Page 401 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

376 CHAPTER 1

VetBooks.ir bulging of the fluid-filled cavity lateral and medial Ultrasonography
This is the technique of choice to assess bursal involve-
to the distal part of the common calcaneal tendon
at and dorsal to the tuber calcis of the calcaneus
vial membrane) and look for injury to the SDFT and/
(Fig. 1.744). The calcaneal branches of the SDFT ment, confirm inflammation (thickening of the syno-
will prevent swelling directly at the point of the or its calcaneal branches, surfaces of the calcaneus
hock, which helps to differentiate from an acquired and gastrocnemius tendon insertions. In septic cases,
subcutaneous bursa (capped hock). there is usually severe synovial hypertrophy and the
fluid may appear echogenic and heterogeneous with
Radiography fibrin clots present in the recesses (Fig. 1.746). Septic
Radiographs should be obtained to rule out asso- osteitis of the calcaneus is often present, creating an
ciated bone disorders, including septic osteitis of irregular defect and/or new bone productions.
the calcaneus, avulsion or fractures (Fig. 1.745).
Lateral, dorsoplantar, flexed lateral, oblique and Management
flexed caudoproximal/plantarodistal (skyline of the If the bursitis is secondary to injury to the peripheral
tuber calcis) views should be obtained for complete structures, the cause should be addressed as required.
assessment. Rest, application of cold and intrasynovial medication

1.744 1.745 1.746

Figs. 1.744–1.746 (1.744) A puncture wound of some days duration is visible on the plantar distal aspect
of the point of the hock (calcaneus). This enters the calcaneal bursa and has led to septic synovitis. Note the
swelling around the wound and proximally either side of the calcaneal tendons. (1.745) Lateromedial radiograph
of the hock of the same horse. Note the soft-tissue swelling at the point of the hock and the small defect in the
plantar calcaneus due to impact of the wounding trauma. (1.746) Transverse sonogram 4 cm proximal to the
point of the hock of the same horse. Note the hypoechogenic distended lateral pouch of the calcaneal bursa with
synovial thickening and proliferation lining the bursa and tendons. The increased fluid in the bursa is speckled
(suggesting increased cellular content) and separates the SDFT and gastrocnemius tendons. (Photos courtesy
Graham Munroe)