Page 303 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

278 CHAPTER 1

VetBooks.ir aseptic preparation of the injection site(s) and place- the sciatic nerve and prominent gluteal vasculature.
For this reason, caution must be used when injecting
ment of a 25 cm (10 inch) 16- or 18-gauge spinal nee-
dle, bent 40° in the direction of the needle’s bevel,
approximately 2.5 cm (1 inch) cranial to the con- into the SI region.
tralateral tuber sacrale. The needle is advanced in Management
a ventrocaudolateral direction, aiming for the mid- An altered work programme focusing on building
way point between the ipsilateral greater trochanter core strength, local and systemic medication, acu-
of the femur and tuber coxae, until it contacts the puncture, chiropractic, mesotherapy, physiotherapy
medial aspect of the ipsilateral tuber sacrale. The and shock-wave therapy has been advocated for SI
needle should then be advanced at a steeper angle, joint pain, but no well-founded reports exist on
sliding alongside the medial aspect of the ilial wing, which aspect to base exact recommendations. It is
until it encounters the dorsal surface of the sacral generally thought that poor muscling may make the
wing, at which point the stylette should be removed problem worse, and that therefore complete (stall)
and injection performed. It is recommended that no rest is contraindicated. Initially, the horse will be
more than 8 ml of solution containing local anaes- worked without a rider, then graduating to work
thetic is injected per SI region. This volume should under saddle as the horse’s strength and comfort
be better confined to the medial aspect of the SI joint increases. The Equiband (Equicore Concepts) can
®
and it should not readily diffuse to other adjacent be very beneficial to help engage the abdominal mus-
structures. Of particular concern is the diffusion of culature and the hind end. Additionally, it is critical
local anaesthetic into large motor nerves (sciatic and to address and treat other concomitant sources of
obturator nerves), which would produce hindlimb pain that may exist.
collapse. Ultrasound guidance (Fig. 1.525) may be The use of systemic NSAIDs is central to thera-
used to improve accuracy and also help in preventing peutic regimes for SI joint OA, with the dose tapering
inadvertent penetration of vital neurovascular struc- as the horse’s comfort level improves. Periarticular
tures in the caudal region. A slightly modified, ultra- injection of the SI region has also been described,
sound-guided approach to the SI region deposited using both corticosteroids and sarapin, whether
injectate within 2 cm of the joint margins in 85% alone or in combination. Additional treatment with
of cadavers. There are anecdotal reports of severe agents such as glucosamine, chondroitin sulphate,
hindlimb paresis leading to recumbency or profuse polysulphated glycosaminoglycan and sodium hyal-
haemorrhage following SI injections, particularly uronate may also be beneficial.
with the caudal approach, caused by the proximity of No specific recommendations for the treatment
and rehabilitation of horses with dorsal SI ligament
desmitis are available. For acute traumatic ligamen-
1.525
tous injuries, an initial period of complete stall rest
may be indicated to allow healing prior to a gradual
Wing of ilium – note reintroduction to work. Intralesional injection with
angle
Path of needle is platelet-rich plasma and stem cells has been per-
parallel to the formed with equivocal results. Acoustic shock-wave
wing of the ilium
and cold laser therapy may also be performed.
Acupuncture and chiropractic are commonly
used to manage and treat horses with pelvic and back
pain. Clinical studies on the efficacy of these treat-
ments specifically for SI pain are lacking, although
anecdotal information abounds.
L6 transverse process
SI injection Prognosis
Fig. 1.525 Cranial approach to sacroiliac region. Although limited literature is available regard-
(Photo courtesy Diane Isbell) ing the response to treatment in horses with