Urea as a measure of dilution of equine synovial fluid

This paper tests the hypothesis that serum and synovial urea concentrations are similar and that urea concentration can be used as an accurate marker for synovial fluid dilution in normal equine joints. Serum and synovial fluid urea concentrations were compared in 42 horses and were equivalent for individual horses (P<0.0001). Mean +/- s.e. serum concentration was 6.1+/-0.552 mmol/l and synovial concentration 6.0+/-0.459 mmol/l. The normal range for synovial urea concentration was determined as 2.5-7.7 mmol/l. The synovial urea concentration from different synovial structures in individual horses were compared and were equivalent (P = 0.002). Known dilutions of synovial fluid with saline were made. The actual and expected synovial urea concentrations were compared and were equivalent (P<0.001). An accurate method of calculating synovial fluid dilution has been determined.

Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 1: forelimb foot and carpus

This paper tests the hypothesis that the local analgesic agent mepivacaine diffuses between adjacent equine synovial structures in the forelimb and with greater frequency than latex, gelatine dye or contrast media. We report the incidence of diffusion of mepivacaine between the distal interphalangeal joint (DIPJ) and navicular bursa (NB) of the forelimbs and between the intercarpal (IC) and radiocarpal (RC) joints of 31 fresh equine cadavers. The DIPJ of one forelimb and the NB of the contra lateral forelimb and the RC joint of one forelimb and the IC joint of the contra lateral forelimb were injected with mepivacaine. After flexion and extension of the joints, synovial fluid was obtained from the synovial structures adjacent to the injected synovial structures. The concentration of mepivacaine in these samples was determined using an enzyme linked immunosorbent assay. For samples obtained by dilution of synovial fluid, the concentration of mepivacaine was determined by comparing the concentrations of urea in the diluted synovial fluid and the concentration of serum urea. Mepivacaine diffused from the DIPJ to the NB or from the NB to the DIPJ in 25/25 (100%) limbs. Mepivacaine diffused from the IC to RC joints in 24/25 (96%) limbs and from the RC to IC joints in 21/25 (84%) limbs. It was detected at concentrations >0.3 mg/l in 9/25 (36%) of IC joints after RC joint injection and in 25/25 (100%) of the NB after DIPJ injection; at concentrations >100 mg/l in 2/25 (8%) of IC and RC joints and 12/25 (48%) of NB following DIPJ injection; and at concentrations >300 mg/l in 1/25 (4%) in the IC joints following RC joint injection and in 11/25 (44%) of DIPJ following NB injection. The results show greater diffusion of mepivacaine between adjacent synovial structures than assumed from previous anatomical, latex injection and contrast arthrographic studies. This study showed that commonly performed intrasynovial analgesic techniques in the forelimb of the horse are not as specific as previously reported.

Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 2: tarsus and stifle

This paper tests the hypothesis that the local analgesic agent mepivacaine diffuses between adjacent equine synovial structures in the hindlimb and with greater frequency than latex, gelatine dye or contrast media. We report the incidence of diffusion of mepivacaine between the tarsometatarsal, centrodistal and tarsocrural joints, and the 3 synovial compartments of the stifle in 33 fresh equine cadavers. The tarsometatarsal joint and one synovial compartment of the stifle in the left limb and the centrodistal joint and a different synovial compartment of the stifle in the right limbs were injected with mepivacaine. Following flexion and extension of the limb, synovial fluid was aspirated from the noninjected centrodistal and tarsometatarsal joints and the tarsocrural joints of the hock and the noninjected compartments of the stifle. Concentrations of mepivacaine in these samples were assayed using an enzyme linked immunosorbent assay. For samples obtained by dilution of synovial fluid the concentration of mepivacaine was determined by comparing the concentration of urea in the diluted synovial fluid and the concentrations of the serum urea. Mepivacaine was detected in 25/25 (100%) adjacent tarsometatarsal and centrodistal joints after diffusion in both directions, in 23/25 (92%) of tarsocrural joints after diffusion from tarsometatarsal joints and in 22/25 (88%) tarsocrural joints after diffusion from centrodistal joints in the hocks. Diffusion from the femoropatellar to medial and lateral femorotibial joints and between the medial and lateral femorotibial joints in both directions were 20/20 (100%). Diffusion from the lateral femorotibial to the femoropatellar joint was 18/20 (90%) and from the medial femorotibial to femoropatellar joints 17/20 (85%). Mepivacaine was detected at concentrations >0.3 mg/l in a proportion of samples ranging from 15/25 (60%) in the tarsocrural joint following tarsometatarsal joint injection to 18/20 (90%) in the lateral femorotibial joint after femoropatellar joint injection. At mepivacaine concentrations >100 mg/l, detection ranged from 3/20 (15%) in the lateral femorotibial joint from the medial femorotibial joint to 19/25 (76%) in the centrodistal joint from the tarsometatarsal joint. At mepivacaine concentrations >300 mg/l, detection ranged from 1/25 (4%) in the tarsocrural joint from the tarsometatarsal joint to 16/25 (64%) in the from centrodistal joint the tarsometatarsal joint. The results show greater diffusion of mepivacaine between these adjacent synovial structures than assumed from previous anatomical, latex injection and contrast arthrographic studies. Therefore, commonly performed intrasynovial local analgesic techniques in the hindlimb of the horse are not as specific as first thought.

Treatment of chronic digital septic tenosynovitis in 12 horses by modified open annular ligament desmotomy and passive open drainage

A modified open annular ligament desmotomy followed by passive open drainage was used to treat 12 horses with chronic digital septic tenosynovitis due to trauma in the form of open wounds or self-sealing punctures. The surgical approach included complete transection of the palmar/plantar annular ligament of the fetlock and proximal digital annular ligament, which facilitated the removal of fibrin, selective debridement and synovectomy, followed by lavage of the digital sheath. The incision was partially closed leaving a 2 cm gap open distally to allow for passive open drainage. Gentamicin was administered intrathecally during surgery. Postoperatively the horses received ceftiofur and non-steroidal anti-inflammatory drugs. A sterile bandage was used to protect the wound until the gap had healed completely by second intention. Infection was controlled in 11 of the horses which all returned to their previous levels of work, but one horse was euthanased as a result of the persistence of the infection and financial considerations.

Endoscopic examination of the tarsal sheath of the lateral digital flexor tendon in horses

This study was designed to develop a reliable technique for endoscopic examination of the tarsal sheath of the lateral digital flexor tendon of horses. The anatomy of the tendon sheath and associated structures was studied in detail in cadavers before determining portals for the insertion of an arthroscope into the sheath. Approaches into the sheath through the proximal pouch and through the flexor retinaculum, at the level of the sustentaculum tali, were performed and compared in cadavers. The proximal pouch portal permitted visualisation only of the proximal half of the sheath, while the approach through the retinaculum allowed examination of the entire sheath. The normal endoscopic appearance of the tarsal sheath was studied. The endoscopic approach was subsequently used to examine and treat 5 horses with tarsal sheath tenosynovitis, including 2 cases of chronic, traumatic tenosynovitis and 3 of subacute septic tenosynovitis. Four of these horses had fragmentation of the sustentaculum tali. The technique allowed adequate examination of the sheath and debridement of adhesions and lesions within the lumen of the sheath. Fragments dorsal to the medioplantar edge of the sustentaculum tali could not be visualised endoscopically and had to be removed after widening of the wound. All 5 horses survived. Follow-up enquiries (8-31 months) revealed that the horses were all reported to be sound. Four were performing at their previous level of activity, 1 was used for hacking. The 2 cases presented with chronic tenosynovitis had residual sheath distension with no associated loss of function. A prospective study, including longer term follow-up investigation, is currently being performed.

Septic osteitis of the distal phalanx: findings and surgical treatment in 18 cases

Eighteen cases of septic osteitis of the distal phalanx were diagnosed clinically and confirmed at surgery over a 6 year period (1990-1996). Focal bone lysis was the most common radiographic finding. Sequestra were identified in 4 horses, one of which was associated with a fractured plantar process. All the horses were treated surgically with open debridement. The septic process recurred in 4 horses: one was subjected to euthanasia due to navicular bursa infection, secondary to a pathological fracture, the other 3 horses responded to further debridement. A pathological fracture occurred in another horse. All the survivors were not lame 3 months post operatively, although complete healing took 1-12 months. Long term follow up was available in 14 cases. One was retired, all the other horses were back in work at a similar level of performance. This series indicates that surgical treatment of septic pedal osteitis carries a fair to good prognosis despite a high rate of post operative complications and convalescence period of up to 12 months.

Gross and ultrasonographic anatomy of the carpal flexor tendon sheath in horses

This study was undertaken to establish the gross anatomy and the ultrasonographic appearance of the carpal digital flexor tendon sheath (carpal sheath) and the palmar carpal region in normal horses. The isolated forelimbs from 15 horses were used to study the morphology of the sheath and associated structures, including a detailed study of the location of the main blood vessels and nerves in that region. These limbs and the forelimbs of five live, sound horses were also examined ultrasonographically. The examination yielded good soft tissue detail of the tendons and ligaments, synovial and perisynovial tissues and larger blood vessels. There was a good correlation between the ultrasonographic and gross anatomical appearance of the limbs. The sheath cavity was only identified after it had been distended with water, and the various synovial recesses at the level of the carpal canal were poorly imaged.

Endoscopic examination of the carpal flexor tendon sheath in horses

This study was undertaken to design a safe technique to examine the carpal flexor tendon sheath (carpal sheath) of horses endoscopically, using an arthroscope. The limbs from 15 horses were used to study the normal anatomy of the carpal sheath and related structures, establish a safe approach and endoscopic technique, and determine the normal endoscopic appearance of the sheath. Major arteries, veins and nerves, present within and around the sheath, left few 'safe' areas to insert the endoscope. Several portals were assessed and a distal lateral approach was found to be safest and to allow adequate visualisation of most of the sheath. The surgical technique and normal endoscopic findings are described in detail and discussed.

Septic tenosynovitis and focal osteomyelitis of the lateral proximal sesamoid bone in a thoroughbred gelding

Chronic septic tenosynovitis with concurrent, associated focal osteomyelitis of the lateral proximal sesamoid bone was diagnosed in a seven-year-old thoroughbred gelding. Surgical management of this case consisted of open annular ligament desmotomy and curettage of the affected sesamoid. Following lavage of the digital sheath the incisional wound was closed but a 2 cm gap was left distally to allow for postoperative open drainage. The distal limb was bandaged and the horse treated with antibiotics and non-steroidal anti-inflammatories. Sepsis resolved and the horse made a gradual return to full work.

Surgical treatment of a comminuted articular fracture of the accessory carpal bone in a thoroughbred horse

The clinical, radiographic and ultrasonographic findings in a case of a comminuted articular fracture of the accessory carpal bone of a thoroughbred chaser are described, and its surgical treatment and aftercare are detailed. The horse made an uneventful recovery and successfully returned to racing.

Treatment of a keratoma in a Clydesdale horse

A keratoma was diagnosed in a six-year-old Clydesdale gelding with recurrent 'pus in the foot'. The keratoma was excised through an inverted 'V' dorsal wall hoof resection up to 2 cm distal to the coronary band, the foot was bandaged and shod, and the horse treated with antibiotics and phenylbutazone. The dorsal hoof wall regrew completely and the horse gradually returned to full work.

Ultrasonographic examination of the femorotibial articulation in horses: imaging of the cranial and caudal aspects

The aim of this study was to determine the normal ultrasonographic features of the cranial and caudal aspects of the femorotibial articulation and, in particular, to establish a method of examining the menisci, cruciate and meniscal ligaments ultrasonographically. Twenty hindlimbs isolated post mortem from 10 horses were used to study the normal ultrasonographic and gross anatomy of the femorotibial joint. Five stifles from 3 normal, live horses were also examined with B-mode, real-time ultrasound imaging. The results of the anatomical study are presented. The joint surfaces, menisci, cruciate and meniscal ligaments could be imaged adequately in all the specimens. No obvious variations in shape or echotexture, that might impair visualisation of potential lesions, were observed. The authors suggest that ultrasonography is a potential, noninvasive means of diagnosing soft tissue lesions in the femorotibial joint.

The use of arthroscopy in the treatment of septic arthritis in two Highland calves

Septic polyarthritis is a common condition in the young bovine animal. Systemic antibacterial treatment is often not sufficient to eliminate the infection, particularly in the subacute or chronic stages. More invasive procedures, including joint drainage and arthrotomy, are often unsatisfactory, either because of the failure to cure the condition or because of the associated complications. This article describes the use of arthroscopy in the treatment of infectious arthritis and osteomyelitis in two calves. In one case, two joints were explored and debrided successfully during the same intervention. The advantages of this technique to treat septic arthritis in the bovine are described and discussed. The use of diagnostic ultrasonography to confirm joint involvement is also described.