Page 199 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

174 CHAPTER 1

VetBooks.ir Clinical presentation Management
Most cases are cosmetic and are not treated, although
The mass is usually non-painful and not associated
with lameness, although it can become infected and
gated. Drainage and placement of a drain may resolve
therefore more swollen and painful and ooze pus. correction of any underlying cause should be insti-
some cases. En-bloc resection can be attempted but
Differential diagnosis wound breakdown is common in this region.
Ulna fractures; soft-tissue trauma.
Prognosis
Diagnosis Where surgical resection is undertaken the risk of
Clinical presentation is usually sufficient for a diag- dehiscence is increased following recovery from
nosis. Ultrasonography can be used to delineate the general anaesthesia, making the prognosis unfavor-
mass, especially when contemplating removal. able in such cases.

HUMERUS AND SHOULDER

SCAPULOHUMERAL OSTEOARTHRITIS Clinical presentation
Horses with scapulohumeral OA tend to show
Definition/overview moderate-severe lameness. Muscle atrophy over the
Degenerative joint disease of the scapulohumeral joint. shoulder region is common and pain on extension
or flexion of the upper limb is usually obvious. Joint
Aetiology/pathophysiology effusion is rarely palpable.
OA of the shoulder can be secondary to joint trauma,
synovial sepsis, OCD or intra-articular fracture. Differential diagnosis
Scapulohumeral OA is associated with dysplasia/ OCD; dysplasia; luxation; synovial sepsis.
luxation in miniature ponies.
Diagnosis
Diagnosis is made through localisation to the scapu-
1.333 lohumeral joint by local analgesia. Radiography
of the joint shows evidence of OA, particularly
at the caudal angle of the scapula and humerus
(Fig. 1.333). Flattening of the joint surface and frag-
mentation may also be appreciated. Craniocaudal
projections may be useful to assess joint congruency
and presence of periarticular osteophytosis. Nuclear
scintigraphy will also reveal increased uptake in the
shoulder region.

Management
Most cases are relatively advanced on diagnosis.
Palliative treatment with NSAIDs or intra-articular
medication may assist these cases. In severe cases,
particularly in conjunction with dysplasia/luxation
in miniature horses, arthrodesis of the scapulo-
Fig. 1.333 Mediolateral radiograph of the shoulder humeral joint has been described.
region of a 3-year-old Shetland pony with a large
osteophyte in the caudal aspect of the scapula Prognosis
consistent with osteoarthritis. Prognosis is guarded with shoulder OA.