Long‐term outcome of 84 horses with sacroiliac joint region pain with (n = 69) or without (n = 15) other orthopaedic problems

Review of the clinical diagnosis of sacroiliac dysfunction in horses - Challenges and limitations

Sacroiliac dysfunction (SID) is a condition seen in horses associated with poor performance that affects hind limb gait and impulsion. The condition comprises pain and dysfunction but there lacks clarity around the aetiopathogenesis and whether SID encompasses abnormal joint pathology, abnormal joint movement, abnormal regional biomechanical function, joint laxity and pain, or various combinations of these that may vary over time. Clinical assessment remains challenging for equine clinicians due to the deep location of the sacroiliac joint (SIJ) and surrounding structures which limits access for palpation, diagnostic imaging and joint-specific injection. There is no recognised single reference standard diagnostic test for SID. Clinical diagnosis has been based on ruling out other causes of hind limb lameness, along with combinations of ultrasonography, scintigraphy and periarticular anaesthesia of the SIJ. Recent studies have highlighted the lack of specificity of injections targeting the SIJ, with significant dispersal of injectate into surrounding structures including around the lumbosacral joint (LSJ). Advanced imaging modalities such as computed tomography offers promise for assessment of the structure and pathology of the SIJ and surrounding bony structures. However, there is a need to improve the understanding of the significance of anatomic variation of the sacroiliac region structures, with recent studies reporting detailed anatomic variation in groups of horses with and without SID. There are also limitations around functional assessment of the joint which is still largely reliant on a thorough clinical examination. This review aims to present an update on clinical approaches to the diagnosis of horses with SID, and to consider the challenges and limitations.

Retrospective analysis of horses with ultrasound evaluation of the sacroiliac region and response to local corticosteroid injection: 42 cases

Local injection of corticosteroids is commonly performed in horses with sacroiliac (SI) region pain and/or dysfunction, ,and ultrasound findings of normal horses and those with SI pain have also been well described. However, no studies have been performed that have evaluated if ultrasound findings, injection technique, or medications injected affect prognosis for return to function. The objectives of the current study are to determine if findings on ultrasound, injection technique, or medications injected are predictive of return to function in horses with SI region pain and/or dysfunction. Medical records were evaluated for horses that had ultrasound exam of the SI region as well as local injection with corticosteroids. A client survey was sent to determine the horse's return to performance. Logistic regression was performed to determine which variables were predictive of horses with SI pain and/or dysfunction returning to performance. A return to the same or higher level of work was found in 26 of 42 (62%) of horses after SI injections, 4 of 42 (10%) of horses returned to a lower level of work, and 12 of 42 (28%) did not return to work at any level. Horses that were injected with methylprednisolone were 4.2 times more likely to return to performance than horses injected with triamcinolone. Factors evaluated on ultrasound of the SI region did not predict whether a horse would return to performance following SI region injection.

Complications following equine sacroiliac region analgesia are uncommon: A study in 118 horses

Background

Diagnosis of sacroiliac region pain is supported by a positive response to sacroiliac region analgesia (SIRA). Varying techniques have been described for SIRA; with clinician preference often dictating method. Potential complications following SIRA include ataxia and recumbency. No study has specifically evaluated the prevalence of complications.

Objectives

To describe the complication prevalence following SIRA in a referral clinic.

Study design

Retrospective cohort study.

Methods

Review of records from horses presented to two of the authors at Rossdales, Newmarket, between January 2014 and December 2018, that underwent SIRA. Injection was performed using a blind midline approach with 20 mL mepivacaine (Intra-Epicaine 20mg/ml; Dechra) infiltrated through a straight 18 gauge 8.9cm spinal needle subdivided into four sub-locations per block.

Results

118 horses were included, with 167 individual blocks. One horse showed a mild hindlimb gait abnormality following SIRA, which resolved uneventfully over 3 hours; complication rate 1/118 horses (0.85%; 95% CI: 0,2.5%), 1/167 joints (0.60%; 95% CI: 0,1.8%). SIRA subjectively improved lameness/performance in 132/167 (79%) joints. 49/118 (42%) received bilateral SIRA with 53/118 (45%) evaluated ridden following SIRA.

Main limitations

Small population numbers with low complication prevalence rate.

Conclusions

SIRA, using the described technique, has a low (0.85%) prevalence of complications.

Generation of Domains for the Equine Musculoskeletal Rehabilitation Outcome Score: Development by Expert Consensus

Simple Summary

Within rehabilitation, measurements taken before, during and after treatments are used to judge patient progress and the effectiveness of prescribed treatments. To know which measurements to use for a given health condition, practitioners must have knowledge of what should be measured, which measurement tools are available and accurate, alongside what they intend to measure. Composite outcome measures (OMs) are tools which use grouped measurement tests to monitor patient progress; they have been tested for a variety of human and canine conditions but none have been designed or tested for use in physical rehabilitation in horses. This study asked leading equine veterinarians, physiotherapists and researchers which measures should be included in an OM for use in the rehabilitation of horses. Using a process to evaluate agreement, ten areas of measurement were included in the final model: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. Existing reliable tests used to measure these areas were evaluated and potential new measures discussed and now should be taken forward to testing as a composite outcome score to see if they are effective in measuring effectiveness of treatment.

Abstract

Outcome measures (OMs) are a requirement of professional practice standards in human and canine physiotherapy practice for measurement of health status. Measures such as pain and functional capacity of specific regions are used to track treatment impact and can be used to develop optimal management strategies. To achieve comparable patient care in equine physiotherapy, OMs must be incorporated into practice; however, no reliable and valid OMs exist for equine rehabilitation. This study utilised the experience and opinion of a panel of experts working in the equine rehabilitation sphere to gain consensus on the core areas (domains) to be included in a model, to lead to an OM scale for horses undergoing rehabilitation. The Delphi method and content validity ratio testing was used to determine agreement with domains reaching the critical value required for inclusion. The expert panel agreed on ten domains to be included in the OM scale: lameness, pain at rest, pain during exercise, behaviour during exercise, muscular symmetry, performance/functional capacity, behaviour at rest, palpation, balance and proprioception. An OM with these domains would provide a holistic objective assessment tool which could be used by equine rehabilitation professionals in clinical practice.