forelimb examination

• label the image

  A) scapula

  B) humerus

  C) carpus

  D) splint bones

  E) cannon

  F) coffin

  
• label the image

  A) white line

  B) angle of the bar

  C) heel bulb

  D) central sulcus

  E) frog

  F) sole

  
• label the image

  A) hoof wall

  B) sole

  C) white line

  D) bars

  E) frog

  F) sulcus

  
• label the joints

  A) antebrachiocarpal

  B) carpometocarpal

  C) fetlock

  D) pastern

  E) coffin

  
• label the image

  A) common digital extensor tendon

  B) lateral digital extensor tendon

  
• label the image

  A) superficial digital flexor tendon

  B) deep digital flexor tendon

  C) accessory

  D) deep

  E) suspensory ligament

  
• label the image

  A) SDFT

  B) DDFT

  C) Check ligament

  D) suspensory ligament

  E) 3rd metacarpal bone

  
• label the image

  A) SDFT

  B) DDFT

  C) Suspensory ligament

  D) 3rd metacarpal bone

  
• label the image

  A) SDFT

  B) DDFT

  C) intersesamoidean ligament

  D) proximal sesamoid bones

  E) 3rd metacarpal bone

  F) SDFT and DDFT tendon sheath

  
• label the image

  A) SDFT

  B) DDFT

  C) Oblique sesamoid ligament

  D) straight sesamoid ligament

  E) pastern

  
• label the image

  A) SDFT

  B) DDFT

  C) accessory ligament

  D) suspensory ligament

  
• What is the site of infection in this horse which was diagnosed with pus in foot?

  white line

  
• What bony landmark is visible within this wound?

  greater tubercle of the humerus

  
• The general principle with nerve blocks is that you deposit local anaesthetic around the nerves, starting from the most distal point and working your way upwards, until you have anaesthetised the painful area, and the horse is no longer lame.
• Below are the nerve blocks from distal to proximal, the first three are the most common…

  • Palmar digital nerve block
  • Abaxial sesamoid nerve block
  • Low four point (fetlock and below)
  • High four point (metacarpal region and below)
  • Lateral palmar nerve block (proximal suspensory ligament)
  • Median and ulna nerve block (carpus and below)
• what does the low four point anaesthesize?

  fetlock and below
• what does the high four point anaesthetize?

  metacarpal region and below
• what does the lateral palmar nerve block anaesthetize?

  the proximal suspensory ligament
• what region does the median and ulna nerve block anaesthetize?

  carpus and below
• In the forelimb we do all our blocks on the palmar aspect of the limb. The radial nerve stops at the carpus in the horse, and the innervation all comes from the median and ulna nerves on the palmar aspect of the limb.
• • Radial nerve
  • Extensors of elbow, carpus and digits
  • Skin sensation on craniolateral aspect of limb not dorsal digit. Stops at carpus
  • Median nerve
  • Flexors of carpus and digit
  • Skin sensation on palmar and dorsal digit
  • Ulna nerve
  • Flexors of carpus and digit
  • Caudal aspect of forearm, lateral and dorsal digit
• fill in the blanks

  A) radial

  B) ulnar

  C) median

  
• 1. Palmar digital nerves in the pastern region (palmar digital nerve block)

  • This removes sensation to the palmar foot
  • Place a pen across the areas to identify if there are areas that have not been desensitised

  1. Palmar digital nerves on abaxial surface of proximal sesamoid bones (abaxial sesamoid nerve block)

  • This removes the sensation to the foot pastern and palmar fetlock

  1. Palmar metacarpal and palmar nerves in distal metacarpus (Low 4 point)

  • Removes sensation to the fetlock and below

  A) ulnar

  B) median

  
• Which is the first nerve block you would start with on a horse which is forelimb lame with no localising signs?

  palmar digital nerve block
• You have been asked to re-examine a horse which has previously had proximal interphalangeal (pastern) joint pain which resolved, and the horse has now gone lame again. What response to nerve blocks would you expect if the proximal interphalangeal joint was still painful?

  the lameness would improve with a palmar digital nerve block and completely resolve with an abaxial sesamoid nerve block