Lameness due to pain associated with the distal interphalangeal joint: 45 cases

This paper describes the clinical and radiographic features, and response to treatment, of 45 horses which showed lameness that was improved by intra-articular anaesthesia of the distal interphalangeal (DIP) joint. Although many horses had poor conformation of the foot of the lame limb, the majority showed no localising clinical signs suggestive of involvement of the DIP joint. Lameness was usually unilateral. No horse with bilateral lameness responded to treatment. Palmar digital nerve blocks frequently improved or alleviated lameness, although in some horses palmar (abaxial sesamoid) nerve blocks were required to eliminate lameness. This difference in response did not affect response to treatment. Intra-articular anaesthesia of the DIP joint usually resulted in resolution of lameness within 5 mins; a partial improvement in lameness or a slow response were poor prognostic indicators. None of the horses had radiographic abnormalities compatible with navicular disease. Radiographic changes of the distal interphalangeal joint per se were generally detectable only in lateromedial views and were identified in less than one third of the horses. Success rates were low following treatment of cases with radiographic abnormalities. In those with no radiographic abnormalities the response to corrective trimming and shoeing and intra-articular administration of sodium hyaluronate, once or repeatedly, was variable and no parameters could be used to predict the likely outcome. Treatment was successful in approximately 30 per cent of cases. Subsequent treatment of horses which remained lame, by intra-articular administration of polysulphated glycosaminoglycans, was not helpful; only a small proportion became sound following prolonged (nine months) rest.(ABSTRACT TRUNCATED AT 250 WORDS)     

Multivariable analysis of factors influencing outcome of 2 treatment protocols in 128 cases of horses responding positively to intra-articular analgesia of the distal interphalangeal joint

REASONS FOR PERFORMING STUDY: There is limited knowledge available of factors influencing response to treatments of the DIP-joint in horses with lameness responding to diagnostic analgesia of the DIP-joint. For this reason a multivariable statistical analysis was performed. HYPOTHESIS: Horses with lameness reduced by > or = 75% 10 min after intra-articular analgesia of the DIP-joint, can be treated successfully by intra-articular medication of the joint. Multiple factors influence the response to treatment. METHODS: The study was performed retrospectively based on clinical records of horses treated with either polysulphated glycosaminoglycan (PSGAG) or methylprednisolone acetate (MPA) in the DIP-joint between January 1996 and January 2003. Information was collected from clinical records and from the owners of the horses via a detailed questionnaire, in which they described their perception of the outcome a minimum of one year after treatment. Allocation of the horses to the 2 treatment groups was done mainly because of a change in treatment policy. In Regime A all horses received 3 intra-articular injections of PSGAG approximately 8 days apart, whereas in Regime B all horses received a single intra-articular injection of MPA as a first treatment. If the horse did not improve sufficiently to return to work by 4 weeks, a series of 3 intra-articular PSGAG injections was administered. RESULTS: Of the horses receiving Regime A, 67% had a successful outcome, compared with 46% of the group receiving Regime B. A significantly better result was obtained in dressage horses than in jumping horses (eventing and showjumping). Other variables such as age, duration of lameness, distribution of lameness, degree of lameness, response to DIP-joint analgesia and radiographic observations were also associated with success of treatment. CONCLUSIONS AND POTENTIAL RELEVANCE: There is a rationale for using either PSGAG or MPA intra-articularly in the treatment of lameness, reduced > or = 75% within 10 min of analgesia of the DIP-joint.     

The synovial response to exogenous phospholipid (synovial surfactant) injected into the equine radiocarpal joint compared with that to prilocaine, hyaluronan and propylene glycol

AIMS: To determine the effects of the intra-articular injection of surface-active phospholipid in a propylene glycol carrier on synovial fluid composition and joint function of horses, and to compare these effects with those observed after the intra-articular administration of prilocaine, hyaluronan and propylene glycol alone. METHODS: Twenty-four horses were randomly allocated to four treatment groups: Group 1 100 mg of surface-active phospholipid in 1 ml of propylene glycol; Group 2 1 ml of propylene glycol; Group 3 10 ml of prilocaine; Group 4 2 ml of hyaluronan. Left radiocarpal joints were injected with the treatments and the right radiocarpal joints were injected with volume-matched saline as controls. Examinations for lameness, arthrocenteses and synovial fluid analyses were performed before and at 1, 3 and 7 days after injection. RESULTS: No horses became lame but treated joints temporarily developed mild to moderate effusions. Synovial fluid analyses indicated significantly greater inflammation in treated compared to control joints and this difference was greatest 24 hours after injection. There were no differences between the four treatments based on synovial fluid analysis except for neutrophil counts and alkaline phosphatase activities, which were significantly higher in prilocaine-treated joints. CONCLUSION: In horses, the intra-articular injection of surface-active phospholipid in a propylene glycol carrier induces clinically insignificant, temporary abnormalities in synovial fluid. Surface-active phospholipid was no more injurious to the synovium than prilocaine or hyaluronan. None of the agents used in this experiment caused lameness when injected into the joints of horses. RELEVANCE: This dose and formulation appear suitable for use in future experiments investigating the efficacy of surface-active phospholipid in the treatment or prevention of osteoarthritis in horses.     

Nonsurgical treatment of cubital subchondral cyst-like lesions in horses: seven cases (1983-1987).

Subchondral cyst-like lesions of the cubital joint were diagnosed in 7 horses at the teaching hospital between 1983 and 1987. Diagnosis of the lesions was made by administration of intra-articular local anesthesia and/or radiographically. Initial treatment for all horses consisted of stall rest for 60 to 90 days. In addition, 2 horses were administered sodium hyaluronate intra-articularly, 1 horse was given injections of polysulfated glycosaminoglycans IM, and 1 horse was given phenylbutazone orally. Follow-up information was compiled 6 weeks to 4 years after initial examination. At the time of follow-up inquiry, 6 horses were sound for intended use and only 1 horse became lame when exercised. A logical approach to choice of surgical or nonsurgical treatment is proposed on the basis of these findings and those reported in the literature.     

Osteoarthritis of the talocalcaneal joint in 18 horses

REASONS FOR PERFORMING STUDY: Talocalcaneal osteoarthritis (TO) is an uncommon cause of moderate to severe hindlimb lameness, on which only isolated case reports have been published to date. OBJECTIVES: To review the clinical features of TO and determine optimal methods for diagnosis, management and prognosis. METHODS: The case records from 4 referral centres of 18 horses showing hindlimb lameness considered, as a result of clinical investigation, to be caused by TO, were reviewed. RESULTS: TO affected mature sports and pleasure horses (age 7-16 years) and caused moderate to severe lameness, usually of sudden onset with no obvious inciting cause. There were few localising signs, other than worsening of lameness by hock flexion. Tarsocrural joint analgesia produced improvement in lameness in 6/11 horses (55%) and perineural analgesia of the tibial and fibular nerves complete soundness in 6/14 horses (43%) in which it was performed; 7/14 horses (50%) showed a further substantial improvement. Radiological findings included subchondral bone lysis and sclerosis and irregular joint space width, seen most obviously in a lateromedial view. Nuclear scintigraphy revealed marked uptake of radiopharmaceutical predominantly plantaromedially in the region of the talus in the 7 horses in which it was performed. Fourteen horses were treated conservatively with box- or pasture-rest, with or without intra-articular corticosteroids, hyaluronic acid or polysulphated glycosaminoglycan, and all remained lame. Intra-articular corticosteroids appeared to have no effect in any horse. Of 10 horses receiving conservative management only, 6 were subjected to euthanasia, 3 were retired and 1 remained in light work, but was still lame. Two horses treated by either partial tibial and fibular neurectomy or subchondral forage failed to regain soundness and were retired. Six horses were treated by surgical arthrodesis of the talocalcaneal joint with 2 or three 5.5 mm AO screws introduced obliquely across the joint from the plantarolateral aspect of the calcaneus, which resulted in improvement in lameness in all cases. CONCLUSIONS: Osteoarthritis of the talocalcaneal joint causes acute onset severe lameness, but clinical findings and diagnostic analgesia often fail to identify precisely the site of pain. Consistent radiographic changes suggested TO was contributing to the lameness and this diagnosis was supported by nuclear scintigraphy. The poor success of conservative treatment (including intra-articular medication) suggests that surgical arthrodesis is the treatment of choice, although the prognosis is still poor for a return to full soundness. POTENTIAL RELEVANCE: The clinical features described should facilitate more accurate diagnosis and prognosis. A novel surgical treatment is described which appears to offer significant improvement in the lameness. Further work is necessary to determine the causes of this condition and more effective management.     

Resection of the common digital extensor tendon in a gelding

A four-year-old gelding was lame owing to a chronic septic common digital extensor tendon and sheath. The horse had been treated by open surgical lavage but the sepsis had recurred after three months. Physical, ultrasonographic, cytological and histological examinations confirmed chronic septic tenosynovitis and tendonitis. The entire intrathecal component of the common digital extensor tendon was resected under general anaesthesia and the synovial lining of the sheath was ablated. Postoperatively the horse regained good limb function and became sound.     

Ossification of the infraspinatus tendon-bursa in 13 dogs

Ossification of the infraspinatus tendon-bursa was diagnosed in 13 labrador retrievers, 12 of which were lame in one thoracic limb and the other in both. They ranged in age from 28 to 121 months (mean 69.4 months). The lameness developed gradually and was progressive in 11 of the 14 affected joints. Scapular muscle atrophy and signs of pain on direct pressure over the infraspinatus tendon of insertion were key clinical signs. Caudocranial radiographs revealed multiple mineralised masses lateral to the proximal humerus or glenohumeral joint in 11 of the 26 joints and single masses in 12. An arthroscopic examination revealed concomitant ligament or tendon abnormalities in six of seven shoulders. The dogs were followed up from one to 55 months (mean 20 months). Of five shoulders treated with non-steroidal anti-inflammatory drugs (nsaids), one resolved, two improved and two were managed surgically. Of six shoulders treated by the injection of long-acting intra-articular corticosteroid (five before and one after surgery), three resolved, two improved and one was unchanged. Of six shoulders treated by the surgical resection of the infraspinatus tendon and bursa (three before and two after treatment with nsaids, and one after treatment with a long-acting intra-articular corticosteroid), four improved, one was unchanged and one was managed with an intra-articular long-acting corticosteroid. One shoulder was managed by restricted exercise and the lameness resolved. Histological examination of the excised tissues revealed heterotopic bone within the infraspinatus tendon and/or bursa.     

Pyloric stenosis in three cats and its correction by pyloroplasty

Lactation was successfully induced in 14 of 15 non-pregnant cows treated for 7 days with twice daily subcutaneous injections of 15 mg oestradiol-17β and 37.5 mg progesterone. The successfully induced cows were first machine-milked about 8 days after the end of treatment and, although they milked for as long as their naturally calving identical twins, produced significantly less milk, fat and lactose. Augmenting the basic regimen with Opticortenol or thyrotrophin-releasing hormone produced no advantage. Plasma and milk hormone analyses were conducted and used to study the onset of lactogenesis and possible meat and milk residues. Ten of the 15 treated cows showed frequent oestrous activity and 4 became lame. Pregnancy rates after an 8-week insemination period were 69% and 93% for treated and control cows, respectively. It is concluded that the technique is unlikely to gain wide acceptance in the form used here.     

Autologous platelet concentrates as a treatment for musculoskeletal lesions in five horses

Two horses with acute tendinopathy of a superficial digital flexor tendon (SDFT) and three horses with chronic proximal desmitis of the suspensory ligament (PDSL) were treated by injecting autologous concentrates of their platelets into the lesions. The lesions were monitored ultrasonographically and clinically. There were significant ultrasonographic and clinical improvements in the two horses with SDFT, but no ultrasonographic improvements in the horses with PDSL; however, they improved clinically and became less lame. All the horses had returned to their pre-injury level of performance by six months after the completion of the treatment, and none of them had suffered a recurrence after 20 months.     

Intracompartmental muscle pressure, temperature and pH in the horse undergeneral anesthesia

Intracompartmental muscle pressure, temperature and pH were measured in a group of 23 anesthetized horses in an attempt to elucidate the etiology of post-anesthetic lameness (PAL). The intramuscular pressure remained reasonably constant throughout anesthesia in most horses, while muscle temperature and pH fell. Five of the horses became lame after anesthesia. Two of these lame horses exhibited atypical trends in the physiological variables measured. The etiology of PAL is discussed in the lightof the results.     

Problems associated with the interpretation of the results of regional and intra-articular anaesthesia in the horse

The difficulties associated with the interpretation of the results of regional and intra-articular anaesthesia are discussed with reference to eight lame horses. The clinical and radiographic features of each horse are described, together with the results of anaesthesia. One horse had clinical and radiographic signs consistent with navicular disease but it was not possible to relieve the lameness. Two horses had fractures of bones within the foot but lameness was not improved by palmar (abaxial sesamoid) nerve blocks. One horse had more than one cause of lameness. Four horses had joint pathology but none responded to intra-articular anaesthesia.     

Fractures of the palmar aspect of the carpal bones in horses: 10 cases (1984-2000)

OBJECTIVE: To determine clinical and radiographic findings, treatment, and outcome of horses with fractures of the palmar aspect of the radial carpal bone, with or without concurrent fractures of the palmar surfaces of the other carpal bones. DESIGN: Retrospective study. ANIMALS: 10 horses. PROCEDURE: Medical records were reviewed to obtain information on history, signalment, clinical and radiographic findings, treatment, and outcome. Follow-up information was gathered from owners and referring veterinarians. RESULTS: 7 horses became lame after recovery from general anesthesia for treatment of an unrelated problem. The remaining 3 horses developed a fore-limb lameness after falling (1 horse) or being turned out in a pasture (2 horses). Fractures involved the palmar surface of the radial carpal bone in all 10 horses; in addition, the ulnar carpal bone was affected in 2 horses, the intermediate carpal bone in 2 horses, and the distal aspect of the radius in 4 horses. None of the 4 horses treated nonsurgically returned to work, and 3 were euthanatized because of recalcitrant lameness. In the other 6 horses, fragments were removed surgically. Two were euthanatized because of continued lameness, 1 was euthanatized for other reasons, 2 were sound enough for light work, and 1 returned to athletic work. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that fractures of the palmar aspect of the carpal bones are uncommon in horses. The prognosis appears to be poor for affected horses but may be better for horses that undergo arthroscopic removal of intra-articular fragments.     

Use of a bioabsorbable implant for the repair of severed digital flexor tendons in four horses

A new bioabsorbable implant composed of poly-L-lactic acid was used to repair the severed digital flexor tendons of four horses. The limbs were immobilised with distal casts which were changed after six to eight weeks and removed after 12 to 16 weeks. The horses were followed clinically and ultrasonographically for from seven to 19 months after the surgery. The ultrasonographic examination after the cast had been removed showed that the implants had been well incorporated into scar tissue. Two of the horses were mildly lame at the trot seven months after the surgery, but had returned to work after 12 months. The other two horses are still lame. No complications were observed with the implant.     

Influence of variable content of dietary zinc on copper metabolism of weanling foals

The influence of variable zinc content (29.1, 250, 1,000 and 2,000 mg/kg of dry weight) in a basic diet containing 7.7 mg of copper/kg on the ability of weanling foals to maintain normal copper balance was investigated. Serum copper and zinc concentrations were monitored, and terminal hepatic copper and zinc contents were measured in 4 weanling foals fed the basic diet containing 29.1 mg of zinc/kg and in 2 foals each fed the higher-zinc diets. Foals fed the lower-zinc diets (29.1 and 250 mg/kg) maintained normal serum copper and zinc concentrations for 14 to 15 weeks, whereas those fed the 2 higher-zinc diets became hypocupremic within 5 to 6 weeks and were lame within 6 weeks, owing to cartilaginous disease characteristic of osteochondritis dissecans. Serum zinc concentration in the foals fed the 2 higher-zinc diets increased to greater than 2 micrograms/ml within 2 weeks. Foals fed the high-zinc diets became lame after serum copper concentration had remained at 0.3 micrograms/ml for greater than 1 week. Serum copper concentration in these arthritic foals was less than or equal to 0.2 micrograms/ml at the end of the study. In lame foals, fractures of the cartilage of the articular and growth physes occurred through the zone of hypertrophic cells, and varied from bilateral to unilateral and from small to large. Free masses and flaps of cartilage attached to one side were numerous.     

Arthroscopy of the Coxofemoral Joint of Foals

An arthroscopic procedure for examination of the coxofemoral joint was developed in nine foals (four cadavers, five anesthetized) to determine if access was sufficient for evaluation and surgical treatment of intra-articular lesions. The joint was distended and the arthroscope inserted through the notch (incisura trochanterica) between the cranial and caudal parts of the greater trochanter. This portal allowed examination of the cranial, lateral, and caudal aspects of the joint. Mechanical distraction of the joint through an instrument portal located 2 to 4 cm cranial and 1 to 2 cm ventral to the arthroscope portal allowed examination of the ligament of the head of the femur, the femoral head, and articular and nonarticular surfaces of the acetabulum. Adduction and rotation of the limb improved visualization of the craniomedial and caudomedial portions of the femoral head. Traction applied to the distal limb allowed visualization of the same structures that were observed when mechanical distraction was used. Traction also created space for placement of surgical instruments into the joint through the instrument portal. Access to most regions of the joint was adequate, but access to the caudal and medial aspects of the joint was limited. Three foals were killed while they were anesthetized, and their coxofemoral joints were dissected. Two foals were allowed to recover from anesthesia and were observed for 30 days after surgery. One foal was mildly lame for 2 days after surgery. The other foal was not lame after surgery. The incisions healed, and the coxofemoral joints were radiographically normal by postoperative day 30.     

The origins of acupuncture channel imbalance in pain of the equine hindlimb

Objective: A study was conducted to define the relationship between oriental channel imbalance and pain of the equine hindlimb.Methods: One hundred eighty-five lame and muscle sore horses from a general equine practice in Virginia were examined by a single observer using traditional manual palpation of the acupuncture channels. The six hindlimb channels were evaluated and graded with particular emphasis on the reactivity of three transpositional acupoints, BL 18, BL 19, BL 20, and five traditional veterinary acupoints Yao Zhong, Shen Shu, Xie Qi, Feng Men, and Fu Tu. All lame patients were evaluated with western methods to establish an anatomical diagnosis. All nonlame horses with channel imbalance were treated with either an intra-articular anesthetic, an intra-articular cortisone, methylprednisolone acetate, or a hyaluronate and triamcinalone combination. The medications were injected into either the three compartments of the stifle joint, tarso-metatarsal and distal inter-tarsal joints, metatarsophalangeal joint, or the distal interphalangeal joint The joint injections were conducted in sequence, distal to proximal, until a definitive change in channel imbalance had occurred. Chi Square analysis was used to assess different frequencies of channel imbalance and the sites responsible for that imbalance, with P<0.05.Results: Channel imbalance was only indirectly associated with extra-articular pathology. Intra-articular structures of three joints of the distal hindlimb, the distal tarsus, metatarsophalangeal, and distal interphalangeal, accounted for all the observed abnormal, referred diagnostic acupoints. In the examined population, channel imbalance was significantly more frequently related to the distal tarsus than the hind fetlock, and both of these were significantly more frequently involved than the distal interphalangeal joint. Channel imbalance relating to the dorsal aspect of the digit was significantly more frequent in metatarsophalangeal lameness than in distal tarsal lameness. Neither the stifle nor midback pain was directly associated with projected, as opposed to local, channel imbalance. If projected channel imbalance could be defined as the presence of reactive acupoints not in the immediate vicinity of the local site of pain, then the projected acupoints detected in stifle lameness or back pain were associated with the tarsus or the hind fetlock.Conclusions: The sites of hindlimb pathology resulting in channel imbalance were intra-articular, and they were located within the distal tarsal, the metatarsophalangeal and the distal interphalangeal joints. Channel diagnosis reflected intra-articular inflammation of only these three joints, and further diagnostic procedures were required to establish a definitive western diagnosis. The presence of channel imbalance should be used to determine pattern differentiation in Traditional Chinese Medicine.     

Incidence and clinical significance of sesamoid disease in rottweilers.

A group of 55 rottweiler pups was studied from three to 12 months old to assess the incidence and clinical significance of disease involving the palmar metacarpal sesamoid bones. The results of physical examination were correlated with clinical signs of lameness and the results of radiographic examination of the forefeet. Twenty-one dogs became lame during the study and in 12 of them the lameness was attributable to sesamoid disease. However by 12 months of age, the incidence of sesamoid disease as assessed by radiographic changes in the sesamoid bones was 73 per cent (30 of 41 dogs). Six of the 12 dogs which were lame owing to sesamoid disease got better without specific treatment. It was concluded that sesamoid disease can result in clinical lameness in young rottweilers, but that subclinical disease is common.     

Preliminary study of joint disease in poultry by the analysis of synovial fluid

Samples of synovial fluid and synovial membrane were obtained from the hock joints of several groups of broilers, including lame birds and two strains of broilers raised on different feeding regimens and given different drug treatments (carprofen or placebo). There were more significant differences between the groups on the basis of the analysis of the synovial fluid samples than the synovial membrane samples. Experimental birds fed ad libitum had the highest median red blood cell counts and median ghost cell counts of all of the groups, but there were no differences between the groups in the thickness of the synovial lining cell layer or the degree of cellular infiltrate in the synovial membrane. The synovial fluid from the broilers and lame birds fed ad libitum was more turbid, suggestive of intra-articular pathology, and the large numbers of heterophils in samples from the lame birds indicated an inflammatory arthropathy. The birds fed ad libitum which were treated with carprofen had more cells in the synovial fluid than the birds given the placebo. A large number of the samples of synovial fluid from the ad libitum-fed broilers contained blood.     

Surgical repair of peripheral detachment of the medial meniscus in 34 cattle

A detachment of the periphery of the medial meniscus from the joint capsule and medial collateral ligament in 34 cattle was repaired by securing the meniscus to the joint capsule with vertical mattress sutures during arthrotomy. Of 28 cattle with follow-up reports, 20 had recovered satisfactorily by their owners' evaluations; 17 were either not lame or slightly lame after the operation and three were moderately lame. Three of four cattle without follow-up reports were either not lame or slightly lame when discharged from the hospital.     

Comparison of the calving-to-conception interval in dairy cows with different degrees of lameness during the prebreeding postpartum period

OBJECTIVE: To compare calving-to-conception intervals among cows classified as nonlame, moderately lame, or lame during the prebreeding postpartum period and to examine the relationship between severity of lameness and time to conception in cows that were classified as lame. DESIGN: Longitudinal study. ANIMALS: 499 Holstein cows. PROCEDURE: Cows in the prebreeding postpartum period were classified as nonlame, moderately lame, or lame by use of a 6-point locomotion scoring system. Time to conception (days) was compared among cows. A low, medium, or high cumulative locomotion score was assigned to lame cows, and time to conception among those cows was compared. Cows classified as lame were examined on a tilt table for diagnosis and treatment of lameness. RESULTS: 154 (31%), 214 (43%), and 131 (26%) cows were classified as nonlame, moderately lame, and lame, respectively. Most cows classified as lame had laminitis (54%) or disorders of the claw (33%). Median time to conception was 36 to 50 days longer in lame cows than in nonlame cows. Among lame cows, the median time to conception was 66 days longer in cows with high cumulative locomotion scores than in cows with low scores. CONCLUSION AND CLINICAL RELEVANCE: Nonlame cows became pregnant more quickly than lame cows. Lame cows with low cumulative locomotion scores during the prebreeding postpartum period became pregnant sooner than lame cows with high scores. Early diagnosis and intervention may mitigate the effects of lameness and improve reproductive performance in lame dairy cows.