articulated with the thigh bone that the means of union are of
sufficient strength to resist the causes which usually give rise to
luxations, yet there is sometimes discovered a peculiar, pathological
state in the hind legs of animals, the effect of which is closely to
simulate the manifestation of many of the general symptoms of
dislocations. This condition originates in muscular cramps, the action
of which is seen in a certain change in the coaptation of the articular
surfaces of the stifle and thigh bone, resulting in the exhibition of a
sudden and alarming series of symptoms which have suggested the phrase
of "stifle out" as a descriptive term.
_Symptoms._--The animal so affected stands quietly and firmly in his
stall, or perhaps with one of his hind legs extended backward, and
resists every attempt to move him backward. If urged to move forward he
will either refuse or comply with a jump, with the toe of the disabled
leg dragging on the ground and brought forward by a second effort. There
is no flexion at the hock and no motion at the stifle, while the
circular motion of the hip is quite free. The leg appears to be much
longer than the other, owing to the straightened position of the thigh
bone, which forms almost a straight line with the tibia from the hip
joint down. The stifle joint is motionless, and the motions of all the
joints below it are more or less interfered with. External examination
of the muscles of the hip and thigh reveals a certain degree of
rigidity, with perhaps some soreness, and the stifle bone may be seen
projecting more or less on the outside and upper part of the joint.
This state of things may continue for some time and until treatment is
applied, or it may spontaneously and suddenly terminate, leaving
everything in its normal condition, but perhaps to return again.
_Cause._--Pseudo-dislocation of the patella is liable to occur under
many of the conditions which cause actual dislocation, and yet it may
often occur in animals which have not been exposed to the ordinary
causes, but which have remained at rest in their stables. Sometimes
these cases are assignable to falls in a slippery stall, or perhaps
slipping when endeavoring to rise; sometimes to weakness in convalescing
patients; sometimes to lack of tonicity of structure and general
debility; sometimes to relaxation of tissues from want of exercise or
use. A straight leg, sloping croup, and the young are predisposed to
this dislocation.
_Treatment._--The reduction of these displacements of the patella is not
usually attended with difficulty. A sudden jerk or spasmodic action will
often be all that is required to spring the patella into place, when the
flexion of the leg at the hock ends the trouble for the time. But this
is not always sufficient, and a true reduction may still be indicated.
To effect this the leg must be drawn well forward by a rope attached to
the lower end, and the patella, grasped with the hand, forcibly pushed
forward and inward and made to slip over the outside border of the
trochlea of the femur. The bone suddenly slips into position, the
excessive rigor of the leg ceases with a spasmodic jerk, and the animal
may walk or trot away without suspicion of lameness. Though this may end
the trouble for the time, and the restoration seem to be perfect and
permanent, a repetition of the entire transaction may subsequently take
place, and perhaps from the loss of some proportion of tensile power
which would naturally follow the original attack in the muscles involved
the lesion might become a habitual weakness.
Warm fomentations and douches with cold water will often promote
permanent recovery, and liberty in a box stall or in the field will in
many cases insure constant relief. The use of a high-heeled shoe is
recommended by European veterinarians. The use of stimulating liniments,
with frictions, charges, or even severe blisters, may be resorted to in
order to prevent the repetition of the difficulty by strengthening and
toning up the parts.
DISEASES OF MUSCLES AND TENDONS.
SPRAINS.
This term expresses a more or less complete laceration or yielding of
the fibers of the muscles, tendons, or the sheaths surrounding and
supporting them. The usual cause of a sprain is external violence, such
as a fall or a powerful exertion of strength, with following symptoms of
soreness, heat, swelling, and a suspension of function. Their
termination varies from simple resolution to suppuration, and commonly
fibrinous exudation difficult to remove. None of the muscles or tendons
of the body are exempt from liability to this lesion, though naturally
from their uses and the exposure of their situation the extremities are
more liable than other regions to become their seat. The nature of the
prognosis will be determined by a consideration of the seat of the
injury and the complications likely to arise.
_Treatment._--The treatment will resolve itself into the routine of
local applications, including warm fomentations, stimulating liniments,
counterirritation by blistering, and in some cases even firing. Rest, in
the stable or in a box stall, will be of advantage by promoting the
absorption of whatever fibrinous exudation may have formed, or
absorption may be stimulated by the careful persevering application of
iodin in the form of ointments of various degrees of strength.
There are many conditions in which not only the muscular and tendinous
structures proper are affected by a strain, but, by contiguity of parts,
the periosteum of neighboring bones may become involved, with a
complication of periostitis and its sequelae.
LAMENESS OF THE SHOULDER.
The frequency of the occurrence of lameness in the shoulder from sprains
entitles it to precedence of mention in the present category, for,
though so well covered with its muscular envelope, it is often the seat
of injuries which, from the complex structure of the region, become
difficult to diagnosticate with satisfactory precision and facility. The
flat bone which forms the skeleton of that region is articulated in a
comparatively loose manner with the bone of the arm, but the joint is,
notwithstanding, rather solid, and is powerfully strengthened by tendons
passing outside, inside, and in front of it. Still, shoulder lameness or
sprain may exist, originating in lacerations of the muscles, the tendons
or the ligaments of the joint, or perhaps in diseases of the bones
themselves. "Slip of the shoulder" is a phrase frequently applied to
such lesions.
The identification of the particular structures involved in these
lesions is of much importance, in view of its bearing upon the question
of prognosis. For example, while a simple superficial injury of the
spinatus muscles, or the muscles by which the leg is attached to the
trunk, may not be of serious import and may readily yield to treatment,
or even recover spontaneously and without interference, the condition is
quite changed in a case of tearing of the flexor brachii, or of its
tendons as they pass in front of the articulation, or, what is still
more serious, if there is inflammation or ulceration in the groove over
which this tendon slides, or upon the articular surfaces or their
surroundings, or periostitis at any point adjacent.
_Causes._--The frequency of attacks of shoulder lameness is not
difficult to account for. The superficial and unprotected position of
the part and the numerous movements of which it is capable, and which,
in fact, it performs, render it both subjectively and objectively
preeminently liable to accident or injury. It would be difficult and
would not materially avail to enumerate all the forms of violence by
which the shoulder may be crippled. A fall, accompanied with powerful
concussion; a violent muscular contraction in starting a heavily loaded
vehicle from a standstill; a misstep following a quick muscular effort;
a jump accompanied with miscalculated results in alighting; a slip on a
smooth, icy road; balling the feet with snow; colliding with another
horse or other object--indeed, the list may be indefinitely extended,
but without profit or utility.
_Symptoms._--Some of the symptoms of shoulder lameness are peculiar to
themselves, and yet the trouble is frequently mistaken for other
affections--navicular disease more often than any other. The fact that
in both affections there are instances when the external symptoms are
but imperfectly defined, and that one of them especially is very similar
in both, is sufficient to mislead careless or inexperienced observers
and to occasion the error which is sometimes committed of applying to
one disease the name of the other, erring both ways in the interchange.
The true designation of pathological lesions is very far at times from
being of certain and easy accomplishment, and, owing to the massive
structure of the parts we are considering, this is especially true in
the present connection. Still there are many cases in which there is
really no reasonable excuse for an error in diagnosis by an average
practitioner.
Shoulder lameness will, of course, manifest itself by signs and
appearances more or less distinct and pronounced, according to the
nature of the degrees and the extent of the originating cause. We
summarize some of these signs and appearances:
The lameness is not intermittent, but continued, the disturbance of
motion gaging the severity of the lesion and its extent. It is more
marked when the bones are diseased than when the muscles alone are
affected. When in motion the two upper bony levers--the shoulder blade
and the bone of the upper arm--are reduced to nearly complete immobility
and the walking is performed by the complete displacement of the entire
mass, which is dragged forward without either flexion of extension. The
action of the joint below, as a natural consequence, is limited in its
flexion. In many instances there is a certain degree of swelling at the
point of injury--at the joint, or, more commonly, in front of it, or on
the surface of the spinatus muscle. Again, instead of swelling there
will be muscular atrophy, though, while this condition of loss of
muscular power may interfere with perfect locomotion, it is not in
itself usually a cause of shoulder lameness. "Sweenied" shoulders are
more often due to disease below the fetlock than to affections above the
elbow.
During rest the animal often carries his leg forward, somewhat analogous
to the "pointing" position of navicular disease, though in some cases
the painful member drops at the elbow in a semiflexed position. The
backing is sometimes typical, the animal when performing it, instead of
flexing his shoulder, dragging the whole leg without motion in the upper
segment of the extremity.
The peculiar manner in which the leg is brought forward in the air for
another step in the act of walking or trotting is in some instances
characteristic of injuries of the shoulder. The lameness also manifests
itself in bringing the leg forward with a circumflex swinging motion and
a shortening in the extension of the step. The foot is carried close to
the ground and stumbling is frequent, especially on an uneven road.
With the utmost scrutiny and care the vagueness and uncertainty of the
symptoms will contribute to perplex and discredit the diagnosis and
embarrass the surgeon, and sometimes the expedient is tried of
aggravating the symptoms by way of intensifying their significance, and
thus rendering them more intelligible. This has been sought by requiring
the patient to travel on hard or very soft ground and compelling him to
turn on the sound leg as a pivot, with other motions calculated to
betray the locality of the pain.
_Treatment._--It is our conviction that lameness of the shoulder will in
many cases disappear with no other prescription than that of rest.
Provided the lesions occasioning it are not too severe, time is all that
is required. But the negation of letting alone is seldom accepted as a
means of doing good, in the place of the active and the positive forms
of treatment. This is in accordance with a trait of human nature which
is universal, and is unlimited in its applications; hence something must
be done. In mild cases of shoulder lameness, then, the indications are
water, either in the cold douche or by showering, or by warm
fomentations. Warm, wet blankets are of great service; in addition, or
as alternative, anodyne liniments, camphor, belladonna, either in the
form of tincture or the oils, are of benefit, and at a later period
stimulating friction with suitable mixtures, sweating liniments,
blistering compounds, subcutaneous injections over the region of the
muscle of 1-1/2 grains of veratrin (the variety insoluble in water)
mixed in 2 drams of water, etc., will find their place, and finally,
when necessity demands it, the firing iron and the seton.
The duration of the treatment must be determined by its effects and the
evidence that may be offered of the results following the action of the
reparative process. But the great essential condition of cure, and the
one without which the possibility of relapse will always remain as a
menace, is, as we have often reiterated in analogous cases, _rest_,
imperatively rest, irrespective of any other prescriptions with which it
may be associated.
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.