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Webster Family Library of Veterinary Medicine
Cummings School of Veterinary Medicine at
Tufts University
200 Westboro Road
North Grafton, MA 01 536
V E T E R I X A R Y PRACTITIONERS' SERIES
N O. 1
LAMENESS of the HORSE
BY
J. V. Lacroix, D. V. S.
Professor of Surgery, The Kansas City Veterinary College
Author of "Animal Castration"
Illustrated
Chicago
AMERICAN JOURNAL OF VETERINARY MEDICINE
1916
Copyright, 1916
By
D. M. CAMPBELL
PREFACE
AH that can be known on the subject of lameness, is founded
on a knowledge of anatomy and of the physiology of locomotion.
Without such knowledge, no one can master the principles of
the diagnosis of lameness. However, it must be assumed that
the readers are informed on these subjects, as it is impossible
to include this fundamental instruction in a work so brief as
this one.
The technic of certain operative or corrective procedures, has
been described at length only where such methods are not gener-
ally employed. Where there is no departure from the usual
methods, treatment that is essentially within the domain of sur-
gery or practice is not given in specific detail.
Realizing the need for a treatise in the English language
dealing with diagnosis and treatment of lameness, the author
undertook the preparation of this manuscript. That the dif-
ficulties of depicting by means of word-pictures, the symptoms
evinced in baffling cases of lameness, presented themselves in
due course of writing, it is needless to say.
It is hoped that this volume will serve its readers to the end
that the handling of cases of lameness will become a more satis-
factory and successful part of their work; that both the prac-
titioner and his clients may profit thereby; and last but by no
means least, that the horse, which has given such incalculable
service to mankind and is deserving of a more concrete reward,
will be benefited by the application of the principles herein out-
lined.
In addition to the consultation of standard works bearing on
various phases of the subject of lameness, the author wishes to
thankfully acknowledge helpful advice and assistance received
from the publisher. Dr. D. ]\I. Campbell ; to appreciatively credit
Drs. L. A. Merillat, A. Trickett and F. F. Brown for valuable
suggestions given from time to time. Particular acknowledg-
ment is made to Dr. Septimus Sisson, author, and W. B. Saun-
ders & Co., publishers of The Anatomy of Domestic Animals,
for permission to use a number of illustrations from that work.
J. V. L.
Chicago, Illinois, October, 1916.
Justice shows a triumphant face at the works of
humane practitioners, ivho give serious thought
and expend honest effort, for the alleviation of
animal suffering.
TABLE OF CONTENTS
Page
Illustrations "^
Introduction 11
SECTION I
Etiology and Occurrence 15
Affections of Bones 15
Rarefying Osteitis, or Degenerative Changes 16
Fractures --- 16
Affections of Ligaments 20
Luxations — Dislocations 21
Arthritis 22
Affections of Bursae and Thecae 27
Affections of Muscles and Tendons 28
Affections of Nerves 30
Affections of Blood Vessels 31
Affections of Lymph Vessels and Glands 32
Affections of the Feet 34
SECTION II
Diagnostic Principles 37
Anamnesis 38
Visual Examination 39
Attitude of the Subject 41
Examination by Palpation 43
Passive Movements 47
Observing the Character of the Gait 48
Special Methods of Examination 53
SECTION III
Lameness in the Fore Leg
Anatomo-Physiologieal Review of Parts of the Fore Leg 55
Shoulder Lameness 61
Fracture of the Scapula 62
Page
Scapulohumeral Arthritis 65
Infectious Arthritis 66
Injuries 66
Wounds 67
Luxation of the Scapuloluuneral Joint 67
Inflammation of the Bicipital Bursa 68
Contusions of the Triceps Brachii 71
Shoulder Atrophy (Sweeny) 73
Paralysis of the Suprascapular Nerve 75
Radial Paralysis _ 77
Thrombosis of the Brachial Artery 81
Fracture of the Humerus 82
Inflammation of the Elbow 84
Fracture of the Ulna _. 86
Fracture of the Radius 87
Wounds of the Anterior Brachial Region 90
Inflammation and Contraction of the Carpal Flexors 93
Fracture and Luxation of the Carpal Bones 96
Carpitis 98
Open Carpal Joint 100
Thecitis and Bursitis 104
Fracture of the INIetacarpus 106
Splints 107
Open Fetlock Joint -- 110
Phalangeal Exostosis (Ring'l)one) 118
Open Sheath of the Flexors of the Phalanges 124
Luxation of the Fetlock Joint 125
Sesamoiditis 127
Fracture of the Proximal Sesamoids 128
Inflammation of the Posterior Ligaments of the Pastern.
Proximal Interphalangeal Joint 129
Fracture of the First and Second Phalanges ...131
Tendinitis (Inflammation of the Flexor Tendons).. 135
Chronic Tendinitis and Contraction of the Flexor Tendons.. ..137
Contracted Tendons of Foals..^ 143
Rupture of the Flexor Tendons and Suspensory Ligament... 146
Tliecitis and Bui-sitis in the P^etloek Region 150
Page
Arthritis of the Fetlock Joint 152
Ossification of the Cartilages of the Third Phalanx ....155
Navicular Disease 157
Laminitis -- IGO
Calk Wounds (Paronychia) 170
Corns -. 172
Quittor 174
Nail Punctures 178
SECTION IV
Lameness in the Hind Leg
Anatomo-Physiological Consideration of the Pelvic Limhs....l85
Hip Lameness 19'5
Fractures of the Pelvic Bones 196
Fractures of the Femur 199
Luxation of the Femur 201
Gluteal Tendo-Synovitis 203
Paralysis of the Hind Leg -204
Paralysis of the Femoral (Crural) Nerve 204
Paralysis of the Obturator Nerve 206
Paralysis of the Sciatic Nerve 208
Iliac Thrombosis - 209
Fracture of the Patella 212
Luxation of the Patella.. 213
Chronic Gonitis 217
Open Stifle Joint 220
Fracture of the Tibia 222
Rupture and AVounds of the Tendo Achillis... 224
Spring-Halt (String-Halt) ..: 225
Open Tarsal Joint 229
Fracture of the Fibular Tarsal Bone (Calcaneum) 230
Tarsal Sprains 232
Curb 233
Spavin (Bone Spavin) 235
Distension of the Tarsal Joint Capsule (Bog Spavin) 242
Distension of the Tarsal Sheath of the Deep Digital Flexor
(Thoroughpin) 246
Page
Capped Hock 251
Rupture and Division of the Long Digital Extensor (Ex-
tensor Pedis) - 2.53
Wounds from Interfering 255
Lymphangitis 257
Authorities Cited 265
Index .- 267
ILLUSTRATIONS
Page
Fig. 1 Hoof Testers 53
Fig. 2 — Muscles of Left Thoracic Limb, Lateral View 56
Fig. 3 — ]\Iiiscles of Left Thoracic Limb, Medial View 57
Fig. 4 — Sagital Section of Digit and Distal Part of Meta-
carpus 59
Fig. 5 — Ordinary Type of Heavy Sling 62
Fig. 6— A Sling Made in Two Parts 63
Fig. 7 — Paralysis of the Suprascapular Nerve of Left
Shoulder 76
Fig. 8— Radial Paralysis 78
Fig. 9 — Merillat's ]\Iethod of Fixing Carpus in Radial
Paralysis 79
Fig. 10 — Contraction of Carpal Flexors, "Knee Sprung".... 95
Fig. 11 — Pericarpal Inflammation and Enlargement Due to
Injury 99
Fig. 12 — Hygromatous Condition of the Right Carpus 100
Fig. 13 — Carpal Exostosis in x\ged Horse 101
Fig. 14 — Exostosis of Carpus Resultant from Carpitis 102
Fig. 15 — Distal End of Radius, Illustrating Effects of
Carpitis 102
Fig. 16 — Posterior View of Radius, Illustrating Effects of
Splint 108
Fig. 17 — Phalangeal Exostoses 120
Fig. 18 — Rarefying Osteitis in Chronic Ringbone 121
Fig. 19 — Phalangeal Exostoses in Chronic Ringbone 122
Fig. 20 — Contraction of Superficial Digital Flexor Tendon
Due to Tendinitis 138
Fig. 21 — Contraction of Deep Flexor Tendon Due to
Tendinitis 139
Fig. 22 — Chronic Case of Contraction of Both Flexor Ten-
dons of the Phalanges 140
Fig. 23 — Contraction of Superficial and Deep Flexor Ten-
dons ...141
Page
Fig. 24 — Contraction of Superficial Digital Flexor and
Slight Contraction of Deep Flexor Tendon 142
Fig. 25— "Fish Knees" 145
Fig. 26 — Extreme Dorsal Flexion 146
Fig. 27 — A Good Style of Shoe for Bracing the Fetlock 148
Fig. 28 — The Roberts Brace in Operation 149
Fig. 29 — Distension of Theca of Extensor of the Digit 151
Fig. 30 — Rarefying Osteitis Wherein Articular Cartilage
Was Destroyed 153
Fig. 31 — Ringbone and Sidebone 156
Fig. 32 — Position Assumed by Horse Having Unilateral
Navicular Disease ..159
Fig. 33 — The Hoof in Chronic Laminitis 165
Fig. 34— Effects of Laminitis 166
Fig. 35 — Cochran Shoe, Inferior Surface 168
Fig. 36 — Cochran Shoe, Superior Surface 169
Fig. 37 — Hyperplasia of Right Forefoot Due to Chronic
Quittor 176
Fig. 38— Chronic Quittor, Left Hind Foot 177
Fig. 39— Skiagraph of Foot 179
Fig. 40— Sagital Section of Right Hock 186
Pig. 41 — Muscles of Right Leg; Front View 187
Fig. 42— Muscles of Lower Part of Thigh, Leg and Foot 189
Fig. 43— Right Stifle Joint; Lateral View .....190
Fig. 44— Left Stifle Joint; I\Iedial View 191
Pig. 45— Left Stifle Joint; Front View 193
Fig. 46 — Oblique Fracture of the Femur 200
Fig. 47 — Fracture of Femur After Six Months' Treatment..201
Fig. 48 — Aorta and Its Branches Showing Location of
Thrombi 210
Fig. 49 — Thrombosis of the Aorta, Iliacs and Branches 211
Fig. 50— Chronic Gonitis 218
Fig. 51 — Position Assumed in Gonitis 219
Fig. 52— Spring-halt -226
Fig. 53 — Lateral View of Tarsus Showing Effects of Tar-
sitis 228
Fig. 54— Right Hock Joint 231
Fig. 55 — Spavin -235
Page
Fig. 56 — Bog Spavin 243
Fig. 57 — Thoroughpin 247
Fig. 58 — Fibrosity of Tarsus in Chronic Thoroughpin 248
Fig. 59 — Another View of Case Shown in Fig. 58 249
Fig. 60— "Capped Hock" 252
Fig. 61 — Chronic Lymphangitis 258
Fig. 62— Elephantiasis 259
INTRODUCTION
Lameness is a symptom of an ailment or affection and is not
to be considered in itself as an anomalous condition. It is the
manifestation of a strnctural or fnnctional disorder of some part
of the loeomotory apparatus, characterized by a limping or halt-
ing gait. Therefore, any affection causing a sensation and
sign of pain which is increased by the bearing of weight upon
tbe aff'ected member, or by the moving of such a distressed part,
results in an irregularity in locomotion, which is known as lame-
ness or claudication. A halting gait may also be produced by
the abnormal development of a member, or by the shortening of
the leg occasioned by the loss of a shoe.
For descriptive purposes lameness may be classified as true and
false. True lameness is such as is occasioned by structural or
functional defects of some part of the apparatus of locomotion,
such as would be caused by spavin, ring-bone, or tendinitis. False
lameness is an impediment in the gait not caused l)y structural
or functional disturbances, but is brought on by conditions such
as may result from the too rapid driving of an unbridle- wise
colt over an irregular road surface, or by urging a horse to trot
at a pace exceeding the normal gait of the animal's capacity,
causing it to "crow-hop" or to lose balance in the stride. The
latter manifestation might, to the inexperienced eye, simulate
true lameness of the hind legs, but in reality, is merely the re-
sult of the animal having been forced to assume an abnormal pace
and a lack of balance in locomotion is the consequence.
The degree of lameness, though variable in different instances,
is in most cases proportionate to the causative factor, and this
fact serves as a helpful indicator in the matter of establishing a
diagnosis and giving the prognosis, especially in cases of some-
what unusual character. An animal may be slightly lame and
the exhibition of lameness be such as to render the cause baf-
flingly obscure. Cases of this nature are sometimes quite diffi-
cult to classify and in occasional instances a positive diagnosis
is impossible. Subjects of this kind may not be sufficiently in-
convenienced to warrant their being taken out of service, yet a
lame horse, no matter how slightly affected, should not be con-
tinued in service unless it can be positively established that the
degree of discomfort occasioned by the claudication is small and
the work to be done by the animal, of the sort that will not
aggravate the condition.
Subjects that are very lame — so lame that little weight is
borne by the affected member — are, of course, unfit for service
and as a rule are not difficult of diagnosis. For instance, a frac-
ture of the second phalanx would cause much more lameness than
an injury to the lateral ligament of the coronary joint wherein
there had occurred only a slight sprain, and though crepitation
is not recognized, the diagnostician is not justified in excluding
the possibility of fracture, if the lameness seems disproportion-
ate to the apparent first cause.
The course taken by cases of lameness is as variable as the
degree of its manifestation, and no one can definitely predict the
duration of any given cause of claudication.
Because of the fact that horses are not often good self -nurses
at best, and that it is difficult to enforce proper care for the parts
affected, one can not wisely state that resolution will promptly
follow in an acute involvement, nor can he predict that the case
will or will not become chronic. Experience has proved that
complete or partial recovery may result, or again, that no change
may occur in any given case, and that in some instances even
where rational treatment is early administered, a decided aggra-
vation of the condition may follow unaccountably.
However, because of the economic element to be reckoned with,
it is of some value to be able to give a fairly accurate prognosis
in the handling of cases of lameness, as in the majority of in-
stances the treatment and manner of after-care are determined
largely by the expense that any prescribed line of attention will
occasion.
A case of acute bone spavin in a horse of little value is not
generally treated in a manner that will incur an expense equiva-
lent to one-half the value of the subject. The fact is always to
be considered in such cases, that even where ideal conditions favor
proi)er treatment, the outcome is uncertain. Where less than
six weeks of rest can be allowed the animal, one affected with
bone spavin would therefore not be treated with the expectation
of obtaining good results, as six weeks' time, at least, is necessary
for a successful outcome. If the cost attending the enforced
idleness of an animal of this kind is considered prohibitive for
the employment of proper measures to affect a cure, and if lame-
ness is slight, the animal should be given suitable work, but in
eases of articular spavin in aged subjects, they should be hu-
manely destroyed and not subjected to prolonged misery.
A thorough knowledge of the structure and functions of the
affected parts is necessary to proceed in cases of lameness ; like-
wise, the age, conformation and temperament of the subject need
to be taken into consideration; the presence or absence of com-
plications demand the attention; the kind of care the subject
will probably receive directly influences the outcome; and the
character of service expected of the subject, too, needs to be
carefully considered before the ultimate outcome may reasonably
be foretold.
The practitioner is often confronted with the prolilem of how
best to handle certain cases. Will they do better under condi-
tions Avhere absolute quiet is enforced, or is it preferable to allow
exercise at will? The temperament of the animal must be con-
sidered in such cases, and if a lame horse is too active and play-
ful when given his freedom, exercise must be restricted or pre-
vented, as the ease may require. In cases of strains of tendons,
during the acute stage, immobilization of the affected parts is in
order. In certain sub-acute inflammatory processes or in in-
stances of paralytic disturbance where convalescence is in prog-
ress, moderate exercise is highly beneficial.
Consequently, each case in itself presents an individual jn-ob-
lem to be judged and handled in the manner experience has
taught to be most effective, appropriate and practical, and the
veterinarian should give due consideration to the comfort and
welfare of the crippled animal as well as to the interests of the
owner.
SECTION I.
ETIOLOGY AND OCCURRENCE.
In discussions of pathological conditions contributing to lame-
ness in the horse, cause is generally classified under two heads —
predisposing and v.rcllinn. It becomes necessary, however, to
adopt a more general and comprehensive method of classification,
herein, which will enable the reader to obtain a better conception
of the subject and to more clearly associate the parts so grouped
descriptively.
Though predisposing factors, such as faulty conformation, are
often to be reckoned with, exciting causes predominate more fre-
quently in any given number of cases. The noble tendency of
the horse to serve its master under the stress of pain, even to
the point of complete exhaustion and sudden death, should win
for these willing servants a deeper consideration of their welfare.
Too frequently are their manifestations of discomfort allowed
to pass unheeded ])y careless, incompetent drivers lacking in a
sense of compassion. Symptoms of malaise should never be
ignored in any case; the humane and economic features should
be realized by any owner of animals.
In the consideration of group causes, lameness may be said
to originate from affections of bones, ligaments, thecae and bur-
sae, muscles and tendons, nerves, lymph vessels and glands, and
blood vessels, and may also result from an involvement of one or
several of the aforementioned tissues, caused by rheumatism.
Further, affections of the feet merit separate consideration, and,
finally, a miscellaneous grouping of various dissimilar ailments,
which for the most part, do not directly involve the locomotory
a]i]iaratus l)ut do. by their nature, impede normal movement.
AFFECTIONS OF BONES.
The bony coliuini serving as the framework and support of
the legs, probably constitutes the most vital element having to
do with weight bearing and locomotion, and therefore during
the acute and painful stage of bone affections, the pain becomes
15
16 LAMENESS OF THE HORSE
more intense in the process and pressure of standing than when
the mem])er is swung or advanced.
Certain bones are so well protected by muscular structures
that they are not frequently injured except as a result of vio-
lence w'hich may produce fracture. However, there are certain
bones which receive the constant shock of concussion when the
animal is subjected to daily, rapid work on hard road surfaces.
Splints, ringbones and spavins are the most general examples
produced by these conditions.
Varying pathological developments often result from concus-
sion, contusion or other violent shocks to the bony structuras.
In such cases there either follows a simple periostitis which may
resolve spontaneously with no obvious outward symptom, or
osteitis, which may occur with tissue changes, as in exostosis; or
the case may produce any degree of reaction between these two
])Ossible extremes.
Rarefying Osteitis, or Degenerative Changes.
Certain bone alfections, such as osteonudacia or osteoporosis,
are in the main, responsible for distortions and morphological
changes of bone, causing lameness, permanent blemish and even
resulting in death of the affected animal. The climatic condi-
tions in some localities favor these occurrences but they may
also be ascribed to improper food constituents and to possible
infective agencies.
Rarefying degenerative changes manifested by exostosis involv-
ing the phalanges of the young, causing ringbone, are fairly com-
mon in occurrence throughout this country. This is due, sup-
posedly, to a lack of mineral substance in the bony structure of
the affected animals, and is known as rachitis — commonly called
rickets. Since the affected subjects suffer involvement of several
of the extremities at the same time, the theory of rachitic origin
seems well supported.
Fractures.
Fractures of bones constitute serious conditions and are always
manifested by lameness. A sub-classification is essential here
ETIOLOGY AND OCCURRENCE 1?
for the student of veterinary medicine who would comprehend
the technic of reduction and subsequent treatment in such
cases.
Fractures are classified by many authorities as being simple,
compound, and comminuted. This method is practical because
it separates dissimilar conditions. There are also grouped frac-
tures, the pathologic anatomy of which is similar. Classification
on an etiological basis would attempt to associate conditions,
the morbid anatomy and gravity of which would justly preclude
their being combined.
Simple Fracture is a condition where the continuity of the
bone has been broken without serious destruction of the soft
structures adjacent, and where no opening has been made to the
surface of the flesh. Such fractures do not reduce the bone to
fragments. Long bones are frequently subjected to simple frac-
ture, while short thick bones, such as the second phalanx, may
suffer multiple or comminuted fractures.
Compound Fracture designates a break of bone with the
destruction of the soft tissues covering it, making an open wound
to the surface of the skin. This form of fracture is serious
because of the attendant danger of infection, and in treatment,
necessitates special precaution being taken in the application of
splints that the wound may be cared for without infection of the
tissues. These fractures generally occur as a result of some
forceful impact through the flesh to the bone, or where the bones
are driven outward by the blow. Common examples are in frac-
tures of the metacarpus and metatarsus of the first phalanx.
This kind of injury in mature horses usually produces an ir-
reparable condition, and viewed economically, is generally con-
sidered fatal.
Comminuted Fractures, as the term implies, are those cases
wherein the bone is reduced to a number of small pieces. This
kind of break may be classified as simple-comminuted fracture
when the skin is unbroken, and when the bone is exposed as a
result of the injury, it is known as a compound-comminuted
fracture. Such fractures are caused by violent contusion or
where the member is caught between two objects and crushed.
18 LAMENESS OP THE HORSE
Multiple Fractures.
Fractures are called multiple when the bone is reduced to a
number of pieces of large size. This condition differs from a
comminuted fracture in that the multiple fracture may break
the bone into several pieces without the pieces being ground or
crushed, and the affected bone may still retain its normal shape.
Further classification is of value in describing fractures of
bone with respect to the manner in which the bone is broken —
the direction of the fissure or fissures in relation to its long
axis.
A fracture is transverse when the bone is broken at a right
angle from its long axis. Such breaks when simple, are the least
trouble to care for because there is little likelihood that the
broken ends of bone will become so displaced that they will not
remain in apposition. Simple transverse fracture of the meta-
carpus, for instance, constitutes a favorable case for treatment
if other conditions are favorable.
Otlique fractures, as may be surmised, are solutions of con-
tinuity of bone in such manner that the fissure crosses the long
axis of a bone at an acute or obtuse angle. These fractures are
prone to injure the soft structures adjacent, and are frequently
compound, as well. IMoreover, because of the fact that the ap-
posing pieces of bone are beveled, the broken ends of bone are
likely to pass one another in such a way as to shorten the dis-
tance between the extremities of the injured member. Con-
traction of muscles also tends to exert traction upon a bone so
fractured, resulting in a lateral approximation of the diaphysis
and thus preventing union because the broken surfaces are not
in proper contact.
Fractures are longiiudinal when the fissure is parallel with
the long axis of the bone. This variety of break is not infre-
quent in the first phalanx ; and a vertical fracture of the second
phalanx is also said to be longitudinal, however, there is little
difference (if any, in some subjects) between the vertical and
transverse diameters of this particular bone.
Green stick fractures are essentially those resulting from falls
to young animals. Thej^ are usuallj^ sub-periosteal and when
ETIOLOGY AND OCCURRENCE 19
the periosteum is left intact or nearly so, no crepitation is dis-
cernible. If this fracture is simple, prompt recovery may be ex-
pected. Bones of young animals, because they do not contain
proportionately as much mineral substance as do bones of adults,
are more resilient and less apt to become completely fractured.
They are, however, subject to what is known as green stick
fracture.
Impacted fractures are usually occasioned by falls. When the
weight of the body is suddenly caught by a member in such man-
ner as to forcefully drive the epiphyseal portions of bone into
and against the diaphysis, niultiple longitudinal fractures occur
at the point of least resistance. Parts so affected undergo a
fibrillary separation, increasing the transverse diameter of the
bone; or if the impact has been sufficiently violent, the portion
becomes an amorphous mass.
In a treatise on the subject of lameness, the bones chiefly con-
cerned and most often affected must be especially considered.
The shape and size of a bone when injured, determines in a
measure, the course and probable outcome in most cases, but of
first and greater importance is the function of the bone. A frac-
ture of the fibula in the horse need not incapacitate the subject,
but a tibial fracture is serious and generally proves cause for
fatal termination. The body of the scapula may be completely
fractured and recovery will probably result in most cases without
much attention being given to the sul)ject, yet a fracture of the
neck of this same bone constitutes an injury of serious conse-
quence. The difference in the function of different parts of this
same bone, as well as its shape and mode of attachment, deter-
mine the gravity of the case ; so it is in fractures of other bones
with respect to the course and prognosis of the case — function
is the important factor to be considered.
Next in importance is the age of the animal suffering fracture
of the bone. Capacity for regeneration is naturally greater in
a vigorous, young animal than in aged or even middle-aged sub-
jects. A healthy condition of the bone and the body favor the
process of repair in case of fracture, and prognosis may be favor-
able or unfavorable, depending upon these factors mentioned for
consideration. Individuals of the same species, differing in tem-
20 LAMENESS OF THE HORSE
perament, may comport themselves in a manner that is conductive
to prompt recovery, or to early destruction. This feature cannot
be overestimated in importance, as it is sometimes a decisive
element, regardless of other conditions. A horse suffering from
an otherwise remediable pelvic fracture may be so worried and
tortured by being confined in a sling that the case calls for spe-
cial attention and care because of the animal's temperament.
Sometimes, the constant presence of a kind attendant will so
reassure the subject that it will become resigned to unnatural
confinement, in a day or two. This precaution may, in itself,
determine the outcome, and the wise veterinarian will not over-
look this feature or fail to deviate from the usual rote in the
handling of average cases. Recovery may be brought about in
irritable subjects by this concession to the individual idiosyn-
crasies of such animals.
AFFECTIONS OF LIGAMENTS.
Ligaments which have to do with the locomotory apparatus
are, for the most part, inelastic structures which are composed
of white fibrous tissue and serve to join together the articular
ends of bones ; to bind down, tendons ; and to act as sheathes or
grooves through which tendons pass, and as capsular membranes
for retention of synovia in contact with articular surfaces oP
bones.
Ligaments are injured less frequently than are bones. Because
of their flexibility they escape fracture in the manner that bones
suffer. They are, however, completely severed by being cut or
ruptured, though fibrillary fracture the result of constant or
intermittent tensile strain is of more frequent occurrence.
Simple inflammation of ligaments is of occasional occurrence
but, unless considerable injury is done this tissue, no perceptible
manifestation of injury results. No doul^t many cases wherein
fibrillary fracture of ligaments (sprain) takes place some lame-
ness is caused, but because of the dense, comparatively non-
vascular nature of these structures, little if any manifestation,
except lameness, is evident. And such eases, if recognized are
usually diagnosed by excluding the existence of other possible
causes and conditions wliidi miti'lit also cause lameness.
ETIOLOGY AND OCCURRENCE 21
Certain ligaments are subjected to strain more than are others
and therefore, when so involved, frequently cause lameness. Ex-
amples of this kind are affections of the collateral (lateral) liga-
ments of the phalanges. Because of the leverage afforded by the
transverse diameter of the foot, when an animal is made to travel
over uneven road surfaces, considerable strain is brought to bear
on the collateral ligaments of the phalanges. A sequel to this
form of injury is a circumscribed periostitis at the site of at-
tachment of the ligaments and frequently the formation of an
exostosis — ringbone — results.
Where sudden and violent strain is placed upon a ligament
and rupture occurs, the division is usually effected by the liga-
ment being torn from its attachment to the bone. In such cases,
a portion of periosteum and bone is usually detached and the
condition may then properly be called one of fracture. In some
cases of this kind recovery is tardy, because of the difficulty
in maintaining perfect apposition of the divided structures, and
reactionary inflammation is not of sufficient extent to enhance
prompt repair. In fact, some cases of this kind seem to progress
more favorably, when no attempt at immobilization of the af-
fected member is attempted.
If some freedom of movement is allowed, acute inflammation
resulting in nature's provisional swelling soon develops and
repair is hastened because of increased vascularity. But where
luxation of phalanges accompanies sprain, reposition and immo-
bilization are necessary — that is if cases are thought likely to
benefit by any treatment.
Luxations — Dislocations.
Luxation or dislocation is a condition where the normal rela-
tion between articular ends of bones has been deranged to the
extent that partial or complete loss of function results. When a
bone is luxated (out of joint), there has occurred a partial or
complete rupture of certain ligaments or tendons; or a bone
may be luxated when an abnormal or unusual elasticity of inhib
itory ligaments or tendons obtains.
Luxations may be practically classified as temporarij and fixed.
In temporary luxations, disarticulation is but momentary and
22 LAMENESS OP THE HORSE
spontaneous reposition always results ; while a fixed luxation does
not reduce spontaneously but remains luxated until reposition
is effected by proper manipulation and treatment. Fixed luxa-
tion may be of such character as to be practically irreducible
because of extensive damage done to ligaments or cartilage.
Where a complete luxation of the metacarpophalangeal joint
exists, it is probal)le that in most cases sufficient injury to col-
lateral and capsular ligaments has been done to render com-
plete recovery improbable, if not impossible.
Temporary luxation of the patella is a common affection of
tbe horse and fixed luxation of this bone also occurs. As a mat-
ter of fact, in the horse, patellar luxation is tbe one frequent
affection of this kind.
As a rule, complete disarticulation immobilizes the affected
joint and in most instances there is noticeable an abnormal prom-
inence in the immediate vicinity — in patellar luxation, the whole
bone. In other instances the articular portion only, of the af-
fected bone is malpositioned. Usually, luxation and fracture
may be differentiated in that there is no crepitation in luxation
and more or less crepitation exists in fracture.
It is evident, when one considers the symptomatology and
nature of the affection, that fixed luxation is usually caused by
undue strain or violent and abnormal movement of a part.
Joints having the greater freedom of movement are apt to suffer
luxation more frequently.
Arthritis.
The study of arthritis in the horse is limited to a considera-
tion of joint inflammations which, for the most part, are of
traumatic origin. Unlike the human, the horse is not subject
to many forms of specific arthritis — tubercular, gonorrheal, syph-
ilitic, etc.
A practical manner of classification of arthritis is traumatic
and metastatic.
Traumatic arthritis may result from all sorts of accidents
wherein joints are contused. Such cases may be considered as
being caused by direct injuries. Instances of this kind, depend-
ing on the degree of insult, manifest evidence of injury which
ETIOLOGY AND OCCURRENCE 23
ranges from a simple synovitis to the most active inflammatory
involvement of the entire structure and adjacent tissues.
The reactionary inflammation wiiich attends a case of tarsitis
caused b}^ a horse being kieked is a good example of the i-esult
of direct injury. Such cases, if the contusion is of sufficient
violence, result in arthritis and periarthritis. In inactive farm
horses, during cold weather, this condition l)ecomes chronic, swell-
ing remains for weeks after all lameness and pain have sub-
sided and occasionally hyperthrophy is permanent.
Arthritis occasioned by indirect injury, such as characterizes
joint inflammation from continuous concussion, is seen in horses
that are worked at a rapid pace on city streets or other hard
road surfaces. Such affections may be acute, as in some cases
of spavin, but are usually inflammatory conditions that do not
occasion serious disturbance when these affections become chronic.
If the involvement persists with sufficient active inflammation,
there may follow erosion of cartilage and incurable lameness.
If extensive necrosis of cartilage takes place, the attendant pain
will be sufficient to cause the animal to favor the diseased part
and such immobilization enhances early ankylosis — nature's sub-
stitute for resolution in this disease.
Wounds invading the tissues adjacent to joints, when these
wounds are of considerable extent, cause inflammation of such
articulations by contiguous extension of inflannnation. As long
as an injury remains practically aseptic, or if infected and the
septic process does not involve the joint proper by direct ex-
tension, no more serious disturbance than a simple synovitis will
result. If, instead, a periarthritic inflammation is serious or
destructive in character, the type of arthritis will be grave —
even though due to an indirect cause.
Where a vulnerant body penetrates all structures and invades
the interior of the joint capsule the result is that a more or less
active disturbance is incited. The introduction of a sterile in-
strument into a joint cavity, under strict asepsis, where a per-
fect technic is executed, does not cause perceptible numifesta-
tion of the injury, if the opening so made is small — such as a
suitable exploratory trocar makes. But a puncture made in a
similar manner and with the same instruinciit witliout due regard
24 LAMENESS OF THE HORSE
te asepsis is likely to cause an infectious synovitis and arthritis
usually follows.
A larger opening than is produced by means of an exploratory
trochar may be made into a joint cavity, causing escape of syn-
ovia as it is secreted for days and even for weeks and no serious
or permanent trouble is experienced in some cases. If the syn-
ovitis or arthritis remains non-infected and the wound, trau-
matic or surgical, is not too large, healing by granulation
occurs, and the discharge of synovia ceases. However, if synovial
discharge persists too long because of tardy closure of an open
joint, there is great danger of infection gaining entrance into
the synovial cavity, or in some instances, desiccation of endo-
thelial cells of the articulation occurs, in areas, and the reaction-
ary inflammation eventually results in ankylosis.
A small puncture which introduces into the synovial cavity
infectious material of active virulence will cause an arthritis
that is more serious, much more painful and more difficult to
handle than is occasioned by a wound of moderate size, that
affords ready escape of synovia even through the virulence of
the infection be the same.
Synovia is a good culture medium and the environment is
ideal for nuiltiplieation of bacteria; consequently, the grave
disturbances which may attend the introduction of pathogenic
organisms into a synovial cavity as the result of a puncture
Avound are not to be forgotten. The veterinarian is m no position
to estimate the virulency of organisms so introduced; neither
can he determine the exact degree of resistance possessed by the
subject in any given case. Therefore, he is uncertain as to the
best method of handling such cases where an injury has been
recently inflicted and positive evidence of the existence of an
infectious synovitis is not present. If one could determine in
advance the degree of infection and injury that is to follow small
penetrant M^ounds of joint capsules, it would then be possible
to select certain cases and immediately drain away all synovia
and fill the cavity by injection with suitable antiseptic solutions.
This offers a broad field for experimentation which will in
time be productive of a radical change in the manner of treating
such cases.
ETIOLOGY AND OCCURRENCE 25
Metastatic arthritis is seen more frequently in colts or young
animals than in mature horses and we here take the liberty of
classifying with the arthritis of omphalophleliitis and strangles
the so-called rheumatic variety.
A specific polyarthritis or synovitis which attends navel in-
fection of foals is perhaps the most frequent form of arthritis
that is to be considered metastatic. This condition is truly a
disease of young animals and, while it is a specific arthritis,
the cause is yet to be attributed to any definite pathogenic organ-
ism with certainty. This condition is well defined by Bollinger
as quoted by Iloare,^ when he calls it a purulent omphalophle-
bitis due to local infection of the umbilicus and umbilical ves-
sels, by pyogenic organisms, causing a metastatic pyemia.
This affection is grave; its course is comparatively brief; the
prognosis is usually unfavorable ; and omphalophlebitis occa-
sions a form of lameness which at once impresses the practi-
tioner that serious constitutional disturbance exists. Its con-
sideration properly belongs to discussions on practice or obstet-
rics and diseases of the new born, and it has received careful
attention and is discussed at length in these works.
A second form of metastatic arthritis is met with in strangles.
Strangles occurs in the young principally and is not a frequent
cause of synovitis or arthritis in the adult animal.
Strangles or distemper is, according to most pathologists, due
to the Streptococcus equi, Hoare^ states that in this type of
specific arthritis the contagium is probably carried by the blood.
He gives it as his opinion that even laminitis has occurred as
a result of the streptococcus-equi. This, indeed, would point
toward probable extension by the blood as well as by way of
lymph vessels.
Septic synovitis and infectious arthritis are always serious af-
fections even in young animals and much depends upon indi-
vidual resistance and early rational treatment in such cases, if
recovery is to follow.
The same general plan of treatment is indicated in this kind
of septic synovitis as is employed in all cases of infective syn-
lA System of Veterinary Medicine by E. Wallis Hoare, F. R. C. V. S., Vol. 1,
page 510.
=Ibid, page 807.
26 LAMENESS OF THE HORSE
ovitis and septie infection in open joints. There is to be consid-
ered, however, the fact that the young animal is more agile, a
better self-nurse, and in a general way more apt to recover than
is the adnlt, under similar conditions.
Rheumatic artJiritis, if one is justified in classifying rheumatic
inflammation of joints as a metastatic form of arthritis, is not
a common condition, though seen in mature and aged animals.
Cases that may be diagnosed with certainty are usually advanced
affections wherein dependable history is obtainable and the symp-
toms are well marked.
Rheumatism may be thought of, with respect to arthritic in-
flammation caused thereby, as a sort of pyemia. Undoubtedly,
exposure to wet and cold weather is an active factor, l;)ut prob-
ably a predisposing one only. Likewise a member that suffers
from chronic inflammation due to recurrent injury or to con-
stant or repeated strain is less able to resist the vicissitudes of
climate and work.
Consec[uentiy, rheumatic arthritis is to be seen affecting horses
that are in service, more often at heavy draft work Avhere they
are exposed to severe straining of joints; where stabling is in-
sanitary; and where they are obliged to lie down (if they do
not remain standing) upon cold and wet ground or upon hard
unbedded floors or paving.
Where such inhumane and cruel treatment is given animals
those responsible ought to be impressed with the unfairness to
the animal as well as the economic loss occasioned by inflicting
such unnecessary and merciless treatment upon their helpless
and uncomplaining subjects. The very nature of the veteri-
narian's work affords liim constant and frequent opportunity to
convince those who are responsil^le for keeping animals in this
manner, that it is inhumane and un]irofita])]e.
Cases of this kind are not uncommon about some grading and
lumbering camps and in contract work where, often, shelter for
animals is given little thought ; the result is a cruel waste of
horseflesh.
Chronic articular rheumatism is occasionally observed in
young animals that have never been in service. In these cases
it seems tliat there exists an individual susceptibility and in
ETIOLOGY AND OCCURRENCE 27
some instances the condition is recurrent. Each attack is of
long-er duration, and eventually death results from continued
suffering, emaciation and intoxication.
AFFECTIONS OF BURSAE AND THECAE.
Acute bursitis and thecitis is of fre(|uent occurrence in horses
])ecause of direct injury from contusion, punctures and other
forms of traumatism. These synovial membranes, with few ex-
ceptions, when inflamed occasion a synovitis that may be very
acute, yet there is less manifestation of pain than in arthritis.
It is only in structures such as the bursa intertubercularis or
in the sheath of the deep digital flexor that an inflammation
causes much pain and is apt to result in permanent lameness.
This is due to the i^eculiar character of the function of such
structures.
An acute inflammation of a small bursa may even result in the
destruction of such synovial apparatus without serious incon-
venience to the subject, either at the time of destruction or there-
after. Obliteration of the superficial bursa over the summit of
the OS calcis is not likely to cause serious inconvenience or distress
to the subject unless it be due to an infected wound. Even then,
with reasonably good care given the animal, recovery is almost
certain. Complete return of function of the member and cessa-
tion of lameness takes place within a few weeks in the average
case.
"Where an infectious synovitis involves a structure such as the
sheath of the tendon of the deep digital flexor (perforans) the
condition is grave and because of the location of this theca the
prognosis is not much more favorable than in an articular syn-
ovitis.
Inflammation of bursae and thecae may be classified on a
chronological basis with propriety 1)ecause the duration of such
affections, in many cases, materially modifies the result. A
chronic inflammatory involvement of a theca through which an
important tendon plays may cause adhesions to form. Or there
may occur erosions of the parts with eventual hypoi-fi-ophy and
loss of function, partial or complete.
However, in general practice a classiflcation on an etiological
28 LAMENESS OF THE HORSE
basis is probably more practical and we shall consider inflamma-
tion of bursae and thecae as infectious and noninfectious.
Infectious bursitis and thecitis is usually the result of direct
introduction of septic material into the synovial structure by
means of injuries. Infection by contiguous extension occurs and
also metastatic involvement is met with occasionally.
The noninfectious inflammation of bursae and thecae usually
result from contusions or strains and generally run their course
without becoming infective in character, where vitality and re-
sistance of the subject are normal.
In a general way, inflammation and other affections of l)ursae
and thecae are considered very similar to like affections of joints.
AFFECTIONS OF MUSCLES AND TENDONS,
Muscles and tendons having to do with locomotion are more
frequently injured than are any of the other structures whose
function is to propel the body or sustain weight. This is due
in part to the exposed position of muscles and tendons. They
serve as a protection to the underlying structures and in this
manner receive many blows the force and violence of which are
spent before injury extends beyond these tissues.
Muscles of the breast, shoulder and rump are most frequently
the recipient of injuries of various kinds. The abductors of the
thigh are subjected to bruising when horses are thrown astride
of wagon poles or similar objects. Thus in one way or another
muscle injuries are occasioned and cause lameness.
Traumatic affection of muscles of locomotion may be surface
or sul)surface — subsurface with little injury done the skin and
fascia, but with subsurface extravasation of blood and maseera-
tion of tissue. Puncture wounds wherein the vulnerant body is
of small diameter, are observed, and they occasion deep seated
infectious inflammation of the parts affected, with surface
wounds that are often unnotieeable. Such injuries — puncture
wounds — are always serious, and because of the fact that there
exists little evidence of injury at the time of their infliction,
treatment is usually deferred several days and often infection
has become quite extensive when the practitioner is consulted.
"Where infective wounds of muscles of locomotion occur, the
ETIOLOGY AND OCCURRENCE 29
course and gravity of the affection are directly influenced by the
proximity of the injury to lymph plexuses. For instance, in-
juries causing an infectious inflammatory involvement of the ad-
ductors of the thigh may result in a generalization of the infec-
tion by way of the inguinal lymph glands.
Large open wounds that extend deep into muscles, render
inactive such structures, and even where division is not com-
plete, the pain occasioned causes the subject to favor the part
in every way possible. Contraction of muscular fibers of such
parts increases pain and because of this fact groups of muscles
are at times disabled because of injury done to one muscle. In-
stances of this kind are frequently seen where shoulder injuries,
which affect but one muscle, exist; yet because of such injury a
marked swinging-leg lameness is present.
Tendons, because of their inelasticity, are subjected to injuries
peculiar to themselves. In addition to being affected as are mus-
cles, wounds of many kinds are found to affect tendons — con-
tusions, interference wounds, penetrant wounds, incised wounds
and lacerations.
However, the commoner form of injury done tendons, is strain
or sprain. Because of the sudden tensile strain brought to bear
upon tendons in the shocks of concussion, as well as in propulsion
of the body, there frequently occure a rupture of fibers and this
we know as sprain.
Sprains may be considered as fibrillary fractures of soft struc-
tures and since this form of injury is sul)surface, and limited to
fractional portions of tendons, the inflammation occasioned usu-
ally remains an aseptic one. Reaction to this form of injury
is characterized by inflammation, the course of which is erratic
and variable. In chronic inflammation of tendons, where ani-
mals are continued in service, the usual sequel is contraction, or
shortening of these structures.
The degree of contraction as well as its import varies in dif-
ferent subjects and in the various tendons which may be affected.
Contraction is a slow-going process that is progressive, gradually
causing a decrease in the length of the affected structure and
eventually rendering the animal useless.
The practice of applying shoes with extended toe-calks for
30 LAMENESS OF THE HORSE
the purpose of "'stretching" contracted deep digital flexor
tendons (tiexor pedis perforans) cannot be too strongly con-
demned. While the addition of an extension such as is ordinarily
employed to the toe of a shoe of this kind, prevents for a time,
frequent stumbling in such cases, the increased tensile strain
which is thus occasioned hastens further contraction and sub-
jects animals so shod to much unnecessary pain.
AFFECTIONS OF NERVES.
Because of their being protected by other structures, nerve
trunks, which supply muscles of locomotion, are not su])jeeted to
frequent injuries such as contusions. However, they do become
injured at times and the result is lameness, more or less severe.
Lameness originating from nerve affection, may involve central
structures as, for example, the spinal cord, medulla oblongata
or parts of the brain. In making an examination of some lame
animals it is necessary to distinguish between cases of lameness
that are of central origin and marked by incoordination of move-
ment, and disturbances caused by other affections. Tetanus in
its incipiency should not be confused with laminitis involving
all four feet, or with certain forms of pleuritis, when careful ex-
amination is made, yet, in a way, to one not trained, the clinical
symptoms are similar.
Disturbances of nerve function are caused in a variety of ways.
It is not within the scope of this work to discuss central nervous
disturbances caused hy ingestion of mouldy provender, or dis-
turbances of the brain or cord occasioned by infectious diseases,
but mention of the existence of such conditions is appropriate.
By direct injury the result of lilows, certain nerves are in-
jured and muscles supplied by such nerves are rendered inactive.
Depending upon the nature and extent of an injury thus in-
flicted, so the manner in which the affection is manifested varies.
The suprascapular nerve is rather frequently injured causing
partial or complete loss of function of the structures supplied
by this nerve, and abduction of the scapulohumeral joint nat-
urally results.
In some cases of dystocia tbe obturator ner\'e, (or nerves, if
the involvement is bilateral), becomes injured by being caught
ETIOLOGY AND OCCURRENCE 31
between tlie maternal pelvis and some dense part of the fetus.
This results in paralysis of the adductors of the thigh if suffi-
cient injury is done.
It is said that nerves become over-stretched and held tense, in
certain positions in which animals are obliged to remain while
cast in confinement such as in some instances where unusual
methods of restraint are employed. When the fore feet are
drawn backward in such numner that great strain is put upon
the radial nerve, it suffers more or less injury, and this is fol-
lowed by partial or complete paralysis which may be temporary
or permanent.
Degenerative changes affecting nerves, as in other tissues, oc-
cur and more or less locomotory impediment will follow — this
depending upon the nerve or nerves affected and the nature of
such involvement. Tumors may surround nerves and eventually
the nerve so exposed becomes implicated in the destructive
process. Before degenerative changes take place in the nerve
substance, in such cases, pressure may completely paralyze a
nerve when it is so situated. Melanotic tumors in the para-
proctal tissue in some cases, because of the large size of the new-
growths, cause paralysis of the sciatic nerve. The author has seen
one case of brachial paralysis occasioned by an enormous de-
veloiunent of fibrous tissue involving the structures about the
ulna.
AFFECTIONS OF BLOOD VESSELS.
Lameness caused by disturbances of circulation may be due to
structural affection of vessels, or functional disorders of the
heart, and in some instances, a combination of these causes may
be active.
Direct involvement of vessels is the commoner form of circu-
latory disturbance which occasions lameness, and the most fre-
quent cause is of parasitic origin. Sclerostomiasis with attendant
arteritis, thrombus formation and su])sequent lodgement of em-
boli in the iliac, femoral, or other arteries, causes sufficient ob-
struction to prevent free circulation of blood, and the character-
istic lameness of thrombosis results.
Indirect injury to vessels may occur because of contused
wounds and subsequent inflammation of tissues supplied by such
32 LAMENESS OF THE HORSE
vessels. If the injury be of sufficient extent, considerable ex-
travasation of blood will take place and the painfully swollen
parts necessarily impair locomotion. In such instances lymph
vessels participate in the disturbance, and the condition then be-
comes one wherein lymphangitis is the predominant disturbing
element.
Angiomatous tumors are occasionally found affecting horses'
legs — usually the result of some injury ; and because of their size
or position, they mechanically interfere with function. Further-
more, when such tumors are located on the inner or flexor side
of joints, enough pain is occasioned that affected animals show
evidence of distress, usually by intermittent lameness.
Horses do not suffer from distension of veins as does man,
that is, there is rarely to be seen a case wherein much disturbance
from this source exists.
AFFECTIONS OF LYMPH VESSELS AND GLANDS.
Inflamed lymph vessels and glands, the result of various causes,
is a rather common source of lameness of horses. When one con-
siders the proportion of tissue that is composed of lymph vessels
and glands, it is then obvious that inflammation of these struc-
tures should cause a painful affection of members, when so af
fected, and that marked lameness and, in some instances, general
constitutional disturbance such as anorexia, hyperthermia and
general circulatory disorder are to follow.
Lymphangitis is most frequently occasioned by the introduc-
tion of septic material into the tissues; consequently, infectious
lymphangitis is more frequently observed than the non-infectious
type.
Specific infectious forms of lymphangitis are seen in glanders
and in strangles ; infectious types of this disturbance are found
in many instances where, initially, a localized or circumscribed
infection has occurred — the contagium having been introduced
by way of an injury. An example of this kind is to be seen in a
wound perforating the tibial fascia, where the injury is inflicted
by means of a horse being kicked by another animal shod with
sharp shoe-calks. Cases of this kind invariably result in a septic
lymphangitis, and frequently lymphadenitis also occurs, for the
ETIOLOGY AND OCCURRENCE 33
inguinal lymph glands are so situated tliat their becoming con-
taminated is almost certain.
The trite phrase that ' ' the tissues are bathed in lymph ' ' should
make clear the reason for the frequent occurrence of infectious
lymphangitis and lymphadenitis. Foreign substances, bacteria
and their products, inorganic material and in fact, anything that
is inti-oduced into the tissues, if soluble or miscible, will be taken
up and conveyed by the afferent lymph vessels and disseminated
throughout the system — hence the constitutional disturbances so
frequently thus caused.
A non-infectious type of lymphangitis is frequently seen in
the heavy draft breeds of horses and in such cases one or both
hind legs are involved — it is very seldom that the thoracic limbs
become so affected. Law^ refers to this ailment as "Acute
Lymphangitis of Plethora in Horse." When one takes into
consideration that these cases so frequently occur in heavy draft
animals that are not worked regularly, that the pelvic limbs are
the ones involved, and that the disorder often runs a short
course (recover}' often taking place within two or three days,
with no treatment given other than a purge, circulatory stim-
ulants and walking exercise) it is plausible to ascribe the con-
dition to idiopathic factors.
Admitting the frequency of non-infectious lymphangitis, the
practitioner must not confuse this type with similar lymphatic
inflammation occasioned by nail punctures of the foot. It is
very embarrassing indeed to make a diagnosis of lymphangitis —
expecting that the disturbance will terminate favorably and un-
eventually — and later to discover a sub-solar abscess caused by
a nail prick in the region of the heel.
Recurrent attacks of this disturbance cause hypertrophy of
the lymph vessels and in some cases lymphangiectasis. In old
subjects used for dissection or surgical purposes, it is very evi-
dent that in the ones which have suffered from chronic lymphan-
gitis there exists an excessive amount of sub-facial connective
tissue, making subcutaneous neurectomies quite difficult in some
instances.
A sequel of chronic lymphangitis is a condition known as ele-
'A'ol. I, page 534, Veterinary Medicine, by James Law, F. R. C. V. S.
34 LAMENESS OF THE HORSE
pliantiasis. In such cases there occurs a hyperplasia of the skin
and subcutaneous tissues, resulting in some instances, in the af-
fected member attaining an enormous size. Sporadic cases of
this kind are to be seen occasionally, and are apparently caused
by repeated attacks of lymphangitis. The affection is not bene-
fited by treatment, and while a horse's leg may become so heavy
and cuniliersome as to mechanically impede its gait, as well as
to fatigue the subject when made to do service even at a slow
pace, elephantiasis causes no constitutional derangement. The
hind legs, in elephantiasis, are affected and a unilateral involve-
ment is more often seen than a bilateral one. The legs may be
enlarged from the extremity to the body, but ordinarily the af-
fection does not extend higher than the hock or the mid-tibial
region.
A chronic, progressive, hyperplastic-degeneration exists in
some cases and the sul)jects are in time rendered unserviceable
because of the l)urden of getting about encumbered by the affected
extremity. In other animals hyperplasia progresses for a time
— until the parts become greatly enlarged and conditions appar-
ently attain an immutable state. Nevertheless animals so af-
fected may continue in service for years without lieing distressed.
AFFECTIONS OF THE FEET.
Lameness is very often due to affections of the feet, and in all
foot diseases probably the most constant cause is injury inflicted
in some manner. Resultant from injury, there frequently de-
velops complications and the one most often seen is infection.
Because of the fact that the feet are constantly exposed to
germ-laden soil and filth, if not actually bathed in such infectious
materials, it naturally follows that septic infection of some part
of the feet must be of frequent occurrence.
Subsequent to being obliged to stand in mud and other damp
or wet media, exposure to desiccating influences such as stabling
U])()n dry floors, or at service on hot and dry road surfaces causes
the insensitive pai'ts of tlie feet to become dry, hard and brittle.
This favors ''checking" of the protecting structures and it fre-
(picntly i-esults in the roi'iiiatioii of large fissures which expose
ETIOLOGY AND OCCURRENCE 35
the underlying sensitive parts of the feet and lameness is the in-
evita])le outcome.
The function of the feet — bearing the weight of the animal at
all times when the subject is not recumbent, and in addition to
this, the increased strain put upon them at heavy draft work,
together ^^ ith the concussion and l)uffeting occasioned by locomo-
tion, make the feet susceptible to frequent affections of various
kinds.
Being almost completely encased by a somewhat inexpansible
and insensitive wall and sole, renders the foot subject to path-
ologic changes peculiar to itself. The very nature of the struc-
ture of the foot together with the function of the sensitive lamina
is sufficient cause for an affection unlike that seen involving other
tissues — laminitis.
An exhaustive consideration of foot affections is a study in
itself and one that comes within the realm of pathologic shoeing;
nevertheless, a practical knowledge of diseases of the foot is
indispensable in the diagnosis of lameness wherein the foot may
be at fault.
The peculiar nature of foot affections renders them difficult
of classification on any sort of basis that is helpful in the con-
sideration of this subject. Injuries are the most constant cause
of foot lameness, yet one must admit that there results compli-
cations because of infection in most instances ; and that in some
cases the injury is slight — just enough to permit the introduction
of vulnerant organisms into the tissues. Therefore, one might
well classify affections of the feet as infectious and non-
infectious. There can be grouped in the class of infectious af-
fections such conditions as nail pricks, calk wounds and canker.
In the class of non-infectious affections one may consider condi-
tions such as laminitis. strain and fractures.
SECTION II.
DIAGNOSTIC PRINCIPLES.
To observe attentively is to remember distinctly. — Poe.
Before treatment is administered in constitutional disturb-
ances resulting in disease, cause is logically sought; so, in
order to handle effectively any case of lameness, it is necessary
first to discover the source of the trouble and contributing con-
ditions affecting the structures. Hence, diagnostic ability is
the prime requisite; and a thorough knowledge of pathologic
anatomy or of surgical technic is of little value if this knowledge
is not applied with the insight of the trained diagnostician.
The cruel and unnecessary methods employed by those un-
trained for diagnostics, cannot be too vigorously condemned. For
instance, the application of an active and depilating vesicant
upon a large area on the gluteal or crural region, in a case
where the practitioner "guesses" the condition to be one of
"hip lameness," constitutes an exposition of gross ignorance,
and at once stamps the perpetrator as a crude bungler without
scientific insight whose works are no credit to his profession.
How much better it would be, if the practitioner does not see
fit to call in a competent consultant, to prescribe a suitable agent
to be given internally, and to recommend complete rest for the
subject.
In establishing a diagnosis in such cases, the student or prac-
titioner seldom has recourse to laboratory assistance, and his
work is done by means of physical examination ; therefore, a
thorough knowledge and a clear conception of the physiology
of locomotion are essential. Memorizing nosological facts with-
out an understanding of underlying principles is of no more
practical benefit for qualification as a diagnostician in cases of
lameness, than is the employment of similar methods in the
study of theory and practice. A knowledge of the dosage of
drugs does not in itself qualify one as being competent to ad-
minister such therapeutic agents to a proper effect. How
S7
38 LAMENESS OF THE HORSE
much is a practitioner benefited by the knowledge that a high
temperature is usually present in septic intoxication, if he is
not possessed of a scientific understanding of anatomy, physi-
olog}', bacteriology and pathology, as well as the principles of
clinical diagnosis?
In order to determine the reasons for certain symptoms mani-
fested by the suliject, an analysis of these symptoms is the proper
method of procedure, insofar as this is poasi])le. If one may
reason that an animal assumes a certain position while at rest
to allow relaxation of an inflamed tendon or ligament, such a
fact enables the diagnostician to recall that this is indicative
of some specific ailment. In acute tendinitis, the subject while
at rest, maintains the afi'ected member in volar flexion because
this position permits relaxation of the inhibitory apparatus,
including the inflamed tendon. Likewise, the various a])normal
positions assumed, — adduction, abduction, undue flexion or
pointing — have their own significance and are taken into ac-
count by the trained diagnostician in the course of an examina-
tion.
In the examination of lame subjects, where the cause is noi
obvious, a systematic method of diagnosis is pursued even by
the most expert practitioners. In all obscure cases of lameness
a methodical and thoroughly practical examination of the ani-
mal according to an established procedure is necessary to de-
termine the nature and source of the affliction.
Anamnesis.
The first thing to be given consideration in diagnosis is the
fact that related history of the case is not always dependable,
because of lack of accurate observation (u^ wilful deceit on the
])art of the owner or attendant. The successful veterinarian
soon acquires the faculty of ol)taining information in a manner
best adapted to his client,— either by direct interrogation or by
subtle means of suggestion, and in this way he draws out evaded
facts essential to his diagnosis. In time he learns to make al-
lowance for misstatements made to shield the owner or driver
and to hide the facts of apparent neglect or abuse that the sub-
ject may have experienced. A suppurating cartilaginous quitter,
DIAGNOSTIC PRINCIPLES 39
complicated by the presence of a large amount of hyperplastic
tissue, cannot be successfully represented to be an acute and
recently developed atfection, where a trained practitioner is left
to judge the validity of the statement.
In complicated conditions, where there is evident a chronic
disturbance which could not be conceived as sufficient cause for
a nuirked manifestation of lameness, accurate history of the case
may he of great aid in arriving at a diagnosis. An aged animal,
having recently become very lame, showing a small exostosis on
the first phalanx, and with the history given that the osseous
deposit was of long standing, should at once lead the veterinarian
to seek the source of trouble elsewhere.
Visual Examination.
As in all diagnostic work, a careful visual examination of the
subject should ])e made before it is approached. The novice is
given to hasty examination by palpation, not realizing how
nnieh may be revealed by a careful scrutiny of the subject. In
this way he is led to erroneous conclusions which the skilled
diagnostician has learned from experience to avoid. Too much
(iitphasis cannot he 2)laccd on the importance of making a
thoughtful visual examination in every instance before the sub-
ject is approached. In this examination, type, conformation
and temperament are taken into account at once, for each of
these qualities is in itself, a determining factor in predisposing
a subject to certain ailments or inherent attributes, which may
exert a favorable or unfavorable intiuenee upon existing condi-
tions and thus make recovery probable or otherwise.
Draft animals are less likely to be permanently incapacitated
as a result of tendinitis, than are thoroughbreds. Likewise,
one would not expect to find this affection present in heavy
harness horses as frequently as in light harness animals.
]\ral-formation of a part, or an asymmetrical development of
the body as a whole, may render an animal susceptible to cer-
tain affections which cause lameness. A "tied in" hock predis-
poses the subject to curb, and an animal having powerful and
well-developed hips and imperfectly formed hocks, will, if sub-
jected to heavy work, be a favorable subject for bone spavin.
40 LAMENESS OF THE HORSE
The matter of temperament cannot be disregarded in diag-
nosis, for in some instances, it is the chief determining factor
which materially influences the outcome of the case. A nervous,
excitable animal, that is kept at hard work, may, under some
conditions, be expected to experience disturbances which more
lethargic subjects escape. Nervous subjects, it is known, are
more prone to azoturia than are those of lymphatic temperament.
Furthermore, the lymphatic subject often recovers from cer-
tain bone fractures which are successfully treated only when
the animal is sufficiently resigned by nature to remain confined
in a sling for weeks without resistance.
The physiognomy of a subject is often indicative of the gravity
of its condition. The facial expression of an animal suffering
the throes of tetanus, azoturia, or acute synovitis, is readily
recognized by the experienced eye, and upon physiognomy alone,
in many instances, may the opinions regarding prognosis be
based. Particularly is this true where death is a matter of min-
utes, or at most is only a few hours distant.
Due allowance should be made for restiveness nmnifested by
some more nervous animals when the surroundings are strange
and unusual. In such instances, even pathognomic symptoms
may be masked to the extent that little, if any, sign of pain
or malaise is evinced. In these cases the subject should be
given sufficient time to adjust itself to the new environment, or
it should be removed to a more suitable place for examination.
Animals quickly detect the note of friendly reassurance in the
human voice and can very often be calmed by being spoken to.
By visual examination one may detect the presence of various
swellings or enlargements, such as characterize bruises and
strains of tendons where inflammation is acute. Inflammation
of the plantar (calcaneocuboid) ligament in curb is readily de-
tected when the affected member is viewed in profile. Spavin,
ringbone, splints, quittor and many other anomalous conditions
may all be observed from certain proper angles.
The fact that the skins of most animals are pigmented and
covered with hair, precludes the easy detection of erythema by
visual examination, consequently this indicator of possible in-
DIAGNOSTIC PRINCIPLES 41
fiammation is not often made use of in the examination of
equine subjects.
Attitude of the Subject.
The position assumed while the subject is in repose, is often
characteristic of certain affections and this, of course, is noted
at once. The manner in which the weight is borne by the animal
at rest, should attract the attention of the diagnostician and if
the attitude of the subject is abnormal or peculiar, the ex-
aminer tries to determine the reason for it. If weight-bearing
causes symptoms of pain, the affected member will invariably be
favored and held in some one of a number of positions. The
foot may contact the ground squarely and yet the leg may re-
main relaxed and free from pressure; volar flexion, in such
cases, is indicative of inflammation of a part of the flexor ap-
paratus. If the condition be very painful, position of the af-
flicted member is frequently shifted, but in all cases where the
pain is not so keenly felt, the inflamed member is held in a
state of relaxation. There is need then, for a knowledge of
anatomy and certain principles in physics to enalile tlie ol)server
to determine just which structures are purposely eased in this
manner. Where palpation of parts is possible, one does not
need to depend on visual examination alone, and it is always
wise to take into consideration every factor that may influence
conditions. Manipulation or palpation of the stnictures thought
to be involved, should not he resorted to until a careful and
thorough observation of the subject has revealed all that it can
reveal to the diagnostician.
In all conditions where extreme pain is manifested by the
constant desire of the animal to keep its foot in motion off
the ground, examination should be made for local cause. This
is seen in certain septic inflammations of the feet such as those
caused by nail punctures invading the navicular joint, or in
newly made wounds where nerves have been divided and the
proximal end of such a nerve is exposed to pressure or irritation.
"Pointing" affords a comfortable position in some cases of
navicular disease, and in a unilateral affection, one may observe
the subject bearing weight with one sound member, while the
affected foot is planted well ahead of the sound one. In a bi-
42 LAMENESS OF THE HORSE
lateral involvement of this kind, weight may be frequently
shifted from one foot to the other, or in chronic cases, where
no marked pain is experienced, the subject stands squarely upon
both front feet and no peculiar shifting of weiglit or pointing is
evident.
In some cases of hip or shoulder involvement, complete re-
laxation of all parts of the affected member may be noticed.
In brachial paralysis, the pectoral member is held limply; if the
patient is made to move, it is evident there is lack of innerva-
tion to the afflicted part. In some cases where contusion has
caused acute inflammation of the member, the subject instinct-
ively tries to keep it inactive to relieve the pain which move-
ment occasions.
Where there is an active and painful inflammation of the
prescapular lymph glands and contiguous structures, in some
cases of ''levator-humeri abscess," the scapulohumeral joint is
extended. This is brought about by flexion of the elbow and
carpal joints.
There are some eases of bi-lateral affections which occasion
such pain during weight-bearing that the subject shifts its
weight from one affected leg to the other; an example of this
condition may be observed in any acute case of gonitis which
affects both patellar regions, making it ecjually painful to bear
the weight on either member.
A peculiar characteristic position is assumed in acute laminitis
of the fore feet. In such instances, the hind feet are brought
forward under the body sufficiently to relieve the front feet of
the weight, insofar as is possible by the abnormal position taken
in cases of acute laminitis.
So in each position that is abnormal to any degree, assumed
by a suffering animal, there may l^e deduced, the fact that the
subject is attempting to relieve the affected structures, and in
each clinical picture of this kind, the trained diagnostician sees
some index to the nature and source of the trouble. Further
examination is rendered more effective because of this prelim-
inary visual examination which has precluded the unnecessary
annoyance of the animal by manii)nlating unaffected structures.
It has been presupposed in the foregoing, that the one raak-
DIAGNOSTIC PRINCIPLES 4'd
iiig visual examination of a lame animal for diagnostic purposes,
will remcml)er that vritli the normal animal the -weight is borne
equally well with both fore legs; and that this is done without
shifting from one to the other; and that the pelvic limbs do not
support the body in this manner. Normal su])jects shift their
weight from one hind leg to the other and the one relaxed, rests
in a state of tiexion with the toe on the ground and the heel
raised.
Examination by Palpation.
In nearly every case where lameness exists an examination of
the affected parts, by palpation or by digital manipulation,
is necessary before an accurate conclusion may be drawn ; but
in making this kind of an examination one needs to exercise good
judgment lest he fail to acquire a correct impression of the
actual existent conditions. There is need for the diagnostician,
here, as well as in other conditions where physical examination
is made, to api)roach the subject in a manner that will not ex-
cite or disturb to the extent that the animal will, in one way
or another, resist or object to the approach of the diagnostician,
thereby masking the symptoms sought. The practitioner would
best acquire skill as a horseman — if he is not possessed of such
— and handle each individual subject in the manner calculated
to best suit the temperament of the animal examined. The
unbroken subject is not handled as satisfactorily as is the in-
telligent family horse ; in the former, in some cases, little de-
pendence is placed upon digital examination.
By palpation one is enabled to recognize hyperthermia and
this, in lieu of dependable history, is at times sufficient evidence
upon which to determine the duration of any given inflammatory
affection.
By comparison of different parts of the same member or with
an analogous portion of another member any marked increase in
the apparently normal temperature of a part at once signalizes
inflammation. In this manner, in examining a case where
laminitis or other inflammation of the feet is suspected, one may
arrive at a fairly accurate conclusion without the employment
of other means. Throbbing vessels are not always easily rec-
ognized if the subject is a victim of chronic lymphangitis.
44 LAMENESS OF THE HORSE
In some instances, where a moderate degree of lameness exists
and cause is apparently obscure, the recognition of hyperthermia
may be the deciding factor in establishing a diagnosis. In cases
of sprained ligaments in the phalangeal region, because of the
dense character of the structures involved, little if any evidence
of the cause of lameness, other than local heat, may be found
twenty-four hours after the injury has been inflicted.
In order to determine the amount or extent of hyperthermia
with a fair degree of accuracy in any given case, one must make
due allowance for external conditions affecting temperature ;
also the effect of a considerable amount of hair covering an area,
as well as any possible dirt contacting the surface of the skin
must be taken into account. All dirt should be removed if prac-
ticable, so that the diagnostician's palms may come as nearly
in contact with the inflamed structures as possible. Then, too,
the sense of touch if the operator's hands are chilled, is not de-
pendable. In such instances the novice wnll need to be de-
liberate as to his findings — whether or not hyperthermia really
exists. Such an examination is of little value where the sub-
ject's feet are wet and an examination is hurriedly made, as in
eases of suspected laminitis.
Often, before being able to di.stinguish the presence of a
hyperthermic condition, one is impressed with the fact that an
animal manifests evidence of being supersensitive. In fact,
some animals in the anticipation of pain at the touch of an in-
jured part, will instinctively withdraw — in self-protection — such
an ailing member or resist the approach of the practitioner. This
sensitiveness is more apparent in animals that have been sub-
jected to previous manipulation or treatment which has oc-
casioned pain, and consequently, allowance must be made for
this exhibition of fear. No better example of this condition can
be imagined than is present in cases of "shoe boil." where
there exists an extensive area of acute inflammation of the el-
bow. There is always more or less surface disturbance wherever
vesication has ])een produced, and in cases where irritants of
any kind have been employed for several days or a week previous
to an examination, more or less supersensitiveness is to be ex-
pected.
DIAGNOSTIC PRINCIPLES 45
One must not lose sight of the fact that unscrupulous dealers,
— "traders" — make use of their knowk^dge of this principle in
various way usually for the purpose of attracting attention to
a part, which, presumably might have been blistei'ed in order to
intentionally produce inflammation of tissu'^s. iti this way;
causing lameness which is not manifested until an animal has
been kept by its new owner for twenty-f( U)- Ik urs or more.
This, to be sure, usually makes a dissatisfied purchaser who is
willing to dispose of his newly acquired animal at a sacrifice.
thus enabling the original owner or his agent to regain posses-
sion of the victimized animal at less than its real value.
Some nervous animals, because of the manner of approach of
the practitioner, are wont to flinch, and there is manifested a
pseudo-supersensitiveness. Young animals not accustomed to be-
ing handled are likely to be timorous, and one must not hastily
conclude that a part is painful to the touch because the subject
resents even gentle digital manipulation of such parts. In
instances of this kind, one needs to compare sensibility by manip-
ulation of different parts of the subject's liody in a careful and
gentle manner ; and by exercising patience and good judgment
in such work, it is possible to actually distinguish between nor-
mal sensibility and abnormal sensitiveness, in most cases. Here,
again, the diagnostician needs to jiossess skill as a horseman and
good judgment as to individual temperament of different animals,
under any condition which may exist af the time he makes his
examination.
By palpation alone, one can recognize the presence of fluctu-
ating enlargements ; one may not oidy recognize such conditions,
but distinguish between a fluctuating ma-s such as exists in non-
strangulated hernia and a large fibrous tumor. By palpation,
for the recognition of density and for determining the presence
or absence of hyperthermia, one may decide that there exists
an abscess and not a tumor. Edematous swellings are recog-
nized by palpation, — the characteristic indentations which may
be made in dropsical swellings are pathognomonic indicafoi-s.
In this manner it is easy to differentiate post-operative or i)cst-
traumatic edemas which may or may not cause lameness. At
any rate, it is essential to take into account all determinate con-
46 LAMENESS OF THE HORSE
ditions that may assist iu the prognosis of any given case,
for the purpose of being able to outline rational remedial
measures. To be able to distinguish between the generalization
of a septic infection in its incipiency, and a more or less benign
edema, is largely possible by digital manipulation alone. An
extremity may be greatly swollen because of the existence of
chronic lymphangitis, influenza, or an acute septic infection oc-
casioned by the introduction of pathogenic and aerogenic or-
ganisms. Since the effect produced by these dissimilar ailments
are productive of conditions that may terminate favorably or
unfavorably, it becomes necessary for the diagnostician to de-
velop a trained, discriminating, tactile-digital sense, in order to
correctly interpret existing conditions, and handle cases in
a rational and skillful manner.
In order to ascertain the extent and exact location of a tumor,
an exostosis, or other enlargements, the diagnostician, here also,
needs to be in possession of a trained tactile sense and in addi-
tion if he be fortified with an accurate knowledge of normal anat-
omy and pathology, he is able to arrive at proper conclusions,
when digital manipulations have been employed. Fibrous tu-
mors are sometimes located in the inferior part of the medial
side of the tarsus — exactly over the seat of bone-spavin. Such
tumors, when the affected member is supporting weight, are not
to be distinguished from exostoses; but as soon as the affected
leg ceases to bear weight, it may be passively flexed and the
nature of the enlargement recognized because it may be slightly
displaced by digital manipulation. Displacement, of course, is
not possible with an exostosis.
A necessary qualification, which the diagnostician must pos-
sess, is that of being able to judge carefully the nearness of any
given exostosis to articular structures. Also, the extent or area
of the base of an exostosis as well as its exact position, needs
be determined before one may estimate the probal)le outcome
in any case, — whether treatment should be encouraged or dis-
couraged by the practitioner. Periarticular ringbone may, be-
cause of the size and location of the exostosis, constitute a con-
dition Avhich cannot be relieved in any way in one case, and in
another, because of the manner of distribution of such osseous
DIAGNOSTIC PRINCIPLES 47
deposits, the eoiulitiou may be such that prompt recovery will
follow proper treatment. In the examination of an exostosis of
the tarsus, it is particularly important to determine the exact
location of the exostosis — whether or not the spavin involves
the ti])ial tarsal (astragulus) ])one very near its tibial articular
portions. Obviously, if articular surfaces of joints are involved,
comjilete recovery cannot result despite the most skillful atten-
tion given the subject.
Passive Movements.
Wherever it is possible to gain the confidence of a tractable
animal to the extent that it will relax the structures sufficiently
to nuike possible passive movement of affected parts, much is
to be learned as a result of such manipulation. By this method
one may differeiitiate true crepitation, false crepitation, luxation
and inflammation of ligaments that have been injured, as in
sprains of such structures in the phalangeal region.
True crepitation is recognizable by the characteristic vibra-
tion which is interjireted by tactile sense. It is possible to rec-
ognize fracture by the use of other methods — auscultation, tun-
ing fork tests, etc., but in ordinary veterinary practice one must
rely upon the sense of touch for recognition of crepitation.
Where pain is not so great tliat relaxation of parts does not
occur, one can, by gently moving an extremity in various di-
rections— as in flexion, extension and lateral motion as well as by
rotation — cause to be manifested this peculiar grating, — the
friction of newly broken bone. This is known as true crepitation.
Where the subject, suffering phalangeal fracture, manifests
evidence of pain due to tensing the structures abinit a fractured
part, one may anesthetize the parts by using a1)0ut two cubic'
centimeters of a two per cent, solution of cocain upon the plantar
nerves, proximal to the fracture. It is perhaps l)est to deposit
the cocain solution by means of two hypodermic punctures at
different points along the course of each nerve, though closely
situated to one another, thereby making more sure of the so-
lution actually contacting the nerve. In some multiple frac-
tures of the first or second phalanx this is quite necessary;
otherwise, pain produced by passive manipulation causes the
48 LAMENESS OF THE HORSE
subject to keep the tendons so tense that crepitation may not
be detected. The unnecessary infliction of pain is always to be
avoided.
We know as false crepitation a vibrating impulse occasioned
by normal contact of articular portions of bones such as in the
metacarpophalangeal joint when this structure is passively
moved, where the subject permits the parts to remain in a state
of complete relaxation.
Attempts to recognize supersensitiveness or inflammation by
means of passive movement of the shoulder or hip, whether
gently or forcefulty, is not productive of good, in any case, in
large animals. Because of the bulk and weight of parts so
manipulated, a.s well as the resistance the subject offers even
in normal cases, no accurate conclusion is to be arrived at in
this manner in the average instance. Animals nearly always
resist the placing of members in any position that is so unusual
and uncomfortable as that which is required to materially dis-
place the component tissues of the shoulder or hip ; therefore,
such ])raetiee is useless because one can not distinguish between
normal resistance and flinching caused by painful sensations in
injured parts. Such manipulations are practical in small ani-
mals.
Observing the Character of the Gait.
In order to determine the degree of lameness as well as its
character, it is necessary to cause the s'ubject which is being
examined, to move in some manner. The degree of inconvenience
or distress experienced by a lame animal that is being so ex-
amined is manifested l)y the character of the claudication ; and
where much pain is occasioned in locomotion there is disturbance
of respiration ; perspiration may be noticeable and in some in-
stances manifestation of nervous shock are very evident — this in
timid, nervous animals that anticipate being punished when
approached and, consequently, make every effort possible to
move when urged to do so. An animal, then, should be moved
only sufficiently to cause it to exhibit the degree of lameness
present in any given case, and if a marked impediment is mani-
fested it is not necessary to cause the subject to be exerted to
DIAGNOSTIC PRINCIPLES 49
the extent of inflicting, in such manner, unnece^sai-y punishment.
Further or conclusive examination is made by palpation. To
cause the subject to move, an assistant may simply lead the ani-
mal with a halter and compel it to walk a few steps. In this
way, lameness, whether manifested during the weight-bearing
period of an alfected member, or when such a meud)er is being
advanced, or whether a com])ination of the two conditions exists,
is made apparent. In the words of Dollar, one is thus enabled
to recognize the existence of "supporting-leg-lameness," "swing-
ing-leg-lameness" or "mixed lameness."
^Yhen the cause of lameness is not strikingly apparent it be-
comes necessary to have the subject moved farther than a few
steps and at different paces. Depending then, upon the charac-
ter of lameness manifested, as well as upon its degree of iu-
tensity, one needs to exercise the subject in various ways, but
this should not be overdone.
The first thing apparent in the lame subject in action, is the
lame leg. If this is not readily determinable, as in some compli-
cated cases, the leg or legs which are at fault are to be dis-
covered by further examination, and to do this, — word-pictures
convey little that is helpful in dif^cult cases, — long practice is
the one route by which one may become efficient; that is, by ex-
perience gained after fundamental principles in the diagnosis
of lameness have been mastered.
For a careful study of supporting-leg-lameness involving a
fore limb, the subject is driven or led toward the one making
such examination. If a hind leg is to be observed, the animal
is made to travel (nraij from the examiner. Where there exists
swinging-leg-lameness, the subject should be caused to movt
past the diagnostician, so that he may get a side view of the
subject while it is in motion.
In every case sucli examinations are made to the best ad-
vantage if the practitioner can view his patient from a little
distance. Here, again, a visual examination is made but this
cannot be successfully executed, in difficult cases, if the prac-
titioner is stationed at too close range.
The average subject is liest observed by being led, rather than
being ridden, and in so doing the animal should be given moder-
50 LAMENESS OP THE HORSE
ately free rein. A close grasp on the lead may interfere some-
what with head movements. Nodding of the head with the catch-
ing up of weight hy a sound member in supporting-leg-lameness
of a fore leg, constitutes the chief symptom considered in de-
tecting 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 iho
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 support-
ing-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 liind 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 limp-
ing, (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 sup-
porting-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^ is shortened. The gait, in such
cases, is peculiar, animals appearing stiff' and they are said, by
horsemen, to have a "choppy" gait.
It i? 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 sup-
^By .stiide i.s mefuit the distance l)etween two successive imi>rints of tlie
same foot. The term is not used in this work as being synonymous with
step.
DIAGNOSTIC PRINCIPLES 51
porting member. To augment the manifestation of certain af-
fections, 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 aft'ections, are made manifest by a
side to side movement or a pivotal movement. In fact, wherever
it is possiI)le to cause undue or unusual tension to be exerted
upon an inflamed structure, manifestation of pain is the re-
sponse. In an inflamed condition of the lateral side of the pha-
langes, unequal weight-bearing such as a rough road surface will,
by virtue of the leverage which the solar surface of the foot af-
fords, cause undue strain upon such inflamed parts, and in-
creased lameness is evident.
When an animal is made to travel in a circle, when a mem-
ber 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 cir-
cuitous 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 sub-
ject is made to travel in a circle, with the lame leg on the out-
side of a circle thus described.
In supporting-leg-lameness, the transientness of the w^eight-
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 ac-
celeration 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 pe-
riod. The result is then, an une(iual division of stride; a nod-
ding 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 dis-
52 LAMENESS OF THE HORSE
tauce, ill some cases, lanieuess becomes less evident — as in sjiavin.
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 ani-
mal should begin in the stall, for in instances where the impedi-
ment is not marked, there may be no evidence of lameness after
the subject ha.s walked a few steps. In other cases, lameness in-
creases as the subject continues to travel, and often to the ex-
tent that tile impediment becomes too severe to allow the animal
being serviceable. Therefore, one can not, in every case of lame-
ness 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 ex-
isting. 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 neces-
sary to see the subject again at a later date, or under more
favorable circumstances. This is to be expected in some con-
ditions 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 allow^ance
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 sub-
jects for examination ami in some eases 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. Jt is especially difficult to satis-
factorily 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 examina-
tion by palpation. In such cases — if an examination does not
reveal the cause of trouble, rest must be recommended and fur-
ther examination made at a later date, whereupon any new
developments iiuiy be noted, if such changes exist.
DIAGNOSTIC PRINCIPLES 53
Special Methods of Examination.
After having coiupk'ted a general examination of a lame ani-
mal—obtaining tlie history of the case, noting its temperament,
type, size, conformation, position assumed while at repose, swell-
ings 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 intlannnation or to recognize crepita-
tion it becomes necessary in some cases to employ peculiar means
of examination in singular instances. This may be done by mak-
ing use of cocain in solution for the production of local anes-
thesia as in lameness of the phalanges. Such means are not, in
themselves, dependable but are valuable when used in conjunc-
tion 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 "breali
over" in a different uumner 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 supersensi-
tiveness is another means that is of practical service. No exam-
Pig. i_Hoof testers with special jaws of sufficient size to grasp the
largest foot.
ination, in any case of lameness, is complete without having re-
moved 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.
SECTION IT I.
LAMENESS IN THE FORE LEG.
Anatomo-Physiological Review of parts of the Fore Leg.
For supporting weight, whether tlie suhjeet is at rest or in
motion, the bony eolunin of the leg, together with attached liga-
ments, tendons and muscles, is wonderfully well adapted by na-
ture 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 prolonga-
tion, is sufficiently broad and flattened that it fits snugly against
the tliorax without necessity for a complicated method of attach-
ment— the clavicle l)eing absent, attachment is muscular.
Smith^ 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 ; l)ut 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 at-
tachment, 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.
iManual of Veterinary I'hysiology, by Major-General F. Smith, page .590.
55
56
LAMENESS OP THE HORSE
Extensor cnrpi obliqum,
Metacarpal tuberosity — ^ [\
Tendon from common to lateral extensor
Lateral small metacarpal bone
Branch of suspensory ligament to
extensor tendon
Olecranon
Ulnar head of deep flexor
Lateral extensor
Deep flexor (humeral head)
Tendon of ulnaris lateralis
Accessory carpal bone
Check ligament
Suspensory ligament
Flexor tendons
Flexor tendons
(Uirtilnge of third phalanx
Fig. 2 — Muscles of Left Thoracic Limb from Elbow Downward; Lateral
(External) View.
a, Extensor carpi radialis; g, brachialis: g', anterior superficial pectoral;
c, common digital extensor; e, ulnaris lateralis (After Ellenberger-Baum,
Anat. fiir Ktinstler.) (From Sisson's "Anatomy of the Domestic Animals").
LAMENESS IN THE FORE LEG
57
Long head of triceps
Medial head of triceps
Olecranon
Ulnar head of deep flexor -
Flexor carpi ulnaris
Flexor carpi radiaUa -
/ Biceps brachii
1-
Extensor carpi radinlis
■ Long tendon of biceps
Brachialis
Long medial ligawcnl
Radius
Accessory carpal hone
Medial ligament of carpjis
Superfwial flf.xnr tendon
Deep flexor lendon
Suspensory ligament
Distal end of Mc. II
Annnl/iT ligament
Superficial flexor tendon
Deep flexor tendon .
Tendon of extensor carpi
obbquus
Metacarpal tuberosity
Mc. Ill
Fetlock joint
Extensor branch of suspcnsorii
ligam.enl
Common extensor tendon
■ Pastirn joint
Cartilage of third phalanx
Fig. 3 — Muscles of Left Thoracic Limb from Ell)o\v Dov.-pward; Medial
(Internal) View.
The fascia and the ulnar head of the flexor carpi ulnaris liave been re-
moved. 1, Distal end of humerus; 2, median vessels and nerve. (From
Sisson's "Anatomy of the Domestic Animals").
58 LAMENESS OF THE HORSE
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 in-
hibited by the biceps braehii (flexor l)rachii or coracoradialis)
muscle.
The distal end of the humerus, however, articulating with the
radius and ulna in a fashion that no support is lent liy any sort
of contact with the liody, is a ginglymus (hinge) joint and later-
al motion, because of the long transverse diameter of its articular
]")ortions, is easily prevented by the medial and lateral ligaments
(internal and external ligaments). Flexion of this, the humero-
radioulnar joint (elbow), is restrained by the triceps braehii
and extension is checked by the biceps braehii (flexor braehii).
The carpal joint (erroneously called the knee joint), is com-
posed of the several carpal bones which interarticulate and,
when taken as a group, serve as a means of attachment and ar-
ticulation for the radius and metacarpal bones.
The transverse diameter of this joint is long, thus giving it
contacting surfaces that are sufiiciently extensive to minimize
the strain upon the mesial and lateral ligaments (internal and
external lateral common ligaments). ]\Iotion 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 cheek 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 liga-
ments bind the bones together. AVhile bearing weight, there is
assumed a position of slight dorsal flexion, undue flexion being
checked by the inhibitory ap])aratus of the joint — cheek liga-
ments, and their tendons and the suspensory ligament. The in-
hibitory apparatus of the fetlock joint is materially reinforced
LAMENESS IN THE FORE LEG
59
})y the proximal sesamoid bones. Situated as they are, between
tlie bifurcatino' portions of the suspensory ligament and the pos-
terior part of the distal end of the metacarpus — with which they
ai'ticulate — the sesamoid bones serve to change the course of the
Stin
Tendon of common exlensoi
Bursa
Capsule of fetlock joint
Cavity of fetlock joint
Cavity of /laslcrti jmnl
Cavity of coffin joint . ^^
Coriinn of pcriople ^^ ^^ /
I'criopk^S^. /
rutin Jg'-- :
Middle scsamoidcan ligamcjil
-f^ir/ Digital synovial sheath
lfJJ~~ Cavity of pastern joint
Superficial sesamoidean ligament
Deep flexor tendon
Distal end of digital sheath
— r2
11
Digital cushion
Corium of sole
Fig. 4— Sagital Section of Digit and Distal Part of Metacarpus.
A, Metacarpal bone; B, first phalanx; C, second phalanx, D, third phalanx;
E, distal sesamoid bone; 1, volar pouch of capsule of fetlock joint; 2, inter-
sesamoidean ligament; 3, 4, proximal end of digital synovial sheath; 5.
ring formed by superficial flexor tendon; 6, fibrous tissue underlying ergot;
7, ergot; 8, 9, 9', branches of digital vessels; 10, distal ligament of distal
sesamoid bone; 11, suspensory ligament of distal sesamoid bone; 12,
12', proximal and distal ends of bursa podotrochlearis. (From Sisson's
"Anatomy of the Domestic Animals"').
branches of the suspensory ligament in a manner that they give
firm support to this joint. Volar Hexion is limited by the ex-
tensors of the phalanges.
The first phalanx (os suffraginis) normally sets at an angle
60 LAMENESS OF THE HORSE
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 inter-
phalangeal (pastern or sutfraginocoronary) joint. This also,
is a gingiymus 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 re-
strained 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 sup-
ported by the hony 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 ap-
paratus, and are slightly flexed, as in the carpus, or considerably
flexed such as in the fetlock joint when weight is being sup-
ported. 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 ar-
ranged 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^, yet
in every instance where weight is not supported by bones, in-
elastic 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 role of supporting weight and as propelling parts,
and net ]i;)rtii'ulai'ly in tlic capacity of these members for in-
^Manual of Veterinary l>hysiolo,a;v liy Major-Oeneral F. Smith, page 580
LAMENESS IN THE FORE LEG 61
flicting 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, how-
ever, a diagnosis is established l)y 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 nu^nbers. 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 diag-
mostician 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 lie caused l)y 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 ell)OW
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; rheu-
matic 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 dis-
similar possible causes of shoulder lameness, it behooves the prac-
titioner 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
62
LAMENESS OF THE HORSE
manifested by more or less difficulty in swinging the affected
member. Swinging-leg-lameness, then, is usually present in
shouAder affections. In some instances lameness is mixed as in
joint ailments, involvement of the bicipital bursa (bursa inter-
tubercularis), etc. In affections of the extremity there exists
supporting leg lameness. Consequently, we employ this ele-
mental principle, and, by a visual examination of the subject,
which is being made to travel suital)ly, one may decide that
lameness is either "high up" — shoulder lameness or, "low
down" — of the extremitv.
Fig. 5 — Ordinary type of heav>- sling.
To make practical use of this principle, the examiner must
be thoroughly familiar with the anatomy of the various struC'
tures concerned in advancing the leg — those which support weight
as well as those concerned l)oth 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
LAMENESS IN THE FORE LEG
63
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 con-
tusions have been the cause as a rule, and serious injury is done
the subject ; consequently, treatment of fracture of the body of
Fig. 6 — A sling made in two parts so that horses may be supported with-
out use of central part or bodice. This sling is more comfortable than
is the ordinary style and is particularly useful in cases that require a
long period of this manner of confinement.
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 inter-
fere with the vitality of the suliject, 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
64 LAMENESS OF THE HORSE
perfect apposition of the fractured ends is difficult, if not ini
possible.
Fractures that extend to the articular surface are very seri-
ous, and complete recovery in such instances is practically impos-
sible. 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 in-
stances, the upper portion of the scapula is disjoined from all
attachment, and with every movement the animal makes, the
scapula is moved l)ack and forth. Complete recovery in such
cases does not occur.
Symptomatology. — Fractures of the scapular spine are ordi-
narily readily recognized because there is usually visible dis-
placement of the broken part. Crepitation is also detected with-
out difficulty.
In fractures of the body of the scapula where an examination
may be made before much swelling has taken place, and in sub-
jects that are not heavily muscled, one should have no difficulty
in recognizing the crepitation.
Fractures of the neck of the scapula are recognized by crepi-
tation, 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 ex-
ists, 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 ^^ay of a cutaneous incision so situated that good drain-
age 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 tliree to six
weeks. Splints or similai' appliances are not of ])ractical value
in scapular fractures.
Compound fractures of tlic scapula usually result from vio-
lence, which at the same time does serious injury to adjacent
LAMENESS IN THE FORE LEG 65
structures, and it then becomes necessary to administer an ex-
pectant treatment, observing general surgical principles and pro-
viding in so far as possible for the comfort of the patient.
Scapulohumeral Arthritis.
Anatomy.— The scapulohumeral joint is an enarthrodial (ball
and socket) joint wherein the ball or humeral articulating head
greatly exceeds in size the socket or glenoid cavity of the scapula.
The capsular ligament surrounding this joint is very large and
admits of free and extensive movement of the articulation. There
exist no lateral or common ligaments jointing the scapula and
humerus as in other joints, but instead the tendinous portions
of muscles perform this function. The principal ones which are
attached to the scapula and humerus that act as ligaments are
the supraspinatus (antea-spinatus), infraspinatus (postea-
spinatus) biceps-brachii (flexor brachii) and subseapularis mus-
cles.
Etiology and Occurrence. — Inflammation of the scapulohum-
eral articulation results from injuries of various kinds, including
punctures which perforate the joint capsule, bruises from col-
lars, metastatic infections and involvement as a result of direct
extension of infectious conditions situated near the joint.
Classification.— Acute arthritis may be septic or aseptic, and
there seems to be a remarkalile tendency for recovery in cases
of septic arthritis involving this joint in the horse.
Chronic arthritis with destruction of articular surfaces and
ankylosis, is seldom observed. It is only in cases of severe in-
jury, where the articular portions of the bones are damaged at
the time of infliction of the injury, and where the articulation
remains exposed for weeks at a time, together with immobility
of the parts because of attending pain, that permanent ankylosis
results.
Scapulohumeral arthritis may result then from infections, local
or metastatic; from injuries, such as contusions of various kinds;
from wounds, which break the surface structure or perforate
the joint capsule; or from luxations.
66 ' LAMENESS OF THE HORSE
Infectious Arthritis.
Infectious arthritis of the scapulohumeral joint the result of
local causes other than produced by septic wounds, seldom causes
serious inconvenience to the subject. "Where such occurs, how-
ever, there is manifested mixed lameness and complete extension
of the extremity is impossible. Local swelling is present and
manifestations of pain are evident upon palpation of the affected
area.
Treatment. — During the first stage of the infection, local ap-
plications, hot or cold, are indicated. A hot poultice of bran
or other suitable material contained within a muslin sack, may
be supported by means of cords or taj^es which are passed over
the withers and tied around the opposite fore leg. Such an
appliance may be held in position more securely by attaching
it to the affected member. Following the acute stage of such an
infection, any local counter-irritating application or even a
vesicant is in order.
Where abatement of the infectious process does not take place,
and suppuration of the structures in the vicinity of the joint
occurs, it is necessary to provide drainage for pus. In some
cases of strangles, for instance, large pus cavities are formed
and drainage is imperative. However, metastatic inflammation
of this joint is seldom observed except in cases of strangles.
The animal should be kept perfectly quiet until recovery has
taken place.
Injuries.
Injuries to the scapulohumeral joint may be the result of
kicks, runaway accidents or bruises from the collar, and there
may result, because of such injuries, reactionary inflammation
which will vary in intensity from the mildest synovitis to the
most severe arthritis, causing more or less lameness.
Treatment. — The general plan of treatment in this form of
arthritis is the same as has been outlined under the head of in-
fectious arthritis, with the exception that there is seldom occa-
sion to provide for drainage of pus.
LAMENESS IN THE FORE LEG 67
Wounds.
Wounds which cause a break of the skin and fascia overlying
the scapulohumeral joint are usually of little consequence, unless
the blow is of sufficient force to directly injure the articulation,
and in such cases, the treatment of the injury along general sur-
gical principles, such as cleansing the area, providing drainage
for wound secretion, and the administration of suitable dress-
ing materials such as antiseptic dusting powder, is all that is
required for the wound. The symptoms manifested by the sub-
ject in such cases are the same as have been discussed hereto-
fore and merit no special consideration.
Prognosis. — Unless very serious injury be done the articular
portions of the scapula or the humerus, resulting in the destruc-
tion of the capsular ligament, prognosis is entirely favorable.
Open Joint. — AVliere the capsular ligament is perforated and
the condition becomes one of open joint, then a special wound
treatment becomes necessary. The surface of the skin is first
freed from all hair and filth in the vicinity of the wound. The
wound proper is cleared of all foreign material either by clipping
with the scissors, curetting or mopping with cotton or gauze
pledgets. The whole exposed wound surface as well as the in-
terior of the joint cavity, if much exposed, is moistened with
tincture of iodin. Subsequent treatment consists in a local appli-
cation of a desiccant dusting poAvder, which should be applied
five or six times daily. The composition of the powder should
be such as to permit of its liberal use, thereby affording mechan-
ical protection to the wound as well as exerting a desiccative
effect. Equal parts of boric acid and exsiccated alum serve
very well in such cases.
Animals suffering from open joints of this kind should be
confined in a standing position, preferably in slings, and kept
so confined for three or four weeks. Since they usually bear
weight upon the affected member, there is no danger of lamin-
itis resulting.
Luxation of the Scapulohumeral Joint.
Because of the large humeral head articulating as it does with
68 LAMENESS OF THE HORSE
a glenoid cavity, scapulohumeral luxations are very rare in the
horse. According to Moller^, luxation is generally due to exces-
sive flexion of the scapulohumeral joint. In such cases the head
of the humerus is displaced anterior to the articular portion of
the scapula and remains so fixed.
Symptoms. — Complete luxation of the scapula is recognized
because of innnobility of the scapulohumeral joint and of the
abnormal position of the head of the humerus, which can be rec-
ognized by palpation, unless the swelling be excessive. Immo-
bility of the scapulohumeral joint is noticeable when one attempts
to passively move the parts.
Treatment. — Reduction of the luxation is effected by mak-
ing use of the same general principles that are employed in the
reduction of all luxations, and they are — the control of the ani-
mal so that the manipulations of the operator are not antagon-
ized by muscular contraction, which is best accomplished by
anesthesia; placing the luxated bones in the position which they
have taken to become unjointed ; and then making use of force
which is directed in a manner opposite to that which has effected
the luxation.
In a forward luxation of this kind, the operator should further
flex the humerus, and while it is in this flexed position, force is
exerted upon the articular head of this bone, and it is pushed
downward and backward into its normal position.
After-care consists in restriction of exercise and, if necessary,
confining the subject in a sling and the application of a vesicant
over the scapulohumeral region.
Inflsunmation of the Bicipital Bursa.
( Bursitis Intertuberculeuis. )
Anatomy. — There is interposed between the tendon of the
biceps brachii (flexor brachii) and the intertubercular or bicipi-
tal groove a heavy cartilaginous pad, which is a part of the bursa
of the biceps brachii. This synovial bursa forms a smooth groove
through wliicli tlie l)ieeps braelni glides in the anterior scapulo-
'Regional Veterinary Surgery and Operative Technique, .Tno. A. W. Dollar,
M. R. C. V. S., F. R. S. E., M. R. I., page 765.
LAMENESS IN THE FORE LEG 69
humeral region. Great strain is put upon these parts because
the biceps brachii is the chief inhibiting structure of the scapu-
lohumeral articulation— the one which prevents further flexion
of the luimerus during weight bearing. Passing, as it does, over
two articulations, the biceps brachii has a somewhat compli-
cated function, being a flexor of the radius and an extensor of
the humerus. Thus it is seen, the biceps brachii is a weight bear-
ing structure, as well as one that has to do with swinging the leg.
Etiology and Occurrence. — Because of the exposed position
of the bicipital bursa (bursa-intertubercularis) it is occasionally
injured. Blows and injuries received in runaway accidents do
serious injury to the bursa and because of the peculiar and im-
portant part it plays during locomotion, serious injuries are
not likely to resolve, and too often chronic lameness results. It
is to be noted that the tendon of the biceps brachii (flexor bra-
chii) is always involved in cases of inflammation of the bicipital
bursa, and according to the late Dr. BelP strain of the biceps
brachii is a frequent cause of lameness in city horses, more fre-
quent than is generally supposed.
Pathological Anatomy. — ]\Iore or less destruction of the car-
tilaginous portion of the bursa, sometimes involving the tendin-
ous portion of the biceps, takes place and, according to MoUer,
in some instances there occurs ossification of the tendon. Autop-
sies in some old horses reveal the presence of erosions of carti-
lage and hyperthrophy of the inflamed parts.
Symptoms. — In acute inflammations, there is always marked
lameness. This is manifested to a greater degree when the sub-
ject advances the affected leg. There is incomplete advancement
of the member; the toe is dragged when the horse is made to
walk and the foot kept in a position posterior to the opposite or
weight bearing foot while the suliject is at rest. Lameness is
disproportionate to the amount of local manifestation in the way
of heat, swelling and pain that is to be recognized on palpation.
In fact, in some cases so much pain attends the condition that
no weight is borne liy the affected member, and when compelled
to walk, the subject hops on the sound leg.
iDr. Roscoe R. Bell in the Proceedings, N. Y. State Veterinary Medical
Society, 1899.
70 LAMENESS OF THE HORSE
Chronic inflammation of the bicipital bursa is occasionally met
with wherein both members are afiPected. Because of the nature
of the structures involved, when inflamed, chronic inflammation
is a more frequent termination than is complete recovery. Bi-
lateral affections are seen in horses that are driven for years,
regularly at a fast pace on paved streets. In such cases, the
gait is stilted, that is, there is incomplete advancement of both
members and, of course, the period of weight bearing is cor-
respondingly shortened; hence the short strides.
In chronic cases, little if any evidence of inflammation is to
be detected by digital manipulation of the parts. If flinching
occurs, one is often unable to interpret the manifestation as to
whether it is due to inflammation or not.
There is no marked "warming out" in this condition, and ani-
mals are nearly as lame after having been driven a considerable
distance as when started, although the lameness is not as a rule
very great.
Treatment. — In very painful cases acute inflammation is
treated by employing cold applications during the initial stage.
Cracked ice when contained in a suitable sack may be held in
contact with the affected part and the pack is supported by
means of cords or tapes as suggested in the discussion on treat-
ment of scapulohumeral arthritis on page 66. Later, hot appli-
cations may be employed to good advantage.
In the course of ten days or two weeks, if the acute painful
condition has entirely subsided, vesication is indicated. The
ordinary mercury and cantharides combination does very well.
Depending upon the course taken in any given case, one is guided
in the treatment employed. If prompt resolution comes to
pass, the subject may be given free run at pasture after three
or four weeks confinement in a box stall. If, however, the case
does not progress in a prompt and satisfactory manner, abso-
lute quiet must be enforced for six weeks or more. Kepeated
blistering is beneficial, although it is doubtful if firing is of
sufficient benefit in the average chronic case of intertubercular
bursitis to justify the punishment which this form of treatment
inflicts, unless infliction of pain is the thing sought, to en-
LA.MENESS IN THE FORE LEG 71
force repose in restless subjects. Patients are best given a long
rest at pasture and returned to work for two or three months
after an acute attack of inflammation of the bursa, lest the con-
dition become chronic. When due consideration is given the
pathology of such cases, the frequent unsatisfactory termination
under the most careful treatment, is readily understood.
Contusions of the Triceps Brachii.
( Triceps Extensor Brachii : Caput Muscles. )
Anatomy. — The triceps brachii is the principal structure
which fills the space between the posterior border of the scapula
and the humerus. The several heads originate for the most part
on the border of the scapula, the deltoid tuberosity of the hu-
merus and the shaft of the humerus. Insertion of this large
muscular mass is effected by means of several tendons to the
olecranon. A synovial bursa is situated underneath the ten-
dinous attachment of the posterior portion of the triceps brachii
— the long head or caput magnum.
The function of the triceps as a whole is to flex the shoulder
joint and extend the forearm. The triceps brachii is the chief
antagonist of the biceps brachii.
Etiology and Occurrence. — Owing to the exposed position of
this structure, it is not infrequently contused, the result of falls,
kicks and other injuries. The function of the triceps is such
that it becomes strained upon rare occasions Avhen a horse resists
confinement of restraint in such manner that the parts are un-
duly tensed in contraction. This sort of resistance may stretch
the radial nerve or its branches in a way that paralysis results.
A condition known as "dropped elbow" is described by Henry
Taylor, F. R. C. V, S., in the Veterinary Record^ wherein a
two-year-old colt while resisting confinement was so injured.
The triceps group because of its convenient location, consti-
tutes the site for hypodermic injection of drugs and biologic
agents, with some practitioners; and as a result, more or less
inflammation may occur. The author has observed and treated
some twenty cases where an intensely painful infectious inflam-
lAmerican Veterinary Review, Vol. 35, P. 456.
72 LAMENESS OF THE HORSE
mation of the triceps brachii was caused by the intramuscular
injection of a caustic solution by a cruel and unscrupulous em
piric, whose object was to increase his practice.
Symptomatology. — As the triceps brachii is not particularly
taxed during weight bearing in the su])ject at rest, there may
be no unnatural position assumed during inflammation of the
triceps. More or less swelling and supersensitiveness is always
present, however, and great care and discrimination must be ex-
ercised in digital manipulation of the triceps region because
many animals are normally sensitive to palpation of these parts.
It is sometimes difficult to correctly interpret the true state of
conditions because of this peculiarity.
There is always swinging-leg-lameness, which is accentuated
when the subject is urged to trot. AVhere symptoms are pro-
nounced, it is unnecessary to cause the subject to move at a
faster pace than at a walk to recognize the condition. The for-
ward stride is shortened and in extremley painful conditions, no
attempt is made to extend the leg. It is simply carried en une
pipce — flexion of the shoulder and elbow joints is carefully
avoided.
Treatraient. — During the early stage of inflammation, hot or
cold applications are beneficial. Long continued use of moist
heat — fomentations — allays pain and stimulates resolution. Keep-
ing in contact with the painfully swollen parts a suitable bag
filled with bran, which can be moistened at intervals with warm
water, constitutes a practical and easy means of treatment. By
employing this method, one is more likely to succeed in having
his patient properly cared for, in that less work is entailed than
if hot fomentations are prescribed.
After the acute and painful stage has subsided, a stimulating
liniment is of benefit. The subject should be kept within a com-
fortable and roomy box stall for a sufficient length of time to
favor prompt resolution. Wild and nervous subjects, if not so
confined, will i)i-()1)ably overexert the affected parts if allowed
the freedom of a paddock or pasture.
Where the inflammation liecomos infective, surgical interfer-
ence is necessary. The prompt evacuation of pus, with adequate
LAMENESS IN THE FORE LEG 73
provision for wound discharge, should be attended to before
extensive destruction of tissue takes place. Resolution is prompt
as a rule in such cases because of the vascularity of the struc-
tures and the ease with which proper drainage may be effected.
No special after-care is necessary if drainage is perfect, ex-
cept that one should avoid injecting the wound cavity with
aqueous solutions unless it be absolutely necessary to cleanse
such cavity, and then it is best to swab the wound rather than
to irrigate it freely.
Shoulder Atrophy.
(Sweeny or Swinney)
No satisfactory consideration of the pathogeny of this condi-
tion is recorded, but practitioners have long distinguished be-
tween muscular atrophies which are apparently caused without
doing serious injury to nerves and muscular atrophy which
seems to be due to nerve affection. In the first instance, recov-
ery Avhen proper attention is given, is prompt; whereas, in the
latter, regeneration of the wasted tissues requires months in
spite of the best sort of treatment.
The parts more frequently affected are the supra- and infra-
scapularis (antea- and posteaspinatus) muscles. But in some
cases the triceps group is involved; however, this occurs in un-
usual and chronic affections. No doubt, these chronic cases are
due to suspended innervation and are not to be classed with
the ordinary case of atrophy of the aliductor muscles of the
liumerus (supra- and infraspinatus) as in the usual case of
"sweeny."
Occurrence. — Shoulder atrophy such as the general practi-
tioner commonly meets with, is an affection, more often seen in
young animals and it seems to be due to injuries of various kinds
which contuse the muscles of the shoulder. Ill-fitting collars
and pulling in a manner that there occurs side draft with un-
usual strain on the muscles of one side of the neck and shoulder,
seem to be the more frequent causes of this trouble. Blows such
as are occasioned by kicks and falls frequently result in atrophy
of shoulder muscles.
74 LAMENESS OF THE HORSE
Course. — In some eases a rapidly progressive atrophy char-
acterizes the case and lameness and atrophy appear at about
the same time. The affection in such instances does not re-
cover spontaneously but constitutes a condition which requires
prompt and rational treatment so that function may be fully
restored to the parts involved.
Occasionally one may observe cases where there is but slight
atrophy; where the disease progresses slowly and atrophy is
not extensive or marked. In vigorous young animals that are
left to run at pasture when so mildly affected, spontaneous re-
covery occurs.
Symptomatology. — Lameness is the first manifestation of
shoulder atroi3hy, and in many cases where lameness is slight,
the veterinarian may fail to discover the exact nature of the
trouble if he is not very proficient as a diagnostician of lame-
ness or if he is careless in taking into consideration obtainable
history, age of the subject, etc. Because of the fact that the
average layman believes that practically every case of fore-leg
lameness wherein it is not obvious that the cause is elsewhere,
is due to a shoulder affection of some kind, we may be too hasty
in giving the client assurance that no "sweeny" exists. In some
of these cases where a diagnosis of "shoulder lameness" has
been made and the client has been assured that no sweeny exists,
the patient is returned in about a week and there is then marked
atrophy of one or both of the spinatus muscles.
A mixed type of lameness characterizes this affection, and in
the average case there exists little evidence of local pain. The
salient points in recognizing the condition are a consideration
of history if obtainable ; age of the subject ; finding slight local
soreness, by carefully manipulating the muscles which are usu-
ally involved; noting the character of the lameness if any is
present ; and where atrophy is evident, of course, the true con-
dition is obvious.
Treatment. — Sulx-iitanooiis injections of (M|ual parts of re-
fined oil of turpentine and alcoliol, with a suitable hypo-
dermic syringe, is a practical and ordinarily effective treatment.
From five to fifteen cubic centimeter.s (the quantity varies with
LAMENESS IN THE FORE LEG 75
the size of the animal), of this mixture is injected into the atro-
phied parts at different points, taking care to introduce only
about one to two cubic centimeters at each point of injection.
The syringe should be sterile and, needless to say, the site of
injections must be surgically clean.
Other agents, such as tincture of iodin, solutions of silver
nitrate, saline solutions and various more or less irritating prep-
arations have been employed ; but in the use of these preparations
one may either fail to stimulate sufficient inflammation to cause
regeneration to take place, or infection is apt to occur. Where
suppuration results, surgical evacuation of pus must be promptly
effected else large suppurating cavities form.
The employment of setons constitutes a dependable method of
treatment of shoulder atrophy, but because of the attendant sup-
purative process which inevitably results, this method is not
popular with modern surgeons and is a last resort procedure.
After-care. — Regular exercise such as the horse usually takes
when at pasture, is very helpful in treating atrophy, and in some
cases it has been found that no reasonable amount of irritation
would stimulate muscular regeneration; but by later allowing
patients to exercise at will, recovery took place in a satisfactory
manner. No special attention is ordinarily necessary.
Paralysis of the Suprascapular Nerve.
Anatomy. — The suprascapular (anterior scapular) nerve, a
small branch of the brachial plexus, is given off from the an-
terior portion of this plexus. The nerve rounds the anterior
border of the neck of the scapula, passing upward and backward
under the supraspinatus (antea-spinatus) muscle and terminat-
ing in the infraspinatus (postea-spinatus) muscle.
Etiology and Occurrence. — As the result of direct injury to
this nerve by contusion such as may be received in runaway
accidents, collar bruises, especially collar bruises in young horses
that are not accustomed to pulling and that walk in a manner
to cause side draft, injury to the nerve occurs, and partial or
complete paralysis supervenes. Some writers state that it may
be produced by confining an animal in recumbency, with the
76
LAMENESS OF THE HORSE
casting harness. The common cause of paralysis or paresis of
this nerve in cases such as one observes in country practice, is
bruises from the collar in colts that are put to heavy farm work
or whore ill fitting collars are used.
Symptomatology. — With partial or complete suspension of
function of the suprascapular nerve there results enervation
of the supraspinatus and infraspinatus muscles. Since these
muscles act as external lateral ligaments
of the scapulohumeral joint, when they
are incapacitated, there naturally fol-
lows more or less abduction of the
shoulder Avhen weight is borne.
In extreme cases, as soon a.!, the ailing
animal is caused to support w^eight with
the affected member, the joint is sud-
denly thrown outw^ard in a manner that
the average layman at once concludes
that there must be scapulohumeral luxa-
tion, and the veterinarian receives a call
to see a case wherein the "shoulder is
out of place." There exists, however, no
luxation in such cases.
If serious injury is done the nerve so
that it undergoes degenerative changes,
there will result atrophy of the muscles
that derive their nerve supply from the
suprascapular nerve.
Treatment. — During the hrst few days
following injuries wiiich result in this
form of paralysis, it is Avell to keep the subject inactive, and
if much inflammation of the injured structures contiguous to
the nerve exists, the application of cold packs is beneficial.
Later, as soon as acute inflammation has subsided, vesication
of a liberal area around the anteroexternal part of the scapu-
lohumeral joint and over the course of the suprascapular nerve,
W'ill stimulate recovery in favorable cases. As a rule, in mild
cases, the subject is in a condition to return to Avork in two or
three weeks.
Fig. 7 — Paralysis of the
.suprascapular nerve of
the left shoulder.
LAMENESS IN THE FORE LEG 77
Radial Paralysis.
Described under the titles of "Radial Paralysis" and "Bra-
chial Paralysis," there is to be found in veterinary literature
a discussion of conditions which vary in character from the
almost insignificant form of paresis to the incurably affected con-
ditions wherein the whole shoulder is completely paralyzed.
When one considers the anatomy of the brachial nerve plexus
and the distribution of its various branches, the location of this
plexus and its proximity to the first rib, and the inevitable in-
jury it must suffer in fracture of this bone, together with the
inaccessibility of the plexus, it is not strange that a correct
diagnosis of the various affections of the brachial plexus and
the radial nerve is often impossible until several days or weeks
have passed. And, in some instances, diagnosis is not established
until an autopsy has been performed. Here, too, we fail to find
cause for paralysis in some rare instances.
Anatomy. — The radial nerve is a large branch of the brachial
plexus and is chiefly derived from the first thoracic root of the
plexus and is here situated posterior to the deep brachial artery.
It is directed downward and backward ander the subscapularis
and teres major muscles, rounding the posterior part of the
humerus, and passing to the anterior and distal end of the
humerus, it finally terminates in the anterior carpal region. The
radial nerve supplies branches to the three heads of the triceps
brachii, to the common and lateral extensors of the digit and also
to the skin covering the forearm.
Etiology and Occurrence.— Nothing definite is known about
the cause of some forms of radial paralysis. However, radial
paralysis is encountered following injury to the nerve occasioned
by its being stretched, as in cases where the triceps brachii is
unduly extended in restraining subjects by means of a casting
harness. Berns^ states that in confining horses on an old oper-
ating table where it was necessary to draw the affected foot for-
ward twenty-four to thirty-six inches in advance of its fellow.
i"Radial Paralysis and Its Treatment by Mechanical Fixation of Knee and
Anltle," Geo. H. Berns, D. V. S. Proceedings of the American Veterinary
Medical Association, 1912, i). 219.
78
LAMENESS OF THE HORSE
which was secured in a natural vertical position, radial paralysis
of a mild form was of frequent occurrence. Country practi-
tioners, in restraining colts by casting with harness or ropes,
occasionally observe a form of paresis wherein the radial nerve
suffers sufficient injury that there is caused a temporary loss of
function of the triceps brachii. Such cases recover within three
Fig. 8 — Radial paralysis.
or four days and are not a true paralysis, but nevertheless con-
stitute conditions wherein normal nerve function is temporarily
suspended.
Symptoms. — Immediately subsequent to injuries which in-
volve the radial nerve, there is manifested more or less impair-
ment of function. Remembering the structures supplied by the
radial nerve and its branches, one can readily understand that
there should occur as Cadiot^ has stated :
^As quoted bv Bcrns, in Radial Paralysis, etc., Proceedings of the A. V.
ivr. A., 1912.
LAMENESS IN THE FORE LEG
79
In complete paralysis, the joints of the affected limb with the
exception of the shoulder are usually flexed when the horse is
resting. In consequence of loss of power in the triceps and an-
terior ])rachial muscles, the arm is extended and straightened on
the shoulder, the scapulohumeral angle is open, and the elbow
depressed. The forearm is flexed on the arm by the contraction
of the coracoradialis (biceps brachii), while the metacarpus and
phalanges are bent by the action of the posterior antibrachial
iiuiscles. The knee is carried in advance, level with, or in front
of, a vertical line dropped from the point of the shoulder. The
hoof is usually rested on the toe, but when advanced beyond the
above mentioned vertical line, it may be placed flat on the
Fig. 9 — Merillat'.s method of fixing carpus in radial paralysis. Courtesy,
Alex. Eger.
ground, the joints then being less markedly bent. When the
limb as a whole is flexed, it may be brought into normal position
by thrusting back the knee with sufficient force to counteract the
action of the flexor muscles.
When made to walk, the animal l)eing unable to exert muscular
action with the paralyzed structures, limply carries the member
as a whole, and there is shortening of the anterior portion of
the stride. There ])eing loss of function of the triceps brachii,
it is impossible for the subject to straighten the leg in the normal
position for supporting weight ; therefore, any attempt to bear
80 LAMENESS OF THE HORSE
weight results in further flexion of the affected member and the
animal will fall if the body is not suddenly caught up with the
sound leg.
Differential Diagnosis. — In making examination of these
cases, one can exclude fracture by absence of crepitation and
usually, also, swelling is absent in radial paralysis. In a typical
case of radial paralysis, the affected leg can sustain its normal
share of weight if placed in position, that is, if the carpal joint
is extended in such manner that the leg is positioned as in its
normal weight-bearing attitude. In brachial paralysis, whether
due to fracture of the first rib or to other serious injury, it is
impossible for the subject to support weight with the affected
member even when it is passively placed in position.
No difficulty is ordinarily experienced in differentiating radial
paralysis from muscular injuries to the triceps; yet, in some
cases of ' ' dropped elbow, " it is necessary to observe the progress
of the case for ten days or two weeks before one can positively
establish a diagnosis.
Quoting Merillat^: "When, after four weeks, there is no
amelioration of the paralysis, the muscles have atrophied, and
the patient has become emaciated from pain and discomfort, the
diagnosis of brachial paralysis with fracture of the first rib may
tlicn be announced."
Prognosis. — AVhen no complete paralysis of the l)rachial
plexus or no fracture of the first rib exists, the majority of cases
recover completely in from ten days to six weeks. Some writers
claim that recoveries occur in ninety per cent of cases when
conditions are favorable.
Treatment. — A\nien incomplete radial paralysis exists, little
needs be done except to allow the subject moderate exercise and
to provide for its comfort. Local applications, stimulative in
character, are beneficial, and the internal administration of
strychnin is indicated.
In the cases where weight is not supported without the affected
leg being passively placed in position, it is necessary to provide
for the subject's comfort in several ways.
Mechanical appliances such as braces of some kind in order
^Veterinary Surgical Operations, by L. A. Merillat, V. S., p. 507.
LAMENESS IN THE FORE LEG 81
to keep the affected leg in a position of carpal extension, consti-
tute the essential part of treatment. The leg is supported in
such a manner that flexion of the carpus is impossible. Due re-
gard is given to prevent chafing or pressure necrosis by contact
of the skin with the braces — this may be done by bandaging with
cotton. The supportive appliance is kept in position for ten
days or two weeks. At the end of this time the brace may be
removed and the subject given a chance to walk, and improve-
ment, if any exists, will be evident. When there is manifested
an amelioration of the condition, moderate daily exercise and
massage of the affected parts are helpful.
Should the subject be seriously inconveuienced by the applica-
tion of a brace or other supportive appliances, it is necessary
to employ slings. Further, if weight is supported entirely by
the unaffected member, laminitis may supervene if a sling is not
used.
Thrombosis of the Brachial Artery.
Thrombosis of the brachial artery or of its i^rincipal branches
is of very rare occurrence in horses.
Etiology. — Partial or complete obstruction of arteries
(brachial or others) occurs as the result of direct injury to the
vessel wall from compression and tension of muscles and re-
sultant arteritis ; lodging of emboli ; and parasitic invasion of
vessel walls causing internal arteritis.
Symptomatology. — If sufficient collateral circulation exists to
supply the parts with blood, no inconvenience is manifested while
the subject is at rest. Where the lumen of the affected vessel
is not completely occluded, there may be no manifestation of
lameness when the ailing animal is moderately exercised. Con-
sequently, the degree of lameness depends upon the extent of
the obstruction to circulation ; and, likewise, the course and
prognosis depend upon the character and extent of such obstruc-
tion.
In severe eases, lameness is markedly increased by causing
the animal to travel at a fast pace for only a short distance. There
are evinced symptoms of pain, muscular tremors and sudation,
but the affected member remains drv and there is a marked dif-
82 LAMENESS OP THE HORSE
ference of temperature between the normal areas and the cool
anemic parts. When the subject is allowed to rest, circulation
is not taxed, and there is a return to the original and apparently
normal condition, only to recur again with exertion. This con-
dition characterizes thrombosis.
Treatment. — In these cases, little if any good directly results
from any sort of treatment in the way of medication. Abso-
lute rest is thought to be helpful. Potassium iodid, alkaline
agents such as ammonium carbonate and potassium carbonate,
have been administered. Circulatory stimulants also have been
given, but it is doubtful if any good has come from medication.
Fracture of Humerus.
The shaft of the humerus, protected as it is by heavy muscles,
is not frequently fractured; and fractures of its less protected
parts, as for example, the head, are complicated in such manner
that resultant arthritis soon constitutes the more serious condi-
tion.
As a result of falls on frozen ground, kicks or any other form
of heavy contusion, the humerus is occasionally broken. It is
rarely fractured otherwise. Because of the force of contusions
usually required to effect humeral fracture, the manner in which
the bone is broken, with respect to direction, is variable. Often
oblique fractures exist and occasionally there occurs multiple
fracture. In addition to the ordinarily serious nature of the
fracture itself, there is always much injury done the adjoining
structures.
Sjrmptomatology. — Mixed lameness and manifestation of
severe pain characterize this affection. Considerable swelling
which increases, in some cases for a week or more, is to be ob-
served. Crepitation is readily detected, if pain and swelling is
not too great to prevent passive movement of the member.
Where intense pain is not manifested, because of manipulation,
one may abduct the extremity and thereby occasion distinct
crepitation; but when it is po-ssible to recognize crepitation by
liolding the hand in contact with the olecranon while tlie animal
is made to walk, this method is to be preferred, if the su])ject
LAMENESS IN THE FORE LEG 83
can move without serious difficulty. The pathognomonic symp-
tcmi here is recognition of crepitation, but this may be very diffi-
cult to recognize in fracture of condyles, and in such instances,
a careful examination is necessary. Gentle manipulation in a
manner that pain is not aggravated will tend to inspire confi-
denee on the part of the subject and relaxation of muscles will
enable the operator to detect crepitation.
Course and Prognosis. — Because of the direction of the long
axis of the humerus, with relation to the bony column of the
extremity, it is obvious that any lateral movement of the leg
tends to rotate the shaft of this bone. In fractures of the shaft
of the humerus, then, it is apparent that immobilization is very
difficult if at all possible.
The proximity to the axillary lymph glands makes for easy
dissemination of infection when the contused musculature be-
comes infected. The adjacent brachial nerve plexus is so very
apt to become involved, if not actually injured at the time frac-
ture occurs, that paralysis is a probable complication. Conse-
quently, it is logical to reason that because of the many possilile
serious complications, such as shock, occasioned by the injury
and the distress and pain which this accident produces, recov-
ery must be the exception in fracture of the humerus. How-
ever, recoveries do take place and in addition to the reported
recoveries by Liautard, ]Moller, Stockfleth, Lafosse, Frohner and
others, we have instances cited by American practitioners where
cases resulted in recovery. Thomp.son^ reports a good recovery
in a 1600-pound mare where there existed an oblique fracture
of the humerus. This mare was kept in slings for eight weeks.
Walters- reports complete recovery in humeral fracture in a foal
three days old. The only treatment given was the application
of a pitch plaster from the top of the scapula to the radius.
The colt was kept in a comfortable box stall and in about four
weeks regained use of the leg. Complete recovery eventually
resulted. In the experience of the author, recovery has not oc-
curred in humeral fractures.
^A paper presented before the Illinois Veterinary Medical Assn. by Dr. H.
Thompson of Paxton, Ul., American Veterinary Review, Vol. 15, p. 134.
-"Fractures in Foals," by Dr. Wilfred Walters, M. R. C. V. S., American
Journal of Veterinary Medicine, Vol. S, p. 669.
84 LAMENESS OF THE HORSE
Treatment. — "When animals are not aged and of sufficient
value to justify treatment, they are best supported in a sling, if
halter broken. If subjects are nervous, wild and unbroken, it
is possible to employ the sling, if care is given to train the ani-
mal to this manner of restraint. The presence of an attendant
for a day or two will reassure such subjects so that even in
these cases it may be j^racticable to employ the sling.
Braces and other mechanical appliances intended to immobi-
lize the parts are not of practical benefit in the horse. Unlike
the dog, the horse as yet has not been successfully subjected to
tolerating rigid braces for the shoulder and hip.
Everything possible must be done that will make for the pa-
tient's comfort. If the subject turns out to be a good self nurse,
and the nature of the fracture is such that practical apposition
of the broken ends of bone may be maintained, recovery will
occur in some cases.
Inflammation of the Elbow.
(Arthritis.)
Affections of this articulation other than those which are pro-
duced by traumatism are rare. This joint has wide articular
surfaces, and securely joined as they are by the heavy medial
and lateral ligaments (internal and external lateral ligaments),
luxation is practically impossible. When luxation does occur,
irreparable injury is usually done. Castagne as quoted by
Liautard^ reports a case of true luxation of the elbow joint in a
horse where reduction was effected and complete recovery took
place at the end of twenty-five days. This is an unusual case.
The average practitioner does not meet with such instances.
Anatomy. — The condyles of the humerus articulate with the
glenoid cavities of the radius and a portion of the ulna. Two
strong collateral ligaments pass from the distal end of the hu-
merus to the head of the radius. The capsular ligament is a
large, loose membrane which encloses the articular portion of the
humerus with the radius and ulna and also the radioulnar articu-
lation. It is attached anteriorly to the tendon of the biceps
^American Veterinary Review, Vol. 26, p. 1068.
LAMENESS IN THE FORE LEG 85
bracliii (flexor braehii). The capsule extends downward be-
neath the origin of these digital flexors. This fact should be
remembered in dealing with puncture woimds in the region, lest
an error be made in estimating their extent and an open joint
be overlooked at the initial examination.
Etiology and Occurrence. — Exclusive of specific or metastatic
arthritis, which is seldom observed except in young animals, in-
flammation of the elbow joint is usually caused by injury. This
articulation is not subject to pathologic changes due to concus-
sion or sprains as occasioned by ordinary service, but is fre-
quently injured by contusion from falls, blows from the wagon-
pole and kicks. Wounds which affect the elbow joint, then, may
be thought of in most cases, as resultant from external violence.
They may be contused wounds or penetrant wounds. Sharp
shoe-calks afford a means of infliction of penetrant wounds which
may occasion open joint and infectious arthritis.
Classification.— A practical manner of classifying inflamma-
tion of the elbow is on an etiological basis. Eliminating the
forms of elbow inflammation, such as are caused by metastatic
infection and other conditions which properly belong to the do-
main of theory of practice, we may consider this affection under
the classification of contusive wounds and penetrative tvounds.
Symptomatology. — Any injury which is of sufficient violence
to occasion inflannnation of the elbow causes marked lameness
and manifestation of pain. The degree of lameness and distress
manifested by the subject, depends upon the nature and extent
of the involvement. A contusion suffered as the result of a fall,
which occasions a circumscribed inflammation of the structures
covering this joint and where little inflammation of the articu-
lating parts exists, marked evidence of pain and lameness might
be absent. On the other hand, if a true arthritis is incited, there
will be evident distress manifested, .such as hurried respiration,
accelerated pulse, inappetence, mixed lameness, local evidence
of inflammation and particularly marked supersensitiveness of
the affected parts. Considering these two extremes of manifested
distrcvss and injury, one may readily conclude that in the fre-
quently seen case, wherein contusion has occasioned a moderate
8G LAMENESS OF THE HORSE
degree of injury, prognosis is favorable and recovery ordinarily
follows in the course of a few weeks' treatment.
In cases of arthritis due to penetrative wounds (because of
the important function of this joint and its large capsule, which
when intlamed discharges synovia in a manner that closure of
such an open joint is seldom possible) a very grave condition
results.
Treatment. — Inflammation of the elbow, such as is frequently
seen in general practice where horses are turned out together
and exposed to kicks and other injuries, yields to treatment
readily, if an open joint does not exist.
Hot packs supported in contact with the elbow and kept around
the inflamed articulation for a few days, materially decrease pain
and tend to reduce inflammation. The subject must be kept
quiet in a comfortable stall and, if necessary, a sling used.
Where it is impossible for the animal to support much weight
with the injured member the sling should be employed.
As inflammation abates, which it does in the course of from
one to three weeks in uncomplicated cases, the subject may be
allowed the freedom of a comfortable box stall. Vesication of
the parts is in order, and this may be repeated in the course of
two weeks, if it is deemed necessary.
Penetrative wounds resulting in open joint are not treated
with success as a rule, and because of the handicap under which
veterinarians labor, methods of handling such cases, where large,
important articulations are affected, are not being rapidly im-
proved. Prognosis is usually unfavorable, and for humane and
economic reasons, animals so affected should be destroyed.
Ordinary wounds of the region of the elbow are treated along
general lines usually employed. They merit no special consid-
eration, except that it may be mentioned that with such injuries
concomitant contusion of the parts occasions injury that does
not recover quickly.
Fracture of the Ulna.
Etiology and Occurrence. — Fractures of the ulna in the horse
are not connuon in s|)ite of the exposed position of the olecranon.
This bone when broken, is usually fractured by heavy blows
LAMENESS IN THE PORE LEG «7
and any form of nlnar fracture is serious because of its function
and position in relation to the joint capsule. Transverse frac-
tures do not readily unite because of the tension of the triceps
muscles, which prevent close approximation of the broken ends
of the bone.
Thompson^, however, reports a case of transverse simple frac-
ture of the ulna in a mare, the result of a kick, in which com-
plete recovery took place. He kept the subject in a sling for
six weeks and then allowed six months rest.
Symptomatology. — The position assumed by a horse sutfer-
ing from a transverse fracture of the ulna, is similar to that in
radial paralysis. Crepitation may be detected by manipulating
the parts, and in some instances of fracture of the olecranon,
there occurs marked displacement of the broken portions of the
bone. Lameness is intense and the parts are swollen and super-
sensitive. The capsular ligament of the elbow joint is usually
involved in the injury because fracture of the ulna may directly
extend within the capsular ligament. In such cases, there is
synovitis, and later arthritis causes a fatal termination.
Treatment. — The impossibility of applying a bandage in any
way to practically immobilize these parts in fracture of the ulna,
prevents our employing bandages and splints. Therefore, one
can do little else than to put the patient in a sling and try to
keep it quiet and as nearly comfortable as circumstances allow.
Fracture of the Radius.
Etiology and Occurrence. — From heavy lilows received such
as kicks, collision with trees or in falls in runaway accidents, the
radius is occasionally fractured. In very young foals, fracture
of the radius, as well as of the tibia and other bones, results
from their being trampled upon by the mother.
Symptomatology. — Excepting in some cases of radial frac-
ture of foals where considerable swelling has taken place, there
is no difficulty in readily recognizing this condition. The heavy
brachial fascia materially contri])utes to the support of the ra-
iPractures, bv H. Thomp.son, Paxton, III., American Veterinary Review,
Vol. 15, p. 134.
88 LAMENESS OF THE HORSE
dius, and in cases where swelling is marked, crepitation may not
be readily detected. In fact, a sub-periosteal fracture may exist
for several days or a week or more and then, with subsequent
fracture of the periosteum, crepitation and abnormal mobility
of the member are to be recognized. In such cases, the subject
will bear some weight upon the affected member, but this causes
much distress. In one instance the author observed a trans-
verse fracture of the lower third of the radius which was not
positively diagnosed until about ten days after injury was in-
flicted. In this case, without doubt, the subject originally suf-
fered a sub-periosteal fracture of the bone and because the animal
was a good self nurse, the brachial fascia supported the radius
until the periosteum gave way and the leg dangled. In this
instance infection took place and suppuration resulted. It was
deemed advisable to destroy this animal.
"" Prognosis. — In adult animals, radial fracture constitutes a
grave condition; generally speaking, prognosis, in such cases, is
unfavorable. Because of the leverage afforded by the extremity,
immobilization of the radius is difficult. Any sort of mechanical
appliance, which will immobilize these parts, is likely to produce
pressure-necrosis of the soft structures so contacted. There is
occasioned thereby much pain and the subject becomes restive,
unmanageable and sometimes the splints are completely deranged
because of the animal's struggles, and much additional injury
to the leg is done. Occasionally, an otherwise favorable case is
thus rendered hopelessly impossible to handle, and the subject
must be destroyed several days after treatment has been insti-
tuted.
Consequently, unless all conditions are good, and the affected
animal a favorable subject, young, of good disposition, and the
fracture a simple transverse one, complete recovery is not likely
to result from any practical means of handling.
Treatment. — Mature subjects ought to be put in slings and
kept so restrained throughout the entire time of treatment.
Immobilization of the broken parts of the bone is the object
sought. This is attempted by practitioners who employ various
methods, and each method has its advocates.
LAMENESS IN THE FORE LEG 89
Casts are used by some and serve very well in many cases ; but
because of their bulk and unyielding and rigid nature, they are
not well adapted to use on fractures of bones proximal to the
carpus and tarsus. This is in reference to plaster-of-paris casts
or those of any similar material.
Appliances which depend on glue or other adhesive substances
combined with leather, wood or fiber for their support, are effi-
cacious but not comfortable.
The use of heavy leather when the member has been suitably
padded with cotton and bandages, constitutes a very good man-
ner of reducing fracture of the radius or of the tibia. Leather
when cut to fit both the medial and lateral sides of a leg, and
firmly held with bandages, will form a firm support that yields
slightly to changes of position, thus making for comfort of the
subject.
Such a splint or support should extend from the fetlock region
to the elbow, but the cotton and bandages are to reach to the
foot. When one considers that, with the supportive appliance
placed on each side of the affected member, rigidity is accom-
plished as much from tensile strain put upon the leather as from
its own stiffness, it is seen that the leather need not be of the
heaviest — sole leather is unnecessary. Because of the more com-
fortable immobilizing appliance, the subject is less restive, and
chances for a successful outcome are materially increased
thereby.
In the mature subject, six or eight weeks' time is required
for union of the parts to occur suf^ciently so that splints may
be dispensed with. Rearrangement of the supportive apparatus,
however, is possible and usually necessary during the first few
weeks of treatment. By employing care in handling the parts,
the subject will be unlikely to do itself injury at the time read-
justment of splints is being effected.
In foals, it is best to give them the run of a box stall with
the mother. Being agile, they get up and lie at will without
doing injury to the fractured member. The splints (leather is
preferable in these cases also) are looked after and readjusted
as necessity demands.
Three or four weeks time is all that is required for the average
90 LAMENESS OF THE HORSE
young colt to be kept in splints when suffering from simple
transverse fracture of the radius.
Compound fractures are necessarily more difficult to treat
than are the simple variety, but even in such cases recovery re-
sults sometimes, and the practitioner is justified in attempting
treatment after having explained the situation to his client.
Oblique fractures, even when simple, do not completely recover,
^luscular and tendinous contraction, together with the natural
tendency for the beveled contacting parts of the broken bone to
pass one another in oblique fracture, results in shortening of the
leg and, if union results, a large callus usually forms. Where
shortening of bones occur, necessarily, permanent lameness
follows.
Wounds of the Anterior Brachial Region.
Etiology and Occurrence. — Contusions and lacerations of the
forearm are of fre(|uent occurrence in horses and are troublesome
cases to handle; particularly is this noticeable where extensive
laceration of the parts occurs. These injuries are caused by
animals being kicked; by striking the forearm against bars in
jumping; and in sections of the country where barbed wire is
used to enclose pastures, extensive lacerated wounds are met
with when horses jump into such fences.
Symptomatology. — Any wound which causes inflammation
of the structures of the anterior half of the forearm, is charac-
terized by swinging-leg-lameness. Depending upon the nature
and extent of the injury, manifestation varies. In cases where
laceration has practically divided all of the substance of the
extensor tendons, it is, of course, impossible for the subject to
advance the leg ; but where lacerated wounds involve only a part
of the extensor apparatus of the foreleg, not so much inconveni-
ence is evident, unless the wound is seriously infected and inflam-
mation involves contiguous structures. Therefore, in many in-
stances, lameness is more pronounced in contusions of the an-
terior brachial region than where tissues have been divided more
or less keenly.
In every instance diagnosis is easily established. The injury
is quite evident, and the nu^nner of locomotion is not in itself
LAMENESS IN THE FORE LEG 91
an essential feature to he considered in a discussion of symptoms.
Where a contusion of the anterior brachial structures occurs,
there is, in addition to lameness, swelling which is painful be-
cause of the pressure occasioned by the heavy non-yielding ])ra-
chial fascia. And where suppuration occurs, there is then an
intensely painful condition which is not relieved until pus has
been evacuated. Rather frequently, drainage for wound secre-
tions is a difficult problem, and approximation of the divided
ends of muscles is always difficult to maintain.
Treatment. — Contused wounds of the anterior brachial region
are treated along usual lines ; that is, attempt is made to stimu-
late prompt resolution. Hot or cold applications are employed
throughout the acute stage of the affection. Complete rest is
provided for until all pain has subsided. Later, stimulating lini-
ments are beneficial.
Where no injury is done the periosteum or bone, complete
resorption of all products of inflammation usually occurs, though
in many instances, this is tardy — six weeks or more are some-
times required for recovery to take plac'?.
If suppuration occurs, it is necessary to provide for drainage
as soon as it is possil)le to distinguish the presence of pus. Due
regard is given the manner of establishing drainage because of
the usual existence of su])-fascial fistulae. In these cases, one
avoids injecting solutions of aqueous antiseptics. By gently com-
pressing the parts, pus is caused to drain out and in enforeinsr
a moderate amount of exercise at a walk, when lameness is not
intense, drainage is maintained. Cotton packs, moistened with
hot antiseptic solutions, and kept around the forearm for sev-
eral hours daily, are helpful because drainage is facilitated,
and resolution is stimulated by the increase of blood thus at-
tracted to the parts, and pain materially diminishes.
In lacerated wounds of the anterior brachial region, after
having controlled hemorrhage, an area around the wound margin
is freed of hair by clipping or shaving. The wound is carefully
examined, and the best site for drainage is selected and a suit-
able opening for wound discharge is provided for. Where the
extensor carpiradialis (metacarpi magnus) with other struc-
tures, is divided and the distal portion is torn downward, as
92 LAMENESS OF THE HORSE
frequently is the case in barbed wire cuts, it is necessary to
make careful provision for drainage. The wound is thoroughly
cleansed by means of ablutions if necess;iry; but preferably l)y
swabbing with pledgets of cotton or gauze which are moistened
in antiseptic solutions. All shreds of macerated tissue are
clipped with scissors and finally the whole wound surface is
painted with tincture of iodin.
If drainage is made by cutting through the tissues in the
median portion of the structures that have been displaced, the
opening should be packed with gauze so that it may remain
patent after swelling has occurred. Such packing is left in
situ for twenty-four hours.
The pendant muscular portions of tissues are sutured up by
means of tapes and, while perfect apposition is not ordinarily
possible, it is very essential to train the pendant tissues in their
normal position even if they require resuturiug within a week.
This minimizes granulation of tissue, and there results less scar
if the detached portions are kept near, even if not in contact with
the proximal wound margins. The skin together with sub-
cutaneous fascia is sutured on either side unless drainage is to
be provided for on one side, and the lowermost part of that side
is left unsutured.
After-care. — Where extensive suturing of tissues has been
necessary, subjects must be kept quiet. They are best confined
in box stalls and not taken out for several weeks. Particularly
is this true where transverse division of extensors has taken place.
Sutures are removed at the end of from ten days to three weeks
as cases permit. Drainage of wound secretions, which usually
become infected, is necessary, because M'ith obstructed drainage
in an infected wound of this kind, there will result an early
destruction of tissue at some point sutured. Daily irrigation
done in a manner that practical asepsis is carried out, is neces-
sary for about a week. All irrigation is done by way of the
drainage opening, and this with warm aqueous solutions of suit-
able antiseptics. After a week or ten days' time, the wound
should not be dressed more frequently than twice weekly.
If it is necessary to leave a portion of the wound uncovered.
LAMENESS IN THE FORE LEG 93
as in cases where skin is destroyed, the frequent (three or four
daily) application of a suitable antiseptic powder is necessary
to check exuberant granulation. This may be directly effected
by the use of an astringent or desiccant preparation, and such
dressing serves as a mechanical protection as well.
When such wounds are kept clean, where drainage is properly
maintained, and the subject kept quiet, no particular attention
other than the local application of an astringent lotion (such
as the zinc and lead lotion) is necessary after the first three or
four weeks. Usually, if the animal gnaws at the parts or other-
wise manifests evidence of discomfort, it is an indication that
new areas of infection are being established because of obstructed
drainage or retained eschars. A thorough cleansing of the
wound with a two per cent solution of Liquor Cresolis Com-
positus and this followed by moistening every part of the wound
with tincture of iodin, will check all such disturbance if done
promptly.
Where practically all of the anterior surface of the radius
has been denuded, recovery is tardy and there is in some cases
imperfect extension of the leg for months after the wound has
healed. But in such instances, animals gradually regain com-
plete use of the affected member and in the course of a year
function is fully restored.
Inflammation and Contraction of the Carpal Flexors.
Anatomy. — The structures w^hich are usually considered as
true flexors of the carpus are a group of three muscles, which
have separate heads of origin and different points of tendinous
insertion.
The flexor carpiradialis (flexor metacarpi internus) originates
from the medial epicondyle of the humerus. It is inserted to
the proximal end of the medial metacarpal (inner metacarpal or
splint) bone. This muscle is the smaller of the three and is not
usually divided in doing carpal tenotomy.
The flexor carpiulnaris (flexor metacarpi medius) has two
heads of origin ; one, the larger, originates from the epicondyle
of the humerus and the other from the posterior surface of the
94 LAMENESS OF THE HORSE
oleenmon. The two heads unite at the upper third of the radius
and the muscle, becoming tendinous, as is the case with the other
carpal flexors, is attached by one point of insertion to the acces-
sory carpal bone (trapezum). The other blends with the
posterior annular ligament of the carpus.
The ulnaris lateralis (flexor metacarpi externus) has its origin
from the lateral epicondyle of the humerus and inserts to the
proximal extremity of the fourth metacarpal (outer splint)
bone and by another attachment to the accessory carpal bone
(trapezium) with the tendon of the flexor carpiulnaris (flexor
metacarpi medius).
Acting together, these muscles flex the carpus or extend the
elbow and this action is antagonized by the biceps brachii (flexor
brachii) and extensors of the carpus and phalanges.
Etiology and Occurrence. — Inflammation of the muscular or
tendinous parts of tlie carpal flexors, does not occur as fre-
quently as does inflammation of the flexors of the extremity.
They are subject to injury such as is occasioned by hard work
and concussion and contract as a result ; but, more frecjuently
a congenital malformation of the leg is responsible for undue
strain upon these parts. Horses that are "knee sprung" or that
have a congenital condition where in the anterior line, as formed
by the radius, carpal and metacarpal bones, is bent forward at
the carpus, are subject to inflammation and contraction of the
carpal flexors. When these flexors are contracted, the condition
is commonly known among horsemen as "buck knee." In itself,
intlaiiimation of the carpal flexors is not a condition which is
likely to prove troulilesome, l)ut because of carpal involvement
(which is often present) the cause of the troul)le remains, and
inHaiinnation of the carpal flexors recurs or becomes chronic
and contraction of tendons results.
Symptomatolog-y. — Inflammation of the carpal flexors, when
acute and uiici»iii|)licated, is characterized ]\v a painfully swollen
condition of the afl'cctcd tendons. No weight is ])orne upon
the affected leg and tlic carpal joint is flexed. .Mixed huneness
is present. There is no difficidty encountered in arriving at a
diagnosis because of Ihe very noticeably inHamed parts.
LAMENESS IN THE FORE LEG
05
IMaiiy fully developed cases of eoiitraction of the tendons of
the carpal flexors are observed where the condition has become
established gradually and no lameness has resulted from tendin-
itis or carpitis. In some of these cases, subjects are stumblers
and when they are carelessly handled or kept at fast work over
irregular or hard roads, chronic carpitis with hyperplasia of the
structures of the anterior carpal region results, owing to frequent
bruising from falls.
Fig. 10 — Contraction of carpal flexors, "knee sprung."
Where inflammation is caused by a puncture wound and sub-
fascial infection occurs, there is evident manifestation of pain.
No weight is supported liy the affected member and because of
the pressure, occasioned by the swollen muscles confined within
the non-yielding brachial fascia, there exists marked supersensi-
tiveness of the affected parts. Flexion of the elliow is avoided
because contraction of the biceps l)rachii (flexor l)rachii) or the
extensors, which are antagonists of the flexors of the carpus,
tenses the carpal flexors and pain is thereby increased.
However, in most instances, the practitioner's attention is not
directed to typical and uncomplicated cases, but to subacute or
chronic inHainmations which are often attended with contraction
of the tendinous pai'ts of the carpal fiexors, and in such cases
96 LAMENESS OF THE HORSE
carpitis is present. Animals so affected have lost the rigidity
Avhich characterizes the normal carpal joint when the leg is a
weight bearing member, and because of its sprung condition,
the leg trembles when supporting weight.
Treatment. — Acute inflammation is treated by means of local
application of cold or hot packs until the pain and acute stage
of inflammation has subsided and later stimulating liniments
are indicated. Absolute quiet must be enforced. Especially
where the carpus is involved must the subject be kept quiet until
all evidence of inflammation has subsided.
The application of vesicants or line-firing is beneficial in sub-
acute inflammation of the tendons of the carpal flexors. Where
contraction of tendons exists and no osseous or ligamentous
change prevents correction of the condition, tenotomy is neces-
sary. The reader is referred to Merillat's "Veterinary Surgery"^
for a good description of the technic of this operation.
In all serious cases of inflammation of the carpal flexors,
whether tenotomy has been performed or not, the subject needs
a long period of rest subsequent to treatment. In fact, three
or four months at pasture is necessary to permit of recovery
and this where no congenital deformity has predisposed the sub-
ject to such affection of the flexors. Return to work must be
gradual and the character of the work such as to enable the
animal to become inured to service without a recurrence of the
trouble if possible.
It follows then, that tenotomy, here as in other cases, is not
practical from an economic viewpoint, unless the animal be of
sufficient value to justify the long period of rest for recovery.
Tenotomy is not of practical benefit unless ample time is allowed
for regeneration of divided tendinous tissue.
Fracture and Luxation of the CarpaJ Bones.
Etiolog-y and Occurrence. — Fracture of the carpal bones is of
infrequent occurrence in horses and, wlien it does occur, it is
usually due to injuries, and because of their nature (resulting
as they generally do from heavy falls or in being run over by
""^Veterinary Surgical Operations, by L. A. Merillat, Vol. 3, p. 19S.
LAMENESS IN THE FORE LEG 97
street ears or wagons), a comminuted fracture of one or more
bones exists. The accessory carpal bone (trapezium) is said to
be fractured at times without being subjected to blows or like
injuries, but this is exceptional.
Luxations of the carpal joint are of rare occurrence, and very
few cases of this kind are on record. Walters^ reports a case
of carpometacarpal luxation in a pony wherein reduction was
spontaneous and an uneventful recovery followed. His reason
for reporting the case, as he states, is its rarity.
Symptomatology. — Fractures of the carpal bones as they
usually take place are diagnosed without difficulty. Because
of their usually being comminuted, abnormal movement of the
joint is possible. Such movement is not restricted and flexion
of the leg at the carpus in any direction is possible. Crepitation
is readily detected and frequently these fractures are of the
compound-comminuted variety.
In fracture of the accessory carpal bone (trapezium) or in
fracture of any other single bone when such exists, there is no
increase in the movement of the joint. The accessory carpal
bone may be readily manipulated and when fractured, its parts
are more or less displaced. Recognition of fracture of any other
single carpal bone must be done by detecting crepitation unless
it be a compound fracture, whereupon probing is of aid in es-
tablishing a diagnosis.
Carpal luxation when present is to be recognized by finding
the apposing carpal bones joined in an abnormal manner — that
is, out of position. There is restricted or suspended function
of the joint, and in the cases recorded, no difficulty has been
experienced in making a diagnosis. The carpometacarpal por-
tion of the articulation is the part which is usually affected.
Prognosis and Treatment. — There is no chance for complete
recovery in the usual case of carpal fracture because of the fact
that there results sufficient arthritis to destroy articular cartilage
beyond repair. In the average instance, because of arthritis
which persists for a considerable length of time, more or less
ankylosis results. At best, one can only hope for partial re-
iWilfred Walters, American Journal of Veterinary Medicine, Vol. 8, p. 606.
98 LAMENESS OF THE HORSE
eovery, that is to say, the member may regain its usefulness as
a weight-supporting- part, but because of restricted or abolished
joint function, locomotion is more or less difficult. Exostoses,
articular and periarticular, occur and the carpus usually be-
comes a large immobile articulation. There is danger of infec-
tion resulting in simple carpal fractures and, needless to say,
in a compound- comminuted fracture of the carpus, infection
usually occurs and a fatal outcome is probable.
When treatment is instituted, antiseptic precautions are taken
in handling the compound fractures, and in any case immobiliza-
tion of the parts is sought. Here, as has been previously pointed
out, it is best to employ leather splints, so that a maximum de-
gree of rigidity with a minimum of distress and inconvenience
to the patient will result. The leg must be bandaged from the
hoof upward, making use of a sufficient amount of cotton to
ensure against pressure-necrosis. The leather splints are placed
mesially and laterally and, of course, need to extend as high
as the proximal end of the radius. SuL-jects must be kept in
slings until union of bones has become established, and as a
rule there will then exist marked ankylosis.
There is no particular difference in the handling of carpal
luxation and dislocation of other bones. Where ligaments have
not been destroyed to the extent that reduction is of no prac-
tical use, the parts are kept immobilized, if thought necessary.
Later, vesication of the whole pericarpal region is done and the
subject allowed exercise at will.
Carpitis.
Etiology and Occurrence. — Inflammation of the carpus is
caused by contusions, such as are occasioned in falling, by kicks
by striking the carpus against objects in jumping and some-
times by striking it against the manger in pawing. The con-
dition is of rather frequent occurrence.
Symptomatology. — Evident symptoms of inflammation in
carpitis are always present — hyperthermia, supersensitiveness
and swelling. Also, there exists lameness which is characterized
by an a])parent inability to flex the leg, and there is eircum-
LAMENESS IN THE FORE LEG
99
duction of the leg as it is advanced l)eeaase in this way littk' if
any flexion of the carpus (which increases pain) is necessary.
Depending upon the nature of the cause, there occurs a
marked difference in the character and amount of swelling.
Fig. 11 Pericarpal inflammation and enlargement due to injurj'.
Naturally, when nuich extravasation of serum and 1)lo()d takes
place, there is occasioned a fluctuating swelling which is usually
less painful to the subject upon manipulation than is a dense
inflammatory change without marked extravasation.
In acute carpitis, there is present, then, a very painful con-
dition which involves the articulation, causing marked lameness,
disturbance of appetite and some elevation of temperature.
Chronic cases do not occasion serious pain or constitutional
disturbances, but do interfere with locomotion in direct propor-
tion to the existing articular inflammation and periarticular
hypertrophy of ligamentous and tendinoi^.s structures.
Treatment.— If possible, keep the subject absolutely quiet,
employing the sling if necessary. During the first stages of in-
flammation, the ai)plication of ice packs to the affected parts, is
100 LAMENESS OF THE HORSE
of marked benefit. At the end of forty-eight hours, hot applica-
tions may be used and this treatment continued throughout sev-
eral days. Anodyne liniments are of service and should be em-
ployed throughout the acute stage of infiammation during in-
tervals between the hydrotherapeutic treatments.
As inflammation subsides, a counterirritating application such
Fig-. 12 — ^HygTomatous condition of the right carpus, also distension of
sheaths of extensor tendons of botli fore legs.
as a suitable liniment and later blistering or line-firing is help-
ful in stimulating resolution.
Open Carpsd Joint.
Anatomy. — The carpal bones as they articulate with one an-
other and with the radius and metacarpal bones, as classed by
anatomists, form three distinct articular parts of the joint as a
whole and are known as radiocarpal, intercarpal and carpometa-
carpal. These three pairs of articulating surfaces are all en-
closed within one capsular ligament. On the anterior face of the
bones, the capsular ligament is attached to the carpal bones in
LAMENESS IN THE FORE LEG 101
such manner that an imperfect partitioning of the three joint
compartments is formed. Posteriorly, the capsule is very heavy
and forms a sort of padding over the irregular surfaces of the
bones, and also its reflexions constitute the sheaths of the flexor
tendons. The anterior portion of the capsular ligament forms
sheaths for the extensor tendons, and both portions of the joint
have an attachment around the distal end of the radius and
another at the proximal end of the metacarpal bones.
Etiology and Opcurrence. — Puncture wounds of any kind
Fig. 13 — Carpal exostosis in aged horse.
may serve to perforate the joint capsule and such traumatisms
are occasioned by falls, kicks and iu various ways in runaway
accidents, and open carpal joint may follow.
Symptomatology. — The pathognomonic symptoms of the ex-
istence of an open joint is the exposure to view of articular
surfaces of bones or noting the escape of synovia from the joint
capsule. As has been previously referred to, there always exists
a peculiar suspension of carpal flexion in all cases of carpitis.
Non-infective wounds which may cause open joint are not
necessarily productive of an active carpitis — a synovitis may
be the extent of the disturbance. Ualike synovitis, which may
102
LAMENESS OF THE HORSE
characterize a non-infectious penetrative wound of the capsular
ligament, septic arthritis which may supervene is a very painful
inflammatory disturbance. It is characterized by all of the
symptoms which attend the case of open joint and synovitis plu.s
the obvious manifestation of great pain. There is an elevation
of temperature of from two to five degrees above normal; cir-
culation is accelerated; the pulse is bounding; respiration is
hurried ; there is an expression of pain as indicated by the
physiognomy; and because of rapid erosive changes of cartilages
which take place, there is soon so much of the articulation de-
stroyed that death is inevitable. Death is usually due to gen-
eralization of the arthritic infection.
In the meanwhile, if the character of the infectious material
is not so virulent, the disease will take on a slower course
and the subject may experience
laminitis from supporting weight
upon the sound member, or be-
cause of continued recumbency,
decubital gangrene and emacia-
Fig. 14 — Exostosis of
resultant from carpitis.
carpu.s
-pig. 15 — Distal end of radius. U-
lustrating the effects of chronic car-
pitis.
LAMENESS IN THE FORE LEG 103
tion sometimes cause death. If the subject does not soon suc-
cumb, it is compelled to undergo days or even weeks of unneces-
sary suffering, and too often in such cases, it is later deemed
advisable to destroy the animal because of the cost of continuing
treatment until the horse is serviceable. Therefore, it is evident
that when such joints as the carpus or tarsus are open and infec-
tion exists, if they are not promptly treated and the infectious
process checked, it is neither humane nor practical to prolong
treatment.
Distinction must be made between the different joints wher,
infected as the condition is much more serious in some cases
than in others. All things considered, perhaps open joints rank,
with respect to being serious cases as follows: elbow, navicular,
stifle, tarsus, carpus, fetlock and pa.stern. This, of course, is
restricted to articulations of the locomotory apparatus.
Treatment. — Preliminary care in the treatment of an open
carpal joint, is the same as has been described in this condition
as it affects the scapulohumeral articulation described on page
65. Likewise the further treatment of such cases is along the
same lines except that where it is possible, the parts are kept cov-
ered with cotton and bandages. However, in some cases, animals
have been successfully treated without bandaging and by keep-
ing the patient in a standing position and on pillar reins until
recovery resulted. Such cases were of the non-infectious type
and recovery was possible within three or four weeks. Further,
the condition is not sufficiently painful in such instances as to
prevent the subjects bearing weight with the affected member ;
hence, no danger of resulting laminitis is incurred. And finally,
where bandages are not employed, the frequent use of antiseptic
dusting powders is substituted for cotton as a protector.
When l)andaged, such wounds need dressing more or less fre-
quently, as individual instances demand. The purulent infective
inflammation of a carpal joint will recpiire daily dressing; where-
as, in other cases (non-infective), semi-weekly change of band-
ages is sufficient. E(|ual parts of l)oric acid and exsiccated alum
constitute a suitalile combination for the treatment of these
cases, and this powder should be liberally employed. Tincture
of iodin may be injected into the joint capsule where there is
104 LAMENESS OF THE HORSE
provision for its ready evacuation, as conditions seem to require.
Daily injections for three, four or five days, are not harmful
and will control infection in many instances.
Thecltis and Bursitis.
Etiology and Occurrence. — The thecae and bursae of the leg
are several in number. In the carpal region, the flexors of the
phalanges are contained together in the carpal sheath, and this
is the principal theca in the carpal region. Each of the tendons
is provided with synovial sheaths which are subject to inflam-
mation and occasionally synovitis and distension of these synovial
sheaths occur.
Because of faulty conformation, some animals are subject to
inflammation of these sheaths, and all forms of strenuous work
which taxes the tendons greatly is apt to result in synovitis.
Direct injury such as blows may be the cause of synovial disten-
sion of thecae and the affection is to be seen in all horses that
have done much fast work on hard road surfaces or pavements.
The usual case as it occurs in practice is a non-infective syn-
ovitis, but where puncture wounds cause the trouble, an in-
fectious inflammation obtains.
Symptomatology. — No trouble is experienced in diagnosing
distension of tendon sheaths, for the affection is very palpable.
During acute inflammatory stages of this affection, some lame-
ness is present — in infectious inflammation lameness is intense.
Local heat and pain upon manipulation are readily discernible
in all acute cases. And finally, where there is reason for doubt,
an aseptic exploratory puncture of the wall of the fluctuating
enlargement may be made with a suitable trocar, and the dis-
charging synovia will be proof of the existence of synovial dis-
tension.
After the affection becomes subacute or chronic, no lameness
or inconvenience is manifested, and the condition is undesirable
only because of its being a blemish.
Treatment. — Acute non-infectious synovial distension of ten-
don sheaths is treated by aspirating as much synovia as pos-
sible from the affected theca (this is, of course, done under
LAMENESS IN THE FORE LEG 105
strict asepsis) and by means of bandages, a uniform degree of
pressure is kept over the parts for ten days or two weeks. The
patient is kept quiet and in the course of two weeks an active
blistering agent is employed over the region affected. Usually,
at the end of a month's time, complete recovery has taken place
and the subject may be gradually returned to work.
When synovial distensions are of long standing, it is necessary
to take special precautions to cheek excessive secretion of synovial
fluid, and, also because of the atonic condition of the tissues
affected, resolution is tardy. In addition to aspirating synovia,
the introduction of equal parts of alcohol and tincture of iodin
into the theca is necessary. The quantity of this combination
injected, depends upon the size of the sheath affected and the
amount of synovia retained at the time injection is made. Ex-
perience is necessary to judge as to this part of the work, but
one may consider that a quantity between three and ten cubic
centimeters of equal parts of tincture of iodin and alcohol con-
stitutes the proper amount to employ. Where much synovia is
contained within the sheath at the time of injection, there occurs
great dilution of the agent injected and consequently less irri-
tation results.
The object of such injections is to check synovial secretion,
and this is sought by the local effect of iodin in contact with the
secreting cells together with the reactionary swelling which oc-
casions pressure. An increase in the local blood supply also
follows. In all cases where it is possible to employ suitable
bandages, this should be done. The ordinary derby bandages
serve well and if their use is continued for a sufficient length of
time, good results follow.
There are other methods of treating these affections, and each
has its advantages and disadvantages. Line-firing, instead of
the vesicant is made use of by some, but the object desired is
the same and results obtained are similar.
Sheaths may be opened surgically by means of a knife, and
the removal of a portion of the wall of distended and atonic
tendon sheaths is possible. These operations belong to the realm
of surgery and are not properly a part of this treatise. However,
in passing, it may be said that if a perfect technic is possible in
106 LAMENESS OF THE HORSE
doing the last iiained operation, a permanent recovery is the
ontcome.
Fracture of the Metacarpus.
Etiology and Occurrence. — As the resnit of all sorts of vio-
lence, such as falls and injuries in accidents of various kinds
wherein the metacarpals are subjected to contusions, fractures
may result. In the horse it is unusual for fracture of one of the
small metacarpal bones to take place without there being at the
same time a fracture of the third (large) metacarpal lione.
Classification. — Fractures of the metacarpal bones as they
occur, are as likely to be compound as simple, and the nudtiple
and comminuted varieties are -occasionally observed. The man-
ner in which the third (large) metacarpus is fractured, largely
determines the outcome in any given case.
Symptomatology. — Abnormal mobility of the l)roken parts
of bone and crepitation mark fracture cf the metacarpus, and
the condition is easily diagnosed. In many instances, when
compound fracture exists, broken ends of bone are protruding
through the skin. No weight is borne upon the fractured mem-
ber ordinarily, altliough during the excitement occasioned by
runaways, horses are sometimes seen to support weight with a
broken leg even when the protruding bone is sunk into the
ground in so doing.
Prognosis. — Generally speaking, fractures other than the
simple-transverse in young animals, are considered unfavorable
eases. With the metacarpus, however, there are instances where
compound fracture occurs in colts that justify treatment. But
in all cases of compound fracture, the element of infection in
addition to the increased difficulty in maintaining immoliility
of the broken bone, creates almost insuperable difficulties in the
average instance. And unless the practitioner distinctly ex-
plains to his client the various reasons wliich make treatment an
economic imin'acticability, dissatisfaction is likely to follow if
treatment is instituted without such an underetanding.
Treatment. — Perfect ai)i)()sition of tiie broken ends of bone
is easily effected and less difficulty is encountered in maintain-
LAMENESS IN THE FORE LEG 107
ing such relations in metacarpal fractures than in fractures of
the radius. However, reduction and immobilization of this as
in all fractures, must be done without delay. In simple fracture,
the metacarinis is covered with enough cotton to pad the parts,
and this is retained in position by liandages. Splints of heavy
leather or of thin pieces of tough flexible wood are placed on
each side of the leg and firmly held in position with bandages.
Bandages may be put on in layers and a coating of glue ap-
plied over each layer if this is thought necessary. The ad-
vantage gained in using glue or other adhesive materials is that
the cast thus formed is more rigid than where such material is
not employed. On the other hand, all elasticity is lost as soon
as the cast adapts itself to the contour of the extremity, and
because of this rigidity, it is doubtful if anything is gained by
the incorporation of glue, except in the way of added strength of
the cast. Since the animal does not walk upon the broken leg,
it is possible to employ splints of suitable materials which are
retained in position without glue and frequent readjustment of
a part of the immobilizing apparatus is possible. This is im-
possible with casts.
In compound fractures, provision ought to be nuide for dress-
ing the wound of the soft structures. This entails adjusting
the splints in such manner that one splint may be retained and
others removed for dressing the wound and readjusted as often
as wound dressing is necessary.
Splints.
By this term is meant a condition where there exists an
exostosis which involves usually the second (inner small) and
third (large) metacarpal bones. While an exostosis involving
any one of the splint bones, even when directly caused by an
injury, is called a "splint," the term is employed here, in refer-
ence to exostoses not due to direct injury such as in contusions.
Etiology and Occurrence. — Tliis condition is one wherein
there is osseous formation following a periostitis and the region
of the upper portion of the second (inner small) metacarpal bone
is the usual site of the exo.stosis. There is incited an intlamma-
108 LAMENESS OF THE HORSE
tion of the periosteum at the site of the interosseous ligament
which attaches the small to the large metacarpal bone. This liga-
ment is involved in the inflammatory process, and according to
Havemann, whose view is supported by Moller, this inflamma-
tion is the origin of the trouble.
Various theories attempting an explanation of the frequent
affection of this one certain part so regularly involved have been
offered, but no proof of the correctness of any exists. It fol-
lows, however, that splints occur in young animals; that the
affection seldom starts in subjects that are ten years of age or
""-■'-isliC J-
Fig'. 16 — Posterior view of radius (rigiit) illustrative of effects of splint.
Note the extent of exostosis.
older, and that when the exostosis has formed, lameness usually
subsides. Anything which will cause undue strain or irritation
of the metacarpal bones in young animals, is quite apt to result
in a splint being formed. Concussion such as is caused by fast
work on hard roads, or work on rough or irregular road surfaces
which cause unequal distribution of weight, will cause splint
lameness and exostosis follows.
Course. — Because of the peculiar manner in which the second
and third metacarpal bones articulate in j^oung animals, until
the bones become ossified and permanently joined, the inflam-
mation which attends the acute stage of this affection, causes
lameness. Later, unless an unusually large exostosis is formed,
whicli may cause a constant irritation due to its size and juxta-
position to the carpus, lameness is disconlinued.
LAMENESS IN THE FORE LEG 109
Symptomatolog'y. — Lameness is usually the first manifesta-
tion of this disorder, and the thing which characterizes splint
lameness is its peculiar intermittence. There is a mixed form of
lameness which may not be in evidence when an affected animal
is started on a drive, but which is marked after the subject has
gone some distance. The animal may, however, go lame through-
out the whole of a drive and continue to be lame for several
days or weeks in some cases. It is noticeable that lameness is
augmented or produced when the sul)ject travels on rough road
surfaces and that little or no difficulty is encountered when roads
are smooth.
The heavy brachial fascia is inserted in part to the head of
the second metacarpal (inner small) bone together with the
oblique digital extensor (extensor metacarpi obliquus) and this
explains the reason for pain being manifested during extension
of the member.
Before there is a visible exostosis, supersensitiveness is readily
recognized upon palpation of the parts, if careful comparison is
made between the sound and unsound members. However, fre-
quently splints occur on both forelegs at the same time and in
some instances exostoses are several in n amber upon each mem-
ber affected. In some instances, the affection involves the outer
splint bone and no evident involvement of the inner one exists.
Treatment. — At the onset complete rest should be provided
and the local application of some good cataplasm is in order. A
stimulating liniment is beneficial when employed several times
daily and massage is also quite helpful. Later, the application
of a blistering ointment is good treatment. The use of the actual
cautery stimulates prompt resolution, but there is seldom any
resorption of products of inflammation following firing. Where-
as, in cases where other treatment is begun early, there usually
follows considerable diminution in the size of the exostosis. A
rest of four or five weeks is necessary and very young animals
should not be put to work too soon, if the character of the work
is such as to induce a recurrence of the trouble.
Many cases are treated successfully in draft types of animals
(where the subjects are not kept at work that occasions seri-
110 LAMENESS OP THE HORSE
ous irritation to the aifected parts) by blistering the exostosis
repeatedly and allowing the animals to continue in service. In
such cases, it is unreasonal)le to expect to check the size of the
exostosis and, of course, such methods are not employed where
lameness causes distress to the subject.
Firing usually causes prompt recovery from lameness and is
a dependable manner of treating such eases but there remains
more blemish following cauterization than where vesication is
done.
OPEN FETLOCK JOINT.
This condition, because of the frequency with which it occurs
may be taken as typal, from the standpoint of treatment and
results obtained therefrom. AVhile it serves to constitute a basis
from which other joints, when open, are to be considered, due
allowance must be made for the fact that, as has been previously
mentioned, some articulations when open constitute cause for
grave consequences; while with others an open capsule, even
when infected, does not cause disturbance enough to be classed
as difficult to handle. IMoreover, the fetlock joint is admirably
suited, anatomically, to bandaging ; and wdien wounded, is easily
kept protected by means of surgical dressings. This fact is of
great importance in influencing the course and termination in
any given case of open fetlock joint and should not be forgotten.
There is no logical reason for comparing the pedal joint with
the pastern on the basis that it may also be completely and se-
curely bandaged. Open navicular joint does not occur, as a
rule, except by way of the solar surface of the foot, and the in-
troduction of active and virulent contagium is certain to happen;
consequently, an acute synovitis quickly rosidting in an intensely
septic and progressively destructive arthritis soon follows in
perforation of the capsule of the distal inlerphalangeal articula-
tion.
Etiology and Occurrence. — Wounds of the fetlock region re-
sulting in perforation or destruction of a part of the capsular
ligament are caused by all sorts of accidents, such as wire cuts,
incised wounds occasioned l)y plowshares, disc harrows, stalk
cutters and other farming implements. In runaways the joint
LAMENESS IN THE FORE LEG 111
capsule is sometimes punctured l)y sliarp pieces of wood or other
objects. In horses driven on un paved country roads the fetlock
is occasionally wounded by being struck against the sharp end
of some object, the other end of which is firmly embedded in the
ground. In one instance the author treated a case wherein the
fetlock joint was perforated by the sickle-guard of a self-binder.
In this case there occurred complete perforation causing two
openings through the cul-de-sac of the joint. Such wounds are
produced l)y implements which are, to say the least, non-sterile,
and this perforation of the uncleansed skin conveys infectious
nuiterial into the joint capsule. Yet in many instances, espe-
cially in country practice, no infectious arthritis results where
cases are promptly cared for.
Symptomatology. — A difiPerence in the character of symp-
toms is evidenced when dissimilar causes exist. Small penetrant
wounds which infect the synovial membranes cause infectious
arthritis in some cases, whereas a wound of sufficient size to
produce evacuation of all synovia will, in many instances, cause
no serious distress to the subject, even wlien not treated for sev-
eral days. If it is not evident that an open joint exists and the
articular cavity is not exposed to view a positive diagnosis may
be early established by carefully probing the wound. In some
cases where a small wound has perforated the joint capsule,
swelling and slight change of relation of the overlying tissues
may preclude all successful exploratory probing. In such in-
stances it is necessary to await development of symptoms.
Twenty-four hours after injury has been inflicted, there is notice-
al)le discharge of synovia which coagulates about the margin of
the orifice, where synovial discharge is possible. Particularly
evident is this accumulation of coagulated synovia where wounds
have been bandaged — there is no mistaking the characteristic
straw-colored coagulum vdiich, in such cases, is somewhat ten-
acious.
No diflPerence exists between otlicr symi)t()ins in infectious
arthritis caused l)y punctures, and non-infectious arthritis, ex-
cepting the intensity of the pain occasioned, the rise in tempera-
ture, circulatory disturbances, etc.; all of which have been pre-
viously mentioned,
112 LAMENESS OF THE HORSE
Treatment. — Just as has been stated in discussions on the
subject of open joint, probing or other instrumentation is to be
avoided until the exterior of the wound and a liberal area sur-
rounding has been thoroughly cleansed — too much importance
can not be placed on this preliminary measure. In cases of open
joint where ragged wound margins exist and the interior of the
joint capsule is contaminated, much time is required to
thoroughly cleanse all soiled parts. In some instances an hour's
time is required for this cleansing process after the subject has
lieen restrained and prepared. In order to thoroughly cleanse
these delicate structures without doing them serious injury, one
ought to be skillful and careful in all manipulations of the ex-
posed parts of the joint capsule.
The general plan of treatment, after preliminary cleansing
has been accomplished, has been outlined on page 66 in the
consideration of scapulohumeral joint affections. The injection
of undiluted tincture of iodin in ounce quantities, it must be
remembered, is not to be done unless there is provision for its
free exit. Where good drainage from the joint cavity exists
all infected wounds should be thus treated, and this treatment
may be repeated as conditions seem to require — until infection
is checked.
If daily injections are necessary, dilution of the tincture of
iodin with an equal amount of alcohol is advisable in order to
avoid doing irreparable damage to the articular cartilages and
synovial membranes.
An antiseptic powder composed of equal parts of boric acid
and exsiccated alum is employed to protect the wound surfaces
and the margins, and the parts are then bandaged. In bandag-
ing wounds of this kind a liberal amount of cotton should be
employed, and after a large surface surrounding the wound has
been thoroughly cleansed, it must be so kept thereafter. This
is impossible, if one uses a small amount of cotton, particularly
if such meager quantity of dressing material is carelessly
wrapped in position with an insufficient amount of bandage ma-
terial. Mention, without description of the elemental problem
of applying cotton and bandages to a wound, would be suffi-
cient, were it not that this is a very important part of the hand-
LAMENESS IN THE FORE LEG 113
ling of such cases, and many practitioners are not only thought-
less in this part of their work, but also apparently careless.
What does it profit to prepare a part and cleanse a wound with
painstaking care and then neglect to take every possible precau-
tion to prevent its subsequent contamination?
In the handling of open joint capsules where the perforation
of the capsular ligament is small and discharge of synovia does
not immediately follow, there is presented a problem which is
difficult to decide upon and that is the manner in which such
wounds are to be handled. One hesitates to enlarge such open-
ings to drain or irrigate the capsule when there is no proof that
serious trouble will follow because of infectious material which
has probably been introduced at the time the wound was in-
flicted. It is especially difficult to decide upon the manner of
handling such cases where the tarsal joint is wounded, although
one hesitates to invade any joint to the extent of incising its
capsule, unless there is urgent need of so doing.
Frost ^ offers the following suggestion in such instances :
The treatment recommended by us for open joints, in which
we wish to prevent ankylosis, is, first, to shave all hair from the
area surrounding the wound, following v>'ith a thorough cleans-
ing of the skin and disinfection of the v/ouud, and then to in-
ject a twenty per cent Lugol's solution in glycerin into the
wound. This should be repeated two or three times a day, each
time enough of the solution being injected to fill the joint cap-
sule, thereby securing the flushing effect. As this solution does
not cause irritation to the tissue and yet is a strong antiseptic,
it serves to shorten the period of congestion and inflammation
and to overcome the infection without causing a destruction of
the secreting membrane until the external wound has had time
to heal. The injection of this solution seems to retard the ex-
cessive secretion of synovia. The larger the joint capsule and
the smaller the external wound, the longer our antiseptic will
remain in contact with the inflamed tissues as the glycerin,
being thick, does not flow through a small opening.
After-care. — Following the initial cleansing and treatment of
open joint, subsequent dressing is necessary as frequently as
conditions demand. If the parts are badly infected and profuse
discharge of pus exists a daily change of dressings is necessary.
ij. N. Frost, assistant professor of Surgery, Veterinary Dept., Cornell
University, in "Wound Treatment," page 159.
il4 LAMENESS OF THE HORSE
In the average instance, however, semi-weekly treatments are
sufficient. And in many instances where one is obliged to travel
a considerable distance to handle the affected animal one weekly
dressing of the wound will suffice after the second treatment.
The same general plan of treatment concerning the subject's
comfort that has lieen previously mentioned in arthritis, is car-
ried out liere. A further and detailed consideration of the
subject of handling of open joints follows.^
*•• * * Such wounds may be elassifi(Hl in two general groups
as follows: First, wounds in which the trauma has exposed
the articulation to view, and second, those the result of punc-
tures, in which the external wound is snmll and free drainage
is lacking.
Wounds in which the articulation is exposed to view have
drainage either all ready provided for, or it is established with-
out hesitancy surgically. AVith free drainage thus established
there is little or no chance for the adjacent tissues to become
infiltrated with infected wound discharge. This prevents an
extension of the injury and the establishment of a good field
for the growth of anaerobic bacteria.
Open joints caused by punctures, unless the puncture is
aseptic, produce a swelling which is more painful than is the
open wound which exposes the joint to view. Especially is this
true if the puncture is of small diameter, allowing the tissues
to partially close the opening immediately after the wound has
been made. Where drainage is lacking there follows an exuda-
tion which congests the tissues surrounding the injury and all
factors favoring germ, growth are present. It is perhaps advis-
able to establish good drainage in such cases as soon as a diag-
nosis is made.
It is not always an easy matter to recognize an open-joint,
when first made, but twelve to twenty-four hours later there is
no cause for doubt. The condition is then a very painful one ;
lameness is excessive; there is rise in temperature; acceleration
of the pulse and manipulation or palpation of the region affected,
occasions great pain.
The treatment of open joints must be varied to suit the dis-
position of the animal, the nature and location of the injury,
the length of time intervening 1)etween the infliction of the
wound and the first attention given, and flie surroundings in
which the patient is kept.
In each and every case in which there exists an open wound
'Open Joints and Their Treatment in my practice, by J. V. Lacroix, Amer-
ican Journal of Veterinary Medicine, Vol. 5, page 203.
LAMENESS IN THE FORE LEG 115
the surface surrountlinti' tlie wound is cleansed thoroughly, the
hair is shaved if possible, and the margin of the wound is cur-
retted and cleansed thoroughly with antiseptic solutions.
If there is evidence that the articulation contains infective
material, it is washed out with copious quantities of peroxide
of hydrogen — usually as nnicli as six or eight ounces. This is
followed by injection of an ounce or two of tincture of iodin.
Even though the joint appears to be clean some tincture of iodin
is used, as it checks the secretion of synovia and is, in every
way, beneficial. Care is taken to apply the iodin also to the sur-
face immediately surrounding the wound. The entire wound is
then covered with a dusting powder composed of zinc oxide, boric
acid, exsiccated alum, phenol and camphor.
This powder is used in abundance and the wound is then
covered with a heavy layer of absorbenc cotton and well ban-
daged. This bandage is not disturl)ed for at least three days
and may be left in place for a week. In cases in which it is
necessary to keep the dressing on for a Vv'cek, or in cases where
the patient is, through necessity, kept in quarters that are wet
or unclean, the first bandage is covered with a layer of oakum
which has been saturated in oil of tar and this in turn is held
in place by means of several layers of bandages. The Ijandages
are also saturated with oil of tar.
In from one to two months wounds so treated, unless they are
foot-wounds, will be ready to dress without being bandaged.
It is ordinarily unnecessary to dress foot-wounds oftener than
every second week after the discharge of synovia has ceased.
When the wound has filled with granulation, a protective dress-
ing is applied which is rendered water proof by the use of
bandages covered with oil of tar. The patient can now be turned
out for a month or six weeks without disturbing the dressing.
After the removal of the bandages, the only treatment necessary
is an occasional application of some mildly antiseptic ointment.
Except in nail pricks of the foot, occasioned by punctures, a
five per cent tincture of iodin is injected into open joints, if the
wound renuiins sufficiently open, and this treatment is continued
so long as there is a discharge of synovia. Surgical drainage is
established if it is considered practicable and the remainder of
the treatment is about the same as for wounds which are open.
Open joints occur in horses at pasture and are sometimes not
discovered until several days or a week after the injury, and in
some instances the wounds are filled with maggots. The only
difference in the treatment of these cases is that more time and
care is taken in cleansing the wound, more curetting is neces-
sary, and after cleansing the Avound with peroxide of hydrogen,
116 LAMENESS OF THE HORSE
the joint is thoroughly washed out with equal parts of tincture
of iodiu and chloroform. This is follo\\ed by the injection of a
quantity of seventy-five percent alcohol and the wound is dressed
and bandaged as already described. At each subsequent dressing
of infected wounds so treated less suppuration is noticed and
the synovial discharge usually ceases in from one to two months.
About ninciij percent of all cases of open joint make complete
recoveries, about four per cent partially recover and six per cent
are fatal. Among the fatal cases are the open joints with com-
plications as severed tendons, those occasioned by calk wounds
in horses that are stabled, and nail punctures of the feet. The
foUoAving report of twelve favorable cases is taken from a record
of sixty-two cases. The favorable ones are reported, chiefly
because there are now enough reports on record of such cases
which have terminated fatally.
Case 1. — A gray gelding used as a saddle pony received a
horizontal wire cut laying completely bare the scapulohumeral
articulation. The margins of the wound were cleansed as here-
tofore described, a drainage was provided surgically, tincture of
iodin was injected and the wound was covered with equal parts
of boric acid and exsiccated alum. The iiorse was kept tied and
a diluted tincture of iodin was injected into the wound once
daily and the powder applied often enough to keep the wound
covered. The case made a complete recovery and the pony was
again in service within sixty days.
Case 2. — A twelve-hundred-pound bay mare with an open car-
pal joint. The wound was an open one al)Out two and one-half
inches in length, and made transversely and when the member
was flexed the articular surface of the carpal bones were pre-
sented to view. An ounce of tincture of iodin was injected into
this joint after having cleansed the margin of the wound and
the mare was cross-tied in a single stall to keep her from lying
down. The owner was instructed to keep the outside of the
wound powdered with air slaked lime and a very unfavorable
prognosis was given.
I heard nothing further from this case until fifty-nine days
from the date of the injury, when I met the owner driving this
mare to a buggy. The wound had healed by first intention and
at that time so little cicatrix remained that it was difficult to
find it.
Case 3. — A brown mare with an open fetlock joint due to a
spike-nail puncture. Lameness was excessive, and joint greatly
swollen. Tincture of iodin was injected into the wound and
towels dipped in hot antiseptic solutions were applied for several
LAMENESS IN THE FORE LEG 117
hours daily until the acute stage had passed. Later the mare
was turned out to pasture and a vesicant was applied once or
twice a month until recovery was complete which was in about
six months.
Case 4. — A four-year-old bay mare having a wire-cut which
opened the tarsus joint was treated as heretofore described. The
wound was kept bandaged for about two weeks and later it was
dressed without being bandaged. In ninety days she had com-
pletely recovered.
Case 5. — A twelve-year-old mare with an open fetlock joint
due to a puncture wound. The margins of the wound were
cleansed and the external wound enlarged to facilitate drainage.
Tincture of iodin was injected; the wound was bandaged and
dressed for a month in the manner heretofore described, when
all discharge had stopped. A vesicant was applied; the mare
was put to pasture and within sixty days from the date of the
injury she was being driven on short trips.
Case 6. — A two-year-old brown gelding with a wire-cut on
the left front foot. The wound extended down through the sole
and opened the navicular joint. This colt was very wild and it
was necessary to tie it down each time the wound was dressed
The wound was dressed weekly for a month and less frequently
thereafter. It was handled eight times; the last dressing was
left in place until worn out. Six months later the colt was prac-
tically well, a very little lameness being shown when walking
on frozen ground.
Case 7. — A seven-year-old saddle-horse weighing eleven hun-
dred and fifty pounds received a wound of the tarsus, laying
bare the articular surfaces of a part of the joint. It was im-
possible to keep this wound bandaged because of the restless
disposition of the subject. Injections of a dilute tincture of
iodin were emploj^ed every second or third day for a month
and the wound was kept covered with the antiseptic dusting
powder referred to heretofore. In five months complete recovery
had taken place, with the exception of a stubborn skin disturb-
ance which was successfully treated six months after the wound
was inflicted. The horse is still in use and is absolutely free
from lameness.
Case 8. — A two-year-old brown gelding with a wire-wound
opening the scapulohumeral joint. This wound was large enough
to expose to view the articular portion of the humerus. The same
treatment as that given case No. one was instituted and in ninety
days the colt was practically well.
118 LAMENESS OF THE HORSE
Case 9. — A three-year-old bay filly was found at pasture with
one fore foot badly injured. The owner intended to destroy her,
hut a neighbor prevailed upon him to have her treated. Ap-
parently the wound was of about a week's standing and in a
very bad condition, filled with maggots and dirt. Both the
navicular and coronary articulations were open. This wound
was cleansed in the usual manner and the owner cared for the
case the balance of the time because the distance from my office
was too great to give her personal attention. She made an al-
most complete recovery in five months.
Case 10. — At two-year-old mule with an open navicular joint
due to a barbed wire wound. Usual care was given this case and
in five months recovery was complete and little scar is to be
seen. This case received seven treatments.
Case 11. — An eighteen-months-old colt at pasture was found
down and unable to rise without help. In addition to several
wounds of lesser importance there was a large wound on the
inner side of the elbow, the joint was open and the entire leg
was greatly swollen and in a state of acute infectious inflamma-
tion. The colt could not walk, its temperature was 105°, pulse
was rapid and respiration was a little hurried. After advising
the owner to put the poor animal out of its misery I left the
place. Four clays later the owner came to my office and asked
if he could borrow some old shears to "trim off some loose hide
from that colt." He left the colt in the pasture and all the
care it received was the regular application of a proprietary
dusting powder. It made a complete recovery.
Case 12. — A family mare, heavy in foal, received a vertical
wound of the fetlock joint inflicted by a disc-harrow. The cid-
de-sac of the ligament of this joint was opened freely. The
wound was dressed in the usual manner and again three days
later when no suppuration had ta _m place. Four days later
the patient gave birth to a colt and suckled it right along through
her convalescence. This wound healed by first intention and
seventy-nine days from the date of the injury the mare was
driven to town, two and one-half miles distant, and showed but
little lameness.
Phalangeal Exostosis (Ringbone)
This tci'iii is applied to exostoses involving the first and second
phalanges (suffraginis and corona), regardless of their size, ex-
tent or location. It is a misnomer, in a sense, and the veter-
inarian is frequently obliged to spend considerable time with his
LAMENESS IN THE FORE LEG 119
clients in order to convince tlicni that a spherodial exostosis of
the proximal phalanx, in certain cases, is in reality ' ' ringbone, ' '
even though there exists no exostosis which completely encircles
the affected bone.
Etiolog'y and Occurrence. — Exostosis of the first and second
phalanges is usually due to some form of injury, whether it be a
contusion, a lacerated wound which damages the periosteum, or
periostititis and osteitis incited by concussions of locomotion,
or ligamentous strain. Practically the only exception is in the
rachitic form of ringbone which affects young animals.
There are predisposing causes that merit consideration, chief
among which is the normal conformation of the coronet joint.
This proclivity is constant ; the normal interphalangeal articula-
tion is an incomplete ginglymoid joint and while its dorso-volar
diameter is great, this in no wise compensates for its dispropor-
tionately narrow transverse diameter. The pivotal strain which
is sometimes thro^Ml upon this articulation when an animal turns
on one foot, as well as the tension which is put on the collateral
ligaments when the inner or the outer quarter of the foot rests
in a depression of the road surface, tends to detach the insertion
of these ligaments or to cause fibrillary fractures of their sub-
stance.
Short, upright, pasterns receive greater concussion during fast
travel on hard roads than do the longer more sloping and well
formed extremities. Those who are advocates of the theory that
this type of osteitis with its complications has its origin in the
articular portion of the joint, claim that the upright pastern con-
stitutes an important tendency toward ringbone. Howbeit, ring-
bone is an active, serious and frequent cause of lameness and it
affects animals of all ages and occurs under various conditions.
Horses having good conformation and kept at work wherein no
great amount of strain is put upon these parts, are occasionally
victims of this affection.
Classification. — The arrangement employed by Moller^ is in-
tensely practical and logical. He considers ringbone as articu-
lar, periarticular, rachitic and traumatic. A mode of classifica-
iRegional Veterinary Sui-gery MiiUer — Dollar, page G05.
120 LAMENESS OF THE HORSE
tion that is common and in a practical way, good, is, high and
low ringbone. When prognosis is considered, for instance, it is
very convenient to state that the chances for recovery are much
better in high ringbone than in low ringbone. The classification
of ]\Ioller will be followed here.
Symptomatology. — In all forms of incipient ringbone except
rachitic, the first manifestation of its existence, or of injury to
the ligaments in the region of the pastern joint which causes
Fig. 17 — Phalangeal exostoses.
periostitis, or affections of the articular portions of the proximal
inter-phalangeal joint, is lameness. Lameness which typifies
ringbone is of the supporting-leg variety and by compelling the
subject to step from side to side, marked flinching is observed,
especially in periarticular ringbone; causing the affected animal
to turn abruptly on the diseased member, using it as a pivot,
likewise accentuates the manifestation. In fact, many subjects
that exhibit no evidence of locomotory impediment while walking
or trotting in a straight line on a smooth road surface, will mani-
fest the characteristic form of lameness from ringbone when the
aforementioned side to side movement is performed.
LAMENESS IN THE FORE LEG
121
When the manner in which pain is occasioned is considered, it
will be understood why lameness is intermittent in the early
stages of this affection and may even be unnoticed by the driver.
An animal may travel on a smooth road without giving evidence
of any inconvenience, but as soon as a rough and irregular pave-
ment or road surface is reached, will limp. As the subject is
driven farther on level streets the lameness may disappear. This
intermittent type of lameness may continue until there is de-
veloped a large exostosis, or until articular involvement causes
Fig. 18 — Rarefying osteitis in chionic ringbone and ossification of lateral
cartilages.
SO much distress during locomotion that lameness is constant.
On the other hand, resolution may occur during the stage of
periosteal inflammation, oi', an exostosis forms which causes no
interference with function.
Before there is evidence of an exostosis, diagnosis of ringbone
is not easy, for it is then a problem of detecting the presence of
a ligamentous sprain, periostitis, or osteitis. The diagnostician
should take note of local manifestations of hypersensitiveness, or
heat if such exist, and, in addition, other conditions must be ex-
cluded before definite conclusions are possible.
In articular ringbone as soon as there is developed an exostosis,
122 LAMENESS OF THE HORSE
it occupies a position on the dorsal (anterior) part of the articu-
lation and extends around the sides of the joint.
Periarticular ringbone is characterized hy exostoses which
are situated on the sides of the phalanges and not extending
around to the anterior part of the joint. This type of ringbone
as well as the articular may occur "high" or "low."
Fig-. 19 — Phalangeal exostoses in chronic ringbone. Museum specimen of
the Kansas City Veterinary College.
With the trau malic form of ringbone, all consequences, as to
the size and form the exostosis is to assume, depend upon the
nature and extent of the injury.
Rachitic ringbone is frequently observed in some sections of
tlie country and docs not oi-diiiarily cause much if any lameness.
It is a disease of colts and may affect one or all of the phalanges
at the same time. As the sul)jcct advances in age there is more
or less diminution in the size of the enlargements.
LAMENESS IN THE FORE LEG 123
Treatment. — Rest is essential in the treatment of ringbone.
If diagnosed during its ineipieney, remedial measures such as
are usually employed to treat sprains, are indicated and hiter
the parts should be blistered. When an exostosis has developed
puncture firing is the remedy par excellence. Not that this
method of treatment is infallible, for to any thinking one who
takes into consideration the pathological anatomy of this condi-
tion, it is evident that no manner of treatment is beneficial in
some eases. If the exostosis is so situated that it does not me-
chanically interfere with function, and is not so large that it
may inhiliit flexion and extension, and where the articular por-
tions of the joint are not eroded, good results attend the use of
the actual cautery.
In firing, after having anesthetized the extremity, and pre-
pared the surgical area, the cautery is deeply inserted in numer-
ous places, taking care, however, not to open the joint. The parts
are immediately covered with aseptic absorbent cotton and this
dressing is left in position for forty-eight hours and if perchance
there is evidence of synovial discharge, the parts are again
aseptically dressed in order to prevent infection of the articula-
tion. If, as is the case usually, no perforation of the joint cap-
sule exists, the openings made by the cautery have been closed
by the coagulation of serum and there is then little chance of
infection causing troul)le, even though the member is left un-
bandaged.
In several instances, the author has treated ringl)one by this
method where the periarticular type existed and lameness was
marked, and in three weeks the subjects were in service and not
lame — this, in one instance in a valual)le polo pony where the
subject continued in service for more than a year without any
evidence of recurrence of the lameness. The production of a
deep-seated and acute inflammation with the actual cautery is
preferable to any sort of counter-irritation which may be pro-
duced by vesicants.
There is no occasion for any ditfereuce in the treatment of
either of the first three classes of ringbone, l)ut in the rachitic;
type where treatment is given, the application of a vesicant is
124 LAMENESS OF THE HORSE
all that is required. In most instances treatment is not neces-
sary.
The affected animals require a month to three months' time
for recovery to take place in the average favorable cases of ring-
bone.
Median neurectomy is of service in many instances where
lameness is not completely relieved by the use of the actual
cauteiy and no bad results attend the performance of this opera-
tion even though no benefit is derived thereby. Plantar neu-
rectomy is contraindicated in all cases where there exists much
lameness. If lameness is due to acute inflammation bad results
such as sloughing and loss of the hoof may follow ; and if large
exostoses mechanically interfere with function of the joint, or
where articular erosions exist, no possible good can come from
neurectomy. Careful discrimination should be employed in se-
lecting cases for neurectomy for this operation; otherwise, it is
very likely to prove disappointing.
Open Sheath of the Flexors of the Phalanges.
This condition does not differ from a like affection involving
other tendons except that the function of these tendons is such
that large synovial sheaths are necessary, and when synovitis
exists, the condition then becomes more serious.
Infectious synovitis involving these tendons in the fetlock
region is of more frequent occurrence than a like affection of
carpal or tarsal sheaths. With the exception of the extent of
the involvement and distress occasioned thereby, synovitis the
result of open tendon sheaths, is similar wherever it occurs.
Etiology. — The same conditions which are responsible for
open fetlock joint and other wounds of the pastern region, cause
open tendon sheaths of the flexor tendons.
Symptomatology. — Because of the size and extent of this
slicalli and the different manner in whidi it is opened, there is
manifested dissimilar symptoms in different cases. A nail
puncture which perforates the sheath in the pastern region and
at the same time produces an infectious synovitis, will cause
a markedly different manifestation than will a wound which
LAMENESS IN THE FORE LEG 125
freely opens the sheath above the fetlock. In the first instance,
the condition is much more painful; swelling is intense in some
cases; and if the subject does not possess sufficient resistance so
that spontaneous resolution promptly occurs, surgical evacua-
tion of pus is usually necessary. When these tendon sheaths
are opened, there follows a reaction which is quite analogous to
that which exists in arthritic synovitis, but instead of ankylosis,
adhesions with thecal obliteration occur. Rarely there result
cartilaginous and osseous formations.
The constitutional disturbances Avhich characterize this con-
dition vary with the degree of distress occasioned. As the in-
fection is virulent and causes serious destruction of the affected
parts, so does evidence of malaise and finally distress appear.
Detailed discussions of symptomatology in similar conditions
have heretofore been given, and further repetition is unneces-
sary.
Treatment. — The same general plan of treatment which is
employed for handling open joint is put in practice in these
cases. Following the preoperative cleansing of the exteriuil
wound and adjacent surfaces, where lilieral drainage exists,
tincture of iodin is injected into the sheath, the parts covered
with a suita])le dressing powder, and th^ entire meml)er is care-
fully dressed with cotton and bandages.
Subsequent treatment is the same as has been outlined \n the
discussion of open fetlock joint on page 112. The same general
plan of after-care is necessary. Recovery, however, does not
require so much time ordinarily, yet punctures of the sheath
occasioned by nails or other siiuiU implcmeiiis make for long
draAvn out cases of infective synovitis.
Luxation of the Fetlock Joint.
Etiology and Occurrence. — The numner of construction of
the fetlock joint is such that disarticulntion without irreparable
injury resulting, is practically impossil)l\ Logically, this joint
in the fore legs (not so in the pelvic limbs) should disarticulate
in such nu^mer that eitlier all of the inhibitory apparatus (flexor
tendons and suspensory ligament) nnist rupture or a lateral
luxation is necessary. Lateral disarticulation must necessarily
126 LAMENESS OF THE HORSE
sever the attachment of one of the common collateral ligaments.
Because of the width (transverse diameter) of the articulating
surfaces of this joint, lateral luxation requires a great strain;
and a force that is sufficient to occasion this trauma usually
causes serious additional injury. Therefore, the condition is
considered one wherein prognosis is always unfavoral)le in so
far as practical methods of treatment are concerned.
Mr. A. Barbier^ reports a case of bilateral luxation of the fet-
lock joints of the hind legs in a horse. This was done in jump-
ing, and the extensor tendon of each leg was ruptured and the
anterior portion of the metatarsus was protruding tli rough the
skin. Profuse hemorrhage had taken place due to tearing of
the blood vessels.
Symptomatology. — Entire luxation of this joint when present
is so evident that one cannot fail to recognize the condition.
Complete disarrangement of normal relation occurs and there is
either a breaking down of the inhil)itory njiparatus, or if a lateral
disarticulation exists, the normally straight line formed by the
bones of the front leg, as viewed from the front or rear, is broken
at the fetlock.
Often fracture of bones are concomitant and then, of course,
mobility is increased and not decreased as is the case in un-
complicated luxation.
Such violence occurs at times, when this joint is disarticulated,
that the joint capsule is also completely ruptured and the articu-
lar portion of the bones is exposed to view.
Treatment.— The condition being practically a hopeless one,
destruction of the subject is the thing which should be promptly
done. Tn valuable breeding animals, owners may prefer that
treatment be attempted when a lateral luxation and detachment
of but one common ligament have permitted luxation without
complete disarticulation and rupture of the joint capsule. In
such eases, by immobilizing the affected parts as in fracture,
and confining the subject in a sling for about sixty days, partial
recovery may occur in some instances.
Experience has shown that where luxation with detachment of
^Extract from Receuil de M^decine V^t^rinaire in Ameircan Veterinary
Review, Vol. 23, p. 893.
LAMENESS IN THE FORE LEG 127
a collateral ligament occurs, recovery is slow and incomplete — •
there always results considerable exostosis at the site of injury.
Sesamoiditis.
Etiology and Occurrence. — Inflammation of the proximal
sesamoid Ijones is caused by any kind of irritation which may
involve this part of the inhibitory apparatus. Positioned as
they are, between the bifurcations of the suspensory ligament
and the pastern joint, they serve as fulcra and effectively assist
in minimizing concussion which is received by the suspensory
ligament. The flexor tendons also, in contracting, exert strain
upon the inter-sesamoidean ligament, which has a similar effect
upon the sesamoid bones as that which is produced by the sus-
pensory ligament.
The condition occurs quite frequently, and because of the
important function performed by these bones, active inflamma-
tion of the sesamoids constitutes a serious affection. Because
of the fact that these bones have proportionately large articular
surfaces, when they are inflamed to the extent that degenerative
changes affect the articular cartilage, complete recovery seldom
results.
The same pathological changes occur here that are to be seen
in any case of arthritis. No special pathological condition char-
acterizes sesamoiditis but this condition causes incurable lame-
ness when the sesamoid bones are much inflamed.
Symptomatology. — In acute inflammation, there exist all tlie
symptoms which portray any arthritic inflammation of like char-
acter. The parts are readily palpable and are found to be hot,
supersensitive, and more or less infiltration of the tissues con-
tiguous to the joint causes swelling. There is volar flexion of the
phalanges when the subject is at rest. Lameness is intense ; in
some acute inflammatory disturbances the subject is unable to
bear weight on the affected member.
In chronic sesamoiditis, constant lameness is the one salient
feature which marks the condition. While it is possible for one
sesamoid bone to become involved without its fellow being af-
fected, this is not usual. Considerable organization of tissue
surrounding the joint is present and no particular evidence of
128 LAMENESS OF THE HORSE
siipersensitiveness exists. However, supporting weight brings
sufficient pressure to bear upon the intlamed and more or less
eroded Imnes so that pain is occasioned and lameness results.
Treatment. — During acute inflammation, absolute quiet is.
of course, of first consideration. Cold packs are to be kept in
contact with the parts until acute inflammatory symptoms sub-
side. The fetlock region is then enveloped with a poultice or an
iodin and glycerin combination (iodin one part to seven parts
of glycerin) is applied and a dressing of cotton is kept in con-
tact with the inflamed region. Following this, a vesicant is em-
ployed and the subject is allowed a month's rest.
Tn sub-acute cases, the entire region .surrounding the pastern
is blistered or the actual cautery is used. Line-firing is pref-
erable. The subject is given a month or six weeks rest and one
may be guided by the presence or absence of lameness as to
whether improvement or recovery i.s taking place.
Old chronic cases, and particularly those where there are con-
siderable induration and fibrous organization of tissue surround-
ing the joint, are not to be benefited by treatment.
The chief consideration in handling sesamoiditis is checking
inflammation as early as possible and preventing, if this can be
done, the erosion of articular surfaces. If destruction of any
part of the articular surfaces can be prevented and the patient
allowed ample time for complete resolution of the affected parts
to occur, permanent relief is possible.
Fracture of the Proximal Sesamoids.
Etiology and Occurrence. — Fracture of the proxinud sesa-
moid bones is caused l)y violent strain when there exists fragilitas
ossenm, or by contusions. The author treated a case where
fracture of one sesamoid was occasioned by a horse receiving a
puncture wound wherein the sharp end of a steel bar was pro-
truding from the ground where it was firmly embedded. The
subject in this case was injured while being driven along a
country road. Frost^ reports simultaneous fracture of all of the
proximal sesamoids occurring in a sixteen-year-old pony. The
'Fracture of All the Sesamoid Bones, by R. F. Frost, M. R. C. V. S.,
A. V. D., Rangoon, Burmah, in American Veterinary Review, Vol, 5, p. 362.
LAMENESS IN THE FORE LEG 129
condition is of rather common occurrence in some countries be-
cause of tlie fragile condition of horses' bones.
Symptomatology. — If the parts can be examined before ex-
travasation of l)lo()d and swelling mask the condition, crepita-
tion may be detected. In other instances, it is possible to note a
displacement of parts of the sesamoid bones — this in horizontal
fracture. There occurs more or less descent of the fetlock which
must not be attributed to rupture of the superficial tlexor tendon
(perforatus). By outlining the course of this tendon with the
fingers, when it is passively tensed sufficiently to follow its course,
one may exclude rupture of the superficial flexor. Finding the
suspensory ligament intact from its origin to the sesamoid at-
tachments, one may also eliminate rupture of this structure as
a cause of the trouble. Needless to say, marked lameness and
swelling of the fetlock soon take place. The condition is painful,
and ordinarily, recovery is impossil)le.
Treatment. — Where treatment is attempted, immobilization
as in luxation is in order. The patient's comfort is sought, and
if the fractured parts can be kept in close proximity, their union
may occur in time. However, chances for partial recovery
(which is the best to be hoped for) are so remote that early de-
struction of the subject is the humane and economical thing to
do.
Where treatment is instituted, it is found that there is required
a long time for union of the fractured bones to occur (where
union does take place) and the cost of treatment together with
the uncertainty of even partial recovery, makes for an unfavor-
able outcome. When the best possi])le results succeed treatment,
a large callosity is formed and movement of the pastern joint
is restricted. Lameness, though not intense, in the case referred
to, where one bone was broken, was i)ermanent and the subject
was out of service for nearly a year.
Inflammation of the Posterior Ligaments of the Pastern (Prox-
imal Interphalangeal) Joint.
Anatomy. — The ligaments here involved are the four vohir
ligaments described by Sisson^ as follows: "The volar ligaments
>The Anatomy of the Domestic Animal, by Septimus Sisson, S. B., V. S.
130 LAMENESS OF THE HORSE
(Ligg Volaria)i consist of a central pair and a lateral and me-
dial bands which are attached below to the posterior margin of
the proximal end of the. second phalanx and its complementary
fibro-cartilage. The lateral and medial ligaments are attached
above to the middle of the borders of the first phalanx, tlie cen-
tral pair lower down and on the margin of the triangular rough
area."
This portion of the inhibitory apparatus is described by
Strangewaj^s' Anatomy as two posterior ligaments which run
each from three points on the sides of the os suffraginis to a
piece of fibro cartilage, described as the glenoid cartilage, and
attached to the postero-superior edge of the os corouae ; between
them is the insertion of the inferior sesamoidean ligament.
Etiolog-y and Occurrence. — Everything tending to increase
strain upon these ligaments is contributory to possible fibrillary
fracture of these structures. Excessive leverage as furnished
by long toes, long toe-calks and low heels increases the normal
tension on the posterior ligaments of the pastern joint. Faulty
conformation, which throws an abnormal strain on these liga-
ments, is a predisposing cause of inflammation of these struc-
tures. Hard pulling upon slippery and rough or frozen roads
is a common exciting cause of this injury. The condition is of
comparatively frequent occurrence and is seen affecting draft
horses frequently, in the hind legs.
Symptomatolog-y.— Lameness is the first manifestation of this
affection and weight bearing is painful in direct proportion to
the extent of injury present. Volar flexion of the phalanges
relieves tension on the parts ; therefore, this position is assumed
while the subject is at rest. When considerable tissue has been
ruptured, and the condition is very painful, the foot is held off
the ground as in ail painful affections of the extremity.
By palpation evidence of pain is discernible, though very little
swelling occurs. Pain is increased by manual tension of the
parts which is done by grasping the toe of the foot and exerting
traction on the flexor apparatus. Care must be taken in execut-
ing such manipulations, and it is only by comparison of the
affected member with the sound one and noting the difference
LAMENESS IN THE PORE LEG 131
in the manifestations of discomfort that we may arrive at the
proper conclusion.
Some hyperthermia is to be recognized in acute inflammation,
by comparing the extremities. In the fore legs, navicular disease
is differentiated by noting absence of contraction at the heel.
By use of the hoof testers one may recognize evidence of inflam-
mation of the navicular apparatus. In inflannnation of the pos-
terior ligaments of the pastern joint, there is also absence of the
characteristic stuml)ling which is seen in navicular disease.
Treatment. — Rest is the first requisite, and in addition every
mechanical means possilile to change the center of gravity in
the phalangeal region, is to be employed. This is best accom-
plished by shortening the toe and paring the sole at the toe as
much as conditions will permit. The heel is raised by means
of a shoe with moderately high heel calks.
The iodin-glycerin combination heretofore mentioned may be
ai)plied and the parts covered with cotton and bandage. Sub-
jects require froin three weeks to several months' rest and must
be returned to work carefully, lest the incompletely regenerated
tissues suffer injury.
Regeneration of tissue in such cases, as has been pointed out,
is slow and sufficient time for complete recovery must be al-
lowed or relapses will occur.
Fracture of the First 2uid Second Phalanges.
Etiology and Occurrence. — Fractures of the first phalanx
(suffraginis) occur with respect to frequency, second to pelvic
fractures. Often, almost insignificant injuries cause phalangeal
fractures. On city streets, horses shod with shoes having long
calks get caught in frogs of street railways or by slipping on
rails, and phalangeal bones are often broken. The author ob-
served a case of comminuted fracture of both the first and sec-
ond phalanges (suffraginis and corona) in a polo pony caused
by making a sudden turn while in action in a contest on the turf.
Symptomatology. — Fracture of the phalanges is nearly al-
ways signalized l)y lameness, and this is marked during the pe-
riod of weight bearing. Lameness is usually intense and where
132 LAMENESS OF THE HORSE
the pathognomonic symptom (crepitation) is not recognized, the
intensity of the chuidication, when other causes are absent, is
indicative of fracture. The subject does not bear weight upon
the affected member and where pain is intense, the foot is held
in an elevated position and swung back and forth. In hind legs
the member is often flexed in abduction and held in this position
for several minutes, being rested on the ground only during
short intervals. When compelled to walk, if pain is excruciating,
the animal hops with the sound leg, no weight being supported
liy the fractured member.
When an examination of the subject is possible before the
extremity is swollen, crepitation is usually found without great
difficulty, except in a subperiosteal break or in some eases of
vertical or oblique fracture. Great care is necessary in handling
the injured extremity in these cases, and particularly in nerv-
ous subjects or in excited animals that have lieen recently in-
jured in runaways, is it necessary to be gentle in manipulating
the extremity, if definite deductions are to be made. As has
l)een mentioned in the chapter on diagnostic principles, if the
condition is so painful that the subject does not relax the parts
and crepitation is masked, local anesthesia is necessary. An
anesthetic solution of cocain or novocain may be applied to the
metacarpal or metatarsal nerves and an entirely satisfactory
examination is then possible.
Passive movement of the phalanges in all directions is prac-
tised in order to produce crepitation. When rotation of the
parts does not occasion crepitation, gentle flexion and extension
may do so. And in many instances, consideral)le manipulation
of the i)halanges is necessary before the pathognomonic symptom
is to be recognized.
In eases where crepitation is not found and lameness is pro-
nounced, out of proportion with other possible existing causes,
one may by exclusion of other causes establish a diagnosis of
fracture in the course of forty-eight hours. In the meanwhile,
support is given the affected member by applying an effective
leather splint, so that pain may ])e diminished. To combat in-
flammation, a suitable cataplasm may l)e applied directly to the
skin, the extremity l)andaged, and the temporary immobilizing
LAMENESS IN THE PORE LEG 133
appliance may be secured over all. In this manner one niay
make repeated examinations of the subject, and if slings are
used and every other necessary precaution taken to promote
comfort for the subject, no harm will result in delaying for
several days the application of permanent immobilization — ban-
dages and splints or casts. In fact, where much swelling exists
at the time one is called to treat such cases, it is advisable to delay
the application of a permanent dressing or east until inflamma-
tion has somewhat subsided.
Course and Prognosis. — AVhere conditions are favorable, the
nature of the fracture one that will yield to treatment, the sub-
ject not aged, and facilities for giving good attention to the
affected animal are ample, fractures of the first and second
phalanges recover completely in from six weeks to four months.
Only simple fractures are considered curable from a practical
and economical point of view, excepting in foals, where com-
pound, and even comminuted, fractures may be so handled that
animals may eventually become serviceable though blemished.
Age retards the process of osseous regeneration, but in one
instance at the Kansas City Veterinary College, a very aged
mare suffering from a multiple fracture of the first phalanx was
treated and at the end of sixty days was able to walk into an
aml)ulance. Large exostoses had developed and the subject re-
mained lame, but union of the broken bone took place in a sur-
privsingly prompt and effective manner, when age of the subject
and nature of the fracture are considered.
As a nde, one is loath to reconnnend treatment, even in a sim-
ple transverse fracture of the first phalanx, in animals ten years
of age or older. The conditions which exist in any given locality
that regulate the expense of caring for an animal during the
period of treatment, especially influence the course to be pur-
sued in treating fractures.
Treatment. — For permanent immobilization of the phalanges
in fracture, materials which might adapt themselves to the irreg-
ular contour of the member and at the same time contribute suf-
ficient rigidity to the parts without doing injury to the soft
134 LAMENESS OF THE HORSE
structures, ^yould coustitute ideal means of treatment; but no
such materials have yet been devised, and opinions are various
as to the most efficient and practical method to employ.
After the fetlock has been shorn of hair and the ergot trimmed,
the skin is thoroughly cleansed and allowed to dry. Several
thin layers of long fiber cotton are then wrapped around the
extremity — enough to pad well the member — and this is retained
in position with a wide bandage. Gauze bandages are prefer-
able to heavier bandages of cotton fabric because they are some-
wliat more elastic and yield to the irregular contour of the parts
to a better advantage. Layers of three inch gauze bandages,
which are soaked with a cold starch paste are wound about the
extremity. Strips of leather that are flexible and not more than
an inch in width are placed in a vertical position around the
leg and these are also covered with the starch and securely held
in position with the bandages. In this way, one is able to pro-
vide a sufficient degree of rigidity and at the same time, where
the cast is carefully applied, little if any injury is done the skin.
Such a cast is not difficult to remove and is so inexpensive that
it may be removed and reapplied at any time it should be
thought preferable to do so. Of course, this does not constitute
an effective means of support if the parts are to be frequently
and thoroughly soaked with water, but animals undergoing this
sort of treatment are usually kept sheltered.
The same after-care is necessary in such eases as is given in
fractures of other bones. Two months after the injury has
been done, the application of a blistering ointment to the entire
region is of benefit.
Results. — Much depends on the nature of fractures as to the
success one may attain in approximating the parts of a broken
bone, and in some cases of oblique fracture for instance, com-
plete recovery is impossible, despite the most skillful and pains-
taking attention given. On the other hand, cases of simple
transverse fractures make perfect recoveries in some instances.
All fractures are serious, and in every instance the practitioner
M'ould best be careful to impress his client with the many diffi-
culties which usually attend the treatment of fracture in horses.
LAMENESS IN THE FORE LEG 135
Tendinitis.
Inflammation of the Flexor Tendons.
One of the most eominon causes of lameness in light harness
and saddle horses is tendinitis, and because of the character of
the structure of tendons and because of their function, an active
inflammation of these parts is always serious.
Being almost inelastic and not well supplied with blood, ten-
dinous tissue is slowly regenerated, and .so much time is required
for complete recovery to take place in tendinitis, that affected
animals seldom fully recover before they are in service or vig-
orously exercising at will. As a result, complete recovery is de-
layed or prevented.
The extensor tendons, because of the nature of their function,
are very seldom strained ; they are often bruised and occasionally
divided, but unlike this condition in the flexors, tendinitis of
the extensors is of rare occurrence.
For a concise discussion of this subject the most practical
classification is one made on a chronological basis and we may
then consider tendinitis as acute and chronic.
ACUTE TENDINITIS.
Etiology and Occurrence. — Causes of tendinitis, as in almost
all diseases, may be considered under the heads of predisposing
and exciting. Among the predisposing causes of tendinitis may
be mentioned, faulty conformation. Everything which has to
do with increasing the strain upon tendons adds to the proba-
bility of their being over-taxed. Long, sloping, pastern bones;
disproportionate development of parts, such as a heavy body
and small, weak tendons and long hoofs, are the principal fac-
tors which usually predispose to tendinous sprains. Degenera-
tive changes which take place in tendons following constitu-
tional diseases such as influenza may also be classed as a predis-
posing cause.
Excessive strain when put upon tendons in any possible man-
ner, such as is occasioned in running and jumping; making mis-
steps and catching up the weight of the body with one foot, when
the force thus thrown upon the supporting structure is great
136 LAMENESS OF THE HORSE
because of monientiiin gained at a rai)id j)aee, are exciting-
causes of tendinitis.
Symptomatolog-y. — In all cases of acute tendinitis there is
presented a characteristic attitude by the subject. Volar flexion
in a sufficient degree to relax the inflamed structures is always
evident. The foot may be rested on the toe or placed slightly
in advance of the one supporting weight, l)ut the fetlock is al-
ways thrown forward. More or less swelling of the inflamed
tendons is present. Where the deep flexor (perforans) is in-
volved swelling is marked and with swelling there is present
the other symptoms of inflammation — heat and supersensitive-
ness.
In manipulating tendons for the purpose of detecting super-
sensitiveness, care must be taken so that no false conclusion
be drawn, because of the aversion many horses have to sul^nit-
ting to palpation of the tendons even when they are in a normal
condition.
Supporting-leg-lameness is present and varies in degree with
the intensity of the pain caused by weight bearing. In many
instances, as soon as the subject has traveled a consideralile dis-
tance, lameness diminishes or discontinues. As soon as the af-
fected animal is permitted to stand long enough to "cool out"
there is a return of the lameness, which is then marked.
No ditflculty is encountered in making a practical diagnosis
in tendinitis ; that is, one may fail to readily recognize the ex-
tent of the involvement as it affects the superficial flexor tendon,
for instance, but this has no {practical liearing on the prognosis
and treatment, when existing inflannnation of the deep flexor is
recognized.
The course of each tendon is readily outlined by palpation ;
all ])arts are easily manipulated ; and with experience one may
readily i-ecognize the extent and degree of the inflammation.
Treatment. — In some cases of acute tendinitis, pain is intense
and Ihc application of cold i)acks during this stage is very
t)eneficial in that ])ain is controlled and inflannnation subsides.
The extremity may be bandaged with a liberal quantity of ab-
sor])ent cotton or with woolen material. Ice water is then poured
LAMENESS IN THE FORE LEG 137
around the bandaged member every fifteen minutes and this
should be continued for al)Out forty-eight hours. In some cases
this treatment is not necessary for more than twelve hours; at
the end of this length of time, pain has subsided and the acute
stage of iiirtammation has passed or its intensity has been dimin-
ished.
Following the a]^plication of cold packs, the use of a poultice
such as some of the sterile, medicated muds, is of marked ben-
efit. The author has made use of tincture of iodin and glycerin
in the proportion of one part of iodin to seven parts glycerin,
with very satisfactory results. This combination is hygroscopic,
anodyne and antiseptic and is easily applied. A liberal quan-
tity is directly applied all around the affected tendons and tlie
leg covered with a heavy layer of cotton, and this is snugly
held in position with liandages. The application may be used
once or twice daily, or if it is thought necessary, an attendant
may pour a quantity of the iodized-glycerin around the leg and
under the bandage once daily without removing the cotton and
bandage. Needless to say, absolute rest is imperative.
When all evidence of acute inflammation has .subsided vesica-
tion is indicated. At this stasre walking exercise is beneficial
and tlie subject may be allowed the freedom of a paddock.
Some practitioners are ]')artial to the use of the actual cautery
in these cases, but it is doubtful if it is necessary to produce
such a great degree of counter-irritation in cases where the sub-
ject is suffering the first attack of tendinitis.
As has been indicated, ample time should be allowed for re-
covery and depending upon conditions, it takes from three weeks
to six months for cnniplete recovery to become established.
Chronic Tendinitis and Contraction of the Flexor Tendons.
Etiolog'y and Occurrence. — Acute inflammation of tlie flexor
tendons may result in chronic tendinitis. Recurrent attacks in
cases where insufficient time is allowed for complete recovery
to result, is followed by chronic inflammation and hypertrophy
of the tendons. Again, in subjects where conformation is faulty,
no amount of care will be sufficient to prevent a recurrence of
the inflammation and the condition must become chronic.
13S
LAMENESS OF THE HORSE
Symptomatology. — On visual examination of the subject at
rest, one may note the hypertrophied condition of the affected
tendons. Their transverse diameter is usually perceptibly in-
creased and in many cases, there is an increase in the antero-
posterior diameter. The latter condition causes a bulging of
the tendon that is so noticeable, because of the convexity thus
formed, it is commonly known as "bowed tendon."
In chronic tendinitis there occurs repeated attacks of inflam-
mation wherein lameness is pronounced and there exists in real-
Fig. 20 — Contraction of tlie superficial digital flexor tendon (perforatus) of
the right hind leg, due to tendinitis.
ity, at such times, acute inflammation of a hypertrophic struc-
ture, where at no time does inflammation completely subside.
Therefore, in chronic tendinitis there is to be found at times the
same conditions which characterize acute inflammation, except
that there is usually a variance of symptoms because of the dif-
ference in the degree of inflammation and pain.
The diagnosis of contraction of tendons is an easy matter be-
cause of the fact that relations between the phalanges are con-
stantly changed with tendinous contraction. If one bears in
mind the attachments and function of the digital flexors, no
difficulty is encountered in recognizing contraction of either ten-
don.
LAMENESS IN THE FORE LEG
139
Contraction of the superficial digital flexor (perforatus), when
nncomplieated, is characterized by volar flexion of the pastern
joint. The foot is flat on the ground and the heel is not raised
because tlie superficial flexor tendon does not have its insertion
to the distal phalanx (os pedis) and therefore can not affect the
position of the foot.
By causing the subject to stand on the affected member, one
Fig. 21 — Contraction of the deep flexor tendon (perforans) of the riglit hind
leg, due to tendinitis.
may outline the course of the flexor tendons by palpation, and
in this way recognize any lack of tenseness or contraction of
tendons or of the suspensory ligament.
Contraction of the suspensory ligament would cause the pas-
tern joint to assume the same position as is occasioned by con-
traction of the superficial digital flexor (perforatus) tendon, but
when the subject is bearing weight on the affected member, it is
easy to determine that no contraction of the suspensory liga-
140
LAMENESS OP THE HORSE
inent exists, by noting an absence of abnormal tenseness of this
structure. And finall}^ contraction of the suspensory ligament
is of rare occurrence.
Contraction of the deep flexor tendon (perforans) causes an
elevation of the heel. The foot can not set flat because the in-
sertion of the deep flexor tendon to the solar surface of the distal
phalanx (os pedis) causes — when the tendon is contracted — a
rotation of the distal phalanx on its transverse axis — hence the
Fig-. 22 — A chronic case of contraction of both flexor tendons of the pha-
langes. In this case (presented at a clinic of the Kansas City Veterinary
College) because of long continued contraction of the flexors, which pre-
vented weight being supported with any degree of comfort, there resulted a
partial paralysis of the extensors, and consequently the extremity was
dragged on the ground.
raised heel. No other tendon has this same effect on the distal
phalanx and the condition is correctly diagnosed without diffi-
culty.
Course and Complications. — This condition may exist for
years without causing the subject any serious inconvenience, if
the affected animal is kept at suitable work. In other instances
recurrent attacks of lameness are of such frequent occurrence
that the subject is not fit for service. Many affected animals
that are kept in service in spite of lameness (and in some in-
LAMENESS IN THE FORE LEG
141
stances where no lameness is present), soon become unservice-
able because of contraction of the inflamed tendon. This, in
fact, is the condition which eventually becomes established in
most instances.
Treatment. — Where conformation is not too faulty so that
recovery may be expected, good results are obtained by line-
firing the tendons and allowing the subject a few months' rest.
Fig. 23 — Contraction of the superficial and deep flexor tendons (perforatus
and perforans) of the left fore leg.
In some cases median neurectomy is advisable. This is recom-
mended by Breton^ as being productive of good results even
where contraction of tendons exists and tenotomy is done.
By shoeing with high heel-calks considerable strain is taken
from the inflamed tendons because of the changed position of
the foot which alters the distribution of weight on different parts
of the leg. Rubber pads materially diminish concussion and
^Traits De Therapeutique Chirursicale Des Animaux Domestique. par 1'. J.
Cadiot et J. Almy, Tome Second, page 547.
142 LAMENESS OF THE HORSE
should be made use of when the subject is returned to work, if
the character of the work is such as to occasion much concussion.
It is to be remembered, however, that in sprains there occurs
fibrillar}^ fracture of soft structures and time is required for
regeneration of tissue which has been injured or destroyed. Ab-
solute rest is necessary where inflammation is acute and in sub-
acute or chronic tendinitis avoidance of all work which causes
irritation to the affected tendons is imperative.
Fig. 24 — Contraction of superficial digital flexor and slight contraction of
deep flexor tendon.
Where contraction of tendons exists surgical treatment is nec-
essary. No good comes from appliances which are calculated to
stretch the affected tendons ; in fact, they aggravate the inflamed
condition and hasten complete loss of function of the affected
member. Where there exists no articular or ligamentous dis-
eases which would defeat the purpose, tenotomy is the only
remedy for contracted tendons.
LAMENESS IN THE FORE LEG 143
Contracted Tendons of Foals.
Etiology and Occurrence. — This condition is occasionally ob-
served aiul no positive explanation of the reason for its exist-
ence can be given. That mal-position en utcro causes the meta-
carpal bones to develop in length so rapidly that the tendons
are too short, is an explanation that is offered. Be that as it
may, in breeding sections of the country the general practitioner
is obliged to handle these cases and successful methods of treat-
ment are essential even though cause is not removable.
Symptomatology. — The superficial flexor tendon (perforatus)
alone, is the one usually contracted, and while both flexors are
at times involved, this rarely occurs. The condition is usually
bilateral.
The degree of contraction varies greatly in different cases.
In some, contraction exists to such extent that it is impossi])le
for the colt to stand, and because of continual decubitus where
no relief is given, the subject is lost because of gangrenous in-
fection occasioned by bed sores. Otherwise the same symptoms
are to be observed in this condition, that exist in contraction of
tendons of the mature animal.
Treatment. — "Wherever contraction is not too marked and
weight is borne with the affected members, and where the feet
can be kept on the ground in a nearly normal position, it is pos-
sible to correct the condition without doing tenotomy. That is,
in cases where the subject is simply "coek-ankled", where volar
flexion of the pastern joint exists but the foot is kept flat on the
ground, correction is possible without tenotomy.
In such instances the foal must be treated early — before the
skin on the anterior pastern region has been badly damaged by
knuckling over. It is possible in many cases to stretch the flexor
tendons by grasping the colt's foot with one hand, and with the
other hand one may push the pastern in the direction of dorsal
flexion. This may be tried and when a reasonable amount of
force is employed, no harm is done, even though no material
benefit results. Some veterinarians claim good results from this
treatment alone and direct their clients to repeat the stretching
process several times daily.
144 LAMENESS OF THE HORSE
Whether the tendons are manually stretched or not, splints
should be adjusted to the affected members. The legs are padded
with cotton and bandages and a suitable splint is applied on
either side of the members and securely fixed in position by
bandaging.
The splints are kept in position for four or five days and then
removed for inspection of the affected parts. If necessary, they
are reapplied and left in position for a week; however, this is
unnecessary in the average case that is treated in this manner.
"Where contraction exists to the extent that the subject can
not stand and where no weight is borne by the feet, it is neces-
sary to divide the affected tendons surgically. The same technic
is put into practice that is employed in the mature subject but
there is much greater chance for a favorable outcome in the foal.
Further, if necessary, one may divide with impunity, both ten-
dons ou each leg, at the same time. In all cases this operation
is done by observing strict aseptic precautions and the legs are,
of course, bandaged. If both tendons are divided, splints should
be employed and kept in position for ten days or two weeks.
Primary union of the small surgical wound of the skin and
fascia occurs in forty-eight hours.
The reader is referred to William's "Veterinary Surgical
and Obstetrical Operations," for a complete description of this
operation.
In veterinary literature there is occasionally described a con-
dition which affects young foals wherein symptoms similar to
those of contraction of the flexors are manifested, but upon
examination it is found that rupture of the extensor of the
digit (extensor pedis) exists. This affection is briefly described
by Cadiot but no complete treatise on this condition has been
published.
In parts of Canada foals of from one to three days of age
are found affected in such manner that more or less interference
with the gait is to be seen in those moderately affected. There
is, in some subjects, only a slight impediment in locomotion
which is occasioned by inability to properly extend the digit.
In other subjects, while able to stand and walk, great difficulty
is experienced because of volar flexion of the phalanges. The
more seriously affected animals are unable to stand and. in most
instances, perish because of the effects of prolonged decubitus.
la:\ieness in the fore lec; 145
A local enlargement occurs at the anterior carpal region and
the mass is somewhat tiuctuating, extravasated fluids becoming
infected in many instances, and necrosis of the skin and fascia
provide means for spontaneous discharge of the contents of
the enlargement if it is not opened. The infection when it
becomes generalized causes a fatal termination in most cases that
are not treated.
Fig. 25 — "Fish knees."
^Photo by Thos. Millar, SI. R. C. V. S.
Native stock owners of some parts of Canada know this con-
dition as "fish knees" because of the presence of the ruptured
end of the extensor tendon which is found coiled in the cavity of
the enlargements caused by the ruptured tendon.
Local practitioners have treated the condition by incising the
swollen mass and removing the part of tendon contained within
such cavities. Treatment has not proved entirely satisfactory
in the majority of instances, perhaps because of tardy inter-
ference.
In a colt's leg sent the author by .Mr. Thoma.s ]\Iillar, Isl. R.
C. V. S., of Asquith, Saskatchewan, a careful dissection of the
carpal region revealed the fact that in this case the ruptured
extensor tendon was due to injury. The colt may have been
trampled upon by its dam in such manner that the tendon was
divided. No noticeable evidence of injury to the skin was to be
seen on its outer surface, but on the fascial side a cyanotic con-
gested area, which was situated immediately over the site of the
ruptured tendon, was very evident.
146
LAMENESS OF THE HORSE
With the execution of a good surgical technic, the ruptured
tendon might be sutured; the wound of the tendon sheath as
well as that of the skin carefully united by means of gut sutures,
the leg bandaged and immobilized with lea,ther splints and re-
covery follow in a reasonable percentage of cases so treated.
These cases afford an opportunity for the perfection of practical
means of treatment by those who frequently meet with this affec-
tion.
Rupture of the Flexor Tendons and Suspensory Ligament.
Etiology and Occurrence. — Rupture of the flexor tendons or
of the suspensory ligament is of rare occurrence. Frequently,
these structures are divided as the result of wounds; but rup-
ture, due to strain, is not frequent.
Fig. 26 — Extreme dorsal flexion said to have resulted from an attack of
distemper. From Amer. J'n'l. Vet. Med., Vol. XI, No. 4.
In some cases in running horses, or in animals that are put
to strenuous performances, such as are jumpers, rupture of ten-
dons or of the suspensory ligament takes place. However, more
frequently this follows certain debilitating diseases such as in-
fluenza or local infectious inflammation of the parts which re-
sults in degenerative changes and rupture follows.
The non-elastic suspensory ligament receives some heavy strains
LAMENESS IN THE PORE LEG 147
during certain attitudes which are taken by horses in hurdle
jumping as is explained in detail by Montane and Bourdelle^
under the description of this ligament. But in spite of the fre-
quent and unusually heavy strains, which these structures re-
ceive, complete rupture is not frequently seen.
Symptomatology. — AYhen the anatomy and function of the
flexor tendons and suspensory ligament is thoroughly under-
stood, recognition of rupture of either of these structures is
easily recognized. When one considers that in rupture, a posi-
tion directly opposite to that which is seen in contraction in
either one of these structures, is assumed, a detailed description
of each separate condition is needless repetition.
However, it is pertinent to suggest that rupture of the deep
flexor tendon (perforans) allows a turning up of the toe.
Whether it be torn loose from its point of attachment or rup-
tured at some point proximal thereto, the position is the same
— heel flat on the ground, toe slightly raised and this raising
of the toe varies in degree as the subject moves al)out.
AVhen the superficial flexor (perforatus) is ruptured there is
no change in the position of the foot but the fetlock joint is
slightly lowered. The pathognomonic symptom is the lax ten-
don during weight bearing, Avhich may l)e felt by palpation of
the tendon along its course in the metacarpal region.
With complete rupture of the suspensory ligament there oc-
curs a marked dropping of the fetlock joint and an alinormal
amount of weight is then thrown upon the superficial flexor ten-
don (perforatus), causing it to be markedly tensed. This is
readily recognized by palpation. By palpating the suspensory
ligament from its proximal portion down to and beyond its
bifurcation, while the affected member is supporting weight, it
is possible to diagnose rupture of one of its branches.
Prognosis and Treatment. — In rupture of the superficial
flexor tendon (perforatus) because of its comparatively less im-
portant function, prognosis is favorable and recovery takes place
when proper treatment is put into practice.
lAnatomie Regionale Des Animaux Domestique, page 695.
148
LAMENESS OF THE HORSE
With rupture of the deep tiexor tendou (perforans), especially
wlien it occurs at or near its point of insertion and sometimes
foUowiug disease, prognosis is unfavorable.
Rupture of the suspensory ligament constitutes a condition
which is, as a rule, hopeless, because of the impracticability of
treating such cases.
The salient feature which characterizes any practical attempt
at treatment of ruptured tendons or other portions of the inhibi-
tory apparatus of the fetlock region, is to retain the phalanges
in their normal position for a sufficient length of time that the
approximated ends of ruptured tendons or ligaments may unite.
The length of time required for this to occur, together with the
Fig. 27 — A good style of shoe for bracing the fetlock where tenotomy has
been performed, or in case of traumatic division of the flexor tendons. An
invention of Dr. G. H. Roberts.
difficulties encountered in confining the affected extremities in
suitable braces or supportive appliances, precludes all possibil-
ity of this condition's being practically amenable to treatment
when the deep flexor tendon (perforans) and suspensory liga-
ment are simultaneously ruptured. It does not follow, even so,
that recovery does not succeed treatment in some of these un-
favorable eases.
J.AMEXESS IN THE FORE LEG 149
Affected subjects are kept in slings as long as it seems neces-
sary— until they learn to get up without deranging the braces
worn.
Several styles of braces are in use and each has its objections ;
nevertheless some sort of support to the affected member is neces-
sary and steel braces which are connected with shoes are usually
employed.
The principal difficulty which attends the use of braces is
pressure-necrosis of the skin which is caused by the constant
and tirm contact of the metal support. The practitioner's in-
genuity is taxed in every case to contrive practical means of
padding the exposed parts in order to prevent or minimize ne-
crosis from pressure. This is attempted — with more or less suc-
cess— by frequent changing of bandages and the local application
Fig. 2H — Showing the Uolierts brace in operation.
of such agents as alcohol or witch hazel. Needless to say, the
skin must be kept perfectly clean and the dressings free from
all irritating substances.
The fact that tendons or ligaments which are ruptured, do
not regenerate as readily as in cases where traumatic or surgical
division occurs, must not be lost sight of, and prognosis is given
in accordance.
150 LAMENESS OF THE HORSE
Thecitis and Bursitis in the Fetlock Region.
Etiology and Occurrence. — Synovial distension of tendon
sheaths and bursae in the region of the fetlock are caused by
the same active agencies which produce this condition in other
parts. The fetlock region is exposed to more frequent injury
than is the carpus and as a consequence is more often affected.
The same proportionate amount of irritation affects this part
of the leg, owing to strains, as affect the carpus from a similar
cause; and synovitis from this cause, is as frequent in one case
as in the other. Therefore, it is a natural sequence that the
tendon sheaths of the metacarpophalangeal region are frequently
distended because of chronic synovitis and thecitis. These in-
flammations are usually non-infective in character.
The cul-de-sac of the capsular ligament of the fetlock joint
which extends upward between the bifurcation of the suspensory
ligament is the most frequently affected structure in this region.
When distended, tM-'o spheroidal masses bulge laterally and an-
terior to the flexor tendons in a characteristic manner. This
condition is known among horsemen as "wind-gall" or "fet-
lock-gall."
The sheath of the flexor tendons, whieli begins about the mid-
dle portion of the lower third of the metacarpus, and continues
downward below the pastern joint is often distended.
Excepting in cases of acute inflammation attending synovitis
of these parts, no lameness marks its existence and in chronic
cases of synovial distension the service of affected animals is not
interfered with. These distensions constitute unsightly blemishes
and they are treated chiefly for this reason.
No difficulty is encountered in recognizing these conditions
even where considerable organization of tissue overlying dis-
tended thecae occurs. In such cases there may be only slight
fluctuation of the enlargement, but if necessary, an aseptic ex-
l)l()ratory puncture may lie nmde with a suitable needle or tro-
car.
LAMENESS IN THE FORE LEG 151
Treatment. — Complete rest and the local application of cold
packs are in order in acute synovitis when there is distension of
tendon sheaths. In the fetlock region, because of the ease with
which pressure may be employed, the parts should be kept
snugly wrapped with cotton, and derby bandages are used to
exert the desired amount of pressure over the affected region.
The pressure-bandages should be employed as soon as all acute
and painful inflammation has subsided ; and then they should be
continued, day and night, for ten days or two weeks. The ban-
Fig. 29 — Distension of tlieca ni tlic rxlt-iisor oi llu- iW-aW U'xtensor pedis).
dages should be removed morning and night. After the skin
of the leg has thoroughly dried off, an infriction of alcohol or
distilled extract of hamamelis is given the parts and the cotton
and bandages are readjusted. A good, even and firm pressure
in such cases is productive of satisfactory results.
In chronic distensions of tendon sheaths synovia may be as-
pirated and about five cubic centimeters of equal parts of tinc-
ture of iodin and alcohol is injected into the cavity. This is not
done, however, without usual aseptic precautions. If no marked
152 LAMENESS OF THE HORSE
swelling- results within forty-eight hours the entire fetlock re-
gion is thoroughly vesicated and, as soon as the skin has recov-
ered from the effects of the vesicant, pressure bandages may be
employed. In these cases, subjects may be put into service after
all swelling which the injection or the vesicant has produced
has subsided. The pressure liandages are used at night or during
the time that the horse is in its stall and they are not worn by
the subject while at work.
Where no marked swelling occurs within ten days, as the re-
sult of the injection of iodin, the injection may be repeated and.
if thought necessary, the quantity may be materially increased.
If sw^elling does not occur it is indicative that no particular irri-
tation has been caused.
Some swelling is desirable and much swelling sometimes re-
sults and persists for weeks. This is not in any way likely to
cause permanent trouble ; and if the technic of injection is skil-
fully ('xecuted no infection will follow.
By persistent and careful use of suitai)]e elastic bandages, the
support thus given the parts, together with the absorption of
products of inflammation whicli constant pressure occasions,
some chronic cases of synovial distension of tendon sheaths re-
cover in two or three months and this without other treatment.
Such good results are not to be expected in aged subjects, nor
in horses having at the same time, chronic lymphangitis.
Where bandages of pure rubber are employed great care is
necessary, if one is not experienced in their use, lest necrosis
result. W^here bandages are unecmfoitabiy tight the subject will
manifest discomfort, and an attendant should observe the animal
at intervals for a few hours (where there may be some doubt as
to the degree of pressure which is exerted by elastic bandages)
and readjustment made before any harm is done.
Arthritis of the Fetlock Joint.
Anatomy. — The anatomy of the metacarpophalangeal arti-
culation is briefly reviewed on page 58 under the heading of
" Anntoino-Physiological Review of Parts of the Foreleg."
Etiology and Occurrence. — The chief causes of non-infective
LAMENESS IN THE FORE LEG
153
arthritis of the fetlock joint are irritations from concussion and
contusions due to interfering. The condition occurs in young
animals tliat are over-driven in livery service or other similar
exhausting work, where they become so weary that serious injury
is done these parts by striking the pasterns with the feet — inter-
fering. In these "leg-weary" animals, that are always kept
shod with fairly heavy shoes, much direct injury is done at times
Fig. 20— Rarefying osteitis whereir articular cartilage was destroyed in a
case of arthritis of fetlock joint.
by concussion due to self-inflicted blov/.s. In older animals,
where there exists similar conditions, with respect to their being
worn from fatigue and, in addition, periarticular inflammatory
organizations, arthritis is not of uncommon occurrence.
Symptomatology. — In true arthritis there exists a very pain-
ful affection which is characterized by manifestations of distress.
The subject may keep the extremity moving about — where pain
is great — suspended and swinging. There is sAvelling which is
more or less hot to the touch and compression of the parts with
the fingers increases pain. Lameness is always pronounced and
no weight is supported witli the affected member in very acute
and generalized arthritic inflammations. There occurs the usual
154 LAMENESS OF THE HORSE
facial manifestations of pain — the tense condition of the facial
muscles and the fixed eye and nostril are in evidence
In cases Avhere there exists a synovitis or where a very limited
portion of the articulation is involved, a somewhat different clin-
ical picture is presented. Then, the disturbance causes less dis-
tress; local SM'elling and evidence of supersensitiveness are not
so pronounced and lameness is not intense, though weight-bearing
is painful.
Prognosis. — There is a constant difference in the degree of
pain manifested, as well as the other symptoms of inflammation,
between true arthritis, which involves much of the joint, and
synovitis; or synovitis plus a small circumscribed area of joint
involvement. This difference is present in all joint affections
of the extremities and, in passing, it is well to say that infection
usually increases every manifestation of pain. Infection occasions
more pronounced local symptoms of inflammation and, l)ecause
of the rapid progress of necrotic destruction of cartilage, the
course of the affection is usually rapid; ankylosis is a frequent
result and loss of the subject is often inevitable. However, in
non-infective arthritis of the fetlock joint, prognosis is favor-
able.
Treatment. — The same general principles which are employed
in arthritis of other joints are used here. Eest and comfort for
the patient is sought in every available manner. If the subject
remains standing too long, the sling should be used and a well-
bedded box-stall will contribute much to the comfort of the
patient.
Pain and acute inflammation is diminished or controlled, if
possible, by using ice-cold packs. In nervous, well-bred animals
analgesic agents may be employed; or small doses of morphin
sulphate — one to two grains — given at intervals of three hours
during the first stages of the affection is very beneficial. This
is especially indicated in infectious arthritis.
As inflammation subsides, hot applications are used and finally
counter irritants are employed. Their selection is a matter of
choice with the practitioner. The object sought is the same
with every practitioner and while methods employed vary, re-
LAMENESS IN THE FORE LEG 155
suits are not markedly different except in so far as the degree
of counter irritation which is produced varies in given cases.
Where a great degree of counter irritation is thought necessary,
line-firing with the actual cautery is the remedy par excellence.
After-care.— In the course of three or four weeks subjects
may be allowed the run of a paddock and, after a complete rest
of six weeks at pasture, they may be returned to w^ork with care,
if the work is not of a nature to occasion concussion or other
manner of irritation to the articulation.
Neurectomy is not indicated even though there is a recurrence
of lameness, unless the lameness is not pronounced and inflamma-
tion is periarticular and no osseous enlargements mechanically
interfere with function of the joint. There are few cases then,
where neurectomy is materially helpful.
Ossification of the Cartilages of the Third Phalanx.
(Ossification of the Lateral Cartilages.)
Anatomy and Function of the Cartilages. — Surmounting each
wing of the distal phalanx (os pedis) is the irregularly-quad-
rangular cartilage. The superior border of this cartilage is thin,
generally convex, and perforated for vessels to pass to the frog ;
the inferior border is attached to the wing of the third phalanx
and posteriorly, it is reflected inward and is continuous with
the inferior surface of the sensitive frog. The anterior border
which is directed obliquely downward and ])ackward becomes
blended with the anterior lateral ligament of the coffin joint.
The fibrous expansion of the anterior digital extensor (extensor
pedis) is united to the anterior borders of the lateral cartilages.
According to Smith^ : These structures form an elastic wall
to the sensitive foot, and attachment to the vascular laminae;
they also admit of increase in width occurring at the posterior
part of the foot without destroying the union of the two set of
leaves. Further, by their connection with the vascular system
of the foot, their elastic movements materially assist the circu-
lation. The primary use of the lateral cartilages is to render
the internal foot elastic, and admit of its change in shape which
occurs under the influence of the weight of the body. The
^Manual of Veterinary Physiology, by Major-General F. Smith, C. B.,
C. M. G., page 678.
156
LAMENESS OF THE HORSE
alteration in the shape of the foot is brought about by pressure
on the pad, which widens and in consequence presses on the bars.
The pressure received by the pad is also transmitted to the plan-
tar cushion, which likewise flattens and spreads under pressure.
Both of these factors force the cartilages slightly outwards.
When the posterior Avail recoils the cartilages are carried back
to their original position. Should the elastic cartilage under
pathological conditions become converted into bone, its functions
are destroyed, and lameness may occur.
Etiolog-y and Occurrence.— The causes of ossification of these
cartilages are several. No doubt there exists a predisposition
to this condition for it is of such frequent occurrence in heavy
\^
/^*-
Fig. 31 — Ring!)one and .sidebone.
draft types of horses. Concussion plays an important role and,
according to Holler's^ theory, which is sound, high heel calks
prevent the frog from contacting the ground, and as weight is
placed upon the foot "the lateral cartilages are subjected to a
continuous inward and downward dragging strain."
The condition affects the cartilages of the fore feet more fre-
quently than those of the hind and the outer cartilage is more
often ossified than is the inner. This fact may be accounted for
by its more exposed position ; it is also frequently injured by
'Moller's Regional Veterinary Surgery, by Dollar, page 630.
LAMENESS IN THE FORE LEG 157
being trampled upon and otherwise contused or cut, as in lacer-
ated wounds of the quarter.
Symptomatology. — Ossification of tlie cartilages is known by
grasping the free borders with the fingers and attempting their
flexion ; the rigid inflexible ossified cartilage is thus easily recog-
nized.
Lameness during weight-bearing occurs in the majority of
cases at some time. Much depends on the conformation of the
foot and whether the involvement affects one or both cartilages
as to the degree and duration of lameness which marks this
affection. In narrow and contracted heels it is reasonable to
expect more lameness than in well formed feet. "Where only
one cartilage is ossified, the other being flexible, there is less in-
convenience experienced by the subject during weight-bearing,
because of the expansion of the heel which the one normal carti-
lage allows.
Treatment. — There is little if anything to be done in case the
cartilage ha.s become ossified except to shoe without high calks
but preferably with rubber pads. The hoof should be kept
moist; the wall at the quarter may be rasped thin and kept
anointed. Firing is of no practical benefit in these cases, and
it is doubtful if vesication is helpful excepting where only a part
of the cartilage is ossified.
Subjects which continue somewhat lame, because of complete
ossification of both cartilages, are best put to slow work on soft
ground and not driven on pavements.
Navicular Disease.
This more or less ambiguous term has been applied to various
diseases affecting the structures which make up the coffin joint.
"We consider this name to be applicable to inflammatory involve-
ment of the third sesamoid (navicular bone), the deep flexor
tendon (perforans) and the bursa podotroehlearis or navicular
bursa.
Etiology and Occurrence. — In 1804 Thomas Greaves^ wrote
on the subject of navicular disease as follows: "The opinion I
^Edinburgh Veterinary Review, Vol. VI, page 616
158 LAMENESS OF THE HORSE
entertain upon the suhjeet of navicular disease is. that in by
far the greater majority (if not all) of these cases there exists
in the animal affected a congenital tendency or predisposition,
that, generally speaking, it is the high stepper, the good goer,
that becomes the victim to this disease ; and it is a fact well at-
tested, that it as frequently develops itself in the feet with wide
frogs, bulbous heels, shallow heels, spread flattisli feet, as in the
narrow upright feet. . . . T have known foals, born from de-
fective parents, in wliicli this condition was so strongly devel-
oped, that all men would at once pronounce them affected with
navicular disease, a^'-d such lameness was permanent."
Often both fore feet are affected and this would point toward
its being a disease wherein either conformation or congenital
tendencies exists. It is rare that hind feet are involved.
There are many theories regarding the possible exciting causes
of navicular disease and, when one has carefully considered the
explanations as offered by Peters, INIoller, Branell, Schrader and
others, he may conclude that navicular disease is a non-infectu-
ous intlammatory affection of the third sesamoid (navicular)
bone, deep flexor tendon (perforans) and adjoining structures.
"Whether it originates in the flexor tendon or whether the bone
is the original part affected, the disease is freciuently met, and
of all possible causes, jars and irritation incident to concussion
of travel, are pro])ably the princij^al causative agents.
Symptomatology. — Lameness is the primary indicator and a
constant sym])t()m which attends navicular disease wherever
much structui-al change aff(M'ts the infirm ])arfs. As the degree
of intensity or extent varies, so is there a dissimilarity in the
character of the impediment. Incipient cases of bilateral in-
volvement are more difficult to diagnose than are unilateral af-
fections, particulai'ly when lameness is not marked. There is
manifested a sui)i)orting-leg-lameness which varies as to degree
in tlie same subject at different times. This may be noticed dur-
ing the same ti-ip in an animal tluit is lieing driven. There is
a tendency for the subject to stumble and, of course, where the
affection is bilateral, there is a stilted gait owing to shortened
strides.
LAMENESS IN THE FORE LEG 159
At rest the lame animal usually points with the afifected mem-
ber. Because of the fact that the distance is lessened between
the origin and insertion of the deep flexor tendon (perforans)
by this attitude, one may readily understand the reason for the
position assumed by the subject. Pressure on the navicular bone
is diminished and tension on the flexor tendon is relieved by
even slight volar fiexion.
In acute inflammatory affections abnormal heat may be de-
tected ill the region of the heel. By exerting tension on the
flexor tendon, by means of passive dorsal flexion of the member,
evidence of hyperesthesia may be detected. With the hoof test-
Fig-. 32 — "Pointing"' — the position as.sumed by horse havirg unilateral navic-
ular disease.
ers one may determine supersensitivenss in most instances. There
occurs more or less contraction of the hoof in navicular disease,
but this is not to be taken as a cause of the affection, but rather
a sequence.
In some cases of unilateral navicular disease there is a marked
contrast in size between the sound and unsound foot. HowcAcr,
one must not be misguided in this particular, for in some pairs
of sound feet there exists considerable difference in size. Finally,
by a change from the normal position of the foot to one in which
the heel .is somewhat elevated (as may be obtained by shoeing
witli big 1 heel calks), relief is evident, and in the opposite
160 LAMENESS OF THE HORSE
position, the condition is aggravated. This experiment may be
used for diagnostic purposes.
Treatment. — When the anatomy of the diseased parts is
taken into consideration, and an analysis of the lesions which
occur in cases where considerable structural change is occasioned
by this affection, it is obvious that recovery is impossible. Only
in eases where the inflammation is promptly cheeked before
damage has been done the navicular bone or the flexor tendon,
is permanent recovery possible. The disease is not frequently
treated during this stage, however, and in the majority of in-
stances the condition becomes chronic.
As soon as a diagnosis is made the shoes must be removed, the
toe shortened with the hoof pincers and rasp and the subject is
put in a well bedded box-stall. If the animal is very lame and
the inflammation is acute, ice-cold packs should be applied to
the feet. As soon as acute inflammation has subsided the foot
may be so pared that all excess of sole and frog is removed with-
out lowering the heels, and the animal may be blistered about
the coronet region. The subject may be shod later, with heel
calks that raise the heel moderately and a protracted period of
rest should be enforced.
Tn cases where no acute inflammatory condition exists, neurec-
tomy is beneficial. One must discriminate, however, between
favorable and unfavorable subjects. This is not a last resort
expedient to be employed in cnses where extensive lesions of the
navicular structures exists. With proper shoeing, and by put-
ting the subject at suitable work, where concussion of fast travel
on hard roads is not necessary, the best results are obtainable.
Laminitis.
This disease is primarily a non-infective inflammation of the
sensitive laminae which very frequently affects the front feet.
Often all four feet are affected, less frequently one foot (when
its fellow is unable to sustain weight) and rarely the hind feet
alone.
Occurrence.— Probably a greater number of cases of laminitis
occur in localities where horses that are worked on heavy trans-
LAMENESS IN THE FORE LEG 161
fer wagons are, when in a state of perspiration, allowed to stand
exposed to sudden lowering of temperature and to stand in a
cool or cold shower of rain such as occurs near the coast of the
Great Lakes or the ocean in some parts of this country.
This disease occurs in connection with digestive disorders of
various kinds and, because of the frequent association of the
two conditions, the common term "founder" has long been em-
ployed to designate laminitis. In cases of "over-loading," par-
ticularly when a large quantity of wheat has been eaten by
animals that are unaccustomed to this diet, laminitis almost con-
stantly results.
Large draughts of cold water, when drunk by animals that
are overheated is often followed by laminitis. Concussion, such
as attends hard driving, especially in unshod horses or on rough
and hard roads, is often succeeded by this affection. Likewise, as
has been stated, injury such as is occasioned by long continued
standing on the same foot is followed by laminitis. Some horses
that are frequently shod, suffer from this affection a few hours
after shoes have been reset. Dr. Chas. R. Treadway of Kansas
City reports the rather frequent occurrence of such conditions
in horses that are in the fire department service in his city.
Age in no way influences the occurrence of laminitis and the
general condition of an animal with regard to its vigor or state
of flesh has no apparent influence toward predisposiag horses to
this ailment.
Etiology and Classification. — As it is with some other dis-
eases, one may unprofitably theorize on cause and readily enu-
merate many conditions which are apparently contributory
toward producing the affection. Causes may well be grouped,
however, and a more definite understanding of laminitis is pos-
sible as a result. Such collocation would include conditions
which directly or indirectly affect the digestion, such as puer-
peral laminitis, drinking of large quantities of cold water and
exposure to cold and rain when the body is warm. All of these
various conditions might be said to affect the vaso-constrictor
nerves in such manner that the natural tendency (because of the
peculiar structure of the sensitive laminae and their mode of
162 LAMExNESS OF THE HORSE
attachment to the non-sensitive wall) which solipeds have for
this affection is indirectly due to this one cause — vaso-constric-
tion. According to Dr. D. ]\I. Campbell, the eft'ect of toxic ma-
terials, which may be absorbed from the digestive tract or the
uterus in parturient females, upon the vaso-constrictor nerves,
is such that a passive congestion of the sensitive laminae occurs
and laminitis is the result. He believes that even the chilling
of the surface of the body when very warm, by a cold rain, con-
stitutes a condition wherein the effect upon the vaso-constrictors
is the same.
This grouping does not include the effect of direct injuries of
any and all kinds to which the feet are subjected such as :
Concussion in fast road work, injuries occasioned by tight or
ill fitting shoes, contusions of any kind resulting in non-infec-
tious inflammation of the sensitive laminae, as well as the causes
which produce laminitis where weight is borne by one foot when
its fellow is out of function.
A classification which is practical is that of aciiie and chronic
laminitis. To the practicing veterinarian it is this manner
of consideration that i.s essential in the handling of these cases.
Symptomatology. — In the acute attack the condition is so
well described by Dr. R. C. Moore^ that we quote him in part as
follows :
The acute form is generally ushered in very suddenly. Often
a horse that is perfectly free from symptoms of the disease is
found a few hours later so stiff and sore that he will scarcely
move. They stand like they were riveted to the ground. If
forced to move the evidence of pain subsides to some extent after
they have gone a short distance, to return more severe than ever
after they have been allowed to stand for a short time. If the
disease is confined to the two front feet, the hind feet are placed
well under the center of the body to support the weight and
the front ones are advanced in front of a perpendicular line so
as to lessen the weight they must bear. If they are made to
move, the same position of the feet is maintained. If made to
turn in a small circle, they do so by using the hind feet as a
pivot, bringing the front parts around l)y i:>lacing as little weight
on them as possible.
Placing the hind feet so far under the body, arches the back
■< !«
^Kquine Laminitis or Pododermatitis, by R. C. Moore, D. V. S., American
Journal of Veterinary Medicine, Vol. XT, page 284.
LAMENESS IN THE FORE LEG 163
and often leads to errors in diagnosis, the condition sometimes
being taken for diseases of the loins or kidneys.
If all four feet are involved, the animal stands in the usual
position assumed in health, but if urged to move, the least effort
to do so usually brings on chronic spasms of the entire body. In
very severe cases, a slight touch of the hand will develop the
spasms. At times they are so severe, and have such short inter-
missions, that the disease has been mistaken for tetanus. How-
ever, the clonic nature of the spasm should prevent such an
error. If tli-y are lying down, it is difficult to get them to arise,
and if they do so, they show marked symptoms of pain for some
time after rising.
If the disease is confined to the hind feet, they are placed
well forward to relieve the strain on the toe caused by the down-
ward pull of the perforans (deep flexor) tendon, but in place of
the front feet ])eing kept in front of a perpendicular line, as they
are when the disease is confined to the front ones, they are placed
far back under the body, so they will carry the maximum share
of the body weight of which they are capable. The position of
the feet is of great importance and offers symptoms that should
not be overlooked.
Wlien the subject is caused to walk, symptoms of excruciating
pain are manifested in all acute cases of laminitis. In some cases
where all four feet are affected, no reasonable amount of per-
suasion will cause the suffering animal to move from its tracks.
There is acceleration of the rate of heart action; the pulse
is full and in some cases, bounding. As the affection progresses
the pulse becomes rather weak and irregular. The character of
the pulse in the region of the extremity is a reliable indicator;
but one has to learn to make necessary discrimination because
of the condition of the parts, as in some cases of lymphangitis
or where the skin is abnormally thick. The characteristic throb-
bing pulse is, however, easily recognized in most cases. Tem-
perature is variable, though usually elevated from one to four
degrees above normal. This symptom varies with the type and
stage of the affection. In a subject tliat has been down, unable
to rise for several days, where there is a suppurative and slough-
ing condition of the laminae, the temperature is high. Whereas,
in some other and less destructive cases there may be little
thermic disturbance after the first few hours have lapsed.
A constant symptom in liilateral affections of acute laminitis
164 LAMENESS OP THE HORSE
is the difficulty with which the subject supports weight with
one foot. It is this which causes the victim to stand as if
"rooted to the ground" when all four feet are involved. If one
attempts to take up one foot, thus causing the subject to stand
on the other, there is much resistance and in many eases the
animal refuses to give the foot.
When we consider that the sensitive parts of the foot are
encased by a horny, unyielding box and that, when the laminae
are congested, a great pressure is brought to bear upon the sensi-
tive structures, it is easy to understand why the condition is so
painful.
Chronic laminitis is a sequel of acute inflammation of the sensi-
tive laminae. It varies as to intensity and the exact manner
of its manifestation depends upon preexisting disturbances.
In some mild cases of laminitis there are recurrent attacks
wherein no particular structural change exists, and diagnosis
is established chiefly by noting the character of the pulse at the
bifurcation of the large metacarpal (or metatarsal) artery just
above the fetlock. The same manifestation of pain is present
when weight is supported by one foot, though in a lesser degree.
There is less local heat to be detected by palpation than in
the acute cases.
Chronic laminitis as it occurs following acute attacks which
have resulted in structural changes of the foot, present the same
symptoms just described and, in addition, the j^eculiar altera-
tions in structure exist. When, owing to acute inflammation of
the sensitive laminae, there has resulted necrosis of this sensitive
tissue together with infiltration between the anterior surface of
the distal phalanx (os pedis) and the contacting hoof, the lower
portion of the distal phalanx is turned downward and backward
(rotated upon its transverse axis). Because of the traction
which is exerted by the deep flexor tendon (perforans), as it
attaches to the solar surface of the distal phalanx, this rotation
is facilitated. With hyperplasia of lamina, at the anterior por-
tion of the distal phalanx, there results a thick "white line."
Rotation of the distal phalanx necessitates a descent of its apical
portion and there occurs a "dropped sole."
LAMENESS IN THE FORE LEG 165
In time, partly because of excessive wear of hoof at the heel,
owing to an altered condition in the normal antagonistic rela-
tion between the flexor and extensor tendons, the toe makes an
excessive growth, and the concavity of the anterior line is ac-
centuated owing to this abnormal length of hoof. The hoof,
because of recurrent inflammator}^ attacks, is corrugated — eleva-
tions of horn in parallel rings are usually present.
Aniiuals that are so affected in traveling strike the heel first
Fig. 33— The hoof in chronic laminitis. Note the concavity. This animal
was serviceable for any worlv that could be performed at a walk.
and the toe is later contacted with the ground surface. Rotation
of the distal phalanx upon its transverse axis produces a con-
dition, with respect to this peculiar impediment, that is equiva-
lent to added and excessive length of the deep flexor tendon.
Where there occurs suppuration, by careful inspection of the
coronary region, one may early recognize detachment of hoof.
In such cases animals remain recumbent and, while the condi-
tion is not so painful at this stage, the practitioner must not
overlook the real state of affairs. History, if obtainable, will
be a helpful guide in such cases. Separation of hoof occurs as
166
LAMENESS OF THE HORSE
a, rule in from four to ten days after the initial attack of acute
laminitis. Needless to say these cases are hojieless, when the
economic phase of handling subjects is considered.
Treatment. — Much depends upon the concomitant disturb-
ances (or causes if one is justified in referring to them as such)
as to the manner in which laminitis is to be treated. In all cases
where digestive disturbances exist, the prompt unloading of the
Fig. 34 — Showing the effects of laminitis. By permission, from Merillat's
"Veterinary Surgical Operations."
contents of the alimentary canal is certainly indicated. D. M.
Campbell^ in a discussion of laminitis has the following to say
regarding the treatment of such cases :
Because superpurgation may be followed by laminitis, the ad-
visa))ility of using the active hypodermic cathartics is questioned.
Neither arecolin nor eserin can cause superpurgation. The action
of the former does not continue longer than an hour after ad-
ministration and of the latter not more than eight hours. The
action of either is mild after the first few minutes.
I do not think that anyone has recommended either arecolin
or eserin where there is severe purgation. Where the intestinal
canal is fairly well emptied and its contents fluid, I should be
inclined to rely ujion intestinal antiseptics to hold in check harm-
ful bacterial growth.
^American Journal of Veterinary Medicine, Vol. XI, page .318.
LAMExNESS IN THE FORE LEG 167
Tlie use of aliiiii in the treatment of laminitis is held to be with
out reason other than the empirical one that it is beneticial. If
laminitis is due chiefly to an autointoxication, good and sufficient
reason for the administration of alum can be shown based upon
its known physiological action. It is the 2nost powerful in-
testinal astringent that I know of and has the fewest disad-
vantages. I have not noted constipation following its use nor
diarrhea, nor a stopping of peristalsis, nor indigestion, and in
any case its action lasts at most only a. few hours, and if it did
all these, it could not much matter. Quitman says, that it con-
stricts the capillaries. If this is true, a thing of which I am not
certain, is it not reasonable to suppose that as with other vaso-
constrictors, e. g., digitalis, there is a selective action on the part
of the capillaries Cnot of the drug) and those that need it most,
i. e., those of the affected feet in laminitis, are constricted most?
All body cells exert this selective action in the assimilation of
food, the tissue needing most any particular kind of food cir-
culating in the blood, gets it.
Our first consideration in laminitis should be to remove the
cause — to stop the absorption of the toxin in the intestinal tract
that is producing the condition. This we accomplish by partially
unloading it by the use of the active hypodermic cathartics and
stopping absorption by the surest and most harmless of intestinal
astringents. Whether the astonishingly prompt and certain
action of alum in this case is due wholly to its astringent action
or whether alum combines with the harmful bacterial products
chemically and forms an innocuous combination, I can only sur-
mise, and it is unimportant. At any rate, when alum is ad-
ministered, the onslaught of the disease is promptly stopped. Ir-
reparable damage may already have been done if the ease is a
neglected one, but whether administered early or late in acute
attacks, the progress of the disease is stopped immediately.
The same authority may be profitably quoted in the matter
of handling all cases wherein the revulsive effect of agents which
diminish vascular tension are chiefly indicated or necessarj^ as
adjuvants. In this connection, Campbell says :
The early and vigorous administration of aconitin in laminitis
to its full physiological effect, is more logical. Assuming that
laminitis is due to absorption of harmful products from the
intestinal tract permitted through the deranged functioning of
the organs of digestion, or assuming that it is due to an exten-
sion of the inflammation from the mucosa to the sensitive lamina,
or that it is a reflex from a sudden chilling of the skin, we have
in anv of these conditions a distui'bed <'irciilalioii. and aconitin
168 LAMENESS OF THE HORSE
is the first and foremost of circulation "equalizers." Further-
more, in laminitis there is an elevation of the temperature, an
almost invariable indication for aconitin. A speedy return of
the temperature to normal, a very marked diminution of the
pain and improved conditions generally, appear coincident with
the symptoms of full physiological effect of aconitin when given
Fig. 35 — Inferior (convex) surface of Cochran shoe.
in cases of laminitis, which constitutes assuredly an important
part of its treatment.
Where lameness is not great as in cases wherein no marked
structural change of the foot has occurred, proper shoeing is very
beneficial. By keeping the heels as low as possible and shoeing
without heel calks a more comfortable position is made possible.
Thin rubber pads which do not elevate the heel are of service in
diminishing concussion.
LAMENESS IN THE FORE LEG
169
Dr. David W. Cocb.ran of New York City has attained unusual
success in cases of chronic laminitis with dropped sole by the use
of a specially designed shoe.
Cochran claims that, not only are horses with dropped soles
that would othei'wisio have to be put off the streets enabled to do
Fig-. 36 — Superior surface, showing- concavity or bowl, as formed by the toe
and branches of the shoe, as designed by Dr. David W. Cochran.
a fair amount of work by means of this shoe, but that continually
wearing it, meanwhile keeping the convexity of the front of the
hoof rasped thin, in time brings about a marked improvement,
and that after some months or years of use the animals are able to
work with ordinary rubber-pad shoes, provided they are ar-
ranged to facilitate breaking over.
From having been successfully used on some race horses of
170 LAMENESS OF THE HORSE
high value, the Cochran shoe has attained considerable notoriety
and is being used by a number of practitioners. A disadvantage,
however, arises from the fact that few horseshoers other than
Doctor Cochran seem able to make the shoe, the peculiar shape
of which offers considerable difficulty in forging Concerning
the application of the shoe Cochran^ says :
' ' The most important primary procedure is the preparation of
the foot to receive the shoe. All excess of growth must be
removed from the anterior face of the hoof. The outer face
must be reduced at the toe (not shortened), but rasped down
thin for the lighter the top of the foot is, the more chance the
sole and coffin bone will have of resuming their former normal
position. The pressure of the wall at the toe upon the exudate
between wall and coffin bone, tends to force the coffin bone and
sole out of their normal position. Leave the sole alone. You can
lower the excess of grow^th at the heels.
"There are many designs of shoes to relieve this condition.
A great deal depends on the judgment of the shoer to meet the
conditions presented, depending on the degree of the convexity
and strength of the sole. In some cases we use a shoe that admits
of a large amount of sole room. Again, we shoe with a shoe of
wide cover. In other cases a shoe with even pressure over the
whole sole. In some cases a high, narrow shoe, resting only on
the wall, or the ordinary plain shoe with side calks welded close
to the outside edge and the shoe dished well from these as a
foundation. Then we have the air cushion pad designed after
the model of the bowl shoe."
In cases when slight and persistent lameness interferes suffi-
ciently to prevent using an animal at any sort of work on hard
roads, median neurectomy will relieve all lameness in most in-
stances. This is a safe operation, moreover, in that no bad after
effects are to be feared, even though lameness were to continue.
Calk Wounds. (Paronychia.)
Etiology and Occurrence. — Injuries of various kinds are in-
flicted upon the coronary region but usually they are due to the
foot being trampled upon. When the foot that inflicts the in-
jury happens to be unshod, a contusion of the injured member
is occasioned, Init in the majority of instances, wounds that de-
mand attention are the result of shoe calks which have pene-
'The Shoeing- of a Dropped Sole Foot by Dr. David W. Cochran. New
York City, The Horse Shoers Journal, March, 1915.
LAMENESS IN THE FORE LEG 171
trated the tissues in the region of the coronary band. Often
calk wounds are self-inflicted. When animals are excited and in
turning crowd one another, they often perform dancing move-
ments which frequently result in deep calk wounds of the coro-
net. Some horses have a habit of i;esting the heel of one hind
foot upon the anterior coronary region of the other. While
sleeping in this position, if they are suddenly awakened, the
weight is abruptly shifted to the uppermost foot and the one un-
derneath is (because of the pain attending its being wounded)
quickly drawn out from under its fellow. In this way deep cuts
may divide the coronary band and inflict extensive injury to the
sensitive lamina as well.
An infectious type of coronary inflannnation occurs in some
localities during the winter months, wherein the condition is
enzootic.
Symptomatology. — Depending upon the manner in which
the injury b.as been produced, the appearance of the wound
varies and likewise lameness is more or less pronounced. If the
tissues are not divided and the wound is chiefly of the sul)sur-
face structures, there will not immediately occur pronounced
local evidence of the existence of injury ; but as soon as the lame
animal is nuide to move, the peculiar character of the impedi-
ment (supporting-leg lameness witli the affected foot kept well
in advance of its normal position) directs attention to the ex-
tremity and all of the symptoms of acute inflanunation are dis-
covered.
Where a wound is inflicted which divides, in some manner,
the surface structures (skin, coronary band, or the hoof wall)
one's attention is at once called to the -i-xistence of the wound.
Because of the fact that there is every facility for the pro-
duction of a sub-coronary and podophylous infection, these
wounds should receive prompt attention. In some instances,
the pastern joint is opened by calk wounds and then, of course,
an infectious arthritis succeeds the injur3\
Treatment. — In all contused wounds of the coronary region
the parts need thorough cleansing; the hair, if long is clipped
and a cataplasm is applied. Or preferably, an iodin-glycerin
com])ination of one part of iodin to four parts of glycerin is
172 LAMENESS OF THE HORSE
poured on a layer of cotton, and this is confined in contact with
the inflamed parts by means of a bandage.
Where normal resistance to infection obtains, the subject usu-
ally suffers no suppurative disturbance when the surface struc-
tures are not broken; and daily applications of the antiseptic
lotion above referred to stimulates complete resolution. This
may be expected in from four to ten days depending upon the
extent of the injury.
If a calk wound has been inflicted, the adjoining surface struc-
tures are freed of hair and the parts cleansed in the usual man-
ner, (which in wounds recently inflicted, should be done without
employing quantities of water) and after painting the wound
surface with tincture of iodin and saturating its depths with the
same agent, the wound is cleansed, if it contains filth, by means
of a small curette. By using a small and sharp curette, one is
enaliled to cleanse the average wound quickly and almost pain-
lessly.
In such cases, equal parts of tincture of iodin and glycerin
are employed. The wound is filled with this preparation and a
quantity of it is poured upon a suitable piece of aseptic gauze
or cotton and this is contacted with the wound. The extremity
is carefully bandaged and this dressing is left in position for
forty-eight hours unless there occurs, in the meanwhile, evidence
of profuse suppuration — which is unusual.
One is to be guided as to the progress made by the degree
of lameness present. If little or no lameness develops, it is
reasonable to expect that infection has been checked; that the
wound is dry and redressing every second day is sufficiently fre-
quent.
Where cases progress favorably, recovery (unless infectious
arthritis results) should occur in from ten days to three weeks.
Where extensive sub-coronary fistulae result, either from lack
of prompt or proper attention, the condition is then one requir-
ing a radical operation to establish drainage and to disinfect
if possible, the suppurating tissues.
Corns.
Etiolog'y and Occurrence. — In horses, because of a tendency
toward contraction of the heel in some subjects, together with
LAMENESS IN THE FORE LEG 173
work on hard roads and pavements, where the feet become dry
and brittle, and because of neglect of the matter of shoeing,
this affection is of frequent occurrence. Unshod horses are rarely
affected. If conformation is faulty and too much weight is
borne on the inner or the outer quarter, and the hoof wall at
the quarter tends to turn inward, corns are usually present.
They occur more frequently on the inner quarters of the front
feet, though the outer quarters are occasionally also affected and
in rare instances corns are found at the toes. They do not often
affect the hind feet.
As soon as injury by pressure, such as is supposed to cause
the formation of corns, is brought to bear on the sensitive sole,
an extravasation of blood occurs. In time when the cause re-
mains active, this discoloration is evident in the substance of the
insensitive sole and consists in a red or yellowish spot which
varies in size — this is ordinarily termed dry corn.
In some cases where infection of this extravasation of blood
and serum occurs, instead of desiccation and discoloration of the
insensitive parts, there is, in time, manifested a circumscribed
area of destruction of the insensitive sole and the abscess may,
where no provision for drainage exists, burrow between sensitive
and insensitive laminae and perforate the tissues at the coronet.
If the suppurative material discharges readily by way of the
sole, no disturbance of the heel or quarters occurs above the
hoof.
Symptomatolog-y. — A supporting-leg-lameness characterizes
this condition; and this lameness in most instances varies in de-
gree with the amount of distress which is occasioned hj pressure
upon the inflamed parts. By an examination of the sole after
having removed all dirt, and exposed the horny sole to view,
no difficulty is encountered in locating the cause of the trouble.
Treatment. — Before suppuration has taken place and in tlie
cases where suppuration does not occur, the horse-shoer's method
of paring out the diseased tissue affords a means of temporary
relief; but unless frequently done, in many cases, lameness re-
sults within about three weeks after such treatment has been
given. In other instances temporary relief is not to be gotten
174 LAMENESS OP THE HORSE
in this manner for any great length of time or until a more
rational mode of treatment becomes necessary so that the sub-
ject may experience a cessation of the inconvenience or distress.
The general plan which meets with the approval of most prac-
titioners consists in careful leveling of the foot and removing
enough of the wall and sole at the quarters to make possible frog
pressure by means of a bar shoe. With frog pressure, expansion
of the heel follows in time, and permanent relief is obtainnble
in this manner. Thinning the wall of the quarter is advocated
by many jn-aetitioners and is undoubtedly beneficial in chronic
cases where marked contraction has taken place. The wall must
be thinned with a rasp until it is readily flexible by compressing
with the thumbs.
There are instances, however, where corns and contraction of
the heel have existed so long that they do not yield to treat-
ment. Such cases are found in old light-harness or saddle-horses
that have been more or less lame for years and where there exists
marked contraction of the heels, rough hoof walls, and hard and
atrophied frogs.
Suppurating corns require surgical attention in the way of
removal of the purulent necrotic mass and making provision
for drainage. Dry dressings, such as equal parts of zinc sulphate
and boric acid, may be employed to pack the cavity. After the
infectious condition has been controlled, and the wound is dry,
the same plan of treatment is indicated that is em{)loyed in the
non-suppurating corn. Ample time is allowed, however, for the
surgically invaded tissues to granulate and, if the subject is to
be put in service, a leather pad, under which there has been
packed oakum and tar. affords good protection.
Quittor.
This name is enqdoyed to designate an infectious inflamnui-
tion of the lateral cartilage and adjoining structures. The
disease is characterized by a slowly progressive necrosis and by
a destruction of moi'e or less of the cartilage and by the presence
of fistulous tracts.
Etiology and Occurrence. — The disease is due to the intro-
duction of pus {)roducing organisms into the subcoronary region
LAMENESS IN THE FORE LEG 175
of the foot under eomlitions whieh favor the retention of such
eontaii'iuni and extension of infection into contiguous tissues.
jMorbitie material is introduced into the region of the lateral
cartilage by means of calk wounds and other penetrant injuries
of the foot. A sub-coronary abscess which, I)ecause of lack of
proper care or because of virulency of the contagium or low
vitality of the subject, is finite apt to result in cartilaginous
affection and its perforation by necrosis follows.
Symptomatology. — Quittor is readily diagnosed on sight in
many instances. AVhere there is depentlable history or other
evidence of the chronicity of an infectious inflammation of the
kind, quittor is easily identified. If no positive evidence of
the disease exists, by means of careful exploration of sinuses
with the probe, one nuiy distinguish between true cartilaginous
quittor and superficial abscess formation that is often accom-
panied by hyperplasia.
Lameness depends upon the extent of the involvement as it
affects the structures contiguous to the cartilage. A variable
degree of lameness is manifested in diff'M-ent cases.
Treatment. — Two general plans of handling this disease are
in vogue. One. the more popular method, consists in the in-
jection of caustic solutions of various kinds into the fistulous
openings with the object of causing sloughing of necrotic tissue
and the stimulation of healthy granulation of such wounds.
The other mode consists in either complete surgical removal of
the cartilage or its remaining j^ortions, or removal of the dis-
eased parts of curettage.
When quittor has not extensively damaged the foot and the
lateral cartilage is not i)artly ossified as it is in some old chronic
cases, the complete removal of the lateral cartilage by means of
the Bayer operation or a modification thereof is indicated. A
complete description of the Bayer operation as well as Merillat's
operation for this disease (the latter consisting in part, in the
removal of diseased cartilage with the curette) are given in
Volume three of ^NFerillat's "Veterinary Surgical Operations."
Treatment by injection of caustic solutions has many advocates
and because of the fact that, in many instances the condition is
176 LAMENESS OF THE HORSE
such that they are not desirable surgical eases and also because
some animals may be put in service before treatment is com-
pleted, the injection method is popular.
The mode of treatment advocated by Joseph Hughes, M. R.
C. V. S., constitutes a very successful manner of handling quit-
tor and we can do no better than quote Dr. J. T. Seeley^ on his
manner of using this particular treatment.
Fig. 37 — Hyperplasia of riglit fore foot, due to chronic quittor.
Preparation. — First remove the shoe, have the foot pared
very thin and balanced as nicely as possible. IMoreover, all loose
fragments of horn must be detached and all crevices cleaned
thoroughly.
Next, have the leg brushed and hair clipped from the knee
or hock to the foot and scrubbed with ethereal soap and warm
water, after which the foot must be scrubl^ed in like manner.
The foot is then placed in a bichlorid ])ath several hours daily,
'Quitter and Its Treatment by the Hughes Method, J. T. Seeley, M. D. C,
Seattle, Washington, Chicago Veterinary College Quarterly Bulletin, Vol. 9,
page 27.
LAMENESS IN THE FORE LEG .177
for from two to five days, depending upon wliether or not sore-
ness is shown. The bichlorid solution is 1 to 1,000 strength.
On removing the horse from the bath a liberal layer of gauze
is soaked in 1 to 1,000 bichlorid solution and placed so as to cover
the entire foot. On discontinuing the bath, cover the foot with
gauze saturated with a 1 to 1,000 bichlorid solution. This is to
be covered with absorbent cotton and a gauze bandage, and over
A» ^
Fig. 38 — Chronic quittor, left hind foot. Showing position assumed because
of painfulness of the affection.
all is placed an oil cloth or silk covering. This pack is kept moist
with bichloride solution for forty-eight hours. The foot is then
ready for injection.
Preparation of the Injection Fluids. — Have on hand a pint
of a one per cent aqueous solution of formaldehyd made under
cleanly conditions, even to a clean bottle and cork, and a clean
container when ready to use the liquid. Prepare also a bichlorid
of mercury solution as follows : Ilydrarg. Chlor. Corros. oIV ;
Acid Hydrochlor. olss. ; Aqua Bulliens, Oij. This should be
178 LAMENESS OF THE HORSE
tiiorouglily triturated, and then filtered into a clean liottle, when
it is ready for use.
Injection. — The patient should be laid on a table, if one is
available, or east, and the foot securely fixed. Then, with an
ordinary one-ounce hard rubber syringe. v,ith a good plunger
(tried first to note Avhether or not any fiuid works around be-
tween the barrel and the plunger), introduce one syringe full
of the formaldehyd solution, then thoroughly probe the quittor
to determine the number of sinuses. This done, inject each
sinus. If two sinuses open on the surface, close one -vith cotton-
while filling" the other so that if there is a connection the solu-
tion will come in contact with all tissues involved. Irrigate with
the full pint of formaldehyd solution first, then follow with six
or eight ounces of the bichlorid solution. Never probe the foot
nor allow it to be tampered with except in the manner pre-
scribed.
After-Treatment. — Put on a pack saturated with a solu-
tion of ])ichlorid of mercurj'^ 1 to 1,000 and let it remain two
days. Remove pack, and once daily afterwards wipe off with
cotton the secretion which accumulates on the outside, and ap-
ply a dry dressing or healing oil composed of phenol, camphor
gum and olive oil.
When Dangerous to Inject. — Never inject a ciuittor in the
acute stage. Never inject a (|uittor if considerable lameness is
present. On injecting a solution of formalin, hold cotton tightly
around the nozzle of the syringe, when the plunger is down,
then withdraw the syringe gently and note particularly if the
fluid returns through the opening; if none returns cease opera-
tions at once, as it is dangerous to proceed farther, it indicates
that the sinus is not well defined and the fluid retained will
cause much trou1)le and often the death of the patient.
Experience has taught that, if extensive destructive changes
of the foot exist, the Bayer operation is not indicated. In the
country, where quittors are not so frequently met as in ur'-an
practice, the ]\Ierillat operation is preferable in all cases. How-
ever, the cost of the protracted period of idleness, which con-
valescent surgical patients require, renders the Hughes method
more satisfactory in the hands of the general practitioner, espe-
cially in the city.
Nail Punctures.
Nail punctures, as herein considered, embrace all penetrant
wounds of the solar surface of the horse's foot due to trampling
LAMENESS IN THE FORE LEG 179
upou street nails. This does not include accidental nail pricks
occasioned in shoeing. In city practice, in some stables, these
cases are of frequent occurrence ; and, generally speaking, nail
punctures are observed more frequently in urban horses than
in animals that are kept in the country.
Occurrence and Method of Examination. — This condition,
then, is a rather conniion cause of lameness and in no case,
where cause of the claudication is not obvious, is the practitioner
Fig. 39 — Skiagraph of foot. The X-ray offers very limited possibilities in
the diagnosis of lameness. The location of a "gravel" or a nail that had
worked its way some distance from the surface, or of an abscess of some
proportion, deep in the tissues, might be facilitated under some circumstances
by the aid of the X-ray. Its use in the detention of fractures is very limited,
owing to the difficulty encountered in getting a view from the right position —
many trials being necessary in most cases. The case shown above was diag-
nosed clinically as incipient ringbone. The X-ray revealed no lesions. (Photo
by L. Griessmann.)
warranted in concluding his examination without careful search
for the possible existence of nail punct'ire of the solar surface
of the foot.
In occasional instances there co-exists an obvious cause for
supporting-leg-lameness and an occult cause — a nail puncture.
Where such complications ai'o met, the practitioner is not neces-
sarily guilty of neglect or carch^ssnoss when the nail puncture
180 LAMENESS OF THE HORSE
is not discovered at once, nevertheless, an examination is not
complete until practically every possible cause of lameness has
been located or excluded in any given case.
In a search for nail puncture it is necessary to expose to view
every portion of the sole and frog in such manner that the
existence of the smallest possible wound will be revealed. This
necessitates removal of the shoe, if, after a preliminary ex-
amination, a puncture is not found, when there is good reason
to suspect its presence. However, where it is readily possible
to locate and care for a wound without removal of the shoe,
allowing the shoe to remain materially facilitates retaining
dressings in position and relieves the solar surface of contact
with the ground. If extensive injury or infection exists, it is
of course necessary to remove the shoe and leave it off. By re-
moving a superficial portion of all of the sole and frog, thus
carefully and completely exposing to view all parts of the solar
surface of the foot, and with the aid of hoof-testers one is enabled
to positively determine the existence of nail punctures. Because
of the tendency of puncture wounds of the foot to close, and
since the superficial portion of the solar structures are usually
soiled, it is absolutely necessary to conduct examinations of this
kind in a thorough manner.
Symtomatology. — Not all cases of nail puncture cause lame-
ness during the course of the disturbance and in many instances
no lameness is manifested for some time after the injury has
been inflicted — not until infection has been the means of caus-
ing consideral)le inflammation of sensitive structures. Never-
theless, this lack of manifestation occurs only in cases where
serious injury has not taken place and the degree of lameness
is a constant and reliable indicator of the character and extent
of nail punctures within twenty-four hours after injury has been
inflicted.
The position assumed by the affected animal inconstantly
varies with the location and nature of the injury and is not
of particular importance in establishing a diagnosis. The sub-
ject may support some Aveight with the affected member and
stand "base-wide" or "base-narrow," or no weight may be
])orne with the foot or the animal may point or keep the ex-
LAMENESS IN THE FORE LEG 181
tremity in a state of volar flexion. In cases where extensive
injury has been inflicted, and great pain exists, the foot is kept
off the ground niiieh of the time and it may be swung back and
forth as in all painful affections of the extremity.
Nail punctures cause typical supporting-leg-lameness and in
some cases certain peculiarities of locomotory impediment are
worthy of notice. Punctures of the region of the heel, which
directly affect or involve the deep tendon sheath, cause a type
of lameness wherein pain is augmented, when dorsal flexion of
the extremity occurs as well as when weight is borne. Wounds
in the region of the toe of the hind feet sometimes cause the
subject to carry the extremity considerably in advance of the
point where it is planted and, just before placing the foot on the
ground, it is carried backward a little way — ten or twelve inches.
However, diagnosis of nail puncture is l)ased on the finding of
the characteristic wound or resultant local changes.
Course and Prognosis. — The nature of the progress and the
manner of termination of these cases are variable. If the coffin
joint has been invaded, and a septic arthritis exists, the condi-
tion is at once grave. An open and infected tendon sheath,
while not so serious, constitutes a condition which is distressing,
and recovery is slow even under the most favorable conditions.
Where a heavy, rigid and sharp nail enters the foot, in such
manner that fracture of the third phalanx (os pedis) occurs,
this complication makes for a protraction of the condition. Ex-
perience teaches that tlie natural course and termination in
these cases are modified by the location and depth of the injury,
virulency of the contagium and resistance of the subject to such
infection.
Prevention. — In all horses w^liich are kept at such work that
exposure to nail punctures is frequent, a practical means of pre-
vention of such injuries consists in ^e employment of heavy
sole leather or suitable sheet metal to cover the sole of the foot
and, at the same time, confine oakum and tar in contact with
the solar surface to prevent the introduction of foreign material
between the foot and such protecting appliances. Further, if
drivers and owners could be impressed with the serious complica-
tions which so frequently attend wounds of this kind, undoubt-
182 LAMENESS OF THE HORSE
edly many cases which are now lost, because of ignorance or
neglect on the part of the teamsters or proprietors of horses,
would lie saved by i)ronipt and rational treatment.
Treatment. — The treatment of this condition falls so largely
within the dominion of surgery that we can give little more
than an outline here.
In cases where there exists no evidence of open joint or open
tendon sheath as judged by the site of the puncture and degree
of lameness present (after having thoroughly cleansed the solar
surface of the foot and enlarged the opening in the nonsensitive
sole) a little phenol is introduced into the wound. In such
cases, where it is possible for the antiseptic to contact every part
of wound surface to the extreme depths of the puncture, in-
fection is prevented when such treatment is promptly admin-
istered. This may be considered as first aid, or emergency care,
and is indicated in all wounds of the foot whether the injury
be serious or almost insignificant.
Subsequently one of two general courses may be pursued in
the treatment of cases of nail puncture. One, by the employ-
ment of means to keep the wound patent and injection of suit-
able antiseptics, or agents that are more or less caustic in con-
junction with strict observance of asepsis and wound protection.
The other method consists in prompt estal)lishment of drainage
by surgical means and includes exploration and curettage.
The first method is better adapted to the use of the average
general practitioner and he would do well to keep the opening
in the nonsensitive structures patent. By introducing equal
parts of tincture of iodin and glycerin daily, good results will
follow in most instances. The wound is protected in unshod
horses, either by completely bandaging the foot and retaining,
in contact with the wound, cotton that is saturated with iodin
and glycerin, or, if a minor injury exists, the moderately en-
larged opening in the nonsensitive sole or frog, which has been
moistened with the antiseptic, is packed with a very small quan-
tity of cotton. A little practice in this mode of closing benign
puncture wounds will enable tlie practitioner to successfully
protect the sensitive parts in the treatment of such cases in un-
shod countrv horses.
LAMENESS IN THE PORE LEG 183
When the condition progresses favorably the wound may be
dressed every second day or twice weekly, and in the course of
from two to six weeks recovery should be complete.
If the practitioner is somewhat proficient as a surgeon, and
has at his command facilities for doing surgery, the second
method is preferable in many cases. By using a local anesthetic
on the plantar nerves and confining the subject on an operating
table, restraint should be perfect. The solar surface of the foot
is first thoroughly cleansed, the puncture wound is enlarged in
the nonsensitive structures and the parts are then moistened
with phenol or other suitable antiseptics. By means of a small
probe the puncture is explored and, depending on the character
of the wound and the structures involved, surgical intervention
is varied to suit the case. If necessary, all of the insensitive
frog is removed, and in wounds aifecting the region of the heel
the tissues may be incised from the puncture outward dividing
all of the tissues outward and backward to the surface. A
suitable surgical dressing is then applied.
If, on the other hand, the puncture extends into the navicular
bursa, the radical operation is perhaps indicated, though not
until one is sure that infection of the bursa and seiious conse-
quences are to follow if this operation is not performed. De-
tailed description of the technic of this operation belongs to the
realm of surgery and a good discussion of it is to he found in
William's work on vetprinary surgical and obstetrical opera-
tions.
One may sunnnarize the discussion of treatment of nail punc-
ture by saying that emergency care as herein described is of first
consideration. In every ease an immunizing dose of anti-tetanic
serum should be given. Subsequently, the method emj-loyed
must suit the character of the wound, existing facilities for
handling the su])ject and the skill and ajititude of the prac-
titioner.
SECTION IV.
LAMENESS IN THE HIND LEG.
Anatomo-Physiological Consideration of the Pelvic Limbs.
The pelvic bones as a whole constitute the analogue of the
scapulae with respect to their function as a part of the mechan-
ism of locomotive and supportive apparatus of the horse. The
manner of attachment or connection between the ilia and the
trunk is materially different from that of the scapulae, how-
ever, and the angles as formed by the long axes of the ilia in
relation to the spinal column are maintained by two functionally
antagonistic structures — the sacrosciatic ligaments, and the a1j-
dominal muscles by means of the prepubian tendon. The sacro-
iliac articulations are such that a very limited amount of move-
ment is possible; free movement, however, is unnecessary be-
cause of the enarthrodial (ball and socket) femeropelvic joint.
The various muscles which exert their effect upon the pelvis
in changing their relationship between the long axes of the ilia
and spinal column, are concerned but little more in propulsion
and weight bearing than are the pectoral muscles. A general
treatise on the subject of lameness does not properly include
such structures any more than it does the various affections of
the dorsal, lumbar and sacral vertebrae or inflammation of the
abdominal parietes. Involvement of such parts cause manifesta-
tions of lameness but the matter of establishing a diagnosis is
difficult in many instances and in some cases impossible.
The femeropelvic articulation is formed by the hemispherical
head of the femur and the acetabulum ; the latter constituting a
cotyloid cavity which is deepened by the cotyloid ligament.
The round ligament (ligamentum teres) is the principal bind-
ing structure of the hip joint and it arises in a notch in the
head of the femur and is attached in the subpubic groove close
to the acetabular notch. Another ligament, peculiar to Equidae
— the accessory (pubiofemoral) — is attached to the head of the
femur near the round ligament and passes through the cotyloid
185
186
LAMENESS OF THE HORSE
Tendon of
gastrocnemius
Superficial
flexor tendon
— Tuber calcis
Subcutaneous
Tendon of per- 1-
oneus tertiuts I
Tibial tarsal bon
Medial ^endon of
tibialis anterior
thickening
Tarsal sheath
Superficial flexor
tendon
igament
11 i_^ -iuperjiciai jie.
t I / tendon
j I / _ Annular ligament
Joint canty
Dorsal ligament Vv Vi
Central tarsal bont
Third tarsal bone
Ml. Ill
Joint capsule (tarso-
metatarsal ligament)
Fourth tarsal
Perforating tarsal vein
Check ligament
Suspensory ligament
Fig. 40 — Sagital section of right hock. The section passes through the
middle of the groove of the trochlea of the tibial tarsal bone. 1 and 2. Prox-
imal ends of cavity of hock joint. 3. Thick part of joint capsule over which
deep flexor tendon pla.vs. 4. Fibular tarsal I)one (sustentaculum). A large
vein crosses the upjjer part of the joint capsule (in front of 1). (From Sis-
son's "Anatomy of the Domestic Animals.")
LAMENESS IN THE HIND LEG
187
Lateral ridge of trochlea of femur
Lateral femoro-tihial ligament
Lateral meniscu
Lateral condyle of tib,
Long extensor (stump)
Peroneus terti.iis
Tibialis anterior
Lateral extensor
Extensor hrevi.
Teruion of lateral extensor
Tendon of long extensor
Tendinous looj j \ - #v J fW
Medial ridge of trochlea of femur
Medial meniscus
Medial femoro-tibial ligament
Tendon of long extensor
Annular ligament
Peroneus tertius
Medial tendon of tibialis anterior
Anterior tendon of tibialis anterior
A nterior tendon of peroneus tertius
Annular ligament
Ml. in
Fig. 41- :\Ius(les of right leg; fioiit view. The greater part of the long
extensor has been removed. 1, 2. 3. Stumps of patellar ligaments. 4
Tuberosity of tibia. (From Sis.son's "Anatomy of the Domestic AnimaLs.")
188 LAMENESS OP THE HORSE
notch and along the under side of tlje pubis. It is inserted or
blends with the prepubic tendon. This ligament prevents ex-
treme abduction of the leg. The joint capsule encompasses the
articulation and is attached to the brim of the acetabulum and
the edge of the head of the femur.
The stifle joint is analagous to the knee joint of man and is
to be considered an atypical ginglymus (hinge) articulation
formed by the femur, tibia and patella. The ligaments are
femerotibial, femeropatellar and capsular.
In addition to the usual provision for articulation of bones
there are situated cartilaginous menisci between the condyles
of the femur and the head of the tibia. These discs surround
the tibial spine and are otherwise shaped to fit perfectly between
the articular portions of the femur and tibia.
Collateral ligaments (internal and external lateral) pass from
the distal end of the femur to the proximal portion of the tibia.
The mesial (internal) arises from the internal condyle of the
femur and is attached to a rough area below the margin of the
medial (internal) condyle of the tibia. The lateral (external),
shorter and thicker, arises from the depression on the lateral
epicondyle and inserts to the head of the fibula.
The crucial or interosseus, anterior and posterior, are situ-
ated between the femur and tibia, and according to Smith,^
the crucial ligaments are necessary to properly join the two
bones, because of the character of the structure of the articular
ends of the femur and tibia.
The femeropatella ligaments are two thin bands which re-
inforce the capsular ligament. They arise from the lateral
aspects of the femur, just above the condyles and are inserted
to the corresponding surfaces of the patella
The patellar ligaments are three strong bands which arise
from the antero-inferior surface of the patella, and are inserted
to the anterior aspect of the tuberosity of the tibia.
Taken as a whole, the tarsal bones, interarticulating and articu-
lating with the tibia and metatarsal bones form the hock joint
and this articulation is analagous to the carpus. As with the
carpus, there is less movement in the inferior portion of the
^Manual of Veterinary Physiology. Page 610.
LAMENESS IN THE HIND LEG
189
PaUlla
Crest oj tibia
Long digital extensor
Lateral digital extensor
Gastrocnemius, lateral head
Sok'us
Tendori of gasiroaiemius
Tarsal icndnn of biceps femcris
Deep f.:xor
Superficial
flexor tendon
Proximal anmdar ligament
Lateral malleolus
Distal annular ligament -
Tendon of long extensor ■ |/ | j
Tendon of lateral extensor t-/
Branch of suspensory lignm(nt to
extensor tendon
Superficial flexor
tendon
Deep flexor tendon
Suspensory
ligament
Fig. 42— Muscles of lower part of thigh, leg and foot; lateral view, o'.
Fascia lata; q, q', q", biceps femoris; r, semitendinosus; 21', lateral condyle
of tibia. The extensor brevis is visible in the angle between the long and
lateral extensor tendons. (After Ellenberger-Baum, Anat. fiir Ktinstler.)
(From Sisson's "Anatomy of the Domestic Animals.")
190
LAMENESS OF THE HORSE
joint than in the superior part of the articulation. The chief
articulating parts are the tibia with the tibial tarsal bone (astra-
gulus).
The capsular ligament is attached around the margin of the
articular surfaces of the tibia, to the tarsal bones, the collateral
Pioximal Liid of
Jimoro-ixUelldr
ca/JbuU
Lateral head of gaslroctumius
Lateral feynoro-paleUar ligament
Attachment of joint capsule
Lateral condyle of femur
Lateral femoro-tibial ligament
Poplileus
Deep digital flexor
Base of patella
Distal end of capsule
Middle patellar ligameiU,
Medial patellar ligament
Lateral patellar ligament
{slump)
Tuberosity of tibia
Tibialis anterior
Long extensor
Laterid rxirnsor
Fig. 43 — Right stifle joint; lateral view. Tlie femoro-patellar capsule was
filled with plaster-of-Paris and then removed after the cast was set. The
femoro-tibial capsule and most of the lateral patellar ligament are removed.
M. Lateral meniscus. (From Sisson's "Anatomy of the Domestic Animals.")
ligaments (internal and external lateral) and to the metatarsus.
The common ligaments of the tarsal joint are the collateral,
the plantar (calcaneo-metatarsal and c. cuboid) and dorsal liga-
ments (oblique).
The medial (internal lateral) ligament serves to join the
medial (internal) tibial malleolus with tibial tarsal (astragulus)
and other tarsal bones.
(LAMENESS IN THE HIND LEG
191
The lateral (external lateral) ligament is inserted to the lateral
(external) tibial malleolus and its distal portions are attached
to the tibial tarsal (astragalus), til)ular tarsal (calcaneum) bone,
fourth tarsal (cuboid) and metatarsus bones.
Base of pnklla
Acccusari/ r:irlili<ie
Medial condyle of
femur
Medial femorn-tibial
ligament
Medial meniscua
Medial condyle of
tibia
5' ' Mcdud ridge of Irovldea
I
Medial patellar ligor-
inenl
Middle patellar ligor
merU
T)d>erosily of tibia
Fig. 44— Left stifle joint; medial view. The capsules are removed. (From
Sisson's "Anatomy of the Domestic Animals.")
The plantar ligament (calcaneo-cuboid) is a strong fiat band
which is attached to the plantar surface of the fibular and fourth
tarsal bones (calcaneum and cuboid) and the head of the lateral
mctalarsal (external small) bone.
The dorsal (oblique) ligament is attached al)ove to the distal
tuberosity on the inner side of the tibia. It is inserted below to
the central (cuneiform magninii) and third (e. medium) tarsal
lyz LAMENESS OF THE HORSE
hones, to the proximal ends of the large and outer small meta-
tarsal bones.
The tarsus is a true hinge joint and because of the great
stram which it sustains, is su])ject to frequent injury. About
seventy-fiye percent of cases of lameness affecting the hind leg
may be said to arise from disease of the hock.
As members of locomotion the legs receive strains of two kinds :
those of concussion and weight-bearing and strains of propul-
sion ; the latter are the greater. In the horse as a work animal,
the hind legs are probably subjected to greater strains than are
the front but the manner of construction of the various parts
of the pelvic limbs with the possible exception (according to
some authorities) of the tibial tarsal joint, offsets this condition.
The femur may be considered analagous to the humerus in
that it bears a similar relationship to the ilium, that exist be-
tween the humerus and scapula. Further flexion during repose
is prevented chiefly by the gluteus medius (maximus) muscle
and its tendons. The larger tendon inserts to the suuniiit of the
trochanter major of the fennir and corresponds to the biceps
brachii in the action of the latter on the seapulohuuieral joint,
except that the gluteus medius, in attnching to the femoral
trochanter, exerts its effect as a lever of the first class. Because
of the relationship between the long axes of the femur and iliac
shaft it is evident that the angle formed by these two bones
is maintained chiefly by the gluteus muscles during weight bear-
ing. Contraction of muscular fibers of the gluteus medius causes
extension of the femur and muscular strain is prevented to a
great degree by the inelastic portion of this muscle. The chief
physiological antagonistics of the glutei are the quadriceps
femoris and tensor fascia lata.
While the leg is supporting weight the stifle joint is fixed in
position mainly by the quadriceps femoris group of muscles
which are attached to the patella. Tendinous fibres intersect
this muscular mass and relieve muscular sti'ain during weight
bearing. Because of the manner in which the patella function-
ates with the trochlea of the femur, comparatively little energy
is required to prevent further flexion of the stifle joints The
OLAMENESS IN THE HIND LEG
193
patella, according to Strangeways, may be considered a sesamoid
bone.
The quadriceps group of muscles is assisted by the anterior
digital extensor (extensor pedis) peroneus tertius and tibialis
Fema
Accessory cartilage of .
patella [
Medial ridge of trochlea
Medial patellar ligament
Medial epicondyle
Medial femoro-lihial ■ i.
ligament |.
Medial mentbcw -'-^
edial ment^cw —^ — \
ondiile of tibia — ET" i
Medial condyle of
Tuberosity of 'Ma
~ Patella
Biceps femoris
- Lateral patellar ligament
Lateral femoro-libial
ligament
Lateral meniscus
Lateral condyle of tibia
Interosseous sj)ace
Fibula
Interosseous ligament
Fig. 45— Left Stifle joint; front view. The capsules are removed. 1. Middle
patellar ligament. 2. Stump of fascia lata. 3. Stump of common tendon of
extensor longus and peroneus tertius. (From Sisson's "Anatomy of Domestic
Animals.")
anticus (flexor metatarsi) muscles. The latter pair (flexor
metatarsi, muscular and tendinous portions, because of their
attachment to the external condyle of the femur and to the
metatarsal bone) are enabled to automatically flex the tarsal
joint when the stifle is flexed.
194 LAMENESS OF THE HORSE
The liock is kept fixed in position by the gastrocnemius and
the superficial digital flexor (perforatus). The latter structure,
which is chiefly tendinous, originates in tlie supracondyloid fossa
of the femur and has an insertion to the summit of the fibular
tarsal (calcis) bone. It relieves the gastrocnemius of muscular
strain during weight bearing.
Smith^ styles the function of the stifle and hock joints a re-
cijirocating action, and we quote from this authority the follow-
ing:
From Avhat has been said, it is evident that flexion and ex-
tension of stifle and hock are identical in their action. When
the stifle is extended, the hock is automatically extended, nor
can it nnder any circumstances flex without the previous flexion
of the stifle. There is no parallel to this in the body. The two
joints, though far apart, act as one, and they are locked by the
drawing up of the patella, and in no other way. The so-called
dislocation of the stifle in the horse is a misnomer. That the
patella is capable of being dislocated is beyond doubt, but the
ordinary condition described under that term, when the stifle
and hock are rigid while the foot is turned back with its wall
on the ground, is nothing more than spasm of the muscles which
keeps the patella drawn np. The moment they relax the pre-
viously immovable limb and useless foot have their function
restored as if by magic, but are immediately thrown out of gear
in the course of a few" minutes as a recurrence of the tetanus of
the petallar muscle takes place. The fascia of the thigh, like
that of the arm, is a most potent factor in giving assistance to
the constant strain imposed on the muscles of the limbs during
standing.
Below the hock the hind liml) is arranged like that of the fore,
the deei5 flexor (perforans) receiving its additional support from
the "check ligament," as in the fore leg.
The natural attitude of standing adopted by the horse is to
rest on three legs — one hind and two fore. If he is alert, he
stands on all four limbs; but if standing in the ordinary man-
ner, he always rests on one hind leg. He does not remain long
in this position witliout changing to the other. Hour by hour
he stands, shifting his weight at intervals from one to the other
hind leg, and resting its fellow by flexing the hock and standing
on the toe. He never spares his fore-limbs in this manner in a
state of health, ])ut always stands squarely on them.
1 Manual of Velerinai-y Physiology, page 601.
[LAMENESS IN THE HIND LEG 195
Hip Lameness.
Fortunately, ])ecause of the heavy miiseuhiture which goes
to form a part of the loeoniotive apparatus of the rear extremity,
hip lameness is comparatively rare. While the term is in itself
ambiguous and signifies nothing more definite than does "shoul-
der lameness," yet diagnosis of almost any condition that may
be classed under the head of "hip lameness" is not easy except in
eases where the cause is obvious, as in wounds of the musculature
and certain fractures. To the complexity which the gait of the
quadruped contributes, because of its being four-legged, there
is added the complicated manner of articulation of the bones of
the hind leg. This involves the hip in the manner of diagnostic
problems and because of the inaccessibility of certain parts,
owing to the bulk of the musculature of these parts, diagnosis
of some hip ailments becomes an intricate problem. Conse-
quently, in some instances, before one may arrive at definite
and enlightening conclusions, repeated examinations are neces-
sary as Avell as a knowledge of reliable history and recorded
observations of the subject over a considerable period.
Rheumatic atfections, when present, usually cause recurrent
attacks of lameness ; myalgia, due to subsurface injury occasioned
l)y contusion, generally produces an ephemeral disturbance ; and
while these are examples of cases where occult causes are active,
tliey are hy no means unprecedented. In cases where the cause
of lameness is not definitely located, and when by the process
of exclusion one is enabled to decide that the seat of trouble is
in the hip, a tentative diagnosis of hip lameness is always ap-
propriate.
In one instance a Shetland pony evinced a peculiar form of
intermittent lameness which affected the left hip, and repeated
examinations did not disclose the cause of the trouble. After
about a jear there was established spontaneously an opening
through the integument overlying the region of the attachment
of the psoas major (magnus"), through which pus discharged.
With the occurrence of this fistula, lameness almost entirely
disappeared, but the emission of a small amount of pus persisted
for more than a year. The subject was not observed thereafter
196 LAMENESS OF THE HORSE
and the outcome in this case is not a matter of record. Whether
there existed a psoic phlegmon due to metastatic infection or
necrosis of a part of a lumbar or dorsal vertebra is a matter for
speculation. Thus the presence of some anomalous conditions
which affect the pelvic region and cause lameness may be dis-
covered, yet both in hip and shoulder regions causes may not be
definitely located by means of practical methods of examination.
Injuries of all kinds are the more frequent causes of hip lame-
ness. In such cases, lameness may result directly and resolution
be prompt, or the claudication become aggravated in time, due
to muscular atrophy or degenerative changes affecting the hip
joint or nerves. Rheumatism or metastatic infection may be
the cause of hip lameness as well as affections of the pelvic ])ones,
lum])ar and sacral vertebrae. Hip lameness may also be pro-
voked by melanotic or other tumors.
In the diagnosis of hip lameness, one is guided in a general
way by the character of the impediment manifested. Swinging-
leg lameness is often present and the impediment is more ac-
centuated when the animal is caused to step backward. In many
cases lameness is ndxed, being about equally noticeable during
weight bearing and while the member is being swung. By ex-
clusion of causes which might affect other parts, one may defi-
nitely locate the cause of the trouble or determine that a certain
region is affected.
The sudden manifestation of lameness is indicative of injury ;
thermic disturbances may signalize metastatic infection ; history,
if dependable, is always helpful. Repeated observations, taking
into account the course which the affection assumes during a
period of a few days, often serve to afford a means of establish-
ing a diagnosis in liaffling cases.
Fractures of the Pelvic Bones.
The OS innominatum may be so fractured that the pelvic girdle
is broken, as in fracture of the iliac shaft, or in a manner that
the girdling continuity of the innominate bones is not inter-
rupted. It naturally follows that greater injury is done when
the pelvic girdle is 1)roken than when it is not, except in cases
(LAMENESS IN THE HIND LEG 197
where the acetalnilmn is involved and its hrim not completely
divided.
Etiology and Occurrence. — Pelvic fractures are usually
caused by falls or other manner of contusion. Cases are re-
ported where it would seem that fracture of the iliac angle re-
sulted from muscular contraction, but it is certain that most
fractures of this kind are due to collisions with door jambs or
similar injuries. In old horses especially, fracture of pelvic
bones occurs frequently. This form of injury is of more frequent
occurrence in animals of all ages that work on paved streets.
The country horse is not subjected to the uncertain footing of
the slippery pavement, nor to injuries which compare with those
caused by contusions sustained in falling npon asphalt or cobble-
stones.
Symjptomatology. — While in many cases of pelvic fracture
lameness or al)nornial decumbency are the salient manifestations,
yet the pathognomic symptoms are crepitation or palpable evi-
dence which may be ol)tained by rectal or vaginal examination.
In fractures of the angle of the ilium and the ischial tulierosity,
perceptible evidence always exists.
In cases where fracture of some portion of the pelvic girdle
is suspected and the subject is able to walk, crepitation is sought
by placing one hand on an external angle of the ilium and the
other on the ischial tul)erosity and the animal is then made to
walk. Or, by placing the hands as just directed, an assistant
may grasp the horse's tail and by alternately exerting traction
on the tail and pushing against the hip in such manner that
weight is shifted from one leg to the other, crepitation may be
detected.
Fracture of the pubis near its symphysis constitutes a grave
injury, as there is danger of the bladder becoming caught in the
fissure and perforation of its wall may result. Such a case is
reported by Bauman'^ wherein a three-year-old gelding bore the
history of having l)een lame for ten days. Upon rectal examina-
tion the bladder was found to be hard and tumor-like and about
the size of a baseball. The body of the ischium in this case
^Case report at meeting of the Iowa State Veterinary Medical Associatioii,
Jan., 1904, by Dr. S. H. Bauman, Birmingham, la.
198 LAMENESS OF THE HORSE
was fractured and a rent in the bladder was caused by a sharp
projecting piece of bone. Autopsy revealed, in addition to the
fracture and rent of the l)ladder wall, a large quantity of urine
in the peritoneal cavity.
In other instances hemorrhage caused death and not infre-
quently infection was responsible for a fatal issue. Moller,-
quoting Nocard, describes a case where fracture occurred through
the region of the foramen ovale and paralysis of the obturator
nerve followed.
Fractures which include the acetabular bones cause great pain.
This is manifested by marked lameness, both during weight
bearing and when the member is swung. Such cases terminate
unfavorably — complete recover}^ is impossible.
Where small portions of the angle of the ilium are broken, and
the skin is left intact, there exists the least troublesome class
of pelvic fracture. If large portions of the ilium are fractured,
considerable disturbance results. There eventually occurs more
or less displacement in such cases, if such displacement does not
take place at the time of injury. The same may be said of frac-
ture of the tuber ischii, but when these bones are fractured a
more serious condition results.
Treatment. — AVhen a case is found to be uncomplicated, that
is, if the fracture is such that recovery seems possible and after
having determined that treatment may be practicable, the first
consideration is that of confining the subject in suitable slings.
In many cases of pelvic fracture, the atfected animal will need
to be kept in slings from six weeks to three months, and it l)e-
comes a difficult problem to minimize the distress during this
long period of confinement in the peculiar manner required for
favorable outcome.
The pattern of sling employed should be the best that is ob-
tainable aud the matter of its adjustment is quite important lest
unnecessary chafing or even necrosis of skin result. Frequent
readjustment may be necessary, and time is well spent in this
manner since this contributes materially toward a favorable
termination by encouraging the subject to remain q\iiet so that
^Regional Veterinary Surgery and Operative Technique, by .Tohn A. W.
Dollar, M. R. C. V. S., F. R. S. E., M. R. I., page 733.
LAMENESS IN THE HIND LEG 199
coaptation of the broken bones may be maintained. Aside from
slings, mechanical appliances that are helpful in the treatment
of these cases are not yet in use.
A regimen that is nutritive and at the same time laxative is
essential and in some cases cathartics and enemata are necessary.
Also, during the t:rst few days, if there is retention of urine,
catheterization is imperative. In a word, the handling of such
cases consists largely in keeping the subject inactive, as com-
fortable as possible, and giving attention to suitable diet.
Simple fracture of the external iliac angle needs no particular
attention, except that the subject is kept quiet until lameness
subsides. In all cases where much of the bone is broken, the ani-
mal is blemished, but interference with function does not follow.
If infection results because of a compound fracture, loose pieces
of bone must be removed surgically and drainage provided for.
In fracture of the ischial tuberosity, infection is more apt to
result than in like injury of the ilium, and greater displacement
of bone occurs. This displacement, due to contraction of the
attached muscles, is in some instances a contributing cause to
the infection which often follows in these cases. In females
where the body of the ischium is fractured, lacerations of the
vagina may be present, and this constitutes a serious complica-
tion which usually terminates fatally.
After-care in fracture of the pelvic girdle consists principally
in allowing a protracted period of rest before subjects are i)ut
to work.
Fractures of the Femur.
Etiology and Occurrence, — This is a comparatively rare in-
jury in the horse because of the protection afforded the femur
by the heavy musculature. Fragilitas of the bone probably
exists in many cases when fracture of its diaphysis occurs. It
is generally conceded that the neck of the femur is rarely broken
because of a lack of constriction in this part, but fracture of the
trochanters has been recorded rather frequently. However,
Lienaux and Zwanenpoete^ state that fracture of the neck of
the femur is of frequent occurrence in Belgian colts. Tapley-
lAs quoted bv A. Liautard, M. 15., V. M., American Veterinary Review,
Vol. 37, page 667.
^Quoted by Prof. Liautard, American Veterinary Review, Vol. 33, page 190.
200 LAMENESS OP THE HORSE
reports in the Veterinary Jonrnal (English) fracture of the head
and internal trochanter of the femur and patellar luxation oc-
curring simultaneously affecting a mule. In this case the mule
was found decumbent on a concrete floor. After three weeks,
the subject was destroyed and autopsy revealed rupture of the
left pubiofemoral ligament, tearing with it a portion of the
articular surface of the femur. The internal trochanter was
also fractured in four small pieces. In this case it is fair to
suppose that the mule in trying to regain footing on a slippery
floor violently abducted the legs and fracture resulted. It is
Fig. 46 — Oblique fracture of the femur of a 1,500 six-year-old draft hoi'se.
Showing- shortening of bone, owing to a lateral approximation of the diaphysis
because of muscular contraction. Photo by Dr. Edward Merillat.
possible also that a temporary luxation of the patella took place
first and caused the animal to struggle in such manner that frac-
ture followed.
Symptomatology. — According to Cadiot and Almy,' "regard-
less of the location of femoral fractures, the subject is usually
intensely lame, the animal frequently w;dking on three legs —
fractures of the diaphysis are characterized by an alinormal mo-
l)ility."
As a rule, crepitation is to be recognized in fractures of the
iTraite de Thgrapeutique Chirurgical des Animaux Domestique par V. J.
Cadiot et J. Almy, Tome second, page 460.
LAMENESS IN THE HIND LEG 201
shaft of the bone, by passively moving the leg to and from the
medial plane (adduction and abduction).
Fracture of the trochanter major is signalized by local swelling
and evidence of pain; the forward stride is shortened because
this movement tenses the tendon of the gluteus major (maximus)
which is attaclicd principally to the trochanter.
Treatment.— Reduction of femoral fracture in the horse is
practically impossible, and retaining the broken bones in coapta-
tion is not possible by means of mechanical appliances. Conse-
ciuently, prognosis is unfavorable in fracture of the body of the
femur. When union of bone occurs, there results shortening of
Pig 47 — Same bone as in Fig. 46 after about six months' treatment. In this
case Dr. Merillat employed a weight to counteract muscular contraction. It
is noticeable that very little provisional callus has formed in this case, and
in spite of unusual ingenuity and good facilities for caring for the subject,
union of bone did not occur.
the leg and animals are rendered permanently lame. If the
immediate region of the head of the bone is involved as well as
in case of fracture of the condyles, an incurable arthritis ensues.
Where the trochanters are broken, chronic lameness and
muscular atrophy is the result. Therefore, it is evident that,
because of the manner of function of the femur, the leverage
afforded by its great trochanter and its heavy muscular attach-
ments, fractures of this bone in the horse do not terminate favor-
ably.
Luxation of the Femur.
Etiology and Occurrence. — Uncomplicated femoral luxation
is of less frequent occurrence in the jiorse than in the other
202 LAMENESS OF THE HORSE
domestic animals. The deep cotyloid cavity renders disarticula-
tion ditBcult and luxation does not often take place. Complica-
tions that usually occur are rupture of the round (coxofemoral)
ligament or fracture of the neck of the femur. Falls or violent
strains are necessary to produce this luxation. Goubaux is
quoted by Cadiot and Almy^ as having observed the head of the
femur in an instance wherein luxation had long existed. In this
case autopsy revealed the fact that the inner portion (two-thirds)
of the head of the femur had completely disappeared.
Luxation of the femur is observed in old emaciated animals
that are worked on slippery pavements. Occasionally, evidence
of chronic luxation of the femur is observed in the anatomical
laboratory. The chronicity of the condition is o])vious when
one notes the well formed articulation which Nature provides
for the head of the femur, where fractuie or other serious com-
plications are not present.
Symptomatology. — In every case there must exist either
restriction of movement or an evident abnormal position of the
leg, or both conditions may exist at once. Also, the leg may be
markedly shortened. IManifestation of this affection varies, de-
pending upon the character of the luxation (position of the
head of the humerus with relation to the acetabulum). Lusk^
cites a case of a mule which had suffered femoral luxation. The
animal was destroyed and on autopsy the head of the fenuir
found to be contained within a false articular cavity situated
about four inches above the acetabulum. In Dr. Lusk's case as
he states it, the following symptoms were presented: "Limb
shortened and fixed in a position of adduction. While standing
the affected limb hung directly across and in front of the oppo-
site one ; upper trochanter very prominent ; skin over hip joint
very tense. The mobility of the limb was very limited, especially
in the forward direction."
Being very prominent when there is an upward luxation and
less perceptible in downward displacement, the location of the
trochanter major is an indicator of the character of the luxation
with respect to the positicm of the head of the femur. This
iTraite de Therapeutique Chiruig-ical, Tome .second, pase ido.
=Luxation of the Femur, by AVm. V. Lusk, Veterinary Surgeon, U. S.
Cavalry, American Veterinary Review, Vol. 21, page 254.
LAMENESS IN THE HIND LEG 203
variation of position causes abnormal tenseness or looseness of
the skin over the region of the trochanter major. Rectal ex-
amination IP of aid in locating the head of the humerus.
Treatment. — AVhen it is evident that a suhjeet should 1)e
given treatment and not destroj^d, the animal must be cast and
completely anesthetized. With complete relaxation thus secured
by rotation of the limb, using the hip joint region as a pivot, re-
duction may be effected. Traction is exerted in the same direction
from the acetabulum that the head of the femur is situated and
by pressing over the joint, the displaced bone may be returned
in position. If luxation is downward, traction on the extremity
will tend to dislodge the head of the femur from the inferior
acetabular margin making reduction possilile.
The same general plan Avhieh is ordinarily employed in cor-
recting luxation is indicated here, but because of the heavy
musculature of the hip, complete anesthesia is imperative in all
such manipulations.
Gluteal Tendo-S5movitis.
The gluteus medius (g. maxinuis) muscle is inserted chiefly by
means of two tendons ; one to the summit of the trochanter major
of the femur and the other passing over the anterior part of the
convexity of the trochanter, and being attached to the crest be-
low it. The trochanter is covered with cartilage, and a bursa
(the trochanteric) is interposed between the tendon and the
cartilage.
Etiology and Occurrence. — This affection is probably caused
in most instances 1)y direct injury to the parts, such as may be
occasioned by being kicked, falling on pavement, or being struck
by the body of a heavy wagon. Strains in pulling or in slipping
are undoubtedly causative factors and in draft horses such
strains may result in involvement of this synovial apparatus.
Symptomatology. — Tf pain l)e severe and inflammation
acute, weight may not be borne with the affected member. There
is some local manifestation of the condition in acute cases.
Swelling of the tissues contiguous to the bursa is present and
204 LAMENESS OP THE HORSE
pain is evinced upon manipulation of the parts. A character-
istic gait marks inflammation of the trochanteric bursa, and as
G-unther has put it, the subject generally moves or trots as does
the dog — the sound member being carried in advance of the
affected one and the forward stride of the diseased leg is short-
ened. In some chronic cases crepitation is discernible by holding
the hand on the trochanter while the subject walks.
Treatment.— In the first stages of an acute affection abso-
lute quiet must be enforced; local antiphlogistic applications
are bencfioial. Later, vesication of a liberal area surrounding
the trochanter major is indicated. Where the condition has be-
come chronic in horses that are to be kept at heavy draft work
there is little chance for complete recovery. And, naturally,
one is not to expect resolution in cases where there exist erosion
and ossification of cartilage — where crepitation is discernible.
Paralysis of the Hind Leg.
Aside from paraplegic conditions due to disease of the cord or
the lumbosacral plexus, and monoplegic affections resultant from
disturbances of this plexus, paralysis of certain nerves are oc-
casionally encountered.
Anatomy. — The lumbosacral plexus results substantially
from the union of the ventral branches of the last three lumbar
and the first two sacral nerves, but it derives a small root from
the third lumbar nerve also. The anterior part of the plexus
lies in front of the internal iliac artery, between the lumbar
transverse processes and the psoas minor. It supplies branches
to the iliopsoas^ (designated by Girard, the iliacomuscular
nerves) . The posterior part lies partly upon and partly in the
texture of the sacrosciatic ligament. From the plexus are de-
rived the nerves of the pelvic limb (Sisson).
Paralysis of the Femoral (Crviral) Nerve.
Anatomy.— Til e femoral nerve (crural) is derived chiefly
from the fourth and fifth lumbar nerves. It runs ventrally
'Because of the intimacy of the psoas major (p. magnus) and the iliacus
they are sometimes called iliopsoas.
[LAMENESS IN THE HIND LEG 205
and backward, at first between the psoas major and minor, then
crosses the deep face of the tendon of the latter and descends
under cover of the sartorious over the terminal part of the
ilioisoas. It innervates the psoas major (magnus), psoas minor
^parvus), sartorious, rectus femoris, vastus lateralis (internus).
Branches supply the stifle and the adductor and pectineus mus-
cles.
Etiology and Occurrence. — While paralysis of the femoral
nerve, also known as "dropped stifle" occurs as a result of local
injuries and melanotic tumors in gray horses, most cases are due
to azoturia. So-called crural paralysis or "hip swinney" is oc-
casionally observed but this is not a condition wherein the nerve
is affected in the manner that characterizes the marked atrophy
of quadriceps femoris (crural) muscles in some cases of hema-
globinuria. This form of paralysis according to Hutyra and
]Marek is due primarily to diffuse degeneration of the muscles.
Symptomatology. — AVhen muscular atrophy is not extensive
no particular evidence of this condition may be manifested while
the subject is at rest, but where muscular waste has occurred,
the nature of the ailment is at once recognized. Since the fem-
oral nerve supplies the quadriceps femoris muscles, it follows
that when the psoic portion of this nerve becomes diseased, the
stifle loses its support, and in a unilateral involvement when the
subject attempts to walk on the affected member, the stifle sinks
down for want of support and the leg collapses unless weight is
caught up with the other leg. Often, following azoturia, a
bilateral affection is to be observed.
Treatment, — Horses may be restrained in the standing posi-
tion, and in the average instance, a twitch and hood are all the
restraining appliances necessary.
In cases where the disease is unilateral and atrophy is not of
too long standing, recovery is possible in vigorous subjects. All
affections, however, wherein degenerative changes involve the
nerve trunk, whether due to diffuse myositis or pressure from
malignant tumors, will not yield to treatment.
The same general plan of treatment is indicated that is de-
scribed on page 7-4 in the consideration of atrophy of the
206 LAMENESS OF THE HORSE
.scapular muscles. It is especially important to provide for the
subject to be exercised when there is atrophy of the quadriceps
muscles following azoturia.
In addition to the foregoing, good results have attended the
use of intramuscular injections of oxygon. The technie of the
operation consists in preparing the area of skin which covers
the atrophied muscles as for any operation. The hair is clipped
over five or six or more circular areas of about an inch in diame-
ter; the skin is cleansed and then painted with tincture of iodin.
A long heavy sterile needle, which is connected with an oxygen
tank by means of six feet of rubber tubing, is thrust into the
depths of the affected muscles and the gas is gently introduced
into the tissues. One needs exercise extreme care that the gas
enter slowly because great pain is produced by the sudden in-
jection of the oxygen. Likewise too nmch of the gas must not
be introduced at one place. When the oxygen is slowly intro-
duced it may be allowed to enter the tissues until the subject
gives evidence of experiencing considerable pain, or if the parts
are not particularly sensitive, a reasonable amount (enough to
cause a mild degree of diffuse inflammation) is introduced at
each one of five or six points. In large animals more points
of injection may be used.
No infection or other bad results will follow the execution of
a good technie and the treatment may be repeated every three
or four weeks until either marked regeneration of tissue is evi-
dent or the case is obviously proved hopeless.
Paralysis of the Obturator Nerve.
Anatomy. — The obturator nerve, situated at first under tlie
peritoneum, accompanies the ol)turator artery through the ob-
turator foramen and gaining tlie muscles on the internal face
of the thigh, terminates in the obturator externus, adductors,
peetineus and gracilis, also giving twigs to the obturator in-
ternus (Strange ways).
Etiology and Occurrence. — This condition occurs upon rare
occasions as tlie result of injury such as falls which cause ex-
treme abduction of the legs, or in pelvic fracture where the
ILAMENESS IN THE HIND LEG 207
nerve is directly injured, or when melanotic tumors or other
new growths compress the nerve in such manner that its function
is suspended. Paralysis of the obturator nerve or nerves is met
with rather frequently, notwithstanding', in mares, following
dystocia. The nerves (one or both) may become bruised at the
lu'im of the oliturator foramen by being caught between the pel-
vis and the body of the fetus in some cases of protracted labor.
Symptomatology. — Tn a unilateral affection there may be
little evidence of the trouble while the subject is standing; or
there is to be seen some abduction; or the affected member may
present abduction of the stifle and stand "toe outward." If
the animal is walked there will be manifested more or less abduc-
tion and the character of the impediment varies according to
the nature of the involvement.
Following protracted cases of labor in some instances where
only a unilateral paralysis exists, walking is performed with
difficulty; the subject may be unal^le to support weight witli the
affected member and is obliged to hop on the one sound hind leg.
In bilateral affections, they are iinable to rise. If the condition
is severe the sling is required to keep the subject standing, and
with this care, recovery Avill follow.
Treatment. — If new growths or callosities or similar condi-
tions affect the nerve, little, if any, hope for recovery exists. In
young and vigorous subjects where cause is not definitely known,
a course of strychnin may be given. Good nursing, providing
for the subject's comfort and allowing moderate exercise, consti-
tute rational treatment. Stimulating embrocations on the ab-
ductor muscles resorted to in cases during the incipient stage
may prove helpful.
"When paralysis of the obturator nerve occurs as a post-partum
complication, and other conditions are favorable, the subject
should be raised to its feet without unnecessary delay. If the
mare is unable to assist in regaining her feet, a sling is recpiired.
Usually little else is necessary and after a few days in the sling
the subject can get about unassisted. In the meanwhile the
well-being of the affected animal is to be considered just as in
any other case where the patient is so confined. The foal in
208 LAMENESS OF THE HORSE
siieh instances constitutes a source of some trouble, but the aver-
age mare offers no serious resistance to the confinement occa-
sioned by the sling.
Good hygienic care, a suitalile diet and full i^hysiological doses
of strychnin are indicated. Cadiot and Almy recommend vaginal
douches of cold water and counterirritation of the region of the
inner thigh in these cases.
Paralysis of the Sciatic Nerve.
Anatomy. — The great sciatic nerve leaves the pelvis in com-
pany with the gluteal nerves, through the great sciatic foramen
(notch), passing downward along the posterior face of the femur.
Near the stifle it passes between the two heads of the gastroc-
nemius muscle and continues as the tibial. Branches supply
the following muscles — ol)turat<)r, semimem])ranosus (adductor
magnus), biceps femoris (triceps abductor femoris), semitendi-
nosus (biceps rotator tibialis), lateral extensor (peroneus) and
the tibial nerve, its continuation, innervates the digital flexors.
Etiology and Occurrence. — Paralysis of the great sciatic
nerve may be caused by central disorders, injury in falling, frac-
tures and new growths. Because of its protected position, this
nerve does not often suffer injury, and paralysis of the sciatic
nerve is recorded in a few instances owing to its rarity.
Symptomatology. — When consideration is given the number
of muscles that are supplied by the sciatic nerve and the func-
tion of these muscular structures, it is obvious that the leg
cannot be used in sciatic paralysis. However, the limb is
capable of sustaining weight when it is fixed in position, but this
is done without exertion of muscular fibers which are supplied
by the great sciatic nerve. Trotting is impossilile and flexion
of the affected member is also likewise precluded. The foot is
dragged when the subject is caused to advance.
Under the heading "sciatica," Scott^ has described a case of
acute sciatic affection wherein a pacing horse manifested evidence
of great pain of a nervous character. There were muscular
iDr. John .Scott, Peoria, III., in The American Veterinary Review, Vol. 16,
page 16.
LAMENESS IN THE HIND LEG 209
twitchings and the leg was held off the floor and moved about
convulsively. Breathing was very much accelerated, pulse 85
per minute, the temperature was 103° and manipuhition of the
hips augmented the pain.
This was not a paralytic condition and recovery resulted, yet
undoubtedly this was a ease which, if not properly cared for,
might have terminated unfavora])ly.
Treatment. — Prognosis is decidedly unfavorable in paraly-
sis of the great sciatic nerve. If treatment is attempted, it is
to be conducted along the same general lines as in femoral
paralysis. Particular attention should be given to conditions
which will make for the patient's comfort, and as soon as it
is evident that the affection is not progressing favorably, the
subject should be humanely destroyed.
Iliac Thrombosis.
This condition is undoubtedly of more frequent occurrence
than we are wont to grant when one considers the comparatively
small number of cases that are actually recognized in practice.
It does not follow, however, that iliac thrombosis rarely exists.
Probably in the majority of instances there is insufficient obstruc-
tion of the lumina of vessels to provoke noticeable inconvenience.
Or, if circulation is hampered to the extent that function is
impaired and manifestations are observed by the driver, the
subject may be permitted to rest a few days and p.-^rtial resolu-
tion occurs, so that further trouble is not noticeable.
As judged by lesions of the aorta and iliac "arteries in dissect-
ing subjects, the conclusion that arteritis and resultant disorders
are of rather frequent occurrence, is logical.
Etiology. — Inflammation of the vessel walls and resultant
prolifieration of tissue together with the accmnulation of clotted
blood becoming organized, serve to obstruct the lumen of the
affected artery. The cause of arteritis is unknown in many
instances, but parasitic invasion and contiguous involvement of
vessels in some inflammatory injuries are etiological factors.
Symptomatology. — A cluiracteristic type of lameness sig-
nalizes iliac thr()ml)osis and the following l)rief abstract from a
210 LAMENESS OF THE HORSE
contribution on this subject by Drs. IMerillat^, clearly portrays
the chief symptoms :
The seizures are accompanied with profuse sudation, tremors,
Fig-. 4S — Exposure of aorta and its branches, showing location of thrombi in
numerous places. In this case (same as Fig. 49) Dr. L. A. and Dr. Edward
Merillat found the cause of the condition to be due to sclerastomiasis.
dilated nostrils, accelerated respirations and otlier symptoms of
pain and distress, all of which, together with the lameness, dis-
appear as rapidl}^ as they had developed, leaving the animal in
lAnnotation on Surgical Items, by Drs. L. A. and Edward Merillat, Ameri-
can Veterinary Review, Vol. 31, page S58.
LAMENESS IN THE HIND LEG
211
an apparently perfect state of health, ready to fall with another
attack of precisely the same kind, a.s soon as enough exercise is
forced upon it. The rectal explorations may reveal a pulseless
state of one or more of the iliac arteries and a hardness and
enlargement of the aortic quadrifurcation, but sometimes this
palpation fails to disclose any perceptihle diminution of the blood
current of these vessels. The obturation being incomplete, it
may be impossible by palpation to decide that thrombosis really
Fig. I'.t— lllu.strativf
by Dr. L. A. Merillat.
ii' Ihi' aorta, iliacs and branches. Photo
exists. In this event and, in fact, in all eases, the clinical sjanj)-
toms are sufficiently characteristic to make a diagnosis without
reservation. It cannot be mistaken for any other disease, once
properly investigated. Any given seizure may easily be mis-
taken for azoturia, at first, but a better examination soon ex-
cludes that disease.
Prognosis and Treatment. — In the majority of instances,
when there is occasioned serious inconvenience, the outcome is
not likely to be favorable, according to Moller. Detachment of
a portion of the thrombus, according to Hoare, may result in
the lodgment of an embolus in the brain or kidneys. The latter
authority also states that muscular atrophy may occur owing to
lack of blood supply in some of these cases. Moller states that
212 LAMENESS OF THE HORSE
moderate exercise or work stiini^lates the estahlishment of col-
lateral circulation, ^lassage per rectum is condemned as danger-
ous by Cadiot.
Fracture of the Patella.
Etiolog-y and Occurrence. — Patellar fractures are rarely met
with in the horse but may be caused. by falls and heavy con-
tusions. Violent muscular contraction, it is said, may also bring
al)Out the same condition.
Symptomatology. — Fracture may be transverse or vertical,
and depending on the manner in which the bone is broken, prog-
nosis is either at once rendered favorable or unfavorable. The
patella performs a function which is in a way similar to that
of the sesamoids and when fractured, complete recovery is im-
probable in the average instance. When complete, transverse
fractures permit of separation of the parts of bone. Tension on
the straight ligaments below and contraction of the quadriceps
above usually cause insuperable difficulty in the handling of this
type of fracture in the horse.
Compound fractures as well as multiple or comminuted frac-
tures occasionally occur and these constitute injuries which are
generally considered fatal, although Andrien, according to Cadiot
and Almy, succeeded in obtaining complete recovery in a case of
compound fracture of the patella and the horse was in service
and almo.st free from lameness two months after treatment was
'begun.
No difficulty is encountered in recognizing the fracture of the
patella because of the exposed position of the bone. Crepitation,
and in some cases fissures, may be easily detected.
Treatment. — In simple fracture, when treatment is thought
a(lvisal)le, the subject is put in a sling and kept as nearly com-
f()rta])le as possibk\ If little inflammation exists, the application
of a vesicant two or three weeks after the injury has been in-
flicted will be helpful and serve to. hasten repair.
Bandages or mechanical appliances are of no practical- use in
the handling of these cases.
LAMENESS IN THE HIND LEG 213
Luxation of the Patella.
Etiology and Occurrence. — This, the iwost common luxation
met with in tlie eijuine sul)ject, has been described by writers
as existing in many forms. Patellar disarticulation may be more
practically considered as momentary and fixed, regardless of the
position taken by the patella. Described under the title of false
luxation are recorded cases wherein the quadriceps (crural)
muscles become contracted in such manner that a condition sinui-
lating- true disarticulation of the patella obtains. Also, some
practictioners report cases of patellar luxation and refer to
pseudo-luxations, without clearly defining the conditions which
constitute pseudo-luxation. This has contributed to the extant
cause of misconception as to actual differences between luxation
and conditions simulating dislocation.
Luxation of the patella is a condition wherein the articular
portions of the femur and patella assume abnormal relations
whether such displacement of the patella be momentary and
capable of spontaneous reduction, or fixed and requiring cor-
rective manipulation. Spasmodic contraction of the crural mus-
cles which sometimes retains the patella in such position that
the leg is rigidly extended, does not in itself constitute luxation
of the patella; and unless this bone becomes lodged on the upper
portion of a femoral condyle or laterally displaced out of its
femoral groove, luxation cannot be said to exist in the horse.
These are sub-luxations.
Occasionally one may observe in suckling colts outward luxa-
tion of the patella wherein there is history of navel infection
and no marked evidence of rachitis is present. Some of these
cases recover. In a unilateral involvement of this kind in a
three-month-old mule colt, the author observed a case wherein
an unfavorable prognosis was given and destruction of the sub-
ject advised, because of the extreme dislocation of the patella.
This colt, however, was not destroyed and in three weeks had
apparently recovered. No treatment was given in this instance ;
the colt was allowed the run of a small pasture with its dam and
in time it matured, becoming a sound and servicea])le animal.
Classification. — Two forms of true patellar luxation in the
214 LAMENESS OF THE HORSE
horse may be considered; one wliicli is due to the patella becom-
ing fixed upon the internal trochlear rim of the femur and the
other when the patella slips over the outer rim of the trochlea.
The first form is known as upward luxation and is made pos-
sible by rupture of the mesial (internal) femeropatellar ligament.
According to Cadiot and Almy, it is only by the rupture of
this ligament — the femeropatellar — that upward luxation may
occur. This type of luxation is rarely observed and is usually
due to violent strain and abnormal extension of the stifle joint.
The second class, outward luxation, occurs in colts and is,
in many instances, congenital. This form of luxation is also
the one usually seen following debilitating diseases such as influ-
enza and pneumonia.
Vpivard luxation of the patella is characterized by the stiff-
extended position of the leg. "When the patella is situated
upon the inner trochlear rim, the tibia must be extended because
of the traction exerted by the straight ligaments. Since the
stifle and hock joints extend and flex in unison, there is presented
also an extension of the tarsus. Extension of the stifle joint
would increase the distance between the femoral origin of the
gastrocnemius and its insertion to the summit of fibular tarsal
bone (calcis) were it not for the gastrocnemius and superficial
flexor (perforatus). Extension of the hock in upward luxation
of the patella, permits of flexion of the phalanges. In upward
luxation, then, the leg is extended as if too long, but the pha-
langes may be in a state of moderate flexion. If the foot rests on
the ground when the extremity is not flexed, it is almost impossi-
ble for the subject to step backward. Because of immobilization
of the stifle and hock joints in upward luxation, the subject can
walk only by hopping on the sound leg and then the extremity
is flexed, allowing the anterior portion of the fetlock to drag on
the ground.
In some cases practitioners are called to attend young animals
that are reported to be "stifled" (often in young mules that
have made a rapid growth) and upon arrival the only noticeable
symptom of preexisting luxation is the soiled condition of the
anterior fetlock region — evidence of its having been dragged.
Such cases may be styled momentary luxation, whether they are
LAMENESS IN THE HIND LEG 215
due to a weakened condition of the patellar ligaments or spas-
modic contraction of the crural muscles.
In upward luxation, reduction is effected by attempting fur-
ther extension of the stitie joint and at the same time the patella
is pulled outward, off the internal rim of the trochlea. This is
attempted by securing the subject in a standing position; the
sound side is kept against a wall if possible and a rope is tied
to the extremity of the affected leg. Traction is exerted upon
tile rope and at the same time force is directed against the stifle
joint to produce further extension if possible, so that the straight
patellar ligaments may relax sufficiently to allow the patella to
be dislodged from its position upon the inner trochlear lip. Fail-
ing in this manner of procedure, the affected animal is to be
cast and anesthetized with chloroform. The relaxation which
attends surgical anesthesia will permit of reduction of the dis-
located bone and uuuiipulations such as have just been outlined
may be employed.
Following reduction in the average case it is essential that the
subject be given vigorous exercise for a few minutes. Reduction
having been affected, the application of a vesicant over the
whole patellar region is customary.
In cases of habitual luxation, unless the ligaments are so lax
that the patella may be displaced laterally over the inner as
well as the outer trochler rims, division of the inner straight
patellar ligament will correct the condition. This desmotomy
has been advocated by Bassi, and good results in appropriate
cases have been reported by Cadiot, Merillat and Schumacher.
This operation has been found a corrective in cases of outward
luxation as well as those of upward dislocation of the patella
when resorted to before the trochleae are worn from frequent
luxation.
Outward luxation of the patella is occasioned by a lax condi-
tion of the internal femeropatellar ligament or a rupture of the
same so that the patella slips over the outer femoral trochlear
rim and permits of an abnormal flexion of the stifle joint. The
outer trochlear rim being the smaller of the two, inward luxation
does not occur in the horse. With the patella disarticulated in
21& LAMENESS OF THE HORSE
this manner, the action of the quapriceps femoral group of
muscles has no effect on the stitie joint and, therefore, flexion of
this articulation occurs as soon as the subject attempts to sustain
weight and the leg collapses unless weight is at once taken up by
the other member if sound.
As a rule, the reduction of this form of luxation is not diffi-
cult. The patella may be pushed inward and into position with-
out manipulation of the leg. Retention of the patella in position
is a difficult problem. Bandaging is considered impractical and
is not ordinarily done in this country. Benard, according to
Cadiot and Almy, recommends bandaging with a heavy piece of
cloth in which an opening is made through which the patella
is allowed to protrude, and by turning such a bandage snugly
about the stifle several times, the patella is held in position. This
bandage should be kept in place for about ten days.
In young and rachitic animals outdoor exercise and a good
nutritive ration for the subject are indicated. Hypophosphites
in assimilal)le form may be beneficial, and vesication of the pa
tellar region contributes to recovery.
Where extreme luxation is present in l)oth stifles, the prog-
nosis is unfavorable. In such cases, degenerative changes may
exist and in some instances the ligaments are so diseased and
elongated that regeneration is impossible. Williams^ reports a
case where bilateral "floating" (outward) luxation was present
and extensive degeneration changes affected the articulation.
In subjects suffering frequent dislocation of the patella (ha-
bitual luxation) it is possible in some cases, to prevent its occur-
rence or at least to minimize the distress occasioned by momen-
tary luxation, l^y keeping the animals in wide stalls so that
"backing" is unnecessary. In some nervous subjects that seem
to be suffering from cramp of the crural muscles, the difficulty
and pain of their being backed out of narrow stalls, accentuates
the nervousness. Sudation and restlessness are manifested and
the subject presents a clinical picture of distress and fear of a
painful ordeal. In some cases of this kind, complete recovery
takes place by the time animals are five or six years of age.
One should avoid keeping such subjects in narrow stalls. Pref-
iW. I.. Williams in American Veterinary Review, Vol. 21, page 452.
[LAMENESS IN THE HIND LEG 217
erably patellar desmotomy should l)e performed that relief may
be obtained at once.
' Luxations attending some cases of influenza recover promptly
when subjects are kept comfortably confined in roomy box-stalls.
The administration of stimulative medicaments such as nux vom-
ica and the application of an active blistering agent to the
patella serve to hasten recovery. Dislocations in such cases are
often bilaterar and they are usually momentary. Reduction
occurs spontaneously, as a rule, and the subjects are not occa-
sioned much distress if they are kept quiet for a few days.
Chronic Gonitis.
Etiolog"y and Occurrence. — Chronic infiammation of tlie
stifle joint is met with following acute synovitis due to strains
and concussion. It is an ailment which affects heavy horses and
particularly animals that are kept at work on paved streets, but
this does not explain its existence in animals that are not sub-
jected to work likely to cause concussion. Berns^ considers rheu-
matism a probable cause of gonitis and, as he states, the dropsical
form of affection of this joint is not ordinarily attended with
manifestations of inconvenience to the subject. Gonitis is often
bilateral and its onset is insidious in many instances.
Symptomatology. — In unilateral gonitis weight is not borne
I)y the affected member. There is noticeable distension of the
joint capsule — a characteristic pendant pouching protrusion.
When both stifles are affected the subject frequently shifts the
weight from one limb to the other. Lameness comes on gradu-
ally and during the incipient stages may be intermittent but it
progressively increases so that in time affected animals become
useless. In bilateral affections animals drag the toes because
of the pain incident to flexing the stifles. This is particularly
evident when the subject is made to trot. iVs the disease pro-
gresses, atrophy of the quadriceps femoris muscles becomes pro-
nounced and as destructive changes involving the articular car-
tilages take place. The su])ject becomes more lame and eventu-
ally is rendered incapable of service.
iGeo. H. Berns, D. V. S., report, American Veterinary Medical Association,
1912, page 238.
218
LAMENESS OF THE HORSE
Upon manipulation of the patellar I'egion, one is impressed
with the fact that hyperesthesia does not exist in proportion to
the pain manifested during locomotion. In some cases a gel-
atinous swelling is present and may be detected by palpating
Fig. 50 — Cliionic gonitis. The knuckling which results from long cuntimKil
inactivity of the crural muscles in chronic cases is marked in this instance.
Photo by Dr. L. A. Merillat.
between the straight ligaments of the patella. "Williams, Hughes,
Merillat, liadley and others have directed attention to the exist-
ence of floating masses {corpora orijzoidea) in the synovial cap-
sule of this joint in gonitis, and as with all cases of arthritis,
irreparable damage is often done the articular cartilages during
the course of the ailment.
ILAMENESS IN THE HIND LEG
219
Treatment. — No effective method is as yet known which
will control this condition dnring its incipiency. The disease
progresses, and more or less damage is done the affected parts
in the course of months or even years in some cases before sub-
Fig. 51 — Gonitis. Showing position assumed in such cases because of pain
occasioned. Photo by Dr. C. A. McKilHp.
jects are rendered hopelessly crippled. When recognized early
(before chronic gonitis exists) aspiration of the synovia and the
injection of diluted tincture of iodin might prove beneficial in
cases of .synovial distension. Chronic gonitis is considered an
incurable affection and as soon as subjects manifest evidence of
distress from this condition they should by all means be taken
from work. Firing and vesication have not been productive of
beneficial results.
220 LAMENESS OF THE HORSE
Open Stifle Joint.
Anatomy of the Joint Capsule. — This joint capsule is thin
and very capacious. On the patella it is attached around the
margin of the articular surface, but on the femur the line of
attachment is at a varying distance from the articular surface.
On the medial side it is an inch or more from the articular car-
tilage; on the lateral side and above, about half an inch. It
pouches upward under the quadriceps femoris for a distance of
two or three inches, a pad of fat separating the capsule from the
muscle. Below the patella it is separated from the patellar liga-
ments by a thick pad of fat, but interiorly it is in contact with
the femerotibial capsules. The joint cavity is the most extensive
in the body. It usually communicates v.-ith the medial sac of
the femerotibial joint cavity by a slit-like opening situated at
the lowest part of the medial ridge of the trochlea. A similar,
usually smaller, communication with the lateral sac of the fe-
merotibial capsule is often found at the lowest part of the lat-
eral ridge. (Sisson's Anatomy.)
Thus it is seen that because of its frequent communication
with the other parts of this large synovial membrane, a wound
which opens the external portion of the femerotibial capsule
may be the cause of contamination and resultant infectious ar-
thritis of the whole stifle joint. Because of the distance between
the most dependent part of the femerotibial articulatioii and
the summit of the patella, one may misjudge the exact location
of the lowermost part of this portion of the capsular ligament
of the stifle joint and thereby fail at once to appreciate the seri-
ousness of calk wounds in this region.
Etiology and Occurrence. — AVounds to the patellar region
are of rather frequent occurrence, and because of the compara-
tively unprotected position of these structures, the capsular liga-
ments of the stifle joint may be perforated as a result of violence
in some form. Calk wounds which penetrate the tissues in the
immediate region of the lower portion of the external part of
the femerotibial capsule sometimes result in open joint because
of tissue necrosis resulting from the introduction of infection.
Contused wounds sometimes destroy the skin and fascia over
LAMENESS IN THE HIND LEG 221
large areas on the lateral patellar region and because of subse-
quent sloughing of tissue due to infection as well as to the man-
ner in which such wounds are inflicted, septic arthritis subse-
quently occurs. Penetrant wounds, such as may be caused by a
fork tine may not result in infection; if infectious material is
introduced an infectious arthritis does not necessarily follow,
though such cases should be considered as serious from the out-
set. ^ ^'
Symptomatology. — The pathognomonic symptom of open
stifle jouit is the profuse escape of synovia, indicating perfora-
tion of the synovial capsule; by means of a probe the wound
may be explored in a way that will clearly reveal the nature of
the injury.
After a few days have elapsed in cases where considerable
infection has taken place, there is manifestation of pain as in
all cases of infective arthritis. Hughes^ gives an excellent de-
scription of the clinical aspect of arthritis Avhich applies here:
Acute arthritis begins like an ordinary attack of synovitis.
In joints other than the pedal and pastern, there is sudden and
extensive swelling, which at first is intra-articular, succeeded by
extra-articular tumefaction, and accompanied by violent lame-
ness. The pain soon becomes intense and agonizing. There is
severe constitutional disturbance, the temperature ranging from
104 to 106 degrees and the pulse from 60 to 72. Painful con-
vulsions of the limb occur, shown by involuntary spasmodic ele-
vations due to reflex irritation of the muscles. There is loss
of appetite, rapid emaciation, the flank is tucked up and the
back arched. In from three to six days, the tumefaction around
the joint tends to soften at a particular place, and bursts, and
a discharge that is sometimes of a sanious character, mixed with
synovia, escapes. Great exhaustion at times supervenes, and
if the joint is an important one, the horse lies or falls and is
unable to rise.
Treatment. — In small puncture Avounds the immediate appli-
cation of a vesicating ointment has given good results, but Avhen
infection has taken place to such extent that the animal mani-
fests evidence of intense pain, and lameness is marked and local
swelling and hyperesthesia are great, vesication is contraindi-
ijoseph Hughes. M. R. C. V. S., in the Chicago Veterinary College Quar-
terly Bulletin, Vol. 10, page 15.
222 LAMENESS OF THE HORSE
eated. In such instances the exterior of the wound and its mar-
gins should be prepared as in similar affections of other joints. A
quantity of synovia is then aspirated by means of a small tro-
car and care should be taken to observe all due aseptic precau-
tions. Subsequently the injection of from four to six ounces
of a mixture of tincture of iodin, one part to ten parts of gly-
cerin, and gentle massage of the joint immediately after the
injection has been made, serves to check the infective process
in some cases.
The subject should be cared for as has been previously sug-
gested in arthritis — proper provisions for comfort being made.
Good nursing is always essential to a successful issue. However,
the author cannot view cases of open stifle joint with the same
optimism concerning their course and outcome that is expressed
by a number of writers on this subject. It is a grave condition
wherein the prognosis should be given advisedly
Fracture of the Tibia.
Etiology and Occurrence. — Because of its exposed position
to kicks, and its lack of protection by heavy musculature (espe-
cially on its inner surface), there is afforded ample opportunity
for frequent injury to the tibia. Fractures are complete and
varying as to nature, or incomplete. The heavy tibial fascia
affords sufficient protection so that fissures without entire solu-
tion of continuity of the bone may occur from violence to which
this part is often subjected. Moller classes tibial fracture as
ranking second in frequency — pelvic fracture being more often
mot with in horses. This does not apply in our country as pha-
langeal and metacarpal and even metatarsal fractures are ob-
served in more instances than are such injuries to the tibia. The
tibia is occasionally broken at its middle and lower thirds, but
malleolar fractures are not common.
Symptomatology. — AVhen fracture is complete and all sun-
port is removed, the leg dangles, and the nature of the injury
is so obvious that there is no mistaking its identity. However,
in case of incomplete fracture one needs to base all conclusi(ms
upon the history of the case, evidence of injury, or other knowl-
(LAMENESS IN THE HIND LEG 223
edge of the character of violence to which this bone has l)een
exposed. For without the presence of crepitation (even by ex-
cluding other possible causes for the pronounced lameness which
characterizes some of these cases) we can only resort to the
knowledge which experience has taught that fracture may be
deemed probable in many injuries to the til)ial region. Con-
sequently, we are to look upon all injuries that affect the tibia
as being fractures of some sort when there is either local evidence
of the infliction of violence or whenever marked lameness attends
such injuries, unless there is positive indication that no fractures
exist.
A careful examination of parts of the tibia, i. e., noting the
amount and painfulness of swellings, exploration with the probe,
and observations of the course taken in any given case, will
determine the exact nature of injuries. Such examination needs
to extend over a period of a week or in some instances two or
three weeks may pass before the true state of affairs is apparent.
In the meanwhile, cases are to be handled as though tibial frac-
ture certainly existed.
Prognosis. — Prediction of the outcome in tibial fracture is
somewhat presumptuous, but in the majority of cases in mature
subjects fatality results. Cadiot^ however, views this condition
with more optimism than have American practitioners. Wliile
he considers the condition grave, in citing case reports of suc-
cessful treatment by d'Arboval, D'uchemin, Leblanc, and others,
his conclusion is that many practitioners erroneously consider
fractures of the tibia as incurable.
The method of handling these cases by Leblanc is as follows :
The subject is placed in a sling; a pit is excavated below the
affected member so that a heavy weight may be attached to the
extremity; splints are applied to each, side of the leg, which is
padded with oakum, and this is kept in position by means of
bandages covered with pitch; The outer splint extends from
the hoof to the stifle and the inner one from the hoof to the
upper third of the leg. This method in the hands of Leblanc
has been successful in several instances, according to Cadiot.
^Traite de Therap. Cliir, Cadiot et .41my, Tome second, page 480,
224 LAMENESS OF THE HORSE
In a foal the author has in one instance succeeded in obtain-
ing complete recovery in a simple fracture of the lower third
of the tibia where the only support given the broken bone was
a four-inch plaster-of-paris bandage which was adjusted above
the hock. Below the tarsus a cotton and gauze bandage was ap-
plied to prevent swelling of the extremity. In this instance
(an emergency case in which materials that are not to be recom-
mended were necessarily employed) recovery took place within
thirty days.
As has been mentioned in the consideration of radial frac-
tures, heavj^ leather is better suited for immobilization of these
parts than a cast or other rigid splint materials. Mature ani-
mals may be expected to resist the immobilization of the hind
legs because of the normal manner of flexion of the tarsal and
stifle joints in unison. Therefore, the application of rigid splints
to the leg and including the hock is productive of disastrous
results in some eases.
The application of cotton and bandages to pad the member
and the adjustiug of heavy leather splints on either side of the
leg, and retaining them in position with four-inch gauze band-
ages will prove more nearly satisfactory than some other meth-
ods employed. Prognosis is unfavorable, however, in most cases
of compound fracture and recovery is improbable when the
upper portion of the tibia is broken.
Rupture and Wounds of the Tendo AchilHs.
Etiology and Occurrence. — Cases are recorded by Uhlridi
in which rupture has followed degenerative changes affecting
the tendo Achillis. Not infrequently, the result of a trauma,
division of the tendo Achillis occurs. IMoller states that rupture
of this tendon may be due to jumping, in riding horses and in
draught horses, in their efforts to avoid slipping. In runaways,
it sometimes occurs where sharp-edged implements are l)Ounced
against the legs in such fashion tliat division of tlie tendon re-
sults.
Symptomatology.— AVith division of the tendo Aeliillis or
of the musculature of the gastrocnemii and the superficial flexor
LAMENESS IN THE HIND LEG 225
(perforatiis), there remains nothing to inhibit tarsal flexion
except the deep flexor tendon (perforans) and this does not sup-
port the leg. When attempt is made to sustain weight with the
affected member, abnormal flexion of the tarsus takes place and
the hock sinks almost to the ground. The symptoms are so char-
acteristic that recognition is always easy even in case no wound
of the skin exists.
Prognosis. — Spontaneous recoveries occur and such cases
are reported by Bouley who is quoted by Cadiot as having ob-
served division of the tendo Achillis due to a sword wound
wherein at the end of four mouths recovery was complete. Di-
vision of this tendon in brood mares has been practiced by the
early settlers of parts of the United States for the purpose of
preventing their straying too far from home. In such instances
one leg only was so mutilated and in most instances, it is re-
ported that spontaneous recovery took place.
In unilateral involvement without complications, the prog-
nosis is not unfavorable if provisions for giving necessary atten-
tion are available.
Treatment.— Tlie subject is to be confined in a sling and the
member bandaged and supported by means of leather splints.
Immobilization as for fracture is not necessary but, nevertheless,
movement is to be restricted as much as possible. In case of
open wounds, tiie exposed tissues are cared for along general
surgical lines. Where the divided parts of the tendon are main-
tained in fairly close and constant relation, granulation of tissue,
sufficient to sustain weight takes place in from six weeks to three
months.
Spring-Halt. ( String-Halt. )
Occurrence. — This condition is a myoclonic affection of the
hind leg which is discussed in works on theory and practice
under the head of neuroses, but the cause or causes have not
been established. Theories that heredity is responsible have
their supporters and advocates of hypotheses attributing it to
disease of the sciatic nerve, patellar subluxation, fascial con-
traction of various muscles, "dry spavin" (tarsal arthritis),
iliac exostoses, disease of the foot and contraction of the hoof.
226
LAMENESS OF THE HORSE
are on record in veterinary literature. This ailment affects old
horses more frequently than it does young and is seen in all
breeds of animals including mules.
Symptomatology. — This disease develops slowly, and pro-
gressively increases in severity as a rule, Init does not ordinarily
Fig. 52— Spring-halt.
constitute cause for rendering an animal unserviceable. While
the affection is sometimes l)ilateral (occasionally affections of
the forelegs are reported) and the extreme flexion of the legs
in the spasmodic manner which characterizes spring-halt, cause
great waste of energy during locomotion, yet such cases are
rare. Usually the ailment is markedly evinced when subjects
are first taken from the stable, but as they are exercised the
manifestation diminishes, and in many instances it completely
subsides. The condition is generally more noticeable when the
subject is made to step backward. In some animals there is
L.AMENESS IN THE HIND LEG 227
marked abduction at the time flexion occurs and in singular
instances the spasmodic contraction is so violent that the subject
falls to the ground as a result of the peculiar flexion of the leg.
In severe cases of "scratches" or chemical irritation of the
extremity, the legs are abnormally flexed in a manner which
simulates spring-halt, but because of the evident injury of the
parts this is not likely to confuse. Since all facts concerning
etiological agencies are surrounded with so much obscurity, clas-
sification does not lend any particular assistance in the consid-
eration of this ailment.
Prog-nosis. — One cannot intelligently give a prognosis in
these cases if forecast is expected to state the exact course fol-
lowing treatment. However, in a general way, cases of recent
affection are thought more favorable than are those of long stand-
ing or in old animals where myositis and other muscular and
fascial affections exist owing to years of hard service.
Treatment. — No known line of medicinal treatment is of
service, nor is any particular surgical operation to be considered
dependable for obtaining relief. Operations of almost every con-
ceivable nature have been tried with the hope of securing recov-
ery in spring-halt but under no condition can the practitioner
as yet be reasonably certain of effecting permanent relief in any
case. Treatment is, therefore, entirely empirical.
Neurectomies have been performed and recoveries follo\\ing
were attributed thereto; fascial divisions in the crural region
have been done \^•ith good results and this manner of treatment
has its favorers. Advocates of tenotomies, likewise, are to be
found. Consequently, one may summarize thus : Spring-halt is
a disease of unknown origin — the exact cause has not been deter-
mined ; therefore, all treatment is, in a way, experimental. The
recommendation of any given procedure in handling cases must
then be a matter of opinion based either upon practical experi-
ence or knowledge of the experiences of others. Divisions of the
lateral digital extensor (peroneus) below the tarsus near its
point of insertion to the extensor of the digit is recommended
here because it is followed by a percentage of recoveries that is
as large as in any other method of treatment and the operation
228
LAMENESS OF THE HORSE
V
k
^^^^£ ■'./ s^
^Ifcjbk %i^J
^|Hb^' J^^
^jL- ■ ■..•^.- '•:
^
%
Li
Fig-. 53— Lateral (external) view of tarsus showing effects of generalized
tarsitis.
LAMENESS IN THE HIND LEG 229
is not difficult to perform nor is its performance fraught with
any dangerous complications. In selected subjects about fifty
per cent of cases recover in from two to six weeks following this
operation.
Open Tarsal Joint.
Like the tibia the hock is exposed to frequent injuries and in
some cases wounds perforate the joint capsule. When due to
calk wounds where horses are kicked, the injury is often on the
side of the tarsus (medial or lateral) and such wounds not in-
frequently result in infectious arthritis. Horses sometimes jump
over wire fences and wounds are inflicted which constitute ex-
tensive laceration of the joint capsule. In firing for bone spavin,
where a deep puncture is made very near the tibial tarsal (tibio-
astragular) joint if infection gains entrance, serious and general-
ized infection of the open joint cavity supervenes in some cases.
Symptomatology. — There is no marked difi^erence in the con-
stitutional disturbances which are occasioned in this condition
and those encountered in other cases of septic arthritis (previ-
ously considered herein) except that there is a difference in tlie
degree of resultant derangement and local tissue changes.
Chiefly, because of the difficulty encountered in keeping the
hock joint in an aseptic condition or securely bandaged, open
tarsal joint constitutes a more serious condition than a similar
affection of the fetlock. Otherwise, a very similar condition ob-
tains and the same diagnostic principles serve here that have
been described on page 110 in considering open fetlock joint.
Treatment. — The same plan that is described in detail for
treatment of similar conditions aft'ecting Mie fetlock joint is indi-
cated in this affection. Exceeding care must be exercised in
bandaging the hock, however, lest the animal be so irritated that
in the extreme flexion of the tarsus which is often caused by
bandaging, the wound dressings may be completely deranged.
A wide gauze bandage material is most satisfactory; cotton of
long fiber is separated in thin layers and wound about the hock,
extending from the site of injury to a point about six inches
proximal to the summit of the os calcis. By using an abundance
230 LAMENESS OF THE HORSE
of cotton in this way, it will not be found necessary to apply the
bandages very snugly; with a four-inch gauze bandage material,
which is supported above the cap of the hock and brought across
the anterior face of the tarsus in a diagonal manner, a comfort-
able and very serviceable protective dressing is provided for.
Animals so treated will not ordinarily resist because of pressure
from the bandages. Pressure is unavoidable in the use of ad-
hesive dressings or where careful attention is not given the man-
ner of applying cotton to the parts. Such methods are sure to
result disastrouslj^ But if subjects are kept quiet after the
parts have been properly bandaged, no difficulty is encountered
in maintaining asepsis in an uninfected wound. Recovery takes
place in favorable cases in from three weeks to three months, de-
pending on the nature and extent of injuries inflicted.
Fracture of the Fibular Tarsal Bone (Calcaneum.)
Etiology and Occurrence. — This condition though rarely met
with in the horse, is the result of violent strain upon the os
caleis by the gastrocnemius and superficial flexor tendons in
efforts put forth by animals in attempts to regain a footing when
the hind feet slip forward under the body, or in jumping and
in falls or direct contusion by heavy bodies. Hoare^ reports a
case of a mare that had produced fracture in jumping.
Fracture of the other tarsal bones are very seldom observed
but may be occasioned by contusions wherein multiple or com-
minuted fractures are produced, such as are to be seen in small
animals. Fracture of the tibial tarsal bone (astragalus) is to be
observed as a complication in luxations of the tarsal joint and,
according to Cadiot, the other tarsal bones may likewise suffer
fracture in luxations of the hock.
Symptomatology. — Great pain attends this accident accord-
ing to the observations given in recorded cases. In the case
cited by Hoare the animal evinced great pain and uneasiness; the
hock was unduly flexed; the calcaneum was displaced forward;
and marked crepitation was present. A portion of the body of
IE. W^allis Hoaro, F. R. C. V. S., American Veterinary Review, Vol. 27,
page 1189.
LAMENESS IN THE HIND LEG ?31
the calcaneum was protruding through the perforated skin. The
animal was destroyed and the bone was found l)roken in three
pieees.
Sinee the support for the tendo Achillis is removed in such
1
Tuber calcis
Lateral malleolus
Short liitiral ligament E_ jp \
/
1
/ Short meiiial ligavjeittn
''rochlea of tibial tarsal
bone
T.f.— . ^-
T.4 -
T t.
Dorsal lii/ament
Mt. IV , _ - - r. .3
. Mt. Ill
Fig. 54 — Right hock joint. Viewed from the front and slightly laterally
after removal of joint capsule and long collateral ligaments. T. t., Tibial
tarsal bone (distal tuberosity). T. c, central tarsal bone. T. 3. Ridge of
third tarsal bone. T. f. Fibular tarsal bone (distal end). T. 4. Fourth tarsal
bone. Mt. Ill, Mt. IV. Metatarsal bones. Arrow points to vascular canal.
(From Sisson's "Anatomy of the Domestic Animals.")
fracture and no leverage on the metatarsus obtains, it naturally
follows that any attempt to sustain weight must result in extreme
flexion of the hock and descent of this part in a manner similar
to cases of rupture or division of the Achilles' tendon. The two
conditions should not be confused, however, as the parts may be
232 LAMENESS OF THE HORSE
definitely outlined by palpation and the slack condition of the
tendon and displaced summit of the calcaneum, which charac-
terize fracture of the fibular tarsal bone, are easily recognized.
Treatment. — Prognosis is unfavorable in the majority of
cases, but should attempts at treatment be undertaken in young
and quiet mares which might prove valualjle for breeding pur-
poses in case of imperfect recovery, they should be put in slings
and the member is to be immobilized as in tibial fracture. Au-
thorities are agreed that prognosis is entirely unfavoralile in
mature animals, when the case is viewed from an economic stand-
point.
Tarsal Sprains.
Etiology and Occurrence. — The hock joint is often sul)jected
to great strain because of the structural ju^ture of this part and
its relation to the hip as well as the manner in which the tarsus
functionates during locomotion. That ligamentous injuries ow-
ing to sprain frequently occur and attendant periarticular in-
flammations with subsequent hypertrophic changes follow, is a
logical inference. Fibrillary fracture of the collateral ligaments
may take place in falls or when animals make violent efforts
to maintain their footing on slippery streets. In expressing
opinions concerning the frequency with which the hock is found
to be the seat of trouble in lameness of the pelvic members, dif-
ferent writers place the percentage of hock lameness at from
seventy-five to ninety per cent. And when one considers the
possibility that a goodly proportion of cases of tarsal exostis are
the outcome of sprains, the occurrence of tarsal sprains may be
more generally admitted.
Symptomatology. — A mixed type of lameness is present and
the nature of the impediment varies, depending upon the loca-
tion of the injury. Sprains of the mesial tarsal ligaments cause
lameness some^\hat similar to that of spavin. However, in es-
tablishing a diagnosis, local evidence in these cases is of greater
significance than the manner of locomotion. During the acute
stage of inflammation there is to be detected local hyperthermia,
some hyperesthesia and a little swelling. Later, when resolution
is not prompt, considerable swelling (or perhaps correctly speak-
LAMENESS IN THE HIND LEG 233
ing, an iiulurated enlargement) variable in size is developed.
In some cases the entire tarsal region becomes greatly enlarged
and this swelling is very slowly absorbed in part or completely.
Sneh snb-acnte cases are observed dnring the winter season and
particularly where subjects are kept in tie stalls without exercise
for weeks at a time.
Treatment. — Attention slionld be directed toward i-elief foi-
the animal in all acute inflammations. Local applications of
heat are helpful and, of course, rest is essential. Towels that
are wrung out of hot water and held in position by means of a
few turns of a loose bandage and this covered with an imper-
vious rubber sheet, will serve as a practical means of application
of hydrotherapy. Following this when conditions improve, as
in the handling of all similar cases, counterirritation is indi-
cated.
When proper care is given at the onset and where injury does
not involve too much ligamentous tissue, recovery takes place
in a few weeks but in some cases which occur during the winter
season in farm horses, complete recovery does not result until
several months have passed.
Curb.
The hock is said to be curl)ed when the normal appearance,
viewed from the side, is that of bulging posteriorly at any point
between the summit of the calcaneum and the upper third of
the metatarsus. Among some horsemen a hock is said to be
"curby" whenever there exists an enlargement of any kind on
the posterior face of the tarsus whether it be due to sprain,
exostosis or proliferation of tissue as a result of contusion.
French veterinarians consider under the title of "courbe," an
exostosis situated on the mesial side of the distal end of the tibia.
Cadiot and Almy state that this condition (courbe) is of rare
occurrence. Percivall defines curb as "a prominence upon the
back of the hind leg, a little below the hock, of a curvilinear
shape, running in a direct line downwards and consisting of
infusion into, or thickening of, the sheath of the flexor tendons. ' '
Moller's version of true curb is a thickening of the plantar liga-
ment (calcaneocuboid or calcaneometatarsal). Hughes and Mer-
234 LAMENESS OF THE HORSE
illat consider curb as a synovitis having for its seat the synovial
bursa which is situated between the superficial flexor tendon
(l)erforatus) and the plantar ligament.
Occurrence. — Certain predisposing factors seem to favor the
occurrence of curb. A malformation of tlie inferior part of the
tai-sus so that its antero-posterior diameter is considei'ably less
than normal is a contributing cause. Such hocks are known as
"tied-in." Another fault in conformation is the existence of a
weak hock that is set low down on a crooked leg, especially when
such a member is heavily muscled at the hip. Given such con-
formation in an excitable horse, and curb is usually produced be-
fore the subject is old enough for service. It is certain that in
cases where conformation is bad, greater strain is put upon the
plantar ligament. This structure serves to bind the tibial tarsal
(calcis) bone to the metatarsus; traction exerted upon its sum-
mit by the tendo Achillis is great when animals run, jump or
rear and also at heavy pulling. In animals having curby hocks,
sprain is likely to result and curb supervenes.
Symptomatology. — The characteristic swellins: which marl^-s
curl) may develop quickly and lameness occur suddenly or the
enlargement comes on gradually and slowly, causing little lame-
ness. Lameness is not proportionate to the si7e of the swelling
and in all cases whether subacute or chronic, the condition im-
proves with rest, but lameness is again manifested upon exertion.
A horse which "throws a curb" will go lame until the acute
inflammatorv condition subsides and depending upon treatment
received and conformation of the hock, this requires from three
days to two or three weeks.
The character of the swelling varies; in some cases it is not
larsre but rather dense and lacking in evidence of heat and
hvperesthesia ; in other eases there is considerable swellinsr, which
is hot and doughy, somewhat painful to the touch but not neces-
sarilv productive of much lameness. Tn anv event, whether the
swelling or enlargement is bier or little, its location makes it
conspicuous when viewed in profile.
Tn most cases after the acute inflammatory period has passed,
lameness is slight, if at all present, and in time no interference
(LAMENESS IN THE HIND LEG
235
with the subject's usefulness is occasioned because of the curb,
but the animals often remain blemished — complete resorption
of inflammatory products being- unusual wlien much disturbance
has existed.
Treatment. — The handling of curl) during the acute inflani-
niMtdry stage is along the same lines as in sprain — local applica-
4^
Fig. 55 — Spavin.
tiotis of cold and heat. Subjects must be kept quiet until all
inflamnuition has subsided, for there are no cases wherein a
little brisk exercise is more likely to cause a recurrence of lame-
ness before recovery is complete than in curb. Vesication is in
order in a week or ten days after the affection has set in ; in old
stubborn cases that have resisted ordinary treatment for a few
months, the use of the actual cautery (line firing) is to be recom-
mended.
Spavin. (Bone Spavin.)
This term is applied to an affection of the tarsus which is usu-
ally characterized by the existence of an exostosis on the mesial
236 LAMENESS OF THE HORSE
and inferior portion of the liock. There is also included under
this name, articular inflammation wherein no external evidence
is shown. Spavin lameness has long been recognized and much
has been written upon this subject. Since authorities are agreed
that most cases of lameness in the hind leg are due to hock
affection, and because the majority of cases of lameness which
have the tarsal region as the seat of trouble are instances of spa-
vin lameness, this disease merits all the attention it has received.
Etiology and Occurrence. — Causes may well be classified as
predisposing and exciting, for there are many etiologic factors
to be reckoned with in spavin, some of which are widely different
in nature.
Considered as predisposing causes, hereditary influences play
an important role and may, owing to faulty conformation, sub-
ject an animal to affections of this kind because of dispropor-
tionate development of parts (weak and small joints and heavy
muscular hips) ; or as a consequence of inherited traits, a sub-
ject may manifest susceptibility to degenerative bone changes
which are signalized by the formation of exostoses of different
parts on one or more of the legs. Hereditary predispositions
make for the presence of spavin in a large percentage of the
progeny of sires so aft'ected. This fact has been repeatedly
demonstrated in this country as well as elsewhere according to
Quitman, Dalrymple and Merillat.^ A number of states have
passed stallion inspection laws stipulating that animals having
such exostoses as spavin and ringbone cannot be registered ex-
cept as ''unsound."
Asymmetrical conformation, particularly where the hock is
obviously small and weak as compared with other parts of the
leg, constitutes a noteworthy predisposing cause.
Peters' theory is plausible that the screw-like joint between
the tibia and the tibial tarsal (astragulus) bones causes these
structures to functionate in a manner not in harmony with the
provisions allowed by the collateral ligaments of the tarsus, per-
iDiscussions on paper entitled "The Spavin Group of Lamenesses," hy W. L.
Williams, Carl W. Fisher and D. H. Udall, Proceedings of American Veteri-
nary Medical Association, 1905.
LAMENESS IN THE HIND LEG 237
mitting movement only in a direction parallel with the long axis
of the body.
Because of the quality of their temperaments, nervous animals
possessing no particular congenital structural defects of the
hock and having no history of spavined progenitors, are subject
to spavin when kept at work likely to produce tarsal sprain.
Spavin usually develops early in such subjects and examples of
this kind may be frequently observed in agricultural sections
of the country. Where spavin develops in unshod colts at three
and four years of age, shoeing is not an influencing agency when
animals are not worked on pavements.
Exciting causes of spavin are sprain and concussion. Various
hypotheses are recorded as to how sprains are influenced and
among others may be mentioned that of McDonough^, which is
that the foot is robbed of its normal manner of support by the
ordinary three-calked shoe. With such a shoe, little support is
given the sides of the foot; hence, undue strain is put upon the
collateral ligaments of the tarsus. ^Moreover, the shoe with its
calks increases the length of the leg and adds to the leverage
on the hock, by virtue of such added length. This makes for
greater strain upon the mesial or lateral tarsal ligaments when-
ever the foot bears upon a sloping ground surface, so that one
side (inner or outer) is higher or lower than the other. But
according to McDonougli's theory (a good one concerning horses
that work on pavements), the chief error in shoeing lies in that
the foot is deprived of its normal base or support on the sides
— the three-calked shoe being an unstable support — and that
this manner of shoeing city horses working on pavements is an
"inhumane" practice, a "diabolical method."
Wliether spavin has its point of origin within the articulation
as a rarefying ostitis of the cancellated structure of the lower
tarsal bones as suggested by Eberlein ; or, as Diekerhoff asserts,
that the cunean bursa may be the initial point of affection, is
unsettled ; but it is reasonable to consider occult spavin as having
its origin within the articulation, and that cases readily yielding
i"Hock-Joint Lameness," by Dr. James McDonough, Proceedings of the
A. V. M. A., 1913, page 545.
238 LAMENESS OF THE HORSE
to cunean tenotomy are primarily due to affection of the cunean
bursa.
Symptomatology. — Where a visible exostosis exists, the pres-
ence of spavin is easily detected, yet exostoses that extend over
large areas may constitute cause for serious trouble and still be
difficult of detection. By observing the internal surface of the
hock from various suitable angles, such as from between the
forelegs or directly behind the subject, one may note the pres-
ence of any ordinary exostosis.
The position assumed by the spavined horse is often charac-
teristic. More or less knuckling is usually present (Liautard,
McDonald) . There is abduction of the stifle in some cases, or the
toe may be worn in unshod horses so that it presents a straight
line at the surface. This is manifested to a great degree in some
animals and in others the foot is not dragged and there is no
wearing of the hoof at the toe.
Spavin lameness is so distinctive that one trained and experi-
enced in the examination of horses that are spavined, should
correctly diagnose the condition in practically every instance
without recourse to other means than noting the peculiar char-
acter of the gait of the subject. Lameness develops gradually
in the majority of instances, and an important feature in spavin
lameness is that it disappears after the subject has gone a little
way, to return again as soon as the animal has rested for a
variable length of time— from a half hour to several hours. This
"warming out" is marked during the incipient stage, but less
pronounced in most chronic cases. A complete disappearance
of lameness is observed in some instances, while in others only
partial subsidence is evident. Because of the fact that pain is
occasioned both during weight bearing and while the leg is being
flexed and advanced, there is manifested the characteristic mixed
lameness and exaggerated hip action which typifies spavin. By
throwing the hips upward with the sound member it is possible
to advance the affected leg with less flexion, hence less pain is
experienced in this manner of locomotion. When made to step
aside in the stall, a spavined horse will flex the affected member
abruptly and when weight is taken on the diseased leg, symp-
(LAMENESS IN THE HIND LEG 239
toms are evinced of pain, and weight is immediately shifted to
the sound limb. This is marked during the incipient stages of
spavin. Lameness usually precedes the formation of exostosis,
though cases are observed wherein an exostosis is present and
no lameness is manifested and no history of the previous exist-
ence of lameness is available.
The "spavin test" is of value as a diagnostic measure when
it is employed with other means of examination, though reaction
to this test is seen in some cases in old "crampy" horses that
have experienced hard service. The test consists in flexing the
affected leg (elevating the foot from the ground twelve to
twenty- four inches) and holding the member in this position for
a minute, whereupon the animal is made to step away immedi-
ately at a trot. During the first few steps taken directly there-
after, the subject shows pronounced lameness and this constitutes
a reaction to the spavin test.
Where no exostosis is present it becomes necessary to exclude
other causes for lameness but the characteristic spavin-lameness
is to be relied upon to a greater extent in such cases than are
other means of examination. Such cases are known as occult
spavin and may be present for months before any external
changes in structure are observable. In some instances no ex-
toses form even during the course of years. The spavin test is
of aid in establishing a diagnosis here but the marked "warm-
ing out" peculiar to spavin is not so pronounced in such cases.
Prognosis. — An animal having hereditary predisposition to
spavin is not likely to recover completely whether this predis-
position be due to faulty conformation or susceptibility to bone
changes. In predicting the outcome, the temperament of the
subject is to be taken into account, as well as the character of
service the animal is expected to perform. And finally, a very
important feature to be noted, is the location of the exostosis.
If situated rather high and extending anterior to the hock, there
is less likelihood of recovery resulting than where an exostosis
is confined to the lower row of tarsal bones. When situated
anterior to the tarsus a large exostosis may by mechanical inter-
ference to function, cause lameness when all other causes are
240 LAMENESS OF THE HORSE
absent. In making examinations one must not be deceived
by the inconspicuous and seemingly insignificant exostosis which
has a broad base. In some eases of this kind, dealers style the
condition as "rough in the hock" when as a matter of fact, in
some instances, incurable spavin lameness develops.
Treatment. — Many incipient cases of spavin yield to vesica-
tion and a protracted period of rest. Results depend primarily,
upon the nature of the affection. However, in every instance
if there is involvement of the tibial tarsal (astragalus) bone,
complete recovery is highly improbable. When the disease is
confined to the lower tarsal bones, lameness subsides as soon as
the degenerative changes are checked and ankylosis occurs.
The use of the actual cautery when properly employed con-
stitutes an excellent method of treatment. The "auto-cautery"
when equipped with a point of about one-eighth of an inch in
diameter and about three-fourths of an inch in length is well
suited for this particular operation. Before deciding to cauter-
ize, it is necessary to ascertain the extent of area affected. The
nearness of the exostosis to the tibiotarsal articulation can be
definitely determined by palpation. The hair over the entire
surgical field is clipped and the cautery at white heat is pushed
through the overlying soft tissues and into the central part of
the exostosis. Care is taken to keep the cautery-point away from
the articular margin of the tibial tarsal bone about three-fourths
of an inch. No danger will result from cauterizing to a depth
of three-fourths of an inch in the average case. Two or three
(and not more) centrally located points for penetration with the
cautery are sufficient. Experience has shown that several (five
or six or more) punctures are not productive of good results.
When considerable cicatricial tissue is present, due to the action
of depilating vesicants or other chemicals, sloughing of tissue
is very apt to follow deep cauterization, if one is not careful to
keep the punctures at least one-half inch apart when three are
made. It is best, in such cases, to make but two deep penetra-
tions with the cautery but additional superficial punctures may
be made if kept about three-fourths of an inch distant and not
nearer than this to one another. Sloughing of tissue is not nec-
essarily productive of bad results but there is occasioned an open
LAMENESS IN THE HIND LEG 241
wound wliieli usually becomes infected and necrosis of tissue may
extend into the articulation. No benefit results from sloughing
and it should be avoided. In small horses, one deep point of
cauterization is sufficient if the osseous tissues are penetrated to
a proper depth so that an active inflammation is induced. The
cautery may, if necessary, be reintroduced several times. When
the field of operation has been properly prepared and it is
thought advisable (as where subjects are kept in the hospital for
a time), the hock may be covered with cotton and bandaged and
no chance for infection w^ill occur.
After cauterization the subject should be kept quiet in a com-
fortable stall for three wrecks; thereafter, if the animal is not
too playful, the run of a paddock may be allowed for about ten
days and a protracted rest of a month or more at pasture is
best. It is unwise in the average case to put an animal in
service earlier than two months after having been "fired."
Where cases progress favorably, lameness subsides in about
three weeks after cauterization and little if any recurrence of
the impediment is manifested thereafter. However, because of
violent exercise taken in some instances when subjects are put
out after being confined in the stall, a return of lameness occurs
and it may remain for several days or in some cases become per-
manent. No good comes from the use of blistering ointments
immediately after cauterization. The actual cautery is a means
of producing all necessary inflammation and it should be so em-
ployed that sufficient reactionary inflammation succeeds such
firing. The use of a vesicating ointment subsequent to cauteriza-
tion invites infection because of the dust that is retained in con-
tact with the w^ound. The employment of irritating chemicals
in a liquid form following firing is needless and cruel.
In many instances lameness is not relieved and subjects show
no improvement at the end of six weeks time and it then becomes
a question of whether or not recovery is to be expected even with
continued rest and treatment. As a rule, such cases are unfavor-
able. In one instance the author employed the actual cautery
three times during the course of six months and lameness gradu-
ally diminished for a year. In this case the spavin was of nearly
one year's standing when treatment was instituted. The sub-
242 LAMENESS OB" THE HORSE
jeet was a nervous and restless but well-formed seven-year-old
gelding. Recovery was not complete; recurrent intervals of
lameness marked this case, but the horse limped so slightly that
the average observer could not detect its existence after the ani-
mal had been driven a little way.
Cunean tenotomy has been advocated and practiced by Abild-
gaard, Lafosse, Peters, Herring, Zuill and others and good re-
sults have followed in many cases so treated.
Considering results, the employment of chemicals of various
kinds for the purpose of relieving spavin lameness does not com-
pare favorably with firing. IMoreover, so many animals have
been tortured and needlessly blemished in the attempted cure
of spavin that agents which are not of known value, the use of
which are likely to result in extensive injury to the tissues, are
only to be condemned.
When spavin is bilateral and lameness is likewise affecting
both members, prognosis is at once unfavorable. Such cases are
often benefited by cauterization but only one leg at a time should
be treated.
Bossi's double tarsal neurectomy (division of the anterior and
posterior tibial nerves) has undoubtedly been of decided benefit
in many cases, but is not at present a popular method of treat-
ment in this country. This operation has its indications, how-
ever, and may be recommended in chronic lameness where no
extensive exostosis exists which may mechanically interfere with
function.
Distension of the Tarsal Joint Capsule. (Bog Spavin.)
Distension of the capsular ligament of the tibial tarsal (tibio-
astragular) joint with synovia is commonly known as bog spavin.
This condition is separate and distinct fiom that of distension
of the sheath of the deep flexor tendon (j^erforans) though not
infrequently the two affections coexist.
Etiolog'y and Occurrence. — Following strains from work in
the harness or under the saddle, horses develop an acute syno-
vitis of the hock joint, which often results in chronic synovial
distension. Debilitating diseases favor the production of this
OLAMENESS IN THE HIND LEG
243
affection in some animals. It is also frequently observed in
young horses and in draught colts of twelve to eighteen months
of age. This condition occurs while the subjects are at pasture
Fig. 56 — Bog spavin. Showing point of view which may be most advan-
tageously taken by the diagnostician in examining for distension of the
capsular ligament of the tarsal joint.
and often spontaneous recovery results by the time the animals
are two years of age.
Symptomatology. — Bog spavin is recognized by the dis-
tended condition of the joint capsule which is prominent just
below the internal tibial malleolus and this affection is character-
244 LAMENESS OF THE HORSE
ized by a fluctuatiug swelling which varies considerably in size
in different subjects. Except in cases of acute synovitis, lame-
ness is not present and in chronic distension of the capsule of
the tarsal joint, no interference with the subject's usefulness
occurs. In the majority of instances, the disfigurement which
attends bog spavin is the jDrincipal objectionable feature. The
condition is bilateral in many instances, and in such cases the
subjects have a predisposition to this condition or it follows
attacks of strangles or other debilitating ailments. Because of
a rapid and unusual growth, bilateral affections are of frequent
occurrence in some animals.
Treatment. — The most practical method of handling bog
spavin consists in aspiration of synovia and injection of tincture
of iodin. Discretion should be employed in selecting subjects
for treatment, regardless of the manner in which such cases are
to be handled. Where there exists chronic distension of the
joint capsule of several years' standing in old or weak subjects,
needless to say, recovery is not likely to result. When animals
are vigorous and two or three months' time is available, treat-
ment may be begun with reasonable hope for success.
The average subject is handled standing and can be restrained
with a twitch, sideline and hood. Aspirating needles and all
necessary equipment must be in readiness (sterile and wrapped
in aseptic cotton or gauze) so that no delay will occur from this
cause when the operation has been started. The central or most
prominent part of the distended portion of the capsule is chosen
for perforation and an area of an inch and a half in diameter
is shaved. The skin is cleansed and then painted with tincture
of iodin. The sterile aspirating needle is pushed through the
tissues and into the capsule with a sudden thrust. With a large
and sharp needle (fourteen gauge), synovia can be drawn from
the cavity in most instances and the subject usually ott'ers no
resistance. By compressing the distended capsule and surround-
ing structures with the fingers, considerable synovia may be
evacuated. In singular instances, no synovia is to be aspirated
with the needle, and in such cases the amount of iodin injected
needs be increased, possibly twenty-five per cent., as experience
[LAMENESS IN THE HIND LEG 245
will indicate. From two to five cubic centimeters of U. S. P.
tincture of iodin is injected through the aspirating needle into
the synovial cavity of the joint, and the exterior of the parts are
vigorously massaged immediately after injection to stimulate
distribution of the iodin throughout the synovial cavity. "Where
a bilateral affection exists, two or three weeks' time should inter-
vene between the treatments of each leg. A sterile metal syringe
equipped with a slip joint for the needle is well adapted to this
operation. Lubrication of the plunger with heavy sterile vaseline
or glycerin will prevent the syringe from being ruined by the
iodin.
Following the injection, the subject is kept in a stall or in
a suitable paddock, so that conditions may be observed for four
or five days. The object sought by the introduction of iodin
is not only for a local effect upon the synovial membranes in
checking secretions, but the production of an active inflamma-
tion and great swelling, which will remain from four weeks
to three months subsequent to the injection. This periarticular
swelling should produce and maintain a constant pressure over
the entire affected parts for a sufficient length of time until nor-
mal tone is re-established.
In some cases, swelling does not develop as the result of a
single injection of iodin. When marked swelling has not taken
place within five days, none will occur and a repetition of the
injection may be made within ten days after the first treatment
has been given. One may safely increase the amount of iodin
at the second injection in such cases by one-fourth to one-third.
In Europe this method of treating bog spavin has been em-
ployed by Leblanc, Abadie, Dupont and others according to
Cadiot; but Bouley, Key, Lafosse and Varrier used it with bad
results. Where a perfect technic is executed (and no other is
excusable in this operation), no infection will occur if a reason-
able amount of iodin is injected. The dilution of iodin with an
equal amount of alcohol has been practised by the author in
many cases, but later this was found unnecessary.
Other methods of treatment have been used with success. Per-
haps the most heroic consists in opening the joint capsule with a
246 LAMENESS OF THE HORSE
bistoury or with the actual cautery. Such practice is too hazard-
ous for general use and is not to be recommended, although good
results should follow the employment of such methods if infec-
tious arthritis does not occur.
Line firing over the distended capsule is a practical method
of treatment. This is attended with good results in young ani-
mals in many cases, but considerable blemish is caused when
sufficient irritation is produced to stimulate resolution.
Vesication also is successfully employed in some instances.
However, only eases of recent origin in young animals — colts of
two years or younger — yield to blistering, and in some affected
colts no doubt recovery would have been spontaneous had no
treatment been instituted.
Ligation of the saphenous vein at two points, one above and
the other below the distended ligamentous capsule, is an old
operation, which has undoubtedly given good results in some
cases, although it does not seem to be a rational procedure.
After-Care. — After swelling has fully developed — which oc-
curs witliin a week — the subject is turned to pasture and no at-
tention is necessary thereafter. A gradual subsidence of the
swelling occurs and in the average instance, this completely re-
solves within six or eight weeks.
Complete recovery succeeds the aspiration-and-injection-treat-
ment in about seventy-five per cent of cases as the result of one
operation, and subjects may be gradually and carefully returned
to work in about sixty days after treatment has been given.
Distension of the Tarsal Sheath of the Deep Digital Flexor.
( Thoroughpin. )
The terms ''thoroughpin" or "throughpin" are translations
from the French vessignon clieviUe and have the same signifi-
cance. They are so named because of the diametrically opposed
distensions of the sheath of the deep flexor tendon in such man-
ner that the distensions appear to be due to a supporting peg.
Anatomy. — The theca tlirough whieli the deep digital flexor
(perforans) plays in the tarsal region, begins about three inches
LAMENESS IN THE HIND LEG 247
above the inner tibial malleolus and extends about one-fourth
of the way down the metatarsus. The posterior part of the
capsular ligament of the hock joint is very thick in its most
dependent portions and is in part cartilaginous, forming a suit-
able groove for the passage of the deep flexor tendon.
Etiology and Occurrence. — Strains and sequellae to debili-
tating: diseases constitute the usual causes of this affection. As
Lz^y
Fig. 57— Thoroughpin. Showing distension of tlie sheath of the deep flexor
tendon as it protrudes antero-externally to the fibular tarsal bone (cal-
caneum).
a result of acute synovitis a chronic synovial distension of the
tarsal sheath occurs. Bog spavin is often present in case of
thoroughpin but the two conditions are separate and distinct
excepting in that both may occur simultaneously and as the
result of the same cause. Some animals are undoubtedly pre-
disposed to disease of synovial structures. The average horse
that has been subjected to hard service on pavements or hard
roads at fast work suffers synovial distension of bursae, thecae
or of joint capsules. Some of the well bred types such as the
248 LAMENESS OF THE HORSE
thoroughbred liorses may be subjected to years of hard service
and still remain "clean limbed" and free from all blemishes.
Thus it seems that subjects of rather faulty conformation, ani-
mals having lymphatic temperaments and the coarse-bred types,
are prone to synovial disturbances such as thoroughpin, bog
spavin, etc., sometimes having both legs affected.
Symptomatology. — Thoroughpin is characterized by a dis-
tended condition of the tarsal sheath which is manifested by
Fig. 58 — Fibrosity of larsus as a complication in clironic thoroughpin.
protrusions anterior to the tendo Achillis. However, where but
moderate distension of the sheath exists, there is little, if any,
bulging on the mesial side of the hock and but a small hem-
ispherical enlargement is presented on the outer side of the
tarsus, anterior to the summit of the os calcis. In some instances
the protruding parts assume large proportions, but always, be-
cause of the relationship between the fibular tarsal bone (cal-
caneum) and the tendon sheath, the larger protrusion is situated
mesially.
LAMENESS IN THE HIND LEG
249
During the acute inflammatory stage there is marked lameness
present but this soon subsides when local antiphlogistic agents
are applied to the parts. In fact, spontaneous relief from lame-
ness usually results in the course of ten days' time following the
appearance of thoroughpin. No lameness marks the advent of
Fig-. 59 — Another view of same case as illustrated in Fig. 58.
this affection when it develops as the result of continuous strain
and concussion occasioned by hard service, and local changes
tend to remain in status quo.
Treatment. — Rest and the local application of heat or cold
will suffice to promote resolution of acute inflammation and lame-
ness when present will subside within two weeks. In chronic
affections, however, the matter and manner of effecting a cor-
250 LAMENESS OF THE HORSE
rection of the condition — distended tarsal sheath — merit careful
consideration. AVhile drainage of distended thecae and bursae
by means of openings made with hot irons was practiced by the
Arabs, centuries ago, and good results have attended such heroic
corrective measures, nevertheless the occasional serious complica-
tions which result from infection likely to be introduced in fol-
lowing such procedures, cause the prudent and skilful practi-
tioner to employ safer methods of treatment.
The application of blistering agents is of no value in stimu-
lating resorption of an excessive amount of synovia in chronic
cases and the actual cautery when employed without perfora-
tion of the synovial structure, is of little benefit. Trusses or
mechanical appliances for the purpose of maintaining pressure
upon the distended parts are of no practical value because
of the great difficulty of keeping such contrivances in position.
They usually cause so much discomfort to the subject that they
are not tolerated.
A very practical and fairly successful method of treatment
consists in the aspiration of a quantity of synovia and injecting
tincture of iodin. Cadiot recommends the drainage of synovia
with a suitable trocar and cannula and injecting a mixture
consisting of tincture of iodin, one part, to two parts of sterile
water, to which is added a small quantity of potassium iodid.
The latter agent is added to prevent precipitation of the iodin.
This authority (Cadiot) further advocates the removal of prac-
tically all of the synovia that will run out through the cannula
and the immediate introduction of as much as one hundred cubic
centimeters of the above mentioned iodin solution. This solu-
tion is allowed to remain in the synovial cavity a few minutes
and by compressing the tissues surrounding the tendon sheath,
the evacuation of as much of the contents of the synovial cavity
as is practicable, is effected. Subsequently the subject is al-
lowed absolute rest and more or less inflammatory reaction fol-
lows. In some cases there occur marked lameness and some
febrile disturbance, but where a good technic is carried out,
no bad results follow. At the end of four weeks' time, horees
so treated may be returned to service, but the full beneficial
[LAMENESS IN THE HIND LEG 251
effect of such treatment is not experienced until several months'
time have elapsed.
Where good facilities for executing a careful technic in every
detail are at hand, incision of the tarsal sheath, evacuation of
its contents and uniting its walls again by means of sutures
and providing for drainage with a suitable drainage tube, may
be practiced. This manner of treatment has been satisfactory
in the hands of a number of surgeons.
Capped Hock.
Enlargements which occur upon the summit of the os calcis,
whether hypertrophy of the skin and rmbcuticular fascia, the
result of injury or repeated vesication, distension of the sub-
cutaneous bursa or injury to the superficial flexor tendon (per-
foratus) or its sheath, are generally known as capped hock.
However, the term should be restricted to use in reference to
distensions of synovial structures of that region.
Etiology and Occurrence. — Usually there occurs a hygrom-
atous involvement of the subcutaneous bursa due to contusion.
As in bog spavin, following certain infectious diseases (influ-
enza, purpura hemorrhagica, etc.) there remains a distended con-
dition of the subcutaneous bursa, after swelling of the member
has subsided. In feeding pens where numbers of young mules
are kept in crowded quarters many cases may be observed. In
some instances where violent contusions result from kicking
cross-bars of wagon shafts (by nymphomaniacs or in habitual
kickers where there is opportunity for doing such injury) the
superficial flexor tendon and its synovial apparatus are injured
and a more serious condition may result.
Symptomatolog'y. — In acute and extensive inflammation of
the pai'ts, lameness is present, but in the average case no in-
convenience to the subject results. The prominent site of the
affection is cause for an unsightly blemish. This is undesirable,
particularly in light-harness or saddle horses. These affections
are characterized by a fluctuating mass which has a thin wall
and in all cases of long standing the condition is painless.
252 LAMENESS OP THE HORSE
By careful palpation one may readily distinguish between a
hygromatous condition of the superficial bursa and involvement
of the underlying structures. Affection of the expanded portion
of the flexor tendon and contiguous structures makes for an
organized mass of tissue which is somewhat dense and in some
instances painful to the subject when manipulated. This is par-
Fig. 60 — "Capped hock." Distension of the bursa over the summit of tlie
OS calcis.
ticularly noticeable in eases where the parts are regularly and
repeatedly injured as in habitual kickers.
Treatment. — In acute inflammation, antiphlogistic applica-
tions arc indicated and the subject must be kept quiet. The
matter of bandaging the hock is a difflcult problem in some cases
and needs be done with care. As has been previously stated in
this volume, the tarsus needs to be well padded with cotton be-
fore the bandages are applied and only a moderate degree of
tension is employed in applying the bandages lest anemic-necrosis
result from pressure. In distension of the . superficial bursa,
after clipping the hair over a liberal area and preparing the skin
LAMENESS IN THE HIND LEG 253
by thoroughly cleansing and painting with tincture of iodin, the
capsule is incised with a bistoury. An incision about an inch
in length, situated low enough to provide drainage, is made
through the tissues and the contents are evacuated. Tincture
of iodin is injected into the cavity and the parts are covered
with cotton and bandaged. No after-care is necessary except to
retain the dressing in position, which is not difficult in the
average case if the subject is kept tied. If much resistance is
exhibited, such as extreme flexion of the bandaged hock, the
animal may be put in a sling and little if any objection to the
bandage will be offered thereafter. The wound may be dressed
at the end of forty-eight hours and no redressing will be neces-
sary in the average instance if infection is not present. But
slight local disturbance and little distress to the subject result
in cases so treated even when infection occurs, but a good technic
is possible of execution in most instances and no infection should
take place.
The surgical wound heals in two or three weeks and inflamma-
tion gradually subsides. Bandages are retained one or two
weeks, as the case may require, and subsequently a good wound
lotion may be employed several times daily. A good lotion for
such cases as well as in many others has long been employed
with success by Dr. A. Trickett of Kansas City. It consists of
approximately equal parts of glycerin, alcohol and distilled ex-
tract of witch hazel, to which is added liquor cresolis compositus,
two percent, and coloring matter q. s.
Complete resolution does not occur in the average case. There
remains some hyperplastic tissue and even where the enlarge-
ment is slight, the prominent situation of the affection precludes
its being unnoticed.
In disease of the flexor tendon and its bursa where contiguous
inflammation of tissue is present, the parts are blistered or fired.
Line firing is beneficial in such instances but in all cases the
cause is to be removed if possible.
Rupture and Division of the Long Digital Extensor
(Extensor Pedis).
Etiology and Occurrence. — Because of the fact that the long
254 LAMENESS OF THE HORSE
digital extensor is the only extensor of the phalanges of the
pelvic limb, its rupture or division coiistitutes a troublesome
condition, which in some eases does not readily respond to treat-
ment.
Rupture of this tendon may occur during work on rough and
uneven roads, particularly in range horses that are ridden over
ground that is burrowed by gophers or prairie dogs; in such
cases, horses are apt to suddenly and violently turn the foot
in position of volar flexion, thereby causing undue strain to the
digital extensor and its rupture sometimes follows. In foals
of one or two days of age, this tendon is sometimes found parted
or ruptured and the condition may be bilateral.
As the result of accidents, the digital extensor may be divided
and when the wound becomes contaminated, as it does because
of the marked volar flexion (knuckling) which occurs during the
course of this affection, regeneration of tissue is checked and re-
covery is tardy.
Symptomatology. — There is no interference with ability to
sustain weight in such cases, when the foot is placed in normal
position; but immediately upon attempting to walk, the toe is
dragged, and if weight is borne with the affected member, it
comes upon the anterior face of the fetlock. The flexors are
not antagonized and if there be an open wound the parts soon
become contaminated; or, in rupture, if animals travel about
very much, there soon occurs necrosis of the tissues of the
anterior fetlock region and the condition is rendered in-
curable. Cases are reported of animals that have suffered rup-
ture of the long digital extensor and the subjects learned to
throw the member forward during extension, substituting for
the extensor tendon the pendulum-like momentum which the foot
affords when so employed; and a walking and even a trotting
pace was possible without doing injury to the fetlock region.
Where a subcutaneous division exists as in rupture, the di-
vided ends of the tendon may ])e definitely recognized liy palpa-
tion.
Treatment. — Subjects are l)est put in slings and k('i)t so con-
fined until regeneration of tendinous structures has been com-
LAMENESS IN THE HIND LEG 255
pleted. This requires from six weeks to two months' time. In
addition, the extremity is kept in a state of extension by means
of suitabk- si)lints ;uid shoes, — a shoe equipped with an exten-
sion at the toe and perforated so that a steel l)raee may be hooked
into the perforation and the brace fashioned to be buckled to
the upper metatarsal region. When braces are placed in front
of the foot, great care is necessary in properly padding the mem-
ber with cotton lest sloughing from pressure occurs at the coro-
net ; but this does not apply in rupture of extensors so nuich
as where flexors are ruptured.
Open wounds are treated along general surgical lines, dressed
as frequently as occasion demands, and recovery will ]:e complete
in a few months' time unless much of the tendon has been de-
stroyed. In one instance, the author had occasion to observe
such a condition, which, because of the extensive destruction
of tendon and lack of facilities for giving proper attention to
the subject, results were so unfavorable that it was deemed
necessary to destroy the animal.
Wounds From Interfering.
When, during locomotion, injury is inflicted upon the mesial
side of an extremity by the swinging foot of the other member,
the condition is termed interfering.
Etiolog-y and Occurrence. — Faulty conformation, bad shoe-
ing and over-work are the prineipal causes of interfering.
Horses that are 'M)ase narrow" or that have crooked legs are
quite apt to interfere. Shoes that are put on a foot that is not
level or applied in a twisted position, or shoes wide at the heel
will often cause interfering and injury. Animals that are driven
at fast work until they become nearly exhausted may be expected
to interfere. Such cases are frequently observed in \oung horses
that are driven over rough roads, particularly when so neai'ly
•exhausted or weakened from disease or inanition that the feet
are dragged forward rather than picked up and advanced in
the normal manner.
Symptomatology.— Wounds inflicted by striking the extrem-
ities in this manner present various appearances and occasion dis-
256 LAMENESS OF THE HORSE
similar manifestaticns. The hind legs are almost as frequently
affected as the front and the fetlock region is most often injured,
though wounds may be inflicted to the coronet. In front, the
carpus is sometimes the site of injury.
When only an abrasion is caused, little if any lameness oc-
curs, but where interfering is continued and nerves are involved
or subfascial infection and extensive inflammation succeed such
abrasions, marked lameness and evidence of great pain are mani-
fested. Frequently, in chronic eases affecting the hind leg, the
fetlock a.ssumes large proportions, and at times during the course
of every drive the subject strikes the niflamed part, immediately
flexing and abducting the injured member, and the victim hops
on the other leg until pain has somewhat subsided.
Interfering is much more serious in animals that are used at
fast work than in draft horses. In light-harness or saddle horses,
it may render the subject practically valueless or unserviceable
if the condition cannot be corrected.
Treatment. — AVherever possible, cause is to be removed and
if animals are properly used, ordinary interfering wounds will
yield to treatment. If the shoeing is faulty, this should be cor-
rected, the foot properly prepared and leveled before being shod
and suitable shoes applied. In young animals that become "leg-
weary ' ' from constant overwork, rest and recuperation are neces-
sary to enhance recovery. In such cases it will be found that
very light shoes, frequently reset, will tend to prevent injury to
the fetlock region such as characterizes these injuries of hind
legs.
Palliative measures of various kinds are employed where
cause is not to be remioved and a degree of success attends
such effort. In draft horses or animals that are used at a slow
pace, shields of various kinds are strapped to the extremity
and protection is thus afforded. Or, large encircling pads of
leather, variously constructed, serve to cause the subject to
walk with the extremities apart.
Interfering shoes of different types are of material benefit in
many instances. Often the principle upon which corrective shoe-
ing is based is that the mesial (inner) side of the foot is too
lew; the foot is consequently leveled and the innci- l)ranch of the
LAMENESS IN THE HIND LEG 257
shoe is made thicker than the outer, altering the position of the
foot in this way. This is productive of desirable results. How-
ever, much depends upon the manner in which the foot in motion
strikes the weight-bearing member as to the corrective measures
that are indicated. This belongs to the domain of pathological
shoeing and the reader is referred to works on this subject for
further study of this phase of lameness.
Lymphangitis.
Excluding glanders, in the majority of instances, lymphangitis
in the horse, such as frequently affects the hind legs, is due to
the local introduction of infectious material into the tissues as
a result of wounds. However, one may observe in some instances
an acute lymphangitis which affects the pelvic limbs of horses
and no evidence of infection exists. Consequently, lymphangitis
may be considered as infectious and non-infectious.
INFECTIOUS LYMPHANGITIS.
Etiolog"y and Occurrence. — Traumatisms of the legs fre-
quently result in infection and when such injuries are near
lymph glands, even though the degree of infection be slight,
more or less disturbance of function of the muscles in the vicinity
of such glands occurs and lameness follows.
The prescapular, axillary and cubital lymph glands when in a
state of inflammation, cause lameness of the front leg, and the
superficial inguinal and deep inguinal lymph glands not infre-
quently become involved also. Because of the location of these
lymph glands, they are subject to comparatively fre(|uent injury
and inflammation, causing lameness more often than other lynipli-
gland-affections.
Small puncture wounds in the region of the elbow are often
met with. These may be inflicted when horses lie down ui)nn
sharp stumps of vegetation or shoe-calk injuries nuiy be the
means of introducing contaginm, and an infectious inflammation
results. A])scess formation, the result of strangles or other in-
fection in the prescapular glands, may l)e observed at times.
Following castration, the inguinal lymph glands may ])ecome
involved in an infectious inflannnation and locomotion is im-
258 LAMENESS OF THE HORSE
peded to a marked degree. Horses running at pasture sometimes
become injured by trampling upon pieces of wood, causing one
end of these or of various implements to become embedded in the
soft earth and the other end to enter at the inguinal region and
even penetrate the tissues to and through the skin and fascia just
below the perineal region.
Nail punctures resulting in infection frequently cause an in-
Fig-. 61 — Chronic lymphangitis. Showing hypertropliy of the left hind leg,
due to repeated inflammation.
fectious lymphangitis and a marked and painful swelling of the
legs supervenes.
Symptomatology. — Lameness, mixed or swinging-leg, signal-
izes the presence of acute lymphangitis. There is always more
or less swelling present and manipulation of the affected parts
gives pain to the subject. Depending upon the character of the
infection and its extent, there is presented a varying degree of
constitutional disturbance. There may be a rise in temperature
of from two to five degrees, and in sucli instances tliere is an
accelerated pulse. Where nnich intoxiccition is present, anorexia
and dipsosis are to be noticed.
LAMENESS IN THE HIND LEG
259
Swelling may increase gradually and in time discharge of pus
may take place spontaneously without drainage being provided
for, if the character of the infection does not cause early death.
Fig. 62 — Elephantiasis.
In these cases lameness is pronounced and the cause of the dis-
turbance is to be sought, particularly if the condition be due to
a nail puncture.
Treatment. — Location of the site of injury is advisable in
260 LAMENESS OF THE HORSE
all cases and in some instances provision for drainage, as in
puncture wounds, is helpful. Locally, curettage and the j.ppli-
cation of suitable antiseptics are indicated. Hot fomentations
are beneficial and should be continued for several days if neces-
sary, to stimulate resolution. A brisk purge should be admin-
tered at the onset and strychnin, because of its indirect stimu-
lative effect upon the circulation together with its tonic effect
upon the musculature, is beneficial.
In all such cases rational treatment, good hygiene and careful
nui*sing are the principal factors which stimulate recovery. In-
dividual resistance or lowered vitality has a marked influence
on the course of this affection.
NON-INFECTIOUS LYMPHANGITIS.
This type of lymphangitis is associated with, or the result of,
a derangement of digestion. It affects heavy draft horses, rarely
other types of animals, and involves one or both hind legs.
Occurrence. — In healthy and well nourished horses irregu-
larly used, this affection may suddenly manifest itself. It oc-
curs in singular instances in mares that are in advanced preg-
nancy even when such animals are at pasture. Usually, however,
this malady is found in heavy draft horses that have been kept
stabled from one to three days.
Symptomatology. — At the outset in severe cases, there is
elevation of temperature, labored breathing, accelerated pulse,
anorexia and more or less swelling of the affected memliers.
Swelling is very painful and when the affected legs are palpated,
pain is manifested by flinching. The inguinal lymph glands
are often swollen but in some cases they are not affected in any
perceptible degree. In the average case suppuration does not
occur and when conditions are favorable, resolution is complete
within ten days. Tlie extent of the involvement and the intensity
of the affection vary materially in different cases and a chronic
lymphangitis may succeed the acute attacks and finally in
some instances, elei)liantiasis results.
Treatment. — An active purgative should be given at once
and in the ordinary case, stimulants are indicated. If marked
distress is present, morphin is given and where there is much
LAMENESS IN THE HIND LEG 261
rise of temperature, cold drinking water is offered in abundance
and catharsis is enhanced by enemata. Locally, hot appli-
cations are of benefit. Hot towels or cotton held in position
ny l)andages and kept soaked with warm water will relieve pain
and stimulate resolution. Diuretics may be of benefit and ano-
dyne applications are to be employed with profit in some cases.
Walking" exercise, if not indulged in to excess, is helpful as soon
as acute inflammation has subsided. By giving careful attention
to the regimen and providing regular exercise for susceptible
hubjects, this type of lymphangitis is often forestalled.
INDEX
A
\cetabuUini 185
Acute arthritis 65
Acute laminitis 162
Acute tendinitis 135
Affertions of blood vessels 31
Affections cf bursae and thecae 27
Affections of the feet 34
Affections of ligaments 20
Affections of lymph vessels and
glands 32
Affectioi s of muscles and ten-
dons 28
Affections of nerves 30
Anamnesis 38
Anatomo-physiological review
of parts of fore leg 55
Anatomo-physiological consid-
eration of the pelvic limbs..! 85
Anatomv of the joint capsule. .220
Annular ligament 58
Antea-spinatus muscle 65
Anterior brachial revion,
wounds of 90
Anterior digital extensor
muscle 193
Arteritis 209
Arterv (brachial), thrombosis
of the SI
Arthritis 22, 84
Arthritis, acute 65
Arthritis, chronic 65
Arthritis, infectious 66
Arthritis, metastatic 25
Arthritis of the fetlock joint....! 52
Arthritis, rheumatic 26
Arthritis, scapulohumeral 65
Arthritis, tarsal 225
Arthritis, traumatic 22
Articular ringbone 121
Articulation, femeropelvic 1S5
Articulation, m e t a carpophal-
angeal 5S
Articulation, scapulohumeral .. 55
Aspiration-and-injection treat-
ment of bog spavin... 241
Aspiration-and-injection treat-
ment of capped hock 252
Aspiration-and-injection treat-
ment of thoroughpin 250
Astragalus 190
Astragalus, fracture of the 230
Attitude of the subject 41
Atrophy of the quadriceps
muscles 205
Atrophy, shoulder 73
B
Biceps brachii 58, 65, 68, 69
Bicipital bursa, inflammation
of 68
Blood vessels, affections of 3!
Bog spavin 242
Bog spavin, aspiration-and-in-
jection treatment of .244
Bog spavin, line firing for 246
Bog spavin, vesication for 246
Bone spavin 235
Bones, degenerative changes in 16
Bones, tarsal 190
Bossi's double tarsal neurec-
tomy 242
Brachial artery, thrombosis of
the 81
Brachial paralvsis 77
Bursa intertubercularis 62. 69
Bursa podotrochlearis, inflam-
mation of the 157
Bursae, affections of 27
LAMENESS OF THE HORSE
Bursitis 27, l04
Bursitis, infectious 28
Bursitis in tlie fetlock region.. ..150
Bursitis intertubercularis 68
Bursitis, noninfectious 28
C
Calcaneocuboid ligaments 190
Calcaneo-metatarsal ligaments. .190
Calcaneum, fracture of the 230
Calk wounds 170
Capped hock .....251
Capped hock, aspiration-and-in-
jection treatment of 252
Capsular ligament 190
Caput muscles 71
Carpal bones, fmcture of the.. 96
Carpal bones, huation of the.... 96
Carpal flexors, contraction of
the 93
Carpal flexors, inflammation of
the 93
Carpal joint 58
Carpal joint, open 100
Carpitis 98
Carpus, inflammation of the.... 98
Cartilage, lateral, inflamma-
tion of 1 74
Cartilages of the third phalanx,
ossification of the 155
Chronic arthritis 65
Chronic gonitis 217
Chronic laminitis 164
Chronic tendinitis 137
Cochran shoe for dropped
soles 169
Collateral ligaments 190
Comminuted fractures 17
Compound fractures 17
Contracted tendons of foals. ...143
Contrat tion of the carpal flexors 93
Contraction of the flexor ten-
dons 137
Contusions of the triceps
brachii 71
Contusive wounds 85
Coracoradialis 58
Corns 172
Coronary region, wounds of
the 170
Corpora oryzoidea 218
Cotyloid ligament 185
Courbe 233
Crepitation, false 48
Crepitation, true 47
Crucial ligaments 188
Crural nerve, paralysis of the. .204
Cunean bursa 237
Cunean tenotomy 242
Cuneiform magnum 191
Cuneiform medium 191
Curb 233
D
Deep digital flexor, distension
of the tarsal sheath of 246
Deep flexor tendon (perforans) 60
Degenerative changes in bones 16
Diagnosis by exclusion 53
Diagnosis by use of the X-
ray 179
Diagnostic principles 37
Disease, navicular 157
Dislocations 21
Distension of the tarsal joint
capsule 242
Distension of the tarsal sheath
of the deep digital flexor 246
Division of long digital ex-
tensor 253
Dorsal ligaments 190
Dropped elbow 71, 80
Dropped soles, shoe for 169
Dropped stifle 205
Dry spavin 225
E
Elbow, dropped 71, 80
Elbow, inflammation of the 84
INDEX
Elbow joint 58
Elephantiasis 34
Etiology, general discussion of 15
Examination by palpation 43
Examination, special methods
of 53
Examination, visual 39
Exclusion, diagnosis by 53
Exostosis of splint bones 107
Exostosis, phalangeal 118
Extensor ( long digital ) rupture
and division of 253
Extensor of the digit, rupture
of 145
Extensor pedis 60
Extensor pedis, rupture of 145
Extensor pedis, rupture and di-
vision of 253
F
False crepitation 48
Feet, affection of the 34
Femoral nerve, paralysis of
the 204
Femeropatella ligaments 188
Femeropelvic articulation 185
Femur 185, 192
Femur, fracture of the 199
Femur, luxation of the 201
Fetlock joint 58
Fetlock joint, arthritis of the....l52
Fetlock joint, luxation of the..l25
Fetlock joint, open 110
Fetlock region, thecitis and
bursitis in 148
Fetlock, shoe for bracing the.. ..181
Fibular tarsal bone, fracture of
the 230
Firing, treatment of ringbone
by 123
First phalanx 59
"Fish knees" 145
Fixed luxations 21
Fixed patellar disarticulation. .213
Flexor brachii 58, 68, 69
Flexor carpiradialis 93
Flexor carpiulnaris 93
Flexor metacarpi externus 94
Flexor metacarpi internus 93
Flexor metacarpi medius 93
Flexor metatarsi 193
Flexor, superficial digital 194
Flexor tendons, contraction of
the 137
Flexor tendons, inflammation
of the 135
Flexor tendons, rupture of 146
Flexors of phalanges, open
sheath of 124
Foals, contracted tendons of.. ..143
Forearm, wounds of 90
Fore leg, lameness in the 55
Fracture of the carpal bones.... 96
Fracture of the femur 199
Fracture of the libular tarsal
bone 230
Fracture of first and second
phalanges 131
Fracture of humerus 82
Fracture of the ilium 198
Fracture of the ischial tuber-
osity 199
Fracture of the metacarpus 106
Fracture of the patella 212
Fractures of the pelvic bones..l96
Fracture of the proximal sesa-
moids 128
Fracture of the pubis 197
Fracture of the radius 87
Fracture of the scapula 62
Fracture of t'he tibia 222
Fracture of the tibial tarsal
bone 230
Fracture of the ulna 86
Fractures 16
Fractures, comminuted 17
Fractures, compound 17
Fractures, green stick 18
Fractures, impacted 19
Fractures, longitudinal 18
LAMENESS OF THE HORSE
Fractures, multiple .._ IS
Fractures, multiple longitu-
dinal 19
Fractures, oblique 18
Fractures, simple 17
Fractures, simple transverse.... IS
Fractures, transverse 18
Fragilitas 199
Fragilitas osseum 128
G
Gait, observing character of.... 4S
Gastrocnemius 194
Gluteal tendo-synovitls 203
Gluteus medius muscle 192, 203
Gonitis, chronic 217
Green stick fractures IS
H
Hind leg. lamenoss in the ISo
Hind leg, paralysis of the 204
Hip lameness 195
Hip swinney 205
Hock, capped 251
Hock joint 1S8
Hoof testers 53
Humeroradioulnar joint 58
Humerus, fracture of 82
I
Iliac thrombosis 209
Iliopsoas 204
Ilium, fracture of the 198
Impacted fractures 19
Infectious arthritis 66
Infectious bursitis 28
Infectious inflammation of the
lateral cartilage 173
Infectious lymphangitis 257
Infectious synovitis 124
Inflammation of the bicipital
bursa 68
Inflammation of the bursa
podotrochlearis 157
Inflammation of the carpal
flexors 93
Inflammation of the carpus 98
Inflammation of the elbow 84
Inflammation of the flexor ten-
dons 125
Inflammation of posterior liga-
ments of pastern 129
Inflammation of proximal sesa-
moid bones 12 1
Inflammation of third sesamoid
and deep flexor tendon 157
Inflammation of the trochan-
teric bursa -^^
Infraspinatus muscle 6o
Injection of fluids for quittor....l77
Injuries to scapulohumeral
joint 6^
Interfering, shoeing for 256
Interfering, wounds from 255
Ischial tuberosity, fracture of
the 199
Joint capsul'^. anatomy of the..220
Joint, carpal 58
Joint, elbow 58
Joint, fetlock 58
Joint capsule, tarsal, distension
of the 242
Joint, fetlock, arthritis of the....! 52
Joint, fetlock, luxation of 125
Joint, hock 18^
Joint, humeroradioulnar 58
Joint, open 67
Joint, open carpal 100
Joint, open fetlock 110
Joint, pastern proximal inter-
phalangeal 129
Joint, shoulder 55
Joint, stifle, open 220
Joint, tarsal, open 229
INDEX
L
Lameness, hip 1!)5
Lameness, mixed 49
Lameness in the fore leg 55
Lameness in the hind leg 185
Lameness, shoulder 61
Lameness, supporting-leg 49
I fimeness, swinging-leg 49
Laminitis 160
Laminitis, acute 162
Laminitis, chronic 164
Lateral cartilage, infectious in-
flammation of the 174
Lateral cartilages, ossification
of 155
Ligaments, affections of 20
Ligament, capsular 190
Ligaments, collateral - 190
Ligament, cotyloid 185
Ligaments, crucial 188
Ligaments, dorsal 190
Ligaments, femeropatella 188
Lisament, medial 190
Ligaments, mesial tarsal,
sprains of the 232
Ligaments of pastern proximal
interphalangeal joint, inflam-
mation of 129
Ligaments, patellar 188
Ligaments, plantar 190
Ligament, pubiofemoral 185
Ligament, superior check 58
Ligament, suspensory, rupture
of 146
Ligaments, volar 129
Ligament, volar-carpal or an-
nular 58
Ligation of the saphenous vein. .246
Line firing for bog spavin 246
Longitudinal fractures IS
Lumbosacral plexus 204
Luxation of the carpal bones.... 96
Luxation of the femur 201
Luxation of fetlock joint 125
Luxation of the patella 213
Luxation cf the patella, out-
ward 215
Luxation of the patella, up-
ward 214
Luxation of scapulohumeral
joint 67
Luxations 21
Luxations, fixed 21
Luxations, temporary 21
Lymph vessels and glands, af-
fections of 32
Lymphangitis 32
Lj'mphangitis, infectious 257
Lymphangitis, non-infectious..260
M
Medial ligament 190
Median neurectomy 124
Mesial tarsal ligaments, sprains
of the 232
Metacarpophalangeal articula-
tion 58
IMetacarpus, fracture of the 106
Metastatic arthritis 25
Mixed lameness 49
Momentary patellar disarticula-
tion 213
;Movements, passive 47
Multiple fractures 18
Multiple longitudinal fractures.. 19
Muscles, affections of 28
Muscle, antea-spinatus 65
Muscle, anterior digital ex-
tensor 193
Muscle, biceps brachii 58
;\Iuscle, caput 71
Muscle, gluteus medium. ...192, 203
Muscle, infraspinatus 65
Muscle, peroneus tertius 193
Muscle, postea-spinatus 65
Muscles, quadriceps 193
Muscles, quadriceps, atrophy
of the 205
Muscle, subscapularis 65
Muscle, supraspinatus 65
LAMENESS OP THE HORSE
IMuscle, tibialis anticus 193
Muscle, triceps brachii 58
Myalgia 195
N
Nail punctures 178
Navicular disease 157
Nerves, affections of 30
Nerve, femoral, paralysis of
the 204
Nerve, obturator, paralysis of
th° - 206
Nerve, sciatic, paralysis of
the 208
Nerve, (suprascapular) par-
alysis of the 75
Non-infectious lymphangitis ..260
Non-infectious bursitis 28
Neurectomy, Bossi's double
tarsal 242
Neurectomy, median 124
Neurectomy, plantar 124
O
Oblique fractures 18
Observing character of gait 48
Obturator nerve, paralysis of
the 206
Occurrence, general discussion
of 15
Omphalophlebitis 25
Open carpal joint 100
Open fetlock joint 110
Open joint 67
Open sheath of flexors of pha-
langes 124
Open stifle joint 220
Open tarsal joint 229
Os corona 60
Ossification of cartilages of the
third phalanx 155
Ossification of the lateral
cartilages 155
Os innominatum 196
Os suffraginis 59
Osteitis, rarefying 16
Outward luxation of the pa-
tella 215
P
Palpption, examination by 43
Paralvsis. brachial 77
Paralysis of the femoral nerve. .204
Paralvsis of the hind leg 204
Paralysis of the obturator
nerve - 206
Paralvsis of the sciatic nerve... .208
Paralysis of the suprascapular
nerve 75
Paralysis, radial 77
Paronychia 170
Passive movements 47
Pastern proximal interpha-
langeal joint, inflammation of
ligaments of 129
Patella - 18S
Patella, fracture of the 212
Patella, luxation of the 213
Patella, outward luxation of
the 215
Patella, upward luxation of
the 214
Patellar disarticulation, fixed.. ..213
Patellar disarticulation, mo-
mentary 21 3
Patellar ligaments 188
Pelvic bones, fractures of the. .196
Pelvic limbs, anatomo-physio-
logical consideration of the....l85
Penetrative wounds 85
Periarticular ringbone 122
Peroneus fortius muscle 193
Phalangeal exostosis 118
Phalanges, fracture of first and
second 131
Phalanges, open sheath of
flexors of 124
Phalanx, first 59
Phalanx, second 60
Phalanx, third, ossification of
cartilages of 155
INDEX
Plantar ligaments 190
Plantar neurectomy 124
Polyarthritis 25
Postea-spinatus muscle 65
Principles, diagnostic 37
Proximal sesamoid bones, in-
flammation of 127
Proximal sesamoids, fracture
of - 128
Pubiofemoral ligament 185
Pubis, fracture of the 197
Punctures, nail 178
Q
Quadriceps muscles 193
Quadriceps muscles, atrophy of
the 205
Quittor 174
Quitter, injection of fluids for.. ..177
R
Rachitic ringbone 122
Radial paralysis 77
Radius, fracture of the 87
Rarefying osteitis 16
Rheumatic arthritis 26
Rheumatism 196
Ringbone 118
Ringbone, articular 121
Ringbone, periarticular 122
Ringbone, rachitic 122
Ringbone, traumatic 122
Ringbone treated by flring 123
Roberts shoe for bracing the
fetlock 181
Rupture of the extensor pedis. .145
Rupture of flexor tendons and
suspensory ligament 146
Rupture of long digital ex-
tensor 253
Rupture of the tendo archillis..224
S
Saphenous vein, ligation of
the 246
Scapula, fracture of the 62
Scapulohumeral articulation .... 55
Scapulohumeral joint, injuries
to 66
Scapulohumeral joint, luxation
of 67
Scapulohumeral joint, wounds
of 67
Scapulohumeral arthritis 65
Sciatica 208
Sciatic nerve, paralysis of the. .208
Second phalanx 60
Sesamoid bones 59
Sesamoid, third, inflammation
of the 157
Sesamoids, proximal, fracture
of 128
Sesamoiditis 127
Setons 75
Sheath of flexors of phalanges,
open 124
Sheath (tarsal) of the deep
digital flexor, distension of
the 246
Shoe for dropped soles 169
Shoeing for interfering 256
Shoulder atrophy 73
Shoulder joint 55
Shoulder lameness 61
Simple fractures 17
Simple transverse fractures.... 18
Soles, dropped, shoe for 169
Spavin, bog 242
Spavin, bone 235
Spavin, dry 225
Spavin test 239
Special methods of examina-
tion 53
Sprains of the mesial tarsal
ligaments 232
Sprains, tarsal 232
Splints 107
Spring-halt 225
Stifle, dropped 205
Stifle joint, open 220
LAMENESS OF THE HORSE
Strangles 25
Streptococcus equi 25
String-halt 225
Subject, attitude of the 41
Subscapularis muscle 65
Supporting-leg-lameness 49
Suprascapular nerve, paralysis
of the 75
Supraspinatus muscle 65
Superficial digital flexor 194
Superior check ligament 58
Suspensory ligament, rupture
of 146
Sweeny "73
Swinging-leg-lameness 49
Swinney 73
Swinney, hip 205
Synovial distension of tendon
sheaths 104
Synovitis 25
Synovitis, infectious 124
T
Tarsal arthritis 225
Tarsal bones 190
Tarsal joint capsule, distension
of the 242
Tarsal joint, open 229
Tarsal sheath of the deep
digital flexor, distension of
the 246
Tarsal sprains 232
Tarsus 192
Temporary luxations 21
Tendinitis 135
Tendinitis, acute 135
Tendinitis, chronic 137
Tendo achillis, rupture and
wounds of the 224
Tendon, deep flexor, inflamma-
tion of the 157
Tendon, deep flexor (per-
forans) 60
Tendon, extensor, rupture of. .145
Tendon, flexor, rupture of ..146
Tendons of foals, contracted.... 143
Tendon sheaths, synovial dis-
tension of 104
Tendons, affections of 28
Tendons, flexor, contraction of
the 137
Tendons, flexor, inflammation
of the 135
Tendo-synovitis, gluteal 203
Tenotomy, cunean 242
Tensor fascia lata 192
Test, spavin 239
Testers, hoof 53
Thecae, affections of 27
Thecitis 27, 104
Thecitis in the fetlock region... .150
Thoroughpin 246
Thoroughpin, aspiration-and-in-
jection treatment of 250
Thrombosis, iliac 209
Thrombosis of the brachial
artery 81
Tibia ..-- 188
Tibia, fracture of the 222
Tibial tarsal bone, fracture of
the : 230
Tibialis anticus muscle 193
Tibioastragular joint, disten-
sion of the 242
Transverse fractures 18
Traumatic arthritis 22
Traumatic ringbone 122
Treatment of bog spavin by
aspiration and injection 244
Treatment of capped hock by
aspiration and injection 252
Treatment of ringbone by fir-
ing 123
Treatment of thoroughpin by
aspiration and injection 250
Triceps brachii 58
Triceps brachii, contusions of.. 71
Triceps extensor brachii 71
INDEX
Trochanteric bursa, inflamraa-
tion of the 204
True crepitation 47
U
Ulna, fracture of the 86
Ulnaris lateralis 94
Upward luxation of the patella.. 214
Vein, saphenous, ligation of
the 246
Vesication for bog spavin 246
Vessignon cheville 246
Visual examination 39
Volar ligaments 129
W
Wounds, calk i7o
Wounds, contusive 85
Wounds from interfering 255
Wounds of anterior brachial
region 90
Wounds of coronary region 170
Wounds of scapulohumeral
joint 67
Wounds of tendo achillis 224
Wounds, penetrative So
Volar-carpal ligament
58 X-ray diagnosis 179
AUTHORITIES CITED
Almy, J
141, 200, 202, 208, 212, 216, 214, 233
Bassi 215
Bauman, S. H 197
Bell, Roscoe R. 69
Benard 216
Berns, Geo. H 77, 218
Bouley 225
Bourdelle 147
Cadiot, P. J....78, 141, 200, 202, 208,
212, 214, 216, 223, 225, 233, 245, 250
Campbell, D. M 162, 166, 167
Castagne - 84
Cochran, David W 169, 170
Diekerhoff 237
Dollar, Jno. A. W 68, 198
Eberlein 237
Fisher, Carl W 236
Frost, J. N 113
Frost, R. F 128
Greaves, Thomas 157
Hoare, E. Wallis 25, 211, 230
Hughes, Joseph 176, 221
Hutyra and Marek 205
Law, James 33
Leblanc 223
Liautard, A 84, 199, 238
Lusk, Wm. V 203
McDonough, James 237
Merillat, Edward 210
Merillat, L. A 80, 96, 175, 210
Millar, Thomas 145
Muller, H 119, 156, 211, 222
Montane 147
Moore, R. C 162
Roberts, G. H 181
Schumacher 215
Scott, John 208
Seeley, J. T 176
Sisson. Septimus 129, 204, 220
Smith, F., Major General 56,
60, 155, 188, 194
Strangeways 193
Taylor, Henry 71
Thompson, H 83, 87
Trickett, A 253
Udall, D. H 236
Uhlrich 224
Walters, Wilfred 83, 97
Williams. W. L 217, 236
Webster Family Library of Veterinary Medicine
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