ligament.
[Illustration: Fig. 21--Contraction of the deep flexor tendon
(perforans) of the right hind leg, due to tendinitis.]
Contraction of the suspensory ligament would cause the pastern joint to
assume the same position as is occasioned by contraction of the
superficial digital flexor (perforatus) tendon, but when the subject is
bearing weight on the affected member, it is easy to determine that no
contraction of the suspensory ligament exists, by noting an absence of
abnormal tenseness of this structure. And finally, contraction of the
suspensory ligament is of rare occurrence.
Contraction of the deep flexor tendon (perforans) causes an elevation of
the heel. The foot can not set flat because the insertion of the deep
flexor tendon to the solar surface of the distal phalanx (os pedis)
causes when the tendon is contracted--a rotation of the distal phalanx
on its transverse axis--hence the raised heel. No other tendon has this
same effect on the distal phalanx and the condition is correctly
diagnosed without difficulty.
[Illustration: Fig. 22--A chronic case of contraction of both flexor
tendons of the phalanges. In this case (presented at a clinic of the
Kansas City Veterinary College) because of long continued contraction of
the flexors, which prevented weight being supported with any degree of
comfort, there resulted a partial paralysis of the extensors, and
consequently the extremity was dragged on the ground.]
Course and Complications.--This condition may exist for years without
causing the subject any serious inconvenience, if the affected animal is
kept at suitable work. In other instances recurrent attacks of lameness
are of such frequent occurrence that the subject is not fit for service.
Many affected animals that are kept in service in spite of lameness (and
in some instances where no lameness is present), soon become
unserviceable because of contraction of the inflamed tendon. This, in
fact, is the condition which eventually becomes established in most
instances.
Treatment.--Where conformation is not too faulty so that recovery may
be expected, good results are obtained by line-firing the tendons and
allowing the subject a few months' rest. In some cases median neurectomy
is advisable. This is recommended by Breton[25] as being productive of
good results even where contraction of tendons exists and tenotomy is
done.
[Illustration: Fig. 23--Contraction of the superficial and deep flexor
tendons (perforatus and perforans) of the left fore leg.]
By shoeing with high heel-calks considerable strain is taken from the
inflamed tendons because of the changed position of the foot which
alters the distribution of weight on different parts of the leg. Rubber
pads materially diminish concussion and should be made use of when the
subject is returned to work, if the character of the work is such as to
occasion much concussion.
It is to be remembered, however, that in sprains there occurs fibrillary
fracture of soft structures and time is required for regeneration of
tissue which has been injured or destroyed. Absolute rest is necessary
where inflammation is acute and in sub-acute or chronic tendinitis
avoidance of all work which causes irritation to the affected tendons is
imperative.
[Illustration: Fig. 24--Contraction of superficial digital flexor and
slight contraction of deep flexor tendon.]
Where contraction of tendons exists surgical treatment is necessary. No
good comes from appliances which are calculated to stretch the affected
tendons; in fact, they aggravate the inflamed condition and hasten
complete loss of function of the affected member. Where there exists no
articular or ligamentous diseases which would defeat the purpose,
tenotomy is the only remedy for contracted tendons.
Contracted Tendons of Foals.
Etiology and Occurrence.--This condition is occasionally observed and
no positive explanation of the reason for its existence can be given.
That mal-position _en utero_ causes the metacarpal bones to develop in
length so rapidly that the tendons are too short, is an explanation that
is offered. Be that as it may, in breeding sections of the country the
general practitioner is obliged to handle these cases and successful
methods of treatment are essential even though cause is not removable.
Symptomatology.--The superficial flexor tendon (perforatus) alone, is
the one usually contracted, and while both flexors are at times
involved, this rarely occurs. The condition is usually bilateral.
The degree of contraction varies greatly in different cases. In some,
contraction exists to such extent that it is impossible for the colt to
stand, and because of continual decubitus where no relief is given, the
subject is lost because of gangrenous infection occasioned by bed sores.
Otherwise the same symptoms are to be observed in this condition, that
exist in contraction of tendons of the mature animal.
Treatment.--Wherever contraction is not too marked and weight is borne
with the affected members, and where the feet can be kept on the ground
in a nearly normal position, it is possible to correct the condition
without doing tenotomy. That is, in cases where the subject is simply
"cock-ankled", where volar flexion of the pastern joint exists but the
foot is kept flat on the ground, correction is possible without
tenotomy.
In such instances the foal must be treated early--before the skin on the
anterior pastern region has been badly damaged by knuckling over. It is
possible in many cases to stretch the flexor tendons by grasping the
colt's foot with one hand, and with the other hand one may push the
pastern in the direction of dorsal flexion. This may be tried and when a
reasonable amount of force is employed, no harm is done, even though no
material benefit results. Some veterinarians claim good results from
this treatment alone and direct their clients to repeat the stretching
process several times daily.
Whether the tendons are manually stretched or not, splints should be
adjusted to the affected members. The legs are padded with cotton and
bandages and a suitable splint is applied on either side of the members
and securely fixed in position by bandaging.
The splints are kept in position for four or five days and then removed
for inspection of the affected parts. If necessary, they are reapplied
and left in position for a week; however, this is unnecessary in the
average case that is treated in this manner.
Where contraction exists to the extent that the subject can not stand
and where no weight is borne by the feet, it is necessary to divide the
affected tendons surgically. The same technic is put into practice that
is employed in the mature subject but there is much greater chance for a
favorable outcome in the foal. Further, if necessary, one may divide
with impunity, both tendons on each leg, at the same time. In all cases
this operation is done by observing strict aseptic precautions and the
legs are, of course, bandaged. If both tendons are divided, splints
should be employed and kept in position for ten days or two weeks.
Primary union of the small surgical wound of the skin and fascia occurs
in forty-eight hours.
The reader is referred to William's "Veterinary Surgical and Obstetrical
Operations," for a complete description of this operation.
In veterinary literature there is occasionally described a
condition which affects young foals wherein symptoms similar to
those of contraction of the flexors are manifested, but upon
examination it is found that rupture of the extensor of the digit
(extensor pedis) exists. This affection is briefly described by
Cadiot but no complete treatise on this condition has been
published.
In parts of Canada foals of from one to three days of age are found
affected in such manner that more or less interference with the
gait is to be seen in those moderately affected. There is, in some
subjects, only a slight impediment in locomotion which is
occasioned by inability to properly extend the digit. In other
subjects, while able to stand and walk, great difficulty is
experienced because of volar flexion of the phalanges. The more
seriously affected animals are unable to stand and, in most
instances, perish because of the effects of prolonged decubitus.
A local enlargement occurs at the anterior carpal region and the
mass is somewhat fluctuating, extravasated fluids becoming infected
in many instances, and necrosis of the skin and fascia provide
means for spontaneous discharge of the contents of the enlargement
if it is not opened. The infection when it becomes generalized
causes a fatal termination in most cases that are not treated.
[Illustration: Fig. 25--"Fish knees."--Photo by Thos. Millar,
M.R.C.V.S.]
Native stock owners of some parts of Canada know this condition as
"fish knees" because of the presence of the ruptured end of the
extensor tendon which is found coiled in the cavity of the
enlargements caused by the ruptured tendon.
Local practitioners have treated the condition by incising the
swollen mass and removing the part of tendon contained within such
cavities. Treatment has not proved entirely satisfactory in the
majority of instances, perhaps because of tardy interference.
In a colt's leg sent the author by Mr. Thomas Millar, M.R.C.V.S.,
of Asquith, Saskatchewan, a careful dissection of the carpal region
revealed the fact that in this case the ruptured extensor tendon
was due to injury. The colt may have been trampled upon by its dam
in such manner that the tendon was divided. No noticeable evidence
of injury to the skin was to be seen on its outer surface, but on
the fascial side a cyanotic congested area, which was situated
immediately over the site of the ruptured tendon, was very
evident.
With the execution of a good surgical technic, the ruptured tendon
might be sutured; the wound of the tendon sheath as well as that of
the skin carefully united by means of gut sutures, the leg bandaged
and immobilized with leather splints and recovery follow in a
reasonable percentage of cases so treated. These cases afford an
opportunity for the perfection of practical means of treatment by
those who frequently meet with this affection.
Rupture of the Flexor Tendons and Suspensory Ligament.
Etiology and Occurrence.--Rupture of the flexor tendons or of the
suspensory ligament is of rare occurrence. Frequently, these structures
are divided as the result of wounds; but rupture, due to strain, is not
frequent.
[Illustration: Fig. 26--Extreme dorsal flexion said to have resulted
from an attack of distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No.
4.]
In some cases in running horses, or in animals that are put to strenuous
performances, such as are jumpers, rupture of tendons or of the
suspensory ligament takes place. However, more frequently this follows
certain debilitating diseases such as influenza or local infectious
inflammation of the parts which results in degenerative changes and
rupture follows.
The non-elastic suspensory ligament receives some heavy strains during
certain attitudes which are taken by horses in hurdle jumping as is
explained in detail by Montané and Bourdelle[26] under the description
of this ligament. But in spite of the frequent and unusually heavy
strains, which these structures receive, complete rupture is not
frequently seen.
Symptomatology.--When the anatomy and function of the flexor tendons
and suspensory ligament is thoroughly understood, recognition of rupture
of either of these structures is easily recognized. When one considers
that in rupture, a position directly opposite to that which is seen in
contraction in either one of these structures, is assumed, a detailed
description of each separate condition is needless repetition.
However, it is pertinent to suggest that rupture of the deep flexor
tendon (perforans) allows a turning up of the toe. Whether it be torn
loose from its point of attachment or ruptured at some point proximal
thereto, the position is the same--heel flat on the ground, toe slightly
raised and this raising of the toe varies in degree as the subject moves
about.
When the superficial flexor (perforatus) is ruptured there is no change
in the position of the foot but the fetlock joint is slightly lowered.
The pathognomonic symptom is the lax tendon during weight bearing, which
may be felt by palpation of the tendon along its course in the
metacarpal region.
With complete rupture of the suspensory ligament there occurs a marked
dropping of the fetlock joint and an abnormal amount of weight is then
thrown upon the superficial flexor tendon (perforatus), causing it to be
markedly tensed. This is readily recognized by palpation. By palpating
the suspensory ligament from its proximal portion down to and beyond its
bifurcation, while the affected member is supporting weight, it is
possible to diagnose rupture of one of its branches.
Prognosis and Treatment.--In rupture of the superficial flexor tendon
(perforatus) because of its comparatively less important function,
prognosis is favorable and recovery takes place when proper treatment is
put into practice.
With rupture of the deep flexor tendon (perforans), especially when it
occurs at or near its point of insertion and sometimes following
disease, prognosis is unfavorable.
Rupture of the suspensory ligament constitutes a condition which is, as
a rule, hopeless, because of the impracticability of treating such
cases.
The salient feature which characterizes any practical attempt at
treatment of ruptured tendons or other portions of the inhibitory
apparatus of the fetlock region, is to retain the phalanges in their
normal position for a sufficient length of time that the approximated
ends of ruptured tendons or ligaments may unite. The length of time
required for this to occur, together with the difficulties encountered
in confining the affected extremities in suitable braces or supportive
appliances, precludes all possibility of this condition's being
practically amenable to treatment when the deep flexor tendon
(perforans) and suspensory ligament are simultaneously ruptured. It does
not follow, even so, that recovery does not succeed treatment in some of
these unfavorable cases.
[Illustration: Fig. 27--A good style of shoe for bracing the fetlock
where tenotomy has been performed, or in case of traumatic division of
the flexor tendons. An invention of Dr. G.H. Roberts.]
Affected subjects are kept in slings as long as it seems
necessary--until they learn to get up without deranging the braces worn.
Several styles of braces are in use and each has its objections;
nevertheless some sort of support to the affected member is necessary
and steel braces which are connected with shoes are usually employed.
The principal difficulty which attends the use of braces is
pressure-necrosis of the skin which is caused by the constant and firm
contact of the metal support. The practitioner's ingenuity is taxed in
every case to contrive practical means of padding the exposed parts in
order to prevent or minimize necrosis from pressure. This is
attempted--with more or less success--by frequent changing of bandages
and the local application of such agents as alcohol or witch hazel.
Needless to say, the skin must be kept perfectly clean and the dressings
free from all irritating substances.
[Illustration: Fig. 28--Showing the Roberts brace in operation.]
The fact that tendons or ligaments which are ruptured, do not regenerate
as readily as in cases where traumatic or surgical division occurs, must
not be lost sight of, and prognosis is given in accordance.
Thecitis and Bursitis in the Fetlock Region.
Etiology and Occurrence.--Synovial distension of tendon sheaths and
bursae in the region of the fetlock are caused by the same active
agencies which produce this condition in other parts. The fetlock region
is exposed to more frequent injury than is the carpus and as a
consequence is more often affected. The same proportionate amount of
irritation affects this part of the leg, owing to strains, as affect the
carpus from a similar cause; and synovitis from this cause, is as
frequent in one case as in the other. Therefore, it is a natural
sequence that the tendon sheaths of the metacarpophalangeal region are
frequently distended because of chronic synovitis and thecitis. These
inflammations are usually non-infective in character.
The _cul-de-sac_ of the capsular ligament of the fetlock joint which
extends upward between the bifurcation of the suspensory ligament is the
most frequently affected structure in this region. When distended, two
spheroidal masses bulge laterally and anterior to the flexor tendons in
a characteristic manner. This condition is known among horsemen as
"wind-gall" or "fetlock-gall."
The sheath of the flexor tendons, which begins about the middle portion
of the lower third of the metacarpus, and continues downward below the
pastern joint is often distended.
Excepting in cases of acute inflammation attending synovitis of these
parts, no lameness marks its existence and in chronic cases of synovial
distension the service of affected animals is not interfered with. These
distensions constitute unsightly blemishes and they are treated chiefly
for this reason.
No difficulty is encountered in recognizing these conditions even where
considerable organization of tissue overlying distended thecae occurs.
In such cases there may be only slight fluctuation of the enlargement,
but if necessary, an aseptic exploratory puncture may be made with a
suitable needle or trocar.
Treatment.--Complete rest and the local application of cold packs are
in order in acute synovitis when there is distension of tendon sheaths.
In the fetlock region, because of the ease with which pressure may be
employed, the parts should be kept snugly wrapped with cotton, and derby
bandages are used to exert the desired amount of pressure over the
affected region. The pressure-bandages should be employed as soon as all
acute and painful inflammation has subsided; and then they should be
continued, day and night, for ten days or two weeks. The bandages should
be removed morning and night. After the skin of the leg has thoroughly
dried off, an infriction of alcohol or distilled extract of hamamelis is
given the parts and the cotton and bandages are readjusted. A good, even
and firm pressure in such cases is productive of satisfactory results.
[Illustration: Fig. 29--Distension of theca of the extensor of the digit
(extensor pedis).]
In chronic distensions of tendon sheaths synovia may be aspirated and
about five cubic centimeters of equal parts of tincture of iodin and
alcohol is injected into the cavity. This is not done, however, without
usual aseptic precautions. If no marked swelling results within
forty-eight hours the entire fetlock region is thoroughly vesicated and,
as soon as the skin has recovered from the effects of the vesicant,
pressure bandages may be employed. In these cases, subjects may be put
into service after all swelling which the injection or the vesicant has
produced has subsided. The pressure bandages are used at night or during
the time that the horse is in its stall and they are not worn by the
subject while at work.
Where no marked swelling occurs within ten days, as the result of the
injection of iodin, the injection may be repeated and, if thought
necessary, the quantity may be materially increased. If swelling does
not occur it is indicative that no particular irritation has been
caused.
Some swelling is desirable and much swelling sometimes results and
persists for weeks. This is not in any way likely to cause permanent
trouble; and if the technic of injection is skilfully executed no
infection will follow.
By persistent and careful use of suitable elastic bandages, the support
thus given the parts, together with the absorption of products of
inflammation which constant pressure occasions, some chronic cases of
synovial distension of tendon sheaths recover in two or three months and
this without other treatment. Such good results are not to be expected
in aged subjects, nor in horses having at the same time, chronic
lymphangitis.
Where bandages of pure rubber are employed great care is necessary, if
one is not experienced in their use, lest necrosis result. Where
bandages are uncomfortably tight the subject will manifest discomfort,
and an attendant should observe the animal at intervals for a few hours
(where there may be some doubt as to the degree of pressure which is
exerted by elastic bandages) and readjustment made before any harm is
done.
Arthritis of the Fetlock Joint.
Anatomy.--The anatomy of the metacarpophalangeal articulation is
briefly reviewed on page 58 under the heading of "Anatomo-Physiological
Review of Parts of the Foreleg."
Etiology and Occurrence.--The chief causes of non-infective arthritis
of the fetlock joint are irritations from concussion and contusions due
to interfering. The condition occurs in young animals that are
over-driven in livery service or other similar exhausting work, where
they become so weary that serious injury is done these parts by striking
the pasterns with the feet--interfering. In these "leg-weary" animals,
that are always kept shod with fairly heavy shoes, much direct injury is
done at times by concussion due to self-inflicted blows. In older
animals, where there exists similar conditions, with respect to their
being worn from fatigue and, in addition, periarticular inflammatory
organizations, arthritis is not of uncommon occurrence.
[Illustration: Fig. 30--Rarefying osteitis wherein articular cartilage
was destroyed in a case of arthritis of fetlock joint.]
Symptomatology.--In true arthritis there exists a very painful
affection which is characterized by manifestations of distress. The
subject may keep the extremity moving about--where pain is
great--suspended and swinging. There is swelling which is more or less
hot to the touch and compression of the parts with the fingers increases
pain. Lameness is always pronounced and no weight is supported with the
affected member in very acute and generalized arthritic inflammations.
There occurs the usual facial manifestations of pain--the tense
condition of the facial muscles and the fixed eye and nostril are in
evidence.
In cases where there exists a synovitis or where a very limited portion
of the articulation is involved, a somewhat different clinical picture
is presented. Then, the disturbance causes less distress; local swelling
and evidence of supersensitiveness are not so pronounced and lameness is
not intense, though weight-bearing is painful.
Prognosis.--There is a constant difference in the degree of pain
manifested, as well as the other symptoms of inflammation, between true
arthritis, which involves much of the joint, and synovitis; or synovitis
plus a small circumscribed area of joint involvement. This difference is
present in all joint affections of the extremities and, in passing, it
is well to say that infection usually increases every manifestation of
pain. Infection occasions more pronounced local symptoms of inflammation
and, because of the rapid progress of necrotic destruction of cartilage,
the course of the affection is usually rapid; ankylosis is a frequent
result and loss of the subject is often inevitable. However, in
non-infective arthritis of the fetlock joint, prognosis is favorable.
Treatment.--The same general principles which are employed in
arthritis of other joints are used here. Rest and comfort for the
patient is sought in every available manner. If the subject remains
standing too long, the sling should be used and a well-bedded box-stall
will contribute much to the comfort of the patient.
Pain and acute inflammation is diminished or controlled, if possible, by
using ice-cold packs. In nervous, well-bred animals analgesic agents may
be employed; or small doses of morphin sulphate--one to two
grains--given at intervals of three hours during the first stages of the
affection is very beneficial. This is especially indicated in infectious
arthritis.
As inflammation subsides, hot applications are used and finally counter
irritants are employed. Their selection is a matter of choice with the
practitioner. The object sought is the same with every practitioner and
while methods employed vary, results are not markedly different except
in so far as the degree of counter irritation which is produced varies
in given cases. Where a great degree of counter irritation is thought
necessary, line-firing with the actual cautery is the remedy _par
excellence_.
After-care.--In the course of three or four weeks subjects may be
allowed the run of a paddock and, after a complete rest of six weeks at
pasture, they may be returned to work with care, if the work is not of a
nature to occasion concussion or other manner of irritation to the
articulation.
Neurectomy is not indicated even though there is a recurrence of
lameness, unless the lameness is not pronounced and inflammation is
periarticular and no osseous enlargements mechanically interfere with
function of the joint. There are few cases then, where neurectomy is
materially helpful.
Ossification of the Cartilages of the Third Phalanx.
(Ossification of the Lateral Cartilages.)
Anatomy and Function of the Cartilages.--Surmounting each wing of the
distal phalanx (os pedis) is the irregularly-quadrangular cartilage. The
superior border of this cartilage is thin, generally convex, and
perforated for vessels to pass to the frog; the inferior border is
attached to the wing of the third phalanx and posteriorly, it is
reflected inward and is continuous with the inferior surface of the
sensitive frog. The anterior border which is directed obliquely downward
and backward becomes blended with the anterior lateral ligament of the
coffin joint. The fibrous expansion of the anterior digital extensor
(extensor pedis) is united to the anterior borders of the lateral
cartilages.
According to Smith[27]: These structures form an elastic wall to
the sensitive foot, and attachment to the vascular laminae; they
also admit of increase in width occurring at the posterior part of
the foot without destroying the union of the two set of leaves.
Further, by their connection with the vascular system of the foot,
their elastic movements materially assist the circulation. The
primary use of the lateral cartilages is to render the internal
foot elastic, and admit of its change in shape which occurs under
the influence of the weight of the body. The alteration in the
shape of the foot is brought about by pressure on the pad, which
widens and in consequence presses on the bars. The pressure
received by the pad is also transmitted to the plantar cushion,
which likewise flattens and spreads under pressure. Both of these
factors force the cartilages slightly outwards. When the posterior
wall recoils the cartilages are carried back to their original
position. Should the elastic cartilage under pathological
conditions become converted into bone, its functions are destroyed,
and lameness may occur.
Etiology and Occurrence.--The causes of ossification of these
cartilages are several. No doubt there exists a predisposition to this
condition for it is of such frequent occurrence in heavy draft types of
horses. Concussion plays an important rôle and, according to
Möller's[28] theory, which is sound, high heel calks prevent the frog
from contacting the ground, and as weight is placed upon the foot "the
lateral cartilages are subjected to a continuous inward and downward
dragging strain."
[Illustration: Fig. 31--Ringbone and sidebone.]
The condition affects the cartilages of the fore feet more frequently
than those of the hind and the outer cartilage is more often ossified
than is the inner. This fact may be accounted for by its more exposed
position; it is also frequently injured by being trampled upon and
otherwise contused or cut, as in lacerated wounds of the quarter.
Symptomatology.--Ossification of the cartilages is known by grasping
the free borders with the fingers and attempting their flexion; the
rigid inflexible ossified cartilage is thus easily recognized.
Lameness during weight-bearing occurs in the majority of cases at some
time. Much depends on the conformation of the foot and whether the
involvement affects one or both cartilages as to the degree and duration
of lameness which marks this affection. In narrow and contracted heels
it is reasonable to expect more lameness than in well formed feet. Where
only one cartilage is ossified, the other being flexible, there is less
inconvenience experienced by the subject during weight-bearing, because
of the expansion of the heel which the one normal cartilage allows.
Treatment.--There is little if anything to be done in case the
cartilage has become ossified except to shoe without high calks but
preferably with rubber pads. The hoof should be kept moist; the wall at
the quarter may be rasped thin and kept anointed. Firing is of no
practical benefit in these cases, and it is doubtful if vesication is
helpful excepting where only a part of the cartilage is ossified.
Subjects which continue somewhat lame, because of complete ossification
of both cartilages, are best put to slow work on soft ground and not
driven on pavements.
Navicular Disease.
This more or less ambiguous term has been applied to various diseases
affecting the structures which make up the coffin joint. We consider
this name to be applicable to inflammatory involvement of the third
sesamoid (navicular bone), the deep flexor tendon (perforans) and the
bursa podotrochlearis or navicular bursa.
Etiology and Occurrence.--In 1864 Thomas Greaves[29] wrote on the
subject of navicular disease as follows: "The opinion I entertain upon
the subject of navicular disease is, that in by far the greater majority
(if not all) of these cases there exists in the animal affected a
congenital tendency or predisposition, that, generally speaking, it is
the high stepper, the good goer, that becomes the victim to this
disease; and it is a fact well attested, that it as frequently develops
itself in the feet with wide frogs, bulbous heels, shallow heels, spread
flattish feet, as in the narrow upright feet.... I have known foals,
born from defective parents, in which this condition was so strongly
developed, that all men would at once pronounce them affected with
navicular disease, and such lameness was permanent."
Often both fore feet are affected and this would point toward its being
a disease wherein either conformation or congenital tendencies exists.
It is rare that hind feet are involved.
There are many theories regarding the possible exciting causes of
navicular disease and, when one has carefully considered the
explanations as offered by Peters, Möller, Branell, Schrader and others,
he may conclude that navicular disease is a non-infectuous inflammatory
affection of the third sesamoid (navicular) bone, deep flexor tendon
(perforans) and adjoining structures. Whether it originates in the
flexor tendon or whether the bone is the original part affected, the
disease is frequently met, and of all possible causes, jars and
irritation incident to concussion of travel, are probably the principal
causative agents.
Symptomatology.--Lameness is the primary indicator and a constant
symptom which attends navicular disease wherever much structural change
affects the infirm parts. As the degree of intensity or extent varies,
so is there a dissimilarity in the character of the impediment.
Incipient cases of bilateral involvement are more difficult to diagnose
than are unilateral affections, particularly when lameness is not
marked. There is manifested a supporting-leg-lameness which varies as to
degree in the same subject at different times. This may be noticed
during the same trip in an animal that is being driven. There is a
tendency for the subject to stumble and, of course, where the affection
is bilateral, there is a stilted gait owing to shortened strides.
At rest the lame animal usually points with the affected member. Because
of the fact that the distance is lessened between the origin and
insertion of the deep flexor tendon (perforans) by this attitude, one
may readily understand the reason for the position assumed by the
subject. Pressure on the navicular bone is diminished and tension on the
flexor tendon is relieved by even slight volar flexion.
In acute inflammatory affections abnormal heat may be detected in the
region of the heel. By exerting tension on the flexor tendon, by means
of passive dorsal flexion of the member, evidence of hyperesthesia may
be detected. With the hoof testers one may determine supersensitivenss
in most instances. There occurs more or less contraction of the hoof in
navicular disease, but this is not to be taken as a cause of the
affection, but rather a sequence.
[Illustration: Fig. 32--"Pointing"--the position assumed by horse having
unilateral navicular disease.]
In some cases of unilateral navicular disease there is a marked contrast
in size between the sound and unsound foot. However, one must not be
misguided in this particular, for in some pairs of sound feet there
exists considerable difference in size. Finally, by a change from the
normal position of the foot to one in which the heel is somewhat
elevated (as may be obtained by shoeing with high heel calks), relief is
evident, and in the opposite position, the condition is aggravated.
This experiment may be used for diagnostic purposes.
Treatment.--When the anatomy of the diseased parts is taken into
consideration, and an analysis of the lesions which occur in cases where
considerable structural change is occasioned by this affection, it is
obvious that recovery is impossible. Only in cases where the
inflammation is promptly checked before damage has been done the
navicular bone or the flexor tendon, is permanent recovery possible. The
disease is not frequently treated during this stage, however, and in the
majority of instances the condition becomes chronic.
As soon as a diagnosis is made the shoes must be removed, the toe
shortened with the hoof pincers and rasp and the subject is put in a
well bedded box-stall. If the animal is very lame and the inflammation
is acute, ice-cold packs should be applied to the feet. As soon as acute
inflammation has subsided the foot may be so pared that all excess of
sole and frog is removed without lowering the heels, and the animal may
be blistered about the coronet region. The subject may be shod later,
with heel calks that raise the heel moderately and a protracted period
of rest should be enforced.
In cases where no acute inflammatory condition exists, neurectomy is
beneficial. One must discriminate, however, between favorable and
unfavorable subjects. This is not a last resort expedient to be employed
in cases where extensive lesions of the navicular structures exists.
With proper shoeing, and by putting the subject at suitable work, where
concussion of fast travel on hard roads is not necessary, the best
results are obtainable.
Laminitis.
This disease is primarily a non-infective inflammation of the sensitive
laminae which very frequently affects the front feet. Often all four
feet are affected, less frequently one foot (when its fellow is unable
to sustain weight) and rarely the hind feet alone.
Occurrence.--Probably a greater number of cases of laminitis occur in
localities where horses that are worked on heavy transfer wagons are,
when in a state of perspiration, allowed to stand exposed to sudden
lowering of temperature and to stand in a cool or cold shower of rain
such as occurs near the coast of the Great Lakes or the ocean in some
parts of this country.
This disease occurs in connection with digestive disorders of various
kinds and, because of the frequent association of the two conditions,
the common term "founder" has long been employed to designate laminitis.
In cases of "over-loading," particularly when a large quantity of wheat
has been eaten by animals that are unaccustomed to this diet, laminitis
almost constantly results.
Large draughts of cold water, when drunk by animals that are overheated
is often followed by laminitis. Concussion, such as attends hard
driving, especially in unshod horses or on rough and hard roads, is
often succeeded by this affection. Likewise, as has been stated, injury
such as is occasioned by long continued standing on the same foot is
followed by laminitis. Some horses that are frequently shod, suffer from
this affection a few hours after shoes have been reset. Dr. Chas. R.
Treadway of Kansas City reports the rather frequent occurrence of such
conditions in horses that are in the fire department service in his
city.
Age in no way influences the occurrence of laminitis and the general
condition of an animal with regard to its vigor or state of flesh has no
apparent influence toward predisposing horses to this ailment.
Etiology and Classification.--As it is with some other diseases, one
may unprofitably theorize on cause and readily enumerate many conditions
which are apparently contributory toward producing the affection. Causes
may well be grouped, however, and a more definite understanding of
laminitis is possible as a result. Such collocation would include
conditions which directly or indirectly affect the digestion, such as
puerperal laminitis, drinking of large quantities of cold water and
exposure to cold and rain when the body is warm. All of these various
conditions might be said to affect the vaso-constrictor nerves in such
manner that the natural tendency (because of the peculiar structure of
the sensitive laminae and their mode of attachment to the non-sensitive
wall) which solipeds have for this affection is indirectly due to this
one cause--vaso-constriction. According to Dr. D.M. Campbell, the effect
of toxic materials, which may be absorbed from the digestive tract or
the uterus in parturient females, upon the vaso-constrictor nerves, is
such that a passive congestion of the sensitive laminae occurs and
laminitis is the result. He believes that even the chilling of the
surface of the body when very warm, by a cold rain, constitutes a
condition wherein the effect upon the vaso-constrictors is the same.
This grouping does not include the effect of direct injuries of any and
all kinds to which the feet are subjected such as: Concussion in fast
road work, injuries occasioned by tight or ill fitting shoes, contusions
of any kind resulting in non-infectious inflammation of the sensitive
laminae, as well as the causes which produce laminitis where weight is
borne by one foot when its fellow is out of function.
A classification which is practical is that of _acute_ and _chronic_
laminitis. To the practicing veterinarian it is this manner of
consideration that is essential in the handling of these cases.
Symptomatology.--In the acute attack the condition is so well
described by Dr. R.C. Moore[30] that we quote him in part as follows:
The acute form is generally ushered in very suddenly. Often a horse
that is perfectly free from symptoms of the disease is found a few
hours later so stiff and sore that he will scarcely move. They
stand like they were riveted to the ground. If forced to move the
evidence of pain subsides to some extent after they have gone a
short distance, to return more severe than ever after they have
been allowed to stand for a short time. If the disease is confined
to the two front feet, the hind feet are placed well under the
center of the body to support the weight and the front ones are
advanced in front of a perpendicular line so as to lessen the
weight they must bear. If they are made to move, the same position
of the feet is maintained. If made to turn in a small circle, they
do so by using the hind feet as a pivot, bringing the front parts
around by placing as little weight on them as possible.
Placing the hind feet so far under the body, arches the back and
often leads to errors in diagnosis, the condition sometimes being
taken for diseases of the loins or kidneys.
If all four feet are involved, the animal stands in the usual
position assumed in health, but if urged to move, the least effort
to do so usually brings on chronic spasms of the entire body. In
very severe cases, a slight touch of the hand will develop the
spasms. At times they are so severe, and have such short
intermissions, that the disease has been mistaken for tetanus.
However, the clonic nature of the spasm should prevent such an
error. If they are lying down, it is difficult to get them to
arise, and if they do so, they show marked symptoms of pain for
some time after rising.
If the disease is confined to the hind feet, they are placed well
forward to relieve the strain on the toe caused by the downward
pull of the perforans (deep flexor) tendon, but in place of the
front feet being kept in front of a perpendicular line, as they are
when the disease is confined to the front ones, they are placed far
back under the body, so they will carry the maximum share of the
body weight of which they are capable. The position of the feet is
of great importance and offers symptoms that should not be
overlooked.
When the subject is caused to walk, symptoms of excruciating pain are
manifested in all acute cases of laminitis. In some cases where all four
feet are affected, no reasonable amount of persuasion will cause the
suffering animal to move from its tracks.
There is acceleration of the rate of heart action; the pulse is full and
in some cases, bounding. As the affection progresses the pulse becomes
rather weak and irregular. The character of the pulse in the region of
the extremity is a reliable indicator; but one has to learn to make
necessary discrimination because of the condition of the parts, as in
some cases of lymphangitis or where the skin is abnormally thick. The
characteristic throbbing pulse is, however, easily recognized in most
cases. Temperature is variable, though usually elevated from one to four
degrees above normal. This symptom varies with the type and stage of the
affection. In a subject that has been down, unable to rise for several
days, where there is a suppurative and sloughing condition of the
laminae, the temperature is high. Whereas, in some other and less
destructive cases there may be little thermic disturbance after the
first few hours have lapsed.
A constant symptom in bilateral affections of acute laminitis is the
difficulty with which the subject supports weight with one foot. It is
this which causes the victim to stand as if "rooted to the ground" when
all four feet are involved. If one attempts to take up one foot, thus
causing the subject to stand on the other, there is much resistance and
in many cases the animal refuses to give the foot.
When we consider that the sensitive parts of the foot are encased by a
horny, unyielding box and that, when the laminae are congested, a great
pressure is brought to bear upon the sensitive structures, it is easy to
understand why the condition is so painful.
_Chronic laminitis_ is a sequel of acute inflammation of the sensitive
laminae. It varies as to intensity and the exact manner of its
manifestation depends upon preëxisting disturbances.
In some mild cases of laminitis there are recurrent attacks wherein no
particular structural change exists, and diagnosis is established
chiefly by noting the character of the pulse at the bifurcation of the
large metacarpal (or metatarsal) artery just above the fetlock. The same
manifestation of pain is present when weight is supported by one foot,
though in a lesser degree. There is less local heat to be detected by
palpation than in the acute cases.
Chronic laminitis as it occurs following acute attacks which have
resulted in structural changes of the foot, present the same symptoms
just described and, in addition, the peculiar alterations in structure
exist. When, owing to acute inflammation of the sensitive laminae, there
has resulted necrosis of this sensitive tissue together with
infiltration between the anterior surface of the distal phalanx (os
pedis) and the contacting hoof, the lower portion of the distal phalanx
is turned downward and backward (rotated upon its transverse axis).
Because of the traction which is exerted by the deep flexor tendon
(perforans), as it attaches to the solar surface of the distal phalanx,
this rotation is facilitated. With hyperplasia of lamina, at the
anterior portion of the distal phalanx, there results a thick "white
line." Rotation of the distal phalanx necessitates a descent of its
apical portion and there occurs a "dropped sole."
In time, partly because of excessive wear of hoof at the heel, owing to
an altered condition in the normal antagonistic relation between the
flexor and extensor tendons, the toe makes an excessive growth, and the
concavity of the anterior line is accentuated owing to this abnormal
length of hoof. The hoof, because of recurrent inflammatory attacks, is
corrugated--elevations of horn in parallel rings are usually present.
[Illustration: Fig. 33--The hoof in chronic laminitis. Note the
concavity. This animal was serviceable for any work that could be
performed at a walk.]
Animals that are so affected in traveling strike the heel first and the
toe is later contacted with the ground surface. Rotation of the distal
phalanx upon its transverse axis produces a condition, with respect to
this peculiar impediment, that is equivalent to added and excessive
length of the deep flexor tendon.
Where there occurs suppuration, by careful inspection of the coronary
region, one may early recognize detachment of hoof. In such cases
animals remain recumbent and, while the condition is not so painful at
this stage, the practitioner must not overlook the real state of
affairs. History, if obtainable, will be a helpful guide in such cases.
Separation of hoof occurs as a rule in from four to ten days after the
initial attack of acute laminitis. Needless to say these cases are
hopeless, when the economic phase of handling subjects is considered.
[Illustration: Fig. 34--Showing the effects of laminitis. By permission,
from Merillat's "Veterinary Surgical Operations."]
Treatment.--Much depends upon the concomitant disturbances (or causes
if one is justified in referring to them as such) as to the manner in
which laminitis is to be treated. In all cases where digestive
disturbances exist, the prompt unloading of the contents of the
alimentary canal is certainly indicated. D.M. Campbell[31] in a
discussion of laminitis has the following to say regarding the treatment
of such cases:
Because superpurgation may be followed by laminitis, the
advisability of using the active hypodermic cathartics is
questioned. Neither arecolin nor eserin can cause superpurgation.
The action of the former does not continue longer than an hour
after administration and of the latter not more than eight hours.
The action of either is mild after the first few minutes.
I do not think that anyone has recommended either arecolin or
eserin where there is severe purgation. Where the intestinal canal
is fairly well emptied and its contents fluid, I should be inclined
to rely upon intestinal antiseptics to hold in check harmful
bacterial growth.
The use of alum in the treatment of laminitis is held to be without
reason other than the empirical one that it is beneficial. If
laminitis is due chiefly to an autointoxication, good and
sufficient reason for the administration of alum can be shown based
upon its known physiological action. It is the most powerful
intestinal astringent that I know of and has the fewest
disadvantages. I have not noted constipation following its use nor
diarrhea, nor a stopping of peristalsis, nor indigestion, and in
any case its action lasts at most only a few hours, and if it did
all these, it could not much matter. Quitman says, that it
constricts the capillaries. If this is true, a thing of which I am
not certain, is it not reasonable to suppose that as with other
vaso-constrictors, e.g., digitalis, there is a selective action on
the part of the capillaries (not of the drug) and those that need
it most, i.e., those of the affected feet in laminitis, are
constricted most? All body cells exert this selective action in the
assimilation of food, the tissue needing most any particular kind
of food circulating in the blood, gets it.
Our first consideration in laminitis should be to remove the
cause--to stop the absorption of the toxin in the intestinal tract
that is producing the condition. This we accomplish by partially
unloading it by the use of the active hypodermic cathartics and
stopping absorption by the surest and most harmless of intestinal
astringents. Whether the astonishingly prompt and certain action of
alum in this case is due wholly to its astringent action or whether
alum combines with the harmful bacterial products chemically and
forms an innocuous combination, I can only surmise, and it is
unimportant. At any rate, when alum is administered, the onslaught
of the disease is promptly stopped. Irreparable damage may already
have been done if the case is a neglected one, but whether
administered early or late in acute attacks, the progress of the
disease is stopped immediately.
The same authority may be profitably quoted in the matter of handling
all cases wherein the revulsive effect of agents which diminish vascular
tension are chiefly indicated or necessary as adjuvants. In this
connection, Campbell says:
The early and vigorous administration of aconitin in laminitis to
its full physiological effect, is more logical. Assuming that
laminitis is due to absorption of harmful products from the
intestinal tract permitted through the deranged functioning of the
organs of digestion, or assuming that it is due to an extension of
the inflammation from the mucosa to the sensitive lamina, or that
it is a reflex from a sudden chilling of the skin, we have in any
of these conditions a disturbed circulation, and aconitin is the
first and foremost of circulation "equalizers." Furthermore, in
laminitis there is an elevation of the temperature, an almost
invariable indication for aconitin. A speedy return of the
temperature to normal, a very marked diminution of the pain and
improved conditions generally, appear coincident with the symptoms
of full physiological effect of aconitin when given in cases of
laminitis, which constitutes assuredly an important part of its
treatment.
[Illustration: Fig. 35--Inferior (convex) surface of Cochran shoe.]
Where lameness is not great as in cases wherein no marked structural
change of the foot has occurred, proper shoeing is very beneficial. By
keeping the heels as low as possible and shoeing without heel calks a
more comfortable position is made possible. Thin rubber pads which do
not elevate the heel are of service in diminishing concussion.
Dr. David W. Cochran of New York City has attained unusual success in
cases of chronic laminitis with dropped sole by the use of a specially
designed shoe.
[Illustration: Fig. 36--Superior surface, showing concavity or bowl, as
formed by the toe and branches of the shoe, as designed by Dr. David W.
Cochran.]
Cochran claims that, not only are horses with dropped soles that would
otherwise have to be put off the streets enabled to do a fair amount of
work by means of this shoe, but that continually wearing it, meanwhile
keeping the convexity of the front of the hoof rasped thin, in time
brings about a marked improvement, and that after some months or years
of use the animals are able to work with ordinary rubber-pad shoes,
provided they are arranged to facilitate breaking over.
From having been successfully used on some race horses of high value,
the Cochran shoe has attained considerable notoriety and is being used
by a number of practitioners. A disadvantage, however, arises from the
fact that few horseshoers other than Doctor Cochran seem able to make
the shoe, the peculiar shape of which offers considerable difficulty in
forging. Concerning the application of the shoe Cochran[32] says:
"The most important primary procedure is the preparation of the
foot to receive the shoe. All excess of growth must be removed from
the anterior face of the hoof. The outer face must be reduced at
the toe (not shortened), but rasped down thin for the lighter the
top of the foot is, the more chance the sole and coffin bone will
have of resuming their former normal position. The pressure of the
wall at the toe upon the exudate between wall and coffin bone,
tends to force the coffin bone and sole out of their normal
position. Leave the sole alone. You can lower the excess of growth
at the heels.
"There are many designs of shoes to relieve this condition. A great
deal depends on the judgment of the shoer to meet the conditions
presented, depending on the degree of the convexity and strength of
the sole. In some cases we use a shoe that admits of a large amount
of sole room. Again, we shoe with a shoe of wide cover. In other
cases a shoe with even pressure over the whole sole. In some cases
a high, narrow shoe, resting only on the wall, or the ordinary
plain shoe with side calks welded close to the outside edge and the
shoe dished well from these as a foundation. Then we have the air
cushion pad designed after the model of the bowl shoe."
In cases when slight and persistent lameness interferes sufficiently to
prevent using an animal at any sort of work on hard roads, median
neurectomy will relieve all lameness in most instances. This is a safe
operation, moreover, in that no bad after effects are to be feared, even
though lameness were to continue.
Calk Wounds. (Paronychia.)
Etiology and Occurrence.--Injuries of various kinds are inflicted upon
the coronary region but usually they are due to the foot being trampled
upon. When the foot that inflicts the injury happens to be unshod, a
contusion of the injured member is occasioned, but in the majority of
instances, wounds that demand attention are the result of shoe calks
which have penetrated the tissues in the region of the coronary band.
Often calk wounds are self-inflicted. When animals are excited and in
turning crowd one another, they often perform dancing movements which
frequently result in deep calk wounds of the coronet. Some horses have a
habit of resting the heel of one hind foot upon the anterior coronary
region of the other. While sleeping in this position, if they are
suddenly awakened, the weight is abruptly shifted to the uppermost foot
and the one underneath is (because of the pain attending its being
wounded) quickly drawn out from under its fellow. In this way deep cuts
may divide the coronary band and inflict extensive injury to the
sensitive lamina as well.
An infectious type of coronary inflammation occurs in some localities
during the winter months, wherein the condition is enzootic.
Symptomatology.--Depending upon the manner in which the injury has
been produced, the appearance of the wound varies and likewise lameness
is more or less pronounced. If the tissues are not divided and the wound
is chiefly of the subsurface structures, there will not immediately
occur pronounced local evidence of the existence of injury; but as soon
as the lame animal is made to move, the peculiar character of the
impediment (supporting-leg lameness with the affected foot kept well in
advance of its normal position) directs attention to the extremity and
all of the symptoms of acute inflammation are discovered.
Where a wound is inflicted which divides, in some manner, the surface
structures (skin, coronary band, or the hoof wall) one's attention is at
once called to the existence of the wound.
Because of the fact that there is every facility for the production of a
sub-coronary and podophylous infection, these wounds should receive
prompt attention. In some instances, the pastern joint is opened by calk
wounds and then, of course, an infectious arthritis succeeds the injury.
Treatment.--In all contused wounds of the coronary region the parts
need thorough cleansing; the hair, if long is clipped and a cataplasm is
applied. Or preferably, an iodin-glycerin combination of one part of
iodin to four parts of glycerin is poured on a layer of cotton, and
this is confined in contact with the inflamed parts by means of a
bandage.
Where normal resistance to infection obtains, the subject usually
suffers no suppurative disturbance when the surface structures are not
broken; and daily applications of the antiseptic lotion above referred
to stimulates complete resolution. This may be expected in from four to
ten days depending upon the extent of the injury.
If a calk wound has been inflicted, the adjoining surface structures are
freed of hair and the parts cleansed in the usual manner, (which in
wounds recently inflicted, should be done without employing quantities
of water) and after painting the wound surface with tincture of iodin
and saturating its depths with the same agent, the wound is cleansed, if
it contains filth, by means of a small curette. By using a small and
sharp curette, one is enabled to cleanse the average wound quickly and
almost painlessly.
In such cases, equal parts of tincture of iodin and glycerin are
employed. The wound is filled with this preparation and a quantity of it
is poured upon a suitable piece of aseptic gauze or cotton and this is
contacted with the wound. The extremity is carefully bandaged and this
dressing is left in position for forty-eight hours unless there occurs,
in the meanwhile, evidence of profuse suppuration--which is unusual.
One is to be guided as to the progress made by the degree of lameness
present. If little or no lameness develops, it is reasonable to expect
that infection has been checked; that the wound is dry and redressing
every second day is sufficiently frequent.
Where cases progress favorably, recovery (unless infectious arthritis
results) should occur in from ten days to three weeks. Where extensive
sub-coronary fistulae result, either from lack of prompt or proper
attention, the condition is then one requiring a radical operation to
establish drainage and to disinfect if possible, the suppurating
tissues.
Corns.
Etiology and Occurrence.--In horses, because of a tendency toward
contraction of the heel in some subjects, together with work on hard
roads and pavements, where the feet become dry and brittle, and because
of neglect of the matter of shoeing, this affection is of frequent
occurrence. Unshod horses are rarely affected. If conformation is faulty
and too much weight is borne on the inner or the outer quarter, and the
hoof wall at the quarter tends to turn inward, corns are usually
present. They occur more frequently on the inner quarters of the front
feet, though the outer quarters are occasionally also affected and in
rare instances corns are found at the toes. They do not often affect the
hind feet.
As soon as injury by pressure, such as is supposed to cause the
formation of corns, is brought to bear on the sensitive sole, an
extravasation of blood occurs. In time when the cause remains active,
this discoloration is evident in the substance of the insensitive sole
and consists in a red or yellowish spot which varies in size--this is
ordinarily termed dry corn.
In some cases where infection of this extravasation of blood and serum
occurs, instead of desiccation and discoloration of the insensitive
parts, there is, in time, manifested a circumscribed area of destruction
of the insensitive sole and the abscess may, where no provision for
drainage exists, burrow between sensitive and insensitive laminae and
perforate the tissues at the coronet. If the suppurative material
discharges readily by way of the sole, no disturbance of the heel or
quarters occurs above the hoof.
Symptomatology.--A supporting-leg-lameness characterizes this
condition; and this lameness in most instances varies in degree with the
amount of distress which is occasioned by pressure upon the inflamed
parts. By an examination of the sole after having removed all dirt, and
exposed the horny sole to view, no difficulty is encountered in locating
the cause of the trouble.
Treatment.--Before suppuration has taken place and in the cases where
suppuration does not occur, the horse-shoer's method of paring out the
diseased tissue affords a means of temporary relief; but unless
frequently done, in many cases, lameness results within about three
weeks after such treatment has been given. In other instances temporary
relief is not to be gotten in this manner for any great length of time
or until a more rational mode of treatment becomes necessary so that the
subject may experience a cessation of the inconvenience or distress.
The general plan which meets with the approval of most practitioners
consists in careful leveling of the foot and removing enough of the wall
and sole at the quarters to make possible frog pressure by means of a
bar shoe. With frog pressure, expansion of the heel follows in time, and
permanent relief is obtainable in this manner. Thinning the wall of the
quarter is advocated by many practitioners and is undoubtedly beneficial
in chronic cases where marked contraction has taken place. The wall must
be thinned with a rasp until it is readily flexible by compressing with
the thumbs.
There are instances, however, where corns and contraction of the heel
have existed so long that they do not yield to treatment. Such cases are
found in old light-harness or saddle-horses that have been more or less
lame for years and where there exists marked contraction of the heels,
rough hoof walls, and hard and atrophied frogs.
Suppurating corns require surgical attention in the way of removal of
the purulent necrotic mass and making provision for drainage. Dry
dressings, such as equal parts of zinc sulphate and boric acid, may be
employed to pack the cavity. After the infectious condition has been
controlled, and the wound is dry, the same plan of treatment is
indicated that is employed in the non-suppurating corn. Ample time is
allowed, however, for the surgically invaded tissues to granulate and,
if the subject is to be put in service, a leather pad, under which there
has been packed oakum and tar, affords good protection.
Quittor.
This name is employed to designate an infectious inflammation of the
lateral cartilage and adjoining structures. The disease is characterized
by a slowly progressive necrosis and by a destruction of more or less of
the cartilage and by the presence of fistulous tracts.
Etiology and Occurrence.--The disease is due to the introduction of
pus producing organisms into the subcoronary region of the foot under
conditions which favor the retention of such contagium and extension of
infection into contiguous tissues.
Morbific material is introduced into the region of the lateral cartilage
by means of calk wounds and other penetrant injuries of the foot. A
sub-coronary abscess which, because of lack of proper care or because of
virulency of the contagium or low vitality of the subject, is quite apt
to result in cartilaginous affection and its perforation by necrosis
follows.
Symptomatology.--Quittor is readily diagnosed on sight in many
instances. Where there is dependable history or other evidence of the
chronicity of an infectious inflammation of the kind, quittor is easily
identified. If no positive evidence of the disease exists, by means of
careful exploration of sinuses with the probe, one may distinguish
between true cartilaginous quittor and superficial abscess formation
that is often accompanied by hyperplasia.
Lameness depends upon the extent of the involvement as it affects the
structures contiguous to the cartilage. A variable degree of lameness is
manifested in different cases.
Treatment.--Two general plans of handling this disease are in vogue.
One, the more popular method, consists in the injection of caustic
solutions of various kinds into the fistulous openings with the object
of causing sloughing of necrotic tissue and the stimulation of healthy
granulation of such wounds. The other mode consists in either complete
surgical removal of the cartilage or its remaining portions, or removal
of the diseased parts of curettage.
When quittor has not extensively damaged the foot and the lateral
cartilage is not partly ossified as it is in some old chronic cases, the
complete removal of the lateral cartilage by means of the Bayer
operation or a modification thereof is indicated. A complete description
of the Bayer operation as well as Merillat's operation for this disease
(the latter consisting in part, in the removal of diseased cartilage
with the curette) are given in Volume three of Merillat's "Veterinary
Surgical Operations."
Treatment by injection of caustic solutions has many advocates and
because of the fact that, in many instances the condition is such that
they are not desirable surgical cases and also because some animals may
be put in service before treatment is completed, the injection method is
popular.
The mode of treatment advocated by Joseph Hughes, M.R.C.V.S.,
constitutes a very successful manner of handling quittor and we can do
no better than quote Dr. J.T. Seeley[33] on his manner of using this
particular treatment.
[Illustration: Fig. 37--Hyperplasia of right fore foot, due to chronic
quittor.]
Preparation.--First remove the shoe, have the foot pared very
thin and balanced as nicely as possible. Moreover, all loose
fragments of horn must be detached and all crevices cleaned
thoroughly.
Next, have the leg brushed and hair clipped from the knee or hock
to the foot and scrubbed with ethereal soap and warm water, after
which the foot must be scrubbed in like manner. The foot is then
placed in a bichlorid bath several hours daily, for from two to
five days, depending upon whether or not soreness is shown. The
bichlorid solution is 1 to 1,000 strength.
On removing the horse from the bath a liberal layer of gauze is
soaked in 1 to 1,000 bichlorid solution and placed so as to cover
the entire foot. On discontinuing the bath, cover the foot with
gauze saturated with a 1 to 1,000 bichlorid solution. This is to be
covered with absorbent cotton and a gauze bandage, and over all is
placed an oil cloth or silk covering. This pack is kept moist with
bichloride solution for forty-eight hours. The foot is then ready
for injection.
[Illustration: Fig. 38--Chronic quittor, left hind foot. Showing
position assumed because of painfulness of the affection.]
Preparation of the Injection Fluids.--Have on hand a pint of a
one per cent aqueous solution of formaldehyd made under cleanly
conditions, even to a clean bottle and cork, and a clean container
when ready to use the liquid. Prepare also a bichlorid of mercury
solution as follows: Hydrarg. Chlor. Corros. 3IV; Acid Hydrochlor.
3Iss.; Aqua Bulliens, Oij. This should be thoroughly triturated,
and then filtered into a clean bottle, when it is ready for use.
Injection.--The patient should be laid on a table, if one is
available, or cast, and the foot securely fixed. Then, with an
ordinary one-ounce hard rubber syringe, with a good plunger (tried
first to note whether or not any fluid works around between the
barrel and the plunger), introduce one syringe full of the
formaldehyd solution, then thoroughly probe the quittor to
determine the number of sinuses. This done, inject each sinus. If
two sinuses open on the surface, close one with cotton while
filling the other so that if there is a connection the solution
will come in contact with all tissues involved. Irrigate with the
full pint of formaldehyd solution first, then follow with six or
eight ounces of the bichlorid solution. Never probe the foot nor
allow it to be tampered with except in the manner prescribed.
After-Treatment.--Put on a pack saturated with a solution of
bichlorid of mercury 1 to 1,000 and let it remain two days. Remove
pack, and once daily afterwards wipe off with cotton the secretion
which accumulates on the outside, and apply a dry dressing or
healing oil composed of phenol, camphor gum and olive oil.
When Dangerous to Inject.--Never inject a quittor in the acute
stage. Never inject a quittor if considerable lameness is present.
On injecting a solution of formalin, hold cotton tightly around the
nozzle of the syringe, when the plunger is down, then withdraw the
syringe gently and note particularly if the fluid returns through
the opening; if none returns cease operations at once, as it is
dangerous to proceed farther, it indicates that the sinus is not
well defined and the fluid retained will cause much trouble and
often the death of the patient.
Experience has taught that, if extensive destructive changes of the foot
exist, the Bayer operation is not indicated. In the country, where
quittors are not so frequently met as in urban practice, the Merillat
operation is preferable in all cases. However, the cost of the
protracted period of idleness, which convalescent surgical patients
require, renders the Hughes method more satisfactory in the hands of the
general practitioner, especially in the city.
Nail Punctures.
Nail punctures, as herein considered, embrace all penetrant wounds of
the solar surface of the horse's foot due to trampling upon street
nails. This does not include accidental nail pricks occasioned in
shoeing. In city practice, in some stables, these cases are of frequent
occurrence; and, generally speaking, nail punctures are observed more
frequently in urban horses than in animals that are kept in the country.
Occurrence and Method of Examination.--This condition, then, is a
rather common cause of lameness and in no case, where cause of the
claudication is not obvious, is the practitioner warranted in concluding
his examination without careful search for the possible existence of
nail puncture of the solar surface of the foot.
[Illustration: Fig. 39--Skiagraph of foot. The X-ray offers very limited
possibilities in the diagnosis of lameness. The location of a "gravel"
or a nail that had worked its way some distance from the surface, or of
an abscess of some proportion, deep in the tissues, might be facilitated
under some circumstances by the aid of the X-ray. Its use in the
detention of fractures is very limited, owing to the difficulty
encountered in getting a view from the right position--many trials being
necessary in most cases. The case shown above was diagnosed clinically
as incipient ringbone. The X-ray revealed no lesions. (Photo by L.
Griessmann.)]
In occasional instances there co-exists an obvious cause for
supporting-leg-lameness and an occult cause--a nail puncture. Where such
complications are met, the practitioner is not necessarily guilty of
neglect or carelessness when the nail puncture is not discovered at
once, nevertheless, an examination is not complete until practically
every possible cause of lameness has been located or excluded in any
given case.
In a search for nail puncture it is necessary to expose to view every
portion of the sole and frog in such manner that the existence of the
smallest possible wound will be revealed. This necessitates removal of
the shoe, if, after a preliminary examination, a puncture is not found,
when there is good reason to suspect its presence. However, where it is
readily possible to locate and care for a wound without removal of the
shoe, allowing the shoe to remain materially facilitates retaining
dressings in position and relieves the solar surface of contact with the
ground. If extensive injury or infection exists, it is of course
necessary to remove the shoe and leave it off. By removing a superficial
portion of all of the sole and frog, thus carefully and completely
exposing to view all parts of the solar surface of the foot, and with
the aid of hoof-testers one is enabled to positively determine the
existence of nail punctures. Because of the tendency of puncture wounds
of the foot to close, and since the superficial portion of the solar
structures are usually soiled, it is absolutely necessary to conduct
examinations of this kind in a thorough manner.
Symtomatology.--Not all cases of nail puncture cause lameness during
the course of the disturbance and in many instances no lameness is
manifested for some time after the injury has been inflicted--not until
infection has been the means of causing considerable inflammation of
sensitive structures. Nevertheless, this lack of manifestation occurs
only in cases where serious injury has not taken place and the degree of
lameness is a constant and reliable indicator of the character and
extent of nail punctures within twenty-four hours after injury has been
inflicted.
The position assumed by the affected animal inconstantly varies with the
location and nature of the injury and is not of particular importance in
establishing a diagnosis. The subject may support some weight with the
affected member and stand "base-wide" or "base-narrow," or no weight may
be borne with the foot or the animal may point or keep the extremity in
a state of volar flexion. In cases where extensive injury has been
inflicted, and great pain exists, the foot is kept off the ground much
of the time and it may be swung back and forth as in all painful
affections of the extremity.
Nail punctures cause typical supporting-leg-lameness and in some cases
certain peculiarities of locomotory impediment are worthy of notice.
Punctures of the region of the heel, which directly affect or involve
the deep tendon sheath, cause a type of lameness wherein pain is
augmented, when dorsal flexion of the extremity occurs as well as when
weight is borne. Wounds in the region of the toe of the hind feet
sometimes cause the subject to carry the extremity considerably in
advance of the point where it is planted and, just before placing the
foot on the ground, it is carried backward a little way--ten or twelve
inches.
However, diagnosis of nail puncture is based on the finding of the
characteristic wound or resultant local changes.
Course and Prognosis.--The nature of the progress and the manner of
termination of these cases are variable. If the coffin joint has been
invaded, and a septic arthritis exists, the condition is at once grave.
An open and infected tendon sheath, while not so serious, constitutes a
condition which is distressing, and recovery is slow even under the most
favorable conditions. Where a heavy, rigid and sharp nail enters the
foot, in such manner that fracture of the third phalanx (os pedis)
occurs, this complication makes for a protraction of the condition.
Experience teaches that the natural course and termination in these
cases are modified by the location and depth of the injury, virulency of
the contagium and resistance of the subject to such infection.
Prevention.--In all horses which are kept at such work that exposure
to nail punctures is frequent, a practical means of prevention of such
injuries consists in the employment of heavy sole leather or suitable
sheet metal to cover the sole of the foot and, at the same time, confine
oakum and tar in contact with the solar surface to prevent the
introduction of foreign material between the foot and such protecting
appliances. Further, if drivers and owners could be impressed with the
serious complications which so frequently attend wounds of this kind,
undoubtedly many cases which are now lost, because of ignorance or
neglect on the part of the teamsters or proprietors of horses, would be
saved by prompt and rational treatment.
Treatment.--The treatment of this condition falls so largely within
the dominion of surgery that we can give little more than an outline
here.
In cases where there exists no evidence of open joint or open tendon
sheath as judged by the site of the puncture and degree of lameness
present (after having thoroughly cleansed the solar surface of the foot
and enlarged the opening in the nonsensitive sole) a little phenol is
introduced into the wound. In such cases, where it is possible for the
antiseptic to contact every part of wound surface to the extreme depths
of the puncture, infection is prevented when such treatment is promptly
administered. This may be considered as first aid, or emergency care,
and is indicated in all wounds of the foot whether the injury be serious
or almost insignificant.
Subsequently one of two general courses may be pursued in the treatment
of cases of nail puncture. One, by the employment of means to keep the
wound patent and injection of suitable antiseptics, or agents that are
more or less caustic in conjunction with strict observance of asepsis
and wound protection. The other method consists in prompt establishment
of drainage by surgical means and includes exploration and curettage.
The first method is better adapted to the use of the average general
practitioner and he would do well to keep the opening in the
nonsensitive structures patent. By introducing equal parts of tincture
of iodin and glycerin daily, good results will follow in most instances.
The wound is protected in unshod horses, either by completely bandaging
the foot and retaining, in contact with the wound, cotton that is
saturated with iodin and glycerin, or, if a minor injury exists, the
moderately enlarged opening in the nonsensitive sole or frog, which has
been moistened with the antiseptic, is packed with a very small quantity
of cotton. A little practice in this mode of closing benign puncture
wounds will enable the practitioner to successfully protect the
sensitive parts in the treatment of such cases in unshod country
horses.
When the condition progresses favorably the wound may be dressed every
second day or twice weekly, and in the course of from two to six weeks
recovery should be complete.
If the practitioner is somewhat proficient as a surgeon, and has at his
command facilities for doing surgery, the second method is preferable in
many cases. By using a local anesthetic on the plantar nerves and
confining the subject on an operating table, restraint should be
perfect. The solar surface of the foot is first thoroughly cleansed, the
puncture wound is enlarged in the nonsensitive structures and the parts
are then moistened with phenol or other suitable antiseptics. By means
of a small probe the puncture is explored and, depending on the
character of the wound and the structures involved, surgical
intervention is varied to suit the case. If necessary, all of the
insensitive frog is removed, and in wounds affecting the region of the
heel the tissues may be incised from the puncture outward dividing all
of the tissues outward and backward to the surface. A suitable surgical
dressing is then applied.
If, on the other hand, the puncture extends into the navicular bursa,
the radical operation is perhaps indicated, though not until one is sure
that infection of the bursa and serious consequences are to follow if
this operation is not performed. Detailed description of the technic of
this operation belongs to the realm of surgery and a good discussion of
it is to be found in William's work on veterinary surgical and
obstetrical operations.
One may summarize the discussion of treatment of nail puncture by saying
that emergency care as herein described is of first consideration. In
every case an immunizing dose of anti-tetanic serum should be given.
Subsequently, the method employed must suit the character of the wound,
existing facilities for handling the subject and the skill and aptitude
of the practitioner.
FOOTNOTES:
[Footnote 5: Manual of Veterinary Physiology, by Major-General F. Smith,
page 590.]
[Footnote 6: Manual of Veterinary Physiology by Major-General F. Smith,
page 589.]
[Footnote 7: Regional Veterinary Surgery and Operative Technique, Jno.
A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 765.]
[Footnote 8: Dr. Roscoe R. Bell in the Proceedings, N.Y. State
Veterinary Medical Society, 1899.]
[Footnote 9: American Veterinary Review, Vol. 35, P. 456.]
[Footnote 10: "Radial Paralysis and Its Treatment by Mechanical Fixation
of Knee and Ankle," Geo. H. Berns, D.V.S. Proceedings of the American
Veterinary Medical Association, 1912, p. 219.]
[Footnote 11: As quoted by Berns, in Radial Paralysis, etc., Proceedings
of the A.V.M.A., 1912.]
[Footnote 12: Veterinary Surgical Operations, by L.A. Merillat, V.S., p.
507.]
[Footnote 13: A paper presented before the Illinois Veterinary Medical
Assn. by Dr. H. Thompson of Paxton, Ill., American Veterinary Review,
Vol. 15, p. 134.]
[Footnote 14: "Fractures in Foals," by Dr. Wilfred Walters, M.R.C.V.S.,
American Journal of Veterinary Medicine, Vol. 8, p. 669.]
[Footnote 15: American Veterinary Review, Vol. 26, p. 1068.]
[Footnote 16: Fractures, by H. Thompson, Paxton, Ill., American
Veterinary Review, Vol. 15, p. 134.]
[Footnote 17: Veterinary Surgical Operations, by L.A. Merillat, Vol. 3,
p. 198.]
[Footnote 18: Wilfred Walters, American Journal of Veterinary Medicine,
Vol. 8, p. 606.]
[Footnote 19: J.N. Frost, assistant professor of Surgery, Veterinary
Dept., Cornell University, in "Wound Treatment," page 159.]
[Footnote 20: Open Joints and Their Treatment in my practice, by J.V.
Lacroix, American Journal of Veterinary Medicine, Vol. 5, page 203.]
[Footnote 21: Regional Veterinary Surgery Möller--Dollar, page 605.]
[Footnote 22: Extract from Receuil de Médecine Vétérinaire in Ameircan
Veterinary Review, Vol. 23, p. 893.]
[Footnote 23: Fracture of All the Sesamoid Bones, by R.F. Frost,
M.R.C.V.S., A.V.D., Rangoon, Burmah, in American Veterinary Review, Vol.
5, p. 362.]
[Footnote 24: The Anatomy of the Domestic Animal, by Septimus Sisson,
S.B., V.S.]
[Footnote 25: Traité De Thérapeutique Chirurgicale Des Animaux
Domestique, par P.J. Cadiot et J. Almy, Tome Second, page 547.]
[Footnote 26: Anatomie Regionale Des Animaux Domestique, page 695.]
[Footnote 27: Manual of Veterinary Physiology, by Major-General F.
Smith, C.B., C.M.G., page 678.]
[Footnote 28: Möller's Regional Veterinary Surgery, by Dollar, page
630.]
[Footnote 29: Edinburgh Veterinary Review, Vol. VI, page 616.]
[Footnote 30: Equine Laminitis or Pododermatitis, by R.C. Moore, D.V.S.,
American Journal of Veterinary Medicine, Vol. XI, page 284.]
[Footnote 31: American Journal of Veterinary Medicine, Vol. XI, page
318.]
[Footnote 32: The Shoeing of a Dropped Sole Foot by Dr. David W.
Cochran, New York City, The Horse Shoers Journal, March, 1915.]
[Footnote 33: Quittor and Its Treatment by the Hughes Method, J.T.
Seeley, M.D.C., Seattle, Washington, Chicago Veterinary College
Quarterly Bulletin, Vol. 9, page 27.]
SECTION IV.
LAMENESS IN THE HIND LEG.
Anatomo-Physiological Consideration of the Pelvic Limbs.
The pelvic bones as a whole constitute the analogue of the scapulae with
respect to their function as a part of the mechanism of locomotive and
supportive apparatus of the horse. The manner of attachment or
connection between the ilia and the trunk is materially different from
that of the scapulae, however, and the angles as formed by the long axes
of the ilia in relation to the spinal column are maintained by two
functionally antagonistic structures--the sacrosciatic ligaments, and
the abdominal muscles by means of the prepubian tendon. The sacro-iliac
articulations are such that a very limited amount of movement is
possible; free movement, however, is unnecessary because of the
enarthrodial (ball and socket) femeropelvic joint.
The various muscles which exert their effect upon the pelvis in changing
their relationship between the long axes of the ilia and spinal column,
are concerned but little more in propulsion and weight bearing than are
the pectoral muscles. A general treatise on the subject of lameness does
not properly include such structures any more than it does the various
affections of the dorsal, lumbar and sacral vertebrae or inflammation of
the abdominal parietes. Involvement of such parts cause manifestations
of lameness but the matter of establishing a diagnosis is difficult in
many instances and in some cases impossible.
The femeropelvic articulation is formed by the hemispherical head of the
femur and the acetabulum; the latter constituting a cotyloid cavity
which is deepened by the cotyloid ligament.
The round ligament (ligamentum teres) is the principal binding structure
of the hip joint and it arises in a notch in the head of the femur and
is attached in the subpubic groove close to the acetabular notch.
Another ligament, peculiar to Equidae--the accessory (pubiofemoral)--is
attached to the head of the femur near the round ligament and passes
through the cotyloid notch and along the under side of the pubis. It
is inserted or blends with the prepubic tendon. This ligament prevents
extreme abduction of the leg. The joint capsule encompasses the
articulation and is attached to the brim of the acetabulum and the edge
of the head of the femur.
[Illustration: Fig. 40--Sagital section of right hock. The section
passes through the middle of the groove of the trochlea of the tibial
tarsal bone. 1 and 2. Proximal ends of cavity of hock joint. 3. Thick
part of joint capsule over which deep flexor tendon plays. 4. Fibular
tarsal bone (sustentaculum). A large vein crosses the upper part of the
joint capsule (in front of 1). (From Sisson's "Anatomy of the Domestic
Animals.")]
[Illustration: Fig. 41--Muscles of right leg; front view. The greater
part of the long extensor has been removed. 1, 2, 3. Stumps of patellar
ligaments. 4. Tuberosity of tibia. (From Sisson's "Anatomy of the
Domestic Animals.")]
The stifle joint is analagous to the knee joint of man and is to be
considered an atypical ginglymus (hinge) articulation formed by the
femur, tibia and patella. The ligaments are femerotibial, femeropatellar
and capsular.
In addition to the usual provision for articulation of bones there are
situated cartilaginous _menisci_ between the condyles of the femur and
the head of the tibia. These discs surround the tibial spine and are
otherwise shaped to fit perfectly between the articular portions of the
femur and tibia.
Collateral ligaments (internal and external lateral) pass from the
distal end of the femur to the proximal portion of the tibia. The mesial
(internal) arises from the internal condyle of the femur and is attached
to a rough area below the margin of the medial (internal) condyle of the
tibia. The lateral (external), shorter and thicker, arises from the
depression on the lateral epicondyle and inserts to the head of the
fibula.
The crucial or interosseus, anterior and posterior, are situated between
the femur and tibia, and according to Smith,[34] the crucial ligaments
are necessary to properly join the two bones, because of the character
of the structure of the articular ends of the femur and tibia.
The femeropatella ligaments are two thin bands which reinforce the
capsular ligament. They arise from the lateral aspects of the femur,
just above the condyles and are inserted to the corresponding surfaces
of the patella.
The patellar ligaments are three strong bands which arise from the
antero-inferior surface of the patella, and are inserted to the anterior
aspect of the tuberosity of the tibia.
Taken as a whole, the tarsal bones, interarticulating and articulating
with the tibia and metatarsal bones form the hock joint and this
articulation is analagous to the carpus. As with the carpus, there is
less movement in the inferior portion of the joint than in the
superior part of the articulation. The chief articulating parts are the
tibia with the tibial tarsal bone (astragulus).
[Illustration: Fig. 42--Muscles of lower part of thigh, leg and foot;
lateral view, o', Fascia lata; q, q', q", biceps femoris; r,
semitendinosus; 21', lateral condyle of tibia. The extensor brevis is
visible in the angle between the long and lateral extensor tendons.
(After Ellenberger-Baum, Anat. für Künstler.) (From Sisson's "Anatomy of
the Domestic Animals.")]
The capsular ligament is attached around the margin of the articular
surfaces of the tibia, to the tarsal bones, the collateral ligaments
(internal and external lateral) and to the metatarsus.
[Illustration: Fig. 43--Right stifle joint; lateral view. The
femoro-patellar capsule was filled with plaster-of-Paris and then
removed after the cast was set. The femoro-tibial capsule and most of
the lateral patellar ligament are removed. M. Lateral meniscus. (From
Sisson's "Anatomy of the Domestic Animals.")]
The common ligaments of the tarsal joint are the collateral, the plantar
(calcaneo-metatarsal and c. cuboid) and dorsal ligaments (oblique).
The medial (internal lateral) ligament serves to join the medial
(internal) tibial malleolus with tibial tarsal (astragalus) and other
tarsal bones.
The lateral (external lateral) ligament is inserted to the lateral
(external) tibial malleolus and its distal portions are attached to the
tibial tarsal (astragalus), fibular tarsal (calcaneum) bone, fourth
tarsal (cuboid) and metatarsus bones.
[Illustration: Fig. 44--Left stifle joint; medial view. The capsules are
removed. (From Sisson's "Anatomy of the Domestic Animals.")]
The plantar ligament (calcaneo-cuboid) is a strong flat band which is
attached to the plantar surface of the fibular and fourth tarsal bones
(calcaneum and cuboid) and the head of the lateral metatarsal (external
small) bone.
The dorsal (oblique) ligament is attached above to the distal tuberosity
on the inner side of the tibia. It is inserted below to the central
(cuneiform magnum) and third (c. medium) tarsal bones, to the proximal
ends of the large and outer small metatarsal bones.
The tarsus is a true hinge joint and because of the great strain which
it sustains, is subject to frequent injury. About seventy-five percent
of cases of lameness affecting the hind leg may be said to arise from
disease of the hock.
As members of locomotion the legs receive strains of two kinds: those of
concussion and weight-bearing and strains of propulsion; the latter are
the greater. In the horse as a work animal, the hind legs are probably
subjected to greater strains than are the front but the manner of
construction of the various parts of the pelvic limbs with the possible
exception (according to some authorities) of the tibial tarsal joint,
offsets this condition.
The femur may be considered analagous to the humerus in that it bears a
similar relationship to the ilium, that exist between the humerus and
scapula. Further flexion during repose is prevented chiefly by the
glutens medius (maximus) muscle and its tendons. The larger tendon
inserts to the summit of the trochanter major of the femur and
corresponds to the biceps brachii in the action of the latter on the
scapulohumeral joint, except that the gluteus medius, in attaching to
the femoral trochanter, exerts its effect as a lever of the first class.
Because of the relationship between the long axes of the femur and iliac
shaft it is evident that the angle formed by these two bones is
maintained chiefly by the gluteus muscles during weight bearing.
Contraction of muscular fibers of the gluteus medius causes extension of
the femur and muscular strain is prevented to a great degree by the
inelastic portion of this muscle. The chief physiological antagonistics
of the glutei are the quadriceps femoris and tensor fascia lata.
While the leg is supporting weight the stifle joint is fixed in position
mainly by the quadriceps femoris group of muscles which are attached to
the patella. Tendinous fibres intersect this muscular mass and relieve
muscular strain during weight bearing. Because of the manner in which
the patella functionates with the trochlea of the femur, comparatively
little energy is required to prevent further flexion of the stifle
joint. The patella, according to Strangeways, may be considered a
sesamoid bone.
[Illustration: Fig. 45--Left stifle joint; front view. The capsules are
removed. 1. Middle patellar ligament. 2. Stump of fascia lata. 3. Stump
of common tendon of extensor longus and peroneus tertius. (From Sisson's
"Anatomy of Domestic Animals.")]
The quadriceps group of muscles is assisted by the anterior digital
extensor (extensor pedis) peroneus tertius and tibialis anticus (flexor
metatarsi) muscles. The latter pair (flexor metatarsi, muscular and
tendinous portions, because of their attachment to the external condyle
of the femur and to the metatarsal bone) are enabled to automatically
flex the tarsal joint when the stifle is flexed.
The hock is kept fixed in position by the gastrocnemius and the
superficial digital flexor (perforatus). The latter structure, which is
chiefly tendinous, originates in the supracondyloid fossa of the femur
and has an insertion to the summit of the fibular tarsal (calcis) bone.
It relieves the gastrocnemius of muscular strain during weight bearing.
Smith[35] styles the function of the stifle and hock joints a
reciprocating action, and we quote from this authority the following:
From what has been said, it is evident that flexion and extension
of stifle and hock are identical in their action. When the stifle
is extended, the hock is automatically extended, nor can it under
any circumstances flex without the previous flexion of the stifle.
There is no parallel to this in the body. The two joints, though
far apart, act as one, and they are locked by the drawing up of the
patella, and in no other way. The so-called dislocation of the
stifle in the horse is a misnomer. That the patella is capable of
being dislocated is beyond doubt, but the ordinary condition
described under that term, when the stifle and hock are rigid while
the foot is turned back with its wall on the ground, is nothing
more than spasm of the muscles which keeps the patella drawn up.
The moment they relax the previously immovable limb and useless
foot have their function restored as if by magic, but are
immediately thrown out of gear in the course of a few minutes as a
recurrence of the tetanus of the petallar muscle takes place. The
fascia of the thigh, like that of the arm, is a most potent factor
in giving assistance to the constant strain imposed on the muscles
of the limbs during standing.
Below the hock the hind limb is arranged like that of the fore, the
deep flexor (perforans) receiving its additional support from the
"check ligament," as in the fore leg.
The natural attitude of standing adopted by the horse is to rest on
three legs--one hind and two fore. If he is alert, he stands on all
four limbs; but if standing in the ordinary manner, he always rests
on one hind leg. He does not remain long in this position without
changing to the other. Hour by hour he stands, shifting his weight
at intervals from one to the other hind leg, and resting its fellow
by flexing the hock and standing on the toe. He never spares his
fore-limbs in this manner in a state of health, but always stands
squarely on them.
Hip Lameness.
Fortunately, because of the heavy musculature which goes to form a part
of the locomotive apparatus of the rear extremity, hip lameness is
comparatively rare. While the term is in itself ambiguous and signifies
nothing more definite than does "shoulder lameness," yet diagnosis of
almost any condition that may be classed under the head of "hip
lameness" is not easy except in cases where the cause is obvious, as in
wounds of the musculature and certain fractures. To the complexity which
the gait of the quadruped contributes, because of its being four-legged,
there is added the complicated manner of articulation of the bones of
the hind leg. This involves the hip in the manner of diagnostic problems
and because of the inaccessibility of certain parts, owing to the bulk
of the musculature of these parts, diagnosis of some hip ailments
becomes an intricate problem. Consequently, in some instances, before
one may arrive at definite and enlightening conclusions, repeated
examinations are necessary as well as a knowledge of reliable history
and recorded observations of the subject over a considerable period.
Rheumatic affections, when present, usually cause recurrent attacks of
lameness; myalgia, due to subsurface injury occasioned by contusion,
generally produces an ephemeral disturbance; and while these are
examples of cases where occult causes are active, they are by no means
unprecedented. In cases where the cause of lameness is not definitely
located, and when by the process of exclusion one is enabled to decide
that the seat of trouble is in the hip, a tentative diagnosis of hip
lameness is always appropriate.
In one instance a Shetland pony evinced a peculiar form of intermittent
lameness which affected the left hip, and repeated examinations did not
disclose the cause of the trouble. After about a year there was
established spontaneously an opening through the integument overlying
the region of the attachment of the psoas major (magnus), through which
pus discharged. With the occurrence of this fistula, lameness almost
entirely disappeared, but the emission of a small amount of pus
persisted for more than a year. The subject was not observed thereafter
and the outcome in this case is not a matter of record. Whether there
existed a psoic phlegmon due to metastatic infection or necrosis of a
part of a lumber or dorsal vertebra is a matter for speculation. Thus
the presence of some anomalous conditions which affect the pelvic region
and cause lameness may be discovered, yet both in hip and shoulder
regions causes may not be definitely located by means of practical
methods of examination.
Injuries of all kinds are the more frequent causes of hip lameness. In
such cases, lameness may result directly and resolution be prompt, or
the claudication become aggravated in time, due to muscular atrophy or
degenerative changes affecting the hip joint or nerves. Rheumatism or
metastatic infection may be the cause of hip lameness as well as
affections of the pelvic bones, lumbar and sacral vertebrae. Hip
lameness may also be provoked by melanotic or other tumors.
In the diagnosis of hip lameness, one is guided in a general way by the
character of the impediment manifested. Swinging-leg lameness is often
present and the impediment is more accentuated when the animal is caused
to step backward. In many cases lameness is mixed, being about equally
noticeable during weight bearing and while the member is being swung. By
exclusion of causes which might affect other parts; one may definitely
locate the cause of the trouble or determine that a certain region is
affected.
The sudden manifestation of lameness is indicative of injury; thermic
disturbances may signalize metastatic infection; history, if dependable,
is always helpful. Repeated observations, taking into account the course
which the affection assumes during a period of a few days, often serve
to afford a means of establishing a diagnosis in baffling cases.
Fractures of the Pelvic Bones.
The os innominatum may be so fractured that the pelvic girdle is broken,
as in fracture of the iliac shaft, or in a manner that the girdling
continuity of the innominate bones is not interrupted. It naturally
follows that greater injury is done when the pelvic girdle is broken
than when it is not, except in cases where the acetabulum is involved
and its brim not completely divided.
Etiology and Occurrence.--Pelvic fractures are usually caused by falls
or other manner of contusion. Cases are reported where it would seem
that fracture of the iliac angle resulted from muscular contraction, but
it is certain that most fractures of this kind are due to collisions
with door jambs or similar injuries. In old horses especially, fracture
of pelvic bones occurs frequently. This form of injury is of more
frequent occurrence in animals of all ages that work on paved streets.
The country horse is not subjected to the uncertain footing of the
slippery pavement, nor to injuries which compare with those caused by
contusions sustained in falling upon asphalt or cobble-stones.
Symptomatology.--While in many cases of pelvic fracture lameness or
abnormal decumbency are the salient manifestations, yet the pathognomic
symptoms are crepitation or palpable evidence which may be obtained by
rectal or vaginal examination. In fractures of the angle of the ilium
and the ischial tuberosity, perceptible evidence always exists.
In cases where fracture of some portion of the pelvic girdle is
suspected and the subject is able to walk, crepitation is sought by
placing one hand on an external angle of the ilium and the other on the
ischial tuberosity and the animal is then made to walk. Or, by placing
the hands as just directed, an assistant may grasp the horse's tail and
by alternately exerting traction on the tail and pushing against the hip
in such manner that weight is shifted from one leg to the other,
crepitation may be detected.
Fracture of the pubis near its symphysis constitutes a grave injury, as
there is danger of the bladder becoming caught in the fissure and
perforation of its wall may result. Such a case is reported by
Bauman[36] wherein a three-year-old gelding bore the history of having
been lame for ten days. Upon rectal examination the bladder was found to
be hard and tumor-like and about the size of a baseball. The body of the
ischium in this case was fractured and a rent in the bladder was caused
by a sharp projecting piece of bone. Autopsy revealed, in addition to
the fracture and rent of the bladder wall, a large quantity of urine in
the peritoneal cavity.
In other instances hemorrhage caused death and not infrequently
infection was responsible for a fatal issue. Moller,[37] quoting Nocard,
describes a case where fracture occurred through the region of the
foramen ovale and paralysis of the obturator nerve followed.
Fractures which include the acetabular bones cause great pain. This is
manifested by marked lameness, both during weight bearing and when the
member is swung. Such cases terminate unfavorably--complete recovery is
impossible.
Where small portions of the angle of the ilium are broken, and the skin
is left intact, there exists the least troublesome class of pelvic
fracture. If large portions of the ilium are fractured, considerable
disturbance results. There eventually occurs more or less displacement
in such cases, if such displacement does not take place at the time of
injury. The same may be said of fracture of the tuber ischii, but when
these bones are fractured a more serious condition results.
Treatment.--When a case is found to be uncomplicated, that is, if the
fracture is such that recovery seems possible and after having
determined that treatment may be practicable, the first consideration is
that of confining the subject in suitable slings. In many cases of
pelvic fracture, the affected animal will need to be kept in slings from
six weeks to three months, and it becomes a difficult problem to
minimize the distress during this long period of confinement in the
peculiar manner required for favorable outcome.
The pattern of sling employed should be the best that is obtainable and
the matter of its adjustment is quite important lest unnecessary chafing
or even necrosis of skin result. Frequent readjustment may be necessary,
and time is well spent in this manner since this contributes materially
toward a favorable termination by encouraging the subject to remain
quiet so that coaptation of the broken bones may be maintained. Aside
from slings, mechanical appliances that are helpful in the treatment of
these cases are not yet in use.
A regimen that is nutritive and at the same time laxative is essential
and in some cases cathartics and enemata are necessary. Also, during the
first few days, if there is retention of urine, catheterization is
imperative. In a word, the handling of such cases consists largely in
keeping the subject inactive, as comfortable as possible, and giving
attention to suitable diet.
Simple fracture of the external iliac angle needs no particular
attention, except that the subject is kept quiet until lameness
subsides. In all cases where much of the bone is broken, the animal is
blemished, but interference with function does not follow. If infection
results because of a compound fracture, loose pieces of bone must be
removed surgically and drainage provided for.
In fracture of the ischial tuberosity, infection is more apt to result
than in like injury of the ilium, and greater displacement of bone
occurs. This displacement, due to contraction of the attached muscles,
is in some instances a contributing cause to the infection which often
follows in these cases. In females where the body of the ischium is
fractured, lacerations of the vagina may be present, and this
constitutes a serious complication which usually terminates fatally.
After-care in fracture of the pelvic girdle consists principally in
allowing a protracted period of rest before subjects are put to work.
Fractures of the Femur.
Etiology and Occurrence.--This is a comparatively rare injury in the
horse because of the protection afforded the femur by the heavy
musculature. Fragilitas of the bone probably exists in many cases when
fracture of its diaphysis occurs. It is generally conceded that the neck
of the femur is rarely broken because of a lack of constriction in this
part, but fracture of the trochanters has been recorded rather
frequently. However, Lienaux and Zwanenpoete[38] state that fracture of
the neck of the femur is of frequent occurrence in Belgian colts.
Tapley[39] reports in the Veterinary Journal (English) fracture of the
head and internal trochanter of the femur and patellar luxation
occurring simultaneously affecting a mule. In this case the mule was
found decumbent on a concrete floor. After three weeks, the subject was
destroyed and autopsy revealed rupture of the left pubiofemoral
ligament, tearing with it a portion of the articular surface of the
femur. The internal trochanter was also fractured in four small pieces.
In this case it is fair to suppose that the mule in trying to regain
footing on a slippery floor violently abducted the legs and fracture
resulted. It is possible also that a temporary luxation of the patella
took place first and caused the animal to struggle in such manner that
fracture followed.
[Illustration: Fig. 46--Oblique fracture of the femur of a 1,500
six-year-old draft horse. Showing shortening of bone, owing to a lateral
approximation of the diaphysis because of muscular contraction. Photo by
Dr. Edward Merillat.]
Symptomatology.--According to Cadiot and Almy,[40] "regardless of the
location of femoral fractures, the subject is usually intensely lame,
the animal frequently walking on three legs--fractures of the diaphysis
are characterized by an abnormal mobility."
As a rule, crepitation is to be recognized in fractures of the shaft of
the bone, by passively moving the leg to and from the medial plane
(adduction and abduction).
Fracture of the trochanter major is signalized by local swelling and
evidence of pain; the forward stride is shortened because this movement
tenses the tendon of the gluteus major (maximus) which is attached
principally to the trochanter.
[Illustration: Fig. 47--Same bone as in Fig. 46 after about six months'
treatment. In this case Dr. Merillat employed a weight to counteract
muscular contraction. It is noticeable that very little provisional
callus has formed in this case, and in spite of unusual ingenuity and
good facilities for caring for the subject, union of bone did not
occur.]
Treatment.--Reduction of femoral fracture in the horse is practically
impossible, and retaining the broken bones in coaptation is not possible
by means of mechanical appliances. Consequently, prognosis is
unfavorable in fracture of the body of the femur. When union of bone
occurs, there results shortening of the leg and animals are rendered
permanently lame. If the immediate region of the head of the bone is
involved as well as in case of fracture of the condyles, an incurable
arthritis ensues.
Where the trochanters are broken, chronic lameness and muscular atrophy
is the result. Therefore, it is evident that, because of the manner of
function of the femur, the leverage afforded by its great trochanter and
its heavy muscular attachments, fractures of this bone in the horse do
not terminate favorably.
Luxation of the Femur.
Etiology and Occurrence.--Uncomplicated femoral luxation is of less
frequent occurrence in the horse than in the other domestic animals.
The deep cotyloid cavity renders disarticulation difficult and luxation
does not often take place. Complications that usually occur are rupture
of the round (coxofemoral) ligament or fracture of the neck of the
femur. Falls or violent strains are necessary to produce this luxation.
Goubaux is quoted by Cadiot and Almy[41] as having observed the head of
the femur in an instance wherein luxation had long existed. In this case
autopsy revealed the fact that the inner portion (two-thirds) of the
head of the femur had completely disappeared.
Luxation of the femur is observed in old emaciated animals that are
worked on slippery pavements. Occasionally, evidence of chronic luxation
of the femur is observed in the anatomical laboratory. The chronicity of
the condition is obvious when one notes the well formed articulation
which Nature provides for the head of the femur, where fracture or other
serious complications are not present.
Symptomatology.--In every case there must exist either restriction of
movement or an evident abnormal position of the leg, or both conditions
may exist at once. Also, the leg may be markedly shortened.
Manifestation of this affection varies, depending upon the character of
the luxation (position of the head of the humerus with relation to the
acetabulum). Lusk[42] cites a case of a mule which had suffered femoral
luxation. The animal was destroyed and on autopsy the head of the femur
found to be contained within a false articular cavity situated about
four inches above the acetabulum. In Dr. Lusk's case as he states it,
the following symptoms were presented: "Limb shortened and fixed in a
position of adduction. While standing the affected limb hung directly
across and in front of the opposite one; upper trochanter very
prominent; skin over hip joint very tense. The mobility of the limb was
very limited, especially in the forward direction."
Being very prominent when there is an upward luxation and less
perceptible in downward displacement, the location of the trochanter
major is an indicator of the character of the luxation with respect to
the position of the head of the femur. This variation of position
causes abnormal tenseness or looseness of the skin over the region of
the trochanter major. Rectal examination is of aid in locating the head
of the humerus.
Treatment.--When it is evident that a subject should be given
treatment and not destroyed, the animal must be cast and completely
anesthetized. With complete relaxation thus secured by rotation of the
limb, using the hip joint region as a pivot, reduction may be effected.
Traction is exerted in the same direction from the acetabulum that the
head of the femur is situated and by pressing over the joint, the
displaced bone may be returned in position. If luxation is downward,
traction on the extremity will tend to dislodge the head of the femur
from the inferior acetabular margin making reduction possible.
The same general plan which is ordinarily employed in correcting
luxation is indicated here, but because of the heavy musculature of the
hip, complete anesthesia is imperative in all such manipulations.
Gluteal Tendo-Synovitis.
The glutens medius (g. maximus) muscle is inserted chiefly by means of
two tendons; one to the summit of the trochanter major of the femur and
the other passing over the anterior part of the convexity of the
trochanter, and being attached to the crest below it. The trochanter is
covered with cartilage, and a bursa (the trochanteric) is interposed
between the tendon and the cartilage.
Etiology and Occurrence.--This affection is probably caused in most
instances by direct injury to the parts, such as may be occasioned by
being kicked, falling on pavement, or being struck by the body of a
heavy wagon. Strains in pulling or in slipping are undoubtedly causative
factors and in draft horses such strains may result in involvement of
this synovial apparatus.
Symptomatology.--If pain be severe and inflammation acute, weight may
not be borne with the affected member. There is some local manifestation
of the condition in acute cases. Swelling of the tissues contiguous to
the bursa is present and pain is evinced upon manipulation of the
parts. A characteristic gait marks inflammation of the trochanteric
bursa, and as Gunther has put it, the subject generally moves or trots
as does the dog--the sound member being carried in advance of the
affected one and the forward stride of the diseased leg is shortened. In
some chronic cases crepitation is discernible by holding the hand on the
trochanter while the subject walks.
Treatment.--In the first stages of an acute affection absolute quiet
must be enforced; local antiphlogistic applications are beneficial.
Later, vesication of a liberal area surrounding the trochanter major is
indicated. Where the condition has become chronic in horses that are to
be kept at heavy draft work there is little chance for complete
recovery. And, naturally, one is not to expect resolution in cases where
there exist erosion and ossification of cartilage--where crepitation is
discernible.
Paralysis of the Hind Leg.
Aside from paraplegic conditions due to disease of the cord or the
lumbosacral plexus, and monoplegic affections resultant from
disturbances of this plexus, paralysis of certain nerves are
occasionally encountered.
Anatomy.--The lumbosacral plexus results substantially from the union
of the ventral branches of the last three lumbar and the first two
sacral nerves, but it derives a small root from the third lumbar nerve
also. The anterior part of the plexus lies in front of the internal
iliac artery, between the lumbar transverse processes and the psoas
minor. It supplies branches to the iliopsoas[43] (designated by Girard,
the iliacomuscular nerves). The posterior part lies partly upon and
partly in the texture of the sacrosciatic ligament. From the plexus are
derived the nerves of the pelvic limb (Sisson).
Paralysis of the Femoral (Crural) Nerve.
Anatomy.--The femoral nerve (crural) is derived chiefly from the
fourth and fifth lumbar nerves. It runs ventrally and backward, at
first between the psoas major and minor, then crosses the deep face of
the tendon of the latter and descends under cover of the sartorious over
the terminal part of the iliopsoas. It innervates the psoas major
(magnus), psoas minor (parvus), sartorious, rectus femoris, vastus
lateralis (interims). Branches supply the stifle and the adductor and
pectineus muscles.
Etiology and Occurrence.--While paralysis of the femoral nerve, also
known as "dropped stifle" occurs as a result of local injuries and
melanotic tumors in gray horses, most cases are due to azoturia.
So-called crural paralysis or "hip swinney" is occasionally observed but
this is not a condition wherein the nerve is affected in the manner that
characterizes the marked atrophy of quadriceps femoris (crural) muscles
in some cases of hemaglobinuria. This form of paralysis according to
Hutyra and Marek is due primarily to diffuse degeneration of the
muscles.
Symptomatology.--When muscular atrophy is not extensive no particular
evidence of this condition may be manifested while the subject is at
rest, but where muscular waste has occurred, the nature of the ailment
is at once recognized. Since the femoral nerve supplies the quadriceps
femoris muscles, it follows that when the psoic portion of this nerve
becomes diseased, the stifle loses its support, and in a unilateral
involvement when the subject attempts to walk on the affected member,
the stifle sinks down for want of support and the leg collapses unless
weight is caught up with the other leg. Often, following azoturia, a
bilateral affection is to be observed.
Treatment.--Horses may be restrained in the standing position, and in
the average instance, a twitch and hood are all the restraining
appliances necessary.
In cases where the disease is unilateral and atrophy is not of too long
standing, recovery is possible in vigorous subjects. All affections,
however, wherein degenerative changes involve the nerve trunk, whether
due to diffuse myositis or pressure from malignant tumors, will not
yield to treatment.
The same general plan of treatment is indicated that is described on
page 74 in the consideration of atrophy of the scapular muscles. It is
especially important to provide for the subject to be exercised when
there is atrophy of the quadriceps muscles following azoturia.
In addition to the foregoing, good results have attended the use of
intramuscular injections of oxygen. The technic of the operation
consists in preparing the area of skin which covers the atrophied
muscles as for any operation. The hair is clipped over five or six or
more circular areas of about an inch in diameter; the skin is cleansed
and then painted with tincture of iodin.
A long heavy sterile needle, which is connected with an oxygen tank by
means of six feet of rubber tubing, is thrust into the depths of the
affected muscles and the gas is gently introduced into the tissues. One
needs exercise extreme care that the gas enter slowly because great pain
is produced by the sudden injection of the oxygen. Likewise too much of
the gas must not be introduced at one place. When the oxygen is slowly
introduced it may be allowed to enter the tissues until the subject
gives evidence of experiencing considerable pain, or if the parts are
not particularly sensitive, a reasonable amount (enough to cause a mild
degree of diffuse inflammation) is introduced at each one of five or six
points. In large animals more points of injection may be used.
No infection or other bad results will follow the execution of a good
technic and the treatment may be repeated every three or four weeks
until either marked regeneration of tissue is evident or the case is
obviously proved hopeless.
Paralysis of the Obturator Nerve.
Anatomy.--The obturator nerve, situated at first under the peritoneum,
accompanies the obturator artery through the obturator foramen and
gaining the muscles on the internal face of the thigh, terminates in the
obturator externus, adductors, pectineus and gracilis, also giving twigs
to the obturator internus (Strangeways).
Etiology and Occurrence.--This condition occurs upon rare occasions as
the result of injury such as falls which cause extreme abduction of the
legs, or in pelvic fracture where the nerve is directly injured, or
when melanotic tumors or other new growths compress the nerve in such
manner that its function is suspended. Paralysis of the obturator nerve
or nerves is met with rather frequently, notwithstanding, in mares,
following dystocia. The nerves (one or both) may become bruised at the
brim of the obturator foramen by being caught between the pelvis and the
body of the fetus in some cases of protracted labor.
Symptomatology.--In a unilateral affection there may be little
evidence of the trouble while the subject is standing; or there is to be
seen some abduction; or the affected member may present abduction of the
stifle and stand "toe outward." If the animal is walked there will be
manifested more or less abduction and the character of the impediment
varies according to the nature of the involvement.
Following protracted cases of labor in some instances where only a
unilateral paralysis exists, walking is performed with difficulty; the
subject may be unable to support weight with the affected member and is
obliged to hop on the one sound hind leg. In bilateral affections, they
are unable to rise. If the condition is severe the sling is required to
keep the subject standing, and with this care, recovery will follow.
Treatment.--If new growths or callosities or similar conditions affect
the nerve, little, if any, hope for recovery exists. In young and
vigorous subjects where cause is not definitely known, a course of
strychnin may be given. Good nursing, providing for the subject's
comfort and allowing moderate exercise, constitute rational treatment.
Stimulating embrocations on the abductor muscles resorted to in cases
during the incipient stage may prove helpful.
When paralysis of the obturator nerve occurs as a post-partum
complication, and other conditions are favorable, the subject should be
raised to its feet without unnecessary delay. If the mare is unable to
assist in regaining her feet, a sling is required. Usually little else
is necessary and after a few days in the sling the subject can get about
unassisted. In the meanwhile the well-being of the affected animal is to
be considered just as in any other case where the patient is so
confined. The foal in such instances constitutes a source of some
trouble, but the average mare offers no serious resistance to the
confinement occasioned by the sling.
Good hygienic care, a suitable diet and full physiological doses of
strychnin are indicated. Cadiot and Almy recommend vaginal douches of
cold water and counterirritation of the region of the inner thigh in
these cases.
Paralysis of the Sciatic Nerve.
Anatomy.--The great sciatic nerve leaves the pelvis in company with
the gluteal nerves, through the great sciatic foramen (notch), passing
downward along the posterior face of the femur. Near the stifle it
passes between the two heads of the gastrocnemius muscle and continues
as the tibial. Branches supply the following muscles--obturator,
semimembranosus (adductor magnus), biceps femoris (triceps abductor
femoris), semitendinosus (biceps rotator tibialis), lateral extensor
(peroneus) and the tibial nerve, its continuation, innervates the
digital flexors.
Etiology and Occurrence.--Paralysis of the great sciatic nerve may be
caused by central disorders, injury in falling, fractures and new
growths. Because of its protected position, this nerve does not often
suffer injury, and paralysis of the sciatic nerve is recorded in a few
instances owing to its rarity.
Symptomatology.--When consideration is given the number of muscles
that are supplied by the sciatic nerve and the function of these
muscular structures, it is obvious that the leg cannot be used in
sciatic paralysis. However, the limb is capable of sustaining weight
when it is fixed in position, but this is done without exertion of
muscular fibers which are supplied by the great sciatic nerve. Trotting
is impossible and flexion of the affected member is also likewise
precluded. The foot is dragged when the subject is caused to advance.
Under the heading "sciatica," Scott[44] has described a case of acute
sciatic affection wherein a pacing horse manifested evidence of great
pain of a nervous character. There were muscular twitchings and the leg
was held off the floor and moved about convulsively. Breathing was very
much accelerated, pulse 85 per minute, the temperature was 103° and
manipulation of the hips augmented the pain.
This was not a paralytic condition and recovery resulted, yet
undoubtedly this was a case which, if not properly cared for, might have
terminated unfavorably.
Treatment.--Prognosis is decidedly unfavorable in paralysis of the
great sciatic nerve. If treatment is attempted, it is to be conducted
along the same general lines as in femoral paralysis. Particular
attention should be given to conditions which will make for the
patient's comfort, and as soon as it is evident that the affection is
not progressing favorably, the subject should be humanely destroyed.
Iliac Thrombosis.
This condition is undoubtedly of more frequent occurrence than we are
wont to grant when one considers the comparatively small number of cases
that are actually recognized in practice. It does not follow, however,
that iliac thrombosis rarely exists. Probably in the majority of
instances there is insufficient obstruction of the lumina of vessels to
provoke noticeable inconvenience. Or, if circulation is hampered to the
extent that function is impaired and manifestations are observed by the
driver, the subject may be permitted to rest a few days and partial
resolution occurs, so that further trouble is not noticeable.
As judged by lesions of the aorta and iliac arteries in dissecting
subjects, the conclusion that arteritis and resultant disorders are of
rather frequent occurrence, is logical.
Etiology.--Inflammation of the vessel walls and resultant
prolifieration of tissue together with the accumulation of clotted blood
becoming organized, serve to obstruct the lumen of the affected artery.
The cause of arteritis is unknown in many instances, but parasitic
invasion and contiguous involvement of vessels in some inflammatory
injuries are etiological factors.
Symptomatology.--A characteristic type of lameness signalizes iliac
thrombosis and the following brief abstract from a contribution on this
subject by Drs. Merillat[45], clearly portrays the chief symptoms:
[Illustration: Fig. 48--Exposure of aorta and its branches, showing
location of thrombi in numerous places. In this case (same as Fig. 49)
Dr. L.A. and Dr. Edward Merillat found the cause of the condition to be
due to sclerastomiasis.]
The seizures are accompanied with profuse sudation, tremors,
dilated nostrils, accelerated respirations and other symptoms of
pain and distress, all of which, together with the lameness,
disappear as rapidly as they had developed, leaving the animal in
an apparently perfect state of health, ready to fall with another
attack of precisely the same kind, as soon as enough exercise is
forced upon it. The rectal explorations may reveal a pulseless
state of one or more of the iliac arteries and a hardness and
enlargement of the aortic quadrifurcation, but sometimes this
palpation fails to disclose any _perceptible_ diminution of the
blood current of these vessels. The obturation being incomplete, it
may be impossible by palpation to decide that thrombosis really
exists. In this event and, in fact, in all eases, the clinical
symptoms are sufficiently characteristic to make a diagnosis
without reservation. It cannot be mistaken for any other disease,
once properly investigated. Any given seizure may easily be
mistaken for azoturia, at first, but a better examination soon
excludes that disease.
[Illustration: Fig. 49--Illustrative of thrombosis of the aorta, iliacs
and branches. Photo by Dr. L.A. Merillat.]
Prognosis and Treatment.--In the majority of instances, when
there is occasioned serious inconvenience, the outcome is not
likely to be favorable, according to Möller. Detachment of a
portion of the thrombus, according to Hoare, may result in the
lodgment of an embolus in the brain or kidneys. The latter
authority also states that muscular atrophy may occur owing to lack
of blood supply in some of these cases. Möller states that
moderate exercise or work stimulates the establishment of
collateral circulation. Massage per rectum is condemned as
dangerous by Cadiot.
Fracture of the Patella.
Etiology and Occurrence.--Patellar fractures are rarely met with in
the horse but may be caused by falls and heavy contusions. Violent
muscular contraction, it is said, may also bring about the same
condition.
Symptomatology.--Fracture may be transverse or vertical, and depending
on the manner in which the bone is broken, prognosis is either at once
rendered favorable or unfavorable. The patella performs a function which
is in a way similar to that of the sesamoids and when fractured,
complete recovery is improbable in the average instance. When complete,
transverse fractures permit of separation of the parts of bone. Tension
on the straight ligaments below and contraction of the quadriceps above
usually cause insuperable difficulty in the handling of this type of
fracture in the horse.
Compound fractures as well as multiple or comminuted fractures
occasionally occur and these constitute injuries which are generally
considered fatal, although Andrien, according to Cadiot and Almy,
succeeded in obtaining complete recovery in a case of compound fracture
of the patella and the horse was in service and almost free from
lameness two months after treatment was begun.
No difficulty is encountered in recognizing the fracture of the patella
because of the exposed position of the bone. Crepitation, and in some
cases fissures, may be easily detected.
Treatment.--In simple fracture, when treatment is thought advisable,
the subject is put in a sling and kept as nearly comfortable as
possible. If little inflammation exists, the application of a vesicant
two or three weeks after the injury has been inflicted will be helpful
and serve to hasten repair.
Bandages or mechanical appliances are of no practical use in the
handling of these cases.
Luxation of the Patella.
Etiology and Occurrence.--This, the most common luxation met with in
the equine subject, has been described by writers as existing in many
forms. Patellar disarticulation may be more practically considered as
_momentary_ and _fixed_, regardless of the position taken by the
patella. Described under the title of false luxation are recorded cases
wherein the quadriceps (crural) muscles become contracted in such manner
that a condition simulating true disarticulation of the patella obtains.
Also, some practictioners report cases of patellar luxation and refer to
pseudo-luxations, without clearly defining the conditions which
constitute pseudo-luxation. This has contributed to the extant cause of
misconception as to actual differences between luxation and conditions
simulating dislocation.
Luxation of the patella is a condition wherein the articular portions of
the femur and patella assume abnormal relations whether such
displacement of the patella be momentary and capable of spontaneous
reduction, or fixed and requiring corrective manipulation. Spasmodic
contraction of the crural muscles which sometimes retains the patella in
such position that the leg is rigidly extended, does not in itself
constitute luxation of the patella; and unless this bone becomes lodged
on the upper portion of a femoral condyle or laterally displaced out of
its femoral groove, luxation cannot be said to exist in the horse. These
are sub-luxations.
Occasionally one may observe in suckling colts outward luxation of the
patella wherein there is history of navel infection and no marked
evidence of rachitis is present. Some of these cases recover. In a
unilateral involvement of this kind in a three-month-old mule colt, the
author observed a case wherein an unfavorable prognosis was given and
destruction of the subject advised, because of the extreme dislocation
of the patella. This colt, however, was not destroyed and in three weeks
had apparently recovered. No treatment was given in this instance; the
colt was allowed the run of a small pasture with its dam and in time it
matured, becoming a sound and serviceable animal.
Classification.--Two forms of true patellar luxation in the horse may
be considered; one which is due to the patella becoming fixed upon the
internal trochlear rim of the femur and the other when the patella slips
over the outer rim of the trochlea.
The first form is known as _upward_ luxation and is made possible by
rupture of the mesial (internal) femeropatellar ligament. According to
Cadiot and Almy, it is only by the rupture of this ligament--the
femeropatellar--that upward luxation may occur. This type of luxation is
rarely observed and is usually due to violent strain and abnormal
extension of the stifle joint.
The second class, _outward_ luxation, occurs in colts and is, in many
instances, congenital. This form of luxation is also the one usually
seen following debilitating diseases such as influenza and pneumonia.
_Upward luxation of the patella_ is characterized by the stiff-extended
position of the leg. When the patella is situated upon the inner
trochlear rim, the tibia must be extended because of the traction
exerted by the straight ligaments. Since the stifle and hock joints
extend and flex in unison, there is presented also an extension of the
tarsus. Extension of the stifle joint would increase the distance
between the femoral origin of the gastrocnemius and its insertion to the
summit of fibular tarsal bone (calcis) were it not for the gastrocnemius
and superficial flexor (perforatus). Extension of the hock in upward
luxation of the patella, permits of flexion of the phalanges. In upward
luxation, then, the leg is extended as if too long, but the phalanges
may be in a state of moderate flexion. If the foot rests on the ground
when the extremity is not flexed, it is almost impossible for the
subject to step backward. Because of immobilization of the stifle and
hock joints in upward luxation, the subject can walk only by hopping on
the sound leg and then the extremity is flexed, allowing the anterior
portion of the fetlock to drag on the ground.
In some cases practitioners are called to attend young animals that are
reported to be "stifled" (often in young mules that have made a rapid
growth) and upon arrival the only noticeable symptom of preëxisting
luxation is the soiled condition of the anterior fetlock
region--evidence of its having been dragged. Such cases may be styled
momentary luxation, whether they are due to a weakened condition of the
patellar ligaments or spasmodic contraction of the crural muscles.
In upward luxation, reduction is effected by attempting further
extension of the stifle joint and at the same time the patella is pulled
outward, off the internal rim of the trochlea. This is attempted by
securing the subject in a standing position; the sound side is kept
against a wall if possible and a rope is tied to the extremity of the
affected leg. Traction is exerted upon the rope and at the same time
force is directed against the stifle joint to produce further extension
if possible, so that the straight patellar ligaments may relax
sufficiently to allow the patella to be dislodged from its position upon
the inner trochlear lip. Failing in this manner of procedure, the
affected animal is to be cast and anesthetized with chloroform. The
relaxation which attends surgical anesthesia will permit of reduction of
the dislocated bone and manipulations such as have just been outlined
may be employed.
Following reduction in the average case it is essential that the subject
be given vigorous exercise for a few minutes. Reduction having been
affected, the application of a vesicant over the whole patellar region
is customary.
In cases of habitual luxation, unless the ligaments are so lax that the
patella may be displaced laterally over the inner as well as the outer
trochler rims, division of the inner straight patellar ligament will
correct the condition. This desmotomy has been advocated by Bassi, and
good results in appropriate cases have been reported by Cadiot, Merillat
and Schumacher. This operation has been found a corrective in cases of
outward luxation as well as those of upward dislocation of the patella
when resorted to before the trochleae are worn from frequent luxation.
_Outward luxation of the patella_ is occasioned by a lax condition of
the internal femeropatellar ligament or a rupture of the same so that
the patella slips over the outer femoral trochlear rim and permits of an
abnormal flexion of the stifle joint. The outer trochlear rim being the
smaller of the two, inward luxation does not occur in the horse. With
the patella disarticulated in this manner, the action of the quapriceps
femoral group of muscles has no effect on the stifle joint and,
therefore, flexion of this articulation occurs as soon as the subject
attempts to sustain weight and the leg collapses unless weight is at
once taken up by the other member if sound.
As a rule, the reduction of this form of luxation is not difficult. The
patella may be pushed inward and into position without manipulation of
the leg. Retention of the patella in position is a difficult problem.
Bandaging is considered impractical and is not ordinarily done in this
country. Benard, according to Cadiot and Almy, recommends bandaging with
a heavy piece of cloth in which an opening is made through which the
patella is allowed to protrude, and by turning such a bandage snugly
about the stifle several times, the patella is held in position. This
bandage should be kept in place for about ten days.
In young and rachitic animals outdoor exercise and a good nutritive
ration for the subject are indicated. Hypophosphites in assimilable form
may be beneficial, and vesication of the patellar region contributes to
recovery.
Where extreme luxation is present in both stifles, the prognosis is
unfavorable. In such cases, degenerative changes may exist and in some
instances the ligaments are so diseased and elongated that regeneration
is impossible. Williams[46] reports a case where bilateral "floating"
(outward) luxation was present and extensive degeneration changes
affected the articulation.
In subjects suffering frequent dislocation of the patella (habitual
luxation) it is possible in some cases, to prevent its occurrence or at
least to minimize the distress occasioned by momentary luxation, by
keeping the animals in wide stalls so that "backing" is unnecessary. In
some nervous subjects that seem to be suffering from cramp of the crural
muscles, the difficulty and pain of their being backed out of narrow
stalls, accentuates the nervousness. Sudation and restlessness are
manifested and the subject presents a clinical picture of distress and
fear of a painful ordeal. In some cases of this kind, complete recovery
takes place by the time animals are five or six years of age. One should
avoid keeping such subjects in narrow stalls. Preferably patellar
desmotomy should be performed that relief may be obtained at once.
Luxations attending some cases of influenza recover promptly when
subjects are kept comfortably confined in roomy box-stalls. The
administration of stimulative medicaments such as nux vomica and the
application of an active blistering agent to the patella serve to hasten
recovery. Dislocations in such cases are often bilateral and they are
usually momentary. Reduction occurs spontaneously, as a rule, and the
subjects are not occasioned much distress if they are kept quiet for a
few days.
Chronic Gonitis.
Etiology and Occurrence.--Chronic inflammation of the stifle joint is
met with following acute synovitis due to strains and concussion. It is
an ailment which affects heavy horses and particularly animals that are
kept at work on paved streets, but this does not explain its existence
in animals that are not subjected to work likely to cause concussion.
Berns[47] considers rheumatism a probable cause of gonitis and, as he
states, the dropsical form of affection of this joint is not ordinarily
attended with manifestations of inconvenience to the subject. Gonitis is
often bilateral and its onset is insidious in many instances.
Symptomatology.--In unilateral gonitis weight is not borne by the
affected member. There is noticeable distension of the joint capsule--a
characteristic pendant pouching protrusion. When both stifles are
affected the subject frequently shifts the weight from one limb to the
other. Lameness comes on gradually and during the incipient stages may
be intermittent but it progressively increases so that in time affected
animals become useless. In bilateral affections animals drag the toes
because of the pain incident to flexing the stifles. This is
particularly evident when the subject is made to trot. As the disease
progresses, atrophy of the quadriceps femoris muscles becomes pronounced
and as destructive changes involving the articular cartilages take
place. The subject becomes more lame and eventually is rendered
incapable of service.
Upon manipulation of the patellar region, one is impressed with the fact
that hyperesthesia does not exist in proportion to the pain manifested
during locomotion. In some cases a gelatinous swelling is present and
may be detected by palpating between the straight ligaments of the
patella. Williams, Hughes, Merillat, Hadley and others have directed
attention to the existence of floating masses (_corpora oryzoidea_) in
the synovial capsule of this joint in gonitis, and as with all cases of
arthritis, irreparable damage is often done the articular cartilages
during the course of the ailment.
[Illustration: Fig. 50--Chronic gonitis. The knuckling which results
from long continued inactivity of the crural muscles in chronic cases is
marked in this instance. Photo by Dr. L.A. Merillat.]
Treatment.--No effective method is as yet known which will control
this condition during its incipiency. The disease progresses, and more
or less damage is done the affected parts in the course of months or
even years in some cases before subjects are rendered hopelessly
crippled. When recognized early (before chronic gonitis exists)
aspiration of the synovia and the injection of diluted tincture of iodin
might prove beneficial in cases of synovial distension. Chronic gonitis
is considered an incurable affection and as soon as subjects manifest
evidence of distress from this condition they should by all means be
taken from work. Firing and vesication have not been productive of
beneficial results.
[Illustration: Fig. 51--Gonitis. Showing position assumed in such cases
because of pain occasioned. Photo by Dr. C.A. McKillip.]
Open Stifle Joint.
Anatomy of the Joint Capsule.--This joint capsule is thin and very
capacious. On the patella it is attached around the margin of the
articular surface, but on the femur the line of attachment is at a
varying distance from the articular surface. On the medial side it is an
inch or more from the articular cartilage; on the lateral side and
above, about half an inch. It pouches upward under the quadriceps
femoris for a distance of two or three inches, a pad of fat separating
the capsule from the muscle. Below the patella it is separated from the
patellar ligaments by a thick pad of fat, but inferiorly it is in
contact with the femerotibial capsules. The joint cavity is the most
extensive in the body. It usually communicates with the medial sac of
the femerotibial joint cavity by a slit-like opening situated at the
lowest part of the medial ridge of the trochlea. A similar, usually
smaller, communication with the lateral sac of the femerotibial capsule
is often found at the lowest part of the lateral ridge. (Sisson's
Anatomy.)
Thus it is seen that because of its frequent communication with the
other parts of this large synovial membrane, a wound which opens the
external portion of the femerotibial capsule may be the cause of
contamination and resultant infectious arthritis of the whole stifle
joint. Because of the distance between the most dependent part of the
femerotibial articulation and the summit of the patella, one may
misjudge the exact location of the lowermost part of this portion of the
capsular ligament of the stifle joint and thereby fail at once to
appreciate the seriousness of calk wounds in this region.
Etiology and Occurrence.--Wounds to the patellar region are of rather
frequent occurrence, and because of the comparatively unprotected
position of these structures, the capsular ligaments of the stifle joint
may be perforated as a result of violence in some form. Calk wounds
which penetrate the tissues in the immediate region of the lower portion
of the external part of the femerotibial capsule sometimes result in
open joint because of tissue necrosis resulting from the introduction of
infection. Contused wounds sometimes destroy the skin and fascia over
large areas on the lateral patellar region and because of subsequent
sloughing of tissue due to infection as well as to the manner in which
such wounds are inflicted, septic arthritis subsequently occurs.
Penetrant wounds, such as may be caused by a fork tine may not result in
infection; if infectious material is introduced an infectious arthritis
does not necessarily follow, though such cases should be considered as
serious from the outset.
Symptomatology.--The pathognomonic symptom of open stifle joint is the
profuse escape of synovia, indicating perforation of the synovial
capsule; by means of a probe the wound may be explored in a way that
will clearly reveal the nature of the injury.
After a few days have elapsed in cases where considerable infection has
taken place, there is manifestation of pain as in all cases of infective
arthritis. Hughes[48] gives an excellent description of the clinical
aspect of arthritis which applies here:
Acute arthritis begins like an ordinary attack of synovitis. In
joints other than the pedal and pastern, there is sudden and
extensive swelling, which at first is intra-articular, succeeded by
extra-articular tumefaction, and accompanied by violent lameness.
The pain soon becomes intense and agonizing. There is severe
constitutional disturbance, the temperature ranging from 104 to 106
degrees and the pulse from 60 to 72. Painful convulsions of the
limb occur, shown by involuntary spasmodic elevations due to reflex
irritation of the muscles. There is loss of appetite, rapid
emaciation, the flank is tucked up and the back arched. In from
three to six days, the tumefaction around the joint tends to soften
at a particular place, and bursts, and a discharge that is
sometimes of a sanious character, mixed with synovia, escapes.
Great exhaustion at times supervenes, and if the joint is an
important one, the horse lies or falls and is unable to rise.
Treatment.--In small puncture wounds the immediate application of a
vesicating ointment has given good results, but when infection has taken
place to such extent that the animal manifests evidence of intense pain,
and lameness is marked and local swelling and hyperesthesia are great,
vesication is contraindicated. In such instances the exterior of the
wound and its margins should be prepared as in similar affections of
other joints. A quantity of synovia is then aspirated by means of a
small trocar and care should be taken to observe all due aseptic
precautions. Subsequently the injection of from four to six ounces of a
mixture of tincture of iodin, one part to ten parts of glycerin, and
gentle massage of the joint immediately after the injection has been
made, serves to check the infective process in some cases.
The subject should be cared for as has been previously suggested in
arthritis proper provisions for comfort being made. Good nursing is
always essential to a successful issue. However, the author cannot view
cases of open stifle joint with the same optimism concerning their
course and outcome that is expressed by a number of writers on this
subject. It is a grave condition wherein the prognosis should be given
advisedly.
Fracture of the Tibia.
Etiology and Occurrence.--Because of its exposed position to kicks,
and its lack of protection by heavy musculature (especially on its inner
surface), there is afforded ample opportunity for frequent injury to the
tibia. Fractures are complete and varying as to nature, or incomplete.
The heavy tibial fascia affords sufficient protection so that fissures
without entire solution of continuity of the bone may occur from
violence to which this part is often subjected. Möller classes tibial
fracture as ranking second in frequency--pelvic fracture being more
often met with in horses. This does not apply in our country as
phalangeal and metacarpal and even metatarsal fractures are observed in
more instances than are such injuries to the tibia. The tibia is
occasionally broken at its middle and lower thirds, but malleolar
fractures are not common.
Symptomatology.--When fracture is complete and all support is removed,
the leg dangles, and the nature of the injury is so obvious that there
is no mistaking its identity. However, in case of incomplete fracture
one needs to base all conclusions upon the history of the case, evidence
of injury, or other knowledge of the character of violence to which
this bone has been exposed. For without the presence of crepitation
(even by excluding other possible causes for the pronounced lameness
which characterizes some of these cases) we can only resort to the
knowledge which experience has taught that fracture may be deemed
probable in many injuries to the tibial region. Consequently, we are to
look upon all injuries that affect the tibia as being fractures of some
sort when there is either local evidence of the infliction of violence
or whenever marked lameness attends such injuries, unless there is
positive indication that no fractures exist.
A careful examination of parts of the tibia, i.e., noting the amount and
painfulness of swellings, exploration with the probe, and observations
of the course taken in any given case, will determine the exact nature
of injuries. Such examination needs to extend over a period of a week or
in some instances two or three weeks may pass before the true state of
affairs is apparent. In the meanwhile, cases are to be handled as though
tibial fracture certainly existed.
Prognosis.--Prediction of the outcome in tibial fracture is somewhat
presumptuous, but in the majority of cases in mature subjects fatality
results. Cadiot[49], however, views this condition with more optimism
than have American practitioners. While he considers the condition
grave, in citing case reports of successful treatment by d'Arboval,
Duchemin, Leblanc, and others, his conclusion is that many practitioners
erroneously consider fractures of the tibia as incurable.
The method of handling these cases by Leblanc is as follows: The subject
is placed in a sling; a pit is excavated below the affected member so
that a heavy weight may be attached to the extremity; splints are
applied to each side of the leg, which is padded with oakum, and this is
kept in position by means of bandages covered with pitch. The outer
splint extends from the hoof to the stifle and the inner one from the
hoof to the upper third of the leg. This method in the hands of Leblanc
has been successful in several instances, according to Cadiot.
In a foal the author has in one instance succeeded in obtaining complete
recovery in a simple fracture of the lower third of the tibia where the
only support given the broken bone was a four-inch plaster-of-paris
bandage which was adjusted above the hock. Below the tarsus a cotton and
gauze bandage was applied to prevent swelling of the extremity. In this
instance (an emergency case in which materials that are not to be
recommended were necessarily employed) recovery took place within thirty
days.
As has been mentioned in the consideration of radial fractures, heavy
leather is better suited for immobilization of these parts than a cast
or other rigid splint materials. Mature animals may be expected to
resist the immobilization of the hind legs because of the normal manner
of flexion of the tarsal and stifle joints in unison. Therefore, the
application of rigid splints to the leg and including the hock is
productive of disastrous results in some cases.
The application of cotton and bandages to pad the member and the
adjusting of heavy leather splints on either side of the leg, and
retaining them in position with four-inch gauze bandages will prove more
nearly satisfactory than some other methods employed. Prognosis is
unfavorable, however, in most cases of compound fracture and recovery is
improbable when the upper portion of the tibia is broken.
Rupture and Wounds of the Tendo Achillis.
Etiology and Occurrence.--Cases are recorded by Uhlrich in which
rupture has followed degenerative changes affecting the tendo Achillis.
Not infrequently, the result of a trauma, division of the tendo Achillis
occurs. Möller states that rupture of this tendon may be due to jumping,
in riding horses and in draught horses, in their efforts to avoid
slipping. In runaways, it sometimes occurs where sharp-edged implements
are bounced against the legs in such fashion that division of the tendon
results.
Symptomatology.--With division of the tendo Achillis or of the
musculature of the gastroenemii and the superficial flexor
(perforatus), there remains nothing to inhibit tarsal flexion except the
deep flexor tendon (perforans) and this does not support the leg. When
attempt is made to sustain weight with the affected member, abnormal
flexion of the tarsus takes place and the hock sinks almost to the
ground. The symptoms are so characteristic that recognition is always
easy even in case no wound of the skin exists.
Prognosis.--Spontaneous recoveries occur and such cases are reported
by Bouley who is quoted by Cadiot as having observed division of the
tendo Achillis due to a sword wound wherein at the end of four months
recovery was complete. Division of this tendon in brood mares has been
practiced by the early settlers of parts of the United States for the
purpose of preventing their straying too far from home. In such
instances one leg only was so mutilated and in most instances, it is
reported that spontaneous recovery took place.
In unilateral involvement without complications, the prognosis is not
unfavorable if provisions for giving necessary attention are available.
Treatment.--The subject is to be confined in a sling and the member
bandaged and supported by means of leather splints. Immobilization as
for fracture is not necessary but, nevertheless, movement is to be
restricted as much as possible. In case of open wounds, the exposed
tissues are cared for along general surgical lines. Where the divided
parts of the tendon are maintained in fairly close and constant
relation, granulation of tissue, sufficient to sustain weight takes
place in from six weeks to three months.
Spring-Halt. (String-Halt.)
Occurrence.--This condition is a myoclonic affection of the hind leg
which is discussed in works on theory and practice under the head of
neuroses, but the cause or causes have not been established. Theories
that heredity is responsible have their supporters and advocates of
hypotheses attributing it to disease of the sciatic nerve, patellar
subluxation, fascial contraction of various muscles, "dry spavin"
(tarsal arthritis), iliac exostoses, disease of the foot and contraction
of the hoof, are on record in veterinary literature. This ailment
affects old horses more frequently than it does young and is seen in all
breeds of animals including mules.
[Illustration: Fig. 52--Spring-halt.]
Symptomatology.--This disease develops slowly, and progressively
increases in severity as a rule, but does not ordinarily constitute
cause for rendering an animal unserviceable. While the affection is
sometimes bilateral (occasionally affections of the forelegs are
reported) and the extreme flexion of the legs in the spasmodic manner
which characterizes spring-halt, cause great waste of energy during
locomotion, yet such cases are rare. Usually the ailment is markedly
evinced when subjects are first taken from the stable, but as they are
exercised the manifestation diminishes, and in many instances it
completely subsides. The condition is generally more noticeable when the
subject is made to step backward. In some animals there is marked
abduction at the time flexion occurs and in singular instances the
spasmodic contraction is so violent that the subject falls to the ground
as a result of the peculiar flexion of the leg.
In severe cases of "scratches" or chemical irritation of the extremity,
the legs are abnormally flexed in a manner which simulates spring-halt,
but because of the evident injury of the parts this is not likely to
confuse. Since all facts concerning etiological agencies are surrounded
with so much obscurity, classification does not lend any particular
assistance in the consideration of this ailment.
Prognosis.--One cannot intelligently give a prognosis in these cases
if forecast is expected to state the exact course following treatment.
However, in a general way, cases of recent affection are thought more
favorable than are those of long standing or in old animals where
myositis and other muscular and fascial affections exist owing to years
of hard service.
Treatment.--No known line of medicinal treatment is of service, nor is
any particular surgical operation to be considered dependable for
obtaining relief. Operations of almost every conceivable nature have
been tried with the hope of securing recovery in spring-halt but under
no condition can the practitioner as yet be reasonably certain of
effecting permanent relief in any case. Treatment is, therefore,
entirely empirical.
Neurectomies have been performed and recoveries following were
attributed thereto; fascial divisions in the crural region have been
done with good results and this manner of treatment has its favorers.
Advocates of tenotomies, likewise, are to be found. Consequently, one
may summarize thus: Spring-halt is a disease of unknown origin--the
exact cause has not been determined; therefore, all treatment is, in a
way, experimental. The recommendation of any given procedure in handling
cases must then be a matter of opinion based either upon practical
experience or knowledge of the experiences of others. Divisions of the
lateral digital extensor (peroneus) below the tarsus near its point of
insertion to the extensor of the digit is recommended here because it is
followed by a percentage of recoveries that is as large as in any other
method of treatment and the operation is not difficult to perform nor
is its performance fraught with any dangerous complications. In selected
subjects about fifty per cent of cases recover in from two to six weeks
following this operation.
[Illustration: Fig. 53--Lateral (external) view of tarsus showing
effects of generalized tarsitis.]
Open Tarsal Joint.
Like the tibia the hock is exposed to frequent injuries and in some
cases wounds perforate the joint capsule. When due to calk wounds where
horses are kicked, the injury is often on the side of the tarsus (medial
or lateral) and such wounds not infrequently result in infectious
arthritis. Horses sometimes jump over wire fences and wounds are
inflicted which constitute extensive laceration of the joint capsule. In
firing for bone spavin, where a deep puncture is made very near the
tibial tarsal (tibioastragular) joint if infection gains entrance,
serious and generalized infection of the open joint cavity supervenes in
some cases.
Symptomatology.--There is no marked difference in the constitutional
disturbances which are occasioned in this condition and those
encountered in other cases of septic arthritis (previously considered
herein) except that there is a difference in the degree of resultant
derangement and local tissue changes. Chiefly, because of the difficulty
encountered in keeping the hock joint in an aseptic condition or
securely bandaged, open tarsal joint constitutes a more serious
condition than a similar affection of the fetlock. Otherwise, a very
similar condition obtains and the same diagnostic principles serve here
that have been described on page 110 in considering open fetlock joint.
Treatment.--The same plan that is described in detail for treatment of
similar conditions affecting the fetlock joint is indicated in this
affection. Exceeding care must be exercised in bandaging the hock,
however, lest the animal be so irritated that in the extreme flexion of
the tarsus which is often caused by bandaging, the wound dressings may
be completely deranged. A wide gauze bandage material is most
satisfactory; cotton of long fiber is separated in thin layers and wound
about the hock, extending from the site of injury to a point about six
inches proximal to the summit of the os calcis. By using an abundance
of cotton in this way, it will not be found necessary to apply the
bandages very snugly; with a four-inch gauze bandage material, which is
supported above the cap of the hock and brought across the anterior face
of the tarsus in a diagonal manner, a comfortable and very serviceable
protective dressing is provided for. Animals so treated will not
ordinarily resist because of pressure from the bandages. Pressure is
unavoidable in the use of adhesive dressings or where careful attention
is not given the manner of applying cotton to the parts. Such methods
are sure to result disastrously. But if subjects are kept quiet after
the parts have been properly bandaged, no difficulty is encountered in
maintaining asepsis in an uninfected wound. Recovery takes place in
favorable cases in from three weeks to three months, depending on the
nature and extent of injuries inflicted.
Fracture of the Fibular Tarsal Bone (Calcaneum.)
Etiology and Occurrence.--This condition though rarely met with in the
horse, is the result of violent strain upon the os calcis by the
gastrocnemius and superficial flexor tendons in efforts put forth by
animals in attempts to regain a footing when the hind feet slip forward
under the body, or in jumping and in falls or direct contusion by heavy
bodies. Hoare[50] reports a case of a mare that had produced fracture in
jumping.
Fracture of the other tarsal bones are very seldom observed but may be
occasioned by contusions wherein multiple or comminuted fractures are
produced, such as are to be seen in small animals. Fracture of the
tibial tarsal bone (astragalus) is to be observed as a complication in
luxations of the tarsal joint and, according to Cadiot, the other tarsal
bones may likewise suffer fracture in luxations of the hock.
Symptomatology.--Great pain attends this accident according to the
observations given in recorded cases. In the case cited by Hoare the
animal evinced great pain and uneasiness; the hock was unduly flexed;
the calcaneum was displaced forward; and marked crepitation was present.
A portion of the body of the calcaneum was protruding through the
perforated skin. The animal was destroyed and the bone was found broken
in three pieces.
[Illustration: Fig. 54--Right hock joint. Viewed from the front and
slightly laterally after removal of joint capsule and long collateral
ligaments. T.t., Tibial tarsal bone (distal tuberosity). T.c., central
tarsal bone. T.3. Ridge of third tarsal bone. T.f. Fibular tarsal bone
(distal end). T.4. Fourth tarsal bone. Mt. III, Mt. IV. Metatarsal
bones. Arrow points to vascular canal. (From Sisson's "Anatomy of the
Domestic Animals.")]
Since the support for the tendo Achillis is removed in such fracture and
no leverage on the metatarsus obtains, it naturally follows that any
attempt to sustain weight must result in extreme flexion of the hock and
descent of this part in a manner similar to cases of rupture or division
of the Achilles' tendon. The two conditions should not be confused,
however, as the parts may be definitely outlined by palpation and the
slack condition of the tendon and displaced summit of the calcaneum,
which characterize fracture of the fibular tarsal bone, are easily
recognized.
Treatment.--Prognosis is unfavorable in the majority of cases, but
should attempts at treatment be undertaken in young and quiet mares
which might prove valuable for breeding purposes in case of imperfect
recovery, they should be put in slings and the member is to be
immobilized as in tibial fracture. Authorities are agreed that prognosis
is entirely unfavorable in mature animals, when the case is viewed from
an economic standpoint.
Tarsal Sprains.
Etiology and Occurrence.--The hock joint is often subjected to great
strain because of the structural nature of this part and its relation to
the hip as well as the manner in which the tarsus functionates during
locomotion. That ligamentous injuries owing to sprain frequently occur
and attendant periarticular inflammations with subsequent hypertrophic
changes follow, is a logical inference. Fibrillary fracture of the
collateral ligaments may take place in falls or when animals make
violent efforts to maintain their footing on slippery streets. In
expressing opinions concerning the frequency with which the hock is
found to be the seat of trouble in lameness of the pelvic members,
different writers place the percentage of hock lameness at from
seventy-five to ninety per cent. And when one considers the possibility
that a goodly proportion of cases of tarsal exostis are the outcome of
sprains, the occurrence of tarsal sprains may be more generally
admitted.
Symptomatology.--A mixed type of lameness is present and the nature of
the impediment varies, depending upon the location of the injury.
Sprains of the mesial tarsal ligaments cause lameness somewhat similar
to that of spavin. However, in establishing a diagnosis, local evidence
in these cases is of greater significance than the manner of locomotion.
During the acute stage of inflammation there is to be detected local
hyperthermia, some hyperesthesia and a little swelling. Later, when
resolution is not prompt, considerable swelling (or perhaps correctly
speaking, an indurated enlargement) variable in size is developed. In
some cases the entire tarsal region becomes greatly enlarged and this
swelling is very slowly absorbed in part or completely. Such sub-acute
cases are observed during the winter season and particularly where
subjects are kept in tie stalls without exercise for weeks at a time.
Treatment.--Attention should be directed toward relief for the animal
in all acute inflammations. Local applications of heat are helpful and,
of course, rest is essential. Towels that are wrung out of hot water and
held in position by means of a few turns of a loose bandage and this
covered with an impervious rubber sheet, will serve as a practical means
of application of hydrotherapy. Following this when conditions improve,
as in the handling of all similar cases, counterirritation is indicated.
When proper care is given at the onset and where injury does not involve
too much ligamentous tissue, recovery takes place in a few weeks but in
some cases which occur during the winter season in farm horses, complete
recovery does not result until several months have passed.
Curb.
The hock is said to be curbed when the normal appearance, viewed from
the side, is that of bulging posteriorly at any point between the summit
of the calcaneum and the upper third of the metatarsus. Among some
horsemen a hock is said to be "curby" whenever there exists an
enlargement of any kind on the posterior face of the tarsus whether it
be due to sprain, exostosis or proliferation of tissue as a result of
contusion.
French veterinarians consider under the title of "courbe," an exostosis
situated on the mesial side of the distal end of the tibia. Cadiot and
Almy state that this condition (courbe) is of rare occurrence. Percivall
defines curb as "a prominence upon the back of the hind leg, a little
below the hock, of a curvilinear shape, running in a direct line
downwards and consisting of infusion into, or thickening of, the sheath
of the flexor tendons." Möller's version of true curb is a thickening of
the plantar ligament (calcaneocuboid or calcaneometatarsal). Hughes and
Merillat consider curb as a synovitis having for its seat the synovial
bursa which is situated between the superficial flexor tendon
(perforatus) and the plantar ligament.
Occurrence.--Certain predisposing factors seem to favor the occurrence
of curb. A malformation of the inferior part of the tarsus so that its
antero-posterior diameter is considerably less than normal is a
contributing cause. Such hocks are known as "tied-in." Another fault in
conformation is the existence of a weak hock that is set low down on a
crooked leg, especially when such a member is heavily muscled at the
hip. Given such conformation in an excitable horse, and curb is usually
produced before the subject is old enough for service. It is certain
that in cases where conformation is bad, greater strain is put upon the
plantar ligament. This structure serves to bind the tibial tarsal
(calcis) bone to the metatarsus; traction exerted upon its summit by the
tendo Achillis is great when animals run, jump or rear and also at heavy
pulling. In animals having curby hocks, sprain is likely to result and
curb supervenes.
Symptomatology.--The characteristic swelling which marks curb may
develop quickly and lameness occur suddenly or the enlargement comes on
gradually and slowly, causing little lameness. Lameness is not
proportionate to the size of the swelling and in all cases whether
subacute or chronic, the condition improves with rest, but lameness is
again manifested upon exertion. A horse which "throws a curb" will go
lame until the acute inflammatory condition subsides and depending upon
treatment received and conformation of the hock, this requires from
three days to two or three weeks.
The character of the swelling varies; in some cases it is not large but
rather dense and lacking in evidence of heat and hyperesthesia; in other
cases there is considerable swelling, which is hot and doughy, somewhat
painful to the touch but not necessarily productive of much lameness. In
any event, whether the swelling or enlargement is big or little, its
location makes it conspicuous when viewed in profile.
In most cases after the acute inflammatory period has passed, lameness
is slight, if at all present, and in time no interference with the
subject's usefulness is occasioned because of the curb, but the animals
often remain blemished--complete resorption of inflammatory products
being unusual when much disturbance has existed.
Treatment.--The handling of curb during the acute inflammatory stage
is along the same lines as in sprain--local applications of cold and
heat. Subjects must be kept quiet until all inflammation has subsided,
for there are no cases wherein a little brisk exercise is more likely to
cause a recurrence of lameness before recovery is complete than in curb.
Vesication is in order in a week or ten days after the affection has set
in; in old stubborn cases that have resisted ordinary treatment for a
few months, the use of the actual cautery (line firing) is to be
recommended.
[Illustration: Fig. 55--Spavin.]
Spavin. (Bone Spavin.)
This term is applied to an affection of the tarsus which is usually
characterized by the existence of an exostosis on the mesial and
inferior portion of the hock. There is also included under this name,
articular inflammation wherein no external evidence is shown. Spavin
lameness has long been recognized and much has been written upon this
subject. Since authorities are agreed that most cases of lameness in the
hind leg are due to hock affection, and because the majority of cases of
lameness which have the tarsal region as the seat of trouble are
instances of spavin lameness, this disease merits all the attention it
has received.
Etiology and Occurrence.--Causes may well be classified as
predisposing and exciting, for there are many etiologic factors to be
reckoned with in spavin, some of which are widely different in nature.
Considered as predisposing causes, hereditary influences play an
important rôle and may, owing to faulty conformation, subject an animal
to affections of this kind because of disproportionate development of
parts (weak and small joints and heavy muscular hips); or as a
consequence of inherited traits, a subject may manifest susceptibility
to degenerative bone changes which are signalized by the formation of
exostoses of different parts on one or more of the legs. Hereditary
predispositions make for the presence of spavin in a large percentage of
the progeny of sires so affected. This fact has been repeatedly
demonstrated in this country as well as elsewhere according to Quitman,
Dalrymple and Merillat.[51] A number of states have passed stallion
inspection laws stipulating that animals having such exostoses as spavin
and ringbone cannot be registered except as "unsound."
Asymmetrical conformation, particularly where the hock is obviously
small and weak as compared with other parts of the leg, constitutes a
noteworthy predisposing cause.
Peters' theory is plausible that the screw-like joint between the tibia
and the tibial tarsal (astragulus) bones causes these structures to
functionate in a manner not in harmony with the provisions allowed by
the collateral ligaments of the tarsus, permitting movement only in a
direction parallel with the long axis of the body.
Because of the quality of their temperaments, nervous animals possessing
no particular congenital structural defects of the hock and having no
history of spavined progenitors, are subject to spavin when kept at work
likely to produce tarsal sprain. Spavin usually develops early in such
subjects and examples of this kind may be frequently observed in
agricultural sections of the country. Where spavin develops in unshod
colts at three and four years of age, shoeing is not an influencing
agency when animals are not worked on pavements.
Exciting causes of spavin are sprain and concussion. Various hypotheses
are recorded as to how sprains are influenced and among others may be
mentioned that of McDonough[52], which is that the foot is robbed of its
normal manner of support by the ordinary three-calked shoe. With such a
shoe, little support is given the sides of the foot; hence, undue strain
is put upon the collateral ligaments of the tarsus. Moreover, the shoe
with its calks increases the length of the leg and adds to the leverage
on the hock, by virtue of such added length. This makes for greater
strain upon the mesial or lateral tarsal ligaments whenever the foot
bears upon a sloping ground surface, so that one side (inner or outer)
is higher or lower than the other. But according to McDonough's theory
(a good one concerning horses that work on pavements), the chief error
in shoeing lies in that the foot is deprived of its normal base or
support on the sides--the three-calked shoe being an unstable
support--and that this manner of shoeing city horses working on
pavements is an "inhumane" practice, a "diabolical method."
Whether spavin has its point of origin within the articulation as a
rarefying ostitis of the cancellated structure of the lower tarsal bones
as suggested by Eberlein; or, as Diekerhoff asserts, that the cunean
bursa may be the initial point of affection, is unsettled; but it is
reasonable to consider occult spavin as having its origin within the
articulation, and that cases readily yielding to cunean tenotomy are
primarily due to affection of the cunean bursa.
Symptomatology.--Where a visible exostosis exists, the presence of
spavin is easily detected, yet exostoses that extend over large areas
may constitute cause for serious trouble and still be difficult of
detection. By observing the internal surface of the hock from various
suitable angles, such as from between the forelegs or directly behind
the subject, one may note the presence of any ordinary exostosis.
The position assumed by the spavined horse is often characteristic. More
or less knuckling is usually present (Liautard, McDonald). There is
abduction of the stifle in some cases, or the toe may be worn in unshod
horses so that it presents a straight line at the surface. This is
manifested to a great degree in some animals and in others the foot is
not dragged and there is no wearing of the hoof at the toe.
Spavin lameness is so distinctive that one trained and experienced in
the examination of horses that are spavined, should correctly diagnose
the condition in practically every instance without recourse to other
means than noting the peculiar character of the gait of the subject.
Lameness develops gradually in the majority of instances, and an
important feature in spavin lameness is that it disappears after the
subject has gone a little way, to return again as soon as the animal has
rested for a variable length of time--from a half hour to several hours.
This "warming out" is marked during the incipient stage, but less
pronounced in most chronic cases. A complete disappearance of lameness
is observed in some instances, while in others only partial subsidence
is evident. Because of the fact that pain is occasioned both during
weight bearing and while the leg is being flexed and advanced, there is
manifested the characteristic mixed lameness and exaggerated hip action
which typifies spavin. By throwing the hips upward with the sound member
it is possible to advance the affected leg with less flexion, hence less
pain is experienced in this manner of locomotion. When made to step
aside in the stall, a spavined horse will flex the affected member
abruptly and when weight is taken on the diseased leg, symptoms are
evinced of pain, and weight is immediately shifted to the sound limb.
This is marked during the incipient stages of spavin. Lameness usually
precedes the formation of exostosis, though cases are observed wherein
an exostosis is present and no lameness is manifested and no history of
the previous existence of lameness is available.
The "spavin test" is of value as a diagnostic measure when it is
employed with other means of examination, though reaction to this test
is seen in some cases in old "crampy" horses that have experienced hard
service. The test consists in flexing the affected leg (elevating the
foot from the ground twelve to twenty-four inches) and holding the
member in this position for a minute, whereupon the animal is made to
step away immediately at a trot. During the first few steps taken
directly thereafter, the subject shows pronounced lameness and this
constitutes a reaction to the spavin test.
Where no exostosis is present it becomes necessary to exclude other
causes for lameness but the characteristic spavin lameness is to be
relied upon to a greater extent in such cases than are other means of
examination. Such cases are known as occult spavin and may be present
for months before any external changes in structure are observable. In
some instances no extoses form even during the course of years. The
spavin test is of aid in establishing a diagnosis here but the marked
"warming out" peculiar to spavin is not so pronounced in such cases.
Prognosis.--An animal having hereditary predisposition to spavin is
not likely to recover completely whether this predisposition be due to
faulty conformation or susceptibility to bone changes. In predicting the
outcome, the temperament of the subject is to be taken into account, as
well as the character of service the animal is expected to perform. And
finally, a very important feature to be noted, is the location of the
exostosis. If situated rather high and extending anterior to the hock,
there is less likelihood of recovery resulting than where an exostosis
is confined to the lower row of tarsal bones. When situated anterior to
the tarsus a large exostosis may by mechanical interference to function,
cause lameness when all other causes are absent. In making examinations
one must not be deceived by the inconspicuous and seemingly
insignificant exostosis which has a broad base. In some cases of this
kind, dealers style the condition as "rough in the hock" when as a
matter of fact, in some instances, incurable spavin lameness develops.
Treatment.--Many incipient cases of spavin yield to vesication and a
protracted period of rest. Results depend primarily upon the nature of
the affection. However, in every instance if there is involvement of the
tibial tarsal (astragalus) bone, complete recovery is highly improbable.
When the disease is confined to the lower tarsal bones, lameness
subsides as soon as the degenerative changes are checked and ankylosis
occurs.
The use of the actual cautery when properly employed constitutes an
excellent method of treatment. The "auto-cautery" when equipped with a
point of about one-eighth of an inch in diameter and about three-fourths
of an inch in length is well suited for this particular operation.
Before deciding to cauterize, it is necessary to ascertain the extent of
area affected. The nearness of the exostosis to the tibiotarsal
articulation can be definitely determined by palpation. The hair over
the entire surgical field is clipped and the cautery at white heat is
pushed through the overlying soft tissues and into the central part of
the exostosis. Care is taken to keep the cautery-point away from the
articular margin of the tibial tarsal bone about three-fourths of an
inch. No danger will result from cauterizing to a depth of three-fourths
of an inch in the average case. Two or three (and not more) centrally
located points for penetration with the cautery are sufficient.
Experience has shown that several (five or six or more) punctures are
not productive of good results. When considerable cicatricial tissue is
present, due to the action of depilating vesicants or other chemicals,
sloughing of tissue is very apt to follow deep cauterization, if one is
not careful to keep the punctures at least one-half inch apart when
three are made. It is best, in such cases, to make but two deep
penetrations with the cautery but additional superficial punctures may
be made if kept about three-fourths of an inch distant and not nearer
than this to one another. Sloughing of tissue is not necessarily
productive of bad results but there is occasioned an open wound which
usually becomes infected and necrosis of tissue may extend into the
articulation. No benefit results from sloughing and it should be
avoided. In small horses, one deep point of cauterization is sufficient
if the osseous tissues are penetrated to a proper depth so that an
active inflammation is induced. The cautery may, if necessary, be
reintroduced several times. When the field of operation has been
properly prepared and it is thought advisable (as where subjects are
kept in the hospital for a time), the hock may be covered with cotton
and bandaged and no chance for infection will occur.
After cauterization the subject should be kept quiet in a comfortable
stall for three weeks; thereafter, if the animal is not too playful, the
run of a paddock may be allowed for about ten days and a protracted rest
of a month or more at pasture is best. It is unwise in the average case
to put an animal in service earlier than two months after having been
"fired."
Where cases progress favorably, lameness subsides in about three weeks
after cauterization and little if any recurrence of the impediment is
manifested thereafter. However, because of violent exercise taken in
some instances when subjects are put out after being confined in the
stall, a return of lameness occurs and it may remain for several days or
in some cases become permanent. No good comes from the use of blistering
ointments immediately after cauterization. The actual cautery is a means
of producing all necessary inflammation and it should be so employed
that sufficient reactionary inflammation succeeds such firing. The use
of a vesicating ointment subsequent to cauterization invites infection
because of the dust that is retained in contact with the wound. The
employment of irritating chemicals in a liquid form following firing is
needless and cruel.
In many instances lameness is not relieved and subjects show no
improvement at the end of six weeks time and it then becomes a question
of whether or not recovery is to be expected even with continued rest
and treatment. As a rule, such cases are unfavorable. In one instance
the author employed the actual cautery three times during the course of
six months and lameness gradually diminished for a year. In this case
the spavin was of nearly one year's standing when treatment was
instituted. The subject was a nervous and restless but well-formed
seven-year-old gelding. Recovery was not complete; recurrent intervals
of lameness marked this case, but the horse limped so slightly that the
average observer could not detect its existence after the animal had
been driven a little way.
Cunean tenotomy has been advocated and practiced by Abildgaard, Lafosse,
Peters, Herring, Zuill and others and good results have followed in many
cases so treated.
Considering results, the employment of chemicals of various kinds for
the purpose of relieving spavin lameness does not compare favorably with
firing. Moreover, so many animals have been tortured and needlessly
blemished in the attempted cure of spavin that agents which are not of
known value, the use of which are likely to result in extensive injury
to the tissues, are only to be condemned.
When spavin is bilateral and lameness is likewise affecting both
members, prognosis is at once unfavorable. Such cases are often
benefited by cauterization but only one leg at a time should be treated.
Bossi's double tarsal neurectomy (division of the anterior and posterior
tibial nerves) has undoubtedly been of decided benefit in many cases,
but is not at present a popular method of treatment in this country.
This operation has its indications, however, and may be recommended in
chronic lameness where no extensive exostosis exists which may
mechanically interfere with function.
Distension of the Tarsal Joint Capsule. (Bog Spavin.)
Distension of the capsular ligament of the tibial tarsal
(tibioastragular) joint with synovia is commonly known as bog spavin.
This condition is separate and distinct from that of distension of the
sheath of the deep flexor tendon (perforans) though not infrequently the
two affections coexist.
Etiology and Occurrence.--Following strains from work in the harness
or under the saddle, horses develop an acute synovitis of the hock
joint, which often results in chronic synovial distension. Debilitating
diseases favor the production of this affection in some animals. It is
also frequently observed in young horses and in draught colts of twelve
to eighteen months of age. This condition occurs while the subjects are
at pasture and often spontaneous recovery results by the time the
animals are two years of age.
[Illustration: Fig. 56--Bog spavin. Showing point of view which may be
most advantageously taken by the diagnostician in examining for
distension of the capsular ligament of the tarsal joint.]
Symptomatology.--Bog spavin is recognized by the distended condition
of the joint capsule which is prominent just below the internal tibial
malleolus and this affection is characterized by a fluctuating swelling
which varies considerably in size in different subjects. Except in cases
of acute synovitis, lameness is not present and in chronic distension of
the capsule of the tarsal joint, no interference with the subject's
usefulness occurs. In the majority of instances, the disfigurement which
attends bog spavin is the principal objectionable feature. The condition
is bilateral in many instances, and in such cases the subjects have a
predisposition to this condition or it follows attacks of strangles or
other debilitating ailments. Because of a rapid and unusual growth,
bilateral affections are of frequent occurrence in some animals.
Treatment.--The most practical method of handling bog spavin consists
in aspiration of synovia and injection of tincture of iodin. Discretion
should be employed in selecting subjects for treatment, regardless of
the manner in which such cases are to be handled. Where there exists
chronic distension of the joint capsule of several years' standing in
old or weak subjects, needless to say, recovery is not likely to result.
When animals are vigorous and two or three months' time is available,
treatment may be begun with reasonable hope for success.
The average subject is handled standing and can be restrained with a
twitch, sideline and hood. Aspirating needles and all necessary
equipment must be in readiness (sterile and wrapped in aseptic cotton or
gauze) so that no delay will occur from this cause when the operation
has been started. The central or most prominent part of the distended
portion of the capsule is chosen for perforation and an area of an inch
and a half in diameter is shaved. The skin is cleansed and then painted
with tincture of iodin. The sterile aspirating needle is pushed through
the tissues and into the capsule with a sudden thrust. With a large and
sharp needle (fourteen gauge), synovia can be drawn from the cavity in
most instances and the subject usually offers no resistance. By
compressing the distended capsule and surrounding structures with the
fingers, considerable synovia may be evacuated. In singular instances,
no synovia is to be aspirated with the needle, and in such cases the
amount of iodin injected needs be increased, possibly twenty-five per
cent., as experience will indicate. From two to five cubic centimeters
of U.S.P. tincture of iodin is injected through the aspirating needle
into the synovial cavity of the joint, and the exterior of the parts are
vigorously massaged immediately after injection to stimulate
distribution of the iodin throughout the synovial cavity. Where a
bilateral affection exists, two or three weeks' time should intervene
between the treatments of each leg. A sterile metal syringe equipped
with a slip joint for the needle is well adapted to this operation.
Lubrication of the plunger with heavy sterile vaseline or glycerin will
prevent the syringe from being ruined by the iodin.
Following the injection, the subject is kept in a stall or in a suitable
paddock, so that conditions may be observed for four or five days. The
object sought by the introduction of iodin is not only for a local
effect upon the synovial membranes in checking secretions, but the
production of an active inflammation and great swelling, which will
remain from four weeks to three months subsequent to the injection. This
periarticular swelling should produce and maintain a constant pressure
over the entire affected parts for a sufficient length of time until
normal tone is re-established.
In some cases, swelling does not develop as the result of a single
injection of iodin. When marked swelling has not taken place within five
days, none will occur and a repetition of the injection may be made
within ten days after the first treatment has been given. One may safely
increase the amount of iodin at the second injection in such cases by
one-fourth to one-third.
In Europe this method of treating bog spavin has been employed by
Leblanc, Abadie, Dupont and others according to Cadiot; but Bouley, Rey,
Lafosse and Varrier used it with bad results. Where a perfect technic is
executed (and no other is excusable in this operation), no infection
will occur if a reasonable amount of iodin is injected. The dilution of
iodin with an equal amount of alcohol has been practised by the author
in many cases, but later this was found unnecessary.
Other methods of treatment have been used with success. Perhaps the most
heroic consists in opening the joint capsule with a bistoury or with
the actual cautery. Such practice is too hazardous for general use and
is not to be recommended, although good results should follow the
employment of such methods if infectious arthritis does not occur.
Line firing over the distended capsule is a practical method of
treatment. This is attended with good results in young animals in many
cases, but considerable blemish is caused when sufficient irritation is
produced to stimulate resolution.
Vesication also is successfully employed in some instances. However,
only cases of recent origin in young animals--colts of two years or
younger--yield to blistering, and in some affected colts no doubt
recovery would have been spontaneous had no treatment been instituted.
Ligation of the saphenous vein at two points, one above and the other
below the distended ligamentous capsule, is an old operation, which has
undoubtedly given good results in some cases, although it does not seem
to be a rational procedure.
After-Care.--After swelling has fully developed--which occurs within a
week--the subject is turned to pasture and no attention is necessary
thereafter. A gradual subsidence of the swelling occurs and in the
average instance, this completely resolves within six or eight weeks.
Complete recovery succeeds the aspiration-and-injection-treatment in
about seventy-five per cent of cases as the result of one operation, and
subjects may be gradually and carefully returned to work in about sixty
days after treatment has been given.
Distension of the Tarsal Sheath of the Deep Digital Flexor.
(Thoroughpin.)
The terms "thoroughpin" or "throughpin" are translations from the French
_vessignon chevillé_ and have the same significance. They are so named
because of the diametrically opposed distensions of the sheath of the
deep flexor tendon in such manner that the distensions appear to be due
to a supporting peg.
Anatomy.--The theca through which the deep digital flexor (perforans)
plays in the tarsal region, begins about three inches above the inner
tibial malleolus and extends about one-fourth of the way down the
metatarsus. The posterior part of the capsular ligament of the hock
joint is very thick in its most dependent portions and is in part
cartilaginous, forming a suitable groove for the passage of the deep
flexor tendon.
[Illustration: Fig. 57--Thoroughpin. Showing distension of the sheath of
the deep flexor tendon as it protrudes antero-externally to the fibular
tarsal bone (calcaneum).]
Etiology and Occurrence.--Strains and sequellae to debilitating
diseases constitute the usual causes of this affection. As a result of
acute synovitis a chronic synovial distension of the tarsal sheath
occurs. Bog spavin is often present in case of thoroughpin but the two
conditions are separate and distinct excepting in that both may occur
simultaneously and as the result of the same cause. Some animals are
undoubtedly predisposed to disease of synovial structures. The average
horse that has been subjected to hard service on pavements or hard roads
at fast work suffers synovial distension of bursae, thecae or of joint
capsules. Some of the well bred types such as the thoroughbred horses
may be subjected to years of hard service and still remain "clean
limbed" and free from all blemishes. Thus it seems that subjects of
rather faulty conformation, animals having lymphatic temperaments and
the coarse-bred types, are prone to synovial disturbances such as
thoroughpin, bog spavin, etc., sometimes having both legs affected.
[Illustration: Fig. 58--Fibrosity of tarsus as a complication in chronic
thoroughpin.]
Symptomatology.--Thoroughpin is characterized by a distended condition
of the tarsal sheath which is manifested by protrusions anterior to the
tendo Achillis. However, where but moderate distension of the sheath
exists, there is little, if any, bulging on the mesial side of the hock
and but a small hemispherical enlargement is presented on the outer side
of the tarsus, anterior to the summit of the os calcis. In some
instances the protruding parts assume large proportions, but always,
because of the relationship between the fibular tarsal bone (calcaneum)
and the tendon sheath, the larger protrusion is situated mesially.
During the acute inflammatory stage there is marked lameness present but
this soon subsides when local antiphlogistic agents are applied to the
parts. In fact, spontaneous relief from lameness usually results in the
course of ten days' time following the appearance of thoroughpin. No
lameness marks the advent of this affection when it develops as the
result of continuous strain and concussion occasioned by hard service,
and local changes tend to remain in _status quo_.
[Illustration: Fig. 59--Another view of same case as illustrated in Fig.
58.]
Treatment.--Rest and the local application of heat or cold will suffice
to promote resolution of acute inflammation and lameness when present
will subside within two weeks. In chronic affections, however, the matter
and manner of effecting a correction of the condition--distended tarsal
sheath--merit careful consideration. While drainage of distended thecae
and bursae by means of openings made with hot irons was practiced by the
Arabs, centuries ago, and good results have attended such heroic
corrective measures, nevertheless the occasional serious complications
which result from infection likely to be introduced in following such
procedures, cause the prudent and skilful practitioner to employ safer
methods of treatment.
The application of blistering agents is of no value in stimulating
resorption of an excessive amount of synovia in chronic cases and the
actual cautery when employed without perforation of the synovial
structure, is of little benefit. Trusses or mechanical appliances for
the purpose of maintaining pressure upon the distended parts are of no
practical value because of the great difficulty of keeping such
contrivances in position. They usually cause so much discomfort to the
subject that they are not tolerated.
A very practical and fairly successful method of treatment consists in
the aspiration of a quantity of synovia and injecting tincture of iodin.
Cadiot recommends the drainage of synovia with a suitable trocar and
cannula and injecting a mixture consisting of tincture of iodin, one
part, to two parts of sterile water, to which is added a small quantity
of potassium iodid. The latter agent is added to prevent precipitation
of the iodin. This authority (Cadiot) further advocates the removal of
practically all of the synovia that will run out through the cannula and
the immediate introduction of as much as one hundred cubic centimeters
of the above mentioned iodin solution. This solution is allowed to
remain in the synovial cavity a few minutes and by compressing the
tissues surrounding the tendon sheath, the evacuation of as much of the
contents of the synovial cavity as is practicable, is effected.
Subsequently the subject is allowed absolute rest and more or less
inflammatory reaction follows. In some cases there occur marked lameness
and some febrile disturbance, but where a good technic is carried out,
no bad results follow. At the end of four weeks' time, horses so treated
may be returned to service, but the full beneficial effect of such
treatment is not experienced until several months' time have elapsed.
Where good facilities for executing a careful technic in every detail
are at hand, incision of the tarsal sheath, evacuation of its contents
and uniting its walls again by means of sutures and providing for
drainage with a suitable drainage tube, may be practiced. This manner of
treatment has been satisfactory in the hands of a number of surgeons.
Capped Hock.
Enlargements which occur upon the summit of the os calcis, whether
hypertrophy of the skin and subcuticular fascia, the result of injury or
repeated vesication, distension of the subcutaneous bursa or injury to
the superficial flexor tendon (perforatus) or its sheath, are generally
known as capped hock. However, the term should be restricted to use in
reference to distensions of synovial structures of that region.
Etiology and Occurrence.--Usually there occurs a hygromatous
involvement of the subcutaneous bursa due to contusion. As in bog
spavin, following certain infectious diseases (influenza, purpura
hemorrhagica, etc.) there remains a distended condition of the
subcutaneous bursa, after swelling of the member has subsided. In
feeding pens where numbers of young mules are kept in crowded quarters
many cases may be observed. In some instances where violent contusions
result from kicking cross-bars of wagon shafts (by nymphomaniacs or in
habitual kickers where there is opportunity for doing such injury) the
superficial flexor tendon and its synovial apparatus are injured and a
more serious condition may result.
Symptomatology.--In acute and extensive inflammation of the parts,
lameness is present, but in the average case no inconvenience to the
subject results. The prominent site of the affection is cause for an
unsightly blemish. This is undesirable, particularly in light-harness or
saddle horses. These affections are characterized by a fluctuating mass
which has a thin wall and in all cases of long standing the condition is
painless.
By careful palpation one may readily distinguish between a hygromatous
condition of the superficial bursa and involvement of the underlying
structures. Affection of the expanded portion of the flexor tendon and
contiguous structures makes for an organized mass of tissue which is
somewhat dense and in some instances painful to the subject when
manipulated. This is particularly noticeable in cases where the parts
are regularly and repeatedly injured as in habitual kickers.
[Illustration: Fig. 60--"Capped hock." Distension of the bursa over the
summit of the os calcis.]
Treatment.--In acute inflammation, antiphlogistic applications are
indicated and the subject must be kept quiet. The matter of bandaging
the hock is a difficult problem in some cases and needs be done with
care. As has been previously stated in this volume, the tarsus needs to
be well padded with cotton before the bandages are applied and only a
moderate degree of tension is employed in applying the bandages lest
anemic-necrosis result from pressure. In distension of the superficial
bursa, after clipping the hair over a liberal area and preparing the
skin by thoroughly cleansing and painting with tincture of iodin, the
capsule is incised with a bistoury. An incision about an inch in length,
situated low enough to provide drainage, is made through the tissues and
the contents are evacuated. Tincture of iodin is injected into the
cavity and the parts are covered with cotton and bandaged. No after-care
is necessary except to retain the dressing in position, which is not
difficult in the average case if the subject is kept tied. If much
resistance is exhibited, such as extreme flexion of the bandaged hock,
the animal may be put in a sling and little if any objection to the
bandage will be offered thereafter. The wound may be dressed at the end
of forty-eight hours and no redressing will be necessary in the average
instance if infection is not present. But slight local disturbance and
little distress to the subject result in cases so treated even when
infection occurs, but a good technic is possible of execution in most
instances and no infection should take place.
The surgical wound heals in two or three weeks and inflammation
gradually subsides. Bandages are retained one or two weeks, as the case
may require, and subsequently a good wound lotion may be employed
several times daily. A good lotion for such cases as well as in many
others has long been employed with success by Dr. A. Trickett of Kansas
City. It consists of approximately equal parts of glycerin, alcohol and
distilled extract of witch hazel, to which is added liquor cresolis
compositus, two percent, and coloring matter q.s.
Complete resolution does not occur in the average case. There remains
some hyperplastic tissue and even where the enlargement is slight, the
prominent situation of the affection precludes its being unnoticed.
In disease of the flexor tendon and its bursa where contiguous
inflammation of tissue is present, the parts are blistered or fired.
Line firing is beneficial in such instances but in all cases the cause
is to be removed if possible.
Rupture and Division of the Long Digital Extensor
(Extensor Pedis).
Etiology and Occurrence.--Because of the fact that the long digital
extensor is the only extensor of the phalanges of the pelvic limb, its
rupture or division constitutes a troublesome condition, which in some
cases does not readily respond to treatment.
Rupture of this tendon may occur during work on rough and uneven roads,
particularly in range horses that are ridden over ground that is
burrowed by gophers or prairie dogs; in such cases, horses are apt to
suddenly and violently turn the foot in position of volar flexion,
thereby causing undue strain to the digital extensor and its rupture
sometimes follows. In foals of one or two days of age, this tendon is
sometimes found parted or ruptured and the condition may be bilateral.
As the result of accidents, the digital extensor may be divided and when
the wound becomes contaminated, as it does because of the marked volar
flexion (knuckling) which occurs during the course of this affection,
regeneration of tissue is checked and recovery is tardy.
Symptomatology.--There is no interference with ability to sustain
weight in such cases, when the foot is placed in normal position; but
immediately upon attempting to walk, the toe is dragged, and if weight
is borne with the affected member, it comes upon the anterior face of
the fetlock. The flexors are not antagonized and if there be an open
wound the parts soon become contaminated; or, in rupture, if animals
travel about very much, there soon occurs necrosis of the tissues of the
anterior fetlock region and the condition is rendered incurable. Cases
are reported of animals that have suffered rupture of the long digital
extensor and the subjects learned to throw the member forward during
extension, substituting for the extensor tendon the pendulum-like
momentum which the foot affords when so employed; and a walking and even
a trotting pace was possible without doing injury to the fetlock region.
Where a subcutaneous division exists as in rupture, the divided ends of
the tendon may be definitely recognized by palpation.
Treatment.--Subjects are best put in slings and kept so confined until
regeneration of tendinous structures has been completed. This requires
from six weeks to two months' time. In addition, the extremity is kept
in a state of extension by means of suitable splints and shoes,--a shoe
equipped with an extension at the toe and perforated so that a steel
brace may be hooked into the perforation and the brace fashioned to be
buckled to the upper metatarsal region. When braces are placed in front
of the foot, great care is necessary in properly padding the member with
cotton lest sloughing from pressure occurs at the coronet; but this does
not apply in rupture of extensors so much as where flexors are ruptured.
Open wounds are treated along general surgical lines, dressed as
frequently as occasion demands, and recovery will be complete in a few
months' time unless much of the tendon has been destroyed. In one
instance, the author had occasion to observe such a condition, which,
because of the extensive destruction of tendon and lack of facilities
for giving proper attention to the subject, results were so unfavorable
that it was deemed necessary to destroy the animal.
Wounds From Interfering.
When, during locomotion, injury is inflicted upon the mesial side of an
extremity by the swinging foot of the other member, the condition is
termed interfering.
Etiology and Occurrence.--Faulty conformation, bad shoeing and
over-work are the principal causes of interfering. Horses that are "base
narrow" or that have crooked legs are quite apt to interfere. Shoes that
are put on a foot that is not level or applied in a twisted position, or
shoes wide at the heel will often cause interfering and injury. Animals
that are driven at fast work until they become nearly exhausted may be
expected to interfere. Such cases are frequently observed in young
horses that are driven over rough roads, particularly when so nearly
exhausted or weakened from disease or inanition that the feet are
dragged forward rather than picked up and advanced in the normal manner.
Symptomatology.--Wounds inflicted by striking the extremities in this
manner present various appearances and occasion dissimilar
manifestations. The hind legs are almost as frequently affected as the
front and the fetlock region is most often injured, though wounds may be
inflicted to the coronet. In front, the carpus is sometimes the site of
injury.
When only an abrasion is caused, little if any lameness occurs, but
where interfering is continued and nerves are involved or subfascial
infection and extensive inflammation succeed such abrasions, marked
lameness and evidence of great pain are manifested. Frequently, in
chronic cases affecting the hind leg, the fetlock assumes large
proportions, and at times during the course of every drive the subject
strikes the inflamed part, immediately flexing and abducting the injured
member, and the victim hops on the other leg until pain has somewhat
subsided.
Interfering is much more serious in animals that are used at fast work
than in draft horses. In light-harness or saddle horses, it may render
the subject practically valueless or unserviceable if the condition
cannot be corrected.
Treatment.--Wherever possible, cause is to be removed and if animals
are properly used, ordinary interfering wounds will yield to treatment.
If the shoeing is faulty, this should be corrected, the foot properly
prepared and leveled before being shod and suitable shoes applied. In
young animals that become "leg-weary" from constant overwork, rest and
recuperation are necessary to enhance recovery. In such cases it will be
found that very light shoes, frequently reset, will tend to prevent
injury to the fetlock region such as characterizes these injuries of
hind legs.
Palliative measures of various kinds are employed where cause is not to
be removed and a degree of success attends such effort. In draft horses
or animals that are used at a slow pace, shields of various kinds are
strapped to the extremity and protection is thus afforded. Or, large
encircling pads of leather, variously constructed, serve to cause the
subject to walk with the extremities apart.
Interfering shoes of different types are of material benefit in many
instances. Often the principle upon which corrective shoeing is based is
that the mesial (inner) side of the foot is too low; the foot is
consequently leveled and the inner branch of the shoe is made thicker
than the outer, altering the position of the foot in this way. This is
productive of desirable results. However, much depends upon the manner
in which the foot in motion strikes the weight-bearing member as to the
corrective measures that are indicated. This belongs to the domain of
pathological shoeing and the reader is referred to works on this subject
for further study of this phase of lameness.
Lymphangitis.
Excluding glanders, in the majority of instances, lymphangitis in the
horse, such as frequently affects the hind legs, is due to the local
introduction of infectious material into the tissues as a result of
wounds. However, one may observe in some instances an acute lymphangitis
which affects the pelvic limbs of horses and no evidence of infection
exists. Consequently, lymphangitis may be considered as _infectious_ and
_non-infectious_.
INFECTIOUS LYMPHANGITIS.
Etiology and Occurrence.--Traumatisms of the legs frequently result in
infection and when such injuries are near lymph glands, even though the
degree of infection be slight, more or less disturbance of function of
the muscles in the vicinity of such glands occurs and lameness follows.
The prescapular, axillary and cubital lymph glands when in a state of
inflammation, cause lameness of the front leg, and the superficial
inguinal and deep inguinal lymph glands not infrequently become involved
also. Because of the location of these lymph glands, they are subject to
comparatively frequent injury and inflammation, causing lameness more
often than other lymph-gland-affections.
Small puncture wounds in the region of the elbow are often met with.
These may be inflicted when horses lie down upon sharp stumps of
vegetation or shoe-calk injuries may be the means of introducing
contagium, and an infectious inflammation results. Abscess formation,
the result of strangles or other infection in the prescapular glands,
may be observed at times. Following castration, the inguinal lymph
glands may become involved in an infectious inflammation and locomotion
is impeded to a marked degree. Horses running at pasture sometimes
become injured by trampling upon pieces of wood, causing one end of
these or of various implements to become embedded in the soft earth and
the other end to enter at the inguinal region and even penetrate the
tissues to and through the skin and fascia just below the perineal
region.
Nail punctures resulting in infection frequently cause an infectious
lymphangitis and a marked and painful swelling of the legs supervenes.
[Illustration: Fig. 61--Chronic lymphangitis. Showing hypertrophy of the
left hind leg, due to repeated inflammation.]
Symptomatology.--Lameness, mixed or swinging-leg, signalizes the
presence of acute lymphangitis. There is always more or less swelling
present and manipulation of the affected parts gives pain to the
subject. Depending upon the character of the infection and its extent,
there is presented a varying degree of constitutional disturbance. There
may be a rise in temperature of from two to five degrees, and in such
instances there is an accelerated pulse. Where much intoxication is
present, anorexia and dipsosis are to be noticed.
Swelling may increase gradually and in time discharge of pus may take
place spontaneously without drainage being provided for, if the
character of the infection does not cause early death. In these cases
lameness is pronounced and the cause of the disturbance is to be sought,
particularly if the condition be due to a nail puncture.
[Illustration: Fig. 62--Elephantiasis.]
Treatment.--Location of the site of injury is advisable in all cases
and in some instances provision for drainage, as in puncture wounds, is
helpful. Locally, curettage and the application of suitable antiseptics
are indicated. Hot fomentations are beneficial and should be continued
for several days if necessary, to stimulate resolution. A brisk purge
should be admintered at the onset and strychnin, because of its indirect
stimulative effect upon the circulation together with its tonic effect
upon the musculature, is beneficial.
In all such cases rational treatment, good hygiene and careful nursing
are the principal factors which stimulate recovery. Individual
resistance or lowered vitality has a marked influence on the course of
this affection.
NON-INFECTIOUS LYMPHANGITIS.
This type of lymphangitis is associated with, or the result of, a
derangement of digestion. It affects heavy draft horses, rarely other
types of animals, and involves one or both hind legs.
Occurrence.--In healthy and well nourished horses irregularly used,
this affection may suddenly manifest itself. It occurs in singular
instances in mares that are in advanced pregnancy even when such animals
are at pasture. Usually, however, this malady is found in heavy draft
horses that have been kept stabled from one to three days.
Symptomatology.--At the outset in severe cases, there is elevation of
temperature, labored breathing, accelerated pulse, anorexia and more or
less swelling of the affected members. Swelling is very painful and when
the affected legs are palpated, pain is manifested by flinching. The
inguinal lymph glands are often swollen but in some cases they are not
affected in any perceptible degree. In the average case suppuration does
not occur and when conditions are favorable, resolution is complete
within ten days. The extent of the involvement and the intensity of the
affection vary materially in different cases and a chronic lymphangitis
may succeed the acute attacks and finally in some instances,
elephantiasis results.
Treatment.--An active purgative should be given at once and in the
ordinary case, stimulants are indicated. If marked distress is present,
morphin is given and where there is much rise of temperature, cold
drinking water is offered in abundance and catharsis is enhanced by
enemata. Locally, hot applications are of benefit. Hot towels or cotton
held in position by bandages and kept soaked with warm water will
relieve pain and stimulate resolution. Diuretics may be of benefit and
anodyne applications are to be employed with profit in some cases.
Walking exercise, if not indulged in to excess, is helpful as soon as
acute inflammation has subsided. By giving careful attention to the
regimen and providing regular exercise for susceptible subjects, this
type of lymphangitis is often forestalled.
FOOTNOTES:
[Footnote 34: Manual of Veterinary Physiology. Page 610.]
[Footnote 35: Manual of Veterinary Physiology, page 601.]
[Footnote 36: Case report at meeting of the Iowa State Veterinary
Medical Association, Jan., 1904, by Dr. S.H. Bauman, Birmingham, Ia.]
[Footnote 37: Regional Veterinary Surgery and Operative Technique, by
John A.W. Dollar, M.R.C.V.S., F.R.S.E., M.R.I., page 733.]
[Footnote 38: As quoted by A. Liautard, M.D., V.M., American Veterinary
Review, Vol. 37, page 667.]
[Footnote 39: Quoted by Prof. Liautard, American Veterinary Review, Vol.
33, page 190.]
[Footnote 40: Traite de Thérapeutique Chirurgical des Animaux Domestique
par P.J. Cadiot et J. Almy, Tome second, page 460.]
[Footnote 41: Traite de Thérapeutique Chirurgical, Tome second, page
465.]
[Footnote 42: Luxation of the Femur, by Wm. V. Lusk, Veterinary Surgeon,
U.S. Cavalry, American Veterinary Review, Vol. 21, page 254.]
[Footnote 43: Because of the intimacy of the psoas major (p. magnus) and
the iliacus they are sometimes called iliopsoas.]
[Footnote 44: Dr. John Scott, Peoria, Ill., in The American Veterinary
Review, Vol. 16, page 16.]
[Footnote 45: Annotation on Surgical Items, by Drs. L.A. and Edward
Merillat, American Veterinary Review, Vol. 31, page 358.]
[Footnote 46: W.L. Williams in American Veterinary Review, Vol. 21, page
452.]
[Footnote 47: Geo. H. Berns, D.V.S., report, American Veterinary Medical
Association, 1912, page 238.]
[Footnote 48: Joseph Hughes, M.R.C.V.S., in the Chicago Veterinary
College Quarterly Bulletin, Vol. 10, page 15.]
[Footnote 49: Traite de Therap. Chir. Cadiot et Almy, Tome second, page
480.]
[Footnote 50: E. Wallis Hoare, F.R.C.V.S., American Veterinary Review,
Vol. 27, page 1189.]
[Footnote 51: Discussions on paper entitled "The Spavin Group of
Lamenesses," by W.L. Williams, Carl W. Fisher and D.H. Udall,
Proceedings of American Veterinary Medical Association, 1905.]
[Footnote 52: "Hock-Joint Lameness," by Dr. James McDonough, Proceedings
of the A.V.M.A., 1913, page 545.]
INDEX
A
Acetabulum, 185
Acute arthritis, 65
Acute laminitis, 162
Acute tendinitis, 135
Affections of blood vessels, 31
Affections of bursae and thecae, 27
Affections of the feet, 34
Affections of ligaments, 20
Affections of lymph vessels and glands, 32
Affections of muscles and tendons, 28
Affections of nerves, 30
Anamnesis, 38
Anatomo-physiological review of parts of fore leg, 55
Anatomo-physiological consideration of the pelvic limbs, 185
Anatomy of the joint capsule, 220
Annular ligament, 58
Antea-spinatus muscle, 65
Anterior brachial region, wounds of, 90
Anterior digital extensor muscle, 193
Arteritis, 209
Artery (brachial), thrombosis of the, 81
Arthritis, 22, 84
Arthritis, acute, 65
Arthritis, chronic, 65
Arthritis, infectious, 66
Arthritis, metastatic, 25
Arthritis of the fetlock joint, 152
Arthritis, rheumatic, 26
Arthritis, scapulohumeral, 65
Arthritis, tarsal, 225
Arthritis, traumatic, 22
Articular ringbone, 121
Articulation, femeropelvic, 185
Articulation, metacarpophalangeal, 58
Articulation, scapulohumeral, 55
Aspiration-and-injection treatment of bog spavin, 244
Aspiration-and-injection treatment of capped hock, 252
Aspiration-and-injection treatment of thoroughpin, 250
Astragalus, 190
Astragalus, fracture of the, 230
Attitude of the subject, 41
Atrophy of the quadriceps muscles, 205
Atrophy, shoulder, 73
B
Biceps brachii, 58, 65, 68, 69
Bicipital bursa, inflammation of, 68
Blood vessels, affections of, 31
Bog spavin, 242
Bog spavin, aspiration-and-injection treatment of, 244
Bog spavin, line firing for, 246
Bog spavin, vesication for, 246
Bone spavin, 235
Bones, degenerative changes in, 16
Bones, tarsal, 190
Bossi's double tarsal neurectomy, 242
Brachial artery, thrombosis of the, 81
Brachial paralysis, 77
Bursa intertubercularis, 62, 69
Bursa podotrochlearis, inflammation of the, 157
Bursae, affections of, 27
Bursitis, 27, 104
Bursitis, infectious, 28
Bursitis in the fetlock region, 150
Bursitis intertubercularis, 68
Bursitis, noninfectious, 28
C
Calcaneo-cuboid ligaments, 190
Calcaneo-metatarsal ligaments, 190
Calcaneum, fracture of the, 230
Calk wounds, 170
Capped hock, 251
Capped hock, aspiration-and-injection treatment of, 252
Capsular ligament, 190
Caput muscles, 71
Carpal bones, fracture of the, 96
Carpal bones, luxation of the, 96
Carpal flexors, contraction of the, 93
Carpal flexors, inflammation of the, 93
Carpal joint, 58
Carpal joint, open, 100
Carpitis, 98
Carpus, inflammation of the, 98
Cartilage, lateral, inflammation of, 174
Cartilages of the third phalanx, ossification of the, 155
Chronic arthritis, 65
Chronic gonitis, 217
Chronic laminitis, 164
Chronic tendinitis, 137
Cochran shoe for dropped soles, 169
Collateral ligaments, 190
Comminuted fractures, 17
Compound fractures, 17
Contracted tendons of foals, 143
Contraction of the carpal flexors, 93
Contraction of the flexor tendons, 137
Contusions of the triceps brachii, 71
Contusive wounds, 85
Coracoradialis, 58
Corns, 172
Coronary region, wounds of the, 170
Corpora oryzoidea, 218
Cotyloid ligament, 185
Courbe, 233
Crepitation, false, 48
Crepitation, true, 47
Crucial ligaments, 188
Crural nerve, paralysis of the, 204
Cunean bursa, 237
Cunean tenotomy, 242
Cuneiform magnum, 191
Cuneiform medium, 191
Curb, 233
D
Deep digital flexor, distension of the tarsal sheath of, 246
Deep flexor tendon (perforans), 60
Degenerative changes in bones, 16
Diagnosis by exclusion, 53
Diagnosis by use of the X-ray, 179
Diagnostic principles, 37
Disease, navicular, 157
Dislocations, 21
Distension of the tarsal joint capsule, 242
Distension of the tarsal sheath of the deep digital flexor, 246
Division of long digital extensor, 253
Dorsal ligaments, 190
Dropped elbow, 71, 80
Dropped soles, shoe for, 169
Dropped stifle, 205
Dry spavin, 225
E
Elbow, dropped, 71, 80
Elbow, inflammation of the, 84
Elbow joint, 58
Elephantiasis, 34
Etiology, general discussion of, 15
Examination by palpation, 43
Examination, special methods of, 53
Examination, visual, 39
Exclusion, diagnosis by, 53
Exostosis of splint bones, 107
Exostosis, phalangeal, 118
Extensor (long digital) rupture and division of, 253
Extensor of the digit, rupture of, 145
Extensor pedis, 60
Extensor pedis, rupture of, 145
Extensor pedis, rupture and division of, 253
F
False crepitation, 48
Feet, affection of the, 34
Femoral nerve, paralysis of the, 204
Femeropatella ligaments, 188
Femeropelvic articulation, 185
Femur, 185, 192
Femur, fracture of the, 199
Femur, luxation of the, 201
Fetlock joint, 58
Fetlock joint, arthritis of the, 152
Fetlock joint, luxation of the, 125
Fetlock joint, open, 110
Fetlock region, thecitis and bursitis in, 148
Fetlock, shoe for bracing the, 181
Fibular tarsal bone, fracture of the, 230
Firing, treatment of ringbone by, 123
First phalanx, 59
"Fish knees", 145
Fixed luxations, 21
Fixed patellar disarticulation, 213
Flexor brachii, 58, 68, 69
Flexor carpiradialis, 93
Flexor carpiulnaris, 93
Flexor metacarpi externus, 94
Flexor metacarpi internus, 93
Flexor metacarpi medius, 93
Flexor metatarsi, 193
Flexor, superficial digital, 194
Flexor tendons, contraction of the, 137
Flexor tendons, inflammation of the, 135
Flexor tendons, rupture of, 146
Flexors of phalanges, open sheath of, 124
Foals, contracted tendons of, 143
Forearm, wounds of, 90
Fore leg, lameness in the, 55
Fracture of the carpal bones, 96
Fracture of the femur, 199
Fracture of the fibular tarsal bone, 230
Fracture of first and second phalanges, 131
Fracture of humerus, 82
Fracture of the ilium, 198
Fracture of the ischial tuberosity, 199
Fracture of the metacarpus, 106
Fracture of the patella, 212
Fractures of the pelvic bones, 196
Fracture of the proximal sesamoids, 128
Fracture of the pubis, 197
Fracture of the radius, 87
Fracture of the scapula, 62
Fracture of the tibia, 222
Fracture of the tibial tarsal bone, 230
Fracture of the ulna, 86
Fractures, 16
Fractures, comminuted, 17
Fractures, compound, 17
Fractures, green stick, 18
Fractures, impacted, 19
Fractures, longitudinal, 18
Fractures, multiple, 18
Fractures, multiple longitudinal, 19
Fractures, oblique, 18
Fractures, simple, 17
Fractures, simple transverse, 18
Fractures, transverse, 18
Fragilitas, 199
Fragilitas osseum, 128
G
Gait, observing character of, 48
Gastrocnemius, 194
Gluteal tendo-synovitis, 203
Gluteus medius muscle, 192, 203
Gonitis, chronic, 217
Green stick fractures, 18
H
Hind leg, lameness in the, 185
Hind leg, paralysis of the, 204
Hip lameness, 195
Hip swinney, 205
Hock, capped, 251
Hock joint, 188
Hoof testers, 53
Humeroradioulnar joint, 58
Humerus, fracture of, 82
I
Iliac thrombosis, 209
Iliopsoas, 204
Ilium, fracture of the, 198
Impacted fractures, 19
Infectious arthritis, 66
Infectious bursitis, 28
Infectious inflammation of the lateral cartilage, 173
Infectious lymphangitis, 257
Infectious synovitis, 124
Inflammation of the bicipital bursa, 68
Inflammation of the bursa podotrochlearis, 157
Inflammation of the carpal flexors, 93
Inflammation of the carpus, 98
Inflammation of the elbow, 84
Inflammation of the flexor tendons, 135
Inflammation of posterior ligaments of pastern, 129
Inflammation of proximal sesamoid bones, 127
Inflammation of third sesamoid and deep flexor tendon, 157
Inflammation of the trochanteric bursa, 204
Infraspinatus muscle, 65
Injection of fluids for quittor, 177
Injuries to scapulohumeral joint, 66
Interfering, shoeing for, 256
Interfering, wounds from, 255
Ischial tuberosity, fracture of the, 199
J
Joint capsule, anatomy of the, 220
Joint, carpal, 58
Joint, elbow, 58
Joint, fetlock, 58
Joint capsule, tarsal, distension of the, 242
Joint, fetlock, arthritis of the, 152
Joint, fetlock, luxation of, 125
Joint, hock, 188
Joint, humeroradioulnar, 58
Joint, open, 67
Joint, open carpal, 100
Joint, open fetlock, 110
Joint, pastern proximal interphalangeal, 129
Joint, shoulder, 55
Joint, stifle, open, 220
Joint, tarsal, open, 229
L
Lameness, hip, 195
Lameness, mixed, 49
Lameness in the fore leg, 55
Lameness in the hind leg, 185
Lameness, shoulder, 61
Lameness, supporting-leg, 49
Lameness, swinging-leg, 49
Laminitis, 160
Laminitis, acute, 162
Laminitis, chronic, 164
Lateral cartilage, infectious inflammation of the, 174
Lateral cartilages, ossification of, 155
Ligaments, affections of, 20
Ligament, capsular, 190
Ligaments, collateral, 190
Ligament, cotyloid, 185
Ligaments, crucial, 188
Ligaments, dorsal, 190
Ligaments, femeropatella, 188
Ligament, medial, 190
Ligaments, mesial tarsal, sprains of the, 232
Ligaments of pastern proximal interphalangeal joint, inflammation of, 129
Ligaments, patellar, 188
Ligaments, plantar, 190
Ligament, pubiofemoral, 185
Ligament, superior check, 58
Ligament, suspensory, rupture of, 146
Ligaments, volar, 129
Ligament, volar-carpal or annular, 58
Ligation of the saphenous vein, 246
Line firing for bog spavin, 246
Longitudinal fractures, 18
Lumbosacral plexus, 204
Luxation of the carpal bones, 96
Luxation of the femur, 201
Luxation of fetlock joint, 125
Luxation of the patella, 213
Luxation of the patella, outward, 215
Luxation of the patella, upward, 214
Luxation of scapulohumeral joint, 67
Luxations, 21
Luxations, fixed, 21
Luxations, temporary, 21
Lymph vessels and glands, affections of, 32
Lymphangitis, 32
Lymphangitis, infectious, 257
Lymphangitis, non-infectious, 260
M
Medial ligament, 190
Median neurectomy, 124
Mesial tarsal ligaments, sprains of the, 232
Metacarpophalangeal articulation, 58
Metacarpus, fracture of the, 106
Metastatic arthritis, 25
Mixed lameness, 49
Momentary patellar disarticulation, 213
Movements, passive, 47
Multiple fractures, 18
Multiple longitudinal fractures, 19
Muscles, affections of, 28
Muscle, antea-spinatus, 65
Muscle, anterior digital extensor, 193
Muscle, biceps brachii, 58
Muscle, caput, 71
Muscle, gluteus medium, 192, 203
Muscle, infraspinatus, 65
Muscle, peroneus tertius, 193
Muscle, postea-spinatus, 65
Muscles, quadriceps, 193
Muscles, quadriceps, atrophy of the, 205
Muscle, subscapularis, 65
Muscle, supraspinatus, 65
Muscle, tibialis anticus, 193
Muscle, triceps brachii, 58
Myalgia, 195
N
Nail punctures, 178
Navicular disease, 157
Nerves, affections of, 30
Nerve, femoral, paralysis of the, 204
Nerve, obturator, paralysis of the, 206
Nerve, sciatic, paralysis of the, 208
Nerve, (suprascapular) paralysis of the, 75
Non-infectious lymphangitis, 260
Non-infectious bursitis, 28
Neurectomy, Bossi's double tarsal, 242
Neurectomy, median, 124
Neurectomy, plantar, 124
O
Oblique fractures, 18
Observing character of gait, 48
Obturator nerve, paralysis of the, 206
Occurrence, general discussion of, 15
Omphalophlebitis, 25
Open carpal joint, 100
Open fetlock joint, 110
Open joint, 67
Open sheath of flexors of phalanges, 124
Open stifle joint, 220
Open tarsal joint, 229
Os corona, 60
Ossification of cartilages of the third phalanx, 155
Ossification of the lateral cartilages, 155
Os innominatum, 196
Os suffraginis, 59
Osteitis, rarefying, 16
Outward luxation of the patella, 215
P
Palpation, examination by, 43
Paralysis, brachial, 77
Paralysis of the femoral nerve, 204
Paralysis of the hind leg, 204
Paralysis of the obturator nerve, 206
Paralysis of the sciatic nerve, 208
Paralysis of the suprascapular nerve, 75
Paralysis, radial, 77
Paronychia, 170
Passive movements, 47
Pastern proximal interphalangeal joint, inflammation of ligaments of, 129
Patella, 188
Patella, fracture of the, 212
Patella, luxation of the, 213
Patella, outward luxation of the, 215
Patella, upward luxation of the, 214
Patellar disarticulation, fixed, 213
Patellar disarticulation, momentary, 213
Patellar ligaments, 188
Pelvic bones, fractures of the, 196
Pelvic limbs, anatomo-physiological consideration of the, 185
Penetrative wounds, 85
Periarticular ringbone, 122
Peroneus tertius muscle, 193
Phalangeal exostosis, 118
Phalanges, fracture of first and second, 131
Phalanges, open sheath of flexors of, 124
Phalanx, first, 59
Phalanx, second, 60
Phalanx, third, ossification of cartilages of, 155
Plantar ligaments, 190
Plantar neurectomy, 124
Polyarthritis, 25
Postea-spinatus muscle, 65
Principles, diagnostic, 37
Proximal sesamoid bones, inflammation of, 127
Proximal sesamoids, fracture of, 128
Pubiofemoral ligament, 185
Pubis, fracture of the, 197
Punctures, nail, 178
Q
Quadriceps muscles, 193
Quadriceps muscles, atrophy of the, 205
Quittor, 174
Quittor, injection of fluids for, 177
R
Rachitic ringbone, 122
Radial paralysis, 77
Radius, fracture of the, 87
Rarefying osteitis, 16
Rheumatic arthritis, 26
Rheumatism, 196
Ringbone, 118
Ringbone, articular, 121
Ringbone, periarticular, 122
Ringbone, rachitic, 122
Ringbone, traumatic, 122
Ringbone treated by firing, 123
Roberts shoe for bracing the fetlock, 181
Rupture of the extensor pedis, 145
Rupture of flexor tendons and suspensory ligament, 146
Rupture of long digital extensor, 253
Rupture of the tendo archillis, 224
S
Saphenous vein, ligation of the, 246
Scapula, fracture of the, 62
Scapulohumeral articulation, 55
Scapulohumeral joint, injuries to, 66
Scapulohumeral joint, luxation of, 67
Scapulohumeral joint, wounds of, 67
Scapulohumeral arthritis, 65
Sciatica, 208
Sciatic nerve, paralysis of the, 208
Second phalanx, 60
Sesamoid bones, 59
Sesamoid, third, inflammation of the, 157
Sesamoids, proximal, fracture of, 128
Sesamoiditis, 127
Setons, 75
Sheath of flexors of phalanges, open, 124
Sheath (tarsal) of the deep digital flexor, distension of the, 246
Shoe for dropped soles, 169
Shoeing for interfering, 256
Shoulder atrophy, 73
Shoulder joint, 55
Shoulder lameness, 61
Simple fractures, 17
Simple transverse fractures, 18
Soles, dropped, shoe for, 169
Spavin, bog, 242
Spavin, bone, 235
Spavin, dry, 225
Spavin test, 239
Special methods of examination, 53
Sprains of the mesial tarsal ligaments, 232
Sprains, tarsal, 232
Splints, 107
Spring-halt, 225
Stifle, dropped, 205
Stifle joint, open, 220
Strangles, 25
Streptococcus equi, 25
String-halt, 225
Subject, attitude of the, 41
Subscapularis muscle, 65
Supporting-leg-lameness, 49
Suprascapular nerve, paralysis of the, 75
Supraspinatus muscle, 65
Superficial digital flexor, 194
Superior check ligament, 58
Suspensory ligament, rupture of, 146
Sweeny, 73
Swinging-leg-lameness, 49
Swinney, 73
Swinney, hip, 205
Synovial distension of tendon sheaths, 104
Synovitis, 25
Synovitis, infectious, 124
T
Tarsal arthritis, 225
Tarsal bones, 190
Tarsal joint capsule, distension of the, 242
Tarsal joint, open, 229
Tarsal sheath of the deep digital flexor, distension of the, 246
Tarsal sprains, 232
Tarsus, 192
Temporary luxations, 21
Tendinitis, 135
Tendinitis, acute, 135
Tendinitis, chronic, 137
Tendo achillis, rupture and wounds of the, 224
Tendon, deep flexor, inflammation of the, 157
Tendon, deep flexor (perforans), 60
Tendon, extensor, rupture of, 145
Tendon, flexor, rupture of, 146
Tendons of foals, contracted, 143
Tendon sheaths, synovial distension of, 104
Tendons, affections of, 28
Tendons, flexor, contraction of the, 137
Tendons, flexor, inflammation of the, 135
Tendo-synovitis, gluteal, 203
Tenotomy, cunean, 242
Tensor fascia lata, 192
Test, spavin, 239
Testers, hoof, 53
Thecae, affections of, 27
Thecitis, 27, 104
Thecitis in the fetlock region, 150
Thoroughpin, 246
Thoroughpin, aspiration-and-injection treatment of, 250
Thrombosis, iliac, 209
Thrombosis of the brachial artery, 81
Tibia, 188
Tibia, fracture of the, 222
Tibial tarsal bone, fracture of the, 230
Tibialis anticus muscle, 193
Tibioastragular joint, distension of the, 242
Transverse fractures, 18
Traumatic arthritis, 22
Traumatic ringbone, 122
Treatment of bog spavin by aspiration and injection, 244
Treatment of capped hock by aspiration and injection, 252
Treatment of ringbone by firing, 123
Treatment of thoroughpin by aspiration and injection, 250
Triceps brachii, 58
Triceps brachii, contusions of, 71
Triceps extensor brachii, 71
Trochanteric bursa, inflammation of the, 204
True crepitation, 47
U
Ulna, fracture of the, 86
Ulnaris lateralis, 94
Upward luxation of the patella, 214
V
Vein, saphenous, ligation of the, 246
Vesication for bog spavin, 246
Vessignon chevillé, 246
Visual examination, 39
Volar-carpal ligament, 58
Volar ligaments, 129
W
Wounds, calk, 170
Wounds, contusive, 85
Wounds from interfering, 255
Wounds of anterior brachial region, 90
Wounds of coronary region, 170
Wounds of scapulohumeral joint, 67
Wounds of tendo achillis, 224
Wounds, penetrative, 85
X
X-ray diagnosis, 179
AUTHORITIES CITED
Almy, J., 141, 200, 202, 208, 212, 216, 214, 233
Bassi, 215
Bauman, S.H., 197
Bell, Roscoe R., 69
Benard, 216
Berns, Geo. H., 77, 218
Bouley, 225
Bourdelle, 147
Cadiot, P.J., 78, 141, 200, 202, 208, 212, 214, 216, 223, 225, 233, 245,
250
Campbell, D.M., 162, 166, 167
Castagné, 84
Cochran, David W., 169, 170
Diekerhoff, 237
Dollar, Jno. A.W., 68, 198
Eberlein, 237
Fisher, Carl W., 236
Frost, J.N., 113
Frost, R.F., 128
Greaves, Thomas, 157
Hoare, E. Wallis, 25, 211, 230
Hughes, Joseph, 176, 221
Hutyra and Marek, 205
Law, James, 33
Leblanc, 223
Liautard, A., 84, 199, 238
Lusk, Wm. V., 203
McDonough, James, 237
Merillat, Edward, 210
Merillat, L.A., 80, 96, 175, 210
Millar, Thomas, 145
Möller, H., 119, 156, 211, 222
Montane, 147
Moore, R.C., 162
Roberts, G.H., 181
Schumacher, 215
Scott, John, 208
Seeley, J.T., 176
Sisson, Septimus, 129, 204, 220
Smith, F., Major General, 56, 60, 155, 188, 194
Strangeways, 193
Taylor, Henry, 71
Thompson, H., 83, 87
Trickett, A., 253
Udall, D.H., 236
Uhlrich, 224
Walters, Wilfred, 83, 97
Williams, W.L., 217, 236
Transcriber's notes:
Accented words: The following spelling differences have been
maintained:
Moller / Möller
Montane / Montané
Traite / Traité.
Hyphenation: The following hyphenation differences have been
maintained:
bilateral / bi-lateral
calcaneocuboid / calcaneo-cuboid
calcaneometatarsal / calcaneo-metatarsal
counterirritation / counter-irritation
counterirritating / counter-irritating
foreleg / fore-leg
interphalangeal / inter-phalangeal
noninfectious / non-infectious
nonsensitive / non-sensitive
overwork / over-work
posteaspinatus / postea-spinatus
ringbone / ring-bone
subacute / sub-acute
subcoronary / sub-coronary
subfascial / sub-fascial
subperiosteal / sub-periosteal
Typographical errors:
sub-facial for sub-fascial
"At two-year-old" for "A two-year-old"
Ameircan for American
Symtomatology for Symptomatology
extoses for exostoses
admintered for administered
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