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Cender AN, Mählmann K, Ehrle A, Merle R, Pieper L, Lischer CJ. Diagnosis and outcome following tenoscopic surgery of the digital flexor tendon sheath in German sports and pleasure horses. Equine Vet J 2023; 55:48-58. [PMID: 35822486 DOI: 10.1111/evj.13856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 06/17/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Digital flexor tendon sheath (DFTS) pathology is an important cause of lameness in horses. The outcome after surgical treatment is variable and depends on the exact diagnosis. OBJECTIVES To (1) describe the prevalence of lesions associated with lameness caused by nonseptic DFTS tenosynovitis in a large population of German sports and pleasure horses; (2) determine the sensitivity and specificity of diagnostic imaging techniques for identifying lesions within the DFTS with tenoscopic diagnosis being the gold standard; (3) explore associations between tenoscopically diagnosed lesions and signalment, purpose, and limb affected; and (4) describe the outcome following DFTS tenoscopy with nonseptic DFTS tenosynovitis in this population. STUDY DESIGN Retrospective case series. METHODS Medical records of horses admitted for tenoscopic surgery of nonseptic DFTS tenosynovitis between 2011 and 2020 were reviewed. Follow-up information was obtained via telephone contact. Sensitivity and specificity of ultrasonography and contrast tenography were determined using tenoscopic diagnosis as gold standard and univariable analysis was used to explore associations between signalment, case history, and tenoscopic diagnosis. RESULTS Medical records from 131 horses were retrieved, of which 8 horses had bilateral disease and 6 horses were presented for tenoscopy on two separate occasions (3 for tenoscopy in the same limb, 3 in a different limb), thus, making a total of 145 limbs. Lesions were most commonly diagnosed in the deep (DDFT; n = 55 limbs) and superficial (SDFT; n = 55 limbs) digital flexor tendons. Manica flexoria (MF) lesions were detected in 44 limbs and palmar/plantar annular ligament (PAL) constriction in 99 limbs. In 36 limbs, only one structure within the DFTS was injured, whereas in 109 limbs a combination of lesions was noted, the most common being the combination of a SDFT lesion with PAL constriction. All affected limbs were examined with diagnostic ultrasonography; contrast tenography was performed in 86 limbs. For diagnosis of MF and DDFT tears, tenography was more sensitive (89% [confidence interval, CI: 65.4%-95.2%]; 72% [CI: 46.4%-89.3%], respectively) than specific (64% [CI: 52.5%-77.6%]; 53% [CI: 42.2%-73.3%], respectively) whereas ultrasonography was more specific (92% [CI: 84.5%-96.3%]; 92% [CI: 83.6%-96.0%]) with lower sensitivity (64% [CI: 47.7%-77.2%]; 54% [CI: 39.5%-67.9%]). For SDFT lesions, ultrasonography was highly specific (94% [CI: 86.9%-97.9%]) with lower sensitivity (66% [CI: 51.3%-77.4%]). Follow-up information following first surgery was obtained for 118 horses (132 limbs): 18 (15.3%) of 118 horses remained chronically lame, 40 (33.8%) performed at a reduced level and 60 (50.8%) performed at the same or higher level following rehabilitation after tenoscopy. Horses with DDFT lesions had the poorest outcomes with only 36.6% returning to the same or higher level of exercise. MAIN LIMITATIONS Retrospective analysis of clinical records and subjective outcome assessment based on owner follow-up with potential recall bias. Findings on diagnostic imaging are impacted by many factors including equipment quality and operator expertise and experience. CONCLUSION Diagnostic imaging techniques were complimentary and contrast tenography was sensitive and ultrasonography was specific for the diagnosis of MF and DDFT lesions. Following tenoscopic surgery for nonseptic tenosynovitis of the DFTS, approximately half the cases were able to return to preinjury level of exercise.
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Affiliation(s)
- Andrea N Cender
- Equine Clinic at the Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Kathrin Mählmann
- Equine Clinic at the Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Anna Ehrle
- Equine Clinic at the Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Roswita Merle
- Equine Clinic at the Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Laura Pieper
- Equine Clinic at the Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Christoph J Lischer
- Equine Clinic at the Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
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A Descriptive Study of the Clinical Presentation, Management, and Outcome of Horses with Acute Soft Tissue Trauma of the Tarsus and the Association with Synovial Involvement. Animals (Basel) 2022; 12:ani12040524. [PMID: 35203232 PMCID: PMC8868076 DOI: 10.3390/ani12040524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary The hock is commonly involved in traumatic injuries in horses and due to the large number of synovial structures located in the region, this frequently results in synovial infection which is a major and potentially life-threatening complication in horses. The aim of this retrospective study was to describe the clinical presentation, diagnostic procedures, management, and outcome of cases with acute soft tissue trauma to the hock and to identify the clinical features that were associated with synovial infection in these cases. This study found that increased synovial effusion, severe lameness on admission, and the persistence of lameness as well as certain wound locations were more commonly associated with a diagnosis of synovial infection. Advanced diagnostic modalities such as radiographs, ultrasonography, and measurements of inflammatory markers aided in establishing the correct diagnosis. The duration of systemic antimicrobial treatment was shorter than previously reported and many cases received local antimicrobial treatment at the site of injury, which may have improved its efficacy. At the time of discharge, while lameness was still present in some cases, the overall survival was excellent. This study describes the clinical features and treatment of these commonly encountered injuries, and this knowledge may benefit clinicians in the future. Abstract The tarsus is one of the most common areas of traumatic injury with associated synovial involvement (SI) in horses. The aim of this retrospective study was to describe the clinical presentation, diagnostic procedures, management (emphasizing the type, duration, and route of antimicrobial administration), and outcome of cases with acute soft tissue trauma to the tarsal region. The presenting clinical features, the results of diagnostic modalities, and the initial response to therapy were assessed for their usefulness to predict SI. Medical records of 72 cases were included and SI was diagnosed in 34 cases (47.2%). Increased synovial effusion, lameness on admission (OR = 4.1; 95%CI 1.0–16.4), persistent lameness (OR = 5.7; 95%CI 1.8–17.9), increased blood SAA values (≥200 mg/L) from initial to second measurement (OR = 4.3; 95%CI 1.2–15.5), and wound location on the plantar/plantarolateral/plantaromedial compared to the lateral aspect of the tarsus (OR = 7.0; 95%CI 1.6–30.9) were associated with SI. Radiographs, ultrasonography, and the use of pressure testing when a wound was present proved to be useful in correctly diagnosing SI. The median duration of systemic antimicrobial administration was 8 (IQR: 5 to 9) days and most horses received local antimicrobial therapy. This study highlights several relevant clinical features and their association with SI and emphasizes the usefulness of local antimicrobial therapy in these cases.
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de Souza TC, Suthers JM, Busschers E, Burford JH, Freeman SL. A scoping review of the current evidence on treatment and outcomes following synovial sepsis. Equine Vet J 2021; 54:467-480. [PMID: 34706106 DOI: 10.1111/evj.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/06/2021] [Accepted: 10/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Synovial sepsis is a frequent cause of morbidity and mortality in horses. Despite advances in diagnostics and treatments, persistent infection or chronic lameness can occur. OBJECTIVES To perform a scoping review to identify and evaluate the current evidence on the factors implicated in the success of treatment for synovial sepsis. STUDY DESIGN Joanna Briggs Institute scoping review. METHODS A protocol was registered, and a systematic literature search was performed on CAB abstracts, Medline, Scopus and Embase. Inclusion and exclusion criteria were developed and studies systematically reviewed against this. Studies relating to factors affecting treatment success following synovial sepsis were retained and data was extracted on study method, population characteristics and factors significantly associated with treatment outcome. RESULTS In total, 2338 studies were identified, and 61 were included to full paper analysis. Eight papers reported significant factors, identifying 15 risk factors associated with two measurements of outcome, either survival and/or return to athletic function. The 15 factors were identified and categorised into pre-, intra- and post-operative factors. Risk factors that were identified included the number or type of synovial structures involved, the presence of pannus, tendon and bone pathology, and the use of systemic antimicrobials. There were many discrepancies in inclusion criteria of cases of synovial sepsis as well as measurement and description of outcome variables. MAIN LIMITATIONS Non-English language studies or conference proceedings were not included. Only small numbers of papers had similar findings. CONCLUSIONS Standardisation of inclusion criteria is essential to enable comparisons and analysis between studies on synovial sepsis. Future studies should use methodologies to reduce bias including multicentre and multinational studies, prospective study design and robust statistical modelling.
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Affiliation(s)
- Therese C de Souza
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | | | | | - John H Burford
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - Sarah L Freeman
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
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Lenoir A, Schramme M, Segard‐Weisse E, Zimmerman M, Lepage OM. Tenectomy of the superficial digital flexor tendon as a treatment of suspected septic tendinitis and tenosynovitis of the digital flexor tendon sheath followed by rehabilitation with an orthotic device. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Lenoir
- Centre for Equine Health Ecole Nationale Vétérinaire de Lyon VetAgro Sup University of Lyon Marcy‐l’Etoile France
| | - M. Schramme
- Centre for Equine Health Ecole Nationale Vétérinaire de Lyon VetAgro Sup University of Lyon Marcy‐l’Etoile France
| | - E. Segard‐Weisse
- Centre for Equine Health Ecole Nationale Vétérinaire de Lyon VetAgro Sup University of Lyon Marcy‐l’Etoile France
| | - M. Zimmerman
- Centre for Equine Health Ecole Nationale Vétérinaire de Lyon VetAgro Sup University of Lyon Marcy‐l’Etoile France
| | - O. M. Lepage
- Centre for Equine Health Ecole Nationale Vétérinaire de Lyon VetAgro Sup University of Lyon Marcy‐l’Etoile France
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Duggan MJS, Mair TS. Comparison of outcomes following treatment of septic calcaneal bursitis by needle or bursoscopic lavage: A retrospective study of 29 horses. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. J. S. Duggan
- Bell Equine Veterinary Clinic Mereworth Maidstone Kent ME18 5GS UK
| | - T. S. Mair
- Bell Equine Veterinary Clinic Mereworth Maidstone Kent ME18 5GS UK
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Crosby DE, Labens R, Hughes KJ, Nielsen S, Hilbert BJ. Factors Associated With Survival and Return to Function Following Synovial Infections in Horses. Front Vet Sci 2019; 6:367. [PMID: 31696123 PMCID: PMC6817570 DOI: 10.3389/fvets.2019.00367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022] Open
Abstract
Synovial infections (SI) are common in horses of all ages and can be associated with high rates of morbidity and mortality. Identifying factors influencing survival and return to function may be useful for management of affected individuals and determination of prognosis. The objectives of this study were to identify factors associated with survival and return to function of horses and foals with SI presented to an equine hospital. This study is a retrospective case series. Data were collected from medical records of all horses with SI that were presented to a single equine hospital between April 1st, 2008 and May 1st, 2017. Long–term follow up was obtained by a semi-structured telephone questionnaire of clinical outcomes and analysis of online race records. Univariate models were created using generalized linear and linear mixed models to assess factors associated with outcomes. Multivariable models were created using generalized linear and linear mixed models to determine factors significantly associated with outcomes. Of 186 horses presented with SI, 161/186 (86.6%) were treated and 145/161 (90.1%) survived to discharge. The majority of joints were treated with synovial lavage (93.8%). One hundred and twenty horses were included in the return to function analysis and 79 (65%) returned to function. Increasing number of days of treatment with systemic antimicrobials was associated with increased likelihood of survival for each horse (OR 1.15, 95% CI 1.04−1.27, P = 0.025) and when considering each individual synovial structure (OR 1.11, 95% CI 1.04−1.17, P = 0.004). Horses treated with doxycycline were less likely to return to function (OR 0.39, 95% CI 0.19−0.8, P = 0.031). The overall rate of survival of horses treated with SI is good. The likelihood of return to function is lower than for survival. The findings of this study, combined with relevant antimicrobial stewardship practices, can be used as a part of evidence-based decision-making when veterinarians are treating horses with SI.
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Affiliation(s)
- Danielle E Crosby
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Raphael Labens
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Kristopher J Hughes
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Sharon Nielsen
- Sharon Nielsen Statistical Consulting and Training, Wagga Wagga, NSW, Australia
| | - Bryan J Hilbert
- School of Animal and Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
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Byrne CA, Lumsden JM, Lang HM, O'Sullivan CB. Synovial sepsis of unknown origin in the adult Thoroughbred racehorse. Equine Vet J 2019; 52:91-97. [PMID: 31006125 DOI: 10.1111/evj.13127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Synovial sepsis of unknown origin is a rare cause of lameness in the adult horse, and a haematogenous pathogenesis has been proposed in previous cases. OBJECTIVES To describe the features and outcome of synovial sepsis of unknown origin in adult Thoroughbred racehorses. STUDY DESIGN Retrospective case series. METHODS Hospital records for admissions between 2005 and 2015 were reviewed to identify adult horses diagnosed with synovial sepsis of unknown origin. Presentation, clinicopathological, microbiological and diagnostic imaging findings were recorded. Treatment methods, surgical findings, complications and long-term outcome were evaluated. RESULTS Eleven cases were identified over the study period. Diagnosis was established from clinical examination and clinicopathologic findings, which were comparable to other aetiologies of synovial sepsis. Affected structures included synovial joints, tendon sheaths and bursae. Concurrent osteochondritis dissecans or articular cartilage lesions were evident during arthroscopic surgery in three cases. Significant intrasynovial haemorrhage was not identified. Microbial culture of synovial fluid or synovial biopsy was positive in 6/11 of cases, with all isolates being Gram-positive cocci. Of the 6 positive microbial cultures, all isolates demonstrated in vitro sensitivity to a cephalosporin antimicrobial agent. A concurrent remote wound was present in a single case. No other potential origins of bacteraemia were identified. Treatment methods included endoscopic surgery, standing multineedle lavage, intravenous regional limb perfusion, intrasynovial medication and/or systemic antimicrobial administration. All horses survived to hospital discharge. For the 6/11 cases that raced following synovial sepsis, the median period for return to racing was 221 days. MAIN LIMITATIONS A small study population, which was retrospectively reviewed. CONCLUSIONS Synovial sepsis of unknown origin is rare in the adult Thoroughbred racehorse and can affect a range of synovial structures. A concurrent potential source of bacteraemia is rarely identified. With appropriate management, the prognosis to return to racing is fair.
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Affiliation(s)
- C A Byrne
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - J M Lumsden
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - H M Lang
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
| | - C B O'Sullivan
- Randwick Equine Centre, Randwick, Sydney, New South Wales, Australia
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Suarez‐Fuentes DG, Caston SS, Tatarniuk DM, Kersh KD, Ferrero NR. Outcome of horses undergoing navicular bursotomy for the treatment of contaminated or septic navicular bursitis: 19 cases (2002–2016). Equine Vet J 2017; 50:179-185. [DOI: 10.1111/evj.12733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 07/28/2017] [Indexed: 11/28/2022]
Affiliation(s)
- D. G. Suarez‐Fuentes
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Iowa State University Ames Iowa USA
| | - S. S. Caston
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Iowa State University Ames Iowa USA
| | - D. M. Tatarniuk
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Iowa State University Ames Iowa USA
| | - K. D. Kersh
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Iowa State University Ames Iowa USA
| | - N. R. Ferrero
- Department of Veterinary Clinical Sciences College of Veterinary Medicine Iowa State University Ames Iowa USA
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Orsini JA. Meta-Analysis of Clinical Factors Affecting Synovial Structure Infections and Prognosis. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Butz N, Dreyfus A, Fürst AE, Bischofberger AS. Wounds to the dorsal carpus (coronation injury) in horses: Treatment, complications and survival. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N. Butz
- Equine Hospital; Equine Department; University of Zürich; Switzerland
| | - A. Dreyfus
- Epidemiology Section; Vetsuisse Faculty; University of Zürich; Switzerland
| | - A. E. Fürst
- Equine Hospital; Equine Department; University of Zürich; Switzerland
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Abstract
The current understanding of pathology as it relates to common diseases of the equine musculoskeletal system is reviewed. Conditions are organized under the fundamental categories of developmental, exercise-induced, infectious, and miscellaneous pathology. The overview of developmental pathology incorporates the new classification system of juvenile osteochondral conditions. Discussion of exercise-induced pathology emphasizes increased understanding of the contribution of cumulative microdamage caused by repetitive cyclic loading. Miscellaneous musculoskeletal pathology focuses on laminitis, which current knowledge indicates should be regarded as a clinical syndrome with a variety of possible distinct mechanisms of structural failure that are outlined in this overview.
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Affiliation(s)
- Frances J Peat
- Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Rd, Fort Collins, CO 80523, USA
| | - Christopher E Kawcak
- Equine Orthopaedic Research Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, 300 West Drake Rd, Fort Collins, CO 80523, USA.
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Pilati N, Pepe M, Gialletti R, Moriconi F, Beccati F. Septic Tenosynovitis Caused by Porcupine Quills: Clinical and Diagnostic Findings, Treatment, and Long-Term Outcome in Seven Horses. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Beccati F, Gialletti R, Passamonti F, Nannarone S, Di Meo A, Pepe M. Ultrasonographic findings in 38 horses with septic arthritis/tenosynovitis. Vet Radiol Ultrasound 2014; 56:68-76. [PMID: 25046562 DOI: 10.1111/vru.12183] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/06/2014] [Indexed: 11/29/2022] Open
Abstract
Septic arthritis/tenosynovitis in the horse can have life-threatening consequences. The purpose of this cross-sectional retrospective study was to describe ultrasound characteristics of septic arthritis/tenosynovitis in a group of horses. Diagnosis of septic arthritis/tenosynovitis was based on historical and clinical findings as well as the results of the synovial fluid analysis and/or positive synovial culture. Ultrasonographic findings recorded were degree of joint/sheath effusion, degree of synovial membrane thickening, echogenicity of the synovial fluid, and presence of hyperechogenic spots and fibrinous loculations. Ultrasonographic findings were tested for dependence on the cause of sepsis, time between admission and beginning of clinical signs, and the white blood cell counts in the synovial fluid. Thirty-eight horses with confirmed septic arthritis/tenosynovitis of 43 joints/sheaths were included. Degree of effusion was marked in 81.4% of cases, mild in 16.3%, and absent in 2.3%. Synovial thickening was mild in 30.9% of cases and moderate/severe in 69.1%. Synovial fluid was anechogenic in 45.2% of cases and echogenic in 54.8%. Hyperechogenic spots were identified in 32.5% of structures and fibrinous loculations in 64.3%. Relationships between the degree of synovial effusion, degree of the synovial thickening, presence of fibrinous loculations, and the time between admission and beginning of clinical signs were identified, as well as between the presence of fibrinous loculations and the cause of sepsis (P ≤ 0.05). Findings indicated that ultrasonographic findings of septic arthritis/tenosynovitis may vary in horses, and may be influenced by time between admission and beginning of clinical signs.
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Affiliation(s)
- Francesca Beccati
- Centro di Studi del Cavallo Sportivo, Dipartimento di Medicina Veterinaria, Università degli Studi di Perugia, Italy
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Milner PI, Bardell DA, Warner L, Packer MJ, Senior JM, Singer ER, Archer DC. Factors associated with survival to hospital discharge following endoscopic treatment for synovial sepsis in 214 horses. Equine Vet J 2014; 46:701-5. [DOI: 10.1111/evj.12212] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- P. I. Milner
- Institute of Ageing and Chronic Disease University of Liverpool Neston UK
| | - D. A. Bardell
- School of Veterinary Science Institute of Learning and Teaching University of Liverpool Neston UK
| | - L. Warner
- School of Veterinary Science Institute of Learning and Teaching University of Liverpool Neston UK
| | - M. J. Packer
- School of Veterinary Science Institute of Learning and Teaching University of Liverpool Neston UK
| | - J. M. Senior
- Institute of Infection and Global Health University of Liverpool Neston UK
| | - E. R. Singer
- Institute of Ageing and Chronic Disease University of Liverpool Neston UK
| | - D. C. Archer
- Institute of Infection and Global Health University of Liverpool Neston UK
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Findley JA, Pinchbeck GL, Milner PI, Bladon BM, Boswell J, Mair TS, Suthers JM, Singer ER. Outcome of horses with synovial structure involvement following solar foot penetrations in four UK veterinary hospitals: 95 cases. Equine Vet J 2013; 46:352-7. [DOI: 10.1111/evj.12124] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 06/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J. A. Findley
- Philip Leverhulme Equine Hospital; School of Veterinary Science; University of Liverpool; UK
| | - G. L. Pinchbeck
- Department of Animal and Population Health; School of Veterinary Science; University of Liverpool; UK
| | - P. I. Milner
- Philip Leverhulme Equine Hospital; School of Veterinary Science; University of Liverpool; UK
| | - B. M. Bladon
- Donnington Grove Veterinary Centre; Newbury Berkshire UK
| | - J. Boswell
- The Liphook Equine Hospital; Liphook Hampshire UK
| | - T. S. Mair
- The Bell Equine Clinic; Meresworth Kent UK
| | - J. M. Suthers
- Philip Leverhulme Equine Hospital; School of Veterinary Science; University of Liverpool; UK
| | - E. R. Singer
- Philip Leverhulme Equine Hospital; School of Veterinary Science; University of Liverpool; UK
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Rubio-Martínez LM, Elmas CR, Black B, Monteith G. Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999-2009). J Am Vet Med Assoc 2013; 241:1650-8. [PMID: 23216042 DOI: 10.2460/javma.241.12.1650] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the clinical use of regional limb perfusion with antimicrobials (A-RLP), complications, and outcome in a large series of patients. DESIGN Retrospective case series. ANIMALS 174 horses. PROCEDURES Medical records of horses treated with A-RLP between 1999 and 2009 were reviewed. Signalment, primary complaint, horse use, etiology, duration of clinical signs, previous treatment, structures involved, concurrent conditions, A-RLP characteristics, additional treatments, complications, and outcome were recorded. At long-term follow-up, 2 outcomes were investigated: survival rate and return to previous use at the same or higher level. Univariate and multivariate logistic regression analyses were conducted. RESULTS Group 1 (96 horses) included septic synovitis. Group 2 (50 horses) included extrasynovial lacerations (23 horses) and fresh, minimally contaminated intrasynovial lacerations without evidence of established synovial infection (27 horses). Group 3 (28 horses) included miscellaneous other conditions. Only minor complications were reported in 12.26% of horses that received IV (n = 155) and 33% of horses that received intraosseous (27) A-RLP. Horses with septic synovitis had a lower survival rate (53.43%) than did horses with lacerations (91.89%). Within group 2, no significant differences in short- or long-term outcomes were found between horses with extrasynovial and fresh, minimally contaminated intrasynovial lacerations. For the horses returning to previous use, 80% of horses with septic synovitis and 72.72% of horses with lacerations were performing at the same or higher level at the time of follow-up. CONCLUSIONS AND CLINICAL RELEVANCE The results of the present study indicated that A-RLP is a safe technique with minimal adverse effects. The IV route presented fewer complications than intraosseous injection. Horses with infection of synovial structures had a lower survival rate than did those with acute, minimally contaminated intrasynovial lacerations. The latter had a similar prognosis for horses with extrasynovial lacerations treated with A-RLP.
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Affiliation(s)
- Luis M Rubio-Martínez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada.
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Mc Nally TP, Slone DE, Hughes FE, Lynch TM. Tenosynoviotomy for sepsis of the digital flexor tendon sheath in 9 horses. Vet Surg 2012; 42:114-8. [PMID: 23164091 DOI: 10.1111/j.1532-950x.2012.01033.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe a tenosynoviotomy technique for treatment of sepsis of the digital flexor tendon sheath (DFTS) in horses and report long-term outcome. STUDY DESIGN Case series. ANIMALS Horses (n = 9). METHODS Horses were positioned in lateral recumbency with the affected limb uppermost. A linear incision was made just lateral to the mesotenon beginning 5 cm proximal to the apices of the proximal sesamoid bones, extending 2 cm distal to the bifurcation of the superficial digital flexor tendon (SDFT). The incision was continued through the skin, subcutaneous tissue, palmar/plantar annular ligament, and DFTS. Tenotomy of the distal lateral branch of the SDFT was also performed. The site was thoroughly debrided, lavaged, and packed with gauze and allowed to heal by second intention. Follow-up was obtained via owner telephone interview. RESULTS Mean surgery time was 32 minutes (range, 10-64 minutes). Systemic antibiotics were administered postoperatively (range, 11-46 days; mean, 23 days). Mean hospitalization was 11 days (range, 0-49 days). Follow-up was available for 7 (70%) horses. One year postoperatively, 5 (71%) horses were serviceable for their intended use, and 2 (29%) had been euthanatized. Of 5 survivors, 3 returned to ridden exercise, 1 was retired as a broodmare, and 1 was a broodmare. All owners were satisfied with the cosmetic appearance of the surgery site. CONCLUSION Open drainage via tenosynoviotomy, performed as a salvage procedure, represents a feasible treatment for DFTS sepsis.
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Kelmer G, Tatz A, Bdolah-Abram T. Indwelling cephalic or saphenous vein catheter use for regional limb perfusion in 44 horses with synovial injury involving the distal aspect of the limb. Vet Surg 2012; 41:938-43. [PMID: 22809228 DOI: 10.1111/j.1532-950x.2012.01006.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe indwelling cephalic or saphenous vein catheter use for intravenous regional limb perfusion (ID-IV-RLP) to treat horses with synovial injury (contamination/infection) of the distal aspect of the limb. STUDY DESIGN Retrospective case series. ANIMALS Horses (n = 44; 45 limbs) treated with proximal ID-IV-RLP. METHODS Horses had ID-IV-RLP using a cephalic (21 limbs) or saphenous (24 limbs) vein. Amikacin was the most frequently used antibiotic. Number of perfusions ranged from 3 to 21 (median 7). A cast was applied to 14 injured limbs (1 tube cast, 1 full-limb cast, 2 foot casts, and 10 half-limb casts). RESULTS Synovial sepsis of the distal portion of 87% of limbs (39) resolved, and 61% of horses returned to soundness. Catheter-related complications occurred in 27% of the limbs but were not significantly associated with outcome. Presence of osteomyelitis was significantly associated with a poor outcome. CONCLUSIONS ID-IV-RLP using the cephalic or saphenous vein is an alternative to traditional RLP. An indwelling catheter provided prolonged venous access and facilitated successive perfusions.
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Affiliation(s)
- Gal Kelmer
- Department of Large Animal Medicine and Surgery, Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Israel.
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Marsh CA, Watkins JP, Schneider RK. Intrathecal Deep Digital Flexor Tenectomy for Treatment of Septic Tendonitis/Tenosynovitis in Four Horses. Vet Surg 2011; 40:284-90. [DOI: 10.1111/j.1532-950x.2011.00795.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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