Page 206 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.4 The forelimb 181

VetBooks.ir injured regions and in the sites of stress fractures. 1.348
Ultrasonography may be useful with fractures of the
spine (Fig. 1.347).

Management
Conservative management of incomplete, non-
articular fractures includes rest and controlled exer-
cise. Presence of a wound may lead to sequestra and
removal of affected fragments can be achieved under
ultrasonographic guidance. Involvement of the supra-
glenoid tubercle can be managed conservatively or
through surgical management. The former is often
associated with ongoing pain and the development
of OA (Fig. 1.348). Surgical management includes
removal or internal fixation. Due to the large distract-
ing forces of the biceps brachii a partial tenotomy may
be required. Internal fixation of fractures of the scap-
ula body has been described. Horses with complete
stress fractures are usually euthanased.

Prognosis Fig. 1.348 Mediolateral radiograph of a 7-year-old
Prognosis following intra-articular fracture is Thoroughbred gelding following a fall the previous
guarded due to the development of secondary day showing a comminuted displaced fracture of the
joint disease. Non-articular fractures have a good supraglenoid tubercle.
outcome.
1.349
INTERTUBERCULAR
(BICIPITAL) BURSITIS

Definition/overview
Intertubercular bursitis relates to inflammation of
the bursa underlying the origin of the biceps brachii
from the supraglenoid tubercle as it passes over the
proximal humerus.

Aetiology/pathophysiology
Trauma to the region may result in the setting up of a
bursitis. Entheseopathies of the origin of the tendon
can result from chronic tearing of the biceps brachii.

Clinical presentation
Bicipital bursitis results in a mild to moderate lame-
ness that often worsens with work. Clinical exami-
nation may reveal pain over the upper humerus, with
resentment following retraction of the limb. Bursal Fig. 1.349 An Arab gelding with swelling and pain
effusion is variable and often difficult to palpate on palpation over the cranial aspect of the shoulder
(Fig. 1.349). Proximal limb muscle loss may be evi- region following a fall. There is both subcutaneous
dent in chronic cases. and bicipital distension (arrow).