Clinical considerations of the thoracic limb.

The avian skeleton is significantly different from the mammalian skeleton, and these differences are important when providing fracture repair and postoperative care for the avian patient. Successful repair depends on an understanding of fracture management and healing and of the anatomical, physiologic, and behavioral concerns of avian patients. Having knowledge of fracture repair without an understanding of the unique needs of avian patients' results in a disappointing treatment response.     

Postprandial arterial vasodilation in the equine distal thoracic limb

The effects of feeding on blood flow to the equine foot are poorly understood. In a temperature-controlled room, duplex Doppler ultrasonographic observations were made pre- and postprandially of the lateral proper palmar digital artery of 5 horses, randomly assigned to twice and 4 times daily feeding in an unbalanced 2 period crossover design. Arterial diameter and blood velocity were measured over 4 h and additional observations made of heart rate, blood pressure, total plasma protein, packed cell volume, plasma glucose and insulin. There was no effect of the feeding regimen on any variable. Postprandially, there were significant increases in arterial diameter, blood velocity, total plasma protein, plasma glucose and insulin; the other variables were unchanged. It appeared that the normal postprandial response was an increase in blood flow to the foot. The value of ultrasonography for noninvasive investigation of the peripheral vasculature of the conscious horse was established; and in the future it may have a role in the diagnosis of vascular diseases of the foot.     

Sonographic observations of the peripheral vasculature of the equine thoracic limb

Investigations of the equine peripheral vascular system have been constrained by the lack of a non-invasive method of examining the arteries and veins of the limbs of the conscious horse. Precise correlations were established between the gross anatomical features of the peripheral vessels and their B-mode sonographic appearance in each thoracic limb of 35 horses. A sonographic imaging protocol was established. Additional Doppler sonographic recordings defined the arterial waveforms and demonstrated that blood flow to the foot could be evaluated in the lateral proper digital artery, distal to the level of the coronary band. Valves (with 2-4 cusps) were identified in the lumina of the medial and lateral palmar common digital veins and those of the medial and lateral palmar proper digital veins. Spontaneous echo contrast, a smoke-like haze of echoic blood, was seen in the lateral and medial palmar common digital veins, the distal deep palmar venous arch and communicating branches, and the palmar proper digital veins, and occasionally seen in the distal deep palmar arterial arch and distal proper palmar digital arteries. The value of duplex sonography (B-mode and Doppler) for anatomical and physiological studies of the peripheral vasculature of the horse was clearly established. Such data could be applied to the investigation of diseases affecting the peripheral circulation.     

Multilobular tumour of bone of the thoracic wall in a cat

Multilobular tumour of bone is a rare neoplasm of the skull in middle-aged, medium-to-large breed dogs even if a few cases have also been described in cats and one horse. The aim of the present paper is to show both the computed-tomography features and the pathological findings of the above neoplasm affecting the thoracic wall of a cat. To the best of the authors' knowledge, such anomalous tumour localisation has never been reported and imaged in feline medicine.     

Macroanatomic investigations of the blood supply of thoracic limb of Kangal dogs

In this study, the arterial supply of the thoracic limb was investigated in Kangal dogs. Twelve adult healthy Kangal dogs of either sex were used. Latex was injected into the common carotid artery, and then the axillary artery was dissected. The axillary artery is a continuation of the subclavian artery and supplies the thoracic limb in Kangal dogs. The axillary artery gave off a deltoid branch and external thoracic, lateral thoracic, and subscapular thoracic arteries in its course along the thoracic wall. The axillary artery continues distally as the brachial artery in the arm. The brachial artery gives rise to the cranial humeral circumflex, deep brachial, bicipital, ulnar collateral, superficial brachial, transverse cubital, and common interosseus arteries. It continues as the median artery after giving off the common interosseus artery. It was observed that the deep antebrachial artery arose from the median artery at the proximal third of the forearm. In the distal third of the forearm, the median artery divided into the palmar carpal and dorsal carpal branches. The deep palmar branch of the radial artery and deep branch of the palmar branch of the caudal interosseus artery form the deep palmar arch. The median artery joined the superficial branch of the palmar branch of the caudal interosseus artery to constitute the superficial palmar arch. The radial artery and cranial interosseus artery contributed to the dorsal carpal rete. The ulnar artery contributed to the formation of the deep and superficial palmar arches.     

Mesenteric lymphography and ligation of the thoracic duct in a cat with chylothorax

Mesenteric lymphography was used to identify and ligate the thoracic duct in a 1-year-old Himalayan cat with chylothorax. Lymphography revealed the thoracic duct to be intact; however, multiple dilated lymphatics, indicative of lymphangiectasia were evident in the cranial portion of the thorax. Hemostatic clips were used to ligate the thoracic duct. The effusion stopped, and 9 months after surgery, effusion has not recurred.     

Doppler ultrasonographic features of thoracic limb arteries in clinically normal horses

OBJECTIVES: To determine blood flow velocities and indices from spectral waveforms obtained by use of Doppler ultrasonography of thoracic limb arteries of horses and to assess interobserver and patient variability associated with the technique. ANIMALS: 9 clinically normal adult horses. PROCEDURE: Left thoracic limb arteries of 8 nonsedated horses were examined at 5 sites by use of pulsed-wave Doppler ultrasonography to determine a range of values for peak systolic, end diastolic, and mean velocities and resistive and pulsatility indices. Interobserver and patient variabilities were determined by 2 operators repeating similar measurements on 1 horse 8 times at weekly intervals. RESULTS: A range of values for each variable measured at the 5 selected sites was obtained. For each variable, strong positive correlations (R > or = 0.7) were detected for > 70% of the site-to-site comparisons made (excluding the coronary band). Among horses, resistive index varied least, whereas over time, mean velocity varied least. Waveform characteristics were consistent with resistive (n = 5) or nonresistive (4) patterns. In the single-horse experiment, waveform characteristics were consistent throughout the 8 weeks, and operator effects were not detected. CONCLUSIONS AND CLINICAL RELEVANCE: Doppler ultrasonography of no one site resulted in more reliable measurements of blood flow characteristics in thoracic limb arteries of horses. Mean velocity and resistive index were the least variable measurements made. Pulsed-wave Doppler ultrasonography may be a useful technique for evaluating diseases that alter normal thoracic limb arterial blood flow in horses.     

Morphology of the thoracic limb of goat as evidenced by gross osteology and radiology

The objective of this study was to provide the detailed normal gross osteology and radiographic anatomy of the thoracic limb in goats as a reference for clinical use and in biomedical research. Radiography of the thoracic limb was performed in five small East African goats. Radiographic findings were correlated with bone specimens from four adult small East African goats. The scapula was narrow. The major tubercle was large and extended proximally above the head of the humerus. The lateral supracondylar crest was less prominent. The lateral and medial epicondyles of the humerus were almost of the same size. The lateral surface of the lateral condyle of the humerus presented a prominent depression for the origin of extensors of the carpus and digits. The cranially located radial notch was deep seated and the radial tuberosity was represented by a rough area located nearer to the head of the radius. The fifth metacarpal bone was seen in all animals. The morphology of the thoracic limb of small East African goats indicated the presence of powerful extensor muscles and is restricted to forward and backward movements as an adaptation to terrestrial lifestyle.     

Effect of an isoxsuprine-resin preparation on blood flow in the equine thoracic limb.

The effects of an oral isoxsuprine-resin preparation on the blood flow in the thoracic limb of seven horses was determined by thermography. Treatment with the oral resin preparation resulted in increased skin temperatures compared with the non-medicated controls. The maximal temperature differences, 2.2 degrees C for the horses treated with 0.9 mg/kg and 1.8 degrees C for the horses treated with 1.2 mg/kg, occurred four hours after dosing. Plasma total isoxsuprine, determined in three horses, was detectable two hours after oral dosing and maximal eight hours after dosing, but free isoxsuprine could not be detected. Receptor binding studies demonstrated strong alpha-receptor binding, and this binding was so strong that even at isoxsuprine concentrations below the detection level receptors could have been stimulated.     

Efficacy of orally administered gabapentin in horses with chronic thoracic limb lameness

ObjectiveTo evaluate the analgesic effects of orally administered gabapentin on horses with chronic thoracic limb lameness.Study designRandomized, crossover design.AnimalsA total of 14 adult horses with chronic thoracic limb lameness.MethodsFollowing baseline measurement of lameness, horses were administered each of four treatments orally in grain: treatment G, gabapentin (20 mg kg^–1) twice daily for 13 doses; treatment F, firocoxib (171 mg once, then 57 mg once daily for six doses); treatment GF, gabapentin and firocoxib at previously stated doses and frequencies; or treatment C, grain only as a control. Treatments were administered in a randomized, crossover design, separated by 2 weeks. Subjective lameness score (SLS), inertial sensor vector sum (VS) calculations, peak vertical ground reaction force (PVGRF) measurements and vertical impulse (VI) calculations were determined immediately prior to each initial treatment dose and 2–4 hours after the final treatment dose for each treatment. Mean change in SLS, VS, PVGRF and VI for each treatment were compared among treatments.ResultsThe rank change in SLS of treatment GF was significantly greater than that of treatments C (p = 0.01) and G (p = 0.01) but not of treatment F (p = 0.08). No differences in VS (p = 0.4), PVGRF (p = 0.4) or VI (p = 0.1) were observed among treatments.Conclusions and clinical relevanceGabapentin, as administered here, did not improve subjective or objective measures of lameness in horses with chronic thoracic limb musculoskeletal pain. Although subjective evaluation identified an improvement in lameness with treatment GF, it was not different from that observed with treatment F. Higher oral dosing and longer treatment regimens of gabapentin may be indicated for the treatment of chronic musculoskeletal pain in horses.     

Changes in the skeletal dimensions of the digits of the thoracic limb of Holstein cows after maturation

The 12 left digits of the thoracic limb of Holstein female cows were obtained from a slaughterhouse, and 13 linear measurements of skeletal specimens of the digits of the thoracic limb were used in this study. Bivariate plots, regressions and correlation analyses were performed to assess the relationships between osteometric data and age, and between osteometric data and body size. The geometric mean (GM) of the metacarpal size was used as a proxy of body weight. The results of the regression analysis demonstrated that the length and the width of the distal phalanx were significantly correlated with age, whereas those of other bones were not. In addition, the correlations of the distal phalanx tended to be higher with age than with the GM of the metacarpal size, and their skeletal measurements tended to be longer in older animals than in younger animals. These findings suggest that the distal phalanx is slightly elongated and enlarged in its solear aspect with increasing age in skeletally mature cows. Moreover, although the side difference in the distal phalanx between the lateral and medial digits did not increase significantly with age, the solear aspect of the distal phalanx tended to be rougher, and deformation of the flexor tubercle tended to be more pronounced in the medial digit compared with the lateral digit. Therefore, in the distal phalanx of the front feet, the skeletal deformation with age and asymmetrical bone development might be related to the pathogenesis of claw horn lesions, as in the hind feet.     

Laminin receptor 1 is differentially expressed in thoracic and limb wounds in the horse

Healing of wounds located on the distal limbs of horses is often complicated by retarded epithelialization and the development of exuberant granulation tissue (proud flesh). Treatments that definitively resolve this pathological process are still unavailable. Molecular studies of the repair mechanism might contribute to the development of new therapeutic strategies. The study presented herein aimed to clone the full length cDNA and to study the spatio-temporal expression profile of mRNA and protein for LAMR1, previously attributed a role in wound epithelialization, during the repair of body and limb wounds in the horse. Cloning was achieved by screening a cDNA library previously derived from 7-day wound biopsies. Expression was studied in unwounded skin and in samples from 1-, 2-, 3-, 4- and 6-week-old wounds of the body and limb. Temporal gene expression was determined by real time polymerase chain reaction (RT-PCR) while protein expression was mapped immunohistochemically. Full-length cDNA for equine LAMR1 was shown to be highly similar to that of other species. The mRNA expression of LAMR1 was significantly up-regulated only in thoracic wounds, 4 and 6 weeks following wounding (upon epithelialization). Cutaneous wounding induced protein expression at both locations. Our data suggest that up-regulation of LAMR1 protein might favour epithelialization during wound healing. However, its interaction with ligands other than laminin complicates data interpretation. Future studies should quantitatively verify the temporal expression of this protein in order to provide the basis for targeted therapies that might enhance epithelialization.     

Analgesic management of an eight-year-old Springer Spaniel after amputation of a thoracic limb

Analgesic agents were administered perioperatively to an eight-year-old Springer Spaniel undergoing amputation of its right thoracic limb. The amputation was carried out due to a painful, infiltrative and poorly differentiated sarcoma involving the nerves of the brachial plexus. A combination of pre-emptive and multimodal perioperative analgesic strategies was used; including intravenous (IV) infusions of fentanyl, morphine, lidocaine and ketamine.     

Development of a technique for continuous perineural blockade of the palmar nerves in the distal equine thoracic limb

Objective To develop a technique for placing continuous peripheral nerve block (CPNB) catheters adjacent to palmar nerves in horses and to evaluate the effect of low‐volume local anesthetic (LA) infusion on nociception in the distal equine thoracic limb. Study design In vitro and in vivo laboratory investigation. Study material and animals Forty‐two thoracic limbs from 22 equine cadavers and five horses. Methods Thoracic limb specimens were dissected to find landmarks for catheter insertion adjacent to medial and lateral palmar nerves. Based on the anatomy of the proximal metacarpus, a technique for placing palmar CPNB catheters was developed and the potential for catheter dislodgement studied in vitro by fluoroscopic visualization during passive carpal flexion and dye injection following simulated limb motion. The feasibility of CPNB catheter instrumentation in standing, sedated horses was tested in five animals, with ultrasound control. Electrical and mechanical stimulation thresholds and response latencies for hoof withdrawal responses (HWR) were determined following saline or LA infusion. Results Medial and lateral CPNB catheters were inserted percutaneously 2 and 4–5 cm, respectively, distal to the accessory carpal bone and advanced for ～7 and 10 cm, respectively, to place the tip just proximal to the communicating branch of the nerves. Catheters were placed correctly in 88% and 85% of cadaver limbs. In the standing horses, LA infusion not only increased HWR thresholds and latencies to noxious mechanical or electrical stimulation but also caused vasodilation and limb swelling over time. Conclusion The technique, developed in vitro, for placing and maintaining palmar CPNB catheters in the equine thoracic limb was successfully applied in vivo. Catheters were well tolerated but LA infusion may cause limb swelling, suggesting a need for further exploration of drug and infusion regimens. Clinical relevance Continuous perineural LA infusion along palmar nerves may develop into an effective analgesic technique in horses suffering from lower limb pain.     

Change in triceps muscle intracompartmental pressure with repositioning and padding of the lowermost thoracic limb of the horse

Triceps intracompartmental pressure was measured in the lowermost limb of the recumbent horse during the initial period of recumbency during elective surgical procedures in 11 horses. Intramuscular pressure, using an IM catheter, was measured with the thoracic limbs in 4 different positions, including (I) table-contact limb unadvanced-unsupported free limb, (II) table-contact limb unadvanced-supported free limb, (III) table-contact limb advanced cranially, unsupported free limb, and (IV) table-contact limb advanced cranially, supported free limb. Pressure was measured in the 4 positions with and without padding. The highest pressure was measured in position I without padding. The lowest pressure was measured with position IV with padding and was significantly lower than all pressures in other positions (P less than 0.05). Foam mattress padding significantly decreased muscle pressure in each position.