Osseous cyst‐like lesions in the feet of lame horses: Diagnosis by standing low‐field magnetic resonance imaging

Osseous cyst‐like lesions (OCLLs) were diagnosed by standing low‐field magnetic resonance (MR) imaging in 9 mature horses (age range 6–17 years). All horses had been subjected to a routine lameness evaluation (including standard foot radiographs) with no diagnosis being reached prior to MR imaging. The duration of lameness ranged from one month to one year. OCLLs were diagnosed in 12 feet. The site of the lesions included the distal phalanx in 11 feet (subchondral bone in 4, insertion of collateral ligaments of the distal interphalangeal joint in 4, insertion of the distal sesamoidean impar ligament in 3) and the subchondral bone of the distal aspect of the middle phalanx in one foot. OCLLs were characterised by discrete spherical or elliptical areas of high or intermediate signal in all MR sequences. In most cases the lesion was surrounded by a rim of bone with abnormally low signal.     

Magnetic resonance imaging findings in the carpus and proximal metacarpal region of 50 lame horses

Reasons for performing study: There is limited information on magnetic resonance imaging (MRI) findings in the carpus and proximal metacarpal region of lame horses. Objectives: To document MRI findings in horses with lameness localised to the carpus and/or proximal metacarpal region. Methods: Clinical records of horses that underwent MRI of the carpus and/or proximal metacarpal region at the Animal Health Trust between January 2003 and September 2010 were reviewed. Magnetic resonance images of all horses and available radiographs, ultrasonographic and scintigraphic images were assessed. When possible, MRI findings were related to the results of other diagnostic imaging techniques. Results: Seventy‐two MR studies of 58 lame limbs in 50 horses from a broad range of work disciplines and ages were reviewed. The most commonly detected primary abnormality was decreased signal intensity in T1‐ and T2‐weighted images in the medial aspect of the carpal bones and/or the proximomedial aspect of the metacarpal bones (n = 29). Nine horses had syndesmopathy between the second and third metacarpal bones. In 6 horses the primary abnormalities were identified in the palmar cortex of the third metacarpal bone (McIII). Significant abnormalities of the suspensory ligament (SL) with associated lesions in the adjacent palmar cortex of the McIII were seen in 4 limbs. Ligament and associated osseous abnormalities between the second and third carpal bones and second and third metacarpal bones were detected in 4 limbs. Conclusions and potential relevance: Magnetic resonance imaging enabled diagnosis of a variety of lesions not detected by conventional imaging in horses from a wide range of work disciplines. The distribution of injury types differed considerably from previous studies.     

The collateral ligaments of the distal interphalangeal joint: magnetic resonance imaging and post mortem observations in 25 lame and 12 control horses

Reasons for performing study: Magnetic resonance imaging (MRI) is used with increasing frequency to diagnose injuries of the collateral ligaments (CLs) of the distal interphalangeal (DIP) joint, but the results have not been verified by histology and the mechanism of injury is poorly understood. Hypothesis: Abnormal signal intensity and tissue contour represents change in tissue structure detected on histology. Objectives: To compare results in horses free from and those with chronic lameness and to describe possible progression of lesions. Methods: One or both feet of horses free from lameness (Group N: n = 12) and with foot‐related lameness (Group L: n = 25) were examined using MRI and by gross post mortem examination. The magnetic resonance (MR) images were graded. Sagittal sections from the proximal and distal aspect of each CL were examined histologically and each ligament assigned a score. Scintigraphic images from lame horses were also evaluated. Results: In Group N, 25 CLs were graded normal on both MR images and histology, 2 CLs were grade 1 on MR images, but were histologically normal, and 2 CLs had MR abnormalities verified histologically. However, 2 CLs appeared normal on MR images but were histologically abnormal. In Group L, 18 CLs were deemed normal on both MR images and histology, and 54 CLs had MR abnormalities verified histologically. However, 13 CLs appeared normal on MR images but were graded abnormal histologically. Lesions appeared to be degenerative, characterised by extensive fibrocartilaginous metaplasia and development of multiple, intercommunicating fissures within the degenerate collagen in severe lesions. There was an association between increased radiopharmaceutical uptake and a higher histological score. Conclusions: High‐field MRI is reasonably reliable for detection of lesions of the CLs of the DIP joint, but may underestimate their prevalence. Clinical relevance: Collateral ligament injury appears to be a primary degenerative process, which may explain the poor response to conservative treatment and a need for promotion of regeneration.     

Pharmacokinetics and antinociceptive effects of the soluble epoxide hydrolase inhibitor t‐TUCB in horses with experimentally induced radiocarpal synovitis

This study determined the pharmacokinetics, antinociceptive, and anti‐inflammatory effects of the soluble epoxide hydrolase (sEH ) inhibitor t ‐TUCB (trans ‐4‐{4‐[3‐(4‐Trifluoromethoxy‐phenyl)‐ureido]‐cyclohexyloxy}‐benzoic acid) in horses with lipopolysaccharide (LPS )‐induced radiocarpal synovitis. A total of seven adult healthy mares (n  = 4–6/treatment) were administered 3 μg LPS into one radiocarpal joint and t ‐TUCB intravenously (i.v.) at 0 (control), 0.03, 0.1, 0.3, and 1 mg/kg in a blinded, randomized, crossover design with at least 3 weeks washout between. Two investigators independently assigned pain scores (at rest, walk and trot) and lameness scores before and up to 48 hr after t ‐TUCB /LPS . Responses to touching the joint skin to assess tactile allodynia, plasma, and synovial fluid (SF ) t ‐TUCB concentrations were determined before and up to 48 hr after t ‐TUCB /LPS . Blood and SF were collected for clinical laboratory evaluations before and up to 48 hr after t ‐TUCB /LPS . Areas under the curves of pain and lameness scores were calculated and compared between control and treatments. Data were analyzed using repeated measures ANOVA with Dunnett or Bonferroni post‐test. p  < .05 was considered significant. Data are mean ± SEM . Compared to control, pain, lameness, and tactile allodynia were significantly lower with 1 mg/kg t ‐TUCB , but not the other doses. For 0.1, 0.3, and 1 mg/kg t ‐TUCB treatments, plasma terminal half‐lives were 13 ± 3, 13 ± 0.5, and 24 ± 5 hr, and clearances were 68 ± 15, 48 ± 5, and 14 ± 1 ml hr^?1 kg^?1. The 1 mg/kg t ‐TUCB reached the SF at high concentrations. There were no important anti‐inflammatory effects. In conclusion, sEH inhibition with t ‐TUCB may provide analgesia in horses with inflammatory joint pain.     

Analgesic efficacy of intra‐articular morphine in experimentally induced radiocarpal synovitis in horses

ObjectiveTo compare the analgesic effect of intra-articular (IA) and intravenous (IV) morphine in horses with experimentally induced synovitis.AnimalsEight adult horses.Study designRandomized, observer blinded, double dummy trial with sequential crossover design.MethodsRadiocarpal synovitis was induced by IA injection of lipopolysaccharide on two occasions separated by a 3-week washout period. In one study period horses received treatment IA; morphine IA (0.05 mg kg^?1) plus saline IV and in the other study period they received treatment IV; saline IA plus morphine IV (0.05 mg kg^?1). Lameness and pain were evaluated repeatedly by two observers throughout each of the two 168-hour study periods. Pain was evaluated by use of a visual analogue scale of pain intensity (VAS) and a composite measure pain scale (CMPS). Comparison of treatments was performed by analysis of variance with repeated measurements. Significance level was set to p ≤ 0.05. Inter-observer agreement and agreement between the VAS and CMPS was assessed by use of the Bland–Altman method.ResultsIntra-articular injection of LPS elicited a marked synovitis resulting in lameness and pain. IA morphine resulted in significantly less lameness than IV morphine (p = 0.03). CMPS (p = 0.09) and VAS (p = 0.10) pain scores did not differ significantly between treatments. Inter-observer agreement of the CMPS was classified as good, but only fair for the VAS. Agreement between the two pain scales was considered fair.Conclusions and clinical relevanceAn analgesic effect of IA morphine was demonstrated by significantly reduced lameness scores. The results support the common practice of including IA morphine in a multimodal analgesic protocol after arthroscopic surgery, although further studies in clinical cases are needed. The employed CMPS had good reproducibility, and was easy to use, but may have limited sensitivity at mild intensity pain.     

Magnetic resonance imaging of the metacarpo(tarso)phalangeal region in clinically lame horses responding to diagnostic analgesia of the palmar nerves at the base of the proximal sesamoid bones: Five cases

Injection of local anaesthetic solution around the palmar nerves at the base of the proximal sesamoid bones is typically considered to desensitise structures distal to this location. There has been recent research investigating the potential for proximal diffusion of local anaesthetic solution resulting in desensitisation of structures other than those intended. This case series describes lame horses that respond to this block but have pathology within the suspensory ligament branches, the distal aspect of the third metacarpal bone and/or the proximal sesamoid bones as seen with high field magnetic resonance imaging.     

A subjective descriptive study of the warm‐up and turn to a fence,approach, take‐off,suspension, landing and move‐off in 10 showjumpers

There is limited knowledge about causes of musculoskeletal injury in showjumpers. The objectives were to describe features of the turn, approach and jump in a group of experienced showjumpers believed by their riders to be sound, to relate these findings to clinical findings, and to identify features that may predispose to injury. Ten experienced showjumpers in normal competition training jumped an upright and a parallel fence four times off the left and right reins respectively, after a rider‐defined period of warm‐up. Real‐time and high‐speed motion capture was undertaken. Detailed subjective assessment of the gait was performed during the warm‐up, on the turn and approach to the jump and all phases of the jump. Six horses had thoracolumbar pain or epaxial muscle tension. Six horses exhibited a poor‐quality canter. The mean duration of warm‐up was 7 min (range 5–10 min). All horses had lean of the trunk and hindlimbs >45° on the turn. The inside hindlimb was placed in front of the outside hindlimb in 75% of the turns. Sideways oscillations of the hocks during stance were seen in all horses on the turn and on the straight approach in five horses. The inside hindlimb had greater magnitude of oscillation than the outside hindlimb on the turns. Repeated asynchronous push‐off with the hindlimbs at take‐off was seen in three horses. The hindlimbs drifted to the left or right during the ascent‐phase of suspension in four horses, reflecting asymmetrical push‐off. Only two horses landed consistently with the correct forelimb leading relative to the direction in which the horse had to turn after the fence. Four horses landed seven (n = 2) or eight (n = 2) times each with the left (n = 2) and right (n = 2) forelimbs respectively. Repetitive overload through asymmetrical use of the left and right canter leads, inadequate warm‐up, and limb instability could potentially predispose to injury.     

Distribution of radiodense contrast medium after perineural injection of the palmar and palmar metacarpal nerves (low 4‐point nerve block): An in vivo and ex vivo study in horses

Reasons for performing study: Evidence‐based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region (‘low 4‐point nerve block’). Objectives: To demonstrate the potential distribution of local anaesthetic solution after a low 4‐point nerve block using a radiographic contrast model. Methods: A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three‐quarters and distal quarter of the Mc region (Pa injection) and over the ipsilateral PaM nerve immediately distal to the distal aspect of the second or fourth Mc bones (PaM injection) in both forelimbs of 10 mature horses free from lameness. Radiographs were obtained 0, 10 and 20 min after injection and analysed subjectively and objectively. Methylene blue and a radiodense contrast medium were injected in 20 cadaver limbs using the same techniques. Radiographs were obtained and the limbs dissected. Results: After 31/40 (77.5%) Pa injections, the pattern of the contrast medium suggested distribution in the neurovascular bundle. There was significant proximal diffusion with time, but the main contrast medium patch never progressed proximal to the mid‐Mc region. The radiological appearance of 2 limbs suggested that contrast medium was present in the digital flexor tendon sheath (DFTS). After PaM injections, the contrast medium was distributed diffusely around the injection site in the majority of the limbs. In cadaver limbs, after Pa injections, the contrast medium and the dye were distributed in the neurovascular bundle in 8/20 (40%) limbs and in the DFTS in 6/20 (30%) of limbs. After PaM injections, the contrast and dye were distributed diffusely around the injection site in 9/20 (45%) limbs and showed diffuse and tubular distribution in 11/20 (55%) limbs. Conclusions and potential relevance: Proximal diffusion of local anaesthetic solution after a low 4‐point nerve block is unlikely to be responsible for decreasing lameness caused by pain in the proximal Mc region. The DFTS may be penetrated inadvertently when performing a low 4‐point nerve block.     

The association of 2‐year‐old training milestones with career length and racing success in a sample of Thoroughbred horses in New Zealand

Reasons for performing study: There is increasing evidence that exercise early in life has a positive effect on musculoskeletal health. At present, there is little whole population research investigating the effect of racing as 2‐year‐olds on future racing career. Objectives: To investigate the association between attaining training milestones as 2‐year‐olds with length of career and racing success in Thoroughbred horses in New Zealand. Methods: Retrospective data were obtained of the 2001/02‐born Thoroughbred foal crop. The 3 training milestones were: registered with a trainer, trialled and raced. The association of the training milestones with career length was measured using the outcomes: number of race starts and number of years raced, in a Cox regression model. Logistic regression models analysed the association of the training milestones with the outcomes: won or placed in a race. Linear regression was performed to assess the association of training milestones with total career earnings. Results: Of 4683 horses in the population; 3152 horses were registered with a trainer, 2661 horses trialled and 2109 horses raced. Horses that raced as 2‐year‐olds had significantly (P<0.001) more race starts than those first raced as 3‐year‐olds or older, this was also true when the 2‐year‐old year data were omitted. Horses that raced as 2‐year‐olds had significantly (P<0.001) more years racing. Horses registered with a trainer, trialled or raced as 2‐year‐olds were more likely to have won or been placed in a race than those that achieved the milestones as 3‐year‐olds or older. Horses that first trialled and raced as 2‐year‐olds had greater total earnings than those that first trialled or raced at a later age. Conclusions and potential relevance: Two‐year‐old training milestones had a strong association with positive racing career outcomes. Horses in training or racing as 2‐year‐olds may have better musculoskeletal health throughout life than horses that are first in training or racing at a later age.     

The use of computed tomography to assist orthopaedic surgery in 86 horses (2002–2010)

Imaging‐assisted orthopaedic surgery is becoming part of routine orthopaedic practice in horses and several techniques have been reported. However, there are no published reports describing the use of intraoperative computed tomography (CT) for surgical guidance and immediate post operative control in the horse. This use of CT in equine orthopaedics is currently limited because of the logistic problems associated with availability of CT scans in surgical theatres as well as concerns over radiation safety. The aim of this report was retrospectively to report CT assisted orthopaedic surgical cases in our practice through identifying the types of surgery where it was used, to list the technical problems that were encountered, to describe solutions to these, and to discuss the applications of the technique. All surgical procedures were performed with the assistance of a peripheral quantitative computed tomography (pQCT) scanner. CT assisted orthopaedic surgery in 86 patients during the study period. Reasons for CT included: 1) use of CT at the beginning of the surgical procedure to document the lesion and identify surgical landmarks (n = 75); 2) pre, intra‐ and post operative use of CT in comminuted fractures of the middle or proximal phalanx to guide and control internal fixation (n = 7); and 3) post operative use of CT to monitor the results of the surgical procedure (n = 4). Proper planning in both the draping steps and the use of polyvinyl splints to stabilise the limb allowed for movements of the gantry around the limb. The time required to obtain one slice was not dissimilar to the time that is necessary to take and process a single digital radiograph. The radiation dose with the pQCT described here is <0.5 µSv and its acquisition time should be balanced against radiation risks of conventional CT systems.     

The use of intraluminal stents for tracheal collapse in two horses: Case management and long‐term treatment

Tracheal collapse is an uncommon clinical disorder in horses but when present can be difficult to correct. Various medical and surgical procedures to correct tracheal collapse have been described in horses with variable success. Recently, the use of an intraluminal stent has been described as a treatment for tracheal collapse in a miniature horse. The long‐term management, utilising intraluminal stents, in 2 miniature horses with tracheal collapse is presented here. In particular, various complications as a result of intraluminal stent placement are described, the most persistent being the formation of granulation tissue at various regions of the stents. Multiple methods of combating granulation tissue in this situation also are discussed.     

Minimally‐invasive plate osteosynthesis of a Salter‐Harris type 2 fracture of the proximal phalanx in a filly

A 7‐month‐old Warmblood filly was referred to the equine hospital because of a Salter‐Harris type 2 fracture of the proximal physis of the right hind P1. On admission, the filly had acute grade 3/5 lameness at the walk and diffuse swelling in the area of the right hind proximal phalanx. Radiographs were taken to assess the fracture and plan treatment. Surgical treatment using two 4.5 mm narrow locking compression plates (PIP‐LCPs) resulted in fracture stabilisation and rapid healing. This case report suggests that internal fixation using PIP‐LCPs is useful for the treatment of Salter‐Harris type 2 fractures of the proximal physis of P1 in large foals.     

The pharmacokinetics of mavacoxib,a long‐acting COX‐2 inhibitor,in young adult laboratory dogs

Cox, S.R., Lesman, S.P., Boucher, J.F., Krautmann, M.J., Hummel, B.D., Savides, M., Marsh, S., Fielder, A., Stegemann, M.R. The pharmacokinetics of mavacoxib, a long‐acting COX‐2 inhibitor, in young adult laboratory dogs. J. vet. Pharmacol. Therap. 33 , 461–470. The pharmacokinetics of mavacoxib were evaluated in an absolute bioavailability study, a dose‐proportionality study and a multi‐dose study in young healthy adult laboratory Beagle dogs and in a multi‐dose safety study in Beagle‐sized laboratory Mongrel dogs. When administered as the commercial tablet formulation at 4 mg/kg body weight (bw) to fasted dogs, the absolute bioavailability (F) of mavacoxib was 46.1%; F increased to 87.4% when mavacoxib was administered with food. Following intravenous administration, the total body plasma clearance of mavacoxib was 2.7 mL·h/kg, and the apparent volume of distribution at steady‐state was 1.6 L/kg. The plasma protein binding of mavacoxib was approximately 98% in various in vitro and ex vivo studies. The dose‐normalized area under the plasma concentration–time curve was similar in Beagle and Beagle‐sized Mongrel dogs when mavacoxib was administered with food. Mavacoxib exhibited dose‐proportional pharmacokinetics for single oral doses of 2–12 mg/kg in Beagle dogs and for multiple oral doses of 5–25 mg/kg in Beagle‐sized Mongrel dogs. Only minor accumulation occurred when mavacoxib was administered at doses of 2–25 mg/kg bw orally to laboratory dogs with a 2‐week interval between the 1st two doses but with a monthly interval thereafter. Across all three Beagle studies (n = 63) the median terminal elimination half‐life (t_½) was 16.6 days, with individual values ranging 7.9–38.8 days. The prolonged t_½ for mavacoxib supports the approved regimen in which doses are separated by 2–4 weeks.     

A randomised, double-blinded, placebo-controlled study on the efficacy of a unique extract of green-lipped mussel (Perna canaliculus) in horses with chronic fetlock lameness attributed to osteoarthritis

Reasons for performing study: Lyophilised products from green‐lipped mussel (Perna canaliculus[LPPC]) are used to orally treat horses with osteoarthritis (OA). However, no randomised, controlled or double‐blinded studies on the efficacy of this treatment in horses have been reported to date. Objective: To investigate the effects of a unique LPPC (Biolane) ¹ in improving clinical signs of OA in the fetlock. Methods: Data were analysed from 26 horses with primary fetlock lameness in a controlled, randomised and double‐blinded, multi‐centre clinical trial. The study design was a partial crossover with a washout period and consisted of 19 horses treated with LPPC and 20 with a placebo. Horses were dosed orally with 25 mg/kg bwt/day LPPC or placebo for 56 days. Efficacy was evaluated by clinical assessment of lameness, passive flexion, pain, swelling and heat in the affected joint. Relationships between variables were analysed using an ordinal logistic model with random effects for horse and horse x treatment according to a modified intention‐to‐treat analysis. Results: Clinical evaluation of horses with a fetlock lameness treated with LPPC showed a significant reduction in severity of lameness (P<0.001), improved response to the joint flexion test (P<0.001) and reduced joint pain (P = 0.014) when compared with horses treated with placebo. Conclusions: The LPPC significantly alleviated the severity of lameness and joint pain and improved response to joint flexion in horses with lameness attributable to OA in the fetlock.