Page 347 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

322 CHAPTER 1

VetBooks.ir it should be noted that ultrasonography is much tenotomy may be envisaged in the rare cases that do
not respond to conservative treatment.
more operator dependent than MRI, providing an
adequate protocol is used. MRI is particularly useful
to detect or confirm osseous pathology at the origin Hindlimb proximal suspensory desmopathy
of the SL and has the advantage over ultrasound that Conservative treatment may be applied as described
the axial borders of the splint bones are clearly delin- above. Even with prolonged rest, however, lameness
eated. It is also sensitive to look for adhesions, char- persists in 80% of cases. Compartment syndrome
acterised by loss of the normal hyperintense border. and nerve damage have been suspected to explain
There is marked variation in the MRI appearance of this lack of spontaneous improvement. The chances
the SL and comparison with the contralateral limb of a successful outcome are also markedly influenced
may be warranted. Finally, MRI is less sensitive in by the severity of the lesion, with better results to
differentiating between chronic lesions and healed be expected with localised ligamentous lesions and
desmitis. Interpretation must therefore be carefully osseous lesions decreasing the chances of full recov-
weighed against the clinical appraisal and a multi- ery. Radial shock-wave therapy has been shown to
modality approach (i.e. MRI and ultrasonography) is improve the clinical signs (lameness) in a significant
probably most efficient. proportion of animals, with 41% of cases returning
to work after 6 months in one study. The ultrasono-
Management graphic appearance of the lesion remained unaltered.
Forelimb proximal suspensory ligament Its mode of action is thought to be analgesia through
desmopathy destruction of nerve endings. Extracorporeal shock-
Conservative treatment is undertaken as for SDF wave therapy probably helps in the early stages by
tendinopathy. It is based on initial box rest with in- providing analgesia.
hand walking for 5–10 minutes 2–4 times daily for Other forms of physiotherapy have generally not
4 weeks, then gradually increasing to 20 minutes been effective in this condition. Many cases have
in-hand walking or in a mechanical walker over a very poor foot conformation and will benefit from
4–8 week period. Local hydro- or cryotherapy may corrective foot trimming and shoeing.
be used in combination. Pressure bandages may be Periligamentous injection using corticosteroids
useful in the early stages. Foot balance should be has been used extensively and may decrease swell-
addressed, and some relief may be obtained with the ing and compartment syndrome in the early stages;
use of shoes set long and wide at the heels or bar however, it may also be detrimental as decreased
shoes. Follow-up ultrasonography should be per- cell metabolism and acute injury are rarely encoun-
formed at 8 weeks. Some acute injuries in the fore- tered. Polysulphated glycosaminoglycans and hyal-
limbs will allow a gradual return to work between 3 uronic acid treatments have lead to disappointing
and 6 months post injury. Full work should not be results.
resumed before complete resolution of the lesion Intralesional biological treatments are popular
on ultrasonography. In chronic cases the lesion may but as yet there are very few published reports to
persist; if this is the case, return to work is based on support their efficacy. Autologous MSCs isolated
the absence of evolution of the lesion on ultrasonog- from bone marrow or adipose tissue, heterolo-
raphy for a period of 3 months. Surgical options or gous stem cells obtained from equine fetal tissue
intraligamentous injections of corticosteroids, hyal- or adult tendon, PRP and porcine urinary bladder
uronate or glycosaminoglycans have not been shown matrix (UBM) powder (A-Cell ) are being used but
®
to improve the outcome, which is considered good to there is mostly circumstantial evidence of mark-
excellent with up to 90% of the horses returning to edly improved success rates compared with other
their previous level of exercise. Bone marrow injec- treatments.
tions, MSCs and microdrilling (‘osteostixis’) have Surgically based treatments include fasciotomy to
all been advocated but are rarely indicated in the relieve the compartment syndrome, specific neurec-
forelimb. Microdrilling combined with longitudinal tomy of the deep branch of the lateral plantar nerve