Read Ebook: Lameness of the Horse Veterinary Practitioners' Series No. 1 by Lacroix John Victor

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Paralysis of the Femoral Nerve.

Anatomy.--The femoral nerve is derived chiefly from the fourth and fifth lumbar nerves. It runs ventrally and backward, at first between the psoas major and minor, then crosses the deep face of the tendon of the latter and descends under cover of the sartorious over the terminal part of the iliopsoas. It innervates the psoas major , psoas minor , sartorious, rectus femoris, vastus lateralis . Branches supply the stifle and the adductor and pectineus muscles.

Etiology and Occurrence.--While paralysis of the femoral nerve, also known as "dropped stifle" occurs as a result of local injuries and melanotic tumors in gray horses, most cases are due to azoturia. So-called crural paralysis or "hip swinney" is occasionally observed but this is not a condition wherein the nerve is affected in the manner that characterizes the marked atrophy of quadriceps femoris muscles in some cases of hemaglobinuria. This form of paralysis according to Hutyra and Marek is due primarily to diffuse degeneration of the muscles.

Symptomatology.--When muscular atrophy is not extensive no particular evidence of this condition may be manifested while the subject is at rest, but where muscular waste has occurred, the nature of the ailment is at once recognized. Since the femoral nerve supplies the quadriceps femoris muscles, it follows that when the psoic portion of this nerve becomes diseased, the stifle loses its support, and in a unilateral involvement when the subject attempts to walk on the affected member, the stifle sinks down for want of support and the leg collapses unless weight is caught up with the other leg. Often, following azoturia, a bilateral affection is to be observed.

Treatment.--Horses may be restrained in the standing position, and in the average instance, a twitch and hood are all the restraining appliances necessary.

In cases where the disease is unilateral and atrophy is not of too long standing, recovery is possible in vigorous subjects. All affections, however, wherein degenerative changes involve the nerve trunk, whether due to diffuse myositis or pressure from malignant tumors, will not yield to treatment.

The same general plan of treatment is indicated that is described on page 74 in the consideration of atrophy of the scapular muscles. It is especially important to provide for the subject to be exercised when there is atrophy of the quadriceps muscles following azoturia.

In addition to the foregoing, good results have attended the use of intramuscular injections of oxygen. The technic of the operation consists in preparing the area of skin which covers the atrophied muscles as for any operation. The hair is clipped over five or six or more circular areas of about an inch in diameter; the skin is cleansed and then painted with tincture of iodin.

A long heavy sterile needle, which is connected with an oxygen tank by means of six feet of rubber tubing, is thrust into the depths of the affected muscles and the gas is gently introduced into the tissues. One needs exercise extreme care that the gas enter slowly because great pain is produced by the sudden injection of the oxygen. Likewise too much of the gas must not be introduced at one place. When the oxygen is slowly introduced it may be allowed to enter the tissues until the subject gives evidence of experiencing considerable pain, or if the parts are not particularly sensitive, a reasonable amount is introduced at each one of five or six points. In large animals more points of injection may be used.

No infection or other bad results will follow the execution of a good technic and the treatment may be repeated every three or four weeks until either marked regeneration of tissue is evident or the case is obviously proved hopeless.

Paralysis of the Obturator Nerve.

Anatomy.--The obturator nerve, situated at first under the peritoneum, accompanies the obturator artery through the obturator foramen and gaining the muscles on the internal face of the thigh, terminates in the obturator externus, adductors, pectineus and gracilis, also giving twigs to the obturator internus .

Etiology and Occurrence.--This condition occurs upon rare occasions as the result of injury such as falls which cause extreme abduction of the legs, or in pelvic fracture where the nerve is directly injured, or when melanotic tumors or other new growths compress the nerve in such manner that its function is suspended. Paralysis of the obturator nerve or nerves is met with rather frequently, notwithstanding, in mares, following dystocia. The nerves may become bruised at the brim of the obturator foramen by being caught between the pelvis and the body of the fetus in some cases of protracted labor.

Symptomatology.--In a unilateral affection there may be little evidence of the trouble while the subject is standing; or there is to be seen some abduction; or the affected member may present abduction of the stifle and stand "toe outward." If the animal is walked there will be manifested more or less abduction and the character of the impediment varies according to the nature of the involvement.

Following protracted cases of labor in some instances where only a unilateral paralysis exists, walking is performed with difficulty; the subject may be unable to support weight with the affected member and is obliged to hop on the one sound hind leg. In bilateral affections, they are unable to rise. If the condition is severe the sling is required to keep the subject standing, and with this care, recovery will follow.

Treatment.--If new growths or callosities or similar conditions affect the nerve, little, if any, hope for recovery exists. In young and vigorous subjects where cause is not definitely known, a course of strychnin may be given. Good nursing, providing for the subject's comfort and allowing moderate exercise, constitute rational treatment. Stimulating embrocations on the abductor muscles resorted to in cases during the incipient stage may prove helpful.

When paralysis of the obturator nerve occurs as a post-partum complication, and other conditions are favorable, the subject should be raised to its feet without unnecessary delay. If the mare is unable to assist in regaining her feet, a sling is required. Usually little else is necessary and after a few days in the sling the subject can get about unassisted. In the meanwhile the well-being of the affected animal is to be considered just as in any other case where the patient is so confined. The foal in such instances constitutes a source of some trouble, but the average mare offers no serious resistance to the confinement occasioned by the sling.

Good hygienic care, a suitable diet and full physiological doses of strychnin are indicated. Cadiot and Almy recommend vaginal douches of cold water and counterirritation of the region of the inner thigh in these cases.

Paralysis of the Sciatic Nerve.

Anatomy.--The great sciatic nerve leaves the pelvis in company with the gluteal nerves, through the great sciatic foramen , passing downward along the posterior face of the femur. Near the stifle it passes between the two heads of the gastrocnemius muscle and continues as the tibial. Branches supply the following muscles--obturator, semimembranosus , biceps femoris , semitendinosus , lateral extensor and the tibial nerve, its continuation, innervates the digital flexors.

Etiology and Occurrence.--Paralysis of the great sciatic nerve may be caused by central disorders, injury in falling, fractures and new growths. Because of its protected position, this nerve does not often suffer injury, and paralysis of the sciatic nerve is recorded in a few instances owing to its rarity.

Symptomatology.--When consideration is given the number of muscles that are supplied by the sciatic nerve and the function of these muscular structures, it is obvious that the leg cannot be used in sciatic paralysis. However, the limb is capable of sustaining weight when it is fixed in position, but this is done without exertion of muscular fibers which are supplied by the great sciatic nerve. Trotting is impossible and flexion of the affected member is also likewise precluded. The foot is dragged when the subject is caused to advance.

Under the heading "sciatica," Scott has described a case of acute sciatic affection wherein a pacing horse manifested evidence of great pain of a nervous character. There were muscular twitchings and the leg was held off the floor and moved about convulsively. Breathing was very much accelerated, pulse 85 per minute, the temperature was 103? and manipulation of the hips augmented the pain.

This was not a paralytic condition and recovery resulted, yet undoubtedly this was a case which, if not properly cared for, might have terminated unfavorably.

Treatment.--Prognosis is decidedly unfavorable in paralysis of the great sciatic nerve. If treatment is attempted, it is to be conducted along the same general lines as in femoral paralysis. Particular attention should be given to conditions which will make for the patient's comfort, and as soon as it is evident that the affection is not progressing favorably, the subject should be humanely destroyed.

Iliac Thrombosis.

This condition is undoubtedly of more frequent occurrence than we are wont to grant when one considers the comparatively small number of cases that are actually recognized in practice. It does not follow, however, that iliac thrombosis rarely exists. Probably in the majority of instances there is insufficient obstruction of the lumina of vessels to provoke noticeable inconvenience. Or, if circulation is hampered to the extent that function is impaired and manifestations are observed by the driver, the subject may be permitted to rest a few days and partial resolution occurs, so that further trouble is not noticeable.

As judged by lesions of the aorta and iliac arteries in dissecting subjects, the conclusion that arteritis and resultant disorders are of rather frequent occurrence, is logical.

Etiology.--Inflammation of the vessel walls and resultant prolifieration of tissue together with the accumulation of clotted blood becoming organized, serve to obstruct the lumen of the affected artery. The cause of arteritis is unknown in many instances, but parasitic invasion and contiguous involvement of vessels in some inflammatory injuries are etiological factors.

Symptomatology.--A characteristic type of lameness signalizes iliac thrombosis and the following brief abstract from a contribution on this subject by Drs. Merillat, clearly portrays the chief symptoms:

Prognosis and Treatment.--In the majority of instances, when there is occasioned serious inconvenience, the outcome is not likely to be favorable, according to M?ller. 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. M?ller states that moderate exercise or work stimulates the establishment of collateral circulation. Massage per rectum is condemned as dangerous by Cadiot.

Fracture of the Patella.

Etiology and Occurrence.--Patellar fractures are rarely met with in the horse but may be caused by falls and heavy contusions. Violent muscular contraction, it is said, may also bring about the same condition.

Symptomatology.--Fracture may be transverse or vertical, and depending on the manner in which the bone is broken, prognosis is either at once rendered favorable or unfavorable. The patella performs a function which is in a way similar to that of the sesamoids and when fractured, complete recovery is improbable in the average instance. When complete, transverse fractures permit of separation of the parts of bone. Tension on the straight ligaments below and contraction of the quadriceps above usually cause insuperable difficulty in the handling of this type of fracture in the horse.

Compound fractures as well as multiple or comminuted fractures occasionally occur and these constitute injuries which are generally considered fatal, although Andrien, according to Cadiot and Almy, succeeded in obtaining complete recovery in a case of compound fracture of the patella and the horse was in service and almost free from lameness two months after treatment was begun.

No difficulty is encountered in recognizing the fracture of the patella because of the exposed position of the bone. Crepitation, and in some cases fissures, may be easily detected.

Treatment.--In simple fracture, when treatment is thought advisable, the subject is put in a sling and kept as nearly comfortable as possible. If little inflammation exists, the application of a vesicant two or three weeks after the injury has been inflicted will be helpful and serve to hasten repair.

Bandages or mechanical appliances are of no practical use in the handling of these cases.

Luxation of the Patella.

Luxation of the patella is a condition wherein the articular portions of the femur and patella assume abnormal relations whether such displacement of the patella be momentary and capable of spontaneous reduction, or fixed and requiring corrective manipulation. Spasmodic contraction of the crural muscles which sometimes retains the patella in such position that the leg is rigidly extended, does not in itself constitute luxation of the patella; and unless this bone becomes lodged on the upper portion of a femoral condyle or laterally displaced out of its femoral groove, luxation cannot be said to exist in the horse. These are sub-luxations.

Occasionally one may observe in suckling colts outward luxation of the patella wherein there is history of navel infection and no marked evidence of rachitis is present. Some of these cases recover. In a unilateral involvement of this kind in a three-month-old mule colt, the author observed a case wherein an unfavorable prognosis was given and destruction of the subject advised, because of the extreme dislocation of the patella. This colt, however, was not destroyed and in three weeks had apparently recovered. No treatment was given in this instance; the colt was allowed the run of a small pasture with its dam and in time it matured, becoming a sound and serviceable animal.

Classification.--Two forms of true patellar luxation in the horse may be considered; one which is due to the patella becoming fixed upon the internal trochlear rim of the femur and the other when the patella slips over the outer rim of the trochlea.

In some cases practitioners are called to attend young animals that are reported to be "stifled" and upon arrival the only noticeable symptom of pre?xisting luxation is the soiled condition of the anterior fetlock region--evidence of its having been dragged. Such cases may be styled momentary luxation, whether they are due to a weakened condition of the patellar ligaments or spasmodic contraction of the crural muscles.

In upward luxation, reduction is effected by attempting further extension of the stifle joint and at the same time the patella is pulled outward, off the internal rim of the trochlea. This is attempted by securing the subject in a standing position; the sound side is kept against a wall if possible and a rope is tied to the extremity of the affected leg. Traction is exerted upon the rope and at the same time force is directed against the stifle joint to produce further extension if possible, so that the straight patellar ligaments may relax sufficiently to allow the patella to be dislodged from its position upon the inner trochlear lip. Failing in this manner of procedure, the affected animal is to be cast and anesthetized with chloroform. The relaxation which attends surgical anesthesia will permit of reduction of the dislocated bone and manipulations such as have just been outlined may be employed.

Following reduction in the average case it is essential that the subject be given vigorous exercise for a few minutes. Reduction having been affected, the application of a vesicant over the whole patellar region is customary.

In cases of habitual luxation, unless the ligaments are so lax that the patella may be displaced laterally over the inner as well as the outer trochler rims, division of the inner straight patellar ligament will correct the condition. This desmotomy has been advocated by Bassi, and good results in appropriate cases have been reported by Cadiot, Merillat and Schumacher. This operation has been found a corrective in cases of outward luxation as well as those of upward dislocation of the patella when resorted to before the trochleae are worn from frequent luxation.

As a rule, the reduction of this form of luxation is not difficult. The patella may be pushed inward and into position without manipulation of the leg. Retention of the patella in position is a difficult problem. Bandaging is considered impractical and is not ordinarily done in this country. Benard, according to Cadiot and Almy, recommends bandaging with a heavy piece of cloth in which an opening is made through which the patella is allowed to protrude, and by turning such a bandage snugly about the stifle several times, the patella is held in position. This bandage should be kept in place for about ten days.

In young and rachitic animals outdoor exercise and a good nutritive ration for the subject are indicated. Hypophosphites in assimilable form may be beneficial, and vesication of the patellar region contributes to recovery.

Where extreme luxation is present in both stifles, the prognosis is unfavorable. In such cases, degenerative changes may exist and in some instances the ligaments are so diseased and elongated that regeneration is impossible. Williams reports a case where bilateral "floating" luxation was present and extensive degeneration changes affected the articulation.

In subjects suffering frequent dislocation of the patella it is possible in some cases, to prevent its occurrence or at least to minimize the distress occasioned by momentary luxation, by keeping the animals in wide stalls so that "backing" is unnecessary. In some nervous subjects that seem to be suffering from cramp of the crural muscles, the difficulty and pain of their being backed out of narrow stalls, accentuates the nervousness. Sudation and restlessness are manifested and the subject presents a clinical picture of distress and fear of a painful ordeal. In some cases of this kind, complete recovery takes place by the time animals are five or six years of age. One should avoid keeping such subjects in narrow stalls. Preferably patellar desmotomy should be performed that relief may be obtained at once.

Luxations attending some cases of influenza recover promptly when subjects are kept comfortably confined in roomy box-stalls. The administration of stimulative medicaments such as nux vomica and the application of an active blistering agent to the patella serve to hasten recovery. Dislocations in such cases are often bilateral and they are usually momentary. Reduction occurs spontaneously, as a rule, and the subjects are not occasioned much distress if they are kept quiet for a few days.

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