Page 1030 - Adams and Stashak's Lameness in Horses, 7th Edition

996 Chapter 9

Intralesional injections of the inferior check ligament thickening (injection of 0.5 mL of 2% iodine in almond
have not been rewarding in the authors’ experience. oils at three levels in each ligament) and an injection
VetBooks.ir SDFT that can be identified during a dynamic ultra­ be treated by ligament splitting, and medial patellar
(1 mL) in the gluteal muscles. More tenacious cases can
Some cases get complicated with adhesions to the
41
sound examination (holding the leg and ultrasounding
desmotomy is reserved for the most severe ones as it has
the area as fetlock flexion and extension are induced). been associated with complications such as patellar
Management of such complications involves surgical fragmentation. 25
separation and 3–4 repeated injections of corticoster­
oids in between the SDFT and the check ligament 2
weeks apart. Synovitis and OA
Synovitis and OA can affect either one or a combina­
Metacarpophalangeal and Metatarsophalangeal (MCP/ tion of the three synovial compartments within the stifle.
Ideally each one should be blocked during lameness
MTP) Joint Injuries examination separately. Radiographs and ultrasonogra­
Synovitis and OA of the fetlock joints are fairly com­ phy especially to evaluate the menisci are necessary.
mon in older jumpers and eventers. Lameness is local­ Osteophytes at the level of the medial tibial condyle are
ized by a positive intra‐articular analgesia or a low relatively common. If no soft tissue injuries are identified,
4‐ or 6‐point nerve block. Fragmentation of the proxi­ intra‐articular injections using a combination of corticos­
modorsal aspect of the first phalanx is not uncommon teroids and hyaluronan or glycosaminoglycan are war­
and is better treated surgically, removing the fragment ranted in each of the affected compartments. Alternatively
arthroscopically. Synovitis, with no evidence of radio­ IRAP could be used. If the injections do not provide
graphically/ultrasonographically visible pathology, usu­ soundness or if they do only for a short period, diagnostic
ally responds well to intra‐articular injections of exploratory arthroscopy is warranted.
corticosteroids and hyaluronan or glycosaminoglycan. Meniscal injuries are diagnosed after identification of
Alternatively series of IRAP injections could be used. If one of the femorotibial joints as source of lameness, using
the response to intra‐articular therapy is incomplete or ultrasonography or during exploratory arthroscopy.
transient, advanced imaging (such as MRI) or explora­ Debridement of meniscal tears is warranted unless
tory arthroscopy is warranted. Severe bone bruising vis­ they are amenable to be sutured, and a period of 3–4
ible on MRI STIR sequences should be addressed and months of rest should ensue. 45
probably treated using bisphosphonates and rest to
help prevent the development of subchondral bone Patellar Fractures
cystic lesions.
Patellar fractures are mostly seen in event horses and
some jumpers. They are associated with moderate to
Stifle Injuries severe lameness and effusion of the femoropatellar joint.
Osteochondrosis and Subchondral Bone Cysts Skyline radiographic view of the patella is necessary to
fully evaluate the fracture. Most of the fractures are
Osteochondrosis of the trochlea ridges of the femur amenable to arthroscopic debridement, and the majority
and of the patella along with subchondral cystic lesions return to full work.
of the medial condyle of the femur is relatively frequent
developmental disorders in Warmbloods. Therefore,
radiographic surveys of yearlings during prepurchase ACKNOWLEDGMENT
examination are highly recommended.
Osteochondrosis lesions are treated surgically with The authors thank Dr. Jack R. Snyder for his contri­
debridement using arthroscopy, and prognosis is rela­ butions to this chapter in the previous edition.
tively good if the lesions are not too sizable.
Subchondral bone cysts are treated with either surgi­
cal debridement or injections of corticosteroids under References
the lining of the cyst, but prognosis is not as good for
44
40
a long career especially if the horse is older. Preoperative 1. Barrey E, Desliens F, Poirel D, et al. Early evaluation of dressage
ability in different breeds. Equine Vet J Suppl 2002;34:319–324.
treatment with a bisphosphonate reduces in the authors’ 2. Bathe A. Surgical Treatment for Tendonitis and Suspensory.
experience the risk of postoperative enlargement of the WEVA, Moscow, 2008.
cyst when debridement is elected. 3. Bertone AL, Ishihara A, Zekas LJ, et al. Evaluation of a single
intra‐articular injection of autologous protein solution for treat­
ment of osteoarthritis in horses. Am J Vet Res 2014;75:141–151.
Intermittent Upward Fixation of the Patella 4. Bohanon TC, Schneider RK, Weisbrode SE. Fusion of the distal
intertarsal and tarsometatarsal joints in the horse using intraar­
This condition affects especially larger young horses ticular sodium monoiodoacetate. Equine Vet J 1991;23:289–295.
and horses after a period of rest. The diagnosis is easy in 5. Butcher MT, Hermanson JW, Ducharme NG, et al. Superficial
digital flexor tendon lesions in racehorses as a sequela to muscle
the most severe cases and necessitates a finer observation fatigue: a preliminary study. Equine Vet J 2007;39:540–545.
in the milder ones who only “catch their patella.” The best 6. Castro FA, Schumacher JS, Pauwels F, et al. A new approach for
way to observe mild cases is during a transition from can­ perineural injection of the lateral palmar nerve in the horse. Vet
Surg 2005;34:539–542.
ter to trot or when they are being asked to back up. 7. Cousty M, Rossier Y, David F. Ultrasound‐guided periarticular
Milder cases respond well to blistering of the medial injections of the sacroiliac region in horses: a cadaveric study.
and middle patellar ligament to induce scarring and Equine Vet J 2008;40:160–166.