Page 676 - Adams and Stashak's Lameness in Horses, 7th Edition

642 Chapter 5

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Figure 5.46. Osseous changes on the tubercles of the
cranioproximal humerus (arrowhead). Infiltration of lidocaine into the
bursa resolved the lameness in this case.

Figure 5.45. Radiopaque contrast medium contained within the
bicipital bursa. Source: Reprinted with permission from Cole et al. .
24

(Figures 5.46 and 5.47). 11,40,48,75,97 Generally, only medi-
olateral, craniomedial to caudolateral oblique, and
flexed cranioproximal to craniodistal (skyline) radio-
graphs are taken in adult horses. 48,58 A cranioproximal
to craniodistal oblique view is useful when the tubercles
78
are thought to be involved. Radiographs may appear Figure 5.47. An osseous cyst located in the intermediate
normal if the disease only involves the bursa. If a wound tubercle in the cranioproximal humerus. Source: Courtesy of
or draining tract is present, centesis with contrast mate- Dr. Colin Mitchell.
rial assesses communication with the bursa.
Ultrasound examination of the biceps tendon, bursa, Treatment
and bicipital groove can be very informative, even Conservative Treatment
when radiographs appear normal (Figure 5.48). 17,49,77,78
Ultrasound changes associated with bursitis have Noninfectious bursitis without radiographic evidence
included edema or hemorrhage in the biceps tendon or of a fracture or pathology on the cranioproximal aspect
bursa, disruption of the tendon architecture with peri- of the humerus may respond favorably to rest, paren-
tendinous thickening, an irregular surface of the bicipi- teral and/or topical administration of nonsteroidal anti‐
tal groove, and hyperechoic material in the bicipital inflammatory drugs (NSAIDs), and in some cases
bursa. 26,97 Infection must be ruled out if hyperechoic intrasynovial injection of the bursa with corticoids and
material is seen in the bursa. Nuclear medicine may be hyaluronic acid (HA). 40,42,59,81
97
useful in some cases to detect early infected or actively The duration of rest generally depends on the nature
remodeling bone adjacent to the bursal region when of the injury, the patient’s clinical response to rest, and
ultrasound and radiography appear normal. 48,78 whether or not the biceps tendon was damaged. NSAIDs