Page 1029 - Adams and Stashak's Lameness in Horses, 7th Edition

Occupational‐Related Lameness Conditions 995

The pain is chronic, and diagnosis is made using radiog­ sciatic nerve that will affect the horse’s ability to walk
raphy (evidence of overriding spinous processes, with and potentially stand). Nuclear scintigraphy using
VetBooks.ir tigraphy. The supraspinous ligament can also be affected somewhat insensitive. Ultrasound evaluation of the dor­
motion correction software can be diagnostic but is
areas of bony sclerosis and bony lysis) or nuclear scin­
sal sacroiliac ligament (transcutaneously) and of the sac­
and should be evaluated ultrasonographically.
Interpretation of radiographs, nuclear scintigraphy, roiliac joint itself (transrectally) can provide supportive
and ultrasound of the supraspinous ligament should be information.
performed with caution as many horses with no clinical Therapeutic trials using periarticular injections of
signs of back pain will have abnormalities. 12,18 Using corticosteroids are used most often to confirm the diag­
local anesthetics around suspected areas could be nosis. Such injections are carried out blindly or with
useful but should also be performed cautiously as it ultrasound assistance, using 8–10‐inch spinal needles. 7,11
will also increase the amplitude of movement of normal Treatment involves periods of rest for the most severe
horses. 20 cases (4–6 months) and periarticular injections using
Treatment of impinging spinous processes involves corticosteroids and potentially sarapin for the least
injections of corticosteroids and sarapin in and around affected ones.
the affected interspinous spaces, muscle relaxants,
NSAIDS, and bisphosphonates. Shockwave therapy is
efficacious in some cases. Ancillary therapies (acupunc­ SDFT and Inferior Check Ligament Injuries
ture, chiropractic work, etc.) and adaptation of the SDFT Injuries
training aimed at encouraging dorsiflexion will comple­ SDFT injures are most common in event horses,
ment the treatment. Refractory cases can be treated sur­
gically (interspinous ligament desmotomy or partial somewhat common in jumpers especially at higher levels
and rare in dressage horses. They almost exclusively
resection of the spinous processes. 22
affect the forelimbs. Presentations range from subclini­
cal progressive tendonitis and peritendonitis (most com­
intervertebral FaCet oa mon in eventers associated with cyclic repetitive loading
and damage) to acute severe tendonitis with large core
Intervertebral thoracolumbar facet OA is to be sus­
pected when horses have recurring back spasm and pain. lesions (eventers and high level jumpers) that are most
often related to one misstep on deeper footing and espe­
Diagnosis can be made using nuclear scintigraphy, radi­
ograph, or ultrasound. Facets are best evaluated on lat­ cially associated with the use of studs.
Diagnosis is easily made by palpation. Ultrasono­
eral oblique (horizontal 20° ventral–dorsal oblique)
15
views taken from left to right and from right to left. graphy further characterizes the injury and allows
follow‐up.
The use of local anesthesia and reevaluation helps con­
Treatment is aimed in the acute stage at minimizing
firm the diagnosis. Treatment consists of intra‐articu­ inflammation, using icing and NSAIDS to minimize
16
lar or periarticular injections of corticosteroids under
ultrasound guidance and/or bisphosphonates added to edema and further fiber disruption. In extremely painful
horses, placing the limb in a cast or a supportive boot
the basic treatment of the associated muscle spasm.
Physiotherapy to improve muscling is helpful for long‐ seems to increase the comfort level. Supportive bandage
and local anti‐inflammatory ointments such as DMSO
term management. Core strengthening exercises (such as
baited stretches), riding or lunging aides to engage the or diclofenac cream alternating with icing are helpful
for the first few days.
hind end (Pessoa lunging rig, Equi‐Band, and equiva­
After a few days, ultrasonographic examination is
lents), and functional electrical stimulation (FES) are repeated. Large core lesions are treated using transcuta­
used most routinely. FES has been really helpful to
31
lower the spasticity of the muscle, as well as the quality neous splitting. Treatment after that consists of rest and
controlled exercise for 3–12 months depending on the
of the muscling around the spine.
extent of the injury, using ultrasonography to monitor
progress and gradually increase the workload. The use of
Sacroiliac Pain intralesional injection is becoming routine for such
lesions using a source of stem cells (bone marrow, bone
Sacroiliac pain is relatively common, more so in
jumpers and eventers than in dressage horses. The dis­ marrow concentrate, fad derived mesenchymal cells, cul­
tured stem cells), a source of growth factors (platelet rich
ease is usually bilateral but one limb is often more
affected than the other. Severity varies widely but the plasma or bone marrow supernatant), a scaffold (porcine
bladder submucosa—Acell), or a combination thereof.
most severely affected horses stand parked out and
resent bearing weight on the most affected limb (com­ Such injections are believed to improve the quality and
speed of healing and decrease the rate of re‐injury. The
plaint is often that the farrier is having a hard time shoe­
ing the horse). Mild to moderate lameness is sometimes use of laser and therapeutic ultrasound is also popular.
present, and some of the horses tend to “bunny hop” at
the canter. Affected horses will often resist or show pain Inferior Check Ligament Desmitis
when the hindleg is picked up and raised enough to tilt This condition affects mostly jumpers and eventers in
the pelvis and are often sore to palpation/pressure over their mid‐teens and younger dressage horses, almost
the tuber sacrale region. exclusively on the forelimbs. Lameness presents acutely
Diagnosis can be reached using local analgesia around with swelling and heat at the site. Ultrasonography con­
the joint (this should be done with extreme caution and firms the diagnosis, and treatments involve mostly rest
never bilaterally, because of the risk of anesthetizing the and controlled exercise for 4–6 months.