Page 263 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

238 CHAPTER 1

VetBooks.ir SOFT-TISSUE INJURIES may be improved by local infiltration of local anaes-
thetic solution around the entheseous new bone.
Definition/overview
Nuchal bursitis is an unusual cause of swelling
There are a variety of acquired soft-tissue injuries of in the poll region with, or without, associated neck
the neck involving the nuchal ligament, the nuchal stiffness. There may or may not be localised dystro-
bursa, muscles and the jugular vein. phic mineralisation (Fig. 1.448). Diagnosis is usu-
ally confirmed using ultrasonography. Some horses
Aetiology/pathophysiology respond to conservative management; in others sur-
These are traumatic injuries, either acute or repeti- gical treatment is required.
tive wear and tear. Occasionally, ill-fitting tack, espe- Brachiocephalicus muscle soreness is often iden-
cially in horses used for driving, can cause muscle tified in association with forelimb lameness due to
dysfunction, pain and reluctance to work, or overt a problem in the distal aspect of the limb (e.g. foot
forelimb lameness. pain or proximal suspensory desmitis). Primary
strain injury can occur and is usually associated with
Clinical presentation/ a gait abnormality most readily detected at the walk
diagnosis/management but may only be evident when the horse is ridden.
The nuchal ligament inserts on the caudal aspect of There is a shortened cranial phase of the step on the
the occiput and signs of entheseopathy, character- affected side and the head and neck are raised as the
ised by new bone on the caudal aspect of the occiput, affected limb is protracted. Physiotherapy treatment
is a common clinical observation, often of no clini- usually results in resolution of the clinical signs.
cal significance (Fig. 1.447). Relatively rarely, a Occasionally, usually as a result of a fall, a horse may
horse may have an abnormal head and neck posture sustain an acute strain/tear of the pectoral muscles,
when ridden, which is not secondary to forelimb or resulting in severe lameness. A torn muscle, with asso-
hindlimb lameness, or an oral problem or another ciated haemorrhage, is extremely painful and the horse
cause of neck pain. The performance of such horses may be distressed and show signs mimicking colic.

1.447 1.448

Ce 1

Fig. 1.447 Laterolateral radiograph of the occiput Fig. 1.448 Laterolateral radiograph of the occiput
and first cervical vertebra of a 12-year-old advanced and first two cervical vertebrae of a 14-year-old
event horse. Cranial is to the left. There is entheseous Icelandic pony mare. Cranial is to the left. There is
new bone on the caudal aspect of the occiput (arrows), extensive mineralisation dorsal to the first cervical
an incidental finding in this horse. vertebra (Ce 1). Ultrasonography revealed marked
fluid distension of the nuchal bursa with multifocal
hyperechogenic foci.