Part 69

SPRAIN OF THE ELBOW MUSCLES.

Causes.--This injury, which fortunately is not very common, is mostly encountered in cities among heavy draft horses or rapidly driven animals which are obliged to travel, often smooth shod, upon slippery, icy, or greasy pavements, where they are easily liable to lose their foothold. The region of the strain is the posterior part of the shoulder, and the affected muscles are those which occupy the space between the posterior border of the scapula and the posterior face of the arm. It is the muscles of the olecranon which give way.

Symptoms.--The symptoms are easily recognized, especially when the animal is in action. While at rest the attitude may be normal, or by close scrutiny a peculiarity may perhaps be detected. The leg may seem to drop; the elbow may appear to be lower than its fellow, with the knee and lower part of the leg flexed and the foot resting on the toe, with the heel raised. Such an attitude, however, may be occasionally assumed by an animal without having any special significance, but when it becomes more pronounced in motion the fact acquires a symptomatic value, and this is the case in the present instance. A rapid gait becomes quite impossible, and the walk, as in some few other diseases, becomes sufficiently characteristic to warrant a diagnosis even when observed from a distance. An entire dropping of the anterior part of the trunk becomes manifest, and no weight is carried on the disabled side in consequence of the loss of action in the suspensory muscles. There are often heat, pain, and swelling in the muscular mass at the elbow, though at times a hollow, or depression, may be observed near the posterior border of the scapula, which is probably the seat of injury.

These hurts are of various degrees of importance, varying from mere minor casualties of quick recovery to lesions which are of sufficient severity to render an animal useless and valueless for life.

Treatment.--The prime elements of treatment, which should be strictly observed, are rest and quiet. Prescriptions of all kinds, of course, have their advocates. Among them are ether, chloroform, camphor, alcoholic frictions, warm fomentations, blisters, setons, etc. Unless the conclusions of experience are to be ignored, my own judgment is decisive in favor of rest, judiciously applied, however, and my view of what constitutes a judicious application of rest has been more than once presented in these pages. There are degrees of this rest. One contemplates simple immobility in a narrow stall. Another means the enforced mobility of the slings and a narrow stall as well. Another a box stall, with ample latitude as to posture and space, and option to stand or lie down. As wide as this range may appear to be, radical recovery has occurred under all of these modified forms of letting our patients alone.

HIP LAMENESS.

The etiology of injuries and diseases of the hip is one and the same with that of the shoulder. The same causes operate and the same results follow. The only essential change, with an important exception, which would be necessary in passing from one region to the other in a description of its anatomy, its physiology, and its pathology would be a substitution of anatomical names in reference to certain bones, articulations, muscles, ligaments, and membranes concerned in the injuries and diseases described. It would be only a useless repetition to cover again the ground over which we have so recently passed in recital of the manner in which certain forms of external violence (falls, blows, kicks, etc.) result in other certain forms of lesion (luxation, fracture, periostitis, ostitis, etc.), and to recapitulate the items of treatment and the names of the medicaments proper to use. The same rules of diagnosis and the same indications and prognosis are applicable equally to every portion of the organism, with only such modifications in applying dressings and apparatus as may be required by differences of conformation and other minor circumstances, which must suggest themselves to the judgment of every experienced observer when the occasion arrives for its exercise.

An exception is to be made, while considering the subject in connection with the region now under advisement, in respect to the formidable affection known as morbus coxarius, or hip-joint disease; and leaving the detail of other lesions to take their place under other heads, that relating to the shoulder, for instance, we turn to the hip joint and its ailments as the chief subject of our present consideration.

Symptoms.--In investigating for morbus coxarius, let the observer first examine the lame animal by scanning critically the outlines of the joint and the region adjacent for any difference of size or disturbance of symmetry in the parts, any prominence or rotundity, and on both sides. The lame side will probably be warmer, more developed, and fuller, both to the touch and to the eye. Let him then grasp the lower part of the leg (as he would in examining a case of shoulder lameness) and endeavor to produce excessive passive motion. This will probably cause pain when the leg is made to assume a given position. Let him push the thigh forcibly against the hip bone, and the contact will again probably cause a manifestation of pain. If the horse is trotted, the limited action of the hip joint proper and the excessive dropping and rising of the hip of the opposite side will be easily recognized. Usually the animal does not extend the foot so far as customarily and picks it up much sooner.

The abductive or circumflex motion observed in shoulder lameness is also present in hip lameness, but under special conditions, and the test of the difficulty, either by traveling on soft ground or in turning the horse in a circle, may here also contribute to the diagnosis, as in testing for lameness in the anterior extremity.

Prognosis.--The prognosis of hip lameness is at times quite serious, not only on account of the long duration of treatment required to effect good results, and because of the character which may be assumed by the disease, but of the permanence of the disability resulting from it. Exostosis and ulcerative arthritis are sequelae which often resist every form of treatment.

Treatment.--As before intimated, this is little more than a repetition of the remarks upon the lameness of the shoulder, with slight modifications occasioned by the muscular structure of the hip, and we are limited to the same recommendations of treatment. The advantages of rest must be reaffirmed, with local applications, of which, however, it may be said that they are more distinctly indicated and likely to be more effective in their results than in shoulder lameness, and may be more freely employed, whether in the form of liniments, blisters (singly or repeated), firing, or setoning.

SPRAINS OF SUSPENSORY LIGAMENTS AND OF FLEXOR TENDONS OR THEIR SHEATHS.

The fibrous structure situated behind the cannon bones, both in the fore and hind legs, is often the seat of lacerations or sprains resulting from violent efforts or sudden jerks.

Cause.--The injury may be considered serious or trifling, according to the circumstances of each case as judged by its own history. Among the predisposing causes are a long, thin fetlock and a narrow knee or hock as viewed from the side, with the flexor muscles tied in just below the joint. The longer and more oblique the pastern the greater is the strain on the flexor tendons and suspensory ligaments; hence a low quarter, a toe calk, and no heel calks, or a thin calk placed at the tip under the toe, and leaving the quarters long abnormally stretches the back tendons and causes a great strain upon them just before the weight is shifted from the foot in locomotion. In runners and hunters the disease is liable to be periodic. In driving horses it is most common in well-bred animals of nervous temperament. Draft horses suffer most frequently in the hind legs.

Symptoms.--The injury is readily recognized by the changed aspect of the region and the accompanying local symptoms. The parts which in health are well defined, with the outlines of the tendons and ligaments well marked, become the seat of a swelling, more or less developed, from a small spot on the middle of the back of the tendon to a tumefaction reaching from the knee down to and even involving the fetlock itself. It is always characterized by heat, and it is variously sensitive, ranging from a mere tenderness to a degree of soreness which shrinks from the lightest touch. The degree of the lameness varies, and it has a corresponding range with the soreness, sometimes showing only a slight halting and at others the extreme of lameness on three legs, with intermediate degrees.

The lameness is always worse when the weight is thrown on the foot and is most marked toward the end of the phase of contact with the ground. Either passive irritation of the leg or turning the animal in a circle causes pain as in diseases of the joints. Sometimes the horse likes to get the heels on a stone or some elevation so as to relieve the weight from the flexor tendons. Finally, in cases of long standing, a shortening of the tendons occurs, resulting in the abnormal flexion of the foot known by horsemen as "broken down," or a more upright position of the foot may follow, producing perhaps knuckling or the so-called clubfoot.

Prognosis.--It may be safely assumed on general principles that a leg which has received such injuries seldom returns to a perfect condition of efficiency and soundness, and that as a fact a certain absolute amount of thickening and deformity will remain permanent, even when the lameness has entirely disappeared.

Treatment.--The injured member should receive the earliest attention possible, not only when the inflammatory condition is present, but when it is subsiding and there is only the thickening of the ligaments, the tendons, or the sheath.

The most important remedy is rest, and the shoes should always be removed. During the first three days cold in the form of immersion or continuous irrigation is indicated. Then warm moisture and continuous pressure are advised. The latter is best applied by placing two padded splints about the thickness of the thumb along the two sides of the tendon and binding them in place with even pressure by bandage. Frequent bathing with warm soap suds is also beneficial. The absorption of the exudate may be promoted and the work of restoration effected by frictions with alcohol, tincture of soap, spirits of camphor, mild liniments, strong, sweating liniments, and blisters. An excellent ointment to apply with massage consists of equal parts of blue ointment and green soap, with double the quantity of vaseline. The action of blisters in these cases depends chiefly upon the massage used in applying them and upon the continuous pressure of the swollen skin on the inflamed tendons. In old cases more beneficial results will follow line firing. In these cases shoeing is very important. Leave the quarters long, shorten the toe, give the shoe rolling motion, and either put short heel calks on the branches or thicken the branches. Although this line of treatment is efficacious in many cases, there are others in which the thickening of the tendons refuses to yield and the changed tissues remain firmly organized, leaving them in the form of a thick mass resting upon the back part of the cannon bone.

KNUCKLING OF FETLOCK.

As a consequence of the last-mentioned lesion of the tendons, a new condition presents itself in the articular disposition, constituting the deformity known as the knuckling fetlock. (See also p. 400.)

By this is meant a deformity of the fetlock joint by which the natural angle is changed from that which pertains to the healthy articulation. The first pastern, or suffraginis, loses its oblique direction and assumes another, which varies from the upright to the oblique, from before backward, and from above downward; in other words, forming an angle with its apex in front.

Causes.--This condition, as we have seen, may be the result of chronic disease producing structural changes in the tendons, and it may also occur as the result of other affections or some peculiarity independent of this and situated below the fetlock, such as ringbones, sidebones, or traumatic disease of the foot proper. Animals are sometimes predisposed to knuckling, such, for example, as are naturally straight in their pasterns, or animals which are compelled to labor when too young. The hind legs are more predisposed than the fore to this deformity, in consequence of the greater amount of labor they are required to perform as the propelling levers of the body.

Symptoms.--The symptoms of knuckling are easily recognized. The changes in the direction of the bones vary more or less with the degree of the lesion, sometimes assuming such a direction that it almost becomes a true dislocation of the pastern.

The effect of knuckling upon the gait also varies according to the degree of the deformity. As the different degrees of the shortening of the leg affect the motion of the fetlock, the lameness may be very slight or quite extreme. Another consequence of this shortening is such a change in the position of the foot that the heels cease to come in contact with the ground and assume a greater elevation, and the final result of this is soon witnessed in the development of a clubfoot.

Treatment.--To whatever cause the knuckling may be ascribed, it is always a severe infirmity, and there is but little room for hoping to overcome it unless it be during the very first stages of the trouble, and the hope dwindles to still smaller dimensions when it is secondary to other diseases below the fetlock. If it is caused by overworking the animal, the first indication, of course, will be rest. Line firing has proved very efficacious in these cases. The animal must be turned loose and left unemployed. Careful attention should be given to the condition of his feet and to the manner of shoeing, while time is allowed for the tendons to become restored to their normal state and the irritation caused by excessive stretching has subsided. A shoe with a thick heel will contribute to this. If no improvement can be obtained, however, and the tendons though retracted have yet been relieved of much of their thickening, the case is not a desperate one, and may yet be benefited by the operation of tenotomy, single or double--an operative expedient which must be committed to the experienced surgeon for its performance.

SPRUNG KNEES.