Chapter 5

The average subject is best observed by being led, rather than being ridden, and in so doing the animal should be given moderately free rein. A close grasp on the lead may interfere somewhat with head movements. Nodding of the head with the catching up of weight by a sound member in supporting-leg-lameness of a fore leg, constitutes the chief symptom considered in detecting the lame leg.

Where supporting-leg-lameness affects a hind limb the head is raised at the time weight is caught by the sound member--here the long axis of the subject's body may be likened unto a lever of the first class. The posterior part of the body, at the time weight is taken upon the sound leg, is as the long arm: the fore limbs the fulcrum, and the subject's head the weight, which is lifted. The head movements of a horse at a trot, in supporting-leg-lameness of a front leg, synchronize with the discharge of weight from a lame leg to the opposite one if sound; but in pelvic limb affections, the head is thrown or jerked upward as weight is caught by the sound member,--this peculiar nodding movement is _opposite_ in the two instances.

In pacing horses, since front and hind legs of the same side are advanced at the same time, there occurs in supporting-leg-lameness, a nodding of the head with discharge of weight from the lame leg, and a dropping of the hip as weight is caught by the sound pelvic member. In observing animals that are limping, (as in supporting-leg-lameness) one notices particularly the sacro-iliac region in hind leg affections and the occipital region in lameness of the front legs.

Where there exists a bilateral affection, (such as characterizes some cases of navicular disease or other affections causing supporting-leg-lameness) there occurs no nodding of the head; weight is supported for an equal length of time upon each one of the two legs, but the stride[4] is shortened. The gait, in such cases, is peculiar, animals appearing stiff and they are said, by horsemen, to have a "choppy" gait.

It is desirable, in some cases, to cause an animal to move from side to side; in other instances the subject is best made to walk or trot in a circle, and if the circle be very small the animal then particularly employs the inner fore leg as a pivotal supporting member. To augment the manifestation of certain affections, it is necessary to cause the patient to walk backward, and each one of these tests of locomotion serves to point out in a more or less characteristic manner, the site of the affection which is causing lameness in different cases.

Sprains or injuries of lateral ligaments of the extremities, ringbone and certain foot affections, are made manifest by a side to side movement or a pivotal movement. In fact, wherever it is possible to cause undue or unusual tension to be exerted upon an inflamed structure, manifestation of pain is the response. In an inflamed condition of the lateral side of the phalanges, unequal weight-bearing such as a rough road surface will, by virtue of the leverage which the solar surface of the foot affords, cause undue strain upon such inflamed parts, and increased lameness is evident.

When an animal is made to travel in a circle, when a member affected with supporting-leg-lameness is on the inner side of the circle, lameness is accentuated because weight is borne by the lame leg for a greater length of time, the result of such circuitous manner of locomotion. In swinging-leg-lameness, on the other hand, because pain is increased at the time an affected member is being advanced, lameness is increased when the subject is made to travel in a circle, with the lame leg on the outside of a circle thus described.

In supporting-leg-lameness, the transientness of the weight-bearing period upon the affected member is the determining factor in the production of lameness. This unequal period of weight-bearing upon the front legs, for instance, causes an acceleration in the advancement of the sound member, in order to relieve the diseased one which is bearing weight. In other words, when an animal that is affected with supporting-leg-lameness travels in a straight line, since weight is borne by the diseased leg for an abnormally short period of time, the sound member needs be in the act of advancement a correspondingly short period. The result is then, an unequal division of stride; a nodding of the head with the catching up of weight by the sound leg,--in front leg affections--and this is termed _limping_.

With continuous exertion as in travel for a considerable distance, in some cases, lameness becomes less evident--as in spavin. This "warming out" process is due in a measure to the parts becoming less sensitive upon exertion, and is to be seen, to a limited extent, in all inflammatory affections that are not too severe; consequently, in some cases, examination of a lame animal should begin in the stall, for in instances where the impediment is not marked, there may be no evidence of lameness after the subject has walked a few steps. In other cases, lameness increases as the subject continues to travel, and often to the extent that the impediment becomes too severe to allow the animal being serviceable. Therefore, one can not, in every case of lameness observed, positively determine the gravity of the situation, without having seen the affected animal in action for a sufficient length of time to understand the nature of the condition existing. This necessitates driving the animal for several miles in certain cases.

Sometimes it is impossible to arrive at any definite conclusion, as the result of a single examination, and it then becomes necessary to see the subject again at a later date, or under more favorable circumstances. This is to be expected in some conditions where there exists rheumatic affections, and also in some foot diseases.

In the examination of young animals, unused to harness and to other strange incumbrances, one is obliged to make allowance for impediments of gait, which are not occasioned by diseased conditions. Such affections have been termed "false lameness." Young mules that are not well broken to harness, are difficult subjects for examination and in some cases it is necessary to have them led or driven for a considerable distance before one can definitely interpret the nature of the impediment in the gait when lameness is not pronounced. It is especially difficult to satisfactorily examine such subjects, for the reason that their normal rebellious temperaments cause resistance whenever a strange person approaches them, as it is necessary to do for an examination by palpation. In such cases--if an examination does not reveal the cause of trouble, rest must be recommended and further examination made at a later date, whereupon any new developments may be noted, if such changes exist.

Special Methods of Examination.

After having completed a general examination of a lame animal--obtaining the history of the case, noting its temperament, type, size, conformation, position assumed while at repose, swellings or enlargements if present, causing the subject to move to note the degree and character of lameness manifested; palpating and manipulating the parts affected to acquire a fairly definite notion of the nature of an inflammation or to recognize crepitation it becomes necessary in some cases to employ peculiar means of examination in singular instances. This may be done by making use of cocain in solution for the production of local anesthesia as in lameness of the phalanges. Such means are not, in themselves, dependable but are valuable when used in conjunction with all other available and practical methods.

Trial use of various shoes in order to shift the weight from one part of the foot to another or to cause an animal to "break over" in a different manner so that the gait may be changed, constitutes a special test procedure. The use of hoof testers or of a hammer to note the degree or presence of supersensitiveness is another means that is of practical service. No examination, in any case of lameness, is complete without having removed the shoe and scrutinized the solar surface of the foot.

Diagnosis by exclusion, finally, is resorted to, and, as in any other case where the recognition of cause is difficult, exclusion of the existence of conditions,--one at a time, by an analysis of symptoms--generally enables the practictioner to eliminate all but the disturbing element.

FOOTNOTES:

[Footnote 4: By stride is meant the distance between two successive imprints of the same foot. The term is not used in this work as being synonymous with step.]

SECTION III.

LAMENESS IN THE FORE LEG.

Anatomo-Physiological Review of parts of the Fore Leg.

For supporting weight, whether the subject is at rest or in motion, the bony column of the leg, together with attached ligaments, tendons and muscles, is wonderfully well adapted by nature for the function which they perform. The several bones which go to make up the supportive portion of the leg, are so joined at their points of articulation, that a minimum degree of strain is put upon each attachment.

The upper third of the scapula, with its cartilage of prolongation, is sufficiently broad and flattened that it fits snugly against the thorax without necessity for a complicated method of attachment--the clavicle being absent, attachment is muscular.

Smith[5] has very aptly stated that:

"It seems quite legitimate to regard the muscular union between the thorax and forelimb as a joint. There are no bones resting on each other, no synovia; but where the scapula has its largest range of movement there is a remarkable amount of areolar tissue, which renders movement easy. The whole central area beneath the scapula and humerus not occupied by muscular attachment, is filled with this easy-moving, apparently gaseously distended, crepitant, areolar tissue over which the fore legs glide on the chest wall as freely as if the parts were a large, well lubricated joint."

The scapulohumeral articulation (shoulder joint) is an enarthrodial (ball and socket) joint but because of its being held more or less firmly against the thoracic wall by muscular and tendinous attachment, and because a part of this attachment affords a means of support for the body itself, there is no need for binding ligaments and movement is possible in all directions even though restricted as to extent.

Undue extension, (by extension is meant such movement as will cause the long axis of two articulating bones to assume a position which approaches or forms a straight line--opposite to flexion), of the scapulohumeral joint is impossible while weight is borne, because of the normally flexed position of the humerus on the scapula; whereas flexion, beyond desirable limits, is inhibited by the biceps brachii (flexor brachii or coracoradialis) muscle.

The distal end of the humerus, however, articulating with the radius and ulna in a fashion that no support is lent by any sort of contact with the body, is a ginglymus (hinge) joint and lateral motion, because of the long transverse diameter of its articular portions, is easily prevented by the medial and lateral ligaments (internal and external ligaments). Flexion of this, the humeroradioulnar joint (elbow), is restrained by the triceps brachii and extension is checked by the biceps brachii (flexor brachii).

The carpal joint (erroneously called the knee joint), is composed of the several carpal bones which interarticulate and, when taken as a group, serve as a means of attachment and articulation for the radius and metacarpal bones.

The transverse diameter of this joint is long, thus giving it contacting surfaces that are sufficiently extensive to minimize the strain upon the mesial and lateral ligaments (internal and external lateral common ligaments). Motion is that of flexion and extension; slight rotation is possible when the position is that of flexion. While supporting weight the carpus is fixed in position by a slight dorsal flexion, but undue dorsal flexion is prevented by the flexor muscles and tendons and volar-carpal or annular ligament, together with the superior check ligament.

The metacarpophalangeal articulation (fetlock joint), is a hinge joint and its articular surfaces contact one another, with respect to their having a long bearing surface from side to side, as do all ginglymus (hinge) joints. Two common lateral ligaments bind the bones together. While bearing weight, there is assumed a position of slight dorsal flexion, undue flexion being checked by the inhibitory apparatus of the joint--check ligaments, and their tendons and the suspensory ligament. The inhibitory apparatus of the fetlock joint is materially reinforced by the proximal sesamoid bones. Situated as they are, between the bifurcating portions of the suspensory ligament and the posterior part of the distal end of the metacarpus--with which they articulate--the sesamoid bones serve to change the course of the branches of the suspensory ligament in a manner that they give firm support to this joint. Volar flexion is limited by the extensors of the phalanges.

The first phalanx (os suffraginis) normally sets at an angle of about 50 to 55 degrees from a horizontal plane while weight is being supported. Its distal end articulates with the second or median phalanx (os corona) and forms the proximal interphalangeal (pastern or suffraginocoronary) joint. This also, is a ginglymus joint, having but slight lateral motion, and that only when it is in a state of flexion. A rather broad articular surface--from side to side--exists here, lessening the strain on the collateral ligaments somewhat. Dorsal flexion is checked by the flexor tendons and dorsal ligaments. Volar flexion is restrained by the extensor tendons.

The distal end of the second phalanx (os corona) has but slight lateral motion and this is manifested principally when it is in a state of volar flexion. Undue dorsal flexion is prevented by the deep flexor tendon (perforans) and volar flexion is inhibited by the extensor of the digit (extensor pedis). Thus it is seen, that when the leg is a weight-bearing member, weight is supported by the bony framework whose constituent parts are joined together by ligaments and tendons and each one of the several bones articulates in such manner that the joint is locked. The articular parts of bones rest upon or against an inhibitory apparatus, and are slightly flexed, as in the carpus, or considerably flexed such as in the fetlock joint when weight is being supported. In the first instance, for example, the flexors of the carpus and the superior check ligament assisted by the flexors of the phalanges constitute the inhibitory apparatus.

It will be noted that provision for weight bearing is so arranged that muscular energy is not required except in the matter of suspension of the body between the scapulae and here tonic impulses only are necessary to maintain an equilibrium[6], yet in every instance where weight is not supported by bones, inelastic ligaments or tendinous structures relieve the musculature of this constant strain. This explains the fact that some horses do not lie in the stall, yet in spite of their constant standing position, they are able to rest and sleep.

The student of lameness is interested in the function of the legs in the rôle of supporting weight and as propelling parts, and not particularly in the capacity of these members for inflicting offense or as weapons of defense. Yet, in the exercise of their functions other than that of locomotive appliances, injury often results, but usually it is the recipient of a blow that suffers the injury, such as an animal may receive upon being kicked. Therefore, we do not often concern ourselves with strains or other injuries that the subject experiences as the result of efforts put forth in kicking or striking. Where such injuries occur, however, a diagnosis is established by making use of the principles heretofore discussed.

As propelling members the front legs bear weight and are advanced alternately when the horse is walking or trotting--in cantering this is not so. When the normal subject travels in a straight line, at a walk or a trot, the length of the stride is the same with the right and left members. The stride of the right foot then, for example, is equally divided by the imprint of the left foot, in the normal horse, when traveling at a walk and in a straight line.

Shoulder Lameness.

This enigmatical term is frequently employed by the diagnostician when he is baffled in the matter of definitely locating the cause of lameness; when he has by exclusion and otherwise arrived at a decision that lameness is "high up." Shoulder lameness may be caused by any one or several of a number of conditions, e.g., fractures of the scapula or humerus; arthritis of the shoulder or elbow joint; luxation of the shoulder or elbow joint (rarely); injuries of muscles and tendons of the region due to strains, contusions or penetrant wounds; paralysis of the brachial plexus or of the prescapular nerve; involvement of lymph glands; arterial thrombosis; metastatic infections; rheumatic disturbances; and as the result of inflammation, infectious or non-infectious occasioned by collar bruises. In some instances such inflammation is due to the manner of treatment of collar injuries. Therefore, when one considers the numerous and dissimilar possible causes of shoulder lameness, it behooves the practitioner to become proficient in diagnostic principles.

A principle which is elemental in the diagnosis of locomotory impediment, is that lameness of the shoulder or hip is usually manifested by more or less difficulty in swinging the affected member. Swinging-leg-lameness, then, is usually present in shoulder affections. In some instances lameness is mixed as in joint ailments, involvement of the bicipital bursa (bursa intertubercularis), etc. In affections of the extremity there exists supporting leg lameness. Consequently, we employ this elemental principle, and, by a visual examination of the subject, which is being made to travel suitably, one may decide that lameness is either "high up"--shoulder lameness or, "low down"--of the extremity.

To make practical use of this principle, the examiner must be thoroughly familiar with the anatomy of the various structures concerned in advancing the leg--those which support weight as well as those concerned both in weight bearing and swinging the member.

Fracture of the Scapula.

Etiology and Occurrence.--Fractures of the body of the scapula are of infrequent occurrence in horses for the reason that protection is afforded this bone because of its position. Its function, too, is such that very unusual conditions are necessary to subject it to fracture. The spine is occasionally broken due to blows such as kicks, etc., and here frequently a compound fracture exists.

Where fractures of the body of the scapula occur, heavy contusions have been the cause as a rule, and serious injury is done the subject; consequently, treatment of fracture of the body of the scapula is seldom successfully practised. Fractures of the body of this bone resulting from accidents not involving internal injury or other disturbances and which would not seriously interfere with the vitality of the subject, are not necessarily serious unless compound.

Fractures of the neck of the scapula are serious because of the fact that there occurs displacement of the broken parts and perfect apposition of the fractured ends is difficult, if not impossible.

Fractures that extend to the articular surface are very serious, and complete recovery in such instances is practically impossible. The cartilage of prolongation of the scapula is sometimes seriously involved in certain cases of fistulous withers, and in some instances it has been separated from its attachment to the rhomboidea muscles, and lameness has resulted. In such instances, the upper portion of the scapula is disjoined from all attachment, and with every movement the animal makes, the scapula is moved back and forth. Complete recovery in such cases does not occur.

Symptomatology.--Fractures of the scapular spine are ordinarily readily recognized because there is usually visible displacement of the broken part. Crepitation is also detected without difficulty.

In fractures of the body of the scapula where an examination may be made before much swelling has taken place, and in subjects that are not heavily muscled, one should have no difficulty in recognizing the crepitation.

Fractures of the neck of the scapula are recognized by crepitation, by passively moving the leg, but it is necessary to exclude fractures of the humerus when one depends upon the finding of crepitation by this means. However, unless undue swelling exists, the exact location of the crepitation is recognized without serious difficulty.

Treatment.--The treatment of compound fractures of the scapular spine consists in the removal of the broken piece of bone by way of a cutaneous incision so situated that good drainage of the wound will follow.

Simple fractures of the body of the scapula are best treated by placing the subject in a sling, if the animal is halter broken, and enforcing absolute quiet for a period of from three to six weeks. Splints or similar appliances are not of practical value in scapular fractures.

Compound fractures of the scapula usually result from violence, which at the same time does serious injury to adjacent structures, and it then becomes necessary to administer an expectant treatment, observing general surgical principles and providing in so far as possible for the comfort of the patient.

Scapulohumeral Arthritis.