Principal manifestations of musculoskeletal disease

LAMEN ESS Lameness is an abnormal gait or locomotion characterized by limping (claudication) or not bearing full weight on a leg, usually associated with pain in the musculoskeletal system. Lameness must be distinguished from ataxia, which is an abnormal gait characterized by lack of coordination of muscular action, usually because of a lesion of the central or peripheral nervous system. Weakness is the inability to maintain a normal posture and gait, usually because of a lesion of muscle or generalized weakness due to an abnormal systemic state such as shock, hypocalcemia, or starvation. ABNORMAL POSTURE AND MOVEMENT As a group, diseases of the musculoskeletal system are characterized by reduced activity in standing up and moving, and the adoption of unusual postures. Abnormal movements include limpness, sagging or stiffness and lack of flexion. Abnormal postures include persistent recumbency, including lateral recumbency. There may be signs of pain on standing, moving or palpation. There is an absence of signs specifically referable to the nervous system. For example, there are no signs of brain damage and the spinal cord reflexes are present but may be only partly elicitable. DEFORMITY Atypical disposition, shape or size of a part of the musculoskeletal system constitutes a deformity. This may occur in a number of ways, and be caused by the following.

M u scle and tendon defects.

Congenital hypermobility of joints, inherited and sporadic Congenital flexed or stretched tendons of limbs causing contracture of joints or hyperextension Inherited congenital splayleg of pigs Muscle hypertrophy (doppelender,culard) of cattle Acquired asymmetric hindquarters of pigs.

Joint defects

Inherited congenital ankylosis of cattle causing fixation of flexion Joint enlargement of rickets and chronic arthritis.
Defects of the skeleton

Dwarfism - inherited miniature calves, achondroplastic dwarves; short legs of inherited congenital osteopetrosis; nutritional deficiency of manganese; acorn calves o Giant stature - inherited prolonged gestation, not really giantism, only large at birth o Asymmetry - high withers, low pelvis of hyena disease of cattle o Limbs - complete or partial absence, inherited or sporadic amputates; curvature of limbs in rickets; bowie or bentleg of sheep poisoned by Trachymene sp. a Head - inherited and sporadic cyclopean deformity; inherited probatocephaly (sheep's head) of calves; inherited moles, bulldog calves; acquired atrophic rhinitis of

pigs. SPONTANEOUS FRACTURES Spontaneous fractures occur uncommonly in farm animals and pre-existing diseases are usually present, which include the following: o Nutritional excess of phosphorus causing osteodystrophia in horses Nutritional deficiency of calcium causing osteodystrophia in pigs Nutritional deficiency of phosphorus or vitamin D in ruminants causing rickets and/or osteomalacia; hypervitaminosis A may contribute to this o Nutritional deficiency of copper Chronic fluorine intoxication. PAINFUL ASPECTS OF LAM EN ESS Musculoskeletal pain can be caused by lacerations and hematomas of muscle, myositis and space-occupying lesions of muscle. Osteomyelitis, fractures, arthritis, joint dislocations, sprains of ligaments and tendons are also obvious causes of severe pain. Among the most painful of injuries are swollen, inflammatory lesions of the limbs caused by deep penetrating injury or in cattle by extension from footrot. Amputation of a claw, laminitis and septic arthritis are in the same i category. Relief of muscu loskeletal pain Treatment of the causative lesion is a major priority but the

lesion may be painful for varying lengths of time. Relief and the control of pain should be a major consideration. FOOD-PRO DUCING ANI MALS Diseases of the musculoskeletal system and feet that cause lameness cause major economic losses. The condemnation of animals to slaughter because of lesions of the musculoskeletal system also contributes to the total economic loss. The epidemiological factors which contribute to lameness include: Injuries due to floor surfaces Persistently wet, unhygienic ground conditions Overcrowding and trampling during transportation and handling Nutritional inadequacies Undesirable skeletal conformation Failure to provide regular foottrimming Osteoarthritis occurs most commonly in old animals. Diseases of the legs of dairy cattle occur most commonly at the time of parturition and during the first 50 days of lactation. Diseases of the feet of dairy cattle occur most commonly in days 50-150 of the lactation period EXAMI NATION OF THE MUSCULOSKELETAL SYSTEM Analysis of gait and conformation Inspection of the gait of the animal is necessary to localize the site of lameness.

Close physical exami nation A close detailed physical examination of the a ffected area is necessary to localize the lesion. This includes passive movements of limbs to identify fractures, dislocations and pain on movement. Muscles can be palpated for evidence of enlargement, pain, or atrophy. Radiography Radiography is useful for the diagnosis of diseases of bones, joints and soft tissue swelling of limbs, which cannot be easily defined by physical examination. Ultrasonographic imaging can be used to differentiate the pathological changes in the soft tissue structures of digital flexor tendon sheaths of cattle. Ultrasonography Ultrasonography is a valuable diagnostic aid for septic arthritis. Joint effusion, which is one of the earliest signs of septic arthritis, the accurate location of soft tissue swelling, the extent and character of joint effusion and involvement of concurrent periarticular synovial cavities or other soft tissue structures can be imaged by ultrasonography.

Muscle biopsy A muscle biopsy may be useful for microscopic and histochemical evaluations

Arthrocentesis Joint fluid is collected by needle puncture of the joint cavity (arthrocentesis) and examined for the presence of cells, biochemical changes in the joint fluid and the presence of infectious agents. Arthroscopy Special endoscopes are available for inspection of the joint cavity and articular surfaces (arthroscopy) . Diagnostic and surgical arthroscopy is now commonplace in specialized equine practice. Surgical arthroscopy is rapidly replacing conventional arthrotomy for the correction of several common surgical conditions of the musculoskeletal system of the horse. Serum biochemistry and enzymology When disease of bone or muscle is suspected, the serum levels of calcium, phosphorus, alkaline phosphatase and the muscle enzymes creatinine phosphokinase (CPK) and aspartate aminotransferase (AST), also known as serum glutamic oxaloacetic transaminase (SGOT), may be useful. The muscle enzymes are sensitive indicators of muscle cell damage; N utriti onal history Because the most important osteodystrophies and myopathies are nutritional in origin a complete nutritional history

must be obtained. This should include an analysis of the feed and determination of the total amount of intake of each nutrient, including the ratio of one nutrient to another in the diet. Environment and housing when outbreaks of lameness occur in housed cattle and pigs the quality of the floor must be examined to evaluate the possibility of floor injuries. Diseases of muscles MYASTHENIA (SKE LETAL MUSCLE ASTHENIA) The differential diagnosis of paresis, paralysis and incoordination should include a consideration of skeletal muscle weakness unrelated to primary neurogenic hypotonia or to permanent muscle injury, including myopathy and myositis The common causes of myasthenia in farm animals are : o Ischemia in iliac thrombosis in the horse and after recumbency in cows with parturient paresis. The end stage is myonecrosis and not reversible o Metabolic effect on muscle fibers causes include hypokalemia, hypocalcemia and pOSSibly hypophosphatemia (in parturient paresis of dairy cows), hypomagnesemia (in lactation tetany), hypoglycemia of newbom pigs and lactic acidemia after engorgement on grain o Toxins - general toxemia is a cause. Also, many plant toxins exert an effect

on skeletal muscle activity. Although in most cases the mode of the action of the toxin is unknown, the toxins have been listed as neurotoxins. MYOPATHY The term myopathy describes the noninflammatory degeneration of skeletal muscle that is characterized clinically by muscle weakness and pathologically by hyaline degeneration of the muscle fibers. The serum levels of some muscle enzymes are elevated and myoglobinuria is a common accompaniment. ETIOLOGY AND EPIDEM IOLOGY The most important myopathies in farm animals are due to nutritional deficiencies of vitamin E and selenium and the effects of unaccustomed exercise. In humans, in contrast, the muscular dystrophies occur as inherited defects of muscle or degenerative lesions caused by interruption of their nerve supply. The skeletal myopathies can be classified into primary and secondary myopathies. The major causes of myopathy in farm animals and their epidemiological determinants are as follows Enzootic nutritional muscu lar dystrophy A nutritional deficiency of vitamin E and I or selenium is a common cause in young calves, lambs, foals, and piglets. The disease also occurs in adult horses. Exertional or postexercise rhabdomyolysis

This is not known to be conditioned by vitamin E (selenium deficiency) and occurs as equine paralytic myoglobinuria (tying-up sYl1drome, azoturia) in horses after unaccustomed exercise or insufficient training. I It also occurs in sheep chased by dogs, in cattle after running wildly for several minutes and as capture myopathy during capture of wildlife. The horses were not in training, creatine kinase levels were elevated and the urine was dark brown; Metabolic Hyperkalemic periodic paralysis occurs in certain pedigree lines of North American show Quarter Horses. Degenerative myopathy This occurs in newborn calves, sheep and goats affected by Akabane virus infected in utero. In herited myopathies The porcine stress syndrome, which is discussed under that heading, now includes herztod pale, soft, exudative pork encountered at slaughter and malignant hyperthermia follOwing halothane anesthesia.

Most of these myopathies of pigs thus have an inherited basis and the stress of transportation, overcrowding and handling at slaughter precipitates the lesion and rapid death.. Toxic agents This is caused by poisonous plants,

including Cassia oeeidentalis, Kanuinskia humboldtiana, Ixioloena spp., Geigeria spp. and lupins. Ischemia Ischemic myonecrosis occurs in the thigh muscles of cattle recumbent for about 48 hours or more and is discussed in detail under the heading Downer cow sYl1drome. Iliac thrombosis in horses is an important cause of ischemic myopathy and has been reported in calves. Neurogenic Neurogenic muscular atrophy occurs sporadically due to traumatic injury and subsequent degeneration or complete severance of the nerve supply to skeletal muscle. Neurogenic Neurogenic muscular atrophy occurs sporadically due to traumatic injury and subsequent degeneration or complete severance of the nerve supply to skeletal muscle. PATHOGEN ESIS Primary myopathy The characteristic change in most cases of . primary myopathy varies from hyaline degeneration to coagulative necrosis, . affecting particularly the heavy thigh muscles and the muscles of the diaphragm. Myocardial lesions are also commonly associated with the degeneration of skeletal muscle. The visible effects of the lesions are

varying degrees of muscle weakness, muscle pain, recumbency, stiff gait, inability to move the limbs and the development of respiratory and circulatory insufficiency In primary nutritional muscular dystrophy associated with a deficiency 'of vitamin E andlor selenium there is lipoperoxidation of the cellular membranes of muscle fibers resulting in degeneration and necrosis.

Myog lobi n u ria Because of the necrosis of muscle, myoglobin is excreted in the urine and myoglobinuric nephrosis is an important complication, particularly of acute primary myopathy. The degree of myoglobinuria depends on the severity of the lesion, acute cases resulting in marked myoglobinuria,. Adult horses with myopathy may liberate large quantities of myoglobin, resulting in dark brown urine. Yearling cattle with myopathy release moderate amounts and the urine may or may not be colored; calves with severe enzootic nutritional muscular dystrophy may have grossly normal urine. In all species the renal threshold of myoglobin is so low that discoloration of the serum does not occur. Muscle enzymes An important biochemical manifestation of myopathy is the increased release of

muscle cell enzymes that occurs during muscle cell destruction. CPK and serum glutamic oxaloacetate transaminase are both elevated in myopathy and CPK, particularly, is a more specific and reliable indication of acute muscle damage. Increased amounts of creatinine are also released into the urine following myopathy. Exertional rhabdomyolysis In exertional rhabdomyolysis in horses there is enhanced glycolysis with depletion of muscle glycogen, the accumulation of large amounts of lactate in muscle and blood and the development of hyaline degeneration of myofibers. Affected muscle fibers are richer in glycogen in the acute stage of 'tying-up' than in the late stages, suggesting an increased glycogen storage in the early phase of the disease compared with normal healthy horses. During enforced exercise there is local muscle hypoxia and anaerobic oxidation resulting in the accumulation of lactate and myofibrillar degeneration. Types of muscle fiber affected In most animals skeletal muscle is composed of a mixture of fibers with different contractile and metabolic characteristics. Fibers with slow contraction times have been called slow twitch or type I fibers and those i"lith fast contraction time are fast twitch or type II. o Type I fibers are characterized by strong aerobic capacity, compared

with type lIA Type lIA fibers are more glycolytic and have strong aerobic and moderate to strong anaerobic capacities , Type IIB fibers are characterized by a relatively low aerobic and a relatively high anaerobic capacity and are gJycolytic Secondary myopathy due to ischemia In secondary myopathy due to ischemia there may be multiple focal areas of necrosis, which causes muscle weakness and results in an increase of muscle enzymes in the serum . The degree of regeneration with myofibers depends on the severity of the lesion In aortic and iliac thrombosis in calves under 6 months of age the thrombosis results in acute-tochronic segmental necrosis of some skeletal muscles and coagulation necrosis in others Neurogenic atrophy of muscle In neurogenic atrophy there is flaccid paralysis, a marked decrease in total muscle mass and degeneration of myofibers, with failure to regenerate unless the nerve supply is at least partially restored. CLINICAL FINDINGS The nutritional myopathies associated with a deficiency of vitamin E and/or selenium occur most commonly in young growing

animals and may occur in outbreak form, particularly in calves and lambs Primary myopathy In general terms, in acute primary myopathy there is a sudden onset of weakness and pseudoparalysis of the affected muscles, causing paresis and recumbency and, in many cases, accompanying respiratory and circulatory insufficiency. The affected animals will usually remain bright and alert but may appear to be in pain. The temperature is usually normal but may be slightly elevated in severe cases of primary myopathy. Cardiac irregularity and tachycardia may be evident, and myoglobinuria occurs in adult horses and yearling cattle Acute cases of primary myopathy may die within 24 hours after the onset of signs. Acute nutritional myopathy While acute nutritional myopathy in horses occurs most commonly in foals from birth to 7 months of age, acute dystrophic myodegeneration also occurs in adult horses. There is muscle stiffness and pain, myoglobinuria, edema of the head and neck, recumbency and death in , a few days Tying-up In tying-up in horses there is a very sudden onset of muscle soreness 10-20 minutes following exercise. There is profuse sweating and the degree of soreness varies from mild, in which the horse moves with a short, shuffling gait, to

acute, in which there is a great disinclination to move at all. In severe cases, horses are unable to move their hindlegs, and swelling and rigidity of the croup muscles develops Postanesthetic myositis In postanesthetic myositis affected horses experience considerable difficulty during recovery from anesthesia. Recovery is prolonged and when initial attempts are made to stand there is lumbar rigidity, pain and reluctance to bear weight Other clinical findings include anxiety, tachycardia, profuse sweating, myoglobinuria and tachypnea. Death may occur in 6-12 hours.

Hyperka lemic period ic paralysis Initially there is a brief period of myotonia with prolapse of the third eyelid. In severe cases, the horse becomes recumbent and the myotonia is replaced by flaCCidity. Sweating occurs, and generalized muscle fasciculations are apparent, with large groups of muscle fibers contracting simultaneously at random. The animal remains bright and alert and responds to noise and painful stimuli Myoglobinuria Myoglobinuria is a common finding in adult horses with acute paralytic myoglobinuria but is not a common finding in acute nutritional muscular dystrophy in young farm animals, except perhaps in yearling cattle with acute muscular

dystrophy. The myoglobinuria may be clinically detectable as a red or chocolate brown discoloration of the urine ECROPSY FINDINGS Affected areas of skeletal muscle have a white, waxy, swollen appearance like fish flesh. Commonly only linear strips of large muscle masses are affected and the distribution of lesions is characteristically bilaterally symmetrical. TREATMENT Vitamin E and selenium are indicated for the treatment of nutritional muscular dystrophy Liberal quantities of thick bedding Q Removal from solid floors to softer ground G Frequent turning from side to side to minimize secondary myopathy o Provision of fluid therapy to prevent myoglobinuric nephroSis o A palatable, nutritious diet. Acute myositis of l i m b muscles This disease is accompanied by severe lameness, swelling, heat and pain on palpation. There may be accompanying toxemia and fever. In chronic myositis there is much wasting of the affected muscles and this is difficult to differentiate clinically from atrophy . In horses traumatic myositis of the posterior thigh muscles may be followed by the formation of fibrous adhesions. njection site lesions in cattle Muscle lesions associated with injection

sites in the cattle industry are a source of major economic loss because of the amount of trim required at slaughter.

Diseases of bones OSTEODYSTROPHY Osteodystrophy is a general term used to describe those diseases of bones in which there is a failure of normal bone development, or abnormal metabolism of bone that is already mature The major clinical manifestations include distortion and enlargement of the bones, susceptibility

to fractures and interference with gait and posture. ETIOLOGY The common causes of osteodystrophy in farm animals include the following. Nutritional causes Calci um, phosphorus and vitamin D Absolute deficiencies or imbalances in calcium-phosphorus ratios in diets cause: Rickets in young animals, e.g., grow ing lambs fed a diet rich in wheat bran Absolute deficiencies of calcium Beef calves on intensive rations with inadequate supplementation1 Osteomalacia in adult ruminants. Osteodystrophia fib rosa in the horse occurs most commonly in animals receiving a diet low in calcium and high in phosphorus. Osteodystrophia fibrosa in pigs occurs as a sequel to rickets and osteomalacia, Copper deficiency Osteoporosis in lambs Epiphysitis in young cattle. Other nutritional causes Inadequate dietary protein and general undernutrition of cattle and sheep can result in severe osteoporosis and a great increase in ease of fr acture Chronic parasitism can lead to oste odystrophy in young growing ruminants Hypovitaminosis A and hyp ervitaminosis A can cause osteodystrophic changes in cattle and

pigs Prolonged feeding of a diet high in calcium to bulls can cause nutritional hypercalcitoninism Multiple vitamin and mineral deficiencies are recorded as causing osteodystrophy in cattle. Chemical agents c Chronic lead poisoning is reputed to cause osteoporosis in lambs and foals Chronic fluorine poisoning causes the characteristic lesions of osteofluorosis, including osteoporosis and exostoses Grazing the poisonous plants Setaria sphaceleta, Cenchrus ciliaris, and Pa nicum maximum var. trichogl ume causes osteodystrophia in horses Bowie or bentleg, a disease caused by poisoning with Tr achy mene glaucifolia, is characterized by extreme outward bowing of the bones of the front limbs. Inherited and congenital causes Achondroplasia and chon drodystrophy in dwarf calves and some cases of prolonged gestation Osteogenesis imperfecta in lambs and Charolais cattle. Osteopetrosis in Hereford and Angus Calves Inherited exostoses in horses; inherited thicklegs and inherited rickets of pigs, which are wellestablished entities.

Angular deformities o joints of long I bones due to asyrnmetnc growth plate activity are common in foals Physitis is dys plasia of the growth plate, characterized by an irregular border between the cartilage and the metaphyseal zone of ossification Physical and environmental causes Moderate osteodystrophy and arthropathy may occur in rapidly growing pigs and cattle raised indoors and fed diets that contain adequate amounts of calcium, phosphorus and vitamm D. traumatic injury of the epiphyses and condyles of long bones may be predisposing factors in osteochondrosis and arthrosis in the pig (leg weakness) and epiphysitis in cattle. Femoral fractures occur in newborn calves during the process of assisted traction during birth Tu mors Osteosarcomas are highly malignant tumors of skeletoblastic mesenchyme in which the tumor cells produce osteoid or bone. Osteosarcomas are the most common type of primary bone tumor in animals such as dogs and cats but are rare in horses and cattle. Most tumors of bone in large animals occur in the skull. A periosteal sarcoma on the scapula has been recorded in the horse6 and an osteosarcoma of the mandible in a co PATHOGENESIS There are some

species differences in the osteodystrophies that occur with dietary deficiencies of calcium, phosphorus, and vitamin D. Rickets and osteomalacia occur primarily in ruminants, osteodystrophia fibrosa in horses, and all three may occur in pigs Rickets Rickets is a disease of young growing animals in which there is a failure of provisional calcification of the osteoid plus a failure of mineralization of the cartilaginous matrix of developing bone. There is also failure of degeneration of growing cartilage, formation of osteoid on persistent cartilage with irregularity of osteochondral junctions and overgrowth of fibrous tissue in the osteochondral zone There is a decreased rate of longitudinal growth of long bones and enlargement of the ends of long bones Eruption of the teeth in rickets is irregular and dental attrition is rapid. Growth of the mandibles is retarded and is combined with abnormal dentition. There may be marked malocclusion of the teeth. .

ARTHRITIS AND SYNOVITIS Inflammation of the synovial membrane and articular surfaces as a result of infection occurs commonly in farm animals. It is characterized by varying degrees of lameness and a warm and swollen painful joint. The arthritis may be severe enough to cause systemic illness, and in some cases a draining sinus tract may occur.

ETIOLOGY AND EPIDEM IOLOGY Specific bacterial infections of the joints are most common in newborn farm animals, in which localization of infection occurs in joints following bacteremia or septicemia. Ca lves c Nonspecific joint-ill from omphalophlebitis associated with A. pyogenes, Fusobacterium necrophorum, Staphylococcus sp. o Erysipelothrix rhusiopathiae sporadically in older calves o Salmonella dublin, Salmonella typhimurium and Mycoplasma bovis. Lambs E. rhusiopathiae in newborn and recently tail-docked lambs o Sporadic cases associated with F. necrophorum, Staphylococcus sp., Corynebacterium pseudotuberculosis, Histophilus somni, Mannheimia haemolytica c Chlamydophila spp. cause polyarthritis extensively in feedlot lambs In tick pyemia associated with Staphylococcus aureus. Foa ls Actinobacillus equuli, Rhodococcus equi, Salmonella abortivoequina in the newborn Chlamydophila sp. has caused polyarthritis in foals. Pig lets Streptococci, Lancefield groups C, E, and L Streptococcus suis

" E. rhusiopathiae C attle His toph il us s0I1111i is a cause of synovitis Mycoplasma agalactia var. bovis is a common cause of synovitis, arthritis and pneumonia in young feedlot cattle Mycoplasma bovigelJitaliurl1 may cause mastitis in cows, with some animals developing arthritis Mycoplasma 171ycoidcs may cause arthritis in calves vaccinated with the organism against contagious bovine pleuropneumonia. Brucella abortus BVD virus in young bulls, rarely c Idiopathic septic arthritis in dairy heifers A. pyogene Sheep a n d goats As part of melioidosis Mycoplasma sp. of serositis - arthritis OJ Streptococcus dysgalactiae in dairy goats. Pigs o Glasser's disease o Mycoplasma sp. in synovitis and arthritis of growing pigs especially in housed pigs Horses c Septic arthritis after penetrating wounds, intra-articular injection of corticosteroids, and surgery. immunemediated

polysynovitis in foals" All species Sporadic cases are due to: Traumatic perforation of the joint capsule " Spread from surrounding tissues, e.g. footrot to interphalangeal joints in cattle and pigs, interdigital abscess in sheep c Hematogenous spread from suppurative lesions commonly in udder, uterus, diaphragmatic abscess infected navel or tail, castration wound.