Page 666 - Adams and Stashak's Lameness in Horses, 7th Edition

632 Chapter 5

lameness. The size of the SCL or its location does not disturb the neurovascular plexus, a known complication
36
appear to influence the degree of lameness. Intrasynovial of this approach, and the humeroradial joint identified
VetBooks.ir is then identified radiographically; extra‐articular oste-
with needle placement. The relative location of the cyst
anesthesia eliminates the lameness in most cases.
8,36
ostixis and/or arthroscopically guided intralesional or
Diagnosis
extra‐articular steroid injection can be performed.
Radiographs are required to make the diagnosis. In
one study, 4 of 7 of the SCLs were located in the proxi- Prognosis
mal medial radius, and 3 of 7 were located in the distal
36
medial condyle of the humerus. In another study, SCLs The prognosis appears to be good for conservative
were located primarily in the proximal medial radius (5 treatment of SCLs as long as there is no radiographic
of 6), and 1 of 6 was located in the distal medial condyle evidence of osteoarthritis. Supporting the conservative
of the humerus. 8 approach for the treatment of SCLs is one report in
which 6 of 7 horses treated with rest and the administra-
tion of anti‐inflammatory agents returned to their
Treatment
intended use. Five of the six horses returned to intense
36
Subchondral defects are generally treated conserva- athletic performance, four flat racing, and one barrel
tively, whereas SCLs can be treated either conservatively racing. The recommendations from this report were that
or surgically. 8,36,95 Both have been treated successfully nonsurgical treatment should be considered in horses
with prolonged rest and NSAID administration. 36,95 without radiographic signs of osteoarthritis and that
Initially, rest with concurrent intrasynovial treatment of surgery could be considered as an option if the horse
triamcinolone and hyaluronic acid may be indicated. If remains lame at the 90‐day follow‐up examination.
the lesions do not appear to be resolving or the lameness The outcome of surgery on three horses with SCLs
does not improve, surgical intervention may be advised. resulted in 2 of the 3 returning to their intended use. The
In one study of six horses with SCLs in which conserva- other horse sustained a comminuted fracture of the
tive (3 of 6) and surgical (3 of 6) treatments were com- radius during recovery from anesthesia. More recently,
8
pared, surgical extra‐articular enucleation of the cyst there is evidence that if accessible, injection of the cyst
provided better long‐term success (determined by return itself with triamcinolone has shown favorable results in
to athletic function) with less evidence of osteoarthritis other joints, 40,88 and there is one report of a successful
29
than conservative therapy. 8 elbow cyst injection. Injection of the cyst with corti-
While extra‐articular access of the cyst is the recom- costeroids either via arthroscopic guidance or in an
mended surgical approach, a complete treatment via extra‐articular manner is recommended if possible.
arthroscopic approach to this joint is limited due to the
cyst location. Lesions located in the proximal radius are Bursitis of the Elbow (Olecranon Bursitis)
generally not amenable to an arthroscopic approach;
however, lesions located in the medial or lateral humeral Historically shoe boil or capped elbow is regarded as
condyles may be accessed more easily arthroscopically. a problem in draft breeds, but there are reports in a vari-
Often the lesions are visualized with the arthroscope, yet ety of horse breeds. 35,74 It may occur on one or both
adequate debridement is difficult (Figure 5.39). For a elbows and is a characteristic movable swelling over the
59
medially located lesion, the surgery is performed with point of the olecranon tuberosity, usually developing
the horse positioned in lateral recumbency with the from trauma. The trauma results in a transudative fluid
affected limb down. Care is taken to identify but not accumulating in the subcutaneous tissue, which becomes

A B
Figure 5.39. Subchondral cystic lesion located on the axial aspect of the lateral epicondyle of the radius demonstrated on cranial to
caudal (A) and lateral (B) radiographic views. This cyst was observable arthroscopically. Source: Courtesy of Dr. Alanna Zantingh.