Infraspinatus muscle contracture in a working dog

A five-year-old Border Collie bitch was presented to Massey University Small Animal Clinic, for examination of a right forelimb lameness of three months duration. The distal forelimb was deviated laterally, there was limited mobility of the shoulder joint, and the animal showed gait abnormalities. Marked atrophy of the infraspinatus, supraspinatus and deltoideus muscles were present. Contracture of the infraspinatus muscle caused the lameness, and tenotomy of the infraspinatus tendon resulted in restoration of a normal gait. Although the exact aetiology is unknown, several possibilities are discussed.     

Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis

A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.     

Mastocytoma in the common carpal sheath of the digital flexor tendons of a horse

A 13-year-old Morgan gelding was examined for right forelimb lameness and tenosynovitis of the right common carpal sheath of the digital flexor tendons. The horse had moderate right forelimb lameness at the trot and marked effusion of the right common carpal sheath of the digital flexor tendons. Ultrasonographic examination revealed a soft tissue mass within the proximal pouch of the affected tendon sheath, located adjacent to the distal physis of the radius. Cytology and culture of the fluid revealed a sterile, eosinophilic tenosynovitis. Tenoscopic exploration confirmed the presence of a capsulated soft tissue mass. Thecotomy was required to fully debride the mass, which histology revealed to be a mast cell tumour. At 22 months postoperatively, the horse developed mild right forelimb lameness and eosinophilic tenosynovitis because of recurrence of the mastocytoma. Mastocytosis is a possible differential diagnosis in any horse exhibiting lameness associated with tenosynovitis. Surgical excision combined with rest and postoperative intrasynovial and systemic corticosteroids may be palliative.     

Idiopathic hopping‐like forelimb lameness syndrome in ridden horses: 46 horses (2002–2014)

There has been no analysis of a hopping‐type forelimb lameness syndrome seen in ridden horses. The objectives of this retrospective study were to describe the clinical features of this syndrome, response to diagnostic analgesia and imaging findings and to document post mortem findings. Clinical records from 2002 to 2014 were reviewed and data concerning signalment, history, lame limb(s), lameness characteristics, response to diagnostic analgesia and diagnostic imaging were recorded. There were 46 horses from 4 to 13 years of age, 6 of which had a history of known or suspected trauma immediately before the onset of reduced performance or lameness. Lameness seen when ridden was characterised by an intermittent shortened cranial phase of the step of the lame forelimb at the trot and marked elevation of the head as the affected limb was protracted, with the horse appearing to ‘hop’ (on the contralateral limb) as if trying to break to canter. When lameness was at its worst horses were unwilling to trot. Three horses showed sporadic severe stumbling. Local analgesia of the affected limb did not improve the lameness and in 16 horses lameness deteriorated. Three of 5 horses showed some improvement (≥2/8 grades) in the hopping‐type lameness after intra‐articular analgesia of the articular process joints of the sixth and seventh cervical vertebrae, ipsilateral to the lame forelimb. Radiographic, ultrasonographic and nuclear scintigraphic examinations were inconclusive. Two of 4 horses responded to treatment with gabapentin. In 3 horses post mortem examination revealed mild lymphocytic inflammation within or around the dorsal root ganglia of the fifth and sixth cervical nerve roots, sixth cervical nerve root or second thoracic nerve root ipsilateral to the lame limb. Idiopathic hopping‐type lameness syndrome in ridden horses may be a pain‐related condition ± a neurological component and currently has a guarded prognosis.     

Individual speed dependency of forelimb lameness in trotting horses

Using a system for motion analysis, linear correlation of speed and forelimb lameness was measured in 16 horses trotting on a treadmill at a minimum of three different trotting speeds. Forelimb lameness was determined as asymmetry of vertical head motion during left and right forelimb stance.In seven horses with a moderate forelimb lameness (head motion asymmetry >40%), lameness increased significantly with trotting speed. In a further seven horses with mild or subclinical forelimb lameness (head motion asymmetry <40%) and in two horses with a moderate forelimb lameness, no significant correlation between speed and motion asymmetry was found.The results indicate that moderate forelimb lameness measured as head motion asymmetry depends on the speed at which the measurements are taken. If head motion asymmetry is measured at two trotting speeds, it can be standardized to any speed within the trotting speed range.     

Bilateral hypoplasia of the minor tubercle of the humerus with medial luxation of the biceps tendon in two Quarter Horses

Two Quarter Horses were examined at the Washington State University Veterinary Teaching Hospital with forelimb lameness. Case 1 was a 4‐year‐old female with a 4 month history of intermittent forelimb lameness that had partially responded to oral anti‐inflammatories. The horse was in full training and actively competing in cutting. Case 2 was a one‐year‐old filly bred for cutting that presented with a right forelimb lameness of 3 weeks’ duration, which was not responsive to oral anti‐inflammatories. The horse was not in training. On lameness examination, Case 1 was grade 1/5 (American Association of Equine Practitioners scale) lame in the left forelimb in a straight line on a hard surface, extension and flexion of the shoulder was resented and exacerbated the lameness. Case 2 was grade 3/5 lame in the right forelimb in a straight line on a hard surface, flexion and extension of the shoulder was resented and exacerbated the lameness. Both horses had a characteristic dished appearance to the dorsal aspect of the shoulder, with prominence of the proximal aspect of the humerus. Ultrasound and proximodistal oblique (skyline) radiographic views of the scapulohumeral joints demonstrated bilateral hypoplasia of the minor tubercle of the humerus with bilateral medial luxation of the proximal biceps tendon in both cases. To the authors' knowledge this is the first report of 2 cases of bilaterally affected horses, as well as the first report of the condition in the Quarter Horse breed.     

Studies on the Pathophysiology of Infraspinatus Muscle Contracture in the Dog

Contracture of the infraspinatus muscle has been recognized as a cause of shoulder lameness in hunting dogs. Electrophysiologic studies of four affected dogs indicated that infraspinatus contracture was a primary muscle disorder rather than a neuropathy. Histologically, affected tissues from six dogs showed degeneration and atrophy of skeletal muscle with fibrous tissue replacement. These findings supported the hypothesis that an acute traumatic event caused incomplete rupture of the infraspinatus muscle, leading to fibrosis and contracture. Seven dogs were successfully treated by infraspinatus tenotomy.     

Glenoid dysplasia and bicipital tenosynovitis in a Maine coon cat

This report describes a rare case of bicipital tenosynovitis in a Maine coon cat. The cat, a three-and-half-year-old neutered female, presented with chronic weightbearing lameness of the left forelimb. Flexion of the left glenohumeral joint and extension of the left cubital joint were resented, and palpation of the biceps brachii tendon in the bicipital groove elicited pain. A mild incongruity of the joint with mild degenerative changes was seen radiographically. Glenohumeral joint dysplasia was suspected. Ultrasound examination revealed marked thickening of the bicipital tendon and moderate effusion of the left bicipital tendon sheath. Positive contrast radiography of the joint confirmed dilation of the tendon sheath. A tentative diagnosis of bicipital tenosynovitis was made and confirmed on arthrotomy. Surgical removal of osteophytes resulted in the cat being free from pain but a mild lameness recurred six months after surgery.     

Clinical and ultrasonographic findings of a tear of the gastrocnemius muscle and enthesopathy of the origin of the superficial digital flexor muscle in a reining Quarter Horse mare

Proximal gastrocnemius and superficial digital flexor (SDF) muscle injuries are reported in the horse but are uncommon. In adult horses, the definitive diagnosis is more commonly based on clinical signs with or without the use of radiographic examination and/or nuclear scintigraphy. This case report describes the clinical and ultrasonographic findings of a tear of the gastrocnemius muscle in a 6-year-old reining mare. At standing physical examination, there was a sickled hock appearance, with the point of the hock of the left hindlimb lower (dropped hock) than that of the right hindlimb. At dynamic examination at walk, the mare had instability of the left hock characterised by medial rotation of the hoof and lateral rotation of the point of the hock (twisting motion); at trot, the horse showed mild/moderate left hindlimb lameness characterised by more downward movement of the pelvis during weightbearing of the lame limb compared with that of the sound limb. Ultrasonographic examination of the left thigh and crus showed a large irregular hypoechogenic area and irregularly shaped, retracted muscle stumps on the lateral aspect of the gastrocnemius muscles; the proximal insertion of the SDF muscle on the supracondylar fossa of the femur was irregular in its outline, hypoechogenic and thickened compared with that of the right side. Characteristic muscle fibre pattern was not identified in the left gastrocnemius muscle. On the radiography, a mild irregularity of the bone margin of the lateral supracondylar tuberosity was detected on the caudo 45° medial-craniolateral oblique view of the distal femur. Clinical and diagnostic imaging findings were consistent with partial failure of the caudal part of the reciprocal apparatus and injury of the gastrocnemius and SDF muscles/origin. The horse was managed conservatively by corrective shoeing, muscle relaxing drugs, controlled exercise and manual stretching.     

MALIGNANT SCHWANNOMA OF THE BRACHIAL PLEXUS IN A DOG

A 4-year-old Labrador bitch was presented for veterinary examination with a history of lameness and muscle atrophy of the left forelimb. On clinical examination a painful mass was detected medial to the left shoulder joint. Radiographs of the shoulder showed mineralisation of this mass. Exploratory surgery revealed a tumour involving the radial nerve, axillary nerve and the trunk of the median and ulnar nerves. Histopathologic diagnosis was a malignant Schwannoma.     

Supraspinatus tendinosis associated with biceps brachii tendon displacement in a dog

A 4-year-old spayed female Australian Cattle Dog (Blue Heeler) was evaluated because of right forelimb lameness of 5 months' duration. Orthopedic evaluation revealed signs of pain localized to the cranial aspects of both shoulder joints. Via magnetic resonance imaging, the mass of the supraspinatus tendon insertion in both shoulder joints was increased, compared with findings in cadavers of clinically normal dogs; additional imaging procedures revealed that, compared with clinically normal tendons, the tendon had increased signal intensity that was consistent with increased fluid content. The increased supraspinatus tendon mass in each shoulder joint was associated with medial displacement of the biceps brachii tendon, which was more severe in the right limb. Arthroscopic evaluations of both shoulder joints revealed no abnormalities. The dog underwent surgery, and the abnormal parts of the tendons were resected. The most prominent finding on histologic examination of excised tissues was severe myxomatous degeneration. The lameness resolved, and at 22 months after surgery, the dog was reported to have had no recurrence of lameness. The clinical signs and histologic appearance of the tendons in this dog strongly resemble findings associated with tendinosis in humans. Decompression of the biceps brachii tendon may have contributed to the successful outcome after surgery in this dog. Supraspinatus tendinosis should be considered among the differential diagnoses in dogs with uni- or bilateral forelimb lameness.     

Clostridial myositis in a dog

Myositis caused by Clostridium septicum was diagnosed in a 3-year-old Doberman Pinscher. The illness was characterized by signs of pain, swelling, and lameness of left forelimb. Despite treatment, the dog died. Necropsy revealed crepitant swelling over the entire left forelimb, thoracic and abdominal wall, and lumbosacral area. Subcutaneous edema and black, emphysematous muscles also were found. Histologically, hemorrhages, congested vessels, and degeneration and necrosis of myofibers with scattered infiltration of neutrophils were seen in the affected muscles.     

Bilateral medial displacement of the biceps tendon of origin: repair using polypropylene mesh and staples

A three‐year‐old male greyhound was presented with acute onset right forelimb lameness because of medial displacement of the biceps tendon of origin. Ultrasonographic examination confirmed the diagnosis, and a concomitant partial tear of the medial glenohumeral ligament was detected during arthroscopy. To stabilise the biceps tendon, polypropylene mesh was fixed across the intertubercular groove to replace the torn transverse humeral retinaculum. Recovery was uneventful and lameness resolved. Fifteen months later, the dog was presented with medial displacement of the biceps tendon of origin of the left shoulder, and was treated successfully using the same technique.     

MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF LYMPHOMA INVOLVING THE BRACHIAL PLEXUS IN A CAT

An 11-year-old, neutered, female Domestic Long Hair cat had a 3-week history of left forelimb lameness. Conscious proprioception and postural reflexes were absent on the left thoracic limb. The cat had slightly reduced placing and hopping responses on the left pelvic limb, absent cutaneous trunci muscle reflex on the left side, and left triceps muscle atrophy. Magnetic resonance imaging revealed a 2 x 2 x 2 cm mass in the region of the left brachial plexus. The cat was treated by left forelimb amputation and hemilaminectomy. Histopathology of the brachial plexus revealed lymphoma.     

Septic arthritis,navicular bursitis and osseous cyst‐like lesion in a foal

The purpose of this report is to describe the clinical, imaging and pathological findings in a Quarter Horse colt admitted to the Texas A&M University Veterinary Medical Teaching Hospital for lameness of the left forelimb and left hindlimb. A presumptive diagnosis of left forelimb septic navicular bursitis was made ultrasonographically. A cyst‐like lesion of the calcaneus was diagnosed radiographically and better characterised with computed tomography. The cyst‐like lesion of the calcaneus was caused by infection with Actinobacillus sp. and extended into the adjacent tarsocrural, proximal intertarsal and talocalcaneal joints causing septic arthritis. The owner elected for euthanasia due to the poor prognosis. The diagnoses were confirmed on histopathology.     

Computed tomographic diagnosis of incomplete palmar cortical (fatigue) fracture of the third metacarpal bone in two young adult endurance horses

Two young adult endurance horses were presented for investigation of sudden-onset forelimb lameness during competition. Clinical examination revealed a severe forelimb lameness and pain on palpation of the proximal palmar metacarpal area. Initial radiographic survey of the affected forelimb was unremarkable in both cases. A week of box rest resulted in only a mild improvement in the lameness. A second radiographic examination did not reveal any significant abnormalities. In both cases, scintigraphic examination was suggested, but was declined by the owner, and the lameness had significantly improved after local infiltration of 3 mL of anaesthetic solution in the proximal suspensory region. Radiographic and ultrasonographic examinations of the carpus and proximal suspensory region were unremarkable in Case 2. Case 1 had increased thickness of the medial lobe of the proximal aspect of the suspensory ligament. A computed tomographic examination was performed and an incomplete longitudinal (fatigue) fracture of the proximal third metacarpal bone was detected. After 8 months of box rest and rehabilitation, re-examination revealed resolution of the lameness in both cases. Advanced diagnostic imaging should be considered in young endurance horses with severe lameness during competition or training, in which radiographic and ultrasonographic examinations are unremarkable or do not explain the severity of the lameness. Computed tomography imaging is considered a useful diagnostic imaging technique to detect incomplete longitudinal palmar metacarpal cortical (fatigue) fractures due to its ability to provide excellent bone detail.     

Infraspinatus muscle contracture associated with trauma in a dog

Infraspinatus muscle contracture was diagnosed in a 4 1/2-year-old female Doberman Pinscher with lameness characterized by abduction and outward rotation of the right antebrachium and carpus. After infraspinatus tenotomy, the dog recovered. This case differs from previously reported cases of infraspinatus muscle contracture because of an associated history of blunt trauma.     

Detection of lameness and determination of the affected forelimb in horses by use of continuous wavelet transformation and neural network classification of kinematic data

OBJECTIVE: To investigate continuous wavelet transformation and neural network classification of gait data for detecting forelimb lameness in horses. ANIMALS: 12 adult horses with mild forelimb lameness. PROCEDURE: Position of the head and right forelimb foot, metacarpophalangeal (ie, fetlock), carpal, and elbow joints was determined by use of kinematic analysis before and after palmar digital nerve blocks. We obtained 8 recordings from horses without lameness, 8 with right forelimb lameness, and 8 with left forelimb lameness. Vertical and horizontal position of the head and vertical position of the foot, fetlock, carpal, and elbow joints were processed by continuous wavelet transformation. Feature vectors were created from the transformed signals and a neural network trained with data from 6 horses, which was then tested on the remaining 2 horses for each category until each horse was used twice for training and testing. Correct classification percentage (CCP) was calculated for each combination of gait signals tested. RESULTS: Wavelet-transformed vertical position of the head and right forelimb foot had greater CCP (85%) than untransformed data (21%). Adding data from the fetlock, carpal, or elbow joints did not improve CCP over that for the head and foot alone. CONCLUSIONS AND CLINICAL RELEVANCE: Wavelet transformation of gait data extracts information that is important for the detection and differentiation of forelimb lameness of horses. All of the necessary information to detect lameness and differentiate the side of lameness can be obtained by observation of vertical head movement in concert with movement of the foot of 1 forelimb.     

Disorders of the infraspinatus tendon and bursa in three horses

CASE DESCRIPTION: 3 horses with penetrating wounds to the shoulder area were examined because of forelimb lameness. CLINICAL FINDINGS: All horses had physical examination findings (decreased cranial phase of the stride, swelling in the shoulder region, and signs of pain on manipulation of the shoulder) that were suggestive of problems in the upper portion of the forelimb. Injury to the biceps tendon or bursa was the primary differential diagnosis in each instance, but no abnormalities involving those structures were found. Radiographic and ultrasonographic imaging revealed injuries to the caudal eminence of the greater tubercle of the humerus, the infraspinatus tendon, and the infraspinatus bursa. Examination with ultrasound was more sensitive than radiography at detecting both osseous and soft tissue changes. TREATMENT AND OUTCOME: All 3 horses responded favorably to treatment with antimicrobials and non-steroidal anti-inflammatory drugs. Although initial response to standing lavage was favorable in 1 horse, endoscopic lavage was later required. Standing removal of fracture fragments was performed in 2 horses. Ultrasonographic imaging was helpful in monitoring the response to treatment and changes in the affected structures. All 3 horses eventually became sound after treatment. CLINICAL RELEVANCE: Infraspinatus bursitis and tendonitis should be included in the differential diagnoses of horses with shoulder lameness. Diagnosis and monitoring should include ultrasonographic monitoring. The prognosis for return to soundness after appropriate treatment appears to be good.     

Spontaneous bilateral ankylosis of the carpometacarpal joint in a Paint Horse

An 8‐year‐old Paint Horse gelding was evaluated for a persistent left forelimb lameness (grade 4/5), with a hard swelling at the dorsomedial aspect of the carpometacarpal joint, due to osteoarthritis. Previous systemic and local anti‐inflammatory therapy had only a temporary effect. Partial carpal arthrodesis was suggested, but the owner elected for conservative treatment. The horse was confined to a small paddock and received phytotherapeutic supplementation with Harpagophytum procumbens. The lameness gradually resolved but a similar hard swelling developed on the right carpus. Radiographic follow‐up 1.5 years later revealed a spontaneous bilateral ankylosis of the carpometacarpal joint.