AABP
Upper Leg Lameness in Calves, Growing Animals and Adult CattleUpper leg lameness (from the fetlock to the spine) constitutes somewhere between 6 to 10% of lameness in dairy cattle. A study of records from five western feedlots indicated that 70% of lameness disorders involved foot problems, 15% upper leg conditions, 12% septic joints and 3% injection site lesions. There are no real data on beef cows and bulls, but slaughter data indicates that arthritis and musculoskeletal disorders are 2 of the most common causes of premature culling in the cow/calf industry. Clearly, for those who are gamblers, when betting on whether a problem is in the foot or the upper leg; bet on it being in the foot. Point here is simply that when attempting to determine the cause of lameness always begin with the foot and move upward. Approach to Diagnosis of Upper Leg Lameness in CattleWhen dealing with upper leg lameness the first step is to obtain a history in terms of the duration, severity, onset of clinical signs and any previous treatment. This information is useful for making a reasonable prognosis and for deciding on possible follow-up treatment approaches. Examination begins with an observation of the animal from a distance while standing and walking. This is followed by hands-on examination techniques which, for the upper leg include palpation during standing and walking as well as manipulation of the leg with the animal in lateral recumbency (i.e. lying on its side). In some cases it may be difficult to distinguish upper from lower leg problems. As described elsewhere in this manual, this can be done placing a tourniquet at the level of the fetlock joint followed by intravenous injection of 20 ml of 2% lidocaine into a vein below the tourniquet. Remove the tourniquet after 5 minutes or so and immediately allow the animal to walk. In cases of upper leg problems the lameness will persist. In the following, we discuss the specific approaches to the diagnosis of upper leg lameness in calves and adult cattle. While these disorders tend to be less common than disorders of the foot, they are nonetheless important and at times more complicated in terms of diagnosis. Upper Leg Lameness in Calves and Growing AnimalsLameness in calves and heifers has multiple underlying causes. For the purposes of this discussion they are discussed under the following general presenting clinical signs: Inability to walk from birthNon-weight bearing lamenessStiffness, inability to advance leg, swelling, abnormal bone curvature, tense musclesCauses of upper leg lameness in calves include trauma, congenital or hereditable problems, septic arthritis, nutritionally-induced lameness and other deficiency diseases. Clinical signs may include non-weight bearing such as with a fracture or septic arthritis. Other signs of upper leg lameness in calves could include some of the following: a stiff painful gait, joint swelling, dragging the affected leg, firm tense muscles and abnormal curvature of the limbs. With congenital or hereditary problems calves could be down and unable to rise or walk from birth. Conditions that may result in an inability to walk from birthThe most common congenital limb deformities are contracted tendons, congenital articular rigidity and athrogryposis. Possible causes include hereditable or congenital factors and a variety of plant toxins such as locoweeds, lupins, sudan grass and others. Of these, contracted tendons, has the best prognosis. Mild to moderate cases will often recover spontaneously over the course of several days to a couple weeks. Contracture of the tendons may involve the fetlock joint only or the carpus (or knee) may also be involved. Although some have attributed this condition to restricted fetal space or a mal-positioning of the fetus in late gestation, exact 26454108763000cause is unknown. At least one source suggests that the cause is genetic. One of the biggest problems for calves is that contracture of the tendons often restricts their ability to stand, walk and therefore nurse. As a consequence, delayed intake or 26536652687320Figure 1. Contracted tendons in a beef calf.00Figure 1. Contracted tendons in a beef plete colostrum-deprivation is not uncommon in affected calves. 27990802657475Figure 2. Calf with splints applied to the front legs to maintain legs in extension00Figure 2. Calf with splints applied to the front legs to maintain legs in extension27559009017000In calves’ contracture of the flexor tendons and muscles may cause flexion of both the carpus and fetlock. In such cases the leg usually cannot be straightened and the flexor carpi ulnaris and flexor carpi radialis muscles can be felt as tight bands at the back of the knee in addition to the superficial and deep digital flexors. Semi-flexion of the knee can also be due to abnormal conformation or metabolic bone disease. Depending on the degree of contracture of the flexors, only the fetlock may be in variable degrees of flexion. In milder cases the animal may be able to walk on its toes and knuckle forward during weight bearing. In more severe cases the animal bears weight on the dorsum of the foot. The superficial and deep flexor tendons and the suspensory ligament of the proximal sesamoid, will feel tight on palpation. Calves with severe contracture of the tendons may be treated with a splint or cast applied to the legs maintaining them in extension for several days. These casts or splints must be monitored carefully for evidence of pressure sores; however putting the legs into extension helps the calf rise for nursing and increases their mobility permitting limited exercise. In extreme cases, surgery may be the only viable option. Early surgical intervention is usually successful in reversing the problem. Necropsy of affected calves tends to show little more than excessive contraction of the joints caused by shortening of the flexor tendons. Bovine virus diarrhea can cause birth of weak calves some with musculoskeletal abnormalities. Treatment with tetracycline to relax the tendons and speed recovery has been advised, but there is little scientific justification for this therapeutic procedure. Non-weight bearing lameness30924502297430Figure 3. Heifer with a fracture of the right rear lower leg that has been fitted with a cast to provide immobilization.Figure 3. Heifer with a fracture of the right rear lower leg that has been fitted with a cast to provide immobilization.30924502540000Fractures The most common causes of lameness resulting in a calf or young animal’s refusal to bear weight on a limb are trauma-related fractures. These often occur in newborn calves where dystocia has required forced extraction of the fetus at calving. Other trauma-related fractures would include fracture of the distal tibia resulting from the cow stepping on the calf. When or if this occurs, the calf should be kept in a confined area to prevent the fracture from compounding and perforating through the skin. Where possible the fracture can be stabilized with a padded bandage or splint. Care should be taken to avoid bandages that become excessively tight. Most fractures in calves below the elbow and stifle joint can be stabilized using long term (6 weeks or so) immobilization of the fracture ends through the use of a cast. Septic Arthritis Another cause of non-weight bearing or toe touching lameness is septic arthritis. Septic arthritis localized in one or more joints is a common outcome of infection via the navel. Secondary involvement of joints may occur from septicemias (bacteria absorbed into the blood stream) arising from gastrointestinal (E. coli, Salmonella, etc.) or respiratory (Mycoplasma sp.) diseases as well. Colostrum-deprived calves are particularly susceptible to septicemia and infectious arthritis. Another source of infection is the feeding of contaminated raw milk. Joints become warm and swollen, with affected animals showing varying degrees of lameness. 33991551983740Figure 4. Calf with infectious arthritis of the right front leg.Figure 4. Calf with infectious arthritis of the right front leg.33991552476500The carpus (front knee) is one of the common joints affected in cases of septic arthritis in calves. The joint is warm and often painful and there is palpable effusion (fluid accumulation) in the joint. For diagnostic purposes a veterinarian may choose to collect joint fluid to confirm the diagnosis. In chronic cases the joint looks and feels thicker and has reduced range of motion. In such cases chronic degenerative changes will also be visible on X-Ray.Navel infections and joint ill (infectious arthritis) are consistent with septicemias in calves. Thus, navel dipping has become a routine health management procedure in most dairy operations. Although there is very little if any scientific evidence to support navel dipping as a means to prevent disease in neonates, the association between navel infection, infectious arthritis and septicemia encourages dairymen to include disinfection of navels in neonatal calf care protocols. Indeed, there’s little question about the importance of colostrum and calving area hygiene in neonatal disease control. Many veterinarians recommend that serum total proteins also be monitored in calves (from 1-7 daysof age) either periodically or as a routine to ensure that colostrum intake and management is adequate. Calving areas should be inspected regularly and changes made as necessary to be sure that close-up cows have the cleanest and most comfortable conditions for calving.Depending upon severity, infectious arthritis conditions result in calves that develop more slowly or in worst case scenarios, calves that may need to be destroyed due to permanent damage of joint cartilage and chronic arthritis. The joints most often affected are the hock, knee (carpus) and stifle joints. As with most diseases, when treatment is instituted early a successful outcome is possible. Delays in identification and treatment create conditions that can be very difficult to manage. Prevention is far more effective than treatment. Problem herds need to ensure colostrum intake and maintain a clean and dry calving area for cows at the time of parturition. Stiffness, inability to advance leg, swelling, abnormal bone curvature, tense musclesSeveral conditions may be included under this general heading. Causes include nerve and muscle damage from trauma-related events, neuromuscular diseases and nutritional deficiencies. Injection site paresis The rear legs and hips are common sites for intramuscular injection in cattle. However, because of limited muscle mass in calves, injections that are given in the hip or rear leg may lead to temporary or even permanent paresis as a result of damage to the sciatic nerve and its distal branches. Damage to the sciatic nerve or its lower branches will cause calves to knuckle under or walk on the front of their pasterns. This problem may be avoided by using alternate sites (such as the neck region) for intramuscular injections or by choosing the subcutaneous route of administration whenever label directions permit it.Femoral nerve paralysis Damage to the femoral nerve results in paralysis of the quadriceps muscles of the rear leg which are required to extend the stifle (cow’s true knee) to bear weight. Affected animals have limited purposeful advancement of the limb which then collapses at the stifle on weight bearing. Femoral paralysis in calves may result from difficult calving situations associated with hip lock. Under these circumstances the hind limbs are over extended when excessive traction is applied to the fetus. This results in damage to the femoral nerve roots as they exit through the spinal column. There is increased laxity of the patella (knee cap) which predisposes to dislocation of the patella. In severe cases the quadriceps muscles atrophy (shrink) to the extent that the femur becomes easily palpable. Prognosis depends on severity with minor injuries having a fair to good prognosis. This is described in greater detail in the section at the end of this Chapter on Dystocia-related injuries in cows and calves. Peroneus tertius rupture Peroneus tertius rupture in calves can occur due to trauma of the front of the leg above the hock. It has also been observed in calves with fractures of the hind leg which were immobilized with heavy cast material forcing the animal to drag the leg. The hock is extended and the animal tends to drag the leg because of difficulty to advance the lower limb by flexing the hock. A unique diagnostic feature of this disease is that the limb can be pulled backward without resistance from the animal. Some improvement may occur by restricting exercise of the affected animal by maintaining it in a stall.29362402074545Figure 5. Spastic paresis in a beef calf. Note the overextension of the hock.00Figure 5. Spastic paresis in a beef calf. Note the overextension of the hock.29362409080500Spastic paresis Spastic paresis is a progressive hereditary contracture of the gastrocnemius muscles resulting in overextension of the hock. It occurs sporadically in both dairy and beef cattle and observed frequently in post-legged cattle. One or both rear legs may be affected. Clinical signs usually develop in young animals from as early as two weeks to six months of age. As the disease progress the animal develops a pendulum-type of gait with the affected limb or limbs. When only one limb is affected the animal will stand with the affected limb held back while simultaneously holding the sound limb forward to balance the animal’s weight. Surgical correction is possible but since it is a hereditary condition affected animals should be culled. Rickets Rickets is a disease of young particularly rapid growing calves due to failure of adequate mineralization of developing bone due to inappropriate ratios or absolute deficiencies of calcium to phosphorus in the body. Vitamin D deficiency is the most common cause of rickets in cattle raised indoors for prolonged periods. Clinical signs include a stiff gait and joint enlargement especially of the front limbs. In severe cases long bones may show abnormal curvature.Vit E /Selenium deficiency (white muscle disease) Clinical signs of Vit E/ selenium deficiency include a stiff gait, the large muscle groups are tense and hard or in some cases the animal is found lying down and unable to rise. Other conditions that may have similar signs include infectious myopathies such as black leg. There is some speculation that weak calf syndrome (described in greater detail below) also referred to as “Congenital Nutritional Muscular Dystrophy, may be associated with selenium deficiency. However a study conducted in the United Kingdom involving long term supplementation of selenium had no effect on the incidence of this condition in calves. Weak Calf Syndrome (Congenital Nutritional Muscular Dystrophy) Calves suffering from weak calf syndrome are often born weak, depressed and unable to stand or walk without assistance. Some of these calves die within minutes to hours of birth, whereas others may struggle-on for several days. Necropsy (autopsy) rarely defines the precise cause of the problem despite lesions in several organs. A quick review of the literature suggests that the primary contributors to weak calf syndrome are suboptimal nutrition of the dam, mineral deficiencies and infectious diseases. Heifers are reported to be more prone to producing calves with this syndrome than are older cows. Late gestation is probably the most critical period of time relative to preventing problems for the cow in early lactation as well as the calf at birth. Cows need to enter late gestation in good body condition and be fed to maintain condition through calving. Vitamin and mineral nutrition (including trace minerals) as described previously are also important for proper skeletal and muscle growth and should not be overlooked when developing rations for late term pregnant heifers and dry cows. In addition to proper nutrition of the dam in late gestation are challenges by a host of infectious diseases associated with weak calf syndrome most notable of which are Bovine Viral Diarrhea Virus (BVDV) and leptospirosis. Other factors that must be considered and eliminated as possible causes include: calves that fail to nurse because of poor udder and teat conformation (i.e. a pendulous udder or bottle teats) or an obstructed teat canal or blind quarter; a cow with acute or chronic mastitis; mismothering that often results in delays or restricted milk intake by the calf; congenital musculoskeletal disorders; calves born prematurely; calves suffering acute septicemia and diarrhea from causes other than BVDV or leptospirosis. Some of the causes of weak calf syndrome are preventable with proper attention to feeding, nutrition and management and a disease control program aimed at providing protection from common cattle pathogens. Dystocia-Related Injuries to Cows and CalvesDystocia is defined as difficult birth and the causes are many; but most calving problems are related to abnormalities in the fetuses’ presentation, posture, position and its size relative to the cow’s pelvis. The “presentation of a fetus” in obstetrical terms, is the spinal axis of the fetus relative to that of the dam. These may be longitudinal (i.e. up and down) or in a transverse (sideways) plane. Presentation also refers to the part of the fetus entering the birth 34772601935480Figure 6. Heifer in labor with front legs of the fetus protruding through the vulva.Figure 6. Heifer in labor with front legs of the fetus protruding through the vulva.34772606286500canal. Most fetuses enter the birth canal head first with the front legs extended forward (anterior presentation), but on occasion fetuses will be presented to the birth canal with their back feet and legs coming first (posterior presentation). Fortunately, on rare occasions a fetus may enter the birth canal with the spine or all 4 feet presented first. These may be longitudinal or transverse and in either case they represent some of the most complicated of obstetrical challenges one can face. These are best left to the experience of a veterinarian. 3283585171450032835851757045Figure 7. Anterior Presentation (Photo from the Drost Project).Figure 7. Anterior Presentation (Photo from the Drost Project).326707521151850032670753853815Figure 8. Posterior Presentation (Photo from the Drost Project).Figure 8. Posterior Presentation (Photo from the Drost Project).A similar complication to that described above may occur when the limbs or feet of more than 1 fetus are simultaneously presented into the birth canal (i.e. such as occurs with the delivery of twins). Before any attempt is made to extract a fetus in this situation one must first determine if the limbs belong to one or more than one fetus. Assuming it is twins and one of the fetuses’ is in anterior presentation (i.e. front legs and head coming first as if diving out of the birth canal) and the other in posterior presentation (i.e. rear legs and buttocks are coming first) one must distinguish front legs from rear legs. While this might seem to be a simple task, in reality the elbow and the hock of the fetus are essentially indistinguishable to the operator working blindly within the uterus of the cow. To sort this out, one need only count the number of joints that flex backward en route the elbow or hock joint which flexes forward. For example starting with the foot and working upward on a front limb the operator encounters the fetlock, the carpus or knee both of which flex backward and finally the elbow joint which flexes forward. In rear limbs starting with the foot and working upward one will encounter the fetlock joint which flexes backward and the hock which flexes forward. Experience is the secret to developing confidence with these techniques. The “position of a fetus” refers to its spinal orientation relative to the dam’s. In other words, the position is incorrect when the fetus is upside down (belly of the fetus is facing upwards toward the cow’s spine) when entering the birth canal. When a fetus is coming backwards (i.e. posterior presentation) and the feet become visible beyond the vulva, the fetus will appear to be upside down. On the other hand, the feet of a fetus in anterior presentation that is upside down will give one the appearance that the fetus is coming backwards. Since dystocia is more common in fetuses coming backwards (i.e. posterior presentation), early intervention is recommended. Rarely, a fetus may be upside down (belly of the fetus on the sky side) and backwards which makes it appear to be coming normally in anterior presentation. It is easy to become fooled by these observations, so it is important to understand these relationships when managing calving situations. Possibly one of the best tools for managing calving situations is a wrist watch. When the fetus (based upon the appearance of the feet at the vulva) appears to be in anterior presentation, continue to monitor the cow closely. If feet are visible at or slightly beyond the vulva, the fetus should be delivered within an hour. If it is not, an examination is in order. 31807151869440Figure 7 Posture is the relationship of the calves extremities with respect to the body. In this case the front leg is held back (Photos from the DrostProject).Figure 7 Posture is the relationship of the calves extremities with respect to the body. In this case the front leg is held back (Photos from the DrostProject).31807153429000Finally, the “posture of a fetus” refers to the extremities of the fetus which may be flexed, extended, or otherwise retained above, below or to one side or another. For example, when 1 leg is retained or the head is turned to one side, the posture of the fetus is incorrect. In dystocia situations the objective is correction of the presentation, position and posture of the fetus so that it may be delivered naturally. When the fetus is too large relative to the dam (particularly the dam’s pelvis), delivery may be prolonged or impossible without assistance. Calving-assistance errors are an important cause of dystocia-related lameness in calves and cows; but by understanding the pelvic anatomy of both the cow and calf and what constitutes reasonable limits on extraction forces, many of these problems can be prevented. For starters, whenever faced with a dystocia problem, the first step in evaluation is to determine presentation, position and posture. Assuming these are normal, determine if the calf can be delivered vaginally; in other words, is the pelvis of the cow large enough to permit delivery of the calf? For a calf in anterior presentation, delivery is possible when the pasterns are extended at least a hand’s width beyond the vulva (the widest part of the fetuses’ pelvis is beyond the cow’s pelvis). When the calf is presented in a posterior presentation, delivery is possible when the hocks are at or slightly beyond the vulva (the shoulders of the calf are beyond the pelvis of the cow). Forced extraction of a fetus should not be attempted until the above criteria have been met as failure to do so will likely result in needless injury to either the cow and calf or both. If these guidelines are met one may begin the fetal extraction process by applying the following techniques: 37344356540500Apply obstetrical chains or ropes to the fetus’s legs for assisted delivery and always use a half-hitch (above and below the fetlock) to avoid excessive pressure that might result in fracture of one or both legs, When applying traction - always avoid excessive traction on the fetus (no more than 2 persons should apply force at one time),3760470290195Figure 8. When the fetus's pelvis enters the dam's pelvis during delivery, hiplock is avoided by rotating the fetus's pelvis approximately 45 degrees to prevent hiplock (photo courtesy of the Drost Project).Figure 8. When the fetus's pelvis enters the dam's pelvis during delivery, hiplock is avoided by rotating the fetus's pelvis approximately 45 degrees to prevent hiplock (photo courtesy of the Drost Project).Work with the cow and synchronize traction with pushing by the cow, and allow the cow to rest between each effort as needed. 36893502277110Figure 9. In this photo the fetus's pelvis is rotated and thereby preventing hip-lock (photo courtesy of the DrostProject).Figure 9. In this photo the fetus's pelvis is rotated and thereby preventing hip-lock (photo courtesy of the DrostProject).368935050736500When applying traction to the fetus always pull straight backwards until the hips of the fetus have cleared hips of the cow (or when the shoulders have cleared the hips of the cow in a fetus coming backwards); a downward pull prior to this point may complicate delivery, Always rotate the fetus during delivery approximately 45 degrees to take advantage of moving the widest part of the fetus’s hips through the widest part of the cow’s pelvis to avoid hip-lock (see photos). For fetuses that may be suffering from hypoxia (lack of oxygen) from prolonged calving, assistance to acquire colostrum may be necessary. Specific injuries resulting in lameness are relatively rare in cattle with exception of those situations where a person or persons have applied excessive force during the delivery process. In calves, fractures of the lower leg immediately above the fetlock are not uncommon when there has been excessive traction applied to the legs during delivery. Femoral nerve paralysis is also a possible sequel to forced extraction resulting from severe stretching of the quadriceps muscle group that leads to vascular (blood vessel) and nerve damage. Calves affected with femoral nerve paralysis will exhibit atrophy and decreased muscle tone of the quadriceps muscles, and have difficulty advancing the affected limb or limbs. Fractures and dislocations of the hip and shoulder are possible, but normally occur infrequently. In cows, damage to the ischiadic and obturator nerves occurs subsequent to dystocia and protracted calving conditions. The actual lesion occurring in the ischiadic nerve (which is also spinal nerve - Lumbar 6) is believed to be within the birth canal on the sacral ridge and its site of exodus near the ischiadic notch in the wing of the ilium. The obturator nerve also courses through the birth canal and is therefore vulnerable in cases of prolonged calving and dystocia. 31851603810000Damage to these nerves may result in downer cow syndrome and varying degrees of peroneal and tibial nerve paralysis as described earlier. Upper Leg Lameness in Adult Cattle3204845986155Figure 10. Damage to the ischiadic nerve occurs within the birth canal along the sacral ridge (photo courtesy of the DrostProject).Figure 10. Damage to the ischiadic nerve occurs within the birth canal along the sacral ridge (photo courtesy of the DrostProject).Upper leg lameness in cattle occurs mostly in rear legs and is associated with either the inability to rise and walk or changes in gait or posture. Specific causes include (but are not limited to): paralyses, fractures, dislocations, cellulitis (inflammation of the subcutaneous soft tissues) of the hock joint, and rupture of the gastrocnemius tendon. Specific conditions are discussed according to the presenting clinical signs:Inability to riseInstability of the fetlock (knuckling)Abnormal hock posture and/or swelling; inability to advance the legAtaxia/wide base stanceOutward rotation of the back leg and foot; knee joint instability; hindquarter dissymmetry Conditions resulting in an Inability to riseThe most common or widely recognized causes of an inability to rise in adult cattle are metabolic disturbances, most notably milk fever in dairy cattle and calving-related injuries common to both dairy and beef cattle. So, we begin with a brief discussion of these conditions and the secondary complications that may result as a consequence. 34150305016500Milk Fever and “Downer Cow Syndrome”34150301487170Figure 11. This cow is suffering from milk fever (hypocalcemia) and is being treated with a systemic calcium therapy.Figure 11. This cow is suffering from milk fever (hypocalcemia) and is being treated with a systemic calcium therapy.The peri-parturient period (i.e. the time around calving) is a time of high risk for dairy cattle. Milk fever (periparturient hypocalcemia) and calving-related injuries are the most common predisposing causes of the down cow condition. In fact, one study identified the 3 major causes of down cow problems in dairy cattle as milk fever 19%, calving-related injuries 22% and injuries from slipping and falling 15%. In beef cattle the primary cause of the downer cow syndrome is calving paralysis. Cattle that are non-ambulatory for a period of more than 24 hours are commonly referred to as “downers”. Occurrence is highest in dairy cattle and often traced to metabolic disorders, injuries, and infectious or toxic disease conditions. Since there are many underlying causes the down cow condition is often referred to as a syndrome, “Downer Cow Syndrome”. Estimates are that about 5% or less of dairy cattle in the US are affected with hypocalcemia annually. The majority (75%) occur within the first 24 hours of calving. Approximately 12% of cases occur within 24 to 48 hours after calving and only about 6% of cases occur at calving. However, when hypocalcemia occurs prior to or in association with calving, it can be an important contributor to dystocia and may result in calving paralysis and associated complications. Hypocalcemia is rare in beef cattle, but may occur in conditions where severe dietary mineral imbalances are present. Calving paralysis is a common cause of recumbency in cattle. It is usually the consequence of attempts to deliver a large calf relative to the size (i.e. size of the pelvis) of the cow. As will be described in greater detail later, calving paralysis frequently results from damage to branches of the obturator and ischiadic (sciatic) nerves which are vulnerable to compression at calving by virtue of their position within the birth canal. 29438602233295Figure 12. Cow suffering from "Down Cow Syndrome"; the longer the cow is down the more she risks complications with "compartment syndrome".Figure 12. Cow suffering from "Down Cow Syndrome"; the longer the cow is down the more she risks complications with "compartment syndrome".29438602540000One of the greatest concerns with an adult cow that is down and unable to rise is that it risks injury to peripheral nerves and muscle damage that can increase the odds of a permanent non-ambulatory state. Because of its sheer size and weight, a non-ambulatory cow develops tremendous pressure on tissues of the down leg leading to decreased blood flow, hypoxia and pressure necrosis of muscle and peripheral nervous system tissues. Because of their anatomic location, the sciatic nerve and its distal branches are subject to injury in down cows. Reduced blood flow and damage to the heavy muscles of the rear legs result in varying degrees of paresis (muscle weakness) that seriously complicate the possibilities of recovery in affected animals. While many may be aware of the concerns for cows to be down for prolonged periods, some would be surprised to learn that the threshold for induction of permanent recumbency may be as short as 6 hours. Of 84 cows down with milk fever, 83 (98.8%) recovered when treatment was instituted within 6 hours after they became recumbent. Similarly, a survey of dairy producers indicated that non-ambulatory cattle that recovered and remained in the herd were down for less than 6 hours. Finally, while good footing, attitude of the cow and body condition are fundamental to care for non-ambulatory animals, research from a UK study suggests that good nursing care may have the single greatest effect on improving the prognosis for non-ambulatory cattle. Compartment SyndromeDown cows need immediate attention in order to prevent further damage that may lead to “compartment syndrome”. For the purposes of understanding this condition it is easiest to think of the heavy muscles of the cow’s front and rear legs as being contained within a series of compartments. These compartments are formed by very sturdy non-elastic connective tissues that surround and contain these muscle groups. When these muscles become inflamed or damaged as in the down cow circumstance, swelling of the muscles plus leakage of blood and other fluids into the compartment creates tremendous pressure within the compartment. As pressure continues to build within the connective tissue compartment, blood vessels, nerves and muscle are compressed and damaged. Eventually, the lack of blood flow leads to death of muscle tissues and an irreversible down cow state. Traumatic Injuries 26638252425700Figure 13. This cow is down and unable to rise in part due to a hip subluxation.Figure 13. This cow is down and unable to rise in part due to a hip subluxation.26638254572000Traumatic injuries may be the primary cause of recumbency or they may occur as a secondary consequence of a cow that is down and struggling to rise. Examples of such lesions would include include trauma of the spine, bilateral sciatic or proximal (upper) radial nerve or muscle damage (muscle damage from interrupted blood flow to dependent tissues) after being down on a hard surface for a prolonged period or pelvic or long bone fractures. These injuries also occur as a consequence of slips and falls. Injuries of the upper leg and pelvis increased significantly in cows during the summer months in a study of a southeastern dairy as a result of wet concrete flooring conditions. Other conditions that may cause an inability to rise include caudo-ventral hip luxation and complete rupture of the Achilles tendon (tendon of the gastrocnemius muscle). Demonstrable over flexion of the hock is diagnostic for complete gastrocnemius rupture. Adductor muscle rupture (muscles of the inner thigh) can also result in inability to rise. The adductor muscles originate from the ileum, pubis and prepubic tendon and insert on the medial aspect of the femoral shaft. A sudden marked abduction of the limb (spread-eagling) results in rupture of the bellies of several of the abductor muscle group. The damage is usually bilateral (occurring on both sides). Calving, milk fever and a slippery flooring surface are predisposing causes. The leg is usually held in extreme abduction (held outward away from the body) when the cow is in sternal recumbency (lying down on her chest). Cows that are unable to rise could be managed by elevation in a sling, flotation in a water bath or by providing a soft bed such as a sand pit or bedded pack. Good footing is essential to cows suffering from maternal obstetrical paralysis. As with other paralyses there is no real specific treatment beyond supportive care. Protecting these animals from environmental exposure (solar radiation), providing them with feed, hay, and water, and occasional lifting and/or repositioning are probably most important to their recovery. Use of a flotation tank can be helpful when used early-on following injury. Some animals excluding long bone fractures or tendon rupture may heal after several weeks. Instability of the fetlock (Knuckling) 31013402207895Figure 14. This heifer had difficulty calving - note that she is knuckling the right rear foot - this suggests peroneal nerve damage.Figure 14. This heifer had difficulty calving - note that she is knuckling the right rear foot - this suggests peroneal nerve damage.31013406477000Knuckling of the fetlock can result from spinal injury caused by trauma such as getting caught under the sides of the free stall or from diseases such as spinal lymphosarcoma. Damage to the sciatic nerve (particularly the peroneal branch of the sciatic) will result in knuckling forward on the fetlock joint. Peroneal nerve paralysis is a common secondary complication with milk fever, downer cow syndrome, or other conditions which may cause a cow to remain down for an extended period of time. The peroneal nerve passes superficially over the lateral aspect of the rear leg where it is vulnerable to external trauma. It is often damaged in cows that suffer milk fever or downer cow syndrome as a result of direct pressure on the nerve from the cow’s body weight. Cows with damage to this nerve will stand with the foot knuckled over onto the dorsum of the pastern and fetlock joint. At the same time the hock joint will appear to be over extended. In mild cases the fetlock tends to knuckle over intermittently when the cow walks. The prognosis for cows affected with peroneal nerve damage depends upon the severity of the nerve injury. Recovery may take days to months depending on severity.Abnormal hock posture and/or swelling; inability to advance the leg Abnormalities in hock posture are often associated with conditions causing upper leg lameness including Ischiadic (sciatic), peroneal or tibial nerve damage, degenerative joint disease and septic arthritis, rupture of the gastrocnemius and peroneus tertius muscles. In the front leg, radial nerve injury usually results in difficulty or inability to advance the leg.Ischiadic nerve paralysis The ischiadic nerve provides innervation to the muscles that flex the stifle, extend the hock, and flex and extend the digits. The ischiadic nerve is vulnerable at the level of the pelvis. Extreme inter-pelvic pressure during calving can damage the nerve whereby the sixth lumbar nerve is compressed against the sacrum before it joins the first two sacral nerve roots to form the ischiadic nerve. Incomplete sciatic nerve damage is characterized by dropped hocks and flexed fetlocks of both hind legs. The animal is unable to extend the hocks and fetlocks during locomotion. The cow walks with short stilted steps whilst both the hocks and fetlocks remain in semi-flexion. 33610552065655Figure 15. This animal calved recently and is suffering bilatteral tibial nerve paralysis.Figure 15. This animal calved recently and is suffering bilatteral tibial nerve paralysis.33610554508500Tibial nerve paralysis The tibial nerve is situated deeper than the peroneal nerve and is therefore less vulnerable to injury as described above for peroneal nerve paralysis. Clinical signs of tibial nerve paralysis include an overflexed hock joint (“dropped hock appearance”) while the fetlock remains partially flexed. With peroneal nerve paralysis the hock joint is overextended. Gait disturbances with tibial nerve paralysis may be milder than with severe peroneal nerve damage but postural disturbances could be permanent.Gastrocnemius muscle rupture Gastrocnemius rupture is another cause of the “dropped hock appearance” that must be differentiated from tibial nerve paralysis. With gastrocnemius muscle rupture usually only one leg is affected. Clinical signs include a dropped hock particularly when the animal is weight bearing on that leg. The point of the hock drops toward the ground especially while walking. The fetlock may be flexed and exhibiting some degree of knuckling. There may be a soft, warm, painless swelling where the rupture occurred, in the typical case. Later on, the swelling becomes firm, larger and somewhat painful. The diagnosis is based on the typical signs and posture. It causes severe disability, and for all practical purposes, is not correctable surgically. Examination of downer cows should include some assessment of this important structure before treatment is instituted. Surprisingly, some will be able to stand despite rupture of this tendon. The only real option is slaughter or euthanasia.Spastic syndrome (also known as Progressive Hindlimb Paralysis) Spastic syndrome is another condition that causes changes in hock posture. Spastic syndrome occurs in older animals usually Guernsey and Holstein dairy cows older than 3 years. It causes intermittent spasticity of the gastrocnemius muscles during locomotion resulting in extension of the hocks. Clinical signs are often exacerbated by encouraging the cow to rise; however pain in the feet or joints are suggested to be possible precipitating factors. Affected animals often exhibit difficulty moving forward, may standing trembling and often extend their hindlimbs backward. The condition is progressive and affected animals will eventually go down unable to rise.Stringhalt Stringhalt is a spasmodic over-flexion of the joints in the rear limb or limbs of cattle. The disease is well-known in horses, but poorly described in cattle. Affected cattle or horses exhibit variable degrees of hyper-flexion from mild (whereby the foot is simply lifted and immediately put back to the ground) to the more extreme case where the foot is drawn up sharply into the abdomen and then immediately placed rapidly and forcefully back to the ground. The exact cause of Stringhalt is unknown, but is believed to be a peripheral neuropathy (nerve disease) of the ischiadic nerve. There are several approaches to therapy in horses, but none of these are practical for cattle. 35540953164205Figure 16. Bull with rupture of the peroneus tertius muscles in the left rear leg. Note the abnormal extension of the hock.Figure 16. Bull with rupture of the peroneus tertius muscles in the left rear leg. Note the abnormal extension of the hock.35540953365500Rupture of the Peroneus Tertius The peroneus and cranial tibial muscles are the primary flexors of the hock. In cattle rupture of these muscles occasionally occurs in the mid belly or at the junction of the proximal or distal tendon attaching to the respective bones. Damage to the peroneus tertius usually results from trauma such as when the limb is pulled up too high or with slipping and falling. Clinical signs include abnormal extension of the hock during locomotion while the stifle remains flexed. Animals affected will drag the leg with the claws scraping the walking surface while the achilles tendon remains slack. If the limb is manually lifted and extended behind the animal, the tibia and metatarsus will remain straight whilst the stifle joint remains at 90o. A unique diagnostic feature of this disease is that the limb can be pulled backward without resistance from the animal. There is usually a painful swelling over the cranial shaft of the tibia. Prolonged rest and confinement result in resolution in some cases. Cows with rupture and separation in the muscle tendon junction or the muscle insertion or origin have a poorer prognosis.Disorders Involving Specific joints of the Rear LegHip joint: Slight abduction of the back leg with outward rotation of the toe is often associated with lesions in the stifle or hip. Crepitation (crackling or grating) may be felt while rocking the animal sideways with one or both hands on the greater trochanter of the femur. Crepitation however is not a reliable sign of the presence of lesions within the hip joint. What sometimes feels like crepitation may turn out to be a normal joint and crepitation originating from the stifle may be interpreted as coming from the hip. Specific problems may include rupture of the round ligament in the hip joint, hip dislocation; pelvic fractures; fractures of the head of the femur, slipped capital femoral epiphysis or severe coxitis. The relative position of the greater trochanter of the femur to the tuber coxae (hooks) and the tuber ischia (pins) should be determined and should form a triangle with the ventral point representing the greater trochanter. This triangle is lost with craniodorsal luxation with the greater trochanter being placed in-line with the tuber coxae and tuber ischia. With caudoventral dislocation the trochanter major may not be palpable. A rectal examination should be performed to determine the presence of crepitation whilst moving the animal from side to side or hard bony protrusions which may indicate the presence of a pelvic fracture.Septic arthritis (Cellulitis) and Degenerative joint disease of the hock joints37471352367280Figure 17. Note the swelling over this hock joint. Lesions such as this suggest stall design and bedding problems.Figure 17. Note the swelling over this hock joint. Lesions such as this suggest stall design and bedding problems.37471353810000Hock Joint Cellulitis Hock joint cellulitis (swollen hocks) is a chronic cellulitis involving the lateral aspect of the hock joints. It is usually bilateral and often more of a cosmetic problem than a lameness problem. It results from repeated trauma to the lateral aspect of the hock joints and is most commonly seen in tie stall or free stall barns where the length of the stall is too short, forcing the cows to lie on the edge of the curb where the hocks are subject to chronic trauma and irritation. Lameness is usually absent except in cases which cause mechanical impairment of the joint or in cases of severe abscessation or septic arthritis. In such cases the animal may become severely lame with a discharging tract over the lateral aspect of the joint. A high incidence may be related to lack of a sufficient number of stalls, flaws in stall design, or cow habit/behavioral patterns in which cows choose to lie on concrete rather than in available stalls. The problem disappears when cows are given access to pasture, dirt lots, or a properly designed stall. It is inadvisable to attempt radical surgery on these lesions since risk of entering the joint is high and postoperative hemorrhage and skin necrosis are likely to result. Delayed healing and recurrence of the swelling are major disadvantages.Hygroma (Precarpal Bursitis) Swelling on the anterior (front) aspect of the carpus is quite often associated with chronic inflammation that results in the formation of a thick-walled subcutaneous bursa (fluid-filled sac just beneath the skin) on the dorsal side of the joint. These are more likely to occur on the anterior side of the carpus (knee in the front leg) as a consequence of the repeated trauma to this area associated with lying on hard surfaces. Since the precarpal bursa which lies above the carpus is often affected, this condition is also referred to as “precarpal bursitis”. Some suggest that a few of the precarpal hygromas observed are congenital conditions but most are associated with chronic inflammation from lying in poorly bedded or ill-designed stalls. 34080452623820Figure 18. Carpal hygroma - surprisingly, these rarely cause significant lameness, but they do suggest that the cow is attempting to deal with an ill-designed or poorly bedded stall.Figure 18. Carpal hygroma - surprisingly, these rarely cause significant lameness, but they do suggest that the cow is attempting to deal with an ill-designed or poorly bedded stall.34080458699500The good thing is the carpal joint is usually not involved. Lameness is absent or mild, with pain becoming most notable when the carpal joint is flexed. Hygromas may become infected, but rarely does the infection extend into the carpal joint. Early work in the 1970’s and 80’s reported isolating Brucella abortus bacteria (the organism responsible for Brucellosis) from fluid contained within these hygromas. The significance of these observations was unclear since antibody titers to Brucellosis were similar for animals with and without hygromas. Treatment of hygromas is unnecessary unless they are causing pain and significant lameness. If treatment is necessary, it is important to distinguish the problem as precarpal bursitis, an “infected” precarpal bursitis or an infection of the carpal joint. This diagnosis and a recommended treatment are best left to a veterinarian. Surgical correction is complicated and not always successful. Readers are reminded that whenever fluid filled masses such as hygromas are probed or opened, they become vulnerable to infection that can become quite complicated; in some cases sufficient to involve the carpal joint. Therefore, carpal hygromas are best left untreated unless they become infected and painful. Hygroma-like lesions (false bursas) can develop on other body contact points most commonly on the lateral side of the hock (described in greater detail below as “hock joint cellulitis”). Other common sites for these lesions are the point of the hock (also known as calcanean bursitis), on the lateral aspect of the stifle joint, over the tuber coxae (hook bone) and tuber ischii (pin bone). As for hygromas on the carpal joint, these are also primarily a consequence of ill-designed and inadequately bedded stalls.Degenerative joint disease (DJD) Degenerative joint disease is a progressive, non-infectious and initially non-inflammatory disease characterized by primary degeneration of articular cartilage. DJD is classified as primary or secondary. Primary DJD may result from an inherited predisposition in cattle. Secondary DJD results from nutritional, developmental and traumatic causes. Examples of these include: hip dysplasia; rupture of the anterior cruciate ligament is a common cause; dietary excess of phosphorus and relative deficiency of calcium; very rapid increase in body weight in young animals such as rapidly growing bulls on a high plane of nutrition which is made worse if complicated by post hocks; and, heavy milk production through many lactations. Animals are usually lame and there may be some joint enlargement. Joint crepitation particularly in the hip and stifle joints is usually present. Cattle with degenerative changes in the hocks, stifles and hips walk slowly and stiffly and have a tendency to drag the claws. Treatment is usually only palliative (i.e. designed to control pain). Rupture of the Cruciate Ligament (Stifle) Trauma is the most common cause for rupture of the cruciate ligament of the rear legs which is often complicated by the involvement of several adjacent joint structures. In rare instances severe trauma may lead to dislocation. Injury resulting from a twisting action of the limb while the claws remain firmly placed on the ground (such as when the hind quarters are swung around during weight-bearing) in a stationary position is the predominant cause of cruciate ligament damage. Diagnosis is based on clinical signs which include a marked lameness; outward rotation of the leg and foot; during non-weight bearing the animal tends to hold the tip of the toe on the walking surface; fluid accumulates in the stifle joint; there may be an audible clunk from the joint during movement or manipulation and sometimes a visible instability of the joint during movement. Joint crepitus (“crackling”) can be elicited by medial and lateral rotation of the point of the hock while holding one’s hand over the patella (knee cap) and collateral ligaments. A drawer movement (forward 29743402271395Figure 19. Typical posture of a cow with a stifle injury most likely involving rupture of the anterior crusciate ligament and damage to the medial and lateral meniscus.Figure 19. Typical posture of a cow with a stifle injury most likely involving rupture of the anterior crusciate ligament and damage to the medial and lateral meniscus.29743401206500movement of the joint) can also be attempted either in the standing position or with the cow in a lying position. In chronic cases, muscle atrophy will further exaggerate enlargement of the affected joint. Because of the accompanying damage to the menisci and articular surfaces, the prognosis is very guarded. Limited movement in a box stall or small yard is essential with the aim to avoid further injury and to permit the development of fibrosis which may help with joint stabilization. Systemic analgesics may be used during the acute phase of the condition. In general surgical repair has been shown to have limited success. Slaughter is likely the best option for all but the most valuable animals.32778702089785Figure 20. Coxofemoral luxation in a fresh cow.Figure 20. Coxofemoral luxation in a fresh cow.32778704953000Coxofemoral joint (hip) luxation (partial or complete dislocation) This condition is commonly seen in dairy cattle and often related to parturition and abduction (doing “the splits” with the rear legs) of the hind legs due to either bilateral (both sides affected) obturator paralysis, milk fever, or slipping on wet, smooth concrete. The head of the femur usually goes in an upward and forward direction as it dislocates itself from the hip joint. In acute cases, clinical signs include an almost total inability to bear weight on the affected leg; an outward rotation of both the stifle and the digit; upward displacement of the greater point of the femur on the affected side; crepitation (roughened feel and sound detected when two ends of bone are rubbed together) and localized pain on manipulation of the affected leg. These must be differentiated from fractures, often requiring veterinary assistance. Conditions causing ataxia (inability to coordinate muscle movement) and wide base stance 28714702427605Figure 21. This cow developed obturator nerve paralysis. She is recovering by virtue of good footing and the lifting device which helps her to her to stand.Figure 21. This cow developed obturator nerve paralysis. She is recovering by virtue of good footing and the lifting device which helps her to her to stand.28714706540500Obturator nerve paralysis (maternal obstetrical paralysis) Obturator nerve paralysis commonly occurs in combination with ischiadic nerve paralysis and primarily affects the adductor muscles of the inner thigh of the rear legs. Damage to the obturator nerve generally occurs in association with calving, particularly when the calving process has been prolonged or difficult. Prolonged pressure as occurs when the fetus becomes lodged within the pelvis for an extended period of time creates the potential for temporary or even permanent paralysis as a result of damage to peripheral branches of the obturator and ischiadic (sciatic) nerves. Severely affected animals are unable to rise. Those able to stand are predisposed to “doing the splits” or falling as a result of the loss of innervation to the adductor muscles of the inner thigh, which under normal conditions keep the legs properly aligned for standing. Animals with a wide based stance following calving or at any other time should be hobbled and kept in areas with good footing to prevent serious injury such as hip dislocation or fractures. Partial tearing of the adductor muscles may lead to the same clinical signs as obturator nerve paralysisClinical Diagnosis of Front Leg Lameness Inability or difficulty in advancing the leg may be associated with suprascapular or radial nerve injury, bicipital bursitis (9) and fracture or dislocation of the shoulder joint. The leg may be held in semi-flexion with the elbow dropped in the case of damage to the radial nerve at the level of the brachial plexus. The radial nerve innervates the extensor muscles of the carpus and foot and also serves to provide sensory innervation to the lateral skin of the forelimb from the elbow to the carpus (or knee in the front leg). Lesions involving the 8th cervical and 1st thoracic vertebrae often results in paralysis which prevents the animal from extending its elbow, carpus and fetlock in order to bear weight. The elbow is dropped, the carpus and fetlock held in partial flexion, and the limb is dragged causing abrasion to the dorsal surface of the foot. In the absence of fractures and obvious muscle damage, difficulty advancing the limb and an inability to extend the elbow, carpus and fetlock to bear weight in combination with an absence of skin sensation on the lateral and dorsal surface of the lower limb, confirms radial nerve paralysis. Clinical signs of suprascapular nerve injury include stumbling, inability to support and extend the shoulder, a shortened stride and abduction (holding away from the body) of the leg. Reflexes and sensation in the lower limb remain normal if only the nerve is affected. Atrophy (shrinkage from non-use) of the supra- and infraspinatus muscles may become visible as early as 5-7 days post injury (9). Front limb lameness associated with injury that may involve fracture or subluxation of the shoulder joint is often accompanied by a reluctance to bear weight on the affected limb, greatly reduced range of motion or movement, severe lameness and swelling of the scapulohumeral joint. Specific Disorders of the Front LimbRadial nerve paralysis In the front leg, trauma to the radial nerve usually results in difficulty or inability to advance the leg. The radial nerve originates from the 7th and 8th cervical and 1st thoracic vertebral portions of the spinal cord. The radial nerve innervates the extensor muscles of the carpus (so-called knee of the front leg) and foot and also serves to provide sensory innervation to the skin on the lateral side of the forelimb from the elbow to the carpus (front knee). Lesions involving the 8th cervical and 1st thoracic vertebrae result in paralysis which prevents an animal from extending its elbow, carpus and fetlock in order to bear weight. The radial nerve crosses over the lateral surface of the humerus and is thus subject to trauma if animals are positioned in lateral recumbency (lying flat on their side) for extended periods of time. Signs of distal radial paralysis include an inability to extend the carpus and the digit. 307276574041000Lesions involving the 7th and 8th cervical region of the spinal cord are associated with the clinical signs of proximal radial paralysis. The elbow is dropped, the carpus and fetlock in partial flexion, and the limb is dragged causing abrasion to the top side of the fetlock. In the absence of fractures and obvious muscle damage, difficulty in advancing the limb and an inability to extend the elbow, carpus and fetlock to bear weight, confirm radial nerve paralysis. 30651451420495Figure 22. The cow above is suffering radial nerve paralysis from being confined too long on tilt table for repair of a foot problem. She recovered full use of her leg after a period of 10-15 minutes. Figure 22. The cow above is suffering radial nerve paralysis from being confined too long on tilt table for repair of a foot problem. She recovered full use of her leg after a period of 10-15 minutes. Injury on tilt tables or in stand-up style chutes Radial nerve paralysis is a common consequence of restraint on tilt tables. It can be prevented to some degree by the positioning of a soft pad under the shoulder and limb and by extending the down limb as far forward as possible. The prognosis is favorable with partial radial nerve damage and most cases improve within minutes to several hours. More severe cases may take several days or up to a week or so for complete recovery. Proximal radial nerve paralysis can occur when the animal goes down forcibly in a standup chute. The animal may be unable to rise in which case the prognosis is poor. Anti-inflammatory treatment, confinement with secure footing and adequate bedding are recommended for protracted cases. Prevention of partial radial paralysis caused by recumbency on hard surfaces should involve the following: 1) insure adequate padding beneath the shoulder and limb, 2) maintain the lower limb in forward extension, 3) avoid tightly fixing the upper limb to the table, secure it to a higher location which will decrease pressure not only on the thorax but also on the lower limb, and 4) the upper limb is best maintained in moderate extension to the rear of the chute rather than in a forward direction.Shoulder Injuries (including Scapulohumeral joint subluxation and fractures)In addition to damage of the scapular and radial nerves, injury to the shoulder frequently leads to lameness resulting from severe bruising of muscles and bone, subluxation of the shoulder joint (also referred to as the Scapulohumeral or Glenohumeral joint) and fractures of the humerus (long bone in the upper front leg) and scapula (the shoulder blade). Diagnosis of the specific cause of front limb lameness associated with shoulder injury is aided by observation of scapulohumeral joint swelling, abnormalities in posture and locomotion, palpation of the humeral head and joint and manipulation of the affected leg. 28587702460625Figure SEQ Figure \* ARABIC 23. The cow in the above photo has severe lameness in the left front limb and a large amount of swelling in the shoulder joint. Manipulation of the shoulder joint causes extreme discomfort. Although the precise lesion is unknown, shoulder injuries are common in dairy cattle.Figure SEQ Figure \* ARABIC 23. The cow in the above photo has severe lameness in the left front limb and a large amount of swelling in the shoulder joint. Manipulation of the shoulder joint causes extreme discomfort. Although the precise lesion is unknown, shoulder injuries are common in dairy cattle.28587709525000The connection of the humerus to the scapula occurs at scapulohumeral joint. Much like the hip, the shoulder is a ball and socket joint. In the case of the shoulder the ball of the joint is formed by the medial surface of the humerus and the socket is formed by a dish-shaped structure in the lateral part of the scapula known as the glenoid fossa (thus the glenohumeral joint). However, unlike the hip which connects the femur to the pelvis through the acetabulum by the round ligament, the humerus is connected to the scapula by a looser (freer) arrangement of ligaments, muscles and tendons. In addition, the socket portion of the shoulder joint is quite shallow as compared with that of the hip joint. This offers the advantage of a wide range of motion for the front limb, but on the downside this anatomical arrangement also makes this joint one of the most vulnerable to dislocation.Despite its greater potential for dislocation, reports in the literature suggest that subluxation of the shoulder joint is a rare occurrence in cattle. On the contrary, these authors have observed that shoulder injuries are actually quite common in modern housing systems. For example, in loose housing systems where cows consume feed through a lockup-type stanchion, contusion of the shoulder joint occurs when an animal is inadvertently pushed forward against the head catch of the lock-up as a result of being struck from the rear by a pen mate. When cattle are handled in a restraint chute, injury to the shoulder may occur subsequent to closure of the head-catch on an animal entering the chute at excessive speed. These injuries are also observed subsequent to slips and falls or sparring (fighting) events amongst herd mates battling to establish dominance. And finally, injury to the shoulder joint may occur subsequent to mounting activity on concrete surfaces associated with estrous behavior. Regardless of the underlying cause, animals affected usually present with a prominent swelling on the lateral side or anterior “point” of the shoulder. Depending upon the degree of damage or injury, lameness may be severe. Confirmation of a possible subluxation or fracture should be should be confirmed if possible by palpation to detect characteristic movement of the humeral head when the limb is rotated. Crepitus or the sound/feel of grating as when the broken ends of a bone are rubbed together is highly suggestive of a fracture within the shoulder joint. The mobility of animals affected with shoulder injuries varies from moderate lameness with contusion-type injuries to those with subluxations and fractures that may be non-weight bearing on the affected limb. The most rational treatment for shoulder-related injuries is confinement in a well-bedded box stall. Some animals may benefit from anti-inflammatory therapy to relieve pain in the acute or early post-injury stages. If the lesion is simply a bruise, time for rest and recuperation in a well-bedded box-stall is likely the best therapy. Subluxations and fractures yield treatment options that range from slaughter to euthanasia depending upon severity and mobility. For welfare reasons, animals with moderate to severe lameness should not be considered candidates for slaughter. Euthanasia may be the best or only option. ReferencesAnderson DE Lameness examination in cattle. In: Proceedings of the AABP preconvention lameness seminar. St Louis, MO. September 21, 2011Chamberlain AT, Cripps PJ. 1986. Prognostic indicators for the downer cow, in Proceedings 6th Int Conf Prod Dis Farm Anim, p. 32–35.Cox VS. Understanding the downer cow syndrome. Compend Contin Educ Pract Vet 1981;3:S472–S478.Current Veterinary Therapy, Food Animal Practice, Fifth Volume. 2009. Edited by DE Anderson and DM Rings, Saunders Elsevier, St. Louis, MO, p. 130-134. Desrochers A, Anderson, DE and St.-Jean, G. Surgical treatment of lameness. 2001. Vet Clin North Am, Food Animal Practice, 17(1):143-147. Desrochers A. Upper leg lameness conditions. In: Proceedings of the AABP preconvention lameness seminar. September 19, 2007Doonan G, Appelt M, Corbin A. Nonambulatory livestock transport: the need of consensus. Can Vet J 2003;44:667–672.Fenwick DC, Kelly WR, Daniel RCW. 1986. Definition of nonalert downer cow syndrome and some case histories. Vet Rec, 118:124–128.Greenough, P. 1997. Lameness in Cattle. W.B. Saunders, Co., Philadelphia, PA, p. 203-218.Greenough PR. Bovine Laminitis and Lameness, A Hands-On Approach. 2007. Saunders Elsevier. Kofler J. Ultrasonography as a Diagnostic Aid in Bovine Musculoskeletal Disorders. In: Smith RA, Buczinski S editors. 2009, (29), 3: 687–752.Morrow DA. Current Therapy in Theriogenology, 1980. WB Saunders, Co.Nelson DR, Kneller SK. Treatment of Proximal Hind-Limb Lameness in Cattle In: Veterinary Clinics of North America: Food Animal Practice. Ferguson JG editor. WB Saunders, Philadelphia, PA. 1985; (1), 1: 153–73Roberts SJ. Veterinary Obstetrics and Genital Diseases. 1971. Distributed by Edwards Brothers, Inc.Sisson SB, Grossman JD. Bovine Nervous System. In: The Anatomy of Domestic Animals, 4th edition. WB Saunders, Philadelphia, PA.Shearer JK, SR van Amstel, and LC Shearer: 2006. Effect of season on claw disorders (including thin soles) in a large dairy in the southeastern region of the USA. 14th International Symposium on Lameness in Ruminants, Colonia, Uruguay, November 8-11, p. 110-111.Shearer JK and SR van Amstel: Effect of flooring and/or flooring surfaces on lameness disorders in dairy cattle. Proceedings of the Western Dairy Management Conference, Reno, NV, March 7-9, 2007, p.149-159.Shearer JK and SR van Amstel. Manual of Foot Care in Cattle, 2nd Edition, published by WD Hoard’s and Sons Company, Fort Atkinson, WI, 2013. Smith GC, Morgan JB, Tatum JD, et al. 1994. Improving the consistency and competitiveness of non-fed beef and improving the salvage value of cull cows and bulls. Fort Collins, Colo: National Cattlemen’s Beef Association and the Colorado State University.Smith GC, Belk KE, Tatum JD, et al. 1999. National market cow and beef bull audit. Englewood, Colo: National Cattlemen’s Beef Association.Smith – Maxie L. Pheripheral nerve diseases In: Paul R Greenough editor. Lameness in Cattle WB Saunders, Philadelphia, PA. 1997: p203–18.Stull CL, Payne MA, Berry SL, and Reynolds JP. 2007. A review of the causes, prevention, and welfare of nonambulatory cattle. JAVMA, 231(2):227-233.USAHA. Report of the Committee on Animal Welfare, in Proceedings. 110th Annu Meet US Anim Health Assoc 2006;137–143.USAHA. Report of the Committee on Animal Welfare, in Proceedings. 110th Annu Meet US Anim Health Assoc 2006;137–143.Van Amstel SR and Shearer JK. Manual for the Treatment and Control of Lameness in Cattle. 2006. Blackwell Publishing Professional, Ames Iowa. p. 59-125. Weaver AD. Spastic paresis and Downer cow. In: Paul R Greenough editor. Lameness in Cattle WB Saunders, Philadelphia, PA. 1997 : p203–18 ................
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