Subclinical ultrasonographic abnormalities of the suspensory ligament branches in National Hunt racehorses.

BACKGROUND: Suspensory ligament branch (SLB) desmopathy is a common cause of lameness and an important cause of lost training in the Thoroughbred racing industry. Studies have assessed the impact of insertional injuries of the SLB on the careers of flat racehorses and established the prevalence of subclinical ultrasonographic SLB abnormalities in this population, but little work has investigated SLB injury in National Hunt (NH) racehorses. OBJECTIVES: To investigate the prevalence of subclinical ultrasonographic SLB abnormalities in NH racehorses with no clinical signs or history of SLB injury and to establish the cross-sectional area (CSA) of SLBs in this population. STUDY DESIGN: Cross-sectional study using data collected from horses on an NH yard. METHODS: Ultrasonographic examination of forelimb SLBs in 62 horses on a single NH yard was performed. Images were graded according to a previously reported system. CSA measurements were obtained from transverse images. RESULTS: Nineteen of 62 horses had at least one SLB with grade 2 ultrasonographic abnormalities. Grade 2 ultrasonographic abnormalities occurred more frequently in the medial than the lateral SLB (P = 0.05). The medial SLB insertional CSA was significantly larger (P<0.001) than that of the lateral SLB. MAIN LIMITATIONS: Length of time on the yard (and therefore available veterinary history) is variable in this population. CONCLUSIONS: One in three NH racehorses without history or clinical signs of SLB injury had at least one SLB with a grade 2 ultrasonographic abnormality. The medial branch was over-represented. The medial SLB insertional CSA is larger than the lateral and thus comparison with the corresponding branch in the contralateral limb is recommended to avoid misdiagnosis of medial SLB enlargement.

The range and prevalence of clinical signs and conformation associated with lameness in working draught donkeys in Pakistan.

REASONS FOR PERFORMING THE STUDY: Lameness is prevalent in working donkeys and has major welfare implications; however, a detailed study of the associated clinical signs is lacking. OBJECTIVES: To describe the range and prevalence of clinical signs and conformation associated with lameness in working draught donkeys. STUDY DESIGN: Prospective, cross-sectional, observational study. METHODS: Data were collected from 102 working draught donkeys in Pakistan. A lameness assessment adapted for working donkeys was used to record clinical signs of lameness, gait, limb conformation and pain responses in the feet, limbs and spine using observation, palpation and manipulation. Lameness at the walk was scored from 0 to 10 (sound to nonweightbearing). RESULTS: Every donkey examined had gait abnormalities, with 5% having a nonweightbearing limb. Lameness was significantly more severe with older age, lower body condition score and forward-at-the-knee conformation. More severe lameness was also associated with pain responses in the hoof walls, palpation of limb joints and spinal flexion. Joint, tendon and foot pathology was highly prevalent, as well as pain responses to joint flexion and spinal manipulation. Conformational abnormalities showed lateral asymmetries. CONCLUSIONS: Over 98% of the world's 42.2 million donkeys are in low-income countries, most being used for work. The high prevalence of lameness, pain and multiple limb and spinal abnormalities in working donkeys is of great welfare concern and highlights the complexity of addressing this problem. This standardised lameness assessment can be used when implementing and monitoring interventions to reduce lameness prevalence in working donkeys.

Distribution of radiodense contrast medium after perineural injection of the palmar and palmar metacarpal nerves (low 4-point nerve block): an in vivo and ex vivo study in horses.

REASONS FOR PERFORMING STUDY: Evidence-based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region ('low 4-point nerve block'). OBJECTIVES: To demonstrate the potential distribution of local anaesthetic solution after a low 4-point nerve block using a radiographic contrast model. METHODS: A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three-quarters and distal quarter of the Mc region (Pa injection) and over the ipsilateral PaM nerve immediately distal to the distal aspect of the second or fourth Mc bones (PaM injection) in both forelimbs of 10 mature horses free from lameness. Radiographs were obtained 0, 10 and 20 min after injection and analysed subjectively and objectively. Methylene blue and a radiodense contrast medium were injected in 20 cadaver limbs using the same techniques. Radiographs were obtained and the limbs dissected. RESULTS: After 31/40 (77.5%) Pa injections, the pattern of the contrast medium suggested distribution in the neurovascular bundle. There was significant proximal diffusion with time, but the main contrast medium patch never progressed proximal to the mid-Mc region. The radiological appearance of 2 limbs suggested that contrast medium was present in the digital flexor tendon sheath (DFTS). After PaM injections, the contrast medium was distributed diffusely around the injection site in the majority of the limbs. In cadaver limbs, after Pa injections, the contrast medium and the dye were distributed in the neurovascular bundle in 8/20 (40%) limbs and in the DFTS in 6/20 (30%) of limbs. After PaM injections, the contrast and dye were distributed diffusely around the injection site in 9/20 (45%) limbs and showed diffuse and tubular distribution in 11/20 (55%) limbs. CONCLUSIONS AND POTENTIAL RELEVANCE: Proximal diffusion of local anaesthetic solution after a low 4-point nerve block is unlikely to be responsible for decreasing lameness caused by pain in the proximal Mc region. The DFTS may be penetrated inadvertently when performing a low 4-point nerve block.

The range and prevalence of pathological abnormalities associated with lameness in working horses from developing countries.

REASONS FOR PERFORMING STUDY: Lameness is highly prevalent in working horses, but published reports on the associated pathological abnormalities are lacking. With over 42 million horses in developing countries and the majority used for work, lameness has major welfare implications. OBJECTIVES: To describe the range and prevalence of pathological abnormalities associated with lameness in working horses. METHODS: A standard lameness assessment was adapted for field use in working equids. Data on pathological abnormalities and pain responses in the feet, limbs and spine were collected through observation, palpation, manipulations and gait assessment in working horses from India (n = 110) and Pakistan (n = 117). Lameness at the walk was scored on a scale of 0-4 (sound-nonweightbearing). RESULTS: All horses examined were lame. Overall, 98% showed a gait abnormality in all 4 limbs and 87% had at least one limb scoring 3 or 4 on the lameness scale. Multiple pathological abnormalities within each limb were associated with lameness, with similar results in both countries. Chronic foot pathology was seen in every horse; 94% horses showed signs of chronic joint disease; 83% had digital flexor tendonitis in at least one limb. Lameness and pathological abnormalities were associated with specific pain responses in the feet, limbs and spine. CONCLUSIONS: The extremely high prevalence of multilimb lameness and its association with pain is of great concern. The multiple pathological abnormalities present in working horses makes lameness complex to address. POTENTIAL RELEVANCE: The results of this detailed study of lameness should facilitate the identification of risk factors and the implementation of interventions to reduce the prevalence of lameness in working equids.

Diffusion of contrast medium after perineural injection of the palmar nerves: an in vivo and in vitro study.

REASONS FOR PERFORMING STUDY: Proximal diffusion of local anaesthetic solution after perineural anaesthesia may lead to the desensitisation of structures other than those intended. However, there is no evidence-based study demonstrating the potential distribution and diffusion of local anaesthetic solution after perineural analgesia in the distal limb. OBJECTIVE: To document the potential diffusion of local anaesthetic solution using a radiopaque contrast model and to evaluate the influence of walking compared with confinement in a stable after injection. METHODS: Radiopaque contrast medium was injected subcutaneously over one palmar nerve at the base of the proximal sesamoid bones in 6 nonlame mature horses. Horses were assigned randomly to stand still or walk after injection. Radiographs were obtained 0, 5, 10, 15, 20 and 30 min after injection and were analysed to determine the distribution and diffusion of the contrast medium. RESULTS: In 89% of injections an elongated pattern of the contrast medium was observed suggesting distribution along the neurovascular bundle. After 49% of injections a fine radiopaque line extended proximally from the contrast 'patch', and in 25% of injections a line extended distally. There was significant proximal and distal diffusion with time when sequential radiographs of each limb were compared. The greatest diffusion occurred in the first 10 min. Walking did not significantly influence the extent of either proximal or distal diffusion. CONCLUSIONS AND POTENTIAL RELEVANCE: Significant proximal diffusion occurs in the first 10 min after perineural injection in the distal aspect of the limb and should be considered when interpreting nerve blocks. Distribution of local anaesthetic solution outside the fascia surrounding the neurovascular bundle or in lymphatic vessels may explain delayed or decreased effects.

High-intensity exercise induces structural, compositional and metabolic changes in cuboidal bones--findings from an equine athlete model.

Fatigue fracture of cuboidal bones occurs in the human foot as well as the equine carpus. The racehorse provides a naturally-occurring model to study the effects of high-intensity exercise on the morphology and metabolism of cuboidal bones. We studied both the mineral and the collagenous matrix of the third (C(3)) and radial (C(r)) carpal bones of raced and non-raced Thoroughbred (TB) horses. We hypothesised that racehorses would show increases in the mineral component of these bones and post-translational modifications of the collagenous matrix alongside changes in markers of collagen remodelling and bone formation. C(3) and C(r) carpal bones were retrieved from raced TB horses (n=14) and non-raced TB horses (n=11). Standardised proximal-distal sections were taken from each bone and these were sliced transversely to study the proximal-distal differences in bone metabolism from the subchondral plate through to trabecular bone. Histomorphometry and bone mineral density measurements were performed in parallel with biochemical analyses including total collagen, collagen synthesis and cross-links, matrix metalloproteinases-2 and 9 and their inhibitors, calcium and phosphate, and bone alkaline phosphatase. The results of this study show that, while there is a net increase in bone formation in the racehorses, there is additionally an increase in bone collagen synthesis and remodelling, particularly within the trabecular regions of the bone. The increase in bone density would lead to greater stiffness, particularly in the cortical bone, and failure of this 'stiffer' cortical bone may result from its lack of support from the rapidly remodelling and structurally weakened underlying trabecular bone.

Validity of indicators of dehydration in working horses: a longitudinal study of changes in skin tent duration, mucous membrane dryness and drinking behaviour.

REASONS FOR PERFORMING STUDY: Dehydration is a serious welfare concern in horses working in developing countries. Identification of a valid and practical indicator of dehydration would enable more rapid treatment and prevention. OBJECTIVES: To examine changes in bodyweight, clinical and blood parameters during rehydration of working horses, identify a 'gold standard' criterion for dehydration and use this to validate a standardised skin tent test, drinking behaviour and mucous membrane dryness as potential field indicators. METHODS: Fifty horses with a positive skin tent test, working in environmental temperatures of 30-44 degrees C in Pakistan, were rested and offered water to drink ad libitum. Bodyweight, clinical and blood parameters, mucous membrane dryness, drinking behaviour and skin tent duration at 6 anatomical locations were measured at 0, 30, 60, 120, 180, 240 and 300 min. RESULTS: Skin tent duration was affected by side of animal (P = 0.008), anatomical location and coat moisture (both P < 0.001). Younger animals had shorter skin tents at all time points (P = 0.007). There was no significant association between plasma osmolality (P(osm)) or water intake and skin tent duration. Horses with a higher P(osm) drank significantly more water (P < 0.001), and had longer (P < 0.001) and more frequent (P = 0.001) drinking bouts. Neither P(osm) nor water intake affected qualitative and semi-quantitative measurements of mucous membrane dryness significantly. CONCLUSIONS AND POTENTIAL RELEVANCE: The standardised skin tent test and measures of mucous membrane dryness investigated in this study were not valid or repeatable indicators of dehydration when compared with P(osm) as a 'gold standard' criterion. The volume of water consumed and the number and duration of drinking bouts were the most reliable guide to hydration status currently available for mature working horses. Offering palatable water to drink ad libitum provides both the diagnosis and the remedy for dehydration in working horses.

Use of matrix metalloproteinases 2 and 9 and white blood cell counts in monitoring the treatment and predicting the survival of horses with septic arthritis.

Thirty-nine samples of synovial fluid were collected from the joints of 32 horses with suspected septic arthritis and 39 samples were collected from horses euthanased for non-orthopaedic conditions. The white blood cell counts (WBCC) were determined and the pro and active forms of matrix metalloproteinases (MMPs) 2 and 9 were measured by gelatin zymography and image analysis in each sample. The initial measurements of the ratio of proMMP9:proMMp2 and WBCC were good prognostic indicators of the survival of the horses. There was no significant relationship between the interval between the injury and the horse being referred for treatment and either the WBCC or the levels of MMP2 and MMP9 initially, and no evidence that this interval significantly affected the chances of the horses surviving.

Validity of a behavioural measure of heat stress and a skin tent test for dehydration in working horses and donkeys.

REASONS FOR PERFORMING STUDY: Dehydration and heat stress are serious welfare issues for equids working in developing countries. There is a lack of any standardised method or validated interpretation of the skin tent test in horses and donkeys. Owners of dehydrated and heat-stressed animals often depend on veterinary examination for identification of these conditions, leading to delays in treatment and unnecessary reliance on external sources to effect welfare improvement. OBJECTIVES: To validate a standardised skin tent test for dehydration and a behavioural measure of heat stress in working equids; and to examine the effect of heat stress and dehydration on tripping and staggering behaviour. METHODS: The study was carried out on 130 working horses and donkeys in Pakistan. Associations between skin tent and blood parameters (packed cell volume [PCV], serum total protein [TP], serum osmolality), clinical parameters, resting and drinking behaviour were examined. Heat stress behaviour (increased respiratory rate and depth, head nodding, flared nostrils, apathy) was observed in conjunction with rectal temperature. Tripping and staggering were assessed using a simple obstacle course. RESULTS: In both species, heat stress behaviour was significantly associated with increased rectal temperature (P<0.001). A positive skin tent test was not significantly associated with PCV or TP, although in donkeys it was significantly associated with lower serum osmolality (P<0.001). More animals age >15 years had a positive skin tent than those in younger age groups (P = 0.037). Very thin horses were more likely to have a positive skin tent than those in thin or moderate condition (P = 0.028). There was no significant correlation between skin tent and tripping or staggering in either species. CONCLUSIONS AND POTENTIAL RELEVANCE: Heat stress behaviour is related to increased body temperature in working horses and donkeys. Owners may use this to make judgements regarding rest and cooling, precluding the need to seek veterinary attention. The skin tent test for dehydration used in this study did not show a significant relationship with PCV or TP. However, the use of blood parameters to validate the skin tent test may be confounded by anaemia, hypoproteinaemia or electrolyte depletion. Alternative methods are needed to confirm or refute the validity of the skin tent test in working equids.

A technique for pelvic radiography in the standing horse.

REASONS FOR PERFORMING STUDY: An alternative technique of radiographing the pelvis in the standing horse is required, to avoid the risks associated with general anaesthesia. HYPOTHESIS: That lateral oblique radiography in the standing horse would be a useful technique in the investigation of pelvic injury. OBJECTIVES: To describe the technique of lateral oblique pelvic radiography in the standing horse and demonstrate the feasibility and usefulness of this technique. METHODS: A technique for lateral oblique radiography in the standing horse was devised and retrospective review made of radiographic findings in 18 clinical cases. RESULTS: The caudal iliac shaft, greater trochanter of the femur, femoral head, acetabulum and coxofemoral articulation on the side under investigation were visualised consistently using this technique. Of the 18 cases, 3 iliac shaft fractures, 1 acetabular fracture, 2 coxofemoral luxations and 4 horses with new bone formation around the coxofemoral joint and/or proximal femur were identified. CONCLUSIONS: Lateral oblique radiography in the standing, conscious horse can be used to investigate conditions affecting the caudal iliac shaft, coxofemoral articulation and proximal femur in the horse. POTENTIAL RELEVANCE: The technique is straightforward, noninvasive and useful in the investigation of horses with suspected pelvic injury. However, not all pelvic injuries would be identified, and normal radiographic findings do not rule out injury or fractures elsewhere in the pelvis.

Ultrasonography of the medial palmar intercarpal ligament in the Thoroughbred: technique and normal appearance.

REASONS FOR PERFORMING STUDY: Tearing of the medial palmar intercarpal ligament (MPICL) has been recognised as a cause of lameness in the Thoroughbred, but diagnosis is difficult due to the nonspecific clinical signs, and can be achieved only by performing arthroscopy on the mid carpal joint (MCJ). It would be beneficial to be able to image the MPICL using ultrasonography to determine whether pathology is present in the ligament in order to aid diagnosis and prognosis. OBJECTIVES: To determine whether the MPICL could be imaged using ultrasound from the dorsal aspect of the MCJ, and to describe the technique and normal ultrasonographic appearance of the ligament. METHODS: A pilot study was performed using 2 cadaver carpi. Each carpus in turn had the MPICL imaged simultaneously using arthroscopy and ultrasound, with a metallic probe positioned on the dorsal aspect of the ligament to highlight the position of the MPICL. Six further pairs of carpi had the MPICL imaged ultrasonographically followed by dissection of the carpus to evaluate the ligament and relate its anatomy to the ultrasound images. Finally, 15 Thoroughbreds with no history of lameness isolated to the carpus had their MPICLs assessed and measured ultrasonographically. RESULTS: The MPICL could be imaged via the dorsal aspect of the MCJ using standard ultrasound equipment. The body and division into medial and lateral branches could be seen as a distinct, moderately dense granular echogenic structure in the palmar aspect of the joint, with clearly defined margins. CONCLUSIONS: The normal MPICL can be imaged reliably using ultrasound in the Thoroughbred from the dorsal aspect of the MCJ. There is a wide range in the normal width of the lateral aspect of the MPICL, but there is good symmetry between contralateral limbs. POTENTIAL RELEVANCE: This report of the normal ultrasonographic appearance of the ligament will be beneficial in acting as a reference for the detection of pathology using ultrasound.

Radiographic progression of osteoarthritis of the canine stifle joint: a prospective study.

A radiographic scoring system for features of osteoarthritis of the canine stifle joint was devised. Intra- and inter-rater agreement was assessed by calculation of unweighted kappa statistics. "Global score," "effusion," "osteophytosis," and "intra-articular mineralization" were all features that had acceptable reliability, but "subchondral sclerosis" did not. The scoring system was used in a 13-month prospective study of the radiographic progression of osteoarthritis of the stifle joint, secondary to cranial cruciate ligament deficiency, in 58 dogs. In the index stifle joints all features were characterized by significant change over time, but osteophytosis had the greatest degree of change. In addition, 40% of contralateral joints showed progressive osteophytosis.

Changes in the canine femoropatellar joint space in the postsurgical, cruciate-deficient stifle joint.

In this study, we investigate the factors that influence changes in articular cartilage thickness in naturally occurring osteoarthritis of the canine stifle joint. Fifty-eight dogs with QA secondary to cranial cruciate ligament deficiency were examined radiographically at 0, 7, and 13 months using 90 degree flexed mediolateral radiographs of both stifle joints. The femoropatellar joint space widths were measured using a computer-assisted video image analysis system. The femoropatellar joint space widths were found to be significantly increased in index joints as compared to contralateral joints. In addition, there was a significant increase in femoropatellar joint space (FPJS) width over the course of the study, particularly between entry and 7 months. Factors that might influence the degree of femoropatellar joint space increase (bodyweight, age, sex, disease duration, radiographic score) were investigated using regression analysis. Body weight at baseline showed a moderate to strong relationship with change in FPJS between 0 and 7 months (Pearson's partial correlation r = 0.417, p = .006). This relationship was less strong for change in femoropatellar joint space between 7 and 13 months (r = 0.324, p = .036).

Plasma and synovial fluid concentrations of calcium pentosan polysulphate achieved in the horse following intramuscular injection.

Results from in vitro studies have indicated that calcium pentosan polysulphate (CaPPS) may be of therapeutic value in osteoarthritis (OA) in the horse. However, no controlled clinical trials using this drug in equine OA have yet been reported. If CaPPS is to be developed for such use, the relationship between the proposed i.m. dose of CaPPS to be used and the concentrations of drug attained in plasma and synovial fluid of the target joint should first be established. An investigation was undertaken to determine these concentrations after a single 2 mg/kg i.m. injection of CaPPS. Blood and synovial fluid samples were taken from 6 healthy, sound horses following i.m. CaPPS administration. Concentrations of CaPPS measured in the synovial fluid were, on the basis of published studies, sufficient to elicit a potential therapeutic effect on synoviocyte metabolism, and possibly also to stimulate proteoglycan synthesis and reduce matrix metalloproteinase activities in articular cartilage. It would therefore seem justified to investigate further the therapeutic effect of CaPPS in OA in the horse.