Ringbone

Ringbone

Ringbone is exostosis (bone growth) in the pastern or coffin joint of a horse. In severe cases, the growth can encircle the bones, giving ringbone its name. whilst commonly used, might be misleading and that it would be better to refer to this condition as

osteoarthritis of the inter-phalangeal joints.

Ringbone

Ringbones are not very common but are serious unsoundnesses. These bony deposits usually appear just above the coronary band on a hind foot, although front feet also may be affected. The long and short pastern bones may fuse together, causing

severe pain and lameness .

Skeleton Hock DownSkeleton Hock Down

Tendons Tendons LigamentsLigaments

Ringbone can be classified by its location, with "high ringbone" occurring on the lower part of the large pastern bone or the upper part of the small pastern bone. "Low ringbone" occurs on the lower part of the small pastern bone or the upper part of the coffin bone. High ringbone is easier seen than low ringbone, as low ringbone occurs in the hoof of the horse. However, low ringbone may be seen if it becomes serious, as it creates a bony bump on the coronet of the horse.

Causes of Ringbone

Excessive tension on the tendons, ligaments, and joint capsules of the pastern area can strain the periosteum. The body compensates by growing bone at the stresspoint. Strain on the extensor tendon, the superficial digital flexor tendon branches, the collateral ligaments, and the distal sesamoidean ligaments are all common factors. If these tissues are stretched or torn, and the joint is instabilized by the injury, new bone is produced to help to stabilize the joint

Causes of Ringbone

Osteoarthritis (the endstage of degenerative joint disease) of the pastern or coffin joint is a very common cause of articular ringbone. Bone is then produced to try to immobilize the joint and to relieve the chronic inflammation of the joint capsule. This process may take years, and lameness will continue until the joint is completely immobilized

Causes of Ringbone

Trauma to the periosteum can cause bone growth on the pastern bone .

Poor shoeing and conformation, such as long, sloping pasterns, upright pasterns, long-toes with low heels, pigeon toes, splay foot, or unbalanced feet may predispose the horse to ringbone, as they create uneven stress on the pastern and coffin joint, unequal tension on the soft tissues, or worsen the concussion that is absorbed by the pastern area.

Signs of Ringbone

Ringbone usually occurs in the front legs, and is usually worse in one leg than the other. Ringbone is most often found in

mature horses, especially those in intensive training.High ringbone: The horse will have a bony growth around the

pastern area, and the pastern will have less mobility. The horse will show pain when the pastern joint is moved or rotated. Early

cases will have a [[lameness (equine)|lameness score of 1-2 out of 5, with little or no bony swelling seen, although possibly

felt when compared to the opposite pastern. Lameness will worsen to a grade 2-3 on a scale of 5 as the ringbone worsens.

High Ringbone

Fig. 1. X-ray of high and low periarticular ringbone (arrows).

Low ringbone: The horse will have moderate lameness (grade 2-3), even in

early cases, because of the closeness of the ringbone to the other structures in the hoof.

When severe or very advanced, the bony growth will be able to be seen on the coronet

Pyramidal Disease(Extensor process disease, Buttress foot)

Once classified as a type of low ringbone ( Ringbone), pyramidal disease arises from a traumatically induced periostitis or an avulsion fracture of the extensor process of the third phalanx caused by excess tension at the tendon insertion. The close association of the extensor process with the distal phalangeal joint means secondary arthritis is a likely complication. In early cases, heat and pain on pressure may be manifest. An enlargement of the toe region just above the coronet is usually present, which results in the “buttress foot” appearance. Systemic anti-inflammatory medication may be beneficial. Surgery

has been successful for avulsion fractures.

Prognosis for RingboneIf the ringbone is close to a joint, the prognosis for

the horse's continued athletic use is not as good than if the ringbone is not near a joint. Ringbone that

is progressing rapidly has a poorer prognosis as well.

Horses that are not performing strenuous work, such as jumping or working at speed, will probably be

usable for years to come. However, horses competing in intense sports may not be able to continue at their previous level, as their pastern

joints are constantly stressed.

Treatment of Ringbone

Ringbone is degenerative (unless it is caused by direct trauma). Treatment works to slow down the progress of the bony changes and alleviate the horse's pain, rather than working to cure it.

Shoeing: The farrier should balance the hoof and apply a shoe that supports the heels and allows for an easy breakover.

NSAIDs: or non-steroidal anti-inflammatory drugs help to alleviate the pain and reduce inflammation within and around the joints. Often NSAIDs make the horse comfortable enough to continue ridden work, which is good for the horse's overall health.

Joint injections: The pastern joint can be injected directly, typically with a form of corticosteroid and hyaluronic acid.

.1Arthrodesis: the fusion of the two bones of the pastern joints eliminates the instability of the joint, and thus the inflammation. This procedure may then eliminate the horse's lameness as well. However, surgical alteration of the joint can promote the growth of bone in the area, which is cosmetically displeasing. Arthrodesis of the coffin joint is usually not performed due to the location of the joint (within the hoof) and because the coffin joint needs some mobility for the horse to move

correctly unlike the pastern joint.

Extracorporeal Shockwave Therapy: A high intensity specialized percussion device can help to remodel new bone tissue and decrease pain.

FOCUSED EXTRACORPOREAL SHOCKWAVE THERAPY ( ESWT )

What is ESWT

?

ESWT, a new, non-invasive technology, has become a popular treatment agent/tool for equine musculoskeletal problems. Results include accelerated healing, improved healing, and lessening of pain. A shock wave is a high pressure ( acoustic ) wave with very high amplitude, rapid rise time, and short pulse duration. These waves are generated outside the body ( extracorporeal ) and can be focused at a specific site within the body.

What is the origin of ESWT

Veterinarians have taken existing science in human beings and applied it to horses and dogs. This type of therapy was originally used to treat human beings with kidney stones, by breaking up the stones without the need for invasive surgery. This technique has been around for years now, and in the process of treating patients this way, it was discovered that many of them had other unrelated aches and pains disappear

Why is it important that shock waves are “focused?”

The tighter the focus area, the more precisely the shock waves can be delivered to specific tissues. This means a greater concentration of therapeutic energy on the specific injured tissue as well as less trauma to the

surrounding tissues .

How does ESWT work

When the shock waves meet tissues of different densities, the energy contained in the shock waves is released and interacts with the tissue .

-the shock wave exerts mechanical pressure and tension force on the afflicted tissue. As a result, both localized circulation and metabolism are

increased in the treated tissue which promotes healing .

-secondary waves are created which break down pathological deposits of calcification in the soft tissues .

-the shock wave appears to stimulate osteoblast cells which are responsible for bone healing and new bone production .

-shock waves cause a decrease in pain perception

.

What conditions benefit from shock wave therapy

The single largest cause of decreased performance in show and pleasure horses is lameness originating from the musculoskeletal system. The most widespread use of ESWT has been for proximal suspensory desmitis (PSD). Currently, the use of ESWT is used primarily on horses that have not responded to other therapies or have injuries that typically heal slow or inconsistently .

suspensory ligament injury (PSD) tissue calcification

back/neck pain navicular disease

fractures or joint ankyloses fatigue injury to bone

bucked shins bone spavin

Before shock wave therapy can be used, a patient needs a thorough examination to determine the specific affected area. Examination usually includes a general physical examination, a lameness (orthopedic) examination, and radiography. It may also be necessary to perform an ultrasound examination or to perform nerve blocks. Shock wave therapy appears to be an exciting and extremely advantageous tool in the arsenal of lameness treatment methods.

What is the treatment protocolThe area to be treated is clipped and thoroughly cleaned, and a gel is applied to ensure good transmission of the energy waves. The treatment requires sedation and during treatment a local analgesic effect may be induced. As a result, horses usually tolerate the procedure well. The exact treatment protocol is customized to each horse and specific diagnosis. Some problems need only a single treatment, while others may require 3 to 5 treatment sessions at intervals ranging from 10 to 30 days between sessions. After completion of the course of treatment, horses are restricted to box rest and controlled exercise between

treatments.

What are the advantages of using ESWT as a therapeutic modality

non-invasive and surrounding tissues are unaffected by the

shock waves accelerated healing

improved healing positive results in previously non-responsive conditions,

injuries that usually are slow to heal, and injuries that heal    inconsistently

attenuation of pain minimal aftercare, discomfort, and recovery time

no drug residues

What are the disadvantages of using ESWT as a therapeutic modality

horses may be slightly sore after treatment

analgesic (decreased pain) period following treatment so horses should not be subjected to strenuous activities for at least 4 days after ESWT where local analgesia might pre-dispose the horse to injury

splint

On each side of the cannon bone is a small bone known as the splint bone. The small splint bones are thin and taper to become a small knob about two-thirds of the way down the cannon bone. A ligament, located between the cannon bone and the splint bones, is quite elastic in young horses. As the horse ages, the ligament ossifies; that is, the ligament is replaced by bone and the three bones fuse. During ossification, there may be inflammation and pain. Jumping, running and working a horse during this time produces further irritation

Splints

Splints usually occur in horses 2 to 5 years old. Most often it is the forelimbs which are affected. Splints rarely occur in the hind limbs. In older horses, the splint bones are fused solidly to the cannon bone .

The majority of splint problems occur on the medial side (inside) of the forelimbs. The medial splint bone usually is the one affected because it has a flat surface next to the knee. The lateral (outer) splint bone has a more slanted surface. When the weight is transmitted to these bones, the medial splint bone probably bears more weight than the lateral splint bone. Therefore, the ligament between the medial splint bone and the cannon bone is subjected to more stress than the outer ligament .

Splints

Lameness due to splints is most common in 2-year-old horses undergoing training. The lameness is most obvious while the horse is trotting or working or soon thereafter. Lameness may come and go or be present continuously for as long as a year. If you probe up and down along the cannon bone, the horse will flinch when the portion of the ligament undergoing ossification is touched. A large swelling or a number of smaller swellings due to ossification may occur along the length of the splint bones. After the ligament has ossified, the swelling and soreness

usually disappears

Sidebone

A Sidebone is a term that describes the process where areas of cartilage in the foot become hard and bony. When this happens it may cause no problem at all, or it may interfere with the way the soft tissues around the area stretch and adjust during exercise. This can cause pain and discomfort. Most

cases of sidebone do not result in pain .

cause:

The cause is unknown but it is most likely to be due to poor conformation or improper shoeing. This causes abnormal pressure and

impact on certain areas of the foot .

Is ossification of the lateral cartilages of the foot, usually the fore foot. Its causes are hereditary tendencyand shoeing with high calkins.

Remedy.—Bar shoe; cold applications. Rest, blisters, firing, neurotomy

Sidebones. This is a common unsoundness resulting from wear, injury or abuse. On each side of

the heel extending above the hoof are elastic cartilages just under the skin that serve as part of the

shock-absorbing mechanism. They are commonly termed lateral cartilages. When they ossify (turn to bone) they are called sidebones. In the process of

ossification they may be firm but movable inward and outward by the fingers. The horse is then considered "hard at the heels." Sidebones are more common to

the front outside lateral cartilage than to other locations .

Ossified lateral cartilage

·Horse goes on his toes

·Horse Rays shuffles instead of picking up his feet

·X- confirm

Sidebone is ossification of the cartilages of the third phalanx. It is most common in the forefeet of heavy horses working on hard surfaces. It also is frequent

in hunters and jumpers but rare in racing Thoroughbreds. Repeated concussion to the

quarters of the feet is probably the essential cause. Predisposition may be inherited, but this has not

been confirmed. Improper shoeing that inhibits normal physiologic movement of the quarters is also predisposing. Some cases arise from direct trauma.

Loss of flexibility on digital palpation of either one or both cartilages is indicative of sidebone .

Because the rigidity of the cartilages is accompanied by ossification, the cartilages may protrude prominently above the

coronet. Lameness may be a sign, depending on the stage of ossification, the amount of concussion sustained by the feet,

and the character of the terrain. Lameness is most likely when sidebone is associated with a narrow or contracted foot or an

accompanying condition such as navicular disease. The stride may be shortened, and walking the horse across a slope may

exaggerate the soreness. Mules often have prominent sidebones, yet seldom show any lameness.

Sidebone may be suspected after palpation and observation, but radiographic examination is

essential for confirmation. It should be remembered that ossification of the cartilages commonly develops

without signs of lameness. When lameness is present, corrective shoeing to promote expansion of the quarters and to protect the foot from concussion

is often of value. Grooving the hooves, along with applying a counterirritant (eg, tincture of iodine) to the coronary region to promote hoof growth, also

may promote expansion of the wall.

Sidebone

Physitis

Physitis is the term applied to pain associated with the abnormal activity in a growth plate (phsysis), usually the lower growth plate of the radius, just above the knee the condition may be related to osteochondrosis, the condition occurs in rapidly growing young horses and most commonly in yearlings, there is usually a slight swelling and heat around the lower end of the radius just above the knee, the horse is not always lame; it may be lame if only one leg is affected or may show a stiff stilted gait if both forelimbs are affected.

Treatment

The diet should be restricted and calcium-phosphorus ratios checked to ensure that there is not an imbalance. If the horse is lame it should be confined to a small paddock. The prognosis is favorable, given time the swelling usually subsides

Sprain of the fetlock

There is enlargement of the fetlock joint it will have warm soft tissue swelling round the joint. The horse is lame .

treatment aims to reduce pain and soft tissue inflammation, cold hosing and water bandages help to reduce swelling.

pain killers are beneficial. , box rest should be continued until all swelling has dissipated

The prognosis is favorable if there has been no major damage to the collateral ligaments of the fetlock joint resulting in instability of the joint.

Ringbone

Ringbone are bony exotosis affecting the interphalangeal joints of the horses foot or any bony enlargment in that regionthere is high ringbone where the pastern joint is the seat of the disease and low ringbone where the deposits occur round the coffin bonethere is also false ringbone where the enlargement occurs upon the shaft of one of the bones and does not involve the edges of the joint surface (although it might do later). The term ringbone should be restricted to conditions in which a partial or complete ring of bone is formed round one or other of the joints , and all other bony enlargements affecting the shafts of the shafts of

the bones but not involeing the edges of the joint surfaces should be called exotosis.

Injury, inflammation of the periosteum of the bone- sometimes following an infection, also possibly a vitamin deficiency, are believed to cause ringboneIt is only in high ringbone that any lumps can be felt if lower ringbone there will be no out ward visable signs at first but after a while the hoof alters shape with a

bulge at the coronet ,

(1)Digital flexor tendon. (2) Sesamoidean ligament. (3) Digital extensor tendon. (4) Long pastern bone. (5) Short pastern bone. (6) Coronary corium. (7) Pedal bone. 

(8) Laminar corium . (2)9-Wall

(10) White line. (11) Sole. (12) Plantar cushion. 

(13) Navicular bone.

Bowed Tendon:

This condition can be mild or severe, yet all bowed tendons should be treated as an emergency. Ligaments and tendons are located at the back of the cannon bone and when the deep flexor tendor and/or the superficial tendon becomes strained or ruptured and the area becomes swollen this is known as a bowed tendon. They are caused by excessive stretching, training and fatigue of the tendons, external damage or long pasterns. Often seen in race horses. Some horses with bowed tendons will be become sound again, but the tendon will be prone to re-injury. Chronic cases will have permanent

scar tissue .Treatment: Lower leg treatments to relieve inflammation/pain and

rest for three - twelve monthes .

Bucked Shins:

This condition is seen often in race horses undergoing intense training. Bucked shins is caused by strain and excessive concussion (overtraining on hard ground) and is usually seen in young horses. The front of the cannon bone becomes sore and inflamed. This is an acute coniditon that can become chronic if not dealt with efficiently. Treatment: Controlled exercise and lower leg

treatments to relieve the inflammation/pain .

Check Ligament Desmitis (sprain):

The check ligament is found behind the upper part of the cannon bone sandwiched between the bone and the deep flexor tendon. The horse may or may not be lame. This injury is caused by a strain or sprain to the area is difficult to determine because of

the depth of the ligament .

Treatment: Lower leg treatment to relieve pain/inflammation. Rest for a number of

monthes. Re-think the training regime .

Curb:

Curbs are common in young horses. It refers to a rupture or strain of the plantar ligament which is located behind the hock. The swelling is visible about four inches below the hock joint and is usually firm when pressed. When healed, the swelling may remain or reduce in size. Initially the curb may be slightly warm and the horse slightly lame, but more often the horse shows no signs of lameness. Curbs can be caused by poor conformation (sickle or cow hocks), kicking hard walls or

excessive bucking, jumping and galloping .Treatment: Lower leg treatments to reduce

inflammation/pain and rest untill healed .

Osselets:

This refers to pain and inflammation that occurs above or below the front of the fetlock. Osselets is caused by strain and is seen often in young racehorses. Pain is evident when the fetlock is

bent and hard swelling might be visible .

Treatment: Rest. Corrective shoeing, controlled exercise and slow training regime. Lower leg

treatments to relieve inflammation/pain .

Ringbone: New bone growth occuring below the fetlock. Low ringbone refers to calcification of the lower, short pastern bone or the coffin

bone (lower phalanx 2 and/or upper phalanx 3). High ringbone refers to calcification of the long pastern bone or higher short pastern bone (phalanx 1 and/or upper phalanx 3). Articular ringbone is calcification

within the joint itself. If the ringbone is below the coronary band it cannot be seen, yet if it is above a bony growth will be evident. Some horses with ringbone recover quite well and lead a usefull life. Initially

their will be heat, lameness and swelling. Ringbone is thought to be caused by poor conformation (long or short pasterns), and repetative concussion to the area. Treatment: Rest and lower leg treatments to

relieve inflammation/pain. Confirm that any calcium/phosphorus imbalance in the diet is not a factor .

Sesamoiditis:

At the back of the fetlock is two sesamoid bones. Sesamoiditis occurs when these bones are damaged or inflamed. Acute lameness is generally present and the fetlock will swell. Long pasterns and repetitive concussion to the area is the usual cause. This is a serious condition and the horse will need to be

immobilized .

Treatment: Long rest period (12 monthes). Pain relief and lower leg treatments .

Splints:

Splints are very common and are usually not serious. A splint is a hard and bony swelling on either side of the cannon bone. Generally occurs in young horses. Initially splints are warm and painful, but become hard, cold and painless when healed (although they do leave a blemish). Strenuous play or work on hard ground/repetative concussion causes splints. Treatment: Anti-inflammatory lotion, a little rest and more conservative training.

Suspensory Ligament Desmitis (sprain):

This injury is the same as a bowed tendon except that a ligament is strained or ruptured--not a tendon. Ligaments have less elasticity than tendons and can therefore be injured easily. The suspensory ligament is located behind the cannon bone beneath the flexor tendons and connects to the sesamoid bones. This condition is caused by excessive strain on the area

and can be aggravated by poor conformation .

Treatment: Lower leg treatments to relieve inflammation/pain, and rest

Founder (Laminitis)

is an inflammation of the sensitive laminae which attach the hoof to the fleshy portion of the foot. Its cause is probably a sensitization (allergy). When horses gain access to unlimited amounts of grain, founder often results. Other conditions conducive to founder are retained placenta after foaling and sometimes lush grass. All feet may be affected, but front feet usually suffer the most. Permanent damage usually can be reduced or eliminated by immediate attention by a

competent veterinarian .Permanent damage results from dropping of the hoof sole and upturn of the toe walls when treatment is

neglected .

Navicular Disease is an inflammation of navicular bone and bursa. The condition causes lingering lameness and should be

diagnosed and treated by a veterinarian .

Corns appear as reddish spots in the horny sole, usually on the inside of the front feet,

near the bars. Advanced cases may ulcerate and cause severe lameness. There are many

causes, but bruises, improper shoeing and contracted feet are the most common.

Response to correct treatment and shoeing is usually satisfactory .

Hoof cracks. When hoof cracks extend upward to or near the hairline, lameness often results. When well established, the

condition is difficult to arrest and cure. It can be prevented in most hooves by proper

trimming and shoeing before it becomes serious .

Contracted feet are a result of continued improper shoeing, prolonged lameness or excessive dryness,

where the heels lose their ability to contract and expand when the horse is in motion. Horses kept shod, those with long feet and those with narrow

heels are susceptible to the condition. Close trimming, going barefooted or corrective shoeing

usually produces sufficient cure to restore the horse to service .

Thrush is a filth disease enhanced by decomposition of stable manure around the

bars and frog of the foot. It may cause lameness. Response to cleanliness and

treatment is usually prompt and complete .

Wind or road puffs. Small swellings around the ankles and lower cannons are common to horses that are used heavily or trailered a lot, or to older

animals. Those with adequate flat bone, well-defined joints and prominent veins usually have sufficient

substance and circulation to withstand wear better than horses with coarse, round bone and meaty legs

with poorly defined joints and veins. Puffs are blemishes .

Capped elbow or "shoe boil" is a blemish at the point of the elbow. It is usually caused by

injury from the shoe when the front leg is folded under the body while the horse is lying

down. Shoes with calks (heels) cause more damage than plates .

Bowed tendons are apparent by a thickening of the back surface of the leg immediately above the

fetlock. One or more tendons and ligaments may be affected, but those commonly involved are the

superflexor tendon, deep flexor tendon and suspensory ligament of one or both front legs.

Predisposing causes are severe strain, wear and tear with age and relatively small tendons attached to light, round bone. Bowed tendons usually cause

severe unsoundness .

Unsoundnesses and blemishes of the hind legsThe hock is the most vulnerable, therefore the most important, joint of the body. All of the power of a pulling horse is generated in the

hindquarters and transmitted to the collar by contact with the ground via the hocks. Working stock horses must bear most of the weight on the hind legs by keeping their hocks well under them, if they are to attain maximum flexibility. Degree of finesse is determined with gaited

and parade horses by how well they "move" off their hocks .Structurally sound hocks should be reasonably deep from top to bottom, well supported by fairly large, flat, straight bone, be characterized

by clean-cut, well-defined ligaments, tendons and veins, and should be free from induced unsoundnesses and blemishes .Bone or jack spavin. Bone spavins are common unsoundnesses of light horses, especially those with sickle hocks or shallow hock joints

from top to bottom surmounting fine, round bone. Such conformation should be seriously faulted in a working stock horse .A bony enlargement at the base and inside back border of the hock may be a bone spavin. Inspect the horse by bending or squatting in front

of it and looking between the front legs at the face of the hocks, or by standing near a front leg and looking under the belly at the opposite hock. Before passing judgment, assume the same position and look at the opposite hock. If they are both alike, the horse is probably normal.

In the early stages, lameness may be apparent only when the horse has remained standing for a while. Bone spavins, like ringbones, may fuse bones and render joints inarticulate .

Bog spavin and thoroughpin. Bog spavins are soft swellings on the inside-front area of the hocks that may result from the presence of synovial fluid ("joint oil"). Blemishes of this type are more common to heavy horses than light ones, although individuals of low quality are

susceptible to the condition .Thoroughpins are blemishes that appear as soft swellings above and back of the hock joint just in front of the large tendon. They can be

pressed from side to side, hence the name .Curbs. Curbs can be seen best from a side view. They appear as swellings on the back border of the base of the hock. They result from

inflammation and thickening of the sheath of one of the important tendons. Shallow, sickle hocks predispose to development of curbs. They may or may not cause lameness .

Capped hock. A thickening of the skin or large callus at the point of the hock is a common blemish. Many capped hocks result from bumping the hocks when trailering in short trailers or with unpadded tail gates .

Stringhalt, or crampiness of the hind leg(s), is a disease of the nervous system resulting in spasmodic flexion of one or both hocks when the horse is first moved after standing or when caused to back. The hock is raised abnormally high. It occurs more frequently in older animals

and may not render the animal unserviceable .Stifled. When the patella of the stifle joint is displaced, the animal is stifled. If the patella is displaced outward, severe lameness results. If it

is displaced inward, lameness is less serious and sudden movement may replace it. However, the condition is likely to recur frequently .

Splints: A splint is a calcification or bony growth, usually occurring on the inside of the cannon or splint bone area.  Splints are a result of trauma but can also have many other

causes, such as slipping, running, and jumping, getting kicked, or receiving a concussion from hard surfaces.  Occasionally a fracture of the splint bones is possible.

 Sore or Bucked Shins:  A bucked shin is an enlargement on the front of the cannon

between the knee and the fetlock joints.  This enlargement, which usually occurs in the front limb, is due to trauma to the periosteum, most often caused by concussion.

 Bowed Tendons or Tendonitis:  A bowed tendon is an inflammation and enlargement of

the flexor tendons at the back of the front cannon.  The general cause of bowed tendons is severe strain.

 Sidebones:  These are calcifications of the lateral cartilages of the third phalanx or coffin

bone.  Sidebones are considered an unsoundness in a young horse because the premature ossification of the lateral cartilages will result in contracted heels and abnormal

foot growth.

Definitions Splints: A splint is a calcification or bony growth, usually occurring on the inside of the cannon or splint bone area. Splints are a result of trauma but can also have many other causes, such as slipping, running, and jumping, getting kicked, or receiving a concussion from hard surfaces. Occasionally a fracture of the splint bones is possible.

Sore or Bucked Shins: A bucked shin is an enlargement on the front of the cannon between the knee and the fetlock joints. This enlargement, which usually occurs in the front limb, is due to trauma to the periosteum, most often caused by concussion.

Bowed Tendons or Tendonitis: A bowed tendon is an inflammation and enlargement of the flexor tendons at the back of the front cannon. The general cause of bowed tendons is severe strain.

Sidebones: These are calcifications of the lateral cartilages of the third phalanx or coffin bone. Sidebones are considered an unsoundness in a young horse because the premature ossification of the lateral cartilages will result in contracted heels and abnormal foot growth.

Ringbone: Ringbone is an exostosis of the pastern bone in the form of a raised bony ridge usually parallel to the coronary band. The classification of ringbone as high or low describes the location of the new bone growth, according to whether it occurs on the lower part of the first phalanx above the pastern joint (high) or the lower part of the second phalanx at the coronary band (low).

Suspensory Ligament Unsoundness: This type of lameness is common in racehorses. The suspensory ligament attaches to the back of the cannon bone just below the knee, travels downward, and splits above the sesamoid bones into two parts, each attaching to a sesamoid bone.

Wind Puffs or Wind Galls (Road Puffs or Road Galls): Wind puffs are soft, puffy, fluid-filled swellings that occur around a joint capsule, tendon sheath or bursa. They are the result of excess synovia and can be found above the knee but usually are on the fetlock and pastern as a result of trauma.

Capped Elbow or Shoe Boil: A capped elbow is a bursitis or swelling at the point of the elbow and is usually caused when the horse irritates the elbow bursa with the shoe or hoof of the front foot when lying down.

Sweeney: Atrophy of the muscles of the shoulder due to paralysis of the supracapsular nerve is called a Sweeney. The condition is usually caused by direct injury to the point of the shoulder and subsequent damage to the nerve.

Stifled or Upward Fixation of the Patella: A particular type of stifle inflammation, in which the patella locks and causes the leg to remain in the extended position, is referred to as the stifled condition. The stifle and the hock are unable to flex and the foot is dragged, but the patella can be released by manipulating the leg forward or backing the horse several steps.

Stringhalt: Stringhalt is an exaggerated lifting and forward motion of one or both hocks that is spasmodic and involuntary.

Capped Hock: A capped hock is one of the most common blemishes of the hind limbs. It is a firm enlargement at the point of the hock that reflects an inflammation of the bursa. Capped hock is caused by trauma to the hock, usually as a result of kicking a wall, trailer gate, or some solid object.

Curb: A curb is a hard enlargement on the rear of the cannon immediately below the hock that develops in response to stress. It develops as an inflammation and subsequently thickening of the plantar ligament on the posterior of the hock.

Thoroughpins: A thoroughpin is a soft, fluid-filled enlargement in the hollow on the outside of the hock. The swelling can be pushed freely from the outside to the inside of the hock by palpation

Bog Spavin:  A soft distension on the inside front portion of the hock joint caused by an inflammation of the synovial membrane of the hock is known as a bog spavin.  Faulty conformation (such as straight hocks), strain (resulting from quick stops), and rickets (caused by a nutritional deficiency) may be predisposing causes that result in inflammation of the bursa and an increased production of synovial fluid.  It rarely interferes with the usefulness of the horse.

 Bone Spavin or Jack Spavin:  A bone spavin is a bony enlargement on the lower interior surface of the hock joint that may result in limited flexion of the hock.  Faulty hock conformation, excessive concussion, nutritional deficiencies, and hereditary predisposition are considered causes of the bone spavin, but a traumatic event, such as jumping or vigorous training, is usually required to cause its development. Quittor:  A chronic, purulent, inflammatory swelling of the lateral cartilage resulting in intermittent subcoronary abscesses is called quitter.  The condition may be caused by a trauma, puncture, bruise, or laceration near the coronary band. Seedy Toe:  Another problem of the white line of the hoof is seedy toe, a condition where the hoof wall separates at the toe.  Good hoof-trimming practices and proper first aid will usually correct or control the condition. Unsoundness:  The majority of the unsoundnesses in the horse result in lameness.  Cracked Hooves or Sand Cracks:  Cracked hooves, usually found on the feet of unshod horses, indicate neglect in the care of the foot.  They may be called quarter crack, toe crack, or heel

crack, depending upon their location on the hoof.  Hoof cracks vary in length and depth.  When a crack reaches the coronet or the sensitive laminae, lameness usually results  . Contracted Heels:  Contracted heels is a condition in which the frog is narrow and shrunken and the heels of the foot are pulled together.  The foot may become smaller at the ground surface than the coronary band. Grease, Grease-heel, or  Scratches:  An inflammation of the back of the pastern is called grease, grease-heel, or scratches.  It leads to a chronic dermatitis that results in scabs, skin cracks and eventually granulation clusters.  While the case is unknown, constant moisture, mud, manure and long coarse hair in the region all encourage its onset Thrush:  Thrush is an infection of the frog of the foot that is quite common in stabled horses.  It is caused by an anaerobic organism that causes necrosis of the tissue of the frog and a foul, blackish discharge.  Extreme cases can lead to lameness and may require veterinary attention. Generally, when treated early and if proper sanitation is followed, the condition can be easily controlled. Gravel:  Gravel is an infection that penetrates the white line of the sole and travels under the hoof wall between the sensitive and insensitive laminae until it abscesses at the coronet.  The term

“gravel” arises because a piece of stone is sometimes the causative agent but any wound, crack, bruise, or infection to the area can have similar symptoms  . Navicular Disease:  Navicular disease is any injury of the navicular bone of the front foot.  Faulty conformation and injuries are the most important causes of navicular disease.  A straight pastern and shoulder or a small foot will increase the concussion on the navicular bone, thus forcing it against the flexor tendon and causing excess friction and possible damage.  Horses worked repeatedly on hard surfaces are predisposed to the disease, which often affects horses during their prime years (ages 6 to 10).  The disease usually begins as an inflammation of the navicular bursa.  The term “navicular disease” is also applied to the chipping or fracture of the navicular bone which may or may not be caused by earlier navicular disease damage.  As a last resort, permanent relief from pain can be accomplished by a posterior digital neurectomy (nerving), but other complications can then arise.  A horse that has had a neurectomy is considered unsound even if there are no outward signs of pain or lameness.

Osselets)Osslets, Periostitis and serous arthritis ( --------------------------------------------------------------------------------Osselets refer to an inflammation, usually bilateral, of the periosteum on the dorsal distal epiphyseal

surface of the third metacarpal bone and the associated capsule of the fetlock joint. The proximal end of the first phalanx may also be involved. Hence, osselets constitutes a form of periostitis and serous

arthritis that may progress to degenerative joint disease. The exciting cause is the strain and repeated trauma of hard training in young horses and is recognized as an occupational hazard of the young

Thoroughbred .The gait is short and choppy. Palpation and flexion of the fetlock joint produce pain, and examination

reveals a soft, warm, sensitive swelling over the front and sometimes the side of the joint. Radiography in the initial stages may show no evidence of new bone formation, in which case the condition is called

“green osselets.” Later, enthesopathy may be seen in the area of attachment of the fetlock joint capsule to the large metacarpal bone and first phalanx. New bone or spur formation may break off and appear as

“joint mice”. Rest is very important and can be curative for early cases. The inflammation may be relieved by the

application of cold packs for several days. Systemic anti-inflammatory drugs such as phenylbutazone may also be used. Corticosteroid can also be injected intra-articularly; however, this and other forms of anti-

inflammatory medication, if used along with continued training or racing, inevitably lead to destruction of the joint surfaces. Intra-articular sodium hyaluronate is useful to reestablish normal synovial viscosity.

Hygroma --------------------------------------------------------------------------------A hygroma is inflammation of an acquired bursa (one that

develops as a result of trauma where normally there is no bursa) over the dorsal aspect of the carpus. There is

accumulation of excessive bursal fluid and thickening of the bursal wall by fibrous tissue. Lameness is not usually present.

The diagnosis is made by palpation and visualization. Hygromas can be treated in the early stage with drainage,

steroid injections, and bandaging. Later, the implantation of drains is required.

sesamoiditis The sesamoid bones are maintained in position by the suspensory ligament proximally and

by a number of sesamoidean ligaments distally. Due to the great stress placed on the fetlock during fast exercise, the insertion of some of these ligaments can tear, which

results in sesamoiditis.The clinical signs are similar to, but less severe than, those resulting from sesamoid

fracture. Depending on the extent of the damage, there are varying degrees of lameness and swelling. Reduced speed may be the only manifestation of lameness. Pain and heat are evident on palpation and flexion of the fetlock joint. The radiographic features include periosteal new bone proliferation or osteolytic lesions (or both), particularly on the abaxial

surface of the affected sesamoid, and radiolucent lines, which look similar to fracture lines except there is no fragment distraction, running obliquely across the bone. These lines are

prominent vascular channels. Oblique radiographic views are essential for accurate diagnosis and evaluation.

Despite various treatments, the prognosis is guarded or poor. Even after 9-12 mo rest, many horses become lame 6-8 wk after resuming training. The recommended treatment is

a 2- to 3-wk course of phenylbutazone. For mild sesamoiditis, ≥6 mo rest is required; for severe cases, 9-12 mo.

Windgalls)Windpuffs ( --------------------------------------------------------------------------------These puffy, fluid-filled swellings around the fetlock joints (of

either or both fore- and hindlimbs) usually are not accompanied by heat, pain, or lameness. They are said to be associated with

trauma and hard exercise, but the exact pathogenesis is uncertain. Although usually benign, windgalls should be

regarded with suspicion in the presence of lameness. Some horses, particularly heavy ones, seem to be more susceptible.

Treatment is problematic; in the absence of lameness, it is unwarranted. Windgalls may disappear spontaneously or

respond to periods of rest, bandaging, and exercise. Recurrence is common

Desmitis or Sprain of the Inferior Check Ligament ------------------------------------------------------------------------------- Inferior check ligament desmitis is a commonly made diagnosis and is

often confused with desmitis of the proximal suspensory ligament. Before the use of diagnostic ultrasound, the differentiation was difficult.

The primary clinical sign is lameness that is alleviated by infiltration of anesthetic behind the proximal aspect of the metacarpus. Anesthetic

injected in this area, however, may infiltrate outpouchings of the carpometacarpal joint in >30% of horses, leading to analgesia of both the carpometacarpal and intercarpal joints. Therefore, a local block of

the proximal aspect of the palmar metacarpal nerves is preferable. This condition has been treated conservatively in the past, but

sectioning of the ligament has been performed more recently with good results.

Fractures of the Small Metacarpal and Metatarsal (Splint) Bones -------------------------------------------------------------------------------- Fractures of the second and fourth metacarpal and metatarsal (splint) bones are not

uncommon. The cause may be from direct trauma, such as interference by the contralateral leg, but splint fractures more often follow a suspensory desmitis (see

Suspensory Desmitis) and the resulting fibrous tissue buildup and encapsulation of the distal, free end of the bone. The usual site of these fractures is through the distal end, ~2

in. (5 cm) from the tip. Immediately after the fracture occurs, acute inflammation is present, usually involving the suspensory ligament. A supporting-leg lameness is noted, which may

recede after several days rest and recur only after work .Chronic, longstanding fractures cause a supporting-leg lameness at speed. Thickening of

the suspensory ligament at and above the fracture site results. The fracture may show a considerable buildup of callus at the fracture site but little tendency to heal .

Diagnosis is confirmed by an oblique radiograph. Surgical removal of the fractured tip and callus is the treatment of choice. The prognosis is based on severity of the associated

suspensory desmitis, which has a greater bearing on future performance than the splint fracture itself.

Fracture of the Third Metacarpal (Cannon) Bone A transverse fracture in the midmetacarpal region can result from direct trauma, usually

from a kick. The stress of racing on a hard surface may result in a longitudinally oblique (ie, condylar) fracture that progresses up the metacarpal shaft from the fetlock and

sometimes also involves the proximal sesamoids. Incomplete fractures of the dorsal cortex of the midmetacarpal region can occur as stress-type fractures. Diagnosis is confirmed by

radiography; the fissure fractures can be difficult to demonstrate, and a range of oblique views may be necessary.

Midmetacarpal fractures may heal with just a cast, although prolonged immobilization may

be necessary because union is often delayed. Malunion and the encroachment of callus on surrounding tendons and ligaments cause further problems. Internal fixation with

dynamic compression plates and screws is the treatment of choice. Condylar fractures can be treated conservatively by casting, but such articular injuries are best managed by screw fixation using interfragmentary compression if osteoarthritis is to be minimized or avoided.

Fissure fractures also may show delayed union unless a cortical bone screw is applied. (See also bucked shins, Bucked Shins.)

Osteoarthritis (Degenerative Joint Disease) -------------------------------------------------------------------------------- In the carpus, osteoarthritis typically appears with chronic

thickening of the joint, usually associated with capsular fibrosis. There is a decreased range of motion and sometimes a history

of treatment of an acute problem. Radiographic changes develop slowly, and usually the degree of articular cartilage

compromise is severe. Cases that can possibly lead to osteoarthritis should be treated aggressively and correctly.

Treatment of severe osteoarthritis is largely palliative, but debridement and lavage, followed by intra-articular and

systemic therapy, may help. (See also osteoarthritis, Osteoarthritis

Rupture of the Common Digital Extensor Tendon -------------------------------------------------------------------------------- This developmental problem is present at birth or is seen

shortly after. Foals usually show a carpal flexure deformity or a fetlock flexural deformity. If the condition is not noticed

immediately, secondary contracture of the flexor muscle-tendon unit develops. The condition is confirmed by palpation of the

swollen disrupted ends of the extensor tendon within the tendon sheath over the carpus. Management involves

preventing secondary tendon contracture with the use of PVC splints to prevent knuckling, if appropriate. Healing will occur.

Splints)Metacarpal exostosis (-------------------------------------------------------------------------------- Splints primarily involve the interosseous ligament between the large (third) and small (second)

metacarpal (less frequently the metatarsal) bones. The reaction is a periostitis with production of new bone (exostoses) along the involved splint bone. Trauma from concussion or injury, strain from excess

training (especially in the immature horse), faulty conformation, imbalanced or overnutrition, or improper shoeing may be contributory factors .

Splints most commonly involve the medial rudimentary metacarpal bones. Lameness is seen only when splints are forming and is seen most frequently in young horses. Lameness is more pronounced after the

horse has been worked. In the early stages, there is no visible enlargement, but deep palpation may reveal local painful subperiosteal swelling. In the later stages, a calcified growth appears. After ossification, lameness disappears, except in rare cases in which the growth encroaches on the

suspensory ligament or carpometacarpal articulation. Radiography is necessary to differentiate splints from fractured splint bones .

Complete rest and anti-inflammatory therapy is indicated. Intralesional corticosteroids may reduce inflammation and prevent excessive bone growth. Their use should be accompanied by counterpressure bandaging. In Thoroughbreds, it has been traditional to point-fire a splint, the aim being to accelerate the ossification of the interosseous ligament; however, in most cases, irritant treatments are contraindicated.

If the exostoses impinge against the suspensory ligament, surgical removal may be necessary.

Synovial Hernia and Ganglion and Synovial Fistulae -------------------------------------------------------------------------------- These conditions are relatively uncommon, but are important in

the differential diagnosis of fluid-filled swellings over the dorsal aspect of the carpus. A synovial hernia is a cyst arising from

herniation of synovial membrane through a defect in the fibrous joint capsule or fibrous sheath of a tendon. Diagnosis of these

conditions is confirmed with contrast radiography; if accessible, the hernia or fistula is surgically repaired

Tenosynovitis of the Tendon Sheaths Associated with the Carpus -------------------------------------------------------------------------------- There are several forms of tenosynovitis, including idiopathic, acute traumatic, chronic traumatic, and

septic. In the idiopathic form, there is no lameness and synovial effusion localized to the tendon sheath is the only manifestation. It may be seen in the common digital extensor tendon sheath or the extensor carpi

radialis tendon sheath; these can be differentiated by knowledge of anatomy. Traumatic forms of tenosynovitis are seen in older animals. In the acute stage, there is fluid distention; in the chronic stage, fibrosis may be present as well. Treatment consists of systemic and local anti-inflammatory therapy (eg,

phenylbutazone therapy for 5-7 days). DMSO can be applied topically to the injured area for 7-10 days. In chronic cases in jumpers, surgical debridement may be helpful. Septic tenosynovitis of the carpus is rare.

When it is seen, there are acute signs of lameness, heat, and swelling as seen in septic arthritis.Traumatic Synovitis and Capsulitis ------------------------------------------------------------------------------- Traumatic synovitis and capsulitis is inflammation of the synovial membrane and fibrous capsule with no

apparent radiographic involvement of bone or other structures. Soft tissues involved can include synovial membrane, fibrous joint capsule, and intra-articular ligaments. Synovitis and capsulitis of the carpus is a

common primary clinical condition but also may be accompanied by radiographically unapparent osteochondral damage. The cause is usually considered to be cyclic trauma .

Clinical signs include varying degrees of lameness with local heat and swelling. In chronic synovitis and capsulitis,

radiographs may show enthesophytes or osteophytes, but in many instances there are no significant radiographic changes.

Treatment is as described under osteoarthritis (see Osteoarthritis (Degenerative Joint Disease)). The most

common treatments are intra-articular corticosteroids, alone or in combination with hyaluronic acid, as well as systemic

NSAID. If carpal synovitis and capsulitis do not respond to intra-articular therapy, diagnostic arthroscopy is indicated to

eliminate medial palmar intercarpal ligament tearing, osteochondral fragmentation not visible on radiographs, or

osteochondral degenerative disease.

Arthritis of the Shoulder Joint -------------------------------------------------------------------------------- Inflammation of the structures of the shoulder joint is uncommon. It is secondary to

changes in the joint capsule or, more frequently, to bony changes of the articular surfaces of the humerus or scapula (such as might be caused by osteochondrosis). Occasionally,

fractures involving the articular surfaces are present. Trauma to the point of the shoulder is a frequent cause. Bacterial infection of the joint from puncture wounds or of

hematogenous origin (pyosepticemia) in foals results in a purulent arthritis .A swinging- and supporting-leg lameness are present in severe cases. In milder cases,

only the swinging-leg lameness may be noted. The forward phase is shortened, the toe may be worn, and the leg is often circumducted to avoid flexion of the joint. Forced

extension of the leg, which pulls the shoulder forward, often causes pain. Radiographs of the shoulder joint, preferably taken with the horse in lateral recumbency, may demonstrate

the arthritic changes.Often, treatment is ineffective because of severe arthritic changes. Intra-articular injections

of a steroid may be of some benefit. Systemic steroids or phenylbutazone may relieve signs of pain. Hyaluronic acid, because of its apparent benefit in cases of degenerative

disease in other joints, may be considered

Bicipital Bursitis ------------------------------------------------------------------------------- Bicipital bursitis is an inflammation of the bursa between the tendon of the

biceps and the bicipital groove of the humerus. The usual cause is direct trauma to the point of the shoulder .

Essentially, bicipital bursitis results in a swinging-leg lameness with the forward phase being shortened. The horse may stumble because the toe is not being

lifted sufficiently to clear the ground. In severe cases, a supporting-leg lameness is also present; the horse rests the limb in a characteristic semiflexed

position. Forced extension of the leg usually causes a pain reaction, as can deep digital pressure over the bursa and the tendon of the biceps.

Ultrasonography can demonstrate the excess fluid and associated lesions of the biceps tendon. In chronic cases, radiographs may show calcification of the

bursa, which is a common sequela .Prolonged rest is indicated (>6 mo), particularly in acute cases. Intrabursal

injection of hyaluronic acid or steroids may be successful. Phenylbutazone and oral steroids may also be helpful. The prognosis is guarded.

Sweeney)Shoulder atrophy, Slipped shoulder (-------------------------------------------------------------------------------- Sweeney is disuse or neurogenic atrophy of the supraspinatus and infraspinatus muscles. Disuse atrophy, sometimes involving

the triceps also, follows any lesion of the limb or foot that leads to prolonged diminished use of the limb. Neurogenic atrophy is due to damage to the suprascapular nerve, which supplies the supraspinatus and infraspinatus muscles. Polo ponies are

occasionally affected because of collision during competition .If trauma is not evident, pain may be absent, and lameness may be difficult to detect until atrophy develops. If injury is evident,

there is usually some difficulty in extending the shoulder. As atrophy progresses, there is a noticeable hollowing on each side of the spine of the scapula, especially in the infraspinous area, resulting in prominence of the spine. Because the tendons of

insertion of the two affected muscles act as lateral collateral ligaments to the humeroscapular joint, atrophy of the muscles leads to a looseness in the shoulder joint. Abduction of the shoulder follows and, in severe cases, is sometimes erroneously

diagnosed as a dislocation. The affected limb, when advanced, takes a semicircular course and, as weight is borne by the limb, the shoulder joint moves laterally (shoulder slip). At rest, along with abduction of the shoulder, there is an apparent abduction of

the lower part of the limb .Treatment for disuse atrophy consists of removing the cause of the failure to use the limb. For neurogenic atrophy, massage

with stimulating liniments or by an electrical vibrator may be of benefit. Rhythmic muscular contractions by faradism have maintained muscle bulk until the nerve regenerates. Surgical release of the suprascapular nerve from scar tissue impingement,

by “notching out” the rostral border of the scapula, has also been recommended. For best results, the surgery should be performed before looseness and slipping of the shoulder joint are advanced.

The prognosis for cases of disuse atrophy depends on removal of the primary cause. In neurogenic atrophy, the prognosis is

guarded; mild cases should recover in 6-8 wk. When damage to the nerve has been severe, spontaneous recovery may take many months, if it occurs at all. Such cases are candidates for surgical release. If the nerve has been severed, recovery is

unlikely

Hygroma: IntroductionA hygroma is a false bursa that develops over bony prominences and

pressure points, especially in large breeds of dogs. Repeated trauma from lying on hard surfaces produces an inflammatory response, which results in a dense-walled, fluid-filled cavity. A soft, fluctuant, fluid-filled,

painless swelling develops over pressure points, especially the olecranon. If longstanding, severe inflammation may develop, and

ulceration, infection, abscesses, granulomas, and fistulas may occur. The bursa contains a clear, yellow to red fluid.

If diagnosed early and if still small, hygromas can be managed medically via aseptic needle aspiration, followed by corrective housing.

Soft bedding or padding over pressure points is imperative to prevent further trauma. Surgical drainage, flushing, and placement of Penrose

drains are indicated for chronic hygromas. Areas with severe ulceration may require extensive drainage, extirpation, or skin grafting procedures. Use of intrahygromal corticosteroids is not recommended .