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

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

The use of force plate measurements to titrate the dosage of a new COX‐2 inhibitor in lame horses

Reasons for performing study: Lameness is a highly prevalent condition in horses and the principal cause of removal from athletic activity. In clinical studies to evaluate nonsteroidal anti‐inflammatory drug therapies, force plates are commonly used to assess improvement of lameness objectively. Hypothesis: To use a force plate to determine the optimal dose of a new COX‐2 inhibitor (firocoxib) that will reduce lameness, when administered orally to horses once daily. Methods: Sixty‐four horses that exhibited chronic lameness presumed due to osteoarthritis, including navicular disease, in at least one of the frontlimbs and at a stable level of severity, were included. Horses were treated per os s.i.d. for 7 days as follows: vehicle control, firocoxib at 0.05, 0.1 or 0.25 mg/kg bwt. Force plate analysis of each horse was done for the selected (most) lame frontlimb at trot. Once between Days ?19 and ?4 (initial examination), and again on Day ?2 or ?1 (baseline), pretreatment force plate assessments were performed, and thereafter horses were assessed on Days 0, 2 and 6, approximately 10 h post treatment each time. Peak vertical force (PVF) and lameness grades at initial examination and at baseline, and their change from baseline in the 4 different treatment groups were analysed statistically at a significance level of P<0.05. Results: The PVF results were found to be superior to vehicle control already at Day 0 for 0.25 mg/kg bwt and at Days 2 and 6 for 0.1 and 0.25 mg/kg bwt (P<0.05). Mean clinical lameness for both concentrations decreased >1 grade at Day 6. Conclusions and clinical relevance: With the dosage of 0.25 mg/kg bwt lameness did not improve more than with 0.1 mg/kg bwt. Thus, 0.1 mg/kg bwt s.i.d. was considered to be the effective dose at reducing chronic lameness in horses presumed due to osteoarthritis, including navicular disease.     

Tiludronate infusion in the treatment of bone spavin: A double blind placebo‐controlled trial

Reasons for performing study: Tiludronate regulates bone remodelling through a decrease of the resorptive process and should therefore ameliorate the remodelling processes active in osteoarthritis of the distal tarsal joints (‘bone spavin’) and alleviate pain associated with abnormal bone lysis. Objective: To confirm the efficacy of tiludronate, administered as a single infusion at a dose of 1 mg/kg bwt, in the treatment of bone spavin in the horse. Methods: A double blind placebo controlled trial on 108 clinical cases of bone spavin was undertaken. The lameness score of the lamest limb was assessed following distal tarsal analgesia of the contralateral limb and followed‐up using the same procedure throughout the study. Bone spavin in the lamest limb was confirmed by distal tarsal analgesia and radiography. Horses were treated at Day 0 and reassessed 60 days later after controlled exercise. A second nonblinded treatment was given to unresponsive horses and all horses were re‐examined at Day 120. Exercise levels were recorded at each examination. Results: Eighty‐seven horses completed the trial as per the protocol. The tiludronate horses were significantly less lame than the placebo horses (P = 0.0318). Horses treated at Day 60 with tiludronate showed further improvement in lameness at Day 120 (P = 0.0096 and P = 0.0034 for horses treated with tiludronate and placebo at Day 0, respectively). The only significant difference in radiographic findings between tiludronate and placebo was for presence of periarticular osteophytes (P = 0.006). Conclusions: Tiludronate treatment is proven to be effective in bone spavin in horses in association with a controlled exercise programme. Clinical relevance: Tiludronate in combination with controlled exercise offers an alternate medical treatment for bone spavin.     

B‐mode and power Doppler ultrasonography of the equine suspensory ligament branches: A descriptive study on 13 horses

Ultrasonography is routinely used to achieve the diagnosis of equine suspensory ligament desmopathy. In human medicine, power Doppler ultrasonography has also been found to be useful for the diagnosis of tendon/ligament injuries. The aim of this prospective, pilot study was to assess the presence or absence of power Doppler signal in suspensory ligament branches and compare B‐mode findings with power Doppler findings in suspensory ligament branches of lame and non‐lame limbs. Thirteen horses were used (eight lame horses, with lameness related to pain in the suspensory ligament branches, and five non‐lame horses). Ten lame limbs and 24 sound limbs were assessed by B‐mode and power Doppler ultrasonography. The severity of power Doppler signal was scored by two independent readers. The B‐mode ultrasonographic examination revealed abnormalities in branches of lame limbs and in branches of sound limbs. Suspensory ligament branches that were considered normal in B‐mode showed no power Doppler signal. However, power Doppler signal was detected in suspensory ligament branches that were abnormal in B‐mode, both in lame and sound limbs. Power Doppler scores were subjectively higher in suspensory ligament branches of lame limbs and in branches with more severe B‐mode changes. Findings supported the use of power Doppler as an adjunctive diagnostic test for lame horses with suspected suspensory desmopathy.     

Osseous cyst‐like lesions of the lateral intertubercular groove of the proximal humerus: A report of 5 cases

This report documents the case presentation, evaluation, treatment and outcome of 5 horses with an osseous cystlike lesion (OCLL) of the intertubercular groove of the proximal aspect of the humerus. In 3 of the 5 cases, delayed phase gamma scintigraphic findings demonstrated increased radiopharmaceutical uptake in the region of the intermediate tubercle of the proximal humerus of the affected limb, demonstrating increased bone remodelling in this region. In 4 of the 5 horses, an OCLL was identified in the intermediate tubercle of the proximal humerus, and in one horse the OCLL was identified in the greater tubercle. Medial‐lateral and craniomedial‐caudolateral oblique radiographic views were helpful to see the lesions in all cases. Ultrasonography confirmed the location of the subchondral and fibrocartilage defect associated with the OCLL and confirmed communication of the cyst with the lateral intertubercular groove of the humerus in 3 of the 5 cases. Ultrasonography also confirmed a variable degree of bicipital tendonitis in 3 of the horses. OCLL of the lateral intertubercular groove of the proximal humerus should be considered in the evaluation of any mature horse with lameness isolated to the bicipital bursa. Development of these OCLL may be a result of trauma or altered limb biomechanics as a result of shoulder osteoarthritis or concurrent chronic lameness, which leads to disruption or thinning of the fibrocartilage, remodelling of the subchondral bone and subsequent cyst development.     

Lesions of the deep digital flexor tendon in the digit: A correlative MRI and post mortem study in control and lame horses

Reasons for performing study: Lameness associated with lesions of the deep digital flexor tendon (DDFT) in the digit is now recognised as an important cause of lameness, but there is currently limited information about the pathological nature of the lesions. Objectives: To compare: signal intensity changes on magnetic resonance images with histopathology; and histopathological changes in the DDFT from horses with no history of foot‐related lameness (Group C) and horses with lesions of the DDFT confirmed using magnetic resonance imaging (MRI) (Group D). Methods: Transverse sections of the DDFT were harvested from 3 sites in all horses: 1) immediately proximal to the navicular bursa (E1); 2) at the level of the navicular bone (E2); and 3) close to the tendon's insertion (E3). If lesions were identified at E1 or had been identified further proximally using MRI, additional sections were obtained until, in most cases, the proximal limit of the lesion was identified. All DDFTs were graded histopathologically using predefined criteria. The MR images were reviewed to determine the location and sequences in which increased signal intensity was seen. Results: No haemorrhage or inflammatory cell infiltration was seen in any horse. At level E 1 , septal thickening, ghosting of blood vessels and blood vessel occlusion were common in Group D, but were not seen in Group C. Less commonly, there was core necrosis, only seen in Group D. At level E 2 , septal and vascular changes were most obvious in Group D. Core necrosis, dorsal splitting, crevicing and fibrillation were seen only in Group D. Septal and vascular changes were present in both Groups C and D at level E 3 , but fibrocartilaginous metaplasia, splitting, crevicing and fibrillation, or core necrosis or fibroplasia were seen only in Group D. Core lesions in Group D often extended proximal to E 1 , and ranged in length from 0.5–13 cm. Core necrosis was generally associated with increased signal intensity in fat suppressed images. Conclusions: Lesions of the DDFT in the digit appear to be primarily degenerative, and may be a sequel to vascular compromise. Increased signal intensity on fat suppressed MR images is not necessarily associated with frank fluid or evidence of inflammation, but may reflect major matrix changes in the tendon. Potential relevance: Further information about the causes of these lesions is required to develop preventative strategies.     

A pilot study of the effects of acupuncture treatment on objective and subjective gait parameters in horses

Objectives

To investigate whether acupuncture can alter gait in horses as assessed by objective and subjective parameters.

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

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

Thrombosis of the median artery and its branches in a gelding: Clinical appearance,diagnosis and surgical management

This case report describes the clinical appearance, diagnosis and surgical management of thrombosis of the median artery and its branches in a gelding. The 4-year-old Danish Warmblood presented with acute severe progressive right front leg lameness, not responding to painkillers. Initial clinical examination including radiographs revealed no significant findings, and a scintigraphic examination showed decreased radiopharmaceutical uptake in the right front toe in comparison to the left limb. The following day, the temperature of the right front leg was significantly decreased, especially in the area distal to the carpus. No pulsation of the digital arteries could be detected. Ultrasonography showed partial thrombosis of the medial digital artery (A. digitalis palmaris medialis). Occlusion of this artery is a sporadic event with impressive clinical signs and might not be directly diagnosed due to it being a rare occurrence. Ultrasound is an excellent technique for diagnosing the presence of thrombosis and can also help delineate the extent. Our case did not respond to the initial treatment with phenylbutazone and acetylsalicylic acid. The ischaemia became even worse, requiring surgical intervention. A similar approach as for the aorta-iliac thrombosis in the hindlimb was undertaken in the front limb, which has not been described previously. The gelding recovered initially. Unfortunately, restenosis occurred and due to a poor prognosis for a second surgery, the gelding was euthanised.     

Chronic lameness caused by vascular compression of the iliac artery and vein by a malignant melanoma in the pelvis of a grey Spanish gelding

An 11-year-old grey Spanish gelding was presented with chronic lameness of the right hindlimb, with abduction of the limb during the swing phase. Based on a comprehensive lameness examination, the problem was localised to the pelvic region. Rectal and ultrasonographic examinations revealed a mass in the pelvic region in close association with the iliac artery and vein, and ultrasonographic indications of vascular compression. Considering the clinical presentation of a grey middle-aged horse with multifocal melanoma-like nodules at the level of the perineum, tail base, preputium and penis, a malignant melanoma with secondary vascular or neurological compression was suspected. Post-mortem and histological examination confirmed the diagnosis of malignant melanoma with vascular compression of the iliac artery and vein and infiltrative growth in the iliac vein.