Treadmill exercise testing. Treadmill installation and training protocols used for clinical evaluations of equine athletes

The use of motorized treadmills has made it possible to evaluate equine poor performance with sophisticated diagnostic techniques during peak exercise. Treadmill exercise tests currently being used for clinical evaluations include treadmill gait analysis, dynamic hoof balancing, endoscopic evaluation of upper airway function, and exercise performance profiling. Large motorized treadmills (1 to 1.5 m in width and 4 to 5 m in length) are best suited for clinical evaluations. Ideally, the treadmill should be installed in-ground using a pit. This type of installation results in the tread surface being at the same level as the surrounding floor. A standard protocol should always be used to train horses to exercise on a treadmill. Training should be designed to introduce the horse to procedures required for a specific clinical evaluation gradually.     

Evaluation of upper respiratory tract function during strenuous exercise in racehorses

Forty-six racehorses with a history of poor performance underwent endoscopic evaluation of laryngeal and pharyngeal function while exercising on a high-speed treadmill. This evaluation allowed the definitive diagnosis of intermittent or continual upper respiratory tract obstruction as a cause of poor performance, as well as the documentation of the dynamic functional anatomy of the obstruction. Ten of the horses (22%) were determined to have a functional abnormality of the upper respiratory tract. These abnormalities included epiglottic entrapment (1 horse), persistent dorsal displacement of the soft palate during exercise (4 horses), and left laryngeal hemiplegia (5 horses). Thirty-two horses were observed to have signs of left laryngeal hemiparesis (asynchronous arytenoid movement) at rest that did not impair full laryngeal abduction during strenuous exercise.     

Mandibular reconstruction of a partial hemimandibulectomy in a dog with severe malocclusion

OBJECTIVE: To report treatment of severe mandibular malocclusion (after left partial hemimandibulectomy, approximately 7 cm gap). STUDY DESIGN: Clinical report. ANIMALS: A 14-month-old golden retriever. METHODS: After corrective osteotomy of the right horizontal mandibular ramus, normal occlusion was reestablished and temporarily maintained while both mandibles were stabilized by miniplates on the lateral alveolar surface spanning the bilateral mandibular defects (right=1.5 cm, left=7 cm). A fenestrated, monocortical rib graft was positioned beneath the left gingival surface to protect the synthetic graft, which was secured to the miniplate. A mandibular reconstruction plate (right) and a locking mandibular reconstruction plate (left) were secured to the ventral borders of the mandibles. Recombinant bone morphogenetic protein-2 delivered in collagen tricalcium phosphate sponges (rhBMP-2 collagen-TCP sponge) was inserted into both mandibular defects. RESULTS: New bone formation was identified at 3 months and bony remodeling was evident at recheck examinations up to 4 years. Scintigraphy (6 months, 1 year) confirmed graft revascularization and viability. Bone collected (1 year) from the left defect site had robust new bone formation and evidence of continued remodeling. Only minor complications were encountered during the postoperative period and were easily resolved. CONCLUSIONS: Reconstruction of a large mandibular defect was facilitated by use of an osteoinductive factor (rhBMP-2 collagen-TCP sponge) as a graft substitute. CLINICAL RELEVANCE: One-step salvage and reconstruction facilitated by use of an osteoinductive factor, as a graft substitute, may be an alternative strategy for repair of large mandibular defects.     

COMPUTED TOMOGRAPHIC EVALUATION OF COMMINUTED MIDDLE PHALANGEAL FRACTURES IN THE HORSE

Comminuted fractures of the middle phalanx have been well described in the horse. Choice of treatment, surgical planning and prognosis have traditionally been based upon evaluation of radiographs. However, the complex nature of comminuted fractures makes radiographic interpretation difficult. Computed tomography (CT) allows the production of cross-sectional images with spatial separation of structures which are superimposed on survey radiographs. This allows accurate assessment of the number and direction of fracture lines within the bone. In this paper we report the use of CT in the evaluation of 6 comminuted middle phalangeal fractures. Computed tomography is potentially useful in deciding the type of treatment, surgical planning and determining the prognosis.     

The use of high-speed treadmills for lameness and hoof balance evaluations in the horse

Examination for lameness remains the most important component of the clinical evaluation for poor performance. Although conventional examinations can be used to diagnose many causes of lameness, treadmill video gait analysis and dynamic hoof balance evaluations have proved to be useful not only for evaluating lameness but also for maintenance of long-term soundness. Treadmill lameness evaluations offer a major advantage compared to conventional evaluations because of the stationary position of the exercising horse relative to the people performing the examination. Lameness is suspected if asymmetric motion is observed or asymmetric sounds of the feet contacting the tread surface are heard during the treadmill evaluation. Localization of lameness to the front or hind legs is the first step in the treadmill gait analysis protocol. In trotting and pacing horses, asymmetric movements associated with foreleg lameness generally are confined to the front end. In contrast to the pacing gait, asymmetric movements associated with hindlimb lameness can involve both the front and rear of the horse at the trot. The evaluation is continued to determine which side of the horse is abnormal. Viewed from the front, horses with primary forelimb lameness appear to have an asymmetric downward rotation of the torso, head, and neck away from the stiffer lame front leg toward the flexed normal leg as it contacts the tread surface. The lame hind leg can appear to be stiff relative to the opposite normal leg. This results in uneven side-to-side oscillations of the pelvis rotating away from the abnormal stiff-appearing hind leg toward the normal, flexed hind leg as it contacts the tread surface. Both front- and hind-leg lamenesses cause dissociation of the normal foot-fall sequence, resulting in the alteration of the normal two beat gait at the trot or the pace to a three-beat gait. The final step of the lameness examination involves the use of diagnostic regional anesthesia to determine the anatomic location of the lameness. Treadmill video gait analysis can be used to evaluate differences in the horse's gait before and after each anesthetic block. Optimal foot balance during exercise is critical for long-term maintenance of musculoskeletal soundness. Combining slow-motion video gait analysis with treadmill exercise provides an excellent method for evaluating hoof balance at a variety of speeds. Optimal hoof balance can be achieved by using the technique of successive trimming and re-evaluation. The principles of hoof balancing include establishing dorsopalmar or dorsoplantar hoof balance.(ABSTRACT TRUNCATED AT 400 WORDS)     

Clinical evaluation of poor performance in the racehorse: the results of 275 evaluations

A clinical sports medicine evaluation was applied to 275 racehorses with a history of poor racing performance. The poor performance evaluation included a) general physical examination and basic laboratory screening; b) respiratory examination including auscultation, thoracic radiographs, ventilation-perfusion lung scintigraphy and upper airway endoscopy at rest and during maximal treadmill exercise c) examination of the musculoskeletal system including lameness examination, video gait analysis at high speed, post exercise serum chemistry to identify obvious as well as sub-clinical myopathies, high detail radiography and nuclear scintigraphy; d) cardiac examination including auscultation, electrocardiographic analysis during strenuous exercise and when indicated, echocardiography; and e) a standardised exercise stress test entailing the measurement of oxygen consumption, carbon dioxide production, venous blood lactate concentration and heart rate during sequentially increasing running speeds on the high speed treadmill. The choice of diagnostic methodologies utilised were tailored to each individual in order to determine most efficiently the abnormalities contributing to inadequate racing performance. The results of this clinical evaluation showed that 1) many of the diagnoses were subtle requiring the use of sophisticated diagnostic equipment including scintigraphy and dynamic evaluation of the horse exercising on the high speed treadmill and 2) 84 per cent of the horses were diagnosed as suffering from more than one problem leading to the supposition that inadequate athletic performance is often caused by a constellation of abnormalities requiring a comprehensive approach to diagnosing decreased athletic capability.     

Clinical application of recombinant human bone morphogenetic protein-2 in 4 dogs

OBJECTIVE: To describe outcome in dogs with insufficient bone healing treated with recombinant human bone morphogenetic protein-2 (rhBMP-2). STUDY DESIGN: Retrospective study. ANIMALS: Four dogs clinically affected with delayed union or nonunion bone healing. METHODS: Medical records were reviewed for signalment, clinical problem, treatment, and outcome. RESULTS: Four dogs that had delayed- or nonunion of bone fracture, osteotomy, or arthrodesis were treated with either minimally invasive, fluoroscopically guided, percutaneous administration or direct surgical application of rhBMP-2. Doses used ranged from 0.2 to 1.6 mg of rhBMP-2. In 3 dogs, a calcium phosphate matrix (CPM) carrier was used whereas in 1 dog commercially prepared rhBMP-2 impregnated in an absorbable collagen sponge (INFUSE Bone Graft) was used. This latter dog had osteomyelitis associated with implant infection before rhBMP-2 administration. Rapid radiographic union was noted in all dogs with excellent long-term outcome. Adverse effects were minimal and included transient worsening of lameness after percutaneous administration of rhBMP-2 in 2 dogs. CONCLUSIONS: rhBMP-2 stimulated rapid bone formation at delayed- or nonunion sites resulting in radiographic bone union with minimal adverse effects and excellent long-term outcome in 4 dogs. CLINICAL RELEVANCE: Direct intraoperative administration or fluoroscopically guided, minimally invasive delivery of rhBMP-2 may be an effective treatment modality for bone delayed- or nonunions and could potentially be used to stimulate new bone production in a variety of orthopedic surgical conditions in dogs.     

Scintigraphic identification of skeletal muscle damage in horses 24 hours after strenuous exercise

The uptake of the bone-seeking radiopharmaceutical 99mTc-MDP by damaged skeletal muscle in horses is evaluated. Twenty-four hours following strenuous exercise, 109 racehorses with a history of inadequate athletic performance and subtle lameness were imaged using scintigraphic techniques. Ten horses (9.2 per cent) demonstrated abnormal uptake of the radioisotope within skeletal muscles. A muscle biopsy from one of these horses confirmed that the muscles with increased scintigraphic activity had histologic evidence of rhabdomyolysis. This technique allows localisation and relative quantification of muscle damage and is a valuable aid in the evaluation of the athletic horse.     

Scintigraphic appearance of stress-induced trauma of the dorsal cortex of the third metacarpal bone in racing Thoroughbred horses: 121 cases (1978-1986)

Review of 121 bone scintigrams obtained on racing Thoroughbred horses with clinical histories indicative of forelimb lameness revealed 3 scintigraphic patterns of stress-induced trauma to the dorsal cortex of the third metacarpal bone: (1) focal, intense uptake associated with recent stress fracture; (2) regional uptake of varying intensity or a mixed pattern of uptake associated with chronic stress fracture; and (3) diffuse, mild to moderate uptake associated with periostitis (bucked shins). The latter scintigraphic pattern appeared to be an exaggerated manifestation of the normal remodeling process evident in immature horses (2 to 3 years old). Scintigraphy was most helpful in identifying radiographically occult stress fractures, determining the extent of cortical involvement before surgical intervention in cases of chronic stress fractures, and monitoring the fracture healing process.     

The use of sports medicine techniques in evaluating the problem equine athlete

Discovering the cause of poor performance in racehorses can often represent a considerable challenge eluding the more common diagnostic techniques available at the racetrack. Application of sports medicine techniques to these problem cases can aid in the diagnosis of poor performance. Central to the development of this capability has been the use of highspeed treadmills, allowing the racehorse to be evaluated in the controlled laboratory setting, at exercise intensities equivalent to those of racing. Video and cinematographic gait analysis can be used in the diagnosis of subtle lameness conditions. Evaluating hoof balance at high speed has also become an important technique for both lameness diagnosis and prevention. Correcting hoof imbalance normalizes the applied stresses on joints, ligaments, and tendons. Abnormal upper airway function resulting in increased resistance to airflow is major cause of poor racing performance. Often this cause of upper airway dysfunction is difficult to evaluate at rest or after exercise. A definitive diagnosis can be made in these cases using treadmill endoscopy to visualize upper airway function during peak exercise. Lower airway function can also affect performance capability. Radiographic and scintigraphic imaging modalities can be used to evaluate both global and regional lung function in cases of suspected pneumonia, EIPH, COPD, or emphysema. Reduced metabolic fitness can be a primary cause of poor performance due to inherent differences in capability, pathologic changes in the major body systems involved in exercise, or inadequate training. Metabolic stress testing can be used to evaluate the level of fitness in these cases. Orthopedic imaging has also become a valuable diagnostic technique for evaluating musculoskeletal injuries. Scintigraphic evaluation of soft tissue and bone and CT scanning are used to localize the source of lameness and to grade the severity of various orthopedic conditions such as arthritis and stress-induced bone disease that are often difficult to categorize with conventional radiography.