Page 677 - Adams and Stashak's Lameness in Horses, 7th Edition

Lameness of the Proximal Limb 643

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Figure 5.48. Core lesion of the medial branch of the biceps tendon just distal to the origin of the biceps brachii muscle (arrowheads).

are generally administered for 10–14 days and hand‐ and then debrided and lavaged copiously under arthro-
walking exercise is begun after that. Manipulating the scopic guidance followed by therapies aimed at treating
limb passively through a range of motion may also be infected synovial cavities Controlled exercise and mov-
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helpful. 40,42,48,81 When the tendon has been injured, rest ing the affected limb through a passive range of motion
periods for up to 3 months followed by paddock rest for are advocated to reduce restrictive adhesion formation. 11
another 3 months may be required to allow healing of In cases where an osseous cyst is detected within the
the tendon. intertubercular groove of the proximal humerus, arthro-
When the tendon has ossified, extracorporeal shock- scopic surgical debridement is recommended. 7,45
wave therapy (ESWT) may be indicated. In humans, calci-
fying tendinitis is commonly treated with ESWT 46,61,82 and
has been used with fair success in horses with calcifying Prognosis
tenopathies of the deep digital flexor tendon. Additional Acute cases of nonseptic bursitis when a fracture is not
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therapy could include stem cells, IRAP, and PRP therapy, the cause often respond favorably to conservative treat-
depending upon the lesion. ESWT applied to tendon ment. Conservative therapy for more chronic cases of
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lesions is still controversial; however, anecdotal reports nonseptic bursitis appears less satisfactory. 11,40,48,97 In one
appear to be encouraging. In these horses, controlled report of 3 horses with chronic nonseptic bicipital bursitis
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exercise was begun as early as possible, generally after 2–3 that were treated surgically, all became pasture sound. 48
weeks of confinement to improve range of motion and Horses with chronic septic bursitis cases treated con-
healing. The patient’s clinical response and ultrasound servatively have a poor prognosis for return to perfor-
findings should be used to determine progress in healing. mance, and surgery is usually recommended. Surgical
intervention with debridement, lavage, and appropriate
Surgical Treatment antimicrobial therapy and rest gives a favorable
prognosis. 40,43–45,64,79,97
Bursitis that results from a displaced fracture, from A small case series described five cases of osseous
osseous changes associated with the proximocranial cyst‐like lesions in the lateral intertubercular groove of
aspect of the humerus, or from sepsis generally requires the proximal humerus that were treated successfully
surgery to resolve the problem. Incisional as well as with corticosteroid and HA. Likewise a report of endo-
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endoscopic approaches to the intertubercular bursa scopic or open debridement of such lesions resulted in a
have been used and described. 4,11,40,48,94 If a fracture is favorable outcome. 7,45
present, the fragment is removed, and the bed debrided
and smoothed. Controlled exercise as described for the
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conservative approach is begun at the time of suture INFLAMMATION OF THE INFRASPINATUS BURSA
removal in most cases.
In cases in which infection appears to be the cause, The infraspinatus bursa is located between the tendon
centesis of the bursa should be done to collect fluid for of the infraspinatus muscle and the caudal eminence of
culture and cytology. Next, the bursa should be drained the greater tubercle of the proximal humerus. The bursa