Case Description—An 18-year-old Paint stallion (horse 1) and a 17-year-old Morgan gelding (horse 2) were evaluated because of an acute onset of severe unilateral forelimb lameness.
Clinical Findings—Both horses were unable to bear weight on the affected forelimb and had a dropped elbow appearance. Radial nerve paralysis, triceps myopathy, and fractures of the humerus and ulna were ruled out. The caudal aspect of the affected antebrachium of each horse was very firm to palpation and became firmer when weight was shifted onto the limb. Ultrasonographic examination revealed swelling and suspected intramuscular hemorrhage of the caudal antebrachial muscles. On the basis of clinical examination and diagnostic imaging findings, both horses had antebrachial compartment syndrome diagnosed. Lameness did not substantially improve with medical treatment in either horse.
Treatment and Outcome—Caudal antebrachial fasciotomy was performed in each horse. Following sedation and local anesthetic administration, a bistoury knife was inserted through small incisions to perform fasciotomy. Horses remained standing throughout the procedure and were immediately able to bear weight on the affected limb without signs of discomfort. Horse 1 developed colitis and horse 2 developed a mild incisional infection, but both fully recovered and returned to their previous activities.
Clinical Relevance—Antebrachial compartment syndrome is a rare cause of severe unilateral forelimb lameness and should be considered as a differential diagnosis in horses with a dropped elbow appearance. Both horses of this report had a successful outcome following antebrachial fasciotomy.
Objective—To determine the effect of limb positioning on the radiographic appearance of the distal and proximal interphalangeal joint spaces of the forelimbs of horses during evaluation of dorsopalmar radiographs.
Animals—14 forelimbs from 9 adult horses.
Procedures—Each horse was in standing position with its forelimbs positioned on blocks. Dorsopalmar radiographs of each foot were obtained with the forelimbs positioned squarely (the metacarpus of both forelimbs was perpendicular to the ground as determined by visual examination [abducted 0°]; baseline) and abducted 5° and 10°. The width of the space at the medial and lateral aspects of the distal and proximal interphalangeal joints (medial and lateral joint space width, respectively) was measured. Mediolateral joint balance was calculated as the difference between the widths of the lateral and medial joint spaces, and joint space width and mediolateral joint balance were compared among all 3 positions.
Results—As the extent of limb abduction increased, the medial aspect of the proximal and distal interphalangeal joints became narrower, compared with the corresponding lateral aspect of those joints. For both the distal and proximal interphalangeal joints, the mediolateral joint balance differed significantly among all limb positions.
Conclusions and Clinical Relevance—Forelimb position significantly affected the mediolateral joint balance of the interphalangeal joints of horses. Thus, it is crucial that the forelimbs of horses be squarely positioned when dorsopalmar radiographs are obtained for accurate evaluation of interphalangeal joint space and balance.
A 6-year-old Quarter Horse gelding used for barrel racing was evaluated for acute onset of non–weight-bearing lameness of the left hind limb following strenuous exercise.
Nuclear scintigraphic imaging revealed focal increased radiopharmaceutical uptake centrally within the left talus. Subsequent standard radiographic and ultrasonographic examinations of the tarsus failed to identify the cause of the increased radiopharmaceutical uptake; however, the lameness was definitively localized to the tarsocrural joint by intra-articular anesthesia. Subsequent MRI sequences of the left tarsus revealed an incomplete fracture of the talus that extended distally from the trochlear groove and evidence of maladaptive stress remodeling of the trochlear groove of the talus and distal intermediate ridge of the tibia.
TREATMENT AND OUTCOME
The horse was treated conservatively, with management consisting of stall confinement, physical rehabilitation, therapeutic laser therapy, and intra-articular autologous conditioned serum administration. The lameness resolved, and the horse was competing at its previous level within 15 months after lameness onset.
Although rare, incomplete fracture of the talus should be considered as a differential diagnosis for horses that develop acute hind limb lameness following strenuous exercise, especially when that exercise involves abrupt changes in direction while the horse is traveling at maximal speed. Acquisition of additional oblique projections during radiographic evaluation of the tarsus might be useful for identification of such fractures, but definitive diagnosis may require advanced diagnostic imaging modalities such as CT and MRI. Horses with incomplete fractures of the talus can be successfully treated with conservative management.
OBJECTIVE To investigate potential associations between repository radiographic findings and subsequent performance of Quarter Horses competing in cutting events.
DESIGN Retrospective cohort study.
SAMPLE Repository radiographs (ie, radiographs obtained at the time of sale) for 343 client-owned horses.
PROCEDURES Repository radiographic findings were compared with objective measures of performance, including the likelihood of competing; the likelihood of earning money as a 3-year-old, as a 4-year-old, and as a 3- and 4-year-old combined; and the amount of money earned as a 3-year-old, as a 4-year-old, and as a 3- and 4-year-old combined.
RESULTS The presence of mild osteophytes involving the distal aspect of the tarsal joint was significantly associated with lower mean earnings as a 4-year-old. The presence of osteophytes on the dorsoproximal aspect of the middle phalanx of the hind limbs was significantly associated with an increased odds of earning money as a 4-year-old. Radiographic lesions of the medial femoral condyle of the stifle joint were not significantly associated with subsequent performance.
CONCLUSIONS AND CLINICAL RELEVANCE Most abnormalities identified on repository radiographs were not significantly associated with subsequent performance. The significant association between mild tarsal osteophytosis and earnings was unexpected. Results of the present study indicated the need for further investigation of the relationship between radiographic findings and performance outcome in Western performance horses.
CASE DESCRIPTION A 12-year-old mixed-breed mare (horse 1) and 6-year-old Friesian gelding (horse 2) were examined for chronic lameness associated with the stifle joint.
CLINICAL FINDINGS Lameness examination revealed effusion of the right (horse 1) or left (horse 2) femoropatellar and medial femorotibial joints and grade 3/5 (horse 1) or 4/5 (horse 2) lameness. A diagnosis of cranial cruciate ligament (CCL) injury with associated mineralization and avulsion (horse 1) or mineralization alone (horse 2) was facilitated in both horses with a caudomedial-craniolateral oblique radiographic view obtained 45° medial to the caudocranial line, which highlighted the origin of the ligament on the caudoaxial aspect of the lateral femoral condyle within the intercondylar fossa. These lesions were subsequently confirmed via CT.
TREATMENT AND OUTCOME Arthroscopy of the medial and lateral femorotibial joints was performed for horse 1 and revealed the osseous fragment associated with the CCL, but the fragment could not be removed. Horse 2 was euthanized while anesthetized following CT owing to the poor prognosis.
CONCLUSIONS AND CLINICAL RELEVANCE Radiography is typically the first imaging modality attempted for horses with CCL injury, particularly outside the hospital setting. A 45° caudomedial-craniolateral oblique radiographic view may aid in diagnosis of CCL injury when avulsion or mineralization is present. Although this view is not commonly included in the typical radiographic series for imaging of the stifle joint in horses, it should be considered when CCL injury is suspected.