Use of ethanol in the treatment of distal tarsal joint osteoarthritis: 24 cases

Pilot testing an ethanol cornual nerve block as a long-term analgesic for calf disbudding

Disbudding prevents horn growth in calves through thermal or chemical cauterization and causes damage that is painful for weeks following the procedure. Current pain management strategies are only effective from 1 to 2 h (local anesthetic) to 1 to 3 d (nonsteroidal anti-inflammatory drugs). A potential practical solution for addressing longer-term pain may be to administer ethanol as a cornual nerve block. When administered at a high concentration, ethanol damages the functionality of peripheral nerves, promoting localized long-lasting analgesia. It is also thought to be painful, thus ethanol may be combined with lidocaine, as a mixed solution or administered beforehand. We tested the use of an ethanol cornual nerve block for anesthesia around the horn bud in 2 pilot studies. We used different concentrations and amounts of ethanol (100% and 70%) in combination with different ratios of lidocaine in our attempt to identify an effective block. In pilot 1, 14 nondisbudded calves were administered 2 to 4 mL of 100% ethanol below the bony ridge on each side of the head to block the cornual nerve at 3 to 10 d of age (n = 28 horn buds) and observed for 5 wk. The duration of loss of sensation was evaluated using pinprick tests 10 min, 1, 3, and 7 d after the block, and then weekly thereafter until 35 d or full sensation had returned. Pinprick tests consisted of lightly pressing a needle in 10 evenly spaced locations around the base of the horn bud (0 responses = no sensation, 1-5 responses = partial sensation, 6-10 responses = full sensation). Pilot 2 looked at the 24 h after the injection and consisted of 9 nondisbudded calves (5 mL of 2:1, 70% ethanol and 2% lidocaine per horn bud) and 6 disbudded individuals (5 mL of 100% ethanol, 70% ethanol, or 2% lidocaine per horn bud). All treatments were administered at the calf level. Anesthesia was checked 10 min after the injection and 4 or 16 h later. In pilot 1, on the day of the ethanol injection (0 d), there was no sensation in 85% of horn buds. Sensation began to return as early as 1 d after blocking, with only 50%, 21%, and 3% of horn buds having no sensation at 1, 7, and 35 d, respectively. Partial sensation was present in 25%, 17%, and 10% of horn buds at these time points. In pilot 2, 27.8% of horn buds in the nondisbudded group had no sensation, whereas 33.3% had partial sensation 10 min after the injection. In the disbudded calves 10 min after the injection, 100% of horn buds from the 100% ethanol group had partial sensation and 100% of horn buds administered 70% ethanol had full sensation. Four or sixteen hours later, 100% of horn buds had full sensation. Together, in these pilot studies, ethanol provided inconsistent anesthesia when used for a cornual nerve block.

Use of Locking Compression Plate and Locking Compression T-Plate for Surgical Arthrodesis of the Carpometacarpal and Distal Tarsal Joints in 13 Horses

OBJECTIVE

 The aim of this study was to describe the use of the locking compression plate (LCP) and locking compression T-plate (LCTP) in cases of carpometacarpal and distal tarsal arthrodesis for the treatment of osteoarthritis and small carpal or tarsal bone fractures, and to document clinical outcomes.

STUDY DESIGN

 Case records of horses treated with carpometacarpal or distal tarsal arthrodesis via internal fixation using an LCP or LCTP between 2013 and 2021 were reviewed. All cases were evaluated retrospectively. Follow-up information was gained via phone conversation with owners and referring veterinarians.

RESULTS

 Data were collected for 13 horses that fulfilled the study criteria. A total of eight horses underwent distal tarsal arthrodesis, and five underwent carpometacarpal arthrodesis. Twelve of thirteen horses went back to some level of athletic performance. Eight of 13 returned to the same level, while 4 of 13 returned to a lower level. Minor postoperative complications were recorded in 3 of 13 cases, with all horses suffering manageable short-term complications returning to the same level of work. Two horses suffered a major complication, with one resulting in euthanasia.

CONCLUSION

 Carpometacarpal and distal tarsal arthrodesis performed using the LCP and LCTP allowed all surviving horses in the study to obtain immediate postoperative comfort and eventual return to use.

Assessment of intrasynovial injection in horses by contrast-enhanced ultrasonography using air bubbles created by agitation of solution

BACKGROUND

Accuracy of intrasynovial injections can be challenging to assess in a clinical setting in horses. Contrast-enhanced ultrasonography (CEUS) using injectate agitated with air has been used to determine the success rates of synovial injections in human rheumatology.

OBJECTIVES

To assess the diagnostic sensitivity and specificity of CEUS and to describe its clinical use.

STUDY DESIGNS

Cadaveric study followed by a prospective descriptive observational study.

METHODS

Part 1: CEUS was performed following injection of agitated methylene-blue solution targeting 13 different anatomical synovial structures from three equine cadavers. Contrast was seen as hyperechoic dots, patches or lines on ultrasonography. CEUS was classified as positive if contrast was considered to be intrasynovial and negative if contrast was considered to be extrasynovial. A second synoviocentesis was performed to determine if the injection was intrasynovial based on the presence or absence of methylene-blue. Estimates of sensitivity and specificity were calculated. Part 2: CEUS was performed following injection of agitated solutions targeting synovial structures as part of routine investigation and treatment of clinical cases.

RESULTS

Part 1: CEUS was correctly classified as positive or negative in all intrasynovial and extrasynovial injections respectively. The sensitivity estimate was 100% (CI 93%-100%) and the specificity estimates was 100% (CI 16%-100%). Part 2: The technique was used safely for 26 injections (14 horses; 19 different synovial structures) administered to localise or treat lameness. Traumatic intersynovial communications or synovial membrane defects were identified using CEUS in 3 horses.

MAIN LIMITATIONS

The low number of extrasynovial injections in Part 1 resulted in an imprecise specificity estimate.

CONCLUSIONS

In horses, CEUS performed following intended intrasynovial injection can be useful for identifying unsuccessful injections.

Metabonomic-Transcriptome Integration Analysis on Osteoarthritis and Rheumatoid Arthritis

Purpose

This study is aimed at exploring the potential metabolite/gene biomarkers, as well as the differences between the molecular mechanisms, of osteoarthritis (OA) and rheumatoid arthritis (RA).

Methods

Transcriptome dataset GSE100786 was downloaded to explore the differentially expressed genes (DEGs) between OA samples and RA samples. Meanwhile, metabolomic dataset MTBLS564 was downloaded and preprocessed to obtain metabolites. Then, the principal component analysis (PCA) and linear models were used to reveal DEG-metabolite relations. Finally, metabolic pathway enrichment analysis was performed to investigate the differences between the molecular mechanisms of OA and RA.

Results

A total of 976 DEGs and 171 metabolites were explored between OA samples and RA samples. The PCA and linear module analysis investigated 186 DEG-metabolite interactions including Glycogenin 1- (GYG1-) asparagine_54, hedgehog acyltransferase- (HHAT-) glucose_70, and TNF receptor-associated factor 3- (TRAF3-) acetoacetate_35. Finally, the KEGG pathway analysis showed that these metabolites were mainly enriched in pathways like gap junction, phagosome, NF-kappa B, and IL-17 pathway.

Conclusions

Genes such as HHAT, GYG1, and TRAF3, as well as metabolites including glucose, asparagine, and acetoacetate, might be implicated in the pathogenesis of OA and RA. Metabolites like ethanol and tyrosine might participate differentially in OA and RA progression via the gap junction pathway and phagosome pathway, respectively. TRAF3-acetoacetate interaction may be involved in regulating inflammation in OA and RA by the NF-kappa B and IL-17 pathway.

Retrospective evaluation of facilitated pastern ankylosis using intra-articular ethanol injections: 34 cases (2006-2012)

REASONS FOR PERFORMING STUDY

While surgical arthrodesis is the treatment of choice for osteoarthritis of the proximal interphalangeal joint, some clients are unable to pursue surgery due to costs. A more economical technique was sought using intra-articular ethyl alcohol injections to facilitate ankylosis.

OBJECTIVES

To describe the technique and outcome of intra-articular ethyl alcohol injections for facilitated ankylosis of proximal interphalangeal joints with osteoarthritis.

METHODS

As a retrospective case series, the medical records (2006-2012) of clinical cases diagnosed with proximal interphalangeal joint osteoarthritis treated with intra-articular ethyl alcohol injections were reviewed. Cases with follow-up of at least 6 months were included. Technique and outcome were determined. Evaluation of outcome was assessed using return to previous performance or intended use and owner satisfaction as the indicators of success. Soundness and level of work are also reported.

RESULTS

Thirty-four horses were included in the study. At the time of follow-up, 17 horses (50%) were sound, while 13 horses (38%) were improved but not sound. One horse's lameness was unchanged, and 3 horses were lost to follow-up. The median time until horses became sound or returned to work was 8 months. Six horses had complications, 4 of which were mild and transient.

CONCLUSIONS AND POTENTIAL RELEVANCE

The use of intra-articular ethyl alcohol in the proximal interphalangeal joint in horses affected by osteoarthritis appears to be a viable method for facilitated ankylosis if surgical management is not an option.