Page 7 - Equine Matters Spring 2013

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POOR PERFORMANCE
Common orthopaedic causes
Whilst clinical signs can be
similar, there are many causes
of poor performance, some
occurring with greater
frequency than others, often
with few outwardly visible
physical signs such as joint
swelling. Some common
conditions include:
Suspensory ligament injury
Common in any or all limbs, in young
and middle aged horses and can vary from
mild pain with little ligament damage, to
marked pain with ligament swelling
and fibre tearing. Ultrasound and nerve
blocks are the most useful diagnostic
tools. Medical treatment involves local
anti-inflammatory injections, such as
cortisone, along with shockwave therapy.
Surgical treatment is really only of
relevance to the hind limbs and involves
removing the nerve branch supplying the
area of injury (Figure 2), along with the
cutting of any restricting soft tissues.
Sacro-iliac (SI) pain
As this structure is the main joint between
the hind limbs and the back, considerable
propulsive forces pass through these
tissues. Often found in association with
other problems such as suspensory injury,
SI pain can be difficult to diagnose as the
structures are buried deep within the pelvic
tissues. Nerve blocks can help localise the
pain and some injuries are detectable on
a bone scan. Treatment can involve
ultrasound guided anti-inflammatory
injections (Figure 3) and may need to
be repeated in recurrent cases.
Kissing spines
A very common condition which can
be present without necessarily causing
constant back pain. Usually affecting
the mid-lower back, underneath and
behind the saddle, kissing spines can
be diagnosed using nerve blocks,
radiography (Figure 4) and in some cases
a bone scan. Medical treatment, aimed at
long term management, involves injecting
anti-inflammatories into the sites of pain
between the impinging bones, along with
shockwave therapy. Cases which fail to
respond can undergo surgery to remove
some of the displaced bony tissue.
Hock joint inflammation
Very common in middle aged horses and
can lead to degenerative, arthritic changes
if untreated. Usually involves the small
joints of the lower hock. Patients will often
develop stiffness, toe dragging and may
become difficult to shoe. Nerve blocks
are an effective means of making the
diagnosis. Radiography is useful but some
patients have little to see on x-rays.
Treatment involves anti-inflammatory joint
injections, along with remedial farriery.
Patients with significant degeneration can
have the small joints surgically fused, which
can offer an effective long term solution.
Stifle joint injury
This is a large and complicated joint
with many supporting tissues. Ligament
and cartilage damage/defects are
relatively common, particularly involving the
inside, lower compartment. Nerve blocks
help localise the pain, while radiography
and ultrasonography are necessary to
examine the tissues. If anti-inflammatory
injections into the joint fail to work, keyhole
surgery may be necessary to make a
diagnosis and to treat the injury.
Foot pain
Foot pain is very common in thoroughbred
and thoroughbred cross horses. Any breed
or individual weakness in foot conformation
such as collapsed heels (Figure 5) will be
exacerbated if there are problems elsewhere.
Nerve blocks will readily localise the pain
to the feet, but a combination of x-rays,
ultrasound and MRI may be necessary to
localise the exact site of pain. Remedial
farriery is very important in the long term
management of foot pain (Figure 6),
correcting any imbalances, providing
support and acting as a shock absorber.
Figure 2
- Identification of the white nerve
branch during surgery for a suspensory
ligament injury
Figure 3
- Ultrasound guided medication of
a sacro-iliac joint using cortisone injected via
a 10 inch needle
Figure 4
- X ray image of kissing spines showing
the bones coming into contact with each other,
where ligament filled gaps should exist
Figure 5
- Long toe and low/collapsed heel
foot conformation is commonly associated
with joint, bone, ligament and tendon injuries
within the hoof capsule
Figure 6
- Remedial farriery takes many
forms, this patient has been given more heel
support and a shock absorber pad applied
between the shoe and the foot
CONCLUSIONS
All treatments usually involve a period of
rest ranging from weeks to months, followed
by a controlled exercise programme
tailored to the particular patient.
Physiotherapy also plays an important role
in rehabilitating many patients. Horses
were never designed to be ridden on the
surfaces on which they regularly exercise,
so it is no surprise that so many sustain
injuries. Whilst it is important that injuries
are treated and given time to heal, it is
also just as important to ensure that
fitness work and core strength training are
undertaken to minimise the risk of re-injury.
SPRING 2013 ISSUE
EQUINE MATTERS
6