CASE DESCRIPTION Over a 2-year period, 6 horses (4 Selle Français, 1 Hanoverian, and 1 Thoroughbred) were referred for evaluation of forelimb lameness. All horses had radiographic evidence of synostosis of the first and second ribs (SFSR).
CLINICAL FINDINGS For 1 horse, the SFSR was considered the probable cause of the lameness (grade 3/5), with a shortening of the cranial phase of the stride in the affected limb. For 3 horses, it was considered a possible cause of the lameness (grade 1/5) for the same reason. For 2 horses, SFSR was considered an incidental finding unassociated with any clinical signs. The 4 horses with lameness suspected as attributable to SFSR had a moderate to severe amount of irregularly marginated new bone formation at the site of the SFSR, with a cranial displacement of the first rib, compared with findings for the 2 horses in which the SFSR was considered incidental. A likely congenital abnormality of the first rib was first suspected on nuclear scintigraphy in the 1 horse for which it was performed or on radiography of the caudal cervical portion of the vertebral column (3 horses) or shoulder joint (2 horses).
TREATMENT AND OUTCOME The horse in which SFSR was considered the probable cause of the lameness was retired to the field and remained chronically lame. Two of the 3 horses in which SFSR was considered a possible cause of lameness received an IV infusion of tiludronate disodium and mesotherapy over the caudal cervical and cranial thoracic regions; both returned to competition but with poor results. One of the 2 horses with subclinical SFSR never developed lameness on the affected side. No follow-up information was available for the other 2 horses.
CLINICAL RELEVANCE SFSR can be an incidental finding in horses, with or without clinical manifestations. This abnormality should be considered as a differential diagnosis for horses with forelimb lameness and associated shortening of the cranial phase of the stride that fails to improve with diagnostic analgesic techniques.
Objective—To characterize the clinical features, diagnostic procedures, treatment, and outcome for horses with an exostosis on the palmar or plantar cortex of the third metacarpal bone (MC3) or third metatarsal bone (MT3).
Design—Retrospective case series.
Procedures—Records from 2001 through 2010 were evaluated to identify horses with radiographic and ultrasonographic evidence of an exostosis on an MC3 or MT3. Signalment, history, lameness examination results, diagnostic imaging results, surgical and histopathologic findings, treatment, and outcome were evaluated.
Results—9 horses (group A) had unilateral lameness of the exostosis-affected limb that was alleviated with local or perineural analgesia. Seven horses (group B) had inconsistent lameness of the affected limb. The exostosis was located between the middle and distal third of the MC3 or MT3 in all horses. Desmopathy or peritendinous fibrosis (or both) of the suspensory ligament at the exostosis site was identified in 6 horses. All horses in group A returned to full function after conservative or surgical management. Lameness did not recur in any of the horses in group B despite no treatment or only conservative management.
Conclusions and Clinical Relevance—Exostosis of the palmar cortex of an MC3 or plantar cortex of an MT3 should be considered as a cause of lameness in horses. The diagnosis can be made by the use of radiography and ultrasonography combined with specific diagnostic analgesia. Prognosis for return to athletic activity can be good but should be modified contingent on concurrent desmopathy of the suspensory ligament.
OBJECTIVE To describe the clinical features, diagnostic procedures, management, and outcome of horses with peripheral neuropathy of a forelimb.
DESIGN Retrospective case series.
ANIMALS 27 horses.
PROCEDURES Records from 2000 to 2013 were reviewed to identify horses with peripheral neuropathy of a forelimb. Horses were grouped as having predominant lesions of a suprascapular nerve, axillary nerve, or radial nerve (alone or in association with other brachial plexus nerves) on the basis of physical examination and diagnostic imaging findings. Treatments were primarily conservative. Signalment, history, lameness characteristics, diagnostic imaging features, case management, and outcomes were evaluated.
RESULTS Predominant lesions of a suprascapular nerve, axillary nerve, and radial nerve were identified in 11, 2, and 14 horses, respectively. Eight horses with predominant suprascapular nerve injury and 9 with injury to a radial nerve alone or in association with other nerves returned to their previous activity level or intended use after mean recovery periods of 9.3 and 13.3 months, respectively; 2 horses with a predominant axillary nerve injury had this outcome after a mean 3.5-month recovery period. Ultrasonography was useful for evaluation of muscle atrophy and other injuries during the initial examination (in 27 horses) and the rehabilitation period (in 7 horses).
CONCLUSIONS AND CLINICAL RELEVANCE Most horses with peripheral neuropathy of a forelimb returned to athletic soundness following an adequate period of rest. Horses with lesions of a radial nerve alone or in association with other nerves typically required longer recovery times than did those with predominant injuries of a suprascapular nerve.
Objective—To evaluate the efficacy of tiludronate for the treatment of horses with signs of pain associated with lesions of the thoracolumbar vertebral column.
Animals—29 horses with clinical manifestations of pain associated with lesions of the thoracolumbar vertebral column and abnormal radiographic findings indicative of osteoarthritis of the articular processes–synovial intervertebral joints.
Procedures—Horses were initially examined in accordance with a standardized protocol, which included radiographic, ultrasonographic, and scintigraphic examinations. Fifteen horses were randomly assigned to receive tiludronate (1 mg/kg, IV, as a slow-rate infusion), and 14 horses received a control substance (day 0). Horses were monitored for the subsequent 120 days. Clinical evaluations were performed on days 60 and 120. Horses that had no evidence of clinical improvement on day 60 were administered tiludronate. Statistical analyses were performed to compare efficacy at day 60, improvement of dorsal flexibility at day 120, and dorsal flexibility before and 60 days after administration of tiludronate.
Results—Horses treated with tiludronate had significant improvement in dorsal flexibility between days 0 and 60, compared with control horses. Clinical improvement in dorsal flexibility was still evident at day 120. The percentage of positive responses was higher in the tiludronate group at 60 days.
Conclusions and Clinical Relevance—Tiludronate had efficacy in the treatment of horses with signs of pain induced by osteoarticular lesions of the thoracolumbar vertebral column, causing a significant improvement in dorsal flexibility. Tiludronate may offer a treatment option for the management of horses with intervertebral lesions and the associated pain.
OBJECTIVE To report history, findings from clinical examinations and diagnostic imaging, treatment, and outcomes associated with distal interphalangeal primary degenerative joint disease (DIP-PDJD) and to evaluate diagnostic usefulness and limitations of standing low-field MRI, relative to radiography and ultrasonography, for the diagnosis of DIP-PDJD in horses.
DESIGN Retrospective case series with nested evaluation study.
ANIMALS 12 client-owned horses.
PROCEDURES Medical records were reviewed, and data were collected regarding signalment, history, results of physical and diagnostic imaging examinations, treatments, and outcomes of horses that underwent radiography, ultrasonography, and standing MRI for DIP-PDJD. Findings from radiography, ultrasonography, and MRI were recorded, and abnormal findings were graded. The diagnostic usefulness of MRI, relative to radiography and ultrasonography, in the diagnosis of DIP-PDJD in horses was evaluated.
RESULTS A diagnosis of DIP-PDJD was established in 12 of 176 (6.8%) horses that underwent MRI examination of a foot for locomotor disorders. Radiography and ultrasonography enabled confirmation of DIP-PDJD in 3 of the 12 horses, and standing MRI enabled confirmation of DIP-PDJD in the remaining 9. Mean grade for thinning joint space and cartilage were significantly greater when determined with MRI, compared with radiography. Mean grade for osteophytes and periarticular bone remodeling were significantly greater when determined with radiography and ultrasonography, compared with MRI.
CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that DIP-PDJD can be challenging to detect with routine imaging, especially when synovial effusion and periarticular new bone formation are absent. Standing low-field MRI represents a potentially useful diagnostic tool to diagnose advanced DIP-PDJD in horses.
Objective—To determine history; clinical, radiographic, ultrasonographic, and scintigraphic features; management; and outcome associated with third trochanter fractures in horses.
Design—Retrospective case series.
Procedures—Records from 2000 to 2012 were reviewed, and signalment, case history, severity and duration of lameness, results of physical and lameness examinations, imaging findings, management, and outcome were evaluated.
Results—All horses had a history of acute onset of severe lameness. Four of the 8 horses had localizing physical signs of fracture. No specific gait characteristics were identified. Ultrasonographically, there was a single bony fragment displaced cranially in 7 of 8 horses and multiple bony fragments in 1. Concurrent gluteus superficialis muscle enthesopathy was identified in 7 horses. A standing craniolateral-caudomedial 25° oblique radiographic view was obtained in 3 horses to document the lesion and revealed in all 3 horses a simple complete longitudinal fracture between the midlevel and the base of the third trochanter. Nuclear scintigraphy was used to identify the affected area of the limb for further examination in 2 horses. Follow-up revealed that fractures healed with a fibrous union, with persistence of cranial displacement of the fragment. Lameness resolved after nonsurgical management for all horses.
Conclusions and Clinical Relevance—Fracture of the third trochanter should be considered as a cause of hind limb lameness in horses when the proximal portion of the limb is affected. Diagnosis can easily be made with ultrasonography, but nuclear scintigraphy may help in identifying the lesion. Prognosis for return to athletic activity is good after an appropriate period of rest and restricted exercise.