The musculoskeletal system in horses encompasses the bones, muscles, tendons, ligaments, and joints that facilitate movement and provide structural support. This system is essential for locomotion, athletic performance, and overall health in equine species. The equine skeleton consists of approximately 205 bones, which are connected by joints and supported by a network of muscles and connective tissues. Tendons connect muscles to bones, while ligaments link bones to other bones, contributing to joint stability. The musculoskeletal system is subject to various conditions, including injuries, degenerative diseases, and developmental disorders, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, physiology, pathology, and treatment of musculoskeletal conditions in horses.
Rawlings CA.Ventricular weights and coronary arterial distribution and diameters were determined in 10 small adult ponies (139 +/- 32 kg). Combined ventricular weights averaged 0.52% of the body weight, with an average of 77% of the total ventricular weight being the left ventricle. The pony is right coronary predominant, with the interventricular subsinusoidal branch of the right coronary artery and interventricular paraconal branch of the left coronary artery providing comparable blood supply to the left ventricular free wall and septum.
Gunson DE, Rooney JR.An 8-year-old gelding with a long-standing, streptococcal respiratory infection developed dyspnoea and colic. Laparotomy disclosed numerous, discrete, hemorrhagic, thick areas of necrosis throughout the intestinal tract. At postmortem examination similar lesions were seen in the laryngeal mucosa and in many skeletal muscles. Microscopically these lesions had massive necrosis and hemorrhage with a leucocytoclastic vasculitis in adjacent tissue. This condition resembled anaphylactoid purpura (Henoch-Schönlein disease) in man. Fungal infection was ruled out by special stains which failed to show...
Guy PS, Snow DH.1. Percutaneous needle biopsies were obtained from six limb muscles in six horses before and during a training programme of 10 or 15 weeks designed to involve both aerobic and anaerobic work. In a subsequent detraining period, biopsies were also taken after 5 and 10 weeks. 2. Samples were analysed biochemically for enzyme activity of lactic dehydrogenase (LDH), creatine phosphokinase (CPK), aldolase (ALD), citrate synthase (CS), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) and for glycogen content. Fibre typing was carried out histochemically before and 10 weeks after c...
Campbell JR.Limb angulation in foals may be due to defects in epiphyseal growth plates. The present state of knowledge concerning rate of growth in foals and differences in growth of different epiphyseal plates is reviewed and the importance of accurate knowledge of these parameters in treatment of angulation by unilateral retardation of an epiphyseal growth plate is stressed. Retardation of epiphyseal plate growth by compression wiring is described and its advantages in comparison with staplings are suggested. Compression wiring was used in 3 cases in which age, bone width and the degree of angulation we...
Frost GE, du Preez HR.A 3 year old thoroughbred colt in full training pulled up
acutely lame during a training gallop on a dirt track.
According to the trainer no reason for the injury was
evident. The horse refused to bear weight on the leg
and when forced to walk back to the stables it would
only touch the affected toe to the ground. The fetlock
soon became swollen and was very painful. The trainer
treated the animal for a sprain with ice packs and
bandages. No improvement occurred in 72 hours and
veterinary advice was sought.
Examination revealed the horse to be in obvious
pain. He was unable to bear ...
Shively JA, Van Sickle DC.The scanning electron microscopy of synovial membrane from the radiocarpal and intercarpal joints near the lateral and medial borders of the tendon of the extensor carpi radialis muscle was studied in 5 ponies. Three different morphologic types of synovial membrane were observed. Type 1 synovial membrane was folded and had a surface mat of fibers separated by 1- to 5-micron-diameter holes. The 2nd and 3rd types of synovial membrane were both villous. The surface of type 2 synovial membrane was fibrillar but the surface of type 3 synovial membrane was cellular. The type of synovial membrane pre...
Adrian M, Grant B, Ratzlaff M, Ray J, Boulton C.Electrogoniometry was used qualitively and quantitatively to assess the movements of the normal and pathologic metacarpophalangeal joints of selected horses. A total of 4 Thoroughbreds, 1 normal and 3 with clinical and radiographic changes in the metacarpophalangeal joints of 1 limb, were evaluated at the walk and trot. Goniograms of the affected joints were compared with those of the normal horse and the normal contralateral metacarpophangeal joint. Qualitative asymmetry was recognized on the goniograms, and the ranges of motion were quantified and related to the clinical and radiologic obser...
Webbon PM.The results of a survey are presented in which 589 limbs from 206 horses were dissected. In174 of the limbs lesions were found in either the superficial (131) or deep (43) digital flexor tendons. Changes occurring with age were also recorded. The sites of the abnormalities and their macroscopical appearance are described and the value of the results is considered in relation to the diagnosis and the treatment of clinical lesions.
Knight AP.Dysphagia developed in a 2-year-old Quarter Horse filly following an incident in which it fell over backward while exercising on a mechanical horse walker. Hyperextension of the neck at this time apparently caused unilateral rupture of the longus capitis (rectus capitis ventralis major) and the rectus capitis ventralis minor muscles at their insertion. An existing mycotic lesion involving the dorsomedial wall of the left guttural pouch may have weakened the area of insertion of the involved muscles. Tearing of the tendinous insertion of these muscles caused damage to the IX, X, and XI cranial ...
Rose RJ.Complications from neurectomy have been well known for many years. A 16-year-old mare suffered bilateral luxation of the coffin joints following palmar neurectomy and was destroyed. Autopsy showed complete rupture of the deep flexor tendons, and the supporting ligaments of the coffin joints. Arthritis of the coffin joints, with erosion of articular cartilage was evident.
Moore JN, Mcilwraith CW.Two cases of osteochondrosis are presented. Lesions involving the lateral trochlear ridge of the femur are demonstrated on conventional radiographs and double-contrast arthrograms. A radiographic suggestion of osteochondrosis lesions in the patella is noted. Post mortem examination of one case confirmed the presence of partially free cartilaginous flaps. Reference is made to familial tendency to osteochondrosis in man, dog, pig and horse. The significance of rapid growth rate in the pathogenesis of the condition is also discussed.
Jones RD, Fessler JF.ALTHOUGH METACARPAL TI-IV and metatarsal II-IV (MC II-IV, MT II-IV) fractures are frequent in horses and surgical intervention routine, a review of the current literature revealed little information about this subject. The authors have found only two complete accounts of this problem (1, 6). The incidence of suspensory desmitis has been previously reported (3), but we find no previous correla-tion of MC II-IV, MT II-IV fractures with suspensory, desmitis. On these bases, a re-trospective study was conducted. At Purdue University from 1967 through 1974, 50 Standardbred horses underwent sur-gery...
Gabel AA, Spencer CP, Pipers FS.The distal radial physes of 113 two-year-old Standardbreds were radiographed an average of 2.6 times each during an average of 4.72 +/- 1.7 months, beginning May 1, 1975. The radiograph of each physis was graded C, B-, B, B+, or A (closed), and the date of closure was determined by a method that proved to be reliable. The average age of closure of the distal radial physes was 29.8 +/- 1.6 months, with age of closure ranging from 26 to 35 months. There were no statistical differences between age of physeal closure of colts, geldings, or fillies; pacers or trotters; "well-bred" or other horses, ...
Gideon L.A discussion of the merits of acupuncture therapy and a review of experiments that support the neurogenic mediation of acupuncture are presented. Case reports are included as examples of the therapeutic value of acupuncture in treatment of intestinal and musculoskeletal disorders in the horse. Statistical importance cannot be credited to the clinical experiences reported here because of the small number of cases. Hopefully, the clinical success reported will encourage continued investigation of the clinical efficacy and adjunctive value of acupuncture in the veterinary profession.
Pratt GW, O'Connor JT.The force plate can measure a wide range of effects in the horse. The same instrument can record forces from more than a ton in the galloping animal to 25 g associated with the action of the heart. In all probability, the force plate will develop into a valuable clinical instrument.
Boyd JS.The deformities observed in 2 Clydesdale foals are described. Both had abnormal joint positions in the forelimbs and discrepancies in the symmetry of the vertebral column. The changes were only mild in one case but extreme in the other where it was accompanied by torticollis, scoliosis and vertebral fusion. A comparison is made with deformities described in the contracted foal syndrome and some of the developmental implications discussed.
Snow DH, Guy PS.The use of the technique of percutaneous needle biopsy in obtaining skeletal muscle samples in the horse is described. The biochemical, ultrastructural and histochemical investigations that can be carried out on this biopsy specimen are outlined. Analyses performed on the specimen may be used to obtain information on racing potential and state of fitness. These studies on normal horses will provide information for future investigations into the structural and biochemical alterations in muscle disorders in the equine.
Rothhaupt D, Ziegler H, Laser T.The orthopedic hippotherapy represents a new form of therapeutic exercise in the conservative treatment of segmental instabilities in the lumbar spine region. This kind of therapy works on the principle of conveying to the patient the three-dimensional swinging motion of the horse's back. The patient reacts to these movement impulses by moving up and down (vertical movement of the spine), back and forth (sagittal movement) and to the right and the left (horizontal movement). The small movements of the spine thus produced bring about a mobilization of the segments involved in movement and there...
Schott HC, Bohart GV, Eberhart SW.Efflux of potassium (K+) and lactate (lac-) from active skeletal muscle during high intensity exercise leads to increased plasma [K+] and [lac-] in venous and arterial blood. The exercise-induced increases in these ions in human athletes is ameliorated, in part, by uptake by noncontracting tissue, reflected by an increase in the arteriovenous difference across these tissues from rest to exercise. To test the hypothesis that these ions are taken up by noncontracting tissue in strenuously exercising horses, plasma [K+] and [lac-] were measured in blood samples collected simultaneously from the c...
Beech J, Lindborg S, Braund KG.Potassium concentrations were measured in semimembranosus muscle, plasma and erythrocytes, and the urinary fractional excretion determined in normal horses and those that had chronic intermittent exercise-associated rhabdomyolysis. Muscle from the rhabdomyolysis horses was also evaluated microscopically. The horses with rhabdomyolysis had a lower muscle potassium concentration on a dry weight basis. Although the wet weight potassium content was also lower, the difference was not significant. Urinary fractional excretion of potassium (and also sodium and chloride) did not differ significantly b...
O'Brien TR, Hornof WJ, Meagher DM.Subchondral lesions were identified in the distal palmar region of the third metacarpus in 21 fetlock joints of 15 Thoroughbred horses. The lesions were more commonly identified on the lateromedial and flexed lateral projection, with the flexed lateral projection permitting optimal visualization of the lesion. Lesions appeared as poorly marginated, radiolucent defects and were located at the level of the base of the proximal sesamoid bones. The shape and distribution of the radiolucent defects were: crescent, 4; flattened, 4; shallow concavity, 5; deep concavity, 3; oval, 3; and circular, 2. S...
Gasthuys F, Vandamme R, De Moor A, De Meurichy W.A commercial neuroleptanalgesic acepromazine-etorphine combination administered intramuscularly to four horses produced a severe tachycardia and an increase in muscular tone, together with hypoxaemia, hypercapnia, metabolic acidosis associated with an increase in the packed cell volume and hyperglycaemia. No electrolyte changes were found. After reversal of the action of etorphine with diprenorphine, there was a prolonged decrease in the calcium and phosphorus serum concentrations and decreases in the packed cell volume and the total protein serum concentration. In a second experiment on the s...
Bolwell CF, Rogers CW, French NP, Firth EC.There is increasing evidence suggesting that early exercise in Thoroughbred racehorses may be beneficial to the development of the musculoskeletal system. At present, information on the exercise programmes and health problems of individual yearlings during a sales preparation is scant. Objective: To describe the exercise and health problems of Thoroughbred yearlings during preparation for sales, and to identify variations in exercise between and within farms. Methods: A prospective cohort study was used to collect exercise and health information from 18 farms across New Zealand. Daily exercise...
Koh RB, Harrison TM.Over the past years, the concept of pain management in veterinary medicine has evolved and led to the establishment of a new concept of multimodal approach to pain management, as the current standard of care. The use of multimodal analgesia combining pharmacologic and nonpharmacologic techniques not only helps optimize the quality and efficacy of analgesia but also may prevent the development of chronic or persistent pain. During the past decade, acupuncture has become more popular and evolved into one of the most used forms of integrative medicine interventions and nonpharmacologic therapeuti...
Adachi M, Aoi S, Kamimura T, Tsuchiya K, Matsuno F.Quadrupedal mammals have fore-aft asymmetry in their body structure, which affects their walking and running dynamics. However, the effects of asymmetry, particularly in the transverse plane, remain largely unclear. In this study, we examined the effects of fore-aft asymmetry on quadrupedal trotting in the transverse plane from a dynamic viewpoint using a simple model, which consists of two rigid bodies connected by a torsional joint with a torsional spring and four spring legs. Specifically, we introduced fore-aft asymmetry into the model by changing the physical parameters between the fore a...
Albu I, Georgia R, Georoceanu M.The Haversian canal system in the diaphysial compacta of the femur in 4 mammalian species (dog, pig, bovine, horse) was studied on the decalcified bone using a method developed by the authors. In the microscopic studies we found that in all species the network aspects vary with the depth of the compacta layer. In all layers, there is a background of longitudinal canals with more or less regular trajectories describing large curves. The anastomoses linking them are main elements that define the variety of the network aspects both from layer to layer and from species to species. The canal densit...
McGuigan MP, Walsh TC, Pardoe CH, Day PS, Wilson AM.Previous studies have implicated tension in the deep digital flexor tendon (DDFT) in the rotation of the distal phalanx (DP) after the breakdown of the dorsal laminae caused by laminitis. Howeveer, once the DP has rotated, the DDFT should become shorter, reducing the force it exerts on the DP. Objective: To compare DDFT force and ground reaction forces (GRFs) in normal ponies and ponies with rotation of the DP as a sequel to laminitis. Methods: Six normal ponies (Group 1) and 6 sound ponies with 6-13 degrees of rotation of the DP in relation to the dorsal hoof wall (Group 2) were assessed at t...
Hennessy SE, Cudmore L, Jackson LP, Vasey JR, Russell T.To (1) develop an arthroscopic approach to the subextensorius recess of the lateral femorotibial (LFT) joint in foals and (2) report its use in foals with LFT joint sepsis. Methods: (1) Anatomic study and (2) retrospective case series. Methods: (1) Cadaveric hind limbs (n = 32 foals) to delineate the anatomy of the subextensorius recess; 13 foal limbs for cadaver surgery to assess the approach to the subextensorius recess; and (2) foals (n = 8) with LFT joint sepsis. Methods: (1) The LFT joint was distended and examined ultrasonographically. Dissection was used to document periarticular landma...
Wulster KB.This article discusses the basis of image formation of radiography, scintigraphy, PET, computed tomography (fan beam and cone beam), and magnetic resonance as it relates to imaging of musculoskeletal injury in the sport horse. The benefits and drawbacks of each modality are discussed with particular emphasis on sensitivity, specificity, and accuracy of identification of subchondral bone injury. Examples of straightforward as well as confounding lesions are provided, emphasizing the need for appropriate clinical workup and diagnostic analgesia, where appropriate.
Lamb CR.Arthrography, tenography, and fistulography (or sinography) can provide additional information about the soft-tissue components of joints, tendon sheaths, and draining tracts, respectively. Arthrography is a valuable aid in the diagnosis of synovial masses, such as villonodular synovitis, and osteochondrosis. Tenography is particularly useful in evaluating chronic tendon sheath distention. Fistulography is an effective means of identifying acute traumatic damage to synovial structures and determining the cause and extent of draining tracts.
Steel CM, Devery S, Hance SR, Adkins AR, Hitchens PL.Fragmentation of the dorsal aspect of the distal talus (FDDT), at the dorsolateral articular margin of the proximal intertarsal joint (PITJ) on pre-sale radiographs of yearling Thoroughbreds has not been previously described and data to support decisions made by veterinarians to predict future racing potential of horses with these lesions are lacking. Methods: In this retrospective case-control study we aimed to determine the prevalence of FDDT in juvenile Thoroughbreds and to report their race records. From a database of survey and repository radiographic examinations of 5709 horses, 36 with ...
Claerhoudt S, Pille F, Vanderperren K, Hauspie S, Duchateau L, Van der Vekens E, Saunders JH.To investigate whether in navicular bones (NB) from warmbloods, distal border fragmentation is associated with the shape of the proximal articular border or other radiological findings. Methods: Radiographs of the front feet of 325 normal, subadult horses presented for admission as breeding stallions were reviewed. Results: The proximal articular border of the total of 650 NB was classified as straight (n = 278), convex (n = 184), undulating (n = 147) or concave (n = 41). Distal border fragments were present in 57 NB (8.8%). They were significantly more prevalent in NB with a concave (9/41; 22...
Meghoufel A, Cloutier G, Crevier-Denoix N, de Guise JA.The fiber bundle density (FBD) calculated from ultrasound B-scan images of the equine superficial digital flexor tendon (SDFT) can serve as an objective measurement to characterize the three metacarpal sites of normal SDFTs, and also to discriminate a healthy SDFT from an injured one. In this paper, we propose a shock filter algorithm for the thinning of hyper-echoic structures observed in B-scan images of the SDFT. This algorithm is further enhanced by applying closing morphological operations on filtered images to facilitate extraction and quantification of fiber bundle fascicles. The mean F...
Gläser KE, Davies ME, Jeffcott LB.This study was designed to examine a new role for cysteine proteinases in the process of endochondral ossification. Objective: The aim of the present study was to investigate the presence and distribution of cathepsin B and cathepsin L in equine articular cartilage during development. Methods: Full-depth cartilage samples from a total of 40 horses (age range: 4 month fetuses to 2 years) were examined and enzymes detected by immunocytochemical localisation. Results: Observations on the presence of cathepsins B and L revealed significant age-related differences, resulting in clear division of th...
Rapoff AJ, Markel MD, Vanderby R.By use of wire ropes as the transosseous component, an external skeletal fixator for the repair of long bone fractures in horses and cattle has been designed and tested in axial compression. Theoretical methods were used in the design process to size fixator components; however, our results suggest that conventional methods of analyzing the displacement of the transosseous component may not apply to wire ropes. Large pretensions in the wire ropes are necessary to obtain functional stiffnesses for fracture fixation. Therefore, a method was sought for terminating the ropes so that an appropriate...
Bennet ED, Parkin TDH.Racehorse training and racing schedules in many parts of the United States and Canada were interrupted or otherwise reduced during the first three to six months of 2020. This was an indirect consequence of mitigations to prevent the spread of the pandemic virus COVID-19. Data from the Equine Injury Database, a census-level survey of all race starts made in the USA and Canada, were used to analyse the incidence of fatalities in 2009-2022 among three age cohorts of racehorses within each year. There was a statistically significant increase in the incidence of musculoskeletal fatalities among 2-y...
Heffron CJ, Baker GJ.Cine-endoscopy was used to study the deglutition reflex in 2 apparently normal horses. Closure of the nasopharyngeal sphincter was brought about by a lowering of the pharyngeal roof and an elevation of the soft palate caudal to the pharyngeal ostia of the auditory tubes. The medial cartilages of the ostia were not directly involved in bringing about closure of the sphincter. It is postulated that the opening of the ostia of the auditory tubes is brought about during deglutition by the combined action of the palatopharyngeus, pterygopharyngeus and tensor veli palatini muscles.
Pham C, Bitonte R.Hippotherapy is the use of equine movement in physical, occupational, or speech therapy in order to obtain functional improvements in patients. Studies show improvement in motor function and sensory processing for patients with a variety of neuromuscular disabilities, developmental disorders, or skeletal impairments as a result of using hippotherapy. Objective: The primary objective of this study is to identify the pervasiveness of hippotherapy in Southern California, and any factors that impair its utilization. Methods: One hundred and fifty-two rehabilitation centers in the Southern Californ...
Davidson EJ, Ross MW, Parente EJ.Little information exists regarding talus fractures in the horse and there have been no previously published case series of racehorses diagnosed with incomplete sagittal fracture of the talus. Objective: To describe the diagnosis, treatment and post injury performance of horses with incomplete sagittal fracture of the talus. Methods: Medical records of 11 racehorses (8 Standardbreds and 3 Thoroughbreds) admitted between January 1992 and January 1999 were reviewed. Subject details, anamnesis, results of lameness examination, radiographs and nuclear scintigraphic findings were evaluated. Racing ...
Rollot Y, Lecuyer E, Chateau H, Crevier-Denoix N.As critical locomotion events (e.g. high-speed and impacts during racing, jump landing) may contribute to tendinopathies, in vivo recording of gaits kinematic and dynamic parameters is essential for 3D reconstruction and analysis. Objective: To propose a 3D model of the forelimb and a ground reaction force recording shoe (GRF-S) for noninvasively quantifying tendon and ligament loads and strains. Methods: Bony segments trajectories of forelimbs placed under a power press were recorded using triads of ultrasonic kinematic markers linked to the bones. Compression cycles (from 500-6000 N) were ap...
Thompson KN, Jackson SG, Baker JP.Effects of high dietary levels of energy, protein and Ca and deficient levels of Ca on skeletal growth and development in the equine were studied in two experiments. The weanlings were fed grain-based diets. In Exp. 1, Group 1 (Ctl) received all nutrients at NRC recommended levels for growth; Group 2 (HE) received 150% of their digestible energy (DE) requirement; Group 3 (LC) received 150% of DE and 35% of Ca requirements. In Exp. 2, Group 1 (Ctl) again received all nutrients at NRC recommended levels for growth; Group 2 (HEP) received 150% of DE and 275% of CP requirements; Group 3 (HEPC) rec...
Lewis CW, Williamson AK, Chen AC, Bae WC, Temple MM, Wong WV, Nugent GE, James SP, Wheeler DL, Sah RL, Kawcak CE.To determine and correlate subchondral bone mineral density and overlying cartilage structure and tensile integrity in mature healthy equine stifle (low magnitude loading) and metacarpophalangeal (high magnitude loading) joints. Methods: 8 healthy horses, 2 to 3 years of age. Methods: Osteochondral samples were acquired from the medial femoral condyle (FC) and medial trochlear ridge (TR) of the stifle joint and from the dorsal (MC3D) and palmar (MC3P) aspects of the distal medial third metacarpal condyles of the metacarpophalangeal joint. Articular cartilage surface fibrillation (evaluated via...
Nocera I, Sorvillo B, Sgorbini M, Aliboni B, Citi S.Few studies have established the normal radiographic anatomical development of the donkey foal and, to date, no data are available for mules. Our aim was thus to evaluate the radiographic development of the fore digit and carpal joint in the mule foal from 0 to 3 months of age. Ten forelimbs of five healthy full-term mule foals were included. Radiographs of the fore digit lateromedial and dorsopalmar and the carpus dorsopalmar were performed weekly for the first month of age, and bi-monthly during the following two months. Fore digit growth plate closure times, morphological, angular, and line...
Richardson DW, Nunamaker DM, Sigafoos RD.Arthrodesis of the metacarpophalangeal joint was attempted in 9 adult horses, using a new external skeletal fixation device and autogenous cancellous bone graft. Four horses had excellent results, 2 horses had fair results, arthrodesis failed in 2 horses, and 1 horse fractured the third metacarpal bone. The advantages of the technique included minimal surgical trauma to the area of injury, immediate rigid fixation of the metacarpophalangeal joint, and access for treatment of soft-tissue lesions at the site of injury. Although pin loosening and pin-track infection were complications when the de...
Colles CM.This paper describes the application of foil strain gauges to the hoof wall, and the use of measuring equipment to monitor weightbearing and changes in hoof shape in shod and unshod horses. It concludes that the systems can detect hoof movement and that results are reproducible. It is also concluded that the use of a conventional nailed on iron shoe restricts flexion and spreading of the hoof wall at the ground surface, but has little effect on the degree of expansion of the heels of the foot.
Anderson BH, Ethell MT.A number of methods for the local delivery of drugs to musculoskeletal tissues in the horse are now available. Further research is required to document the disposition of drugs delivered by such methods and to correlate this information with efficacy. Perhaps the greatest potential area for the methods discussed is the treatment of synovial and bone infections. To be able to provide high and sustained therapeutic concentrations of antimicrobials to the site of infection should increase the chances of success in such cases. These methods of drug delivery need to be used in conjunction with othe...
Schneider RK, Ratzlaff MC, White KK, Hopper SA.To determine effect of 3 half-limb casts on bone strains recorded from the proximal phalanx (P-1) and third metacarpal bone (MCIII) of equine cadaver limbs, using a mechanical testing machine. Methods: 12 equine cadaver limbs and 4 live horses. Methods: Bone strains were recorded at middorsal P-1 and the dorsal cortical aspect of the distal third of MCIII while limbs were variably loaded with 100 to 1,000 lb of force. To determine ability of the cast to protect the distal portion of the limb from weight-bearing loads, strains were recorded with the limb in 1 of the 3 casts and with it unsuppor...