Diagnosis and Management of Lameness in the Horse - E-Book

Michael W. Ross; Sue J. Dyson

BOOK

Diagnosis and Management of Lameness in the Horse - E-Book

Michael W. Ross | Sue J. Dyson

(2010)

Additional Information

Book Details

ISBN: 978-1-4377-1176-9
Edition: 2
Language: English
Pages: 1424
Subjects: Medicine: general issues
Pharmacology
Veterinary medicine
Equine veterinary medicine
Horses & ponies: general interest

Abstract

Covering many different diagnostic tools, this essential resource explores both traditional treatments and alternative therapies for conditions that can cause gait abnormalities in horses. Broader in scope than any other book of its kind, this edition describes equine sporting activities and specific lameness conditions in major sport horse types, and includes up-to-date information on all imaging modalities.

This title includes additional digital media when purchased in print format. For this digital book edition, media content may not be included.

Cutting-edge information on diagnostic application for computed tomography and magnetic resonance imaging includes the most comprehensive section available on MRI in the live horse.
Coverage of traditional treatment modalities also includes many aspects of alternative therapy, with a practical and realistic perspective on prognosis.
An examination of the various types of horses used in sports describes the lameness conditions to which each horse type is particularly prone, as well as differences in prognosis.
Guidelines on how to proceed when a diagnosis cannot easily be reached help you manage conditions when faced with the limitations of current diagnostic capabilities.
Clinical examination and diagnostic analgesia are given a special emphasis.
Practical, hands-on information covers a wide range of horse types from around the world.
A global perspective is provided by a team of international authors, editors, and contributors.
A full-color insert shows thermography images.

Updated chapters include the most current information on topics such as MRI, foot pain, stem cell therapy, and shock wave treatment.
Two new chapters include The Biomechanics of the Equine Limb and its Effect on Lameness and Clinical Use of Stem Cells, Marrow Components, and Other Growth Factors. The chapter on the hock has been expanded substantially, and the section on lameness associated with the foot has been completely rewritten to include state-of-the-art information based on what has been learned from MRI. Many new figures appear throughout the book.

Section Title	Page	Action	Price
Front cover	cover
Diagnosis and Management of Lameness in the Horse	i
Copyright page	iv
Contributors	v
Foreword	xi
Second Foreword	xiii
Preface	xv
Preface—Companion Web Site www.rossanddyson.com	xv
Table of Contents of Companion Website	xvi
Acknowledgments	xvii
Table of Contents	xix
I Diagnosis of Lameness	1
1 The Lameness Examination	1
Chapter\t1 Lameness Examination:	1
Chapter\t2 Lameness in Horses:	3
Definition	3
Localization of Pain	3
Baseline and Induced Lameness	3
Coexistent Lameness	3
Lameness Distribution	4
Hindlimb Lameness	5
Relationship of Lameness and Conformation	6
Poor Performance	6
Gait Deficits not Caused by Lameness	7
Unexplained Lameness	7
Components of the Lameness Examination and Lameness Strategy	7
Lameness Examination	7
Lameness Etiquette	7
Prognosis Assessment	7
Chapter\t3 Anamnesis (History)	8
Clinical History: Basic Information	9
Signalment	9
Age	9
Sex	11
Breed and Use	11
Current Lameness	11
Determination of the Problem	11
History of Trauma	11
Duration	12
Worsening of Condition	12
Warming into Lameness	12
Recent Management Changes	12
Shoeing	12
Training or Performance Intensity	13
Surface	13
Diet and Health	13
Housing	13
Current Medication Changes and Response	13
Past Lameness History	14
Further Information	15
Chapter\t4 Conformation and Lameness	15
Relevance of Evaluation of Conformation	15
Hereditary Aspects of Conformation	15
Objective Evaluation of Conformation: Is It Possible?	16
Evaluation of Conformation	18
Balance	18
Lengths, Angles, and Heights	20
Limbs	21
Forelimb Conformation	21
Front Perspective	21
Lateral Perspective	25
Hindlimb Conformation	28
Lateral Perspective	28
Rear Perspective	30
Conformation of the Digit	31
Chapter\t5 Observation:	32
Forelimb Symmetry	32
Muscle Atrophy	32
Swelling	33
Angular Deformity	33
Foot Size	33
Fetlock Height	34
Scapular Height	34
Hindlimb Symmetry	35
Muscle Atrophy	35
Swelling	36
Bony Asymmetry	37
Tubera Coxae	37
Tubera Sacrale	37
Midline-to-Lateral Pelvic Width	37
Swelling over the Greater Trochanter	38
Crepitus	38
Calcaneus	38
Fetlock Height	39
Posture	39
Forelimb Posture	39
Pointing	39
Treading	39
Buckling Forward at the Knee	39
Dropped Elbow	39
Severe Lameness of the Shoulder Region	40
Neck Pain	40
Hindlimb Posture	41
Resting a Hindlimb	41
Abnormal Tail Position	41
External Rotation of the Hindlimb	41
Hindlimb Varus Posture	41
Treading	41
Camped Under	41
Soft Tissue Injuries Altering Hindlimb Posture	41
Peripheral Nerve Deficits (see Chapter 11)	42
Other Unusual Leg Positions	42
Stance in Horses with Pelvic Fractures and Conditions Affecting the Coxofemoral Region	42
Chapter\t6 Palpation	43
The Art of Palpation	44
Palpation of the Forelimb	44
Foot	44
Hoof Tester Examination	46
Wedge Test and Other Forms of Static Manipulation	47
Pastern	48
Fetlock	48
Metacarpal Region	50
Carpus	51
Antebrachium (Forearm)	52
Elbow	52
Brachium (Arm) and Shoulder	53
Palpation of the Cervical and Thoracolumbar Spine	53
Cervical Spine (Neck)	53
Thoracolumbar Spine (Back)	54
Palpation of the Lateral and Ventral Thorax and Abdomen	54
Palpation of the External Genitalia	54
Palpation of the Pelvis	54
Palpation of the Pelvis per Rectum	55
Palpation of the Hindlimb	56
Thigh	56
Stifle	56
Crus	57
Tarsus	58
The Churchill Hock Test	60
Saphenous Filling Time	61
Metatarsal Region	61
Metatarsophalangeal Joint	61
Pastern	62
Foot	63
The Role of Physical Examination in the Lameness Examination	63
Chapter\t7 Movement	64
Gait	64
The Lameness Examination: Which Gait Is Best?	65
Comparing Lameness Seen at the Walk and Trot	65
Relevance of Lameness at a Trot in Hand	65
Horse Temperament and Lameness Examination	65
Leading the Horse during Lameness Examination	66
Surface Characteristics and Lameness Examination	66
Determination, Grading, and Characterization of Lameness	66
Compensatory Lameness	66
Supporting, Swinging, and Mixed Lameness	67
Determining the Location of Lameness	69
Recognition of Forelimb Lameness	69
Recognition of Hindlimb Lameness	70
Hindlimb Lameness Confused with Forelimb Lameness	70
Bilaterally Symmetrical Forelimb or Hindlimb Lameness	71
The Lameness Score: Quantification of Lameness Severity	71
Lameness Detection	72
Fetlock Drop	72
Use of Sound	72
Drifting	73
Evaluation of Limb Flight	73
Cranial and Caudal Phases of the Stride	73
Abnormalities of Limb Flight	74
Front Foot Interference	74
Front Foot Hitting the Contralateral Forelimb	74
Interference within the Same Limb	74
Front Foot Hitting the Ipsilateral Hindlimb	74
Front Foot Hitting the Contralateral (the Diagonal) Hindlimb	75
Hind Foot Interference	75
Forelimb: Common Abnormalities of Limb Flight	75
Winging In and Winging Out	75
Lateral Placement of the Foot during Advancement (Abduction)	75
Plaiting	75
Limb Flight in Horses with Shoulder Region Lameness	75
Hindlimb: Common Abnormalities of Limb Flight	75
Stabbing or “Stabby” Hindlimb Gait	75
Abduction of the Hindlimbs during Advancement	76
Plaiting	76
Mechanical Lameness of the Hindlimb and Limb Flight	76
Stringhalt	76
Fibrotic Myopathy	76
Upward Fixation of the Patella	76
Shivers	76
Other Hindlimb Gait Deficits	76
Evaluation of Foot Placement	77
Additional Movement During Lameness Examination	77
Hard and Soft Surfaces	77
Circling	77
Forelimb	78
Lameness Worsened with Limb on the Inside of the Circle	78
Lameness Worsened with Limb on the Outside of the Circle	78
Lameness Improved When Circling	78
Hindlimb Lameness and Circling	78
Observation during Riding	79
Observation of Inclines	79
Evaluation of Lameness with a Treadmill or Gait Analysis	79
Chapter\t8 Manipulation	80
Induced and Baseline Lameness	80
Flexion Tests	80
Order, Duration, Force, and Venue during Flexion Tests	81
Causes of Pain during Flexion and Positive Flexion Test Results	81
Positive Responses to Flexion	81
Forelimb Flexion Tests	82
Lower Limb Flexion Test	82
Fetlock Flexion Test	82
Flexion of Interphalangeal Joints	83
Carpal Flexion Test	83
Upper Limb Manipulation	83
Hindlimb Flexion Tests	84
Lower Limb Flexion Test	84
Fetlock Flexion and Interphalangeal Joint Tests	84
Upper Limb Flexion Test	84
Hindlimb Flexion Test	85
“Hock” Extension Test	85
“Stifle Flexion” Test	86
Direct or Local Palpation Followed by Movement	86
Digital Compression of a Painful Area	86
Axial Skeleton	86
Induced Lameness after Hoof Tester Examination	86
The Wedge Test	87
Varus or Valgus Stress Tests	87
Flexion Tests and Diagnostic Analgesia	87
Chapter\t9 Applied Anatomy of the Musculoskeletal System	88
The Language of Anatomy	92
Forces	92
Specialized Structures	92
Synovial Structures	92
Intercalated Bones	93
Fibrocartilaginous Structures	93
Interarticular Fibrocartilage	93
Connecting Fibrocartilage	94
Circumferential Fibrocartilage	94
Stratiform Fibrocartilage	94
Passive Stay Apparatus	94
Distal Limb	94
Forelimb	94
Hindlimb	94
Three-Dimensional Anatomy	95
Chapter\t10 Diagnostic Analgesia	100
Local Anesthetics: Pharmacology and Tissue Interactions	100
Strategy, Methodology, and Other Considerations	101
Lameness Is Worse after Diagnostic Analgesia	105
Perception of Diagnostic Analgesia by Laypersons	106
Role of Chemical Restraint	106
Horse Preparation	106
Injection Techniques	107
Perineural Analgesia in the Forelimb	108
Palmar Digital Analgesia	108
Midpastern Ring Block	108
Abaxial Sesamoid Block	110
Low Palmar Analgesia	111
High Palmar Block	112
Lateral Palmar Block	114
Median, Ulnar, and Medial Cutaneous Antebrachial Blocks	114
Intraarticular Analgesia in the Forelimb	116
Distal Interphalangeal Joint	116
Proximal Interphalangeal Joint	117
Metacarpophalangeal Joint	118
Carpal Joints	120
Cubital (Elbow) Joint	121
Scapulohumeral (Shoulder) Joint	121
Analgesia of Forelimb Bursae and Tendon Sheaths	122
Podotrochlear (Navicular) Bursa	122
Digital Flexor Tendon Sheath	124
Carpal Sheath	124
Olecranon Bursa	124
Bicipital Bursa	124
Perineural Analgesia in the Hindlimb	124
Plantar Digital Analgesia	125
Dorsal Ring Block of the Pastern	125
Basisesamoid and Abaxial Sesamoid Blocks	125
Low Plantar Block	125
High Plantar Nerve Block	125
Fibular (Peroneal) and Tibial Nerve Blocks	127
Intraarticular Analgesia in the Hindlimb	128
Tarsus	128
Tarsometatarsal Joint	128
Centrodistal Joint	129
Tarsocrural Joint	129
Stifle Joint	130
Coxofemoral (Hip) Joint	131
Analgesia of Hindlimb Bursae and Tendon Sheaths	133
Cunean Bursa	133
Tarsal Sheath	133
Calcaneal Bursa	133
Trochanteric Bursa	133
Local Infiltration in the Forelimb and Hindlimb	133
Splints	134
Suspensory Ligament Origin	134
Curb	134
Dorsal Spinous Process Impingement	134
Orthopedic Implants	135
Chapter\t11 Neurological Examination and Neurological Conditions Causing Gait Deficits	135
Diagnosis	135
Clinical Examination	135
Hematology and Serology	136
Cerebrospinal Fluid Aspiration and Analysis	137
Radiography	139
Electromyography and Nerve Conduction Studies	140
Nuclear Scintigraphy	140
Ultrasonography	141
Virus Isolation	141
Immunohistochemistry and Polymerase Chain Reaction Testing	141
Specific Diseases and Syndromes	141
Equine Protozoal Myelitis (EPM)	141
Cervical Spinal Cord Compression	142
Equine Degenerative Myeloencephalopathy and Neuroaxonal Dystrophy	143
Equine Lower Motor Neuron Disease	143
Equine Herpesvirus 1 Infection	143
Miscellaneous Diseases of the Spinal Cord	144
Peripheral Nerve Injuries	144
Chapter\t12 Unexplained Lameness	145
False-Negative Responses to Diagnostic Analgesia	145
Failure to Perform the Appropriate Nerve Blocks	147
Blocking the Wrong Limb	147
Sources of Pain That Cannot Be Desensitized by Nerve Blocks	147
Pain Associated with a Neuroma	148
Potentially Confusing Responses to Local Analgesic Techniques	148
False Positive Results of Intrasynovial Analgesia	149
Multiple Sources of Pain in a Limb and More than One Lame Limb	149
Very-Low-Grade Lameness	149
Improvement of Lameness in Some Situations, but Unrelieved Lameness under All Situations: Which Is the Baseline Lameness?	149
Challenges to Lameness Diagnosis	149
Very Intermittent or Sporadic Lameness	149
Lameness That Varies within and between Examinations	151
The Dangerous Horse and Nerve Blocks	152
Negative Responses	152
Negative Response to All Nerve Blocks: Where Next?	152
Negative Responses to Nerve Blocks, No Clinical Clues, and Negative Scintigraphic Findings	152
Neck Lesions and Forelimb Lameness	152
Referred Pain	152
Previously Unrecognized Causes of Lameness Proximal to the Carpus And Tarsus	152
Misinterpreted Imaging Findings that Result in Misdiagnosis	152
Odd Lameness Apparent Only During Riding	155
Identifiable Lesions: Which Contribute to the Current Lameness?	155
Other Causes of Lameness	155
Lacerations and Occult Spiral Fractures	155
Rib Lesions	155
Sternal Injury	155
Fracture of the Summits of the Dorsal Spinous Processes in the Withers Region	155
Temporomandibular Joint Pain	155
Neurological Problems and Lameness or Stiffness	156
Lyme Disease	156
Immune-Mediated Polysynovitis	156
Tack-Induced Pain	156
Rider-Induced Problems	157
Physical Limitations of the Horse, Temperament, and Confidence	157
Reproductive Problems*	157
Other Medical Problems	157
Atypical Equine Rhabdomyolysis	157
Vascular Lesions	158
Bone Fragility Disorder	158
Panosteitis-like Lesions	158
Chapter\t13 Assessment of Acute-Onset, Severe Lameness	159
Field Diagnosis of the Injured Horse	159
Assessment	159
Medical History	159
Limb Examination	160
Shoulder and Chest	160
Elbow and Carpus	161
Forelimb Soft Tissue Injuries	161
Fractures of the Distal Aspect of the Limbs	162
Feet	162
Hindlimb Injuries	162
Stress Fractures	163
Hemarthrosis	163
Transportation	163
Guidelines for Humane Destruction of an Injured Horse	164
Chapter\t14 The Swollen Limb	164
Diagnosis	164
History	165
Clinical Examination	165
Management	166
Mud Fever	166
Scabs on the Palmar Aspect of the Fetlock	166
Cellulitis Caused by Trauma	166
Cellulitis Caused by Infection	166
Lymphangitis	167
Purpura Hemorrhagica	167
2 Diagnostic Imaging	168
Chapter\t15 Radiography and Radiology	168
Radiographic Detail	168
Image Resolution	168
Image Contrast	168
Exposure Factors	168
Exposure Latitude	168
Image Sharpness and Resolution	168
Film and Screen Factors	169
Radiation Safety	169
Response of Bone to Stimuli: Wolff’s Law	169
Periosteal New Bone	170
Endosteal New Bone	171
Sclerosis	171
Osteophyte Formation	171
Enthesophyte Formation	172
Spondylosis	173
New Bone of Unknown Origin	173
Hypertrophic Osteopathy	173
Osteitis	173
Infectious Osteitis and Osteomyelitis	173
Osseous Cystlike Lesions and Subchondral Bone Cysts	173
Osteochondrosis	174
Fracture	174
Degenerative Joint Disease: Osteoarthrosis or Osteoarthritis	177
Luxation and Subluxation	177
Dystrophic and Metastatic Mineralization	177
Radiographic Examination	177
Interpreting Radiographs	178
Determining the Age of a Lesion	178
Radiographic Technique	178
Chapter\t16 Ultrasonographic Evaluation of the Equine Limb:	182
Equipment	182
Horse Preparation	183
Medical Records	183
Thermal Print Storage Envelope	183
Image Labeling	184
Exercise Levels	184
Scanning Technique	184
Artifacts	185
Operator Errors	185
Inadequate Skin Preparation	185
Ultrasound Beam Angle	185
Improper Gain Settings	186
Improper Focal Zone Use	186
Incorrect Frequency Transducer	187
Recording Images	187
Standoff Pads	188
Ultrasound Tissue Interaction Artifacts (Horse-Produced Artifacts)	188
Skin Surface Contact	188
Acoustic Enhancement	188
Refractive Scattering	188
Acoustic Shadowing	188
Reverberation	189
Mirror Image Artifacts	189
Future Technology	189
Terminology and Quantitative Measurements	189
Echogenicity	189
Fiber Alignment Pattern Assessment	190
Cross-Sectional Area	190
Zone Designations	191
Distal Aspect of Forelimbs	191
Zone Definitions	192
Zone 0	192
Zone 1A	192
Zone 1B	194
Zone 2A	194
Zone 2B	194
Zone 3A	194
Zone 3B	194
Zone 3C	195
Distal Aspect of Hindlimbs	195
Hindlimb Zones	195
Zone 1A	195
Zone 1B	196
Zone 2A	196
Zone 2B	197
Zone 3A	197
Zone 3B	197
Zone 4A	197
Zone 4B	198
Zone 4C	198
Palmar and Plantar Pastern Zones and Descriptions	198
Pastern Zone Designations and Descriptions	198
Zone P1A	198
Zone P1B	198
Zone P1C	199
Zone P2A	199
Ultrasonography of Proximal Parts of the Limbs	199
Clinical Ultrasonography	199
Quantitative Analysis	199
Quantitative Terms	200
Lesion Categories	200
Category I	200
Category II	200
Category III	201
Category IV	201
Category V	202
Category VI	203
Summary	203
Exceptions	204
Clinical Applications	204
Timing of Ultrasonographic Examinations: When to Scan	204
Serial Ultrasonographic Examinations as Part of Case Management	205
Chapter\t17 Ultrasonographic Examination of Joints	206
Fetlock	206
Dorsal Aspect	206
Dorsomedial and Dorsolateral Aspects	207
Medial and Lateral Aspects	207
Palmar Aspect	207
Stifle	208
Femoropatellar Joint	208
Medial and Lateral Femorotibial Joints	208
Collateral Ligaments of the Hock	211
Chapter\t18 Ultrasonography and Orthopedic (Nonarticular) Disease	212
Skeletal Muscle	212
Nerve	213
Penetrating Injuries	213
Draining Tracts	213
Foreign Bodies	213
Bone	213
Fractures	213
Osteitis and Osteomyelitis	214
Bone Abscess	214
Implants	215
Chapter\t19 Nuclear Medicine	215
General Considerations	215
Scintigraphy and Other Imaging Modalities: Where do They Fit?	216
Radioisotopes and Radiopharmaceuticals	216
Imaging Equipment	217
Image Acquisition	218
Image Quality	220
Number of Counts	220
Distance	221
Shielding	221
Motion	222
Background Radiation	222
Poor-Quality Bone Uptake	222
Radiation Safety	223
Bone Scan Phases	223
Scan Interpretation	224
Location of Increased Radiopharmaceutical Uptake	224
Intensity of Increased Radiopharmaceutical Uptake	224
Character of Increased Radiopharmaceutical Uptake	225
False-Positive Findings	227
False-Negative Findings	228
Negative Bone Scan Results	228
Osteochondrosis in Delayed Images	228
Artifacts	229
Nerve Blocks	229
Indications and Case Selection	229
Knowledge Gained from Scintigraphic Examination of the Lame Horse	230
Stress-Related Bone Injury in Cortical and Subchondral Bone	230
Confusing or Equivocal Radiological Changes	231
Confusing Clinical Signs and Unexplained Lameness	232
Lameness Related to the Pelvis	233
Damaged Skeletal Muscle	233
Chapter\t20 Computed Tomography	234
Physics	234
Equipment	234
Image Display and Processing	235
Image Display	235
Image Processing	235
Image Reconstruction	235
Contrast Media	235
Clinical Applications	236
Fracture Assessment	236
Lameness Diagnosis	236
Laminitis Evaluation	238
Interventional Computed Tomography	238
Advantages and Disadvantages	239
Advantages	239
Disadvantages	239
21 Magnetic Resonance Imaging	239
Production of Magnetic Resonance Images	240
Equipment for MRI in Horses	241
Advantages and Disadvantages Compared with other Imaging Techniques	241
Advantages	241
Disadvantages	241
Interpretation of Magnetic Resonance Images	241
Bone	243
Tendon	243
Ligament	244
Articular Cartilage	244
Synovial Fluid, Synovium, and Joint Capsule	244
Muscles	244
Artifacts	244
Indications for MRI in Equine Lameness	245
Chapter\t22 Gait Analysis for the Quantification of Lameness	245
Kinetics	246
Kinematics	247
Chapter\t23 Arthroscopic Examination	251
Advantages and Disadvantages of Arthroscopic Surgery Compared with Arthrotomy	251
Advantages	251
Improved Visibility	251
Reduced Trauma and Morbidity	252
Better Cosmetic Results	252
Earlier Functional Capability	252
More Versatility	252
Fewer Complications	252
Disadvantages	252
Expensive Instrumentation	252
Lack of Surgical Experience	252
Equipment Problems	252
Improper Case Selection	252
Principles, Instrumentation, and Technique	253
Surgical Procedures	258
Cartilage Resurfacing	259
Postoperative Care	259
Complications	259
Chapter\t24 Tenoscopy and Bursoscopy	260
General Principles of Tenoscopy and Bursoscopy	260
Equipment	260
Surgical Principles and Techniques	260
Tenoscopy	260
Tenoscopy of the Digital Flexor Tendon Sheath	260
Anatomy	260
Surgical Technique	261
Postoperative Care	262
Tarsal Sheath	262
Anatomy	262
Surgical Technique	262
Carpal Sheath	263
Anatomy	263
Surgical Technique	264
Other Tendon Sheaths	265
Bursoscopy	265
Bursoscopy of the Intertubercular Bursa	265
Bursoscopy of the Navicular Bursa	265
Surgical Technique	265
Postoperative Management and Results	265
Chapter\t25 Thermography:	266
Image Acquisition	266
Clinical Imaging	267
Conclusion	269
II The Foot	270
Chapter\t26 The Biomechanics of the Equine Limb and Its Effect on Lameness	270
When Do Musculoskeletal Structures Fail?	270
Functional Anatomy of the Horse Limb	270
Horse Limbs Function Like Pogo Sticks	271
Bones	271
Synovial Joints	271
The Foot as Interface to the Ground	272
Ability of Structures to Cope with Mechanical Demands	273
Structural and Material Properties	273
Changes in Structural Properties	274
Locomotion and Its Effect on Musculoskeletal Tissues	274
Impact	275
Peak Force	276
Number of Loading Cycles	276
What Happens to the Individual Musculoskeletal Element during Locomotion?	277
Foot	277
Tendons	278
Bones	278
Joints	278
The Effects of Conformation on Equine Distal Limb Mechanics	278
Effect of Toe Length and Angle	278
Effect of Mediolateral Imbalance	279
Effect of Heel Height	279
Joint Angles, Tendon Strain, and Navicular Force	279
Joint Pressure and Articular Contact	279
Hoof Capsule	280
Effect of Shoeing	280
Application of a Shoe	280
The Influence of Shoe Material	280
The Influence of Shoe Type	280
Alterations in Mechanics with Specific Orthopedic Disorders	280
Mechanics of Palmar Foot Pain and Navicular Syndrome	280
Changes in Mechanics in Horses with Laminitis	281
Changes in Mechanics in Horses with Osteoarthritis of the Distal Hock Joints	281
Changes in Mechanics in Horses with Superficial Digital Flexor Tendonitis	281
Conclusion	281
Chapter\t27 The Foot and Shoeing	282
Foot Balance, Conformation, and Lameness	282
Foot Function	282
At Rest	282
At Exercise	283
Stride Phases	283
Initial Contact	283
Impact Phase	283
Support Phase	283
Breakover Phase	284
Flight Phase	284
Stride Characteristics	284
Optimum Balance and Conformation	284
Static Balance and Conformation	284
Dynamic Balance	285
Imbalance and Poor Conformation	285
Mediolateral Imbalance	286
Dorsopalmar Imbalance	287
Other Forms of Imbalance	288
Imbalance and Poor Conformation as a Cause of Lameness	288
Clinical Identification of Hoof Imbalance	288
Mediolateral Imbalance	288
Dorsopalmar Imbalance	290
Treatment of Imbalance and Poor Conformation	291
Mediolateral Imbalance	292
Dorsopalmar Imbalance	292
Horseshoes and Shoeing	293
Horseshoes	293
Foot Preparation	293
The Horseshoe Form	294
Materials and Size	294
Cross-Sectional Profile of Shoe Stock	294
Extensions	296
Bars	296
Calks, Grabs, and Other Devices Added to the Ground Surface of the Shoe	297
Pads	297
Miscellaneous Changes in Shoe Form or Fit	298
Hot versus Cold Shoeing	298
Attachment of the Shoe to the Hoof	298
Horseshoe Functions	299
Balance	299
Protection	299
Traction	299
Breakover Modification	299
Animation	300
Support	300
Prevention of Interference Injury	301
The Practice of Shoeing	301
Effects of Shoeing on Foot Function	301
Shoeing Sound Horses for Performance	302
Corrective Shoeing	302
Lameness Associated with Shoeing	302
Natural Balance Trimming and Shoeing	303
Appearance of a Self-Maintained Foot	303
Natural Balance Trimming for a Barefooted Horse	304
Normal Feet	304
Flat Feet	305
Clubfeet	305
Feet with Long Toes and Underrun Heels	305
Natural Balance Shoeing	305
Shoe Placement and Application	306
Hoof Reconstruction Materials and Glue-On Shoes	306
Adhesive Types	306
Glue-on Horseshoes	307
Hoof Wall Reconstruction	308
Composite Materials and Hoof Repairs	308
Chapter\t28 Trauma to the Sole and Wall	309
Problems Associated with Horseshoe Nails	309
Nail Bind	309
History and Clinical Signs	309
Diagnosis	309
Treatment and Prognosis	310
Nail Prick	310
History and Clinical Signs	310
Diagnosis	310
Treatment	310
Prognosis	310
Solar Bruising	310
History and Etiology	310
Clinical Signs	311
Treatment	311
Prognosis	311
Thrush	311
Clinical Signs and Diagnosis	311
Treatment	312
Prognosis	312
Sheared Heel	312
III The Forelimb	387
Chapter\t35 The Proximal and Middle Phalanges and Proximal Interphalangeal Joint	387
Anatomical Considerations	387
Lameness Examination	387
Imaging Considerations	388
Breed Predilection	388
Fractures of the Proximal Phalanx	388
Dorsal Osteochondral Fragments in the Metacarpophalangeal/Metatarsophalangeal Joint	390
Osteochondrosis of the Proximal Interphalangeal Joint	391
Osteoarthritis of the Proximal Interphalangeal Joint	391
Arthrodesis of the proximal Interphalangeal Joint	392
Bone Trauma	392
Soft Tissue Injuries	392
Subluxation of the Proximal Interphalangeal Joint	393
Wounds and INFECTION in the Pastern Region	393
Chapter\t36 The Metacarpophalangeal Joint	394
Anatomical Considerations	394
Diagnosis	394
Imaging Considerations	395
Types of Fetlock Joint Lameness	395
Acute or Repetitive Overload Injuries	395
Capsulitis/Synovitis	395
Clinical Signs	395
Diagnosis	395
IV The Hindlimb	475
Chapter\t41 The Hind Foot and Pastern	475
Anatomy and Innervation of the Hind Foot and Pastern	475
Examination, Clinical Signs, and Diagnosis	475
Specific Lameness Conditions	476
Fractures of the Distal Phalanx	476
Laminitis	477
Keratoma	478
Navicular Syndrome	478
Distal Interphalangeal Joint	478
Deep Digital Flexor Tendonitis	479
Infectious Osteitis in Foals	479
The Hind Pastern	479
Chapter\t42 The Metatarsophalangeal Joint	480
Anatomy	480
Conformation	481
Clinical Characteristics and Diagnosis of Metatarsophalangeal Joint Lameness	481
Severe, Unrelenting Lameness	481
Intermittent, Severe Lameness	481
Chronic, Low-Grade Lameness	482
Diagnostic Analgesia	482
Imaging Considerations	482
Radiography and Radiology	482
Scintigraphic Examination	483
Magnetic Resonance Imaging	484
Ultrasonographic Examination	485
Computed Tomography	485
Arthroscopic Examination	486
Specific Conditions of the Metatarsophalangeal joint	488
Stress-Related Subchondral Bone Injury and Osteoarthritis	488
Management of Stress-Related Bone Injury and Osteoarthritis	489
Bisphosphonate Therapy for Management of Subchondral Bone Pain	490
Surgical Management of Subchondral Bone Injury	491
Plantar Process Osteochondral Fragments	492
Axial Articular Fragments	492
Abaxial, Nonarticular Fragments	493
Nonarticular Fragments Originating from the Proximal Sesamoid Bones	494
Acute Fractures of the Proximal Plantar Process	494
Osteochondrosis of the Sagittal Ridge of the Third Metatarsal Bone	494
Osteochondral Fragments of the Dorsoproximal Aspect of the Proximal Phalanx	494
Other Osteochondral Fragments	494
Fractures of the Proximal Phalanx	495
Dorsal Frontal Fractures of the Proximal Phalanx	495
Fractures of the Proximal Sesamoid Bones	496
Fractures of the Distal Aspect of the Third Metatarsal Bone	496
Sesamoiditis	496
Radiolucent Defects of the Axial Border of the Proximal Sesamoid Bones	497
Flexural Deformity of the Metatarsophalangeal Joint	497
Soft Tissue Injuries of the Metatarsophalangeal Joint and Fetlock Region	498
Proliferative Synovitis	498
Luxation and Subluxation: Tearing of a Collateral Ligament	498
Collateral Desmitis	498
Suspensory Desmitis	498
Distal Sesamoidean Ligament Injury	498
Tenosynovitis of the Digital Flexor Tendon Sheath	498
Deep Digital Flexor Tendonitis	498
Chapter\t43 The Metatarsal Region	499
Anatomy	499
Conformation	500
Clinical Characteristics and Diagnosis of Lameness in the Metatarsal Region	500
Diagnostic Analgesia	500
Imaging Considerations	501
Specific Conditions of the Metatarsal Region	502
Bucked and Sore Shins: Dorsal Cortical Fractures of the Third Metatarsal Bone	502
Medial and Lateral Condylar and Spiral Fractures of the Third Metatarsal Bone	502
Midshaft, Simple, or Comminuted Fractures of the Third Metatarsal Bone	502
Physeal Fractures of the Distal Aspect of the Third Metatarsal Bone	503
Incomplete Longitudinal Fractures of the Plantar Aspect of the Third Metatarsal Bone and Stress Reactions	503
Transverse Stress Fractures of the Distal Aspect of the Third Metatarsal Bone	503
Avulsion Fractures of the Third Metatarsal Bone Associated with the Origin of the Suspensory Ligament	503
Articular Fracture of the Dorsoproximolateral Aspect of the Third Metatarsal Bone	504
Exostoses of the Second, Third, and Fourth Metatarsal Bones	504
Fractures of the Second and Fourth Metatarsal Bones	505
Enostosis-like Lesions of the Third Metatarsal Bone	506
Hypertrophic Osteopathy	506
Suspensory Desmitis	506
Tenosynovitis of the Digital Flexor Tendon Sheath	507
Desmopathy of the Accessory Ligament of the Deep Digital Flexor Tendon	507
Deep Digital Flexor Tendonitis	507
Superficial Digital Flexor Tendonitis	507
Undiagnosed Metatarsal Region Lameness	507
Wounds of the Metatarsal Region	507
Diffuse Swelling in the Metatarsal Region	508
Severe Cellulitis of the Metatarsal Region	508
Chapter\t44 The Tarsus	508
Anatomical Considerations	508
Diagnosis	510
Clinical Signs	510
Diagnostic Analgesia	511
Diagnostic Imaging	511
Articular Diseases of the Tarsus	512
Osteoarthritis of the Distal Hock Joints and Distal Hock Joint Pain	512
History	513
Clinical Signs	513
Diagnostic Analgesia	513
Radiography and Radiology	514
Nuclear Scintigraphy	515
Treatment	515
Osteoarthritis of the Talocalcaneal Joint	516
Osteoarthritis of the Tarsocrural Joint	516
Incomplete Ossification of the Central and Third Tarsal Bones	517
Distention of the Tarsocrural Joint Capsule	517
Osteochondrosis of the Tarsocrural Joint	518
Subchondral Bone Trauma	518
Osseous Cystlike Lesions	518
Fragments in the Talocalcaneal-Centroquartal (Proximal Intertarsal) Joint	518
Tarsal Bone Fractures and Luxations	518
Fractures of the Distal Tarsal Bones	518
Sagittal Fracture of the Talus	520
Fractures of the Fibular Tarsal Bone	520
Fracture of the Lateral Malleolus of the Tibia	521
Fractures of the Medial Malleolus of the Tibia	522
Tarsal Joint Luxation	522
Soft Tissue Injury of the Tarsus	523
Collateral Ligament Damage	523
Enthesopathy of the Lateral Collateral Ligaments of the Tarsocrural Joint	523
Rupture of the Fibularis Tertius	524
Stringhalt	524
Miscellaneous Tarsal Injuries	524
Osseous Cystlike Lesions in the Tuber Calcanei	524
Infectious (Septic) Osteitis of the Calcaneus	524
Osteitis of the Sustentaculum Tali	525
Lesions of the Sustentaculum Tali	525
Congenital Deformations of the Tarsus	525
Infectious Arthritis	526
Periarticular Cellulitis (see also Chapter 107)	526
Chapter\t45 The Crus	526
Anatomy	526
Clinical Characteristics and Diagnosis of Lameness of the Crus	526
Diagnostic Analgesia	527
Imaging Considerations	527
Specific Conditions of the Crus	527
Tibial Stress Fractures	527
Tibial Diaphyseal Fractures in Adult Horses	528
Tibial Fractures in Foals	529
Proximal Physeal Tibial Fractures	529
Middiaphyseal Tibial Fractures	529
Distal Physeal Fractures of the Tibia	529
Tibial Malleolar Fractures	529
Tibial Tuberosity Fractures	530
Enostosis-like Lesions of the Tibia	530
Osteochondroma of the Tibia	530
Osseous Cystlike Lesions of the Proximal Aspect of the Tibia	530
Osseous Cystlike Lesions of the Distal Aspect of the Tibia	531
Physitis of the Distal Tibia	531
Fibular Fractures	531
Nonossifying Fibromas of the Proximal Tibia	532
Tumors	532
Soft Tissue Injuries of the Crus	532
Chapter\t46 The Stifle	532
Anatomy	532
Developmental Anatomy	532
Reciprocal Apparatus	533
Femoropatellar Joint	533
Femorotibial Joints	533
Diagnosis	533
General Considerations	533
Gait and Manipulative Tests	534
Diagnostic Analgesia	534
Imaging Considerations	534
Radiography	534
Lateromedial Image	535
Flexed Lateromedial Image	535
Caudocranial Image	535
Caudal 30° Lateral-Craniomedial Oblique Image	535
Cranioproximal-Craniodistal Oblique Image	535
Ultrasonography	535
Scintigraphy	536
Articular Diseases	536
Femoropatellar Joint	536
Osteochondrosis	536
Signs and Diagnosis	537
Treatment	537
Prognosis	537
Upward Fixation of the Patella and Delayed Patellar Release	538
Signs and Diagnosis	538
Treatment	538
V The Axial Skeleton	564
Chapter\t49 Diagnosis and Management of Pelvic Fractures in the Thoroughbred Racehorse	564
Pelvic Anatomy	564
Diagnostic Techniques	564
Clinical Examination	564
Diagnostic Ultrasonography	565
Radiography	566
Scintigraphy	566
Fractures of the Tuber Coxae	567
VI Developmental Orthopedic Disease and Lameness	617
Chapter\t54 Pathogenesis of Osteochondrosis	617
Osteochondrosis: Definitions and Terminology	617
Endochondral Ossification	617
Characteristics of Osteochondrosis	617
Relationship among Physeal Dysplasia (Physitis), Subchondral Bone Cysts, and Osteochondrosis	620
Proposed Causative Factors	620
Involvement of Cartilage Canals	620
Body Size and Growth Rate	621
Nutrition	621
Digestible Energy and Protein	621
Calcium and Phosphorus	622
Copper	622
Heredity	623
Gender	624
Exercise	624
Trauma and Biomechanical Force	624
The Role of Enzymes and Signaling Peptides	624
Toxic Causes of Osteochondral Lesions	625
Summary	625
Chapter\t55 The Role of Nutrition in Developmental Orthopedic Disease:	625
Nutritional Factors as a Cause of Developmental Orthopedic Disease	625
Mineral Deficiencies	625
Mineral Excesses	625
Mineral Imbalances	626
Dietary Energy Excesses	626
Ration Evaluations	626
Types of Evaluations	627
Protocol	627
Describing the Horse	627
Defining Nutrient Requirements	627
Determining Nutrients in Feedstuffs	627
Determining Intake of Feedstuffs	627
Calculating Nutrient Intake	627
Comparing Intake with Requirements	628
Feeding Practices that Contribute to Developmental Orthopedic Disease	628
Overfeeding	628
Inappropriate Grain for Forage Provided	628
Inadequate Fortification in Grain	629
Feeding Systems to Prevent Developmental Orthopedic Disease	629
Early Pregnancy	629
Late Pregnancy	629
Lactation	630
Sucklings	630
Weanlings	630
Yearlings	630
Nutritional Management of Developmental Orthopedic Disease	630
Physitis	631
Cervical Vertebral Malformation	631
Osteochondrosis	631
Chapter\t56 Diagnosis and Management of Osteochondrosis and Osseous Cystlike Lesions	631
Lesions in the Metacarpophalangeal and Metatarsophalangeal Joints	632
Osteochondritis Dissecans of the Sagittal Ridge of the Third Metacarpal and Metatarsal Bones	632
Osseous Cystlike Lesions	632
Palmar or Plantar Osteochondral Fragments of the Proximal Phalanx	633
Osteochondral Fragments on the Dorsoproximal Aspect of the Proximal Phalanx	633
Lesions of the Proximal Interphalangeal Joint	633
Lesions of the Distal Interphalangeal Joint	634
Lesions of the Scapulohumeral Joint	634
Osteochondrosis of the Tarsocrural Joint	635
Lesions of the Stifle	638
Chapter\t57 Physitis	638
Pathogenesis	638
Clinical Signs	639
Treatment	640
Chapter\t58 Angular Limb Deformities	640
Diagnosis and Conservative Management	640
Examination of the Foal	641
Periarticular Laxity	641
Asymmetrical Physeal Growth	641
Trauma-Related Deformities	642
Conservative Management	642
Surgical Management	642
Chapter\t59 Flexural Limb Deformities in Foals	645
Congenital Flexural Deformities	645
Acquired Flexural Deformities	647
Chapter\t60 Cervical Stenotic Myelopathy	649
Clinical Signs	649
Diagnosis	650
Conservative Management	653
Surgical Treatment	653
VII Arthritis	655
Chapter\t61 Osteoarthritis	655
Structure and Function of Normal Joints	655
Synovium and Synovial Fluid	655
Periarticular Soft Tissues	655
Subchondral Bone	656
Articular Cartilage	656
Collagens	656
Proteoglycans	658
Matrix Proteins	658
Chondrocytes	659
Nutrition	659
Joint Lubrication	659
Intraarticular Volume and Pressure	659
Biomechanical Considerations	659
Osteoarthritis	660
Etiopathogenesis	660
Role of the Synovium	661
Role of the Chondrocyte	661
Matrix-Degrading Enzymes	662
Cytokines	662
Nitric Oxide	664
Prostaglandins	664
Clinical Evaluation of Joint Disease	664
Joint Pain	664
Local Signs	665
Synovial Fluid Changes	665
Role of Radiography/Radiology	665
Other Imaging Modalities	667
Nuclear Scintigraphy	667
Magnetic Resonance Imaging	667
Ultrasonography	668
Chapter\t62 Markers of Osteoarthritis:	668
Structure and Metabolism of Articular Cartilage and Bone in Health and Disease	668
Individual Skeletal Biomarkers of Articular Cartilage Metabolism in Osteoarthritis	669
Anabolic Processes	669
Catabolic Processes	669
Individual Skeletal Biomarkers of Bone Metabolism in Joint Disease	670
Anabolic Processes	670
Catabolic Processes	670
Future of Biomarkers in Osteoarthritis	670
Chapter\t63 Gene Therapy	671
Review of Components of Gene Therapy	671
Gene Therapy and Joint Disease	671
Use of Gene Therapy to Prevent Articular Cartilage Degradation in Osteoarthritis	672
Gene Therapy and Promotion of Cartilage Healing	673
Gene Therapy and Bone Healing	673
Chapter\t64 Models of Equine Joint Disease	673
Complexity of Joint Disease	674
Types of Models	674
In Vitro Models	674
In Vivo Studies	675
Biomechanical Models	677
Chapter\t65 Infectious Arthritis and Fungal Infectious Arthritis	677
Infectious Arthritis	677
Causes	677
Examination and Initial Management	677
Diagnosis	678
Antimicrobial Therapy	679
Systemic Therapy	679
Local Therapy	680
Direct Local Infusion of Antimicrobial Drugs	680
Antimicrobial-Impregnated Biomaterials	680
Antimicrobial-Impregnated Biodegradable Drug Delivery Systems	681
Regional Perfusion	681
Balloon Constant Rate Infusion Systems	682
Joint Drainage and Debridement	682
Articular Osteomyelitis	683
Pain Management	683
Nonsteroidal Antiinflammatory Drugs	683
Epidural Narcotics	684
Topical Treatment, Bandaging, and Alternative Therapy	684
Prognosis	684
Future Treatments	684
Fungal Infectious Arthritis	684
Literature Review	684
Clinical Signs and Diagnosis	685
Management	685
Prognosis	687
Chapter\t66 Noninfectious Arthritis	687
Joint Physiology	687
Joint Pathophysiology (Synovitis)	687
Pathological Joint Conditions Associated with Arthritis	688
Effusion	688
Inflammation	688
Ischemia	688
Synovial Fluid Lubrication: Hyaluronan	688
Pain in Arthritis	688
Autoimmmune-Mediated Arthritis	689
Immune-Mediated Arthritis	689
Reactive Synovitis	689
Traumatic Synovitis	690
Proliferative (Villonodular) Synovitis	690
Idiopathic Arthritis	690
Hemarthrosis	690
Lyme Disease	690
Chapter\t67 Other Joint Conditions	691
Diseases of Soft Tissues of the Joint	691
Ligament Injuries	691
Hygroma	691
Synovial Hernia	692
Ganglion	692
Synovial Fistula	692
Neoplasia	692
Osteochondromatosis	693
Calcinosis Circumscripta	693
VIII The Soft Tissues	694
Chapter\t68 Pathophysiology of Tendon Injury	694
Functional Anatomy of Equine Tendons and Ligaments	694
Functional Characteristics	694
Biomechanical Properties	694
Biomechanical Parameters	694
Structural Properties	694
Material Properties	695
Hysteresis	695
Classification of Tendons and the Relationship to Function	695
Anatomical Structure	696
Morphology of Tendons	696
Crimp	696
Collagen Fibril Diameter	696
Associated Structures	696
Blood Supply	696
Cellular Components	697
Molecular Composition of Tendon Matrix	699
Collagen	699
Noncollagenous Glycoproteins	699
Cartilage Oligomeric Matrix Protein	699
Proteoglycans	700
Other Noncollagenous Glycoproteins	700
Types of Tendon Injury	700
Mechanisms of Tendon Injury: Effect of Aging and Exercise	701
Hypothesized Mechanisms of Tendon Degeneration	703
Mechanical Influences	703
Physical Influences: Exercise-Induced Hyperthermia	703
Vascular Theories	703
Proteolytic Enzymes	704
Factors Affecting the Loading of the Superficial Digital Flexor Tendon and Initiation of Clinical Tendonitis	704
Strategies for Preventing Tendon Disease	704
Pathological Conditions and Phases of Tendon Healing	705
Chapter\t69 Superficial Digital Flexor Tendonitis	706
Superficial Digital Flexor Tendonitis in Racehorses	706
Clinical Signs	707
Lameness	708
Swelling	708
Thickening	708
Heat	708
Sensitivity to Direct Digital Palpation	708
Tendon Profile	708
Swelling in the Distal Metacarpal Region	709
Tenosynovitis of the Carpal Sheath or Digital Flexor Tendon Sheath	709
Tendon Injury Limited to the Pastern	710
Management of the Acute Phase of Tendon Injury in Racehorses	710
Injury Assessment and Goals for an Athletic Outcome	710
Ultrasonographic Evaluation and Categorization of Injuries	710
Initial Evaluation	710
Baseline Evaluation	711
Subacute Phase Treatment and Long-Term Rehabilitation	711
History of Treatment in Racehorses	711
Symptomatic Treatment with Continued Exercise	711
Common Long-Term Treatment Programs	713
Controlled Exercise and Time Out of Training	713
External and Internal Blistering, Pin Firing, and Time Off for Long-Term Rehabilitation	713
Intralesional β-Aminopropionitrile Fumarate and Controlled Exercise	714
Intralesional or Perilesional Administration of Hyaluronan	714
Corticosteroids	715
Intralesional and Systemic Administration of Polysulfated Glycosaminoglycans	715
Physical Therapies	715
Other Proposed Long-Term Treatments	715
Surgical Management of Superficial Digital Flexor Tendonitis	715
Transection of the Accessory Ligament of the Superficial Digital Flexor Tendon	715
Surgical Procedure	716
How Transection Works	716
When Transection Should Be Performed	717
Horse Selection for Transection	717
Bilateral Transection	717
Aftercare	718
Palmar Annular Desmotomy	718
Tenoscopy of the Digital Flexor Tendon Sheath and Carpal Sheath	719
Proximal Metacarpal Fasciotomy and Carpal Retinacular Release	719
Tenoplasty—Tendon Splitting	720
Combined Surgical Procedures	720
Superficial Digital Flexor Tendonitis in Event Horses, Show Jumpers, Dressage Horses, and Pleasure Horses	721
Superficial Digital Flexor Tendonitis in Event Horses	721
Clinical Signs	721
Diagnostic Ultrasonography	722
Treatment	723
Pastern Lesions	723
Superficial Digital Flexor Tendonitis in Show Jumpers	724
Superficial Digital Flexor Tendonitis in Dressage Horses	725
Rupture of the Superficial Digital Flexor Tendon in Pleasure Horses	726
Chapter\t70 The Deep Digital Flexor Tendon	726
Anatomy	726
Deep Digital Flexor Tendonitis Associated With Recurrent Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon	727
Deep Digital Flexor Tendonitis in the Carpal Sheath Secondary to Solitary Osteochondroma or a Distal Radial Physeal Exostosis	727
Deep Digital Flexor Tendonitis within the Digital Flexor Tendon Sheath in the Fetlock Region	727
Enlargement or Change in Shape of the Deep Digital Flexor Tendon	728
Focal Hypoechoic Lesions	729
Fibrosis and Mineralization within the Deep Digital Flexor Tendon	729
Marginal Tears of the Deep Digital Flexor Tendon	730
Deep Digital Flexor Injuries in the Pastern Region	731
Deep Digital Flexor Tendonitis	731
Injury Caused by Blunt Trauma in the Pastern Region	732
Puncture Wounds of the Deep Digital Flexor Tendon and Blunt Trauma	732
Rupture of the Deep Digital Flexor Tendon	732
Lesions of the Deep Digital Flexor Tendon within the Hoof Capsule	733
Lesions of the Deep Digital Flexor Tendon in the Tarsal and Proximal Metatarsal Regions	733
Infection of the Deep Digital Flexor Tendon	733
Chapter\t71 Injuries of the Accessory Ligament of the Deep Digital Flexor Tendon	734
Anatomy	734
Pathogenesis	734
History and Clinical Signs	735
Ultrasonography	735
Treatment	737
Chapter\t72 The Suspensory Apparatus	738
Anatomy and Pathophysiology	738
Proximal Suspensory Desmitis in the Forelimb	739
Diagnostic Analgesic Techniques	740
Differential Diagnosis	740
Diagnostic Ultrasonography	741
Radiography and Radiology	741
Nuclear Scintigraphy	742
Magnetic Resonance Imaging	743
Computed Tomography	743
Treatment	743
Proximal Suspensory Desmitis in the Hindlimb	744
Diagnostic Analgesic Techniques	745
Diagnostic Ultrasonography	745
Radiography and Radiology	745
Nuclear Scintigraphy	746
Magnetic Resonance Imaging and Computed Tomography	747
Differential Diagnosis	747
Treatment	747
Gross Pathological and Histopathological Findings	749
Avulsion Fractures of the Third Metacarpal or Metatarsal Bone at the Origin of the Suspensory Ligament	749
Suspensory Desmitis: Body Lesions	749
Clinical Signs	749
Diagnosis	749
Management	750
Suspensory Desmitis Associated with an Exostosis on the Second or Fourth Metacarpal or Metatarsal Bone (Splint)	751
Suspensory Desmitis Associated with Fracture of the Distal Third of the Second or Fourth Metacarpal or Metatarsal Bone	751
Suspensory Desmitis: Branch Lesions	751
Clinical Signs	751
Diagnosis	751
Management	752
Proximal Sesamoid Bone Fracture Associated with a Branch Injury	754
Avulsion Fracture of a Proximal Sesamoid Bone at the Insertion of the Palmar Annular Ligament	754
Damage of the Palmar (Plantar) Ligament of the Fetlock (Intersesamoidean Ligament)	754
Focal Tears in the Body of the Intersesamoidean Ligament	754
Degeneration or Partial Rupture of the Intersesamoidean Ligament	754
Insertional Injury of the Intersesamoidean Ligament	755
Infection of the Axial Aspect of the Proximal Sesamoid Bones	755
Straight Sesamoidean Desmitis	756
Oblique (Middle) Sesamoidean Desmitis	758
Progressive Atraumatic Breakdown of the Suspensory Ligaments	760
Traumatic Disruption of the Suspensory Apparatus	760
Chapter\t73 Clinical Use of Stem Cells, Marrow Components, and Other Growth Factors	761
Stem Cell Therapies	761
Commonly Used Stem Cell Products	761
Bone Marrow–Derived MSCs (BM-MSCs)	761
Bone Marrow Aspirate and Injection of Fresh Bone Marrow	762
Culture-Expanded BM-MSCs	762
Adipose-Derived MSCs (A-MSCs)	763
The Future of Stem Cell Therapy	763
Growth Factor–Based Biologics	763
Platelet-Rich Plasma (PRP)	763
Chapter\t74 Diseases of the Digital Flexor Tendon Sheath, Palmar Annular Ligament, and Digital Annular Ligaments	764
Anatomical Considerations	764
Diagnostic Techniques	765
Imaging of the Digital Flexor Tendon Sheath	765
Diseases of the Digital Flexor Tendon Sheath	766
Noninfectious Tenosynovitis	766
Etiopathogenesis	766
Diagnosis	767
Treatment	768
Prognosis	769
Infectious Tenosynovitis	770
Etiopathogenesis	770
Diagnosis	770
Treatment	770
Prognosis	771
Palmar Annular Ligament Syndrome	771
Etiopathogenesis	771
Diagnosis	771
Primary Palmar Annular Ligament Thickening	772
Primary Tenosynovitis with Secondary Palmar Annular Ligament Thickening	773
Subcutaneous Fibrosis with a Normal or Minimally Enlarged Palmar Annular Ligament	773
Tendon Injuries with Secondary Palmar Annular Ligament Thickening	773
Treatment and Prognosis	773
Diseases of the Intersesamoidean (Palmar) Ligament of the Fetlock	774
Etiopathogenesis	774
IX Therapeutics	840
1 Traditional Therapy	840
Chapter\t84 Principles and Practices of Joint Disease Treatment	840
Medical Treatment	840
Nonsteroidal Antiinflammatory Drugs	840
Intraarticular Corticosteroids	841
Hyaluronan (Sodium Hyaluronate)	842
Polysulfated Glycosaminoglycan	843
Pentosan Polysulfate	844
Combination Intraarticular Therapy	844
Oral Joint Supplements	845
Summary of Use of Conventional Medications	846
Newer Biologically Based Therapies	846
Inhibition of Metalloproteinases as a Therapeutic Approach	846
Inhibiting Interleukin–1	846
Mesenchymal Stem Cells	847
Calcitonin	848
Radiation Synovectomy	848
Surgical Treatment	848
Recent Progress at Healing Articular Cartilage Lesions and Resurfacing Joints	849
Stimulation of Endogenous Repair	850
Debridement and the Need for Removal of Calcified Cartilage	850
Partial-Thickness Chondrectomy	850
Spongialization, Abrasion Arthroplasty, and Subchondral Bone Drilling	850
Subchondral Micropicking (Microfracture)	851
Further Manipulation of Endogenous Healing Using Growth Factors (Protein Administration or Gene Therapy)	851
Articular Grafting	852
Reattachment of Cartilage Flaps and Periosteal and Sternal Grafts	852
Implantation of Autologous Chondrocytes	852
What about Stem Cells?	852
Osteochondral Grafts	852
Chapter\t85 Analgesia and Hindlimb Lameness	852
Epidural Analgesia	852
Technique for Epidural Administration	853
Epidural Catheter Placement	853
Drug Selection	855
Epidural Opioids	855
Epidural α2-Adrenergic Agonists	856
Other Drugs for Epidural Analgesia	856
Clinical Applications	857
Contraindications and Complications	857
Novel Analgesic Drugs and Adjunctive Therapies	857
Chapter\t86 Bandaging, Splinting, and Casting	858
Stable and Traveling Bandages	858
Bandaging Wounds	858
Pressage Bandages	859
Ether Bandages	859
Stent Bandages	859
Wet-to-Dry Bandages	859
Foot Poultice	859
Robert Jones Bandage	860
Splinting	860
Transport of an Injured Horse	861
Cast Bandage	861
Cast Application	861
Transfixation Pin Casts	862
Chapter\t87 External Skeletal Fixation	863
History and Development	863
Mechanics of External Skeletal Fixation	863
Preoperative Planning, Indications, Tips, and Limitations	865
Postoperative Care	866
Removing the External Skeletal Fixation Device	866
Results of Treatment (2008)	866
Chapter\t88 Counterirritation	867
Brief History and Outline of Techniques	867
Blistering	867
Cautery or Firing	868
Chapter\t89 Cryotherapy	869
Mechanisms of Cryonecrosis	869
Basic Technique	869
Treatment of Specific Lesions	870
Splint Exostoses (Splints)	870
Second and Fourth Metacarpal or Metatarsal Bone Fractures	870
Periostitis of the Third Metacarpal Bone (Bucked Shins)	871
Suspensory Desmitis	871
Distal Hock Joint Pain (Bone or Jack Spavin, Cunean Tendonitis)	871
Osteoarthritis of the Proximal Interphalangeal Joint	871
Curb	871
Cryoneurectomy	871
Tendonitis	872
Chapter\t90 Radiation Therapy	872
Radiobiological Aspects	872
Antiinflammatory Effects	872
Analgesic Effects	873
Antiproliferative Effects	873
Treatment Side Effects	873
Skin Damage	873
Osteopenia	873
Irradiation Techniques	873
External Beam Irradiation	873
Brachytherapy	874
Interstitial Brachytherapy	874
Surface Brachytherapy	874
Intracavitary Brachytherapy	874
Clinical Applications	875
Chronic Synovitis	876
Degenerative Bone and Joint Disorders	876
Preventing New Bone Growth	877
Chapter\t91 Rest and Rehabilitation	877
Principles of Rest and Rehabilitation Programs	877
Rest	878
Complete Immobilization	878
Stall Rest	878
Reduction of Excessive Movement	878
Paddock Rest	879
Ridden Walking	879
Exercise	879
Passive Exercise	879
Handwalking	879
Aquatreds and Swimming	880
High-Speed Treadmills	880
Active Training	880
Hill Training	880
2 Complementary (Nontraditional) Therapy	881
Chapter\t92 Acupuncture	881
Equine Acupuncture for Lameness Diagnosis and Treatment	881
Scientific Basis	881
Traditional Chinese Medical Theories	882
Techniques and Instrumentation	883
Clinical Applications in Lameness Examination and Treatment	884
Acupuncture Diagnostic Examination	884
Acupuncture Therapy for Lameness	884
Back Pain	886
Pain Associated with Lameness of the Distal Aspect of the Limb	886
Summary	886
Acupuncture Channel Palpation and Equine Musculoskeletal Pain	887
Chapter\t93 Chiropractic Evaluation and Management of Musculoskeletal Disorders	892
Manual Therapy and Chiropractic	892
Practitioner Qualifications	892
History of Equine Chiropractic	893
Complementary Approaches	893
Pathophysiology and Mechanisms of Action	894
Equine Chiropractic Research	894
Clinical Evaluation	895
Indications for Chiropractic Care	898
Contraindications	899
Chiropractic Techniques	899
Complications or Adverse Effects	900
Adjunct Recommendations and Prognosis	900
Summary	901
Chapter\t94 Electrophysical Agents in Physiotherapy	901
Electrotherapeutic Windows	901
Therapeutic Ultrasound	901
Therapeutic Ultrasound Waves	901
Ultrasound Waveform	901
Ultrasound Transmission through the Tissues	902
Care of the Machine	902
Contraindications	902
Precautions	902
Treatment Record	902
Absorption and Attenuation	902
Therapeutic Effects of Ultrasound	902
Thermal	902
Nonthermal	902
Ultrasound Application in Relation to Soft Tissue Repair	903
Inflammatory Phase	903
Proliferation	903
Remodeling	903
Other Applications of Therapeutic Ultrasound	903
Ultrasound for Fracture Repair	903
Ultrasound at Trigger Points	903
Pulsed Electromagnetic Field Therapy	903
Primary Effects of Pulsed Electromagnetic Field Therapy	903
Contraindications	904
Laser Therapy	904
Biophysics of Laser	904
LLLT in Veterinary Medicine	904
Clinical Applications	904
Human Studies	904
Pain	904
Musculoskeletal Use in People	904
Animal Studies	905
Wounds	905
Electrical Stimulation	905
Electrical Current/Waveforms	905
Parameters Used in Neuromuscular Electrical Stimulation	905
Amplitude	905
Pulse Duration	905
Pulse Rate	905
Duty Cycle	905
Ramp	905
Recruitment	905
Indications for NMES Treatment	906
Overall Effects of NMES	906
Transcutaneous Electrical Nerve Stimulation	906
Machine Parameters	906
Mechanism of Action	906
Traditional TENS (Hi TENS, Normal TENS)	906
Acupuncture TENS (Lo TENS, Acu-TENS)	906
Brief Intense TENS	906
Stimulation Intensity	907
Electrode Placement	907
Contraindications (from Human Medicine)	907
Precautions	907
Chapter\t95 Osteopathic Treatment of the Axial Skeleton of the Horse	907
Neurophysiological Basis of Osteopathy	907
Normal Neurophysiology	908
Sensory Component	908
Motor Component	908
Autonomic Component	908
Response to Injury	908
Altered Neurophysiology	908
Sensory Effects	908
Motor Effects	909
Autonomic Effects	909
Clinical Implications for Altered Neurophysiology	909
Effects of Osteopathic Treatment	909
Diagnosis and Case Selection for Osteopathic Treatment	910
Infrared Thermographic Imaging	911
Treatment	913
Results of Treatment	914
Chapter\t96 Shock Wave Therapy	914
Historical Perspective	914
Shock Wave Generators	914
Dose Dependence	915
Applications	915
Bone	915
Tendons and Ligaments	916
Suspensory Desmitis	917
Superficial Digital Flexor Tendonitis	917
Additional Applications	917
Osteoarthritis	917
Navicular Syndrome	918
Collateral Ligament Injury of the Distal Interphalangeal Joint	918
Back Pain	918
Therapy Planning	918
Potential Complications	918
Analgesia	919
X Lameness in the Sports Horse	920
1 Poor Performance	920
Chapter\t97 Poor Performance and Lameness	920
Challenge of Assessment	920
History	920
Clinical Assessment	922
Diagnostic Analgesia	924
Diagnostic Imaging	924
Common Performance Problems	924
Chapter\t98 Experiences Using a High-Speed Treadmill to Evaluate Lameness	925
Criteria for Case Selection	925
History	925
Equipment	925
Preparation of the Horse and Safety Considerations	926
Lameness Diagnosis	927
Additional Tests	928
2 The Racehorse	928
Chapter\t99 The Sales Yearling	928
Purchase Examination of A Thoroughbred Sales Yearling in North America	928
Conditions of Sale	928
Presale or Postsale Examination	929
Clinical Examination	929
Endoscopy, Echocardiography, and Ophthalmology	929
Radiography and Radiology	929
Drug Screening for Anabolic Steroids and Other Prohibited Practices	930
Purchase Examination of A Thoroughbred Sales Yearling in Europe	930
Monitoring and Sale Selection	930
Preparation	931
Conditions of Sale	931
Orthopedic Conditions	931
Ultrasonographic Examinations	932
North American Standardbred Sales Yearling	932
Location and Time of Major Sales	932
Conditions of Sale	933
Resolution of Disputes	933
Role of the Veterinarian	934
Conformation	934
Radiography and Radiology	934
Future Direction	934
Chapter\t100 Pathophysiology and Clinical Diagnosis of Cortical and Subchondral Bone Injury	935
Pathophysiology	935
Clinical Examination	936
Diagnostic Analgesia	936
Diagnostic Imaging	937
Radiography and Radiology	937
Nuclear Scintigraphy	937
Ultrasonography	937
Magnetic Resonance Imaging and Computed Tomography	938
Specific Locations of Cortical and Subchondral Bone Injury	938
Distal Phalanx	938
Palmar or Plantar Aspects of the Metacarpophalangeal/Metatarsophalangeal Joints	939
Dorsal Cortex of the Third Metacarpal Bone	940
Proximal Palmar Aspect of the Metacarpal Region	941
Subchondral Injury of the Third Carpal Bone	942
Radius	943
Humerus	943
Scapula	944
Tibia	945
Ilium	945
Lumbar Vertebrae	946
Chapter\t101 Bone Biomarkers	947
Biomarkers That Reflect Changes in Bone Formation	948
Bone-Specific Alkaline Phosphatase	948
Osteocalcin	948
The Carboxy-Terminal Propeptide of Type I Collagen	949
Biomarkers That Measure Changes in Bone Resorption	949
Cross-Linked Collagen Telopeptides	949
Other Biomarkers of Bone Resorption	949
Factors That Influence Biochemical Markers of Bone Cell Activity in Horses	949
Circadian Variability	949
Diet	949
Seasonal Changes	950
Age	950
Gender	950
Pregnancy, Lactation, and the Estrous Cycle	950
Breed	950
Intercurrent Disease	950
Clinical Applications for Bone Biomarkers	950
Bone Biomarkers and Fracture	951
Bone Biomarkers and Dorsal Metacarpal Disease	951
Bone Biomarkers and Osteochondrosis	951
Bone Biomarkers and Osteoarthritis	951
Effects of Exercise on Bone Biomarkers	951
Monitoring Responses to Therapy	952
Chapter\t102 The Bucked-Shin Complex	953
Etiology, Pathogenesis, and Conservative Management	953
Research Findings	953
Geometric Properties of the Third Metacarpal Bone: Comparison of Thoroughbreds and Standardbreds	953
In Vitro Comparison of Local Fatigue Failure of the Third Metacarpal Bone	953
Third Metacarpal Bone Stiffness Measurements	954
In Vivo Strain Measurements: Relationship to Exercise	954
Relationship of Exercise to Bone Fatigue	954
Exercise Programs Designed to Decrease the Incidence of Fatigue Failure	955
In Vitro Bone Testing	956
Discussion	956
Training to Prevent Bucked Shins	957
Stress Fractures of the Third Metacarpal Bone: Surgical Management	959
Surgical Procedure	959
Postoperative Treatment	960
Prognosis	960
Chapter\t103 On-the-Track Catastrophes in the Thoroughbred Racehorse	960
Regulatory Veterinarian	960
Management Considerations	961
Equipment	961
Medication	962
Training Injuries	962
Humeral Fractures	962
Collision Injuries	962
Location of Injuries on the Racetrack	962
Public Relations and Media Issues	963
Racing Injuries	963
Fractures of the Forelimb	963
Foot and Pastern	963
Metacarpophalangeal Joint	963
Proximal Sesamoid Bones	964
Third Metacarpal Bone	964
Carpus	964
Radius	965
Shoulder	965
Fractures of the Hindlimb	965
Pastern	965
Third Metatarsal Bone	965
Tarsus and Tibia	965
Stifle and Femur	965
Pelvis	965
Head and Axial Skeleton	966
Soft Tissue Injuries	966
Digital Flexor Tendon Injuries	966
Suspensory Ligament Injuries	967
Regulatory Considerations	967
Euthanasia and Insurance	967
Chapter\t104 Catastrophic Injuries	968
Types of Catastrophic Injuries	969
Traumatic Disruption of the Suspensory Apparatus	969
First Aid	970
Nonsurgical Management	970
Surgical Management	971
Other Catastrophic Distal Limb Fractures	972
Chapter\t105 Track Surfaces and Lameness:	972
Racing Surfaces	973
The Risk of Injury on Different Racing Surfaces	973
Evidence from Multivariable Epidemiological Studies	975
Studies within the Same Racecourse	975
Quality of the Racing Surface	975
Turf Tracks	975
All-Weather Tracks	976
Training Surfaces	976
Future Directions	976
Chapter\t106 The North American Thoroughbred	977
Description of the Sport	977
Conformation	979
Track Surface and Lameness	980
Medication and Drug Testing Considerations	980
Lameness Examination	981
History	981
Palpation	981
Movement	982
Diagnostic Analgesia	982
Imaging Considerations	983
Shoeing	983
Inability to Make a Diagnosis	984
Ten most Common Lameness Conditions	984
Specific Lameness Conditions	984
Lameness of the Foot	984
Bruised Heels or Quarters	984
Abscesses	985
Quarter Cracks	985
Osteoarthritis of the Distal Interphalangeal Joint	985
Navicular Syndrome	985
Distal Phalanx Fractures	985
Lameness of the Fetlock Joint	986
Synovitis	986
Distal Third Metacarpal or Metatarsal Bone Disease	986
Osteochondral Fragmentation	986
Osteoarthritis	987
Other Conditions	987
Lameness of the Carpus	987
Nonadaptive Remodeling of the Third Carpal and Radial Carpal Bones	987
Carpal Fractures	988
Osteoarthritis	988
Intercarpal Ligament Damage	988
Suspensory Desmitis	988
Proximal Suspensory Desmitis	988
Suspensory Branch Desmitis	989
Midbody Desmitis	989
Bucked Shins: Dorsal Metacarpal Disease	989
Superficial Digital Flexor Tendonitis	990
Tibial Stress Fractures	991
Distal Hock Joint Pain	991
Myositis	992
Other Stress Fractures	992
Other Lameness Conditions	993
Stifle	993
Secondary Shoulder Region Pain	993
Chapter\t107 The European Thoroughbred	994
History of Horse Racing in the United Kingdom	994
Pattern of Racing	994
Comparisons with Racing in North America	995
Training Regimens in Europe	996
Clinical History	997
Clinical Examination	997
Imaging Considerations	999
Radiography and Radiology	999
Scintigraphy	1000
Ultrasonography	1001
Diagnostic Analgesia	1001
Shoeing Considerations	1004
Brushing Injuries of the Hindlimbs	1004
Brushing Interference in the Forelimbs	1004
Scalping, Forging, and Overreaching	1004
Ten Most Common Lameness Conditions	1004
Foot-Related Lameness	1005
Suspensory Desmitis	1005
Fetlock Lameness and Subchondral Bone Injuries to the Distal Aspect of the Third Metacarpal/Metatarsal Bone	1006
Lameness Associated with the Middle Carpal Joint	1008
Lameness Subsequent to Bacterial Infection	1009
Staphylococcal Abscesses on the Palmar Aspect of the Metacarpophalangeal Joint	1009
Focal Peritarsal Cellulitis	1010
Axillary and Scrotal Intertrigo Infections	1010
Stress Fractures of the Long Bones and Pelvis	1010
Periostitis of the Dorsal Cortex of the Third Metacarpal Bone (Sore or Bucked Shins)	1011
Fracture of the Dorsal Aspect of the Third Metacarpal Bone	1011
Tibia	1011
Humerus	1012
Pelvis and Axial Skeleton	1012
Exostosis of the Second and Fourth Metacarpal/Metatarsal Bones (Splints)	1012
Undiagnosed Hindlimb Lameness	1012
Fractures of the Proximal Phalanx and Distal Condyles of the Third Metacarpal/Metatarsal Bone	1013
Pain Associated with the Tarsometatarsal Joint	1013
Chapter\t108 The North American Standardbred	1014
Description of the Sport	1014
Training	1016
Training the Young Standardbred	1016
Retraining a Racehorse	1016
Lameness and Poor Racing Performance	1017
Track Surface and Lameness	1017
Track Size and Lameness	1017
Conformation	1017
Distribution of Lameness	1018
Lameness in the Young Standardbred	1018
Clinical History	1019
Lameness Examination	1020
Palpation	1020
Movement	1021
Diagnostic Analgesia	1022
Imaging Considerations	1022
Radiography	1022
Ultrasonographic Examination	1023
Scintigraphic Examination	1023
Proceeding Without a Diagnosis	1023
Shoeing and Lameness	1023
10. Ten Most Common Lameness Conditions in the North American Standardbred Racehorse	1024
Specific Lameness Conditions of the Standardbred Racehorse	1024
Front Foot Lameness	1024
Bruises, Corns, and Abscesses	1024
Sheared Heel	1024
Hoof Cracks	1025
Contracted Heel	1025
Wall Separation and Gravel	1025
Sidebone	1025
Fractures of the Distal Phalanx	1025
Osteoarthritis of the Distal Interphalangeal Joint	1026
Other Foot Lameness	1026
Carpal Lameness	1026
Metatarsophalangeal Joint Lameness	1027
Stress and Maladaptive or Nonadaptive Remodeling	1027
Fractures	1028
Osteochondrosis	1029
Distal Hock Joint Pain and Other Tarsal Lameness	1029
Suspensory Desmitis	1032
Metacarpophalangeal Joint Lameness	1033
Splint Bone Disease	1033
Exostoses and Fractures of the Second and Fourth Metacarpal Bones (Splints)	1033
Exostoses and Fractures of the Second and Fourth Metatarsal Bones	1034
Stifle Joint Lameness	1035
Rhabdomyolysis and Muscle Soreness	1036
Curb and Superficial Digital Flexor Tendonitis	1036
Chapter\t109 The European and Australasian Standardbreds	1036
The European Standardbred	1036
Dimensions and Characteristics	1036
Approaching Lameness Problems	1037
Lameness Examination	1038
Palpation	1038
Movement	1039
Diagnostic Analgesia	1040
Diagnostic Imaging	1040
Final Diagnosis, Prognosis, and Treatment Options	1042
Corrective Shoeing	1042
Training Programs	1043
Proceeding without A Diagnosis	1043
Ten Most Common Lameness Conditions	1043
Lameness in the European Trotter	1043
Hoof Pain	1043
Osteoarthritis of the Distal Interphalangeal Joint	1043
Osteoarthritis of the Metacarpophalangeal Joint	1044
Middle Carpal Joint	1044
Proximal Palmar Metacarpal Pain Including Proximal Suspensory Desmitis	1045
Sesamoiditis	1045
Suspensory Branch Desmitis	1046
Metatarsophalangeal Joint	1046
Superficial Digital Flexor Tendonitis	1047
Osteochondrosis of the Tarsocrural Joint	1047
The Australasian Standardbred	1047
Description of the Sport	1047
Track Surface or Training Surface and Lameness	1048
Training Methods	1048
Lameness Examination	1048
Examination at Rest (Preferably in a Stable)	1048
Trotting in a Straight Line	1048
Flexion Tests	1048
Diagnostic Analgesia	1048
Imaging Considerations	1049
Proceeding without a Diagnosis	1049
Shoeing Considerations	1049
Ten Most Common Lameness Conditions	1049
Diagnosis and Management of Lameness	1049
Subsolar Bruising and Abscessation	1049
Osteoarthritis of the Fetlock Joint	1049
Proliferative Synovitis	1050
Axial, Articular (Type 1) Osteochondral Fragments of the Proximal Plantar Aspect of the Proximal Phalanx	1050
Carpal Joint Disease	1050
Suspensory Desmitis	1050
Superficial Digital Flexor Tendonitis	1050
Osteoarthritis of the Distal Tarsal Joints	1050
Fracture of the Distal Phalanx	1051
Sagittal Fracture of the Proximal Phalanx	1051
Tarsocrural Osteochondrosis	1051
Stifle Disease	1051
Chapter\t110 The Racing Quarter Horse	1051
History and Description of the Sport	1051
Training the Racing Quarter Horse	1052
Lameness Related to Track Surface	1052
Conformation Relating to Lameness	1052
Lameness Examination	1052
Imaging Considerations	1053
Shoeing	1053
Ten Most Common Lameness Conditions of the Racing Quarter Horse	1053
Specific Lameness Conditions	1053
Synovitis of the Carpal and Metacarpophalangeal Joints	1053
Arthrosis of the Distal Interphalangeal Joint and Problems Associated with the Foot	1053
Dorsal Metacarpal Disease	1054
Osteochondral Fragmentation of the Carpus	1054
Osteochondral Fragmentation of the Metacarpophalangeal Joint	1055
Distal Hock Joint Pain	1055
Stifle Lameness	1055
Proximal Suspensory Desmitis	1055
Tibial Stress Fractures	1056
Miscellaneous Fractures of Importance	1056
Chapter\t111 Lameness in the Arabian Racehorse:	1057
History of Racing	1057
Ten most Common Racing-Related Lameness Conditions in the Middle East Arabian Racehorse	1057
Ten most Common Racing-Related Lameness Conditions in the North American Arabian Racehorse	1058
Metacarpophalangeal Joint Lameness and Carpal Osteochondral Fragmentation	1058
Superficial Digital Flexor Tendonitis	1058
Suspensory Desmitis	1059
Tarsocrural Osteochondrosis and Distal Hock Joint Pain	1059
Lameness of the Foot	1060
Myopathy	1060
Stifle and Carpal Lameness	1060
Back Pain	1060
Dorsal Third Metacarpal Bone Disease	1061
Fractures of Various Bones, Including Stress Fractures	1061
Proceeding without a Diagnosis	1061
Chapter\t112 National Hunt Racehorse, Point to Point Horse, and Timber Racing Horse	1062
Description of the Sport	1062
National Hunt Horses	1063
Training National Hunt Horses	1065
Racing National Hunt Horses	1065
Timber Racing	1067
Track Surface or Training Surface and Lameness	1067
Conformation and Lameness	1068
Lameness Examination	1068
Diagnostic Analgesia	1069
Imaging Considerations	1070
Proceeding without A Diagnosis	1070
Shoeing Considerations and Lameness	1070
The Ten Most Common Causes of Lameness in Steeplechasers, Hurdlers, and Point to Point Horses	1070
Diagnosis and Management of Lameness in Steeplechasers, Hurdlers, and Point to Point Horses	1070
Superficial Digital Flexor Tendonitis	1070
Suspensory Desmitis	1072
Lameness Associated with the Carpus	1072
Lameness Associated with the Hock	1072
Lameness Associated with the Pelvis	1073
Lameness Associated with the Front Feet	1073
Fractures of the Third Metacarpal and Metatarsal Bones	1073
Lameness Associated with the Metacarpophalangeal Joint	1074
Neck Lesions	1074
Back Pain	1074
Other Injuries	1075
The Ten Most Common Causes of Lameness in Timber Racing Horses	1075
Diagnosis and Management of Lameness in Timber Racing Horses	1075
Chapter\t113 The Finnish Horse and Other Scandinavian Cold-Blooded Trotters	1076
History of the Breeds	1076
Training a Cold-Blooded Trotter	1076
Racetracks and Weather Conditions	1077
Shoeing Considerations	1077
Conformation and Lameness	1077
Lameness Examination	1077
Imaging Considerations	1079
Undiagnosed Lameness	1079
Ten Most Common Causes of Lameness	1079
Lameness Conditions Typical of Finnhorses	1079
3 Nonracing Sports Horses	1081
114 Prepurchase Examination of the Performance Horse	1081
Goals of the Examination	1081
Contract	1082
Purchaser’s Reservations	1082
Purchase for Resale	1082
Insuring the Horse	1082
Blood Tests and Limitations	1082
Conflicts of Interest	1083
Communication with the Vendor	1083
Examination at a Distance	1083
Clinical Examination at Rest	1083
Conformation	1089
Muscle Symmetry	1090
Tendons and Ligaments	1090
Assessment of Joints	1090
Assessment of Gait	1090
Flexion Tests	1091
Lunging and Ridden Exercise	1091
Evaluation of Identified Problems	1091
Rectal Examination	1091
Radiographic Examination	1091
Nuclear Scintigraphic Examination	1093
Ultrasonographic Examination	1094
Thermographic Examination	1094
Magnetic Resonance Imaging	1094
Blood Tests	1094
Nerve Blocks	1095
Summary of Observations	1095
Guidelines for Reporting Prepurchase Examinations	1095
Chapter\t115 Lameness in the Show Hunter and Show Jumper	1096
Historical Perspective	1096
Structure of the Sport	1096
Characteristics of the Jumping Sports Horse	1097
Training	1097
Training and Competition Surfaces	1097
Conformation and Lameness	1098
Shoeing Considerations	1098
Lameness Examination	1098
Imaging Considerations	1099
Failure to Make a Diagnosis	1099
Treatment	1099
Ten Most Common Lameness Problems of Show Hunters and Show Jumpers	1100
Diagnosis and Management of Common Causes of Lameness	1100
Foot Pain	1100
Foot Soreness	1100
Subsolar Bruising	1100
Subsolar Abscess	1101
Navicular Disease	1101
Sheared Heel	1102
Distal Interphalangeal Joint Synovitis and Osteoarthritis	1102
Collateral Ligament Injury of the Distal Interphalangeal Joint	1103
Distal Hock Joint Pain	1103
Suspensory Desmitis	1104
Back Pain	1106
Impinging Spinous Processes	1106
Muscle Injury and Pain	1106
Fracture of the Withers	1106
Sacroiliac Joint Pain	1106
Osteoarthritis of the Thoracolumbar Synovial Intervertebral (Facet) Joints	1107
Fetlock Joint	1107
Synovitis and Osteoarthritis	1107
Sesamoiditis	1107
Stifle Joint Pain	1108
Cranial Cruciate Ligament and Meniscal Injury	1108
Osteochondrosis and Subchondral Bone Cysts	1108
Synovitis and Osteoarthritis	1108
Pastern	1109
Soft Tissue Injury	1109
Croup and Hip Region Pain	1109
Superficial Digital Flexor Tendonitis, Tenosynovitis of the Digital Flexor Tendon Sheath, and Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon	1110
Superficial Digital Flexor Tendonitis	1110
Tenosynovitis of the Digital Flexor Tendon Sheath	1111
Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendons	1111
Cervical Osteoarthritis and Pain	1111
Chapter\t116 Lameness in the Dressage Horse	1112
The Sport	1112
The Dressage Horse	1113
Training Surfaces	1114
Tack	1115
Lameness Examination	1115
Diagnostic Analgesia	1116
Imaging Considerations	1116
Ten Most Common Lameness Conditions in Dressage Horses	1117
Proximal Suspensory Desmitis: Hindlimbs	1117
Proximal Suspensory Desmitis: Forelimbs	1118
Desmitis of the Suspensory Ligament Branches: Forelimbs and Hindlimbs	1119
Synovitis or Osteoarthritis of the Distal Interphalangeal Joint	1119
Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon: Forelimbs	1120
Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon: Hindlimbs	1120
Osteoarthritis of the Centrodistal and Tarsometatarsal Joints	1120
Synovitis of the Middle Carpal Joint	1121
Synovitis or Osteoarthritis of the Metatarsophalangeal and Metacarpophalangeal (Fetlock) Joints	1121
Palmar or Plantar Annular Ligament Desmitis	1121
Tenosynovitis of the Digital Flexor Tendon Sheath	1121
Proximal Palmar Cortical Stress Fracture of the Third Metacarpal Bone	1122
Thoracolumbar and Sacroiliac Pain	1122
Chapter\t117 Lameness in the Three Day Event Horse	1123
Sport of Eventing	1123
Horse Types	1124
Influence of the Sport on Lameness	1125
Training Methods	1125
Conformation and Lameness	1126
Clinical History	1126
Lameness Examination	1126
Diagnostic Analgesia	1127
Imaging Considerations	1128
Radiography	1128
Ultrasonography	1128
Scintigraphy	1128
Thermography	1128
Magnetic Resonance Imaging	1129
Saddle Pressure Analysis	1129
Proceeding without a Diagnosis	1129
Shoeing Considerations	1131
Tack Considerations	1132
Ten Most Common Lameness Conditions	1132
Diagnosis and Management of Lameness	1133
Thoracolumbar and Cervical Soreness and Restriction	1133
Foot Soreness (Bruising, Imbalance, and Nail Bind)	1133
Osteoarthritis	1133
Superficial Digital Flexor Tendonitis	1134
Suspensory Desmitis	1135
External Trauma	1136
Pain in the Sacroiliac Region	1136
Fractures in the Stifle Region	1136
Other Fractures	1136
Rhabdomyolysis	1137
Prevention of Lameness	1137
Chapter\t118 Lameness in Endurance Horses	1137
Evolution of Endurance	1137
Description of the Sport	1137
Veterinary Controls	1138
Type of Horse	1139
Training Methods and Competition Speeds	1139
Course Terrain	1139
Lameness and Conformation	1139
The Lameness Examination and Proceeding without a Diagnosis	1140
Common Causes of Lameness in Endurance Horses	1140
Proximal Palmar Metacarpal Pain	1140
Proximal Suspensory Desmitis	1141
Stress Pathology of the Proximal Palmar Aspect of the Third Metacarpal Bone	1142
Pathology Associated with the Second and Fourth Metacarpal Bones	1142
Foot Problems	1143
Metacarpophalangeal and Metatarsophalangeal Osteoarthritis, Capsulitis, Synovitis, and Periarticular Pathology	1144
Stress Pathology of the Distal Aspect of the Third Metacarpal or Third Metatarsal Bone	1144
Superficial Digital Flexor Tendonitis	1145
Paravertebral and Gluteal Myalgia	1146
Osteoarthritis of the Distal Hock Joints	1146
Desmitis of the Suspensory Body and Branches	1146
Other Bone Injury	1147
Exertional Myopathy	1147
Metabolic Problems	1147
Synchronous Diaphragmatic Flutter	1148
Prevention of Metabolic Problems	1149
Chapter\t119 Lameness in the Polo Pony	1149
History of the Sport	1149
Polo as an Industry	1149
Lameness Examination	1151
Undiagnosed Lameness	1152
Imaging Considerations	1152
Ten Most Common Lameness Problems in Polo Ponies	1153
Superficial Digital Flexor Tendonitis	1153
Medical Management	1153
Surgical Management	1154
Metacarpophalangeal (Fetlock) Osteoarthritis	1155
Suspensory Desmitis	1156
Proximal Suspensory Desmitis	1156
Body Suspensory Desmitis	1157
Suspensory Branch Desmitis	1157
Injury to the Hoof and Distal Phalanx	1157
Fractures of the Distal Phalanx	1158
Palmar Foot Pain Including Navicular Disease	1158
Osteitis of the Distal Phalanx (Pedal Osteitis)	1158
Navicular Disease	1158
Distal Interphalangeal Osteoarthritis	1159
Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon	1159
Splint Bone Disease	1159
Distal Hock Joint Pain	1160
Gluteal Myositis and Back Pain	1161
Other Conditions	1161
Dislocation (Luxation) of the Superficial Digital Flexor Tendon	1161
Fractures of the Cranial Thoracic Dorsal Spinous Processes (Fracture of the Withers)	1161
Proximal Interphalangeal Osteoarthritis and Other Pastern Region Injuries	1162
Sesamoiditis	1162
Digital Flexor Tenosynovitis and Desmitis of the Palmar Annular Ligament	1163
Desmitis of the Distal Sesamoidean Ligaments	1163
Carpal Region Lameness	1163
Desmitis of the Accessory Ligament of the Superficial Digital Flexor Tendon	1164
Upper Forelimb Lameness	1164
Other Hindlimb Lameness	1164
Rhabdomyolysis	1164
Gracilis Muscle Tear	1164
Equine Protozoal Myelitis	1164
Chapter\t120 The Western Performance Horse	1165
The Cutting Horse	1165
Description and History of the Sport	1165
Training	1165
Lameness Examination	1166
Diagnosis and Management of Specific Lameness	1166
Selected Lameness of the Tarsus	1166
Osteoarthritis of the Distal Tarsal Joints (Distal Hock Joint Pain)	1166
Arthrosis of the Tarsocrural Joint	1167
Selected Lameness of the Stifle	1167
Osteochondrosis	1167
Subchondral Bone Cysts	1167
Upward Fixation of the Patella	1168
Femorotibial Joint Pain	1169
Thoracolumbar Injuries	1169
Thoracolumbar Myositis	1169
Sacroiliac Region Pain	1169
Forelimb Lameness in the Cutting Horse	1170
The Roping Horse	1170
Team Roping Horse	1170
Description of the Sport	1170
Conformation	1171
Training	1171
Historical Data and Decreased Performance	1171
Lameness Examination	1172
Diagnosis and Management of Specific Lameness	1172
Palmar Foot Pain	1172
Soft Tissue Injuries	1173
Distal Hock Joint Pain	1174
Back and Pelvic Region Pain	1174
Shoeing Considerations	1175
Calf Roping and Breakaway Roping Horses	1175
Description of the Sport	1175
Conformation	1175
Historical Data and Poor Performance	1175
Diagnosis and Management of Specific Lameness	1175
Shoeing Considerations	1176
The Reined Cow Horse	1176
Training Surfaces	1176
The Relationship of Training to Lameness	1177
Conformation and Lameness	1177
Lameness Evaluation	1177
Imaging Considerations	1178
Proceeding without a Diagnosis	1178
Lameness and Shoeing Considerations	1178
Ten Most Common Lameness Conditions in the Reined Cow Horse	1179
Treatment of Lameness	1179
Suspensory Desmitis	1179
Centrodistal and Tarsometatarsal Joint Pain	1179
Navicular Syndrome	1179
Traumatic Hoof Injuries	1179
Superficial Digital Flexor Tendonitis	1179
Stifle Pain	1179
Metatarsophalangeal Joint Pain	1180
Sesamoiditis	1180
Distal Interphalangeal Joint Pain	1180
Osteitis of the Distal Phalanx	1180
Barrel-Racing Horses	1180
Conformation	1181
Training	1181
Historical Data and Poor Performance	1181
Lameness Examination	1182
Diagnosis and Management of Specific Lameness	1182
Shoeing Considerations	1183
Other Considerations	1183
The European Western Performance Horse	1183
Ten Most Common Lameness Conditions in 2- to 8-Year-Old European Western Performance Horses	1183
Lameness of the Foot	1183
Lameness of the Hock	1184
Superficial Digital Flexor Tendonitis	1184
Lameness of the Stifle	1185
Suspensory Desmitis	1185
Lameness of the Fetlock Joint	1185
Lameness of the Carpus	1186
Exostosis of the Second or Fourth Metacarpal/Metatarsal Bones (Splints)	1186
Curb	1186
Fracture of the Plantar Process of the Middle Phalanx	1186
The Racing Quarter Horse	1186
Chapter\t121 Walking Horses	1186
Description of the Sport	1186
Lameness Examination	1187
Chapter\t122 Lameness in the American Saddlebred and Other Trotting Breeds with Collection	1188
Description of the Sport	1188
American Saddlebred	1189
Saddlebred Gaits	1189
Lameness Examination	1190
Diagnostic Analgesia	1190
Imaging Considerations	1190
Shoeing Gaited Horses	1190
Ten Most Common Lameness Conditions	1191
Specific Lameness Conditions	1191
Distal Hock Joint Pain and Distal Tarsitis	1191
Gluteal Myositis and Back Pain	1191
Palmar Foot Pain	1192
Osteitis of the Distal Phalanx	1192
Osteoarthritis and Osteochondrosis of the Tarsocrural Joint	1192
Osteoarthritis and Osteochondrosis of the Fetlock Joint	1193
Osteoarthritis and Osteochondrosis of the Stifle Joint	1193
Suspensory Desmitis	1194
Tendonitis	1194
Splint Exostoses	1194
Other Lameness Conditions	1194
Stringhalt	1194
Semimembranosus or Semitendinosus Myositis	1194
Tibial Stress Fractures	1195
Hindlimb Extensor Tenosynovitis	1195
Cervical Myositis	1195
Chapter\t123 Lameness in the Arabian and Half-Arabian Show Horse	1195
History of the Arabian	1195
History of the Sporting Event	1195
Training: Impact of Industry	1196
Conformation and Lameness	1197
Lameness Examination	1197
History	1197
Static Examination	1198
Visual Examination	1198
Palpation	1198
Hoof Tester Examination	1198
Dynamic Examination	1198
Flexion Tests	1198
Examination in Hand and under Saddle	1199
Diagnostic Analgesia	1199
Neurological Examination	1199
Undiagnosed Lameness	1200
Ten Most Common Lameness Conditions of the Arabian and Half-Arabian Show Horse	1200
Diagnosis and Management of Lameness	1200
Bruised and Inflamed Feet	1200
Osteoarthritis of the Distal Interphalangeal Joint and Palmar Foot Pain	1201
Suspensory Desmitis	1202
Osteoarthritis of the Stifle Joints	1202
Thoracolumbar (Back), Sacroiliac, and Gluteal (Croup) Pain	1203
Osteoarthritis of the Metacarpophalangeal and Metatarsophalangeal Joints	1204
Distal Hock Joint Pain	1204
Splint Bone Injuries	1204
Osteoarthritis of the Proximal Interphalangeal Joint	1205
Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon	1205
Chapter\t124 Lameness in the Driving Horse	1205
Description of the Sport	1205
Types of Horses Used	1206
Training	1207
Ground Conditions	1207
Conformation	1208
Lameness Examination	1208
Diagnostic Analgesia	1208
Imaging Considerations	1209
Difficulties in Diagnosis	1209
Shoeing	1209
Ten Most Common Lameness Conditions	1210
Diagnosis and Management of Lameness	1210
Suspensory Desmitis	1210
Foot Lameness	1210
Distal Hock Joint Pain	1211
Exertional Rhabdomyolysis	1212
Tenosynovitis of the Digital Flexor Tendon Sheath	1213
Chronic Osteoarthritis of the Lower Limb Joints	1214
Stifle Lameness	1214
Direct Trauma	1214
Interference Injuries	1214
Injuries to the Brisket, Lower Neck, Antebrachium, Stifle, and Crus	1215
Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon	1215
Superficial Digital Flexor Tendonitis	1215
Chapter\t125 Lameness in Draft Horses	1216
Modern-Day Draft Horses	1216
Lameness Examination	1216
Ten Most Common Lameness Problems	1217
Lameness Common to the Forelimb and Hindlimb	1217
Foot	1217
Subsolar Abscess	1217
Hoof Wall Cracks	1218
Laminitis	1219
Sidebone	1220
Quittor	1220
Osteitis of the Distal Phalanx	1221
Canker	1221
Osteoarthritis of the Proximal and Distal Interphalangeal Joints, Ringbone	1222
Metacarpophalangeal (Fetlock) Joint Lameness	1223
Splints	1223
Tendonitis and Suspensory Desmitis	1223
Other Forelimb Lameness	1224
Unusual Signs Consistent with Lameness Caused by Mange Mites	1224
Hindlimb Lameness	1224
Tarsus	1224
Stifle Joint	1226
Shivers	1226
Lameness of Foals, Weanlings, and Yearlings	1227
Infectious Arthritis	1227
Developmental Orthopedic Disease	1227
Physitis and Epiphysitis and Flexural Deformities	1227
Osteochondritis Dissecans and Osteochondrosis	1227
Chapter\t126 Lameness in the Pony	1228
Lameness Affecting the Pony	1228
Lameness Examination	1228
Diagnostic Analgesia	1228
Imaging Considerations	1229
Ten Most Common Conditions Affecting Competition Ponies	1229
Limb Deformities	1229
Joint Disease	1229
Osteochondrosis	1229
Osteoarthritis	1229
Scapulohumeral Joint	1229
Carpus	1230
Stifle	1230
Hock	1230
Other Specific Joint Conditions	1230
Luxation of the Coxofemoral Joint	1230
Dysplasia of the Coxofemoral Joint	1230
Luxation of the Patella	1230
Upward Fixation of the Patella	1231
Hemarthrosis	1232
Subluxation of the Proximal Interphalangeal Joint	1232
Treatment of Joint Disease	1232
Fractures	1232
Foot-Related Problems	1233
Laminitis	1233
Soft Tissue Injuries	1233
Superficial Digital Flexor Tendonitis	1233
Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon	1233
Digital Flexor Tendon Sheath	1234
Wounds	1234
Other Conditions	1234
Back Pain	1234
Muscular Disorders	1234
Cerebellar Abiotrophy	1235
Chapter\t127 Lameness in Breeding Stallions and Broodmares	1235
The Stallion	1235
Examination	1235
Specific Diagnostic Considerations and Therapy	1236
Sore Back	1236
Osteoarthritis	1236
Neurological Disease	1236
Sore Feet	1236
Fractures of the Distal Phalanx	1237
Laminitis	1237
Muscle Disease	1237
Injuries	1237
Aortoiliac Thrombosis	1238
Comprehensive Management	1238
Pain Management	1238
Fitness and Weight Management	1238
Breeding Management and Handling	1238
Breeding Schedule	1238
Maintaining Ideal Levels of Libido	1238
Breeding Shed Handling Considerations	1239
Monitoring Breeding Performance	1240
One Mount Rule	1240
Ground Semen Collections	1240
Pharmacologically Induced Ex Copula Ejaculation	1240
Broodmare	1240
Specific Diagnostic Considerations and Therapy	1241
Sore Feet	1241
Laminitis	1241
Osteoarthritis	1241
Enlarged or Swollen Limbs	1241
Rhabdomyolysis	1241
Foaling-Related Injuries	1241
Neurological Disease	1241
Old Injuries	1242
General Husbandry and Breeding Management Considerations	1242
Chapter\t128 Lameness in Foals	1242
Evaluation of a Lame Foal	1242
Noninfectious Causes of Lameness	1243
Fractures of Long Bones	1243
Fractures of the Pelvis	1244
Fractures of the Physes	1244
Cuboidal Bone Injury	1245
Fractures of the Distal Phalanx	1245
Fractures of the Proximal Sesamoid Bones	1246
Developmental Orthopedic Disease	1247
Vascular Thrombosis	1247
Traumatic Nerve Injury	1247
Miscellaneous Soft Tissue Injury	1248
Infectious Causes of Lameness	1248
Immune-Mediated Synovitis	1251
Infection of the Digit	1251
Chapter\t129 Pleasure Riding Horse	1252
References	1255
CHAPTER 1 Lameness Examination: Historical Perspective	1255
CHAPTER 2 Lameness in Horses: Basic Facts Before Starting	1255
CHAPTER 3 Anamnesis (History)	1255
CHAPTER 4 Conformation and Lameness	1255
CHAPTER 5 Observation: Symmetry and Posture	1256
CHAPTER 6 Palpation	1256
CHAPTER 7 Movement	1256
CHAPTER 8 Manipulation	1257
CHAPTER 9 Applied Anatomy of the Musculoskeletal System	1257
CHAPTER 10 Diagnostic Analgesia	1257
CHAPTER 11 Neurological Examination and Neurological Conditions Causing Gait Deficits	1258
CHAPTER 12 Unexplained Lameness	1260
CHAPTER 13 Assessment of Acute-Onset, Severe Lameness	1260
CHAPTER 14 The Swollen Limb	1260
CHAPTER 15 Radiography and Radiology	1260
CHAPTER 16 Ultrasonographic Evaluation of the Equine Limb: Technique	1260
CHAPTER 17 Ultrasonographic Examination of Joints	1261
CHAPTER 18 Ultrasonography and Orthopedic (Nonarticular) Disease	1261
CHAPTER 19 Nuclear Medicine	1262
CHAPTER 20 Computed Tomography	1263
CHAPTER 21 Magnetic Resonance Imaging	1263
CHAPTER 22 Gait Analysis for the Quantification of Lameness	1264
CHAPTER 23 Arthroscopic Examination	1265
CHAPTER 24 Tenoscopy and Bursoscopy	1266
CHAPTER 25 Thermography: Use in Equine Lameness	1267
CHAPTER 26 The Biomechanics of the Equine Limb and Its Effect on Lameness	1267
CHAPTER 27 The Foot and Shoeing	1268
Horseshoes and Shoeing	1270
Additional Reading	1270
Natural Balance Trimming and Shoeing	1270
Hoof Reconstruction Materials and Glue-On Shoes	1270
CHAPTER 28 Trauma to the Sole and Wall	1270
CHAPTER 29 Functional Anatomy of the Palmar Aspect of the Foot	1271
CHAPTER 30 Navicular Disease	1271
CHAPTER 31 Fracture of the Navicular Bone and Congenital Bipartite Navicular Bone	1273
CHAPTER 32 Primary Lesions of the Deep Digital Flexor Tendon within the Hoof Capsule	1273
CHAPTER 33 The Distal Phalanx and Distal Interphalangeal Joint	1274
Fractures and Fragmentation of the Extensor Process of the Distal Phalanx	1275
Injuries of the Collateral Ligaments of the Distal Interphalangeal Joint	1275
Osseous Cystlike Lesions in the Distal Phalanx	1275
Osseous Trauma of the Distal and Middle Phalanges	1275
Keratomas and Neoplastic and Nonneoplastic Space-Occupying Lesions in the Hoof	1275
Fractures of the Distal Phalanx	1276
Pedal Osteitis: Does It Exist?	1276
Osteitis of the Palmar Processes of the Distal Phalanx	1276
Disease of the Cartilages of the Foot	1276
CHAPTER 34 Laminitis	1276
Diagnosis of Laminitis	1278
Medical Therapy of Laminitis	1278
Chronic Laminitis	1278
Venography	1279
Hoof Care of a Laminitic Horse	1279
Deep Digital Flexor Tenotomy for Managing Laminitis	1279
Other Management Aspects of Laminitis	1279
CHAPTER 35 The Proximal and Middle Phalanges and Proximal Interphalangeal Joint	1279
CHAPTER 36 The Metacarpophalangeal Joint	1280
CHAPTER 37 The Metacarpal Region	1281
CHAPTER 38 The Carpus	1282
CHAPTER 39 The Antebrachium	1283
CHAPTER 40 The Elbow, Brachium, and Shoulder	1283
CHAPTER 41 The Hind Foot and Pastern	1284
CHAPTER 42 The Metatarsophalangeal Joint	1285
CHAPTER 43 The Metatarsal Region	1286
CHAPTER 44 The Tarsus	1286
CHAPTER 45 The Crus	1288
CHAPTER 46 The Stifle	1288
CHAPTER 47 The Thigh	1290
CHAPTER 48 Mechanical and Neurological Lameness in the Forelimbs and Hindlimbs	1291
CHAPTER 49 Diagnosis and Management of Pelvic Fractures in the Thoroughbred Racehorse	1291
CHAPTER 50 Lumbosacral and Pelvic Injuries in Sports and Pleasure Horses	1292
CHAPTER 51 Diagnosis and Management of Sacroiliac Joint Injuries	1293
CHAPTER 52 Thoracolumbar Spine	1293
CHAPTER 53 The Cervical Spine and Soft Tissues of the Neck	1294
CHAPTER 54 Pathogenesis of Osteochondrosis	1295
CHAPTER 55 The Role of Nutrition in Developmental Orthopedic Disease: Nutritional Management	1297
CHAPTER 56 Diagnosis and Management of Osteochondrosis and Osseous Cystlike Lesions	1297
CHAPTER 57 Physitis	1298
CHAPTER 58 Angular Limb Deformities	1298
Suggested Readings	1298
CHAPTER 59 Flexural Limb Deformities in Foals	1298
CHAPTER 60 Cervical Stenotic Myelopathy	1298
CHAPTER 61 Osteoarthritis	1299
CHAPTER 62 Markers of Osteoarthritis: Implications for Early Diagnosis and Monitoring of the Pathological Course and Effects of Therapy	1305
CHAPTER 63 Gene Therapy	1306
CHAPTER 64 Models of Equine Joint Disease	1306
CHAPTER 65 Infectious Arthritis and Fungal Infectious Arthritis	1308
Fungal Infectious Arthritis	1310
CHAPTER 66 Noninfectious Arthritis	1311
CHAPTER 67 Other Joint Conditions	1312
CHAPTER 68 Pathophysiology of Tendon Injury	1312
CHAPTER 69 Superficial Digital Flexor Tendonitis	1314
Surgical Management of Superficial Digital Flexor Tendonitis	1314
Superficial Digital Flexor Tendonitis in Event Horses, Show Jumpers, Dressage Horses, and Pleasure Horses	1315
CHAPTER 70 The Deep Digital Flexor Tendon	1315
CHAPTER 71 Injuries of the Accessory Ligament of the Deep Digital Flexor Tendon	1316
CHAPTER 72 The Suspensory Apparatus	1316
CHAPTER 73 Clinical Use of Stem Cells, Marrow Components, and Other Growth Factors	1317
CHAPTER 74 Diseases of the Digital Flexor Tendon Sheath, Palmar Annular Ligament, and Digital Annular Ligaments	1318
CHAPTER 75 The Carpal Canal and Carpal Synovial Sheath	1319
CHAPTER 76 The Tarsal Sheath	1319
CHAPTER 77 Extensor Tendon Injury	1320
CHAPTER 78 Curb	1320
CHAPTER 79 Bursae and Other Soft Tissue Swellings	1320
CHAPTER 80 Other Soft Tissue Injuries	1321
CHAPTER 81 Tendon Lacerations	1321
CHAPTER 82 Soft Tissue Injuries of the Pastern	1321
CHAPTER 83 Skeletal Muscle and Lameness	1321
CHAPTER 84 Principles and Practices of Joint Disease Treatment	1325
CHAPTER 85 Analgesia and Hindlimb Lameness	1329
CHAPTER 87 External Skeletal Fixation	1330
CHAPTER 88 Counterirritation	1330
CHAPTER 89 Cryotherapy	1330
CHAPTER 90 Radiation Therapy	1330
CHAPTER 91 Rest and Rehabilitation	1331
CHAPTER 92 Acupuncture	1331
Acupuncture Channel Palpation and Equine Musculoskeletal Pain	1332
CHAPTER 93 Chiropractic Evaluation and Management of Musculoskeletal Disorders	1333
CHAPTER 94 Electrophysical Agents in Physiotherapy	1333
CHAPTER 95 Osteopathic Treatment of the Axial Skeleton of the Horse	1335
CHAPTER 96 Shock Wave Therapy	1335
CHAPTER 97 Poor Performance and Lameness	1336
CHAPTER 98 Experiences Using a High-Speed Treadmill to Evaluate Lameness	1336
CHAPTER 99 The Sales Yearling	1336
CHAPTER 100 Pathophysiology and Clinical Diagnosis of Cortical and Subchondral Bone Injury	1337
CHAPTER 101 Bone Biomarkers	1338
CHAPTER 102 The Bucked-Shin Complex	1340
Stress Fractures of the Third Metacarpal Bone: Surgical Management	1341
CHAPTER 103 On-the-Track Catastrophes in the Thoroughbred Racehorse	1341
CHAPTER 104 Catastrophic Injuries	1341
CHAPTER 105 Track Surfaces and Lameness: Epidemiological Aspects of Racehorse Injury	1341
CHAPTER 107 The European Thoroughbred	1342
CHAPTER 108 The North American Standardbred	1342
CHAPTER 109 The European and Australasian Standardbreds	1343
The Australasian Standardbred	1343
CHAPTER 110 The Racing Quarter Horse	1343
CHAPTER 112 National Hunt Racehorse, Point to Point Horse, and Timber Racing Horse	1344
CHAPTER 113 The Finnish Horse and Other Scandinavian Cold-Blooded Trotters	1344
CHAPTER 114 Prepurchase Examination of the Performance Horse	1344
CHAPTER 116 Lameness in the Dressage Horse	1344
CHAPTER 117 Lameness in the Three Day Event Horse	1344
CHAPTER 118 Lameness in Endurance Horses	1345
CHAPTER 120 The Western Performance Horse	1345
The Roping Horse	1345
Barrel-Racing Horses	1345
CHAPTER 122 Lameness in the American Saddlebred and Other Trotting Breeds with Collection	1345
CHAPTER 123 Lameness in the Arabian and Half-Arabian Show Horse	1345
CHAPTER 125 Lameness in Draft Horses	1346
CHAPTER 126 Lameness in the Pony	1346
CHAPTER 127 Lameness in Breeding Stallions and Broodmares	1347
CHAPTER 128 Lameness in Foals	1348
Index	1349
A	1349
B	1351
C	1353
D	1357
E	1360
F	1362
G	1365
H	1365
I	1368
J	1369
K	1369
L	1370
M	1372
N	1374
O	1376
P	1377
Q	1382
R	1382
S	1384
T	1390
U	1395
V	1395
W	1395
X	1396
Y	1396
Z	1396
Legends for color insert figures	c1
Normal Gait	endsheet2
Unilateral Forelimb Lameness	endsheet2
Bilateral Forelimb Lameness	endsheet2
Effect of Circling on Forelimb Lameness	endsheet2
Hindlimb Lameness without a Head and Neck Nod	endsheet2
Hindlimb Lameness with an Associated Head and Neck Nod	endsheet2
Bilateral Hindlimb Lameness	endsheet2
Effect of Circling on Hindlimb Lameness	endsheet2
Concurrent Forelimb and Hindlimb Lameness	endsheet2
Other Aspects of Hindlimb Lameness	endsheet2
Neurological Gait Deficits	endsheet2
Mechanical Gait Deficits	endsheet2
Esoteric Gait Abnormalities	endsheet2
AD	endsheet3
Abbreviations	endsheet6

Diagnosis and Management of Lameness in the Horse - E-Book

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