Knee Injury

[KsKingBee]

@casportpony , @Garden Peas, @DylansMom, I have a leg injury on a 2016 bird. It came up lame about two weeks ago and isn't getting any better, have you seen this type of injury before? It is rock hard an isn't getting any better.

 

[hhn2002]

Tophaceous gout, pseudogout, septic arthritis. These are human diseases that can occur with symptoms of hard swollen painful warm/hot knee joints but maybe peafowl can get them too. They first two leave hard crystal or calcium deposits. gout can caused by kidney disease, which may have led to kidney failure and death. septic arthritis is a bacterial infection of the joint and seems most easily and quickly to led to death without treatment. A good option is to check out a comprehensive veterinary poultry diseases handbook for joint/leg swelling problems.

 

[KsKingBee]

Maybe someone can spot something in these pics I haven't noticed.





The swelling is very hard and when the bird was alive very warm.



The bird could not stand on the leg and was in a lot of pain.




The first incision is around and through the swollen area.



The yellow in the center is very hard and crunchy, I believe it is calcium.



The white under the skin is very much like gristle.




I cut through the bone in the middle of the swollen area.





This is the second cut through the bone. It appears to me that the bird had a green fracture that was mending or growing out of control.

 

[Sydney Acres]

Quote:
Welllll ---

It's really hard for me to interpret from pictures, without seeing, feeling, manipulating and smelling it myself, but I'll stick my toe in the water (since everybody has popcorn, after all

).

The first pictures look like the lesion is below the joint, not in it. The picture where the joint is disarticulated looks like the articular cartilage was not inflammed, and there is a clear glistening of what I assume is normal joint fluid. The surrounding area does look a little thickened, which I assume is inflammation moving upwards from the lesion and surrounding the joint, but hasn't invaded into the protective joint capsule yet. It appears that the swelling started distinctly below the hock joint (the knee is the next one up the leg, and points towards the head when flexed, whereas the hock, the equivalent to our ankle, points towards the tail when flexed), with the greatest amount of inflammation on the back of the leg, with progressively thinning areas of swelling wrapping mostly around the outside, but somewhat also around the inside of the leg, the extending upwards toward the joint as well.

The description of the center of the swelling being hard and crunchy means that either bony tissue is involved, or there is some kind of crystal formation, or mineralization of soft tissue, or some combination of those. Other things that I would consider are the lack of a distinct tubular bone structure, very inflammed/thickened connective tissue outside the bone (probably either the (normally) thin periosteum that surrounds the outside of the mineralized bone, or the ends of tendons that were attached to the bone in that location), the level of pain the bird showed (laying down instead of limping), and the sudden change in the birds condition from being disabled to being really sick. That bone, focally, was really compromised and desperately remodeling with a huge amount of disorganized bone tissue, instead of healing with a strong, functional bony structure. That kind of bone growth is kind of like rapidly building something with styrofoam instead of slowly creating steel. The repair takes up more space and isn't nearly as strong. That rarely happens with a fracture. I suppose it could if the animal was forced to use the leg with an unstable fracture, where the broken bone ends aren't held together and they rub against each other with each step. But typically you would have a bird that suddenly went down, before the extreme bony swelling had a chance to develop, and you would first see soft tissue swelling from the trauma and maybe be able to detect the instability. A green stick fracture shouldn't have that level of instability, so the bony callous that it develops shouldn't be that exuberant, and the inflammation shouldn't be so extreme. And there should still be an obvious strong bony "pipe" that the new mineralization is adhering to and trying to repair. So to my eyes, this doesn't look like a typical green stick fracture, although I can't be sure from just pictures.

The two things that first come to mind that would cause this level of disorganized bony proliferation are a bone infection (bacterial or fungal are most common), or bone cancer. Depending on where you live, fungal infections may be common, can seat anywhere on a bone, and will look exactly like this. Bacterial infections can get into bone through injury and a tiny penetrating wound that might never be seen, or can land focally on a bone after traveling through the blood. An injury that would cause a green stick fracture plus a tiny penetrating wound leading to bone infection would be a double whammy. These types of infections don't look like typical abscesses, don't form pus, and rarely smell bad. This bird is a little young for cancer, but realistically, they have pediatric oncology wards for a reason. Youngsters get cancer too, unfortunately, and bone cancer typically causes first lytic resorption of bone tissue, then desperate disorganized attempts at repairing of the bone, ending in severe focal pain, then obvious illness. So either infection or cancer could look exactly like this. Gout could potentially also cause this, but the location is weird, the progression isn't right, and the response would be extreme for just a few uric acid crystals. This level of gout typically would take a very long time to develop, and should not be painful enough outside of a joint to create these symptoms. I could see this level of inflammation if gout settled in a tendon, but that shouldn't trigger this kind of bony remodeling. A "slipped tendon" causes some obvious abnormal angulation of the leg at the hock joint, and may cause some local soft tissue inflammation and swelling, but would have no reason to cause bony remodeling to this extent. Something had to be destroying bony tissue to justify this kind of a response.

Or at least that's my best guess, based just on pictures and a few symptoms. I could be wrong.

If the dissected area was saved, you could send it in for a biopsy. That would likely give you a more definitively answer.

 

[ChickenTDuck1234321]

Hello!

Okay, what you have here looks to me to be sequelae of the earlier infection! So when a bird gets sick with a systemic infection (meaning the pathogen has reached the bloodstream), there are some common lesions we see in the veterinary world. In birds you see three lesions following a bacterial or viral insult: hepatomegaly (enlarged liver), splenomegaly (enlarged spleen), and swollen joints. Since we cannot see the spleen or liver, this is what we probably have to work with on this bird.

This is not medical advice, but I would quarantine the bird, monitor for changes in appetite/water intake, and just make the bird as happy as possible! If I had to guess what you're dealing with based on respiratory signs is most likely a fowl cholera (P. multocida), colibacillosis (E. coli), Mycoplasmosis (Mycoplasma spp.), etc. If more of your flock gets sick, please do not hesitate to shoot me a PM. I can help you and your veterinary professional to the best of my ability.

Have a great day,

Luke

 

[Sydney Acres]

Hello Dr. Luke,
I don't mean to be a witch here, but clearly you have not represented your profession well in this situation. You have neither read the history of the illness, nor looked over most of the information provided. You have no business giving medical advice in this situation, which you are doing despite the claim that you are not giving any.. You clearly have not evaluated the most critical part of the thread, or you would not be recommending that this bird be quarantined, monitored, and "made as happy as possible" AFTER IT HAS BEEN CULLED AND ITS LEG HAS BEEN DISSECTED TO SHOW US THE LESION. Did you think you were looking at a backyard surgery and didn't notice that the rest of the bird wasn't attached??? Your cavalier declarations of medical differentials are ridiculous in this situation -- you are not addressing an audience of other veterinarians who understand all the medical terms that you are using, or appreciate your attempt at elevating your assumed status by using such language. You come off as arrogant, callous, and clueless. I can only hope that you are a new grad who hasn't yet learned that such behavior is offensive, and will later mature into a caring professional, one that is willing to share some hard-earned knowledge with compassion and humility.

And while the textbooks do teach that fungal infections are systemic, with both respiratory and neurologic involvement, there are many cases of isolated lesions, regardless of the fungal organism involved. You may "not have seen one to date," but I have seen several. However, I suspect that I have been around a few decades longer than you. With age, you will find that patients don't always read the book, and that many individual illnesses don't match their description.

 

[new 2 pfowl]

I think they're still here @KsKingBee ...are you here @Garden Peas ? @DylansMom ? I think the @ function is just misbehaving.

 

[KsKingBee]

Is he valuable? If so, maybe an X-ray?

-Kathy

It is a hi% Spaulding Black Shoulder, cock I think... $175 ish in healthy condition. I have a few more but spending a bunch of money on this one is not really appealing to me. BTDT... I will call and see how much an X-ray is. If it is a hen I will be more inclined to get that X-ray. Gerald has a full brother to this one and he really likes his cock.

 

[barkerg]

It is a hi% Spaulding Black Shoulder, cock I think...  $175 ish in healthy condition.  I have a few more but spending a bunch of money on this one is not really appealing to me.  BTDT...  I will call and see how much an X-ray is.  If it is a hen I will be more inclined to get that X-ray.  Gerald has a full brother to this one and he really likes his cock.

Your Killin' me! I almost fell off my seat laughing but, I do love his brother indeed, very tall bird and coloring up real nice.

Gerald Barker

 

[Birdrain92]

I wonder if he got a green stick fracture and the bone tried to repair itself and caused calcification to form that bump. If it's do to bone trauma I don't think you can do anything unless you want to pay a ridiculous amount of money for surgery. He's probably just going to have to live with it.