Can distal border fragments of the navicular bone be a primary cause of lameness?

A horse with unilateral forelimb lameness and pain localised to the palmar aspect of the foot was evaluated using radiography and low field magnetic resonance (MR) imaging. A distal border fragment of the navicular bone, an osseous cyst‐like lesion (OCLL) in the distal third of the navicular bone and focal distal sesamoidean impar desmitis were identified as the most likely causes of pain and lameness. No other lesions likely to contribute to pain and lameness were identified on MR images or gross post mortem examination. The OCLL was characterised histologically by enlarged bone lacunae containing proliferative fibrovascular tissue. Focal lesions of the distal aspect of the navicular bone are rarely found in isolation but can be causes of pain and lameness in horses.     

An unusual cyst‐like lesion in the metaphysis of the tibia in a horse

A 6‐year‐old Haflinger gelding was presented with a chronic right hindlimb lameness. Scintigraphy, radiography and computed tomography confirmed an active large cyst‐like lesion in the distal metaphysis of the right tibia. A transcortical surgical approach was used to curette the lesion and fill it with an autologous bone graft and a calcium phosphate bone substitute material. Histopathology revealed mild histiocytic inflammatory changes, mild fibrosis and bone necrosis. This case report describes an unusual cyst‐like lesion in the tibial metaphysis of a horse.     

Arthroscopic treatment of meniscal cysts in the horse

Reasons for performing study: To describe the clinical symptoms, treatment, and outcome of meniscal cysts in horses. These structures have not been previously described in the literature as a potential cause of lameness in the horse. Hypothesis: Meniscal cysts are an uncommon condition of the femorotibial joint but can be a significant cause of lameness. Symptoms can be resolved by arthroscopic excision. Methods: Records of horses diagnosed with meniscal cysts and treated by cyst excision and meniscal debridement at 2 surgical practices were reviewed. Clinical outcome was determined by repeat veterinary examination and contact with owner. Results: Seven cases of meniscal cyst were treated with arthroscopic cyst excision and meniscal debridement. Five of 7 horses had lameness attributable to femorotibial joint pathology, while the remaining 2 horses had meniscal cysts found incidentally during diagnostic arthroscopy for the treatment of osteochondritis dissecans of the lateral trochlear ridge of the femur. Five of 6 horses with long‐term follow‐up were sound and a 7th horse was improved 11 months after surgery. Conclusions and potential relevance: Meniscal cysts, while uncommon, can be associated with progressive lameness in the horse. Surgical excision of the cysts results in resolution or improvement of symptoms, without evidence of recurrence on follow‐up examination.     

Use of the Cobra Head Bone Plate for Distal Long Bone Fractures in Large Animals A Report of Four Cases

Four long bone fractures with a short distal fragment were repaired with a cobra head bone plate alone (2 cattle) or in combination with a straight, broad dynamic compression plate (2 horses). Three fractures were of the distal femur (1 horse, 2 cattle) and one was of the distal radius (1 horse). The long-term outcome of the three femoral fractures was soundness in one case and mild lameness in two. Although satisfactory bone healing progressed in the horse with the radial fracture, laminitis in the contralateral forelimb necessitated euthanasia at week 6.     

Progression of Femoropatellar Osteochondrosis in Nine Young Horses Clinical, Radiographic and Arthroscopic Findings

The clinical and radiographic progression, and arthroscopic findings for nine young horses (<1 year of age) with femoropatellar osteochondrosis (OCD) are presented. Horses had a 2 to 12 week history of bilateral (8 horses) or unilateral (1 horse) hindlimb lameness. The most consistent clinical signs included femoropatellar joint distention and bilateral hindlimb lameness. At the onset of clinical signs, radiographic lesions were not present (4 horses) or subtle (5 horses), but were easily identified on radiographs taken 4 to 24 weeks later. Arthroscopic surgery was delayed until radiographic changes became obvious. Surgical findings in 20 femoropatellar joints were most commonly osteochondral "flaps" located on the proximal lateral trochlear ridge of the femur and were larger than had been indicated by the radiographs. Eight horses were being used for their intended purpose, which was racing (3 horses were racing and 3 were in race training), dressage (1 horse) or pleasure riding (1 horse). One horse required a second surgery when similar lesions developed in the opposite stifle, and was euthanatized 2 months later because of persistent lameness. Once clinical signs are observed, osteochondrosis lesions of the distal femur can progress in foals younger than 9 months of age and the full extent of the radiographic lesion may take several weeks to develop.     

Osseous cyst‐like lesions/subchondral bone cysts of the phalanges

In the horse, the phalanges are the second most common location for the occurrence of osseous cyst‐like lesions (OCLLs) after the medial femoral condyle of the stifle. Phalangeal OCLLs occur in a variety of locations, most of which are adjacent to, if not communicating with, a joint. The aetiology of these lesions is considered to be multifactorial by most authors. Horses with OCLLs demonstrate lameness of varying severity. Diagnostic analgesia should be used to localise the lameness. After localisation of the lameness, standard radiographic views of the isolated area should be performed. The radiographic characteristics of OCLLs are dependent on the stage of development of the OCLL; OCLLs may first be identified as a small lucent flattening or depression in the articular surface; however, they may progress to a circular, oval or conical single or multi chambered radiolucency within the bone. There may be a rim of radiodense sclerosis around the lucency. Diagnosis of some OCLLs may only be achieved using nonstandard radiographic views or may require advanced diagnostic imaging modalities such as computed tomography or magnetic resonance imaging. Treatment of phalangeal cysts may be conservative or surgical. Surgical treatment options generally aim to prevent cyst enlargement and promote filling of the lesion with osseous material. Depending on the cyst, this can be performed arthroscopically or via an extra‐articular approach. Occasionally, the severity of proximal interphalangeal joint OCLLs warrants surgical arthrodesis. Overall the prognosis for return to performance for horses with OCLLs ranges from 30–90% but is dependent on the breed, age and intended use of the horse, surface area of weightbearing cartilage affected, concurrent osteoarthritis within the joint and treatment administered.     

Multiple skeletal metastases from a penile squamous cell carcinoma in a horse

A 21‐year‐old gelding with ventral abdominal and preputial oedema was evaluated for right hindlimb lameness. Partial phallectomy had been performed 3 years prior for treatment of squamous cell carcinoma. Regional analgesia did not localise the source of lameness and nuclear scintigraphy was recommended. The results of the scan revealed severe increased radiopharmaceutical uptake in the proximal femur. Radiographic and ultrasound examinations were inconclusive. The horse was discharged with recommendations of stall confinement and a 2 week course of nonsteroidal anti‐inflammatory drugs. Four weeks later the horse presented for an inability to elevate his neck and persistent hindlimb lameness. The owner elected humane euthanasia. Post mortem examination revealed metastatic squamous cell carcinoma in the proximal femur and fifth cervical vertebrae consistent with metastasis from the penile squamous cell carcinoma. To the authors’ knowledge, multiple site bone metastasis of squamous cell carcinoma has not been reported previously in the horse.     

Osteosarcoma in the proximal humerus of a mare

A 15‐year‐old Quarter Horse mare was examined for significant and progressive lameness in the right front limb. On physical examination, muscle atrophy over the scapular and pectoral regions were noted. A pain response was elicited on palpation of the scapulohumeral joint. No other abnormalities were noted on examination of the limb. Diagnostic nerve blocks ruled out a source of lameness in the distal limb. Arthrocentesis of the scapulohumeral joint was performed and results were within normal limits. Radiographs of the right scapulohumeral joint revealed an extensive, aggressive bone lesion in the proximal humerus, suspected to be an osteosarcoma. After a course of nonsteroidal anti‐inflammatory therapy, minimal improvement to the lameness was noted. The owner elected to subject the horse to euthanasia due to the lack of significant response to treatment. Post mortem radiographic and histological examinations determined a definitive diagnosis of an osteosarcoma in the proximal humerus.     

Multiloculated solitary (unicameral) bone cyst in a young dog

A 20‐month‐old female spayed Staffordshire Terrier (22.3 kg) presented to the Orthopedic Surgery Service at North Carolina State University Veterinary Teaching Hospital for evaluation of a 6‐week history of toe‐touching to nonweight‐bearing lameness in the right hind limb. Radiographs of the right stifle revealed a multiloculated lytic lesion of the distal femur, with a large open lytic zone centrally, numerous osseous septations peripherally, and focal areas of cortical thinning and loss. An aspirate of the right distal femoral lesion yielded mildly cloudy serosanguineous fluid. Cytologic examination of the fluid revealed a pleomorphic population of discrete cells that exhibited marked anisocytosis and anisokaryosis and a variable nuclear‐to‐cytoplasmic (N:C) ratio, which were interpreted as probable neoplastic cells, with few macrophages, and evidence of hemorrhage. Given the clinical signs of pain, lesion size, and concern for malignant neoplasia, amputation of the right hind limb was performed. Histologically, the lesion had undulating walls 1‐3 mm thick with a continuous outer layer of dense fibrous tissue and an inner layer composed of reactive cancellous bone with no cortical compacta remaining. Remnants of thin fibrous or fibro‐osseous septa projected from the bony wall into the cyst lumen. The final histologic diagnosis was a benign multiloculated solitary (unicameral) bone cyst of the distal right femur. Based on the histopathologic findings, it was speculated that the cells identified on cytology were a mixture of developing osteoclasts, osteoblasts, endothelial, and stromal cells. This is the first report describing the cytologic examination of a solitary bone cyst in veterinary medicine.     

Disruption of the caudal component of the reciprocal apparatus in two horses

Two horses became acutely lame following a fall during strenuous exercise and were diagnosed as having disruption of the caudal component of the reciprocal apparatus. Clinical signs consisted of lameness of the right pelvic limb, characterized by flexion of the hock and simultaneous extension of the stifle. Radiography revealed an avulsion fracture from the supracondylar tuberosity and fossa of the distal portion of the femur in one horse. Clinical and radiographic findings indicated avulsion of the lateral origin of the gastrocnemius and superficial digital flexor muscles. Treatment consisted of stall rest, limb immobilization, and phenylbutazone administration. One horse recovered to soundness and the other deteriorated and was euthanatized.     

IMAGING DIAGNOSIS—ENOSTOSIS-LIKE LESION IN THE FEMUR OF A HORSE

An enostosis-like lesion was diagnosed in the left femur of a Swedish Warmblood horse that had a left hindlimb lameness of 3 weeks duration. With scintigraphy using technetium 99m-hydroxymethylene diphosphonate (^99m Tc-HDP) a marked regional focal increase in radioactivity was identified in the medullary cavity of the left femur. Radiographically there was a corresponding focal increase in bone opacity in the middiaphysis of the left femur. Histopathologically, a 5 cm area of bone matrix was present in the diaphysis of the left femur and confirmed as an enostosis-like lesion. Enostosis-like lesions should be considered as a source of pain in horses with difficult to localize, moderate to severe chronic lameness.     

Acquired peri-articular ganglion cyst in the lateral femorotibial joint in an 18-year-old Percheron cross mare

This report describes a case of sudden lameness in an 18-year-old Percheron cross mare after presumably being kicked by another horse, and the subsequent formation of a ganglion cyst originating from the lateral femorotibial joint. Physical examination, radiographic and ultrasonographic investigation identified a soft round 5 cm diameter mass attached to the left lateral femorotibial joint. After surgical removal, histopathological examination confirmed a ganglion cyst. The horse responded well to the surgical removal of the cyst, and 4 weeks after the surgery, the mare has returned back to her same athletic performance. According to the authors’ knowledge, this is the first reported case that describes a peri-articular ganglion cyst originating from the stifle joint.     

Diagnosis, relative incidence, and probable cause of cunean tendon bursitis-tarsitis of Standardbred horses

A prospective study of the diagnostic results on 25 previously untreated, slightly lame Standardbred horses showed that manipulative tests are of some help in diagnosis. The lameness of each horse was diminished or the horse went lame on the opposite limb after being given an injection of anesthetic in the cunean bursa, and lameness improved more when local anesthetic was injected in the distal intertarsal and tarsometatarsal articulations. In four horses, lesions of the distal articulation of the hock were evident on radiography.     

Severe hindlimb lameness and pathological femur fracture in a horse secondary to haemangiosarcoma

An 18‐year‐old Warmblood stallion was presented for an acute onset nonweightbearing right hindlimb lameness following a mild lameness of 2 weeks' duration. Severe swelling was present in the right femoral area. Despite extensive diagnostic procedures, no definitive diagnosis could be made. Packed red cell volume was persistently low. The horse improved with supportive treatment and was discharged at the owner's request. The horse presented 4 days later for bleeding from a previously made incision on the lateral femoral area. Due to deterioration of his condition, the stallion was subjected to euthanasia. Diagnosis of disseminated haemangiosarcoma, affecting primarily the hindlimb musculature and leading to pathological fracture of the femur was made at necropsy and subsequent histopathology.     

Which anatomical region determines a positive flexion test of the distal aspect of a forelimb in a nonlame horse?

Reasons for performing study: The flexion test is used routinely as part of lameness and prepurchase examinations. However, little is known about the mechanisms that cause a positive response to a flexion test. Objective: To determine which anatomical regions play a role in a positive outcome of a flexion test of the distal aspect of a forelimb in a nonlame horse. Methods: Eight clinically sound Dutch Warmblood horses were subjected to a standardised flexion test (force 250 N, time 60 s) inducing a consistent lameness. To discriminate between different areas of the distal aspect of a forelimb, effects of various nerve blocks on the outcome of the flexion test were investigated. Low palmar digital, palmar at the abaxial aspects of the base of the proximal sesamoids, high palmar, ulnar and low 4‐point nerve blocks were performed. Flexion test induced lameness was scored before and after each nerve block in separate sessions. Results: The low palmar digital nerve blocks and nerve blocks of the palmar nerves at the abaxial aspect of the base of the proximal sesamoid bones had no significant effect on the flexion test induced lameness score. The ulnar, high palmar and, most dramatically, the low 4‐point nerve blocks all caused a significant (P<0.05) reduction in the flexion test induced lameness score. Conclusions: Anatomical structures (soft tissue nor synovial structures) located distal to the metacarpophalangeal joint appear to contribute only minimally to the outcome of a positive flexion test of the distal aspect of a forelimb in a clinically nonlame horse. The structures in the region of, and including, the metacarpophalangeal joint appear to contribute most to a positive flexion test of the distal aspect of a forelimb in a nonlame horse. Potential relevance: The flexion test of the distal aspect of a forelimb may be sensitive for investigating the metacarpophalangeal joint region in horses free from lameness, but may be less relevant for structures distal to this region.     

Removal of large fragments of the extensor process of the distal phalanx via arthrotomy in horses: 14 cases (1992-1998)

OBJECTIVE: To evaluate the outcome of horses with large fragments of the extensor process of the distal phalanx that were removed by use of arthrotomy. DESIGN: Retrospective study. ANIMALS: 14 horses with large fragments of the extensor process of the distal phalanx. PROCEDURE: Medical records for horses with large fragments of the extensor process that were removed by use of arthrotomy were reviewed. Data retrieved from medical records included signalment, use of horse, affected limb, lameness history, lameness examination findings, radiographic findings, surgical technique, and outcome. Follow-up evaluation was obtained by telephone interview. RESULTS: Most affected horses were < 5 years old and had a history of chronic lameness. Lameness grade ranged from 1/5 to 4/5. Fragments involved 20 to 45% of the dorsopalmar articular surface of the distal phalanx. Eight of 14 horses had a successful outcome. Outcome was not associated with age, duration or severity of lameness, or fragment size. CONCLUSIONS AND CLINICAL RELEVANCE: Despite involvement of a large portion of the articular surface and use of arthrotomy, joint instability and permanent soft tissue injury was not a problem in most horses. Outcome may be improved by selection of horses with lameness of < 2 years' duration and careful management after surgery. A fair prognosis may be anticipated for removal of large fragments of the extensor process via arthrotomy.     

Evaluation of poor performance in competition horses: A musculoskeletal perspective. Part 2: Further investigation

There is not a right and a wrong way of investigating musculoskeletal causes of poor performance in sports horses and the methods of investigation are, in part, determined by the clinical signs. Measurement of serum muscle enzyme concentrations before and after exercise is essential for recognition of primary muscle pathology. Many horses with multilimb lameness have a secondary reduced range of motion of the thoracolumbosacral region mimicking primary thoracolumbar pain. Radiographic examination of the thoracolumbar vertebrae may be confusing unless combined with diagnostic analgesia because many clinically normal horses have radiological abnormalities. Nuclear scintigraphy offers a method of evaluating a large proportion of the horse, but there are many false positive and false negative results. Diagnostic analgesia is the most reliable method of investigation but requires experience and skill in interpretation and is time consuming in a horse with multilimb lameness.     

Intra-articular Anesthesia of the Distal Interphalangeal Joint Alleviates Lameness Associated With the Navicular Bursa in Horses

Objective — To determine if intra-articular anesthesia of the distal interphalangeal joint could alleviate lameness associated with the navicular bursa in horses.
Study Design — Experimental investigation.
Animals — Six clinically normal horses.
Methods — Lameness was induced in each horse by injecting either the left or right front navicular bursa with 5 mg of amphotericin-B. Forty-eight hours later each horse was videotaped walking and trotting before, and 5, 30, and 60 minutes after injecting the distal interphalangeal joint of the treated limb with 5 mL of 2% mepivacaine hydrochloride. All video recordings were then rerecorded onto master tapes in a random sequence. Four clinicians, unaware of the animal identity related to observation time or limb treated, independently viewed these tapes and graded the lamenesses.
Results — There was a significant reduction in lameness 5 and 30 minutes after anesthetic was injected into the distal interphalangeal joint. Lameness scores 60 minutes after anesthetic administration were not significantly different than baseline values. Gross pathological examination confirmed marked inflammation of the treated navicular bursae and normal appearance of the distal interphalangeal joints.
Conclusions — Intra-articular anesthesia of the distal interphalangeal joint can alleviate lameness associated with the navicular bursa.
Clinical Relevance — Intra-articular anesthesia of the distal interphalangeal joint is not specific only for lameness originating in the distal interphalangeal joint.     

Pathological fracture through a subchondral bone cyst in the proximal phalanx of a horse

A 12‐year‐old Morgan broodmare presented for a nonweightbearing right forelimb lameness. Radiography and computed tomography confirmed the presence of a pathological fracture of the proximal first phalanx through a large subchondral bone cyst (SBC) in the right forelimb and a large SBC in the proximal first phalanx of the left forelimb. Surgical repair of the large palmar medial eminence fracture of the proximal first phalanx fracture was performed using bone screws placed in lag fashion placed through stab incisions after debridement and bone grafting of the SBCs. Approximately 6 months after surgery the mare was ambulating comfortably at pasture. This case report describes a fracture through a large subchondral bone cyst in a horse despite chronicity and ongoing bone remodelling. Careful consideration regarding exercise or use should be considered in horses with large SBCs.     

Fracture repair of the distal portion of the radius by use of a condylar screw implant in an adult horse.

An 8-year-old American Quarter Horse gelding was evaluated because of an open fracture involving the left radius. The horse had fallen during training and became immediately non-weight-bearing in the left forelimb. On initial evaluation, the horse was unable to bear weight on that limb; radiography revealed a long oblique fracture of the distal metaphysis of the radius with minimal displacement of the fracture fragments. Because of the configuration of the fracture, we recommended surgical intervention with internal fixation. A condylar screw implant and 4.5-mm broad dynamic compression plate were applied to the medial and dorsolateral aspects of the radius, respectively. The horse recovered in a sling and full-limb bandage. Six months after discharge, the horse was reevaluated because of a grade 4/5 lameness in the same limb. Palpation revealed signs of severe pain over the distomedial aspect of the radius. Radiography of the left radius revealed severe osteolysis beneath the distal aspect of the condylar screw implant. Surgical removal of the medial plate was performed. Sixteen months after the initial fracture repair, the horse had returned to light training without signs of lameness. Removal of the dorsal plate may be indicated if this horse is to return to aggressive training or becomes lame in the left forelimb.