Dynamic respiratory endoscopy in 67 Thoroughbred racehorses training under normal ridden exercise conditions

Reasons for performing study: There are potential advantages to imaging the upper portion of the respiratory tract (URT) of horses during ridden exercise. With the advent of a wireless endoscope, this is now possible. However, there has been no detailed validation of the technique and findings have not been compared to ridden speed. Objectives: To assess the combined use of a Dynamic Respiratory Scope (DRS) and global positioning system (GPS) receiver for examining the URT of a group of Thoroughbred racehorses randomly selected from a single flat racehorse training establishment. Methods: Horses were selected randomly from a population of Thoroughbred horses in training at the same training yard. Endoscopic images of the URT were recorded during a ridden exercise test on an ‘all‐weather‐gallop’ and were reviewed post testing. Speed was measured using a wrist mounted GPS receiver. Results: A total of 67 (34%) of the 195 horses in training were examined. Endoscopic findings included: normal URT function (44 cases); dorsal displacement of the soft palate (DDSP) (13 cases); laryngeal asymmetry (4 cases); and axial deviation of the aryepiglottic folds (3 cases). Maximum speed obtained by individual horses ranged from 41.8–56.3 km/h. Ridden speed was variably affected by DDSP. Conclusions: The DRS provides a safe effective system for imaging the equine URT during ridden exercise at speed. The abnormalities of the URT identified were similar to those observed during treadmill endoscopy studies reported in the literature. The effect of URT abnormalities on ridden speed requires further investigation. Potential relevance: This technique can be used to diagnose common causes of URT associated with poor performance in horses during normal training. This has substantial implications for future clinical diagnosis and treatment of URT pathology.     

Descriptive epidemiology of joint injuries in Thoroughbred racehorses in training

Reasons for performing study: No large scale epidemiological studies have previously quantified the occurrence of carpal, metacarpo‐ and metatarsophalangeal (MCP/MTP) joint injuries in Thoroughbred racehorses. Objectives: To develop an objective classification system for carpal and MCP/MTP joint injuries and estimate the incidence of these injuries in young Thoroughbreds in flat race training. Methods: In a prospective cohort study, data on daily exercise and veterinary‐diagnosed carpal and MCP/MTP joint injuries were collected from Thoroughbreds monitored since starting training as yearlings, for up to 2 years. Cases were classified in one of 4 categories: 1) localised to a carpal or MCP/MTP joint based on clinical examination and/or diagnostic analgesia; no diagnostic imaging performed; 2) localised to a carpal or MCP/MTP joint based on clinical examination and/or diagnostic analgesia; radiographs taken but no abnormalities detected; 3) evidence of abnormality of subchondral bone and/or articular margin(s) on diagnostic imaging and 4) evidence of discontinuity of the articular surface on diagnostic imaging. Incidence rates and rate ratios were estimated using Poisson regression, adjusting for trainer‐level clustering. Results: A total of 647 horses from 13 trainers throughout England contributed 7785 months at risk of joint injury. One‐hundred‐and‐eighty‐four cases of carpal (n = 82) or MCP/MTP (n = 102) joint injury were reported in 165 horses and classified in Category 1 (n = 21), Category 2 (n = 21), Category 3 (n = 72) or Category 4 (n = 70). The overall joint injury rate was 1.8 per 100 horse months (95% CI = 1.2, 2.8); rates did not differ significantly between 2‐ and 3‐year‐olds but females sustained Category 1 injuries at triple the rate of males (P = 0.03). Joint injury rates differed significantly between trainers (P<0.001) and there was trainer variation in anatomical site and severity of injury. Conclusions and potential relevance: Carpal and MCP/MTP joint injuries are an important cause of morbidity in Thoroughbred racehorses. Identification of modifiable risk factors for these injuries may reduce their incidence.     

Dynamic respiratory endoscopy without treadmill in 68 performance Standardbred,Thoroughbred and saddle horses under natural training conditions

Reasons for performing study: High speed treadmill endoscopy provides a true assessment and diagnosis of the dynamic obstructions of the upper equine respiratory tract (DO‐URT). However, treadmills do not always allow reproduction of the exact conditions of dynamic collapse of the URT. The availability of on‐board endoscopes, which could be used without a treadmill, would make exercising endoscopy readily available to more equine practices. Objectives: To develop and validate an innovative endoscope which could be used for the examination of the URT at exercise in ridden and harnessed sport horses performing in natural conditions. Methods: Authors worked closely with engineers of a company manufacturing veterinary endoscopes. Over a 2‐year period several prototypes were tested on more than 20 cooperative horses performing either in trot, gallop, jumping or endurance. The final Dynamic Respiratory Scope (DRS) allows real‐time visualisation of the URT and video recordings for post test reviewing and archiving. The DRS was then tested in 2 equine livery yards. Performance horses presented for investigation of abnormal respiratory noises at exercise and/or poor performance were subjected to exercising endoscopy. Endoscopic images of the URT were recorded and video recordings of the URT were reviewed post test. Results: A total of 68 horses were examined: 39 harnessed Standardbred and 29 mounted horses (16 Thoroughbred and 13 saddle horses). Of these, 44 were diagnosed with a URT abnormality. Good quality videos were obtained even at maximum speed in all cases. The innovative insertion tube provided very stable images compared to those obtained with flexible video endoscopes on treadmills. Conclusions: This study validates the safety and the reliability of the DRS for imaging the equine URT during natural exercising conditions. Potential relevance: Most common causes of DO‐URT can be diagnosed easily during any type of performance without a treadmill and the DRS offers a great potential for further URT clinical research.     

Size and geometry of apical sesamoid fracture fragments as a determinant of prognosis in Thoroughbred racehorses

Reason for performing study: Analysis was performed to examine a method for refining the preoperative prognosis for horses that had surgery to remove apical fractures of the proximal sesamoid bones (PSBs). Objectives: To determine if: 1) there was a difference in size or configuration of apical fractures between the different anatomical locations of the PSBs, which have been shown to affect the prognosis; and 2) the size or configuration could predict the prognosis for racehorses with these fractures. Methods: The study included 110 weanlings and yearlings and 56 training racehorses that underwent surgery to remove apical PSB fractures. Radiographs of the fractures were used for measurement of the abaxial and axial proportion and the abaxial to axial ratio, and race records were used to determine average earnings per start (AEPS) and total post operative starts. Analysis of variance and regression statistics were used to compare the fragment sizes between the specific PSBs on each of the limbs and compare size and configuration of the fractures to prognosis. Results: There was a significantly larger abaxial to axial ratio (more transverse fracture) for the forelimb medial sesamoids than for all other sesamoids in untrained racehorses (P = 0.03). There were no other significant differences in size. There was no relationship between fracture size or configuration and AEPS nor total post operative starts. Conclusions: Apical fractures in weanlings and yearlings tend to be more transverse in the forelimb medial PSBs than the other PSBs. Apical fracture size and geometry does not determine prognosis for apical sesamoid fractures. Potential relevance: Horses that undergo surgery to remove larger apical fractures of the PSBs do not have a worse outcome than those horses with smaller fractures.     

Characteristics of Thoroughbred and Quarter Horse racehorses that sustained a complete scapular fracture

Reasons for performing study: To determine if scapular fractures occur in racehorses with distinctive characteristics. Objectives: To test the hypothesis that Thoroughbred (TB) and Quarter Horse (QH) racehorses with a scapular fracture have similar characteristics that are different from those of their respective racetrack populations. Methods: Necropsy findings, case details, last race information and career earnings for TB and QH racehorses that had a scapular fracture in California between 1990 and 2008 were retrospectively compared between breeds. Horse signalment, career earnings, career starts and race characteristics were obtained for all California racehorses. Comparisons were made between affected horses, other racehorses that died, and all horses that raced, in California during the 19 year period. Results: Seventy‐three TB and 28 QH racehorses had a similar, complete comminuted scapular fracture with an articular component, and right forelimb predilection. The QHs had a higher incidence of scapular fracture incurred during racing than TBs (0.98 vs. 0.39/1000 starters). The TB and QH incident rates for musculoskeletal deaths incurred racing were 20.5 and 17.5/1000 starters, respectively; however, a greater proportion of TB musculoskeletal deaths occurred training (40% vs. 8%). Horses with a scapular fracture were more likely to be male and aged 2 or ≥5 years than the racetrack population. Most affected QHs (64%) were 2‐year‐olds; most TBs (74%) were aged ≥3 years. Scapular fractures occurred more commonly during racing in QHs (70%) than TBs (44%). Race‐related scapular fracture was more likely to occur in a Maiden race than in a non‐Maiden race. Horses with a scapular fracture had fewer career starts than the racetrack population. Conclusions and potential relevance: Despite breed differences for signalment and exercise distances, both breeds incur a complete scapular fracture that is more likely to occur in the right scapula of young and older, male racehorses, early in their race career or after few races. Quarter Horses sustain a catastrophic scapular fracture more frequently than TBs.     

Relative prevalence of upper respiratory tract obstructive disorders in two breeds of harness racehorses (185 cases: 1998-2006)

Reasons for performing study: Two genetically and phenotypically distinct horse breeds are used for harness racing in Scandinavia: the Standardbred (SB) and Coldblooded Trotter. These racehorses have identical environmental, management and racing conditions. Therefore, this study was undertaken to identify and compare the relative prevalence of upper respiratory tract (URT) obstructive disorders in these 2 breeds. Objectives: To determine whether these 2 phenotypically different breeds of harness racehorses have different predispositions for URT disorders. Methods: Retrospective study of 88 Norwegian Coldblooded Trotters (NCT) and 97 SBs referred to this hospital for URT evaluation between 1998 and 2006. Case records of all horses diagnosed with an URT disorder during resting endoscopy, and all horses undergoing high‐speed treadmill videoendoscopy (HSTV) with one or more periods of induced poll flexion were evaluated. The relative prevalence of URT disorders between the 2 breeds was analysed using a Fisher's exact test. Results: There was a significant (P<0.05) breed predisposition regarding 6 URT disorders. Bilateral dynamic laryngeal collapse associated with poll flexion and flaccid epiglottis was significantly more frequent in the NCT. Alar fold collapse and nasopharyngeal collapse were significantly more frequent in SBs. Epiglottic entrapment and nasal flutter were only diagnosed in the SBs. Dynamic disorders were more common than resting disorders in both breeds. Conclusion: URT obstructive disorders (dynamic laryngeal collapse associated with poll flexion, flaccid epiglottis, pharyngeal collapse, alar fold collapse, nasal flutter and epiglottic entrapment) are breed related, indicating an anatomic or functional cause. Periods of induced poll flexion during HSTV was essential to declare harness racehorses free of URT disorders. Potential relevance: Further anatomic or physiological studies comparing these breeds could potentially provide insight into the pathogenesis of certain URT obstructive disorders. Induced poll flexion should be included in routine HSTV examinations of all harness racehorses.     

Risk factors for superficial digital flexor tendinopathy in Thoroughbred racehorses in hurdle starts in the UK (2001-2009)

Reasons for performing study: Superficial digital flexor (SDF) tendinopathy is a common injury in Thoroughbred horses racing over hurdles. Identification of risk factors may allow the introduction of measures to minimise the incidence of this injury. Objective: To identify risk factors for SDF tendinopathy in Thoroughbred horses in hurdle races in the UK. Methods: Potential risk factors for SDF tendinopathy were studied between 1 January 2001 and 31 December 2009 using a retrospective cohort study design with 1031 case starts and 168,637 control starts. Potential risk factors were screened using univariable logistic regression prior to multivariable model building. Results: In the final multivariable model, 20 statistically significant risk factors were identified. Variables found to be associated with increased odds of SDF tendinopathy included: firmer going; increased horse age at first race; having had a previous SDFT injury; and racing in the summer compared to other seasons. Variables found to be associated with decreased odds included: being trained by a more successful trainer; and having raced more frequently in the preceding 9–12 months. Conclusions: This study identified multiple risk factors associated with SDF tendinopathy, some of which are difficult to explain with the current data source. Factors resulting in increased cumulative horse and tendon fatigue (increased years in racing; carrying increased weight; and racing over longer distances), firm ground, and the presence of previous tendon injury should be considered when attempting to reduce the likelihood of sustaining SDF tendinopathy. Potential relevance: The results will facilitate the development of strategies to improve the overall safety of horses in hurdle racing in the UK.     

Cytology of the lower respiratory tract in horses: An updated review

The diagnosis of respiratory diseases in horses can be difficult due to the nonspecific nature of the clinical signs, which overlap between the different diseases. Cytological examination of the respiratory secretions is a helpful diagnostic tool that, when combined with clinical features and other diagnostic techniques, has the potential to improve diagnostic accuracy significantly. This review article should help readers to become familiar with the cytology of the normal respiratory tract and with the cytopathological abnormalities associated with common respiratory disorders in horses.     

Assessment of dynamic upper respiratory tract function in the equine athlete

Dynamic upper respiratory tract (URT) obstructions occur commonly in the equine athlete. During the past 25 years, veterinary diagnostic capabilities have improved greatly with the ability to perform endoscopy during exercise and thus to visualise upper airway function during various types of exercise. After correctly reproducing and diagnosing an URT obstruction, the veterinary surgeon must consider the functional significance of the endoscopic findings for that individual athlete. This is the third paper in this series and focuses on the diagnosis of URT obstructions, their relationship to the exercise test and their functional significance.     

Dynamic collapse of the upper respiratory tract: A review

Dynamic collapse of the upper respiratory tract is a common cause of poor performance in athletic horses. Most commonly, airway obstruction occurs during strenuous exercise when the upper respiratory tract is exposed to high pressure swings. In horses undertaking submaximal exercise, the pressures may also be increased due to flexion of the neck. The nasopharynx and larynx are particularly prone to dynamic collapse and a number of different forms of upper airway obstruction are now recognised. However, due to the dynamic nature of the collapse a definitive diagnosis is often not possible from resting observations alone.     

Descriptive epidemiology of fracture,tendon and suspensory ligament injuries in National Hunt racehorses in training

Reasons for performing study: While fractures and tendon injuries are known to be important diseases in National Hunt (NH) racehorses during racing, there are no accurate estimates of their incidence in NH training yards. Objectives: To estimate the incidence of fractures and tendon and suspensory ligament injuries (TLIs) in NH racehorses in training; to describe the injuries incurred and to compare injury incidence rates by horse age, trainer, gender and background (ex‐flat vs. ex‐store horses). Methods: Cohort data were collected from 14 UK NH training yards for 2 racing seasons. Daily exercise regimens and details of fractures and TLIs occurring in study horses were recorded. Results: Data were gathered from 1223 horses that spent 9466 months at risk of injury. The fracture incidence rate was 1.1/100 horse months and varied significantly by trainer (P<0.001) but not by gender, age or background. The pelvis and third metacarpal bone (MCIII) were the most common fracture sites, although this varied between racing and training. The TLI incidence rate was 1.9/100 horse months and varied significantly by trainer (P = 0.05) and age (P<0.001) but not by gender or background. However, exstore horses were significantly more likely to have a TLI on the racecourse than ex‐flat horses (P = 0.01). Superficial digital flexor injuries accounted for 89% of all TLIs, the remainder being suspensory ligament injuries. Conclusions and potential relevance: Fractures and TLIs are important causes of morbidity and mortality in NH racehorses in training in England. This study provides accurate estimates of their incidence in this population and provides a baseline against which to monitor the effect of future interventions.