The cranial nuchal bursa: anatomy, ultrasonography, magnetic resonance imaging and endoscopic approach

Use of a novel helical fan beam imaging system for computed tomography of the head and neck in sedated standing horses: 120 cases (2019–2020)

OBJECTIVE

To evaluate the diagnostic capabilities of a novel helical fan beam CT system used for imaging of horses with clinical problems of the head and neck.

ANIMALS

120 horses.

PROCEDURES

Medical records were reviewed of horses presented for CT of the head or neck at 2 university hospitals. The following data were recorded: age, sex, breed, presenting complaint, sedation used for imaging, scanning time, procedure time, other diagnostic imaging methods performed, imaging diagnosis, clinical diagnosis, and complications during imaging.

RESULTS

Quarter Horses and Warmbloods were the most common breeds, and the most common complaint was nasal discharge. The head (101/120 [84%] horses) was scanned most frequently, and the most common diagnoses were primary dental disease and a space-occupying lesion of the paranasal sinuses. Nuchal bursitis was the most common imaging diagnosis in the neck region. Procedure time ranged from 20 to 45 minutes with a scanning time of 30 to 40 seconds. No complications with horse sedation occurred, and horses tolerated scanning well. An imaging diagnosis was more frequently achieved with CT (109/120 [91%] horses) than with planar digital radiography (23/61 [38%] horses).

CLINICAL RELEVANCE

The helical fan beam CT system had fast scanning times and could be used safely for routine imaging of the teeth and sinuses in horses. The caudal extent of scanning in the neck region was limited by the shape of the horse’s neck and thorax.

Case Report: Nuchal Bursitis Associated With Borrelia burgdorferi Infection in a Horse

Cases of cranial nuchal bursitis associated with Borrelia burgdorferi infection have not been thoroughly described. Here, we describe the case of a 17-year-old mare that was presented for low head carriage, dull demeanor, and resistance to haltering. Imaging supported a diagnosis of nuchal bursitis, and bursoscopy with surgical debridement of the nuchal bursa was performed. B. burgdorferi was identified by molecular diagnostics in serial samples of the bursal fluid, with no other organisms identified. Serology revealed significant elevation in antibodies directed against OspA of B. burgdorferi, but not the typical infection markers, OspC and OspF. Intravenous ceftiofur was administered for 80 days, and the nuchal bursa was directly injected with ceftiofur. The mare recovered and was able to return to work with no recrudescence of clinical signs over the following year to date. Infection with B. burgdorferi should be considered as a differential in cases of septic nuchal bursitis.

Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment

Simple Summary

Neck pain and dysfunction in the horse is becoming an increasingly important topic among riders, trainers and veterinarians. Some horses may present for a subtle performance decline, while others may show dramatic, dangerous behavior. It is important to recognize how to carefully evaluate the horse in an effort to understand the different types of pain that may be contributing to the different behaviors. The musculoskeletal and nervous systems may both play a role in the development of clinical signs. Recognizing that there are many diagnostic options as well as several treatments choices is important. This synopsis covers the disease processes that may contribute to the development of neck pain and dysfunction in the horse, as well as several possible diagnostic and treatment options.

Abstract

Interest in the cervical spine as a cause of pain or dysfunction is increasingly becoming the focus of many equine practitioners. Many affected horses are presented for poor performance, while others will present with dramatic, sometimes dangerous behavior. Understanding and distinguishing the different types of neck pain is a starting point to comprehending how the clinical presentations can vary so greatly. There are many steps needed to systematically evaluate the various tissues of the cervical spine to determine which components are contributing to cervical pain and dysfunction. Osseous structures, soft tissues and the central and the peripheral nervous system may all play a role in these various clinical presentations. After completing the clinical evaluation, several imaging modalities may be implemented to help determine the underlying pathologic processes. There are multiple treatment options available and each must be carefully chosen for an individual horse. Provided is a synopsis of the current knowledge as to different disease processes that can result in cervical pain and dysfunction, diagnostic approaches and treatment strategies. Improving the knowledge in these areas will ideally help to return horses to a state of well-being that can be maintained over time and through the rigors of their job or athletic endeavors.

Clinical findings and management of six horses with subtendinous bursitis of the long digital extensor tendon in the hind limb fetlock

OBJECTIVE

To describe the history, clinical signs, and management of six horses in which subtendinous bursitis of the long digital extensor tendon (LDET) in the hind limb fetlock had been diagnosed.

STUDY DESIGN

Retrospective case series.

SAMPLE POPULATION

Six privately owned horses.

METHODS

The medical records of horses presented at the hospital with similar sypmtoms were evaluated and collected. Finally 6 horses met the inclusion criteria and the relevant data were compiled and analysed. In three of the six cases a surgical treatment was carried out.

RESULTS

All horses had similar clinical signs, mainly distention beneath the long digital extensor tendon (LDET) at the level of the hind limb fetlock without associated lameness; the major issues were the presence of cosmetic defects and concern about their functional use in the future. Three of the six horses were treated surgically with bursoscopic debridement. The cosmetic results were excellent in two of these three horses. One horse that underwent an operation experienced a recurrence. None of the horses with bursitis treated medically experienced resolution of the problem.

CONCLUSION

Bursoscopy is a technique to consider for the management of bursitis of the LDET at the level of the fetlock combined with prolonged bandage application when medical treatment has failed to manage the condition.

CLINICAL SIGNIFICANCE

To the best of our knowledge, subtendinous bursitis of the LDET in the hind limb is not a commonly diagnosed condition. This small case series provides some insight into methods for the clinical management of this issue.

An equine cadaver study investigating the relationship between cervical flexion, nuchal ligament elongation and pressure at the first and second cervical vertebra

Pressure in the atlanto-axial region due to hyperflexion ('rollkur') may influence the development of a nuchal bursa, as adventitious bursae may be caused by pressure. Investigating the pressure between the nuchal ligament and atlas/axis in a flexed position may provide information on the pathogenesis of nuchal bursitis. In this study, ten equine head and neck specimens with one side of the soft tissues over the cervical vertebral spine removed were placed in lateral recumbency on a table in neutral, mildly flexed, and hyperflexed head and neck positions. Angulations of the neck were measured using markers placed on the nuchal ligament and drilled into the skull, vertebrae and withers. In six specimens, the pressure between the nuchal ligament and the atlas and the axis was measured using an inflatable air pouch. Hyperflexion was associated with the highest nuchal ligament length and with the highest pressure values at the site of the nuchal bursa over the atlas (99±24mmHg, more than four times the pressure in the neutral position) and over the axis (77±30mmHg, more than twice the pressure values of the neutral position). Also, over the three head and neck positions, neck flexion angles were highly correlated with pressure values and with nuchal ligament length. This marked increase in pressure at the level of atlas and axis caused by head and neck hyperflexion should be considered during training of horses at risk of, or diagnosed with, nuchal bursitis.