Ultrasonographic diagnosis of septic arthritis of the distal interphalangeal joint in cattle

Diagnosis of septic arthritis in the distal interphalangeal joint (SADIJ) is often difficult, particularly when arthrocentesis or probing of the joint space are inconclusive. The aim of this prospective study was to investigate the usefulness of ultrasonography in reinforcing a tentative clinical diagnosis of SADIJ in 60 Holstein–Friesian cows with septic arthritis in one distal interphalangeal joint (DIJ). The diagnosis of septic arthritis was based on the results of clinical examination and radiographic images, as well as surgical findings. The DIJ of the partner claw of the same foot and the normal DIJs of 18 healthy Holstein–Friesian cows were used as controls. Visualisation, echogenicity and flow phenomena of the synovial fluid were assessed ultrasonographically. The size of the dorsal pouch of the distal interphalangeal joint (DPDIJ) was determined by measuring two defined distances.The DPDIJ could be imaged in all cows with SADIJ, although the quality of the image varied from good (63%) or moderate (30%) to poor (7%). The echogenicity of the synovial fluid in joints with SADIJ did not differ from those of the partner claws. Flow phenomena were seen in only 30% of the DPDIJs with septic arthritis and in none of the DPDIJs of the partner claws. The DPDIJ was larger in DIJs with septic arthritis than in those of the partner claws and controls (P < 0.05). The dorsopalmar/plantar distance of the DPDIJ indicated a suitable sensitivity (0.97) and specificity (1.0) for the diagnosis of septic arthritis when a threshold value of 6 mm was used. Ultrasonographic examination of the DIJ appeared to be a reliable method for confirming a tentative clinical diagnosis of septic arthritis in cattle.     

Communication between the distal interphalangeal joint and the navicular bursa in the horse at Computed Tomography Arthrography

Diffusion of drugs injected into the distal interphalangeal joint or the navicular (podotrochlear) bursa can influence diagnosis and treatment of foot pain. Previous anatomical and radiographic studies of the communication between these synovial structures have produced conflicting results and did not identify the location of any communication if present. This anatomic study aimed to assess the presence and site of communication between the distal interphalangeal joint and the navicular bursa in the horse by computed tomography arthrography. Sixty‐six pairs of cadaver forelimbs were injected with contrast medium into the distal interphalangeal joint and imaged by computed tomography arthrography. The presence of a communication, location of the communication and additional structural changes were assessed. Navicular bursa opacification occurred in 7 distal limbs (5.3%) following distal interphalangeal joint injection. One limb showed a communication through the T‐ligament and 6 limbs showed a communication through the distal sesamoidean impar ligament. In 3 cases, the communication through the distal sesamoidean impar ligament was associated with a distal border fragment. Our study showed that communication between the distal interphalangeal joint and navicular bursa is uncommon and inconsistent. Clinically, the presence of a communication could (1) influence the interpretation of diagnostic analgesia of the distal interphalangeal joint or the navicular bursa by facilitating the diffusion of local anaesthetic between these structures; (2) allow the drug and its potential adverse effects to spread from the treated synovial cavity to the non‐targeted synovial cavity; (3) be responsible for the failure of joint drainage in the case of sepsis.     

Advances in surgical treatment of septic arthritis of the distal interphalangeal joint in cattle: a review

This review describes the indications for surgical treatment of distal interphalangeal joint (DIJ) infection in cattle and presents an overview of former surgical methods that have been modified for current use, including arthrotomy, resection of the distal sesamoid bone, resection of the DIJ and digital amputation. The post-operative life span, reasons for culling, pros and cons of claw-preserving techniques versus digital amputation, and pain management in general are also discussed. It would appear that severe claw diseases that result in septic arthritis of the DIJ do not necessarily lead to a reduced life span if cows are adequately treated and thorough aftercare is provided.     

Ultrasound examination of distal interphalangeal joint, navicular bursa, navicular bone and deep digital tendon

Techniques were devised for real-time ultrasound examination of the coffin joint, navicular bursa, navicular bone and deep digital flexor tendon of the forelimb of the horse, including their anatomical relationships and associated fluid spaces. Correlation was made between the echogram, positive contrast arthrograms, and freeze dried gross specimens. Anatomical structures were imaged in a midsagittal plane, of a standing, clinically normal horse.     

Evaluation of the diffusion of corticosteroids between the distal interphalangeal joint and navicular bursa in horses

OBJECTIVE: To determine whether clinically effective concentrations of methylprednisolone or triamcinolone can be achieved in the navicular bursa after injection of methylprednisolone acetate (MPA) or triamcinolone acetonide (TA) into the distal interphalangeal joint (DIPJ) and whether clinically effective concentrations of these drugs can be achieved in the DIPJ after injecting the navicular bursa with the same doses of MPA or TA. ANIMALS: 32 healthy horses. PROCEDURES: Horses in groups 1 through 4 received 40 mg of MPA in the DIPJ, 10 mg of TA in the DIPJ, 40 mg of MPA in the navicular bursa, and 10 mg of TA in the navicular bursa, respectively. Concentrations of corticosteroids that diffused into the adjacent synovial structure were determined. RESULTS: For group 1, injection of MPA into the DIPJ yielded a mean +/- SD concentration of 0.24 +/- 0.072 microg of methylprednisolone/mL in the navicular bursa. For group 2, injection of TA into the DIPJ yielded 0.124 +/- 0.075 microg of triamcinolone/mL in the navicular bursa. For group 3, injection of MPA into the navicular bursa yielded 0.05 +/- 0.012 microg of methylprednisolone/mL in the DIPJ. For group 4, injection of TA into the navicular bursa yielded 0.091 +/- 0.026 microg of triamcinolone/mL in the DIPJ. CONCLUSIONS AND CLINICAL RELEVANCE: A clinically effective concentration of methylprednisolone or triamcinolone diffused between the DIPJ and navicular bursa after intra-articular or intrabursal injection, which would justify injection of the DIPJ with MPA or TA to ameliorate inflammation of the navicular bursa.     

Arthrodesis of the proximal interphalangeal joint affected with septic arthritis in 8 horses

Arthrodesis was performed to treat septic arthritis of the proximal interphalangeal joint of 8 horses. Records of the horses were reviewed to determine outcome and possible factors that influenced success or failure. All horses were female. Seven horses had 1 joint treated and 1 horse was treated for bilateral pelvic limb involvement. The duration of sepsis before surgery ranged from 1 to 66 days. Bone lysis and production was radiographically apparent in 7 horses before surgery. Six horses had multiple bacterial organisms cultured from bone or synovial tissues; 2 horses had single isolates identified. After aggressive curettage, arthrodesis was accomplished with 3 parallel screws in 1 horse, 2 divergent narrow dynamic compression plates in 3 horses, and a single broad dynamic compression plate in 4 horses. Casts were applied to all horses for 1 to 6 weeks. Four horses survived to successful brood mare status. Four horses were euthanized during hospitalization because of continued discomfort or complications of sepsis. Arthrodesis of the proximal interphalangeal joint affected with septic arthritis appears to be an acceptable alternative to euthanasia for some horses.     

Ultrasonographic examination of the dorsal aspect of the distal interphalangeal joint of the horse

Ultrasonographic examination of the dorsal aspect of the distal interphalangeal joint is part of the routine examination of the foot structures. The purpose of this paper is to describe the ultrasonographic anatomy of the area, and normal transverse and longitudinal images. Clinical cases are presented to illustrate abnormal findings and lesions of the dorsal aspect of the joint. Ultrasonography can complement radiography for the diagnosis and documentation of many soft tissue and joint abnormalities such as synovitis, fluid distension, cartilaginous defects, periarticular osteophytes and bone fragments.     

Mandibular condylectomy and meniscectomy for the treatment of septic temporomandibular joint arthritis in a horse

OBJECTIVE: To report use of mandibular condylectomy for treatment of advanced degenerative joint disease of the temporomandibular joint (TMJ) caused by sepsis. DESIGN: Clinical case report. ANIMALS: Two-year-old Noriker filly. METHODS: Computed tomography (CT) was used to confirm advanced degenerative joint disease of the left TMJ and for follow-up after mandibular condylectomy and removal of necrotic meniscus. RESULTS: Painful swelling (3 weeks duration) with drainage located just caudal to the left lateral canthus of the eye was associated with atrophy of the left masseter muscle, masticatory problems, and inappetence. There was incisor malocclusion with a 1.4 cm resting lateral mandibular deviation to the right and inability to open the mouth more than a few centimeters. Left mandibular condylectomy combined with meniscectomy and thorough debridement of the septic left TMJ resulted in resolution of clinical signs and complete return of function. Streptococcus zooepidemicus, intermediately resistant to penicillin and subsequently to enrofloxacin, was isolated from the wound. Regeneration of a mandibular "pseudocondyle" was evident on CT at 4 months. At 4 months and 1 year the filly had maximal mouth opening >10 cm and no malocclusion. CONCLUSION: Mandibular condylectomy can be used to facilitate management of septic TMJ arthritis. There was no radiologic or clinical evidence of TMJ ankylosis >1 year after meniscal removal. CLINICAL RELEVANCE: Mandibular condylectomy, including meniscectomy, is an acceptable treatment option for advanced TMJ septic arthritis and allowed return of normal masticatory function.     

Fenestration of the abaxial hoof wall and implantation of gentamicin-impregnated collagen sponges for the treatment of septic arthritis of the distal interphalangeal joint in cattle.

A novel surgical approach to the distal interphalangeal joint of cattle, through the abaxial hoof wall, for the treatment of septic arthritis is described. In seven cattle a rectangular piece of horn (15 x 40 mm) was excised from the abaxial hoof wall and the joint was lavaged with Ringer's solution. Infected and/or necrotic tissue was removed from the joint and gentamicin-impregnated collagen sponges were introduced. The piece of horn was reattached, a rubber block was glued to the contralateral claw, and a bandage applied. Aftercare consisted of changes of bandage, systemic administration of antimicrobial drugs and box rest. At follow-up, six of the cattle were sound but one cow which had been slaughtered five months after surgery had remained slightly lame.     

Facilitated ankylosis of the distal interphalangeal joint in a foal

A 3-month-old Quarter Horse colt sustained a penetrating injury over the coronary band on the right forelimb resulting in an articular bone sequestrum and septic arthritis of the distal interphalangeal joint. Despite aggressive treatment for septic arthritis, severe osteoarthritis and ongoing sepsis resulted in persistent lameness. Facilitated ankylosis of the distal interphalangeal joint was performed using a combination of open surgical debridement, placement of an autogenous cancellous bone graft and stabilisation within a transfixation cast. Bony ankylosis of the joint was observed radiographically 7 weeks following surgery. Evaluation of the horse 30 months following surgery revealed complete fusion of the middle and distal phalanges, and the distal sesamoid bone. The horse is pasture sound and is used as a breeding stallion. This report describes the surgical approach and case management employed to achieve facilitated ankylosis as a treatment for unresolved septic arthritis of the distal interphalangeal joint. This is the first report of successful facilitated ankylosis of the distal interphalangeal joint in a foal.     

Fracture, luxation, and chronic septic arthritis of the temporomandibular joint in a juvenile horse

This case report describes chronic sepsis of the right temporomandibular joint in a juvenile horse. Diagnostic work-up included physical examination, radiography, and computed tomography. Humane euthanasia was indicated due to the chronicity of the condition, prognosis, and financial constraints.     

Effects of analgesia of the distal interphalangeal joint and navicular bursa on experimental lameness caused by solar pain in horses

It has been hypothesized that pain originating from the dorsal margin of the sole of the hoof in horses can be attenuated by analgesia of either the distal interphalangeal (DIP) joint, or of the navicular bursa (NB). To test this hypothesis, an experimental lameness was induced in the toe region of the left forelimb in six adult horses. After this, both synovial structures were blocked and the effects on the lameness were semi-quantitatively scored. Lameness was induced by creating pressure on the dorsal margin of the sole with the help of set-screws that were screwed into a nut, welded to the inside of each branch of the shoe. Gaits were recorded on a videotape before and after application of the screws, and after application of either a local anaesthetic or saline into the DIP joint or NB. The gaits were independently evaluated by two blinded clinicians and scored. Lameness scores were high after application of the screws and remained high after the administration of saline, but decreased significantly (P < 0.05) after administration of the local anaesthetic. Analgesia of the DIP joint as well as the NB appeared to be able to desensitize a portion of the sole. It was concluded that pain arising from the toe region of the sole should not be excluded as a cause of lameness when lameness is attenuated by analgesia of the DIP joint, or of the NB.     

Differences in the concentration of various synovial fluid constituents between the distal interphalangeal joint, the metacarpophalangeal joint and the navicular bursa in normal horses

As a prerequisite for the identification of navicular disease markers, the concentrations of cartilage oligomeric matrix protein (COMP), total glycosaminoglycans (GAG), hyaluronan, metalloproteinases (MMP) 2 and 9 and total protein were measured in synovial fluid samples obtained from the distal interphalangeal joint (DIP), the metacarpophalangeal joint (MCP) and the navicular bursa of 24 horses. Mean GAG, COMP and total protein levels were significantly higher in the DIP joint and in the navicular bursa compared to the MCP joint. Hyaluronan content was lower. MMP -2 activity was present in all fluids measured and had similar levels in different joints. MMP -9 was present in 42 per cent of MCP joint samples and 58 per cent of DIP joint samples and of navicular bursal samples. In relation to the constituents measured, the composition of navicular bursal fluid was similar to the articular synovial fluids, in particular that obtained from the DIP joint. Correlation between the constituents of DIP joint fluid and navicular bursal fluid obtained from the same legs was statistically significant for all the parameters measured.     

Medial collateral ligament desmitis of the distal interphalangeal joint in the hindlimb of a horse: treatment with cast immobilisation

A 12‐year‐old show‐jumping mare was presented for investigation of a chronic hindlimb lameness of 16 weeks duration. Perineural anaesthesia and ultrasonography localised the lesion to the medial collateral ligament of the distal interphalangeal joint of the left hindlimb. Treatment consisted of a heavily padded distal limb cast for 6 weeks, strict box rest and a strictly regulated hand walking program. Serial ultrasonographic examinations were performed throughout the rehabilitation period. Collateral ligament desmitis of the distal interphalangeal joint is a commonly diagnosed condition of the forelimb; however, hindlimb collateral ligament desmitis has been rarely reported. Ultrasonographic examination in this case was an invaluable diagnostic and follow‐up tool. Immobilisation of the foot by means of a heavily padded distal limb cast allowed excellent healing of the ligament and is presented as a novel treatment for collateral ligament desmitis. At the time of writing the mare had returned to her previous level of exercise and was showing no signs of lameness.     

The effects of local anaesthetic solution in the navicular bursa of horses with lameness caused by distal interphalangeal joint pain

REASONS FOR PERFORMING STUDY: Analgesia of the palmar digital (PD) nerves has been demonstrated to cause analgesia of the distal interphalangeal (DIP) joint as well as the sole. Because the PD nerves lie in close proximity to the navicular bursa, we suspected that that analgesia of the navicular bursa would anaesthetise the PD nerves, which would result in analgesia of the DIP joint. OBJECTIVES: To determine the response of horses with pain in the DIP joint to instillation of local anaesthetic solution into the navicular bursa. METHODS: Lameness was induced in 6 horses by creating painful synovitis in the DIP joint of one forefoot by administering endotoxin into the joint. Horses were videorecorded while trotting, before and after induction of lameness, at three 10 min intervals after instilling 3.5 ml local anaesthetic solution into the navicular bursa and, finally, after instilling 6 ml solution into the DIP joint. Lameness scores were assigned by grading the videorecorded gaits subjectively. RESULTS: At the 10 and -20 min observations, median lameness scores were not significantly different from those before administration of local anaesthetic solution into the navicular bursa (P > or = 0.05), although lameness scores of 3 of 6 horses improved during this period, and the 20 min observation scores tended toward significance (P = 0.07). At the 30 min observation, and after analgesia of the DIP joint, median lameness scores were significantly improved (P < or = 0.05). CONCLUSIONS: These results indicate that pain arising from the DIP joint can probably be excluded as a cause of lameness, when lameness is attenuated within 10 mins by analgesia of the navicular bursa. POTENTIAL RELEVANCE: Pain arising from the DIP joint cannot be excluded as a cause of lameness when lameness is attenuated after 20 mins after analgesia of the navicular bursa.     

Retrospective study of 24 cases of septic calcaneal bursitis in the horse

REASONS FOR PERFORMING STUDY: Wounds to the plantar aspect of the tarsus present a diagnostic and treatment challenge. This study was undertaken to describe specific features of traumatic wounds involving the calcaneal bursa, with a view to determining which clinical examination findings and diagnostic tests results could provide reliable indicators of prognosis. OBJECTIVES: To report clinical presentation, diagnostic findings, treatment and outcome of 24 cases of septic calcaneal bursitis; and to determine the importance of the involvement of specific anatomical structures in relation to the prognosis for survival and return to athletic function. METHODS: Records of 24 horses that had suffered traumatic wounds involving the calcaneal bursae were reviewed and divided into 3 groups, based on the bursa involved and presence or absence of involvement of the tuber calcanei. Clinical, diagnostic imaging and surgical findings were recorded for each case. Differences between groups and outcome were examined for significance with Chi-squared, Fisher's Exact or Kruskal-Wallis tests, as appropriate. RESULTS: Wounds involving only the subcutaneous bursa had an excellent prognosis for survival. Seventy-five percent of horses with wounds involving the intertendinous calcaneal bursa survived. Involvement of the tuber calcanei presented a fair to guarded prognosis, with only 44% of horses with involvement of this structure surviving. CONCLUSIONS: In contrast to other studies of septic synovial structures, the time between initial injury and referral did not affect the outcome. Correct identification of invasion of the calcaneal bursa(e) and/or tuber calcanei in wounds to the plantar aspect of the tarsus allows for more accurate pronostication. Damage to the tuber calcanei presents a poorer prognosis than for cases that involve only the soft tissue structures in the region. POTENTIAL RELEVANCE: This study demonstrates the importance of correct anatomical identification of structures involved in wounds in the region of the calcaneal bursa. The use of radiography, ultrasonography and synoviocentesis are essential in these cases to provide the most appropriate treatment for the horse and accurate prognosis for the owner.     

Arthrotomy,curettage and medical management of septic arthritis and osteomyelitis of the temporomandibular joint in a horse

Osteomyelitis and/or bone sequestra are commonly reported in equids following traumatic wounds. This report describes the clinical management and outcome following an arthrotomy of the temporomandibular joint of a 1-year-old Quarter Horse gelding with septic osteomyelitis and arthritis. Computed tomography was used for further assessment of the lesions within the temporomandibular joint and helped guide surgical planning.