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- Author or Editor: Mary Beth Whitcomb x
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Abstract
Objective—To characterize ruptures of collateral ligaments (CLs) in metacarpophalangeal and metatarsophalangeal joints in horses.
Design—Retrospective case series.
Animals—17 horses with ruptured CLs.
Procedures—Data were obtained from medical records, including signalment, history, clinical signs, ultrasonographic and radiographic findings, treatment, and outcome. Additional follow-up information was obtained from owners or referring veterinarians.
Results—The lateral CL was ruptured in 11 horses; the medial CL was ruptured in 6 horses. Ultrasonography revealed ipsilateral rupture of the short and long components of the CL in 11 horses and rupture of only 1 component in 6 horses. No biaxial ruptures were detected, but 9 horses had desmitis of the CL on the nonruptured side of the affected joint. All horses were lame (lameness score range, 2/5 to 4/5). Joint instability was palpable in 9 horses; only 4 horses had episodes of joint luxation. Avulsion fractures were identified radiographically in 6 horses and ultrasonographically in another 2 horses. Stress radiography revealed joint instability in 10 horses. Horses were managed by stall confinement, limb immobilization, and gradual return to exercise. Eight horses returned to riding, 2 resumed breeding, 2 were retired, 2 were euthanized, and 3 were doing well 86 to 139 days after injury.
Conclusions and Clinical Relevance—Ultrasonographic examination is indicated in horses with acute lameness and swelling at the metacarpophalangeal or metatarsophalangeal joint, particularly when stress radiography cannot be performed or findings are equivocal. Affected horses can be conservatively managed. Prognosis for athletic use may be better than originally believed.
Abstract
OBJECTIVE
Femoral fractures are often catastrophic in large animals. Radiographic diagnosis is limited by patient size and feasibility, especially in ambulatory settings. Ultrasonography is widely available and may provide an alternative to radiography for definitive diagnosis.
ANIMALS
12 large animals (6 horses, 5 cattle, and 1 elephant).
PROCEDURES
Retrospective analysis of large animal patients diagnosed with femoral fracture by use of femoropelvic ultrasonography (2000 to 2019).
RESULTS
5 of 12 cases were ≤ 1 year of age. The remaining 7 cases were 2 to 33 years of age (median, 13 years). All patients developed severe acute lameness after falling (n = 4), limb entrapment (2), dystocia (1), vehicular collision (1), ipsilateral full limb casting (1), or unknown events (3). All were non–weight-bearing or lame at the walk, including 2 recumbent cattle. Ten cases showed upper limb swelling that was variable in location, and 3 had nonspecific upper limb crepitus. Ultrasonography revealed evidence of diaphyseal (n = 6), greater trochanteric (2), capital physeal (2), and distal femoral (2) fractures. Fracture movement during limb manipulation or weight shifting was sonographically visualized in 5 animals. Radiography confirmed fractures in 3 of 8 animals: 2 bovines with distal femoral fractures detected on standing projections and 1 capital physeal fracture that required ventrodorsal projections under general anesthesia. All animals were euthanized (11) or slaughtered (1 bovine). Postmortem examination confirmed ultrasonographic findings in 10 of 10 necropsied animals.
CLINICAL RELEVANCE
Femoral fractures were not localized nor confirmed in any case prior to ultrasonography. Study findings supported the use of ultrasonography for rapid patient-side diagnosis, prognostication, and decision-making in suspect cases.
Abstract
Objective—To evaluate use of a diode laser to induce tendinopathy in the superficial digital flexor tendon (SDFT) of horses.
Animals—4 equine cadavers and 5 adult horses.
Procedures—Cadaveric SDFT samples were exposed to a diode laser at various energy settings to determine an appropriate energy for use in in vivo experiments; lesion size was assessed histologically. In vivo experiments involved laser energy induction of lesions in the SDFT (2 preliminary horses [0, 25, 75, and 87.5 J] and 3 study horses [0 and 125 J]) and assessment of lesions. Study duration was 21 days, and lesions were assessed clinically and via ultrasonography, MRI, and histologic evaluation.
Results—Lesion induction in cadaveric tissues resulted in a spherical cavitated core with surrounding tissue coagulation. Lesion size had a linear relationship (R 2 = 0.9) with the energy administered. Size of in vivo lesions in preliminary horses indicated that larger lesions were required. In study horses, lesions induced with 125 J were ultrasonographically and histologically larger than were control lesions. At proximal and distal locations, pooled (preliminary and study horses) ultrasonographically assessed lesions were discrete and variable in size (mean ± SEM lesion percentage for control lesions, 8.5 ± 3%; for laser lesions, 12.2 ± 1.7%). Ultrasonography and MRI measurements were associated (R 2 > 0.84) with cross-sectional area measurements.
Conclusions and Clinical Relevance—In vivo diode laser–induced lesions did not reflect cadaveric lesions in repeatable size. Further research is required before diode lasers can reliably be used for inducing tendinopathy.
Abstract
Objective—To define scintigraphic, physical examination, and scapular ultrasonographic findings consistent with bone fragility syndrome (BFS) in horses; develop indices of BFS severity; and assess accuracy of physical examination, scapular ultrasonography, and serum biomarkers for BFS diagnosis.
Design—Prospective case-control study.
Animals—48 horses (20 horses with BFS and 28 control horses).
Procedures—Horses underwent forelimb scintigraphic evaluation, physical examination, scapular ultrasonography, and serum collection. Scintigraphy was used as a reference standard to which physical examination, scapular ultrasonography, and concentrations of serum biomarkers (carboxy-terminal telopeptide of collagen crosslinks and bone-specific alkaline phosphatase activity) were compared for assessing accuracy in BFS diagnosis.
Results—A diagnosis of BFS was strongly supported on scintigraphy by ≥ 2 regions of increased radiopharmaceutical uptake, including 1 region in the scapular spine and 1 region in the scapular body or ribs; on physical examination by lateral bowing of the scapulae; and on ultrasonography by widening of the scapular spine. None of the tests evaluated were accurate enough to replace scintigraphy for mild disease; however, physical examination and scapular ultrasonography were accurate in horses with moderate to severe BFS. Serum biomarkers were not accurate for BFS diagnosis.
Conclusions and Clinical Relevance—Scintigraphy remained the most informative diagnostic modality for BFS, providing insight into disease severity and distribution; however, physical examination and scapular ultrasonographic abnormalities were diagnostic in horses with moderate to severe disease. Proposed severity indices classified the spectrum of disease manifestations. Clearly defined criteria for interpretation of diagnostic tests aid in the detection of BFS. Severity indices may be useful for assessing disease progression and response to treatment.
Abstract
Objective—To estimate likelihood ratios (LRs) of correctly identifying internal Corynebacterium pseudotuberculosis infection in horses by measurement of antibody titers via serum synergistic hemolysis inhibition (SHI) testing.
Design—Retrospective case-control study.
Animals—170 horses (171 records; 92 cases of C pseudotuberculosis infection and 79 controls).
Procedures—Medical records were reviewed, and horses were grouped on the basis of evidence of internal or external C pseudotuberculosis infection. The LRs and 95% confidence intervals for identification of internal C pseudotuberculosis infection by use of SHI test results were estimated.
Results—LRs for C pseudotuberculosis infection increased as antibody titers increased when all horses were included in analyses; LRs for detecting internal infection were significantly > 1 (null value) for reciprocal antibody titers ≥ 1,280 overall and > 160 when horses with external abscesses were excluded. Likelihood ratios for detecting internal infection did not differ from 1 (indicating no change in pretest-to-posttest odds of internal infection) when only horses with external C pseudotuberculosis infection (horses with external and internal abscesses vs those with external abscesses only) were included. The LR for detecting internal infection was 2.98 (95% confidence interval, 2.19 to 4.05) for horses with titers ≥ 512.
Conclusions and Clinical Relevance—In the study population, higher titers were typically more indicative of active external or internal C pseudotuberculosis infection than of internal disease specifically. The SHI test was not a useful predictor of internal C pseudotuberculosis infection in horses with external abscesses but was useful in the absence of external disease.
Abstract
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.
Abstract
Objective—To evaluate effects of toe grabs, exercise intensity, and distance traveled as risk factors for subclinical to mild suspensory apparatus injury (SMSAI) in Thoroughbred racehorses and to compare incidence of severe musculoskeletal injury (MSI) in horses with and without SMSAI.
Design—Nested case-control study.
Animals—219 Thoroughbred racehorses racing or in race training.
Procedure—Racehorses were examined weekly for 90 days to determine incidence of suspensory ligament injury and monitor horseshoe characteristics. Every horse's exercise speeds and distances were recorded daily. Conditional logistic regression was used to compare exposure variables between incident case (n = 25) and selected control (125) horses. Survival analysis was used to compare time to MSI for horses with (n = 41) and without (76) SMSAI.
Results—The best-fitting logistic model for the data included age (< 5 vs ≥ 5 years old), toe grab height the week of injury (none vs very low, low, regular, or Quarter Horse height), and weekly distance the week preceding injury (miles). Although the 95% confidence intervals for all odds ratios included 1, the odds for SMSAI appeared to increase with the presence of a toe grab, higher weekly distance, and age ≥ 5 years. Horses that had SMSAI were significantly more likely to have a severe MSI or severe suspensory apparatus injury than were horses that did not.
Conclusions and Clinical Relevance—Results suggest that pre-existing SMSAI is associated with development of severe MSI and severe suspensory apparatus injury. Modifying training intensity and toe grab height for horses with SMSAI may decrease the incidence of severe MSI. (J Am Vet Med Assoc 2001; 218:1136–1144)
Abstract
Objective—To determine clinical signs, results of diagnostic testing, and outcome in horses with internal Corynebacterium pseudotuberculosis infection.
Design—Retrospective study.
Animals—30 horses.
Procedure—Information pertaining to clinical data, results of diagnostic tests, and costs of hospitalization and treatment was extracted from medical records of affected horses.
Results—Internal C pseudotuberculosis infection was diagnosed on the basis of clinical signs, diagnostic imaging, and clinicopathologic data, including results of serologic tests and bacterial culture. The most common clinical signs were concurrent external abscesses, anorexia, fever, lethargy, weight loss, and signs of respiratory tract disease or abdominal pain. Clinicopathologic abnormalities included a geometric mean reciprocal serum synergistic hemolysin inhibition titer ≥ 512, leukocytosis with neutrophilia, hyperglobulinemia, hyperfibrinogenemia, and anemia. Specific organ involvement was diagnosed in 27 of 30 horses. Affected organs included the liver (18 horses), lungs (12), kidneys (7), and spleen (3); multiple organs were affected in 10 horses. Treatment with antimicrobials for a median of 36 days (range, 7 to 97 days) was usually successful, yielding an overall survival rate of 71%.
Conclusions and Clinical Relevance—Early diagnosis and long-term antimicrobial treatment were important for a successful outcome in horses with internal C pseudotuberculosis infection. Ultrasonographic imaging was an important technique for identifying specific organs affected, aiding in obtaining samples for a definitive diagnosis, and monitoring response to treatment. Pregnant mares with internal infections are at risk for fetal loss. Preexisting chronic organ disease may be associated with a poor prognosis. (J Am Vet Med Assoc 2005;227:441–448)
Abstract
OBJECTIVE To describe clinical features and outcome of horses with severe large intestinal thickening diagnosed with transabdominal ultrasonography.
DESIGN: Retrospective case series.
ANIMALS 25 horses.
PROCEDURES Medical records of horses that underwent transabdominal ultrasonography between 2003 and 2010 were reviewed. Horses were included if the wall of the large intestine was ≥ 9 mm thick in any of 6 abdominal zones.
RESULTS Median age was 13 years (range, 3 to 28 years). Horses were initially examined because of colic, diarrhea, inappetence, weight loss, lethargy, fever, or hematuria. Severe large intestinal thickening (range, 9 to 46.6 mm; mean ± SD, 18.8 ± 6.8 mm) was the primary ultrasonographic finding in all horses. Thickened large intestine was more likely to be detected in ventral versus upper (ie, combined paralumbar and intercostal) abdominal zones and in right versus left zones. Eleven horses survived and had resolution of clinical signs, including the l horse treated surgically for colon torsion. An additional horse survived but continued to have intermittent colic. Ten horses were euthanized or died, including 3 horses with neoplasia and 3 with colitis. Three horses were lost to follow-up, including 1 horse with a cecal mass and 1 with hepatosplenic lymphoma. Severity of thickening and number of zones affected were not significantly different between survivors and nonsurvivors.
CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that in horses undergoing transabdominal ultrasonography, large intestinal wall thickness ≥ 9 mm may be detected in patients with a variety of conditions. Ultrasonographic examination of all abdominal zones was helpful to determine the extent of thickening and identify additional findings that helped prioritize differential diagnoses.
