Case Report Experiment

Harvey Saunders

Signalment and Initial Complaint

Harvey Saunders

• 13 year old, Anglo-Arab Gelding, weighing 559kg.
• He presented with an intermittent right forelimb lameness of 2 -3 month duration.

What would your work up now consist of?

There are 6 things that could be done to achieve a full work up.... (highlight to reveal answers)

• Further history
• Physical Examination
• Gait Analysis
• Diagnostic Analgesia
• Radiographs or Ultrasounds
• Scintigraphy

Clinical Examination Results

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• Forelimb palpation:
  • Right Forlimb:
    • heat and swelling at proximal metacarpal region
    • mild pain elicited on suspensory ligament palpation
    • mild thickening of lateral branch of SL (no pain)

• Hoof testers: negative

Gait Analysis

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• Trot straight line: 2/10 Right Forelimb lame

• Soft lunge:
  • right rein: 3/10 Right Forelimb lame
  • left rein: 2/10 Right Forelimb lame

• Hard lunge:
  • right rein: 2/10 RF lame
  • left rein: no lameness

• Proximal forelimb flexion, right and left: negative

• Distal forelimb flexion, right and left: negative

What is your Problem List and Differential List?

Problem List

• Pain on palpation
• Swelling
• Lameness
• Thickening of Suspensory Ligament

Differential List

• ?????????
• ????????

What is your revised action plan?

• Diagnostic Analgesia
• Radiographs and Ultrasound
• Scintigraphy

Diagnostic Imaging Results

Ultrasonography

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Q: What do you think is going?

A: There is a focal hypoechoic area on the dorsal border of the suspensory ligament at its proximal insertion

Radiographs

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Q; How would you interpret these radiographs?

A: Small radiolucent area with new bone formation on palmar mid aspect of the MC3 of RF. This has questionable significance.

Scintigraphy

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Q: How would you interpret these results?

A: Mild IRU w/in proximal aspect of left MC2. Mild IRU w/in middle aspect of R MC2 - unlikely to be of clinical significance

What is your diagnosis?

• proximal suspensory ligament desmitis of right forelimb

Treatment

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What do you feel should be done to treat this case?

This is what actually was done:

• Box rest – 2 weeks 15 mins in hand walking BID

- 2 weeks 30 mins in hand walking BID - 2 weeks 40 mins in hand walking BID