Lameness: Diagnostic Tests Articles

Extracorporeal Shock Wave Therapy in Horses: What We Know

Flex Test
Forelimb Flexion Test
The Use of Thermography in ameness Eval!ation
Scintigraphy
"rthroscopic S!rgery: is it for treatment# $iagnosis or both%

Extracorporeal Shock Wave Therapy in Horses: What
We Know
by y Scott !" #c$l%re& D'#& (hD& Diplomate A$'S
" shock wave is an aco!stic &press!re' wave with very high amplit!$e an$ rapi$ rise time(
The original !se of shock waves to fragment !roliths was expan$e$ to orthope$ic applications
when# following a safety st!$y# the $ensity of a portion of the pelvis within the treatment area
increase$( S!bse)!ently# the original m!sc!loskeletal applications were associate$ with
stim!lation of non!nion fract!res to heal( *!ltiple st!$ies have $oc!mente$ the effectiveness of
extracorporeal shock wave therapy &ESWT' in treating hypertrophic non!nions( +nvestigations
into m!ltiple other areas have le$ to the F," approval of ESWT for heal sp!rs an$ recently tennis
elbow(
There are m!ltiple ways to generate a shock wave( The press!re wave can be instit!te$ by
vapori-ation of fl!i$ across a spark gap &electrohy$ra!lic'# expansion of pie-oelectric crystals
&pie-oelectric'# or p!shing a membrane with opposite electrical c!rrent &electromagnetic'( +n all
three mechanisms# the press!re wave is bro!ght to a focal point by lenses or a parabolic
reflector( This mechanism allows the energy in the wave to aim at a specific point within the
tiss!e( "n alternative mechanism# ra$ial press!re waves# has been $evelope$( This !tili-es a
pne!matically $riven $evice to strike the s!rface( This creates a press!re wave# b!t the
parameters of the wave are $ifferent from that of a shock wave(
The mechanisms by which ESWT provi$es a therape!tic o!tcome are minimally !n$erstoo$( +n
vitro st!$ies have shown that shock wave can stim!late the pro$!ction of cytokines by cells an$
increase cell!lar $ivision( +n vivo st!$ies have shown increase$ bone formation an$ healing of
non!nions an$ neovasc!lari-ation of bone.ten$on /!nctions(
+n the horse# m!ltiple applications have been trie$( 0ne of the first case series complete$ was in
a gro!p of horses with bone spavin where 12 of 34 horses &567' improve$ at least one lameness
gra$e( ,ata from bone.healing st!$ies wo!l$ in$icate ESWT wo!l$ be beneficial in treating stress
fract!res in horses( While m!ltiple !sers of this technology report goo$ o!tcomes in stim!lating
stress fract!res to heal# there have been no p!blishe$ reports( Similarly# m!ltiple veterinarians
have reporte$ s!ccess in stim!lating s!spensory $esmitis to heal an$ $ecrease lameness( The
first clinical reports from two separate !niversities in$icate$ seven of eight an$ five of six horses
improve$ following treatment( " controlle$ st!$y with collagenase.in$!ce$ s!spensory $esmitis
fo!n$ that the $efects fille$ in faster as $etermine$ by !ltrasonography( So far there is $ata
s!pporting the !se of ESWT for s!spensory $esmitis# bone spavin# stress fract!res an$ navic!lar
syn$rome( There are also m!ltiple $isc!ssions as to the !se of ESWT for ten$onitis# s!bchon$ral
bone cysts an$ for sore backs( With time# more controlle$ st!$ies will be complete$ for a more
thoro!gh an$ ob/ective assessment of o!tcome(
While the positives of this therapy are being eval!ate$# the negatives m!st be consi$ere$( *ost
importantly there is a perio$ of analgesia following treatment( H!mans treate$ with ESWT report
an initial $ecrease in pain in the area treate$# lasting !p to a week# then some ret!rn of the
original pain that gra$!ally $ecreases as the !n$erlying problem heals( +n a st!$y f!n$e$ by the
8rayson Fo!n$ation at +owa State University# we fo!n$ that in the horse# a perio$ of analgesia
appears to be present for abo!t fo!r $ays after treatment( The analgesia is not profo!n$ like a
local anesthetic# b!t there is a $ecrease in pain perception( The exact mechanism is not known(
There is some inflammation in the nerves in the treatment fiel$( 9esearchers at o!isiana State
University have fo!n$ a $ecrease in sensory nerve con$!ction velocity following ra$ial shock
wave treatment(
*!ltiple racing /!ris$ictions have instit!te$ or are consi$ering reg!lations concerning when a
horse can compete after being treate$( *ost are in the neighborhoo$ of seven $ays( The FE+ has
$etermine$ that ESWT sho!l$ not be !se$ for five $ays prior to competition( This sho!l$ allow the
analgesia to regress( "$$itionally# the in$ications for shock wave therapy wo!l$ in$icate most
horses sho!l$ be on a $ecrease$ level of activity while healing(
The $ata in$icate that there are benefits associate$ with ESWT( "$$itional controlle$ st!$ies are
in$icate$ to f!lly eval!ate this new therape!tic mo$ality(
,r( *c:l!re is assistant professor at the +owa State University :ollege of ;eterinary *e$icine an$
has been a member of the ""E< since =22>
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)lex Test
by Davi* W" !amey& D'#

David W. Ramey, DVM
Youve decided to sell your horse and the potential buyer has sent a veterinarian to
our farm to perform a purchase exam. As you stand beamin !ith satisfaction next
to !ho you hope !ill be the ne! o!ner, the veterinarian pic"s up your horses left
front le. #endin it at the "nee, he holds it for about $% seconds, returns it to the
round and as"s that the horse be &oed do!n your asphalt drive. 'n astonishment,
you !atch as the horse moves off most decidedly lame. What happened(
What you have !itnessed is a phenomenon not necessarily of the veterinarians
creation, but somethin that can sometimes occur follo!in a procedure called a
forelimb flexion test. 'n a forelimb flexion test, various &oints and soft tissue
structures of the lo!er limb are stretched and)or compressed for a brief period of
time by bendin the limb. After!ard, the horse is immediately trotted off and
observed for sins of lameness.
*orelimb flexion tests !ere described in +!edish veterinary literature as early as
,-./. 0hey appear to have become an interal part of the evaluation of the horse
intended for sale. 'n performin the tests, a veterinarian !ill li"ely pic" up the
horses le and bend it, !ith the bendin force centerin around the fetloc" &oint. 1e
or she !ill hold the le for a period of /% seconds to $% seconds, and then let o,
as"in the horse to trot off immediately.
0he test is not unli"e !ht you miht experience if someone as"ed you to sit in a
crouch for sixty seconds and then run riht off. 2sually, you can run off &ust fine, but
occasionally, you miht experience some soreness or pain in the &oint that results in
some initial stiffness !hen you first try to run. You may be normal or the soreness
could sinal a problem 3such as a bad "nee4.
While forelimb flexion tests are 5uite commonly performed, veterinarians have not
ared on the optimum duration of the test, !hich can vary from /% seconds to three
minutes. Althouh there are devices available to measure the force applied durin
the test, these are not !idely used in practice. A study involvin 6% horses has been
conducted to determine the effects that force of the test may have on the result. 0he
study suests that reliance on forelimb flexion tests for a dianosis of impendin
lameness or other problems may not be reasonable. 0he study also indicates that a
positive response to the test does not correlate !ell !ith other indicators, such as x7
rays of the lo!er limb.
A positive response to forelimb flexion tests, meanin lameness !as evident after the
limb !as released, is one reason horses may be deemed unsuitable for purchase
durin the prepurchase exam. 0here seems to be a !ide rane of sinificance
attributed to these tests that varies accordin to opinion and the experience of the
examiner. 0here have been many purchase exams discontinued solely because a
positive response to a flexion test in one or both forelimbs. #ecause of the variable
response to the test dependin on such thins as the force applied, duration of the
test, ae of the horse and the day of examination, demonstrated in this and other
studies, discontinuation of a prepurchase examination based solely on a failed
forelimb flexion test is probably un!arranted.
8!ners and trainers have become increasinly s"eptical of the sinificance of
forelimb flexion tests durin the examination. 1orses can and do perform !ell for a
variety of ridin endeavors even then they do not perform !ell on a forelimb flexion
test.
'f you horse does respond to forelimb flexion test, dont stop there. *urther
examination of the horse throuh the use of x7ray may be !arranted. 9oo" for other
sins of a problem, such as lameness, loss of limb flexibility or a painful response to
palpation and)or manipulation of the area that you suspect may be a problem. With
a complete examination, you !ill li"ely receive the ans!er you need and could be
loo"in for.
Dr. David Ramey is a 1983 graduate of Colorado State University. After completing
an internship in euine medicine and surgery at !o"a State University# he entered
private practice in southern California. $is practice is devoted to the care of pleasure
and performance horses of many different %reeds and occupations. $e is the author
of numerous %oo&s and articles on horse health. $e presented his findings during the
199' AA() Convention in )hoeni*# Ari+ona.
:osted; <uly .%%%
:opyright A =22B.@666 "merican "ssociation of E)!ine <ractitioners( "ll rights reserve$(
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)orelimb )lexion Test
by Davi* !amey& D'#

Do!Eve $eci$e$ to sell yo!r horse an$ the potential b!yer has sent a veterinarian to yo!r farm to
perform a p!rchase exam( "s yo! stan$ beaming with satisfaction next to who yo! hope will be
the new owner# the veterinarian picks !p yo!r horseEs left front leg( Fen$ing it at the fetlock# he or
she hol$s it for abo!t B6 secon$s# ret!rns it to the gro!n$# an$ asks that the horse be /ogge$
$own yo!r asphalt $rive( +n astonishment# yo! watch as the horse moves off most $eci$e$ly
lame( What happene$%
What yo! have witnesse$ is a phenomenon not necessarily of the veterinarianEs creation b!t
something that can sometimes occ!r following a proce$!re calle$ a forelimb flexion test( +n a
forelimb flexion test# vario!s /oints an$ soft tiss!e str!ct!res of the lower limb are stretche$ an$?or
compresse$ for a brief perio$ of time by ben$ing the limb( "fterwar$# the horse is imme$iately
trotte$ off an$ observe$ for signs of lameness(
Forelimb flexion tests were $escribe$ in Swe$ish veterinary literat!re as early as =2@>( They
have become an integral part of the eval!ation of the lame horse an$ are ro!tinely incl!$e$ in
prep!rchase eval!ations of the horse inten$e$ for sale( +n performing the tests# a veterinarian will
likely pick !p the horseEs leg an$ ben$ it# with the ben$ing force centering aro!n$ the fetlock /oint(
He or she will hol$ the leg for a perio$ of time# then let go# asking the horse to be trotte$ off
imme$iately(
The test is not !nlike what yo! might experience if someone aske$ yo! to sit in a cro!ch for sixty
secon$s# then r!n( Us!ally# yo! can r!n /!st fine# b!t occasionally# yo! might experience some
soreness or pain in the /oint that res!lts in some initial stiffness( Do! might be normal or the
soreness co!l$ signal a problem &s!ch as a ba$ knee'(
While forelimb flexion tests are )!ite commonly performe$# veterinarians have not agree$ on the
optim!m $!ration of the test# which accor$ing to reports can vary from >6 secon$s to three
min!tes( "ltho!gh there are $evices available to meas!re the force applie$ $!ring the test# these
are not wi$ely !se$ in practice( " st!$y involving 16 horses has been con$!cte$ to $etermine the
effects that force of the test might have on the res!lt( The st!$y s!ggests that reliance on forelimb
flexion tests for a $iagnosis of impen$ing lameness or other problems is not reasonable( The
st!$y also in$icates that a positive response to the test $oes not correlate well with other
in$icators# s!ch as G rays of the lower limb(
" positive response to forelimb flexion tests# meaning lameness was evi$ent after the limb was
release$# is one reason horses might be $eeme$ !ns!itable for p!rchase $!ring the prep!rchase
exam( There seems to be a wi$e range of significance attrib!te$ to these tests that varies
accor$ing to opinion an$ the experience of the examiner( There appears to have been many
p!rchase exams $iscontin!e$ solely beca!se of a positive response to a flexion test in one or
both forelimbs( Feca!se of the variable response to the test $epen$ing on s!ch things as the
force applie$# $!ration of the test# age of the horse# an$ the $ay of examination &$emonstrate$ in
this an$ other st!$ies'# $iscontin!ation of a prep!rchase examination base$ solely on a faile$
forelimb flexion test probably is !nwarrante$(
0wners an$ trainers seem to have become increasingly skeptical of the significance of the
forelimb flexion test $!ring these examinations( Horses can an$ $o perform well for a variety of
ri$ing en$eavors even when they $o not perform well on a forelimb flexion test(
+f yo!r horse $oes limp after a forelimb flexion test# $onEt stop there( F!rther examination of the
horse thro!gh the !se of s!ch techni)!es as G ray might be warrante$( ook for other s!pporting
signs# s!ch as lameness# loss of limb flexibility# or a painf!l response to palpation an$?or
manip!lation of the area that yo! s!spect co!l$ be a problem( With a complete examination# yo!
will likely receive the answer yo! are looking for(
David Ramey, DVM, has a practice devoted to the care of pleasure and performance horses in
Glendale, Calif., and he is the author of numerous books and articles on horse health. He
presented his findings of this study during the !!" ##$% Convention in %hoeni&, #ri'. (or a
copy of this article and other articles of interest, check out ##$% )nline at http*++,,,.aaep.org.
American Association o+ E,%ine (ractitioners
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Lexington& K2 -.033
45.56 7889.3-/
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The :se o+ Thermography in Lameness Eval%ation
by Tracy A" T%rner& D'#& #S& Dipl" A$'S

Lameness diagnosis can be very frustrating when the source of pain is located in the
upper leg and is not associated with a synovial structure, or the lameness is too subtle to
utilize diagnostic analgesic injections, or the patient is not amenable to these injections,
or the lameness is difficult to eliminate by local analgesic injection. These cases usually
require the practitioner to treat the horse symptomatically or to perform other diagnostic
techniques to try and determine possible areas of injury.
Thermography is one such technique. It is the pictorial representation of the surface
temperature of an object. It is a non-invasive technique that measures emitted heat.
medical thermogram represents the surface temperatures of s!in, ma!ing thermography
useful for the detection of inflammation. lthough thermographic images measure only
s!in temperature, they also reflect alterations in the circulation of deeper tissues. This
ability to assess inflammatory change non-invasively ma!es thermography an ideal
imaging tool to aid in the diagnosis of certain lameness conditions in the horse. The
purpose of this paper is to describe the use of thermography as an aid to clinical lameness
diagnosis.
Thermography has most commonly been used to evaluate horses with bac! or hind limb
lameness. The second most common use of thermography was to evaluate the horse for
performance or pre-purchase. In this capacity, the horses were e"amined to determine if
any area of inflammation that would account for decreased performance or determine a
source of pain that might e"plain a horse#s change in attitude toward wor! or to try to
identify subclinical areas of inflammation could be detected. Thermography has been
used least frequently for investigation of forelimb problems. Thermography has provided
significant information in $%& of the horses e"amined. Temperature changes were
identified as either 'hot spots( or 'cold spots.( The thermographic image was very useful
in localizing the area of injury, but did not characterize the specific nature or etiology of
the injury. Investigation of the upper limb lameness was the region where thermography
was most useful. The most frequent upper limb problems were located over large muscle
masses and thought to be either muscle strains or muscle inflammation. In the upper
foreleg, the most common areas of temperature asymmetry were located over the
pectoralis muscles or the biceps brachii )shoulder*. In those cases, showing increased heat
over the shoulder region, meant we were able to identify specific lesions within the
biceps tendon or bicipital bursa utilizing ultrasonography.
In the upper hind leg, abnormal thermal patterns of three distinct regions were commonly
seen+ cranial thigh, caudal thigh, and croup region. In the cranial thigh, distinct hot spots
were associated with the quadriceps musculature just pro"imal to the insertion on the
patella. In each of the cases, we subsequently have been able to find evidence of muscle
damage utilizing ultrasonography. The caudal thigh thermography showed several
common areas of abnormal heat+ The most common was at the musculotendinous
junction of the semitendinosus muscle. third area of abnormal thermal patterns was
commonly seen in the caudal thigh, just caudal to the third trochanter of the femur
directly over the biceps femoris. The thermal changes noted were both a 'hot spot( and
an intense 'cold spot.( ,e have not correlated any sonographic findings with this injury
to date. The croup area injuries involved hot spots over the loin region, over the sacroiliac
region, over the body of the gluteal muscle, and over the third trochanter.
-ltrasonography has been used in these cases to characterize a 'muscle cramp,( dorsal
spinous ligament desmitis, and suspect sacroiliac desmitis. .asciitis was diagnosed in one
case based on muscle biopsy. In the assessment of horses that 'tie up,( thermography
indicated that the longissimus and gluteal muscle regions had the most intense heat.
.urther, the behavior the horse showed during the 'tying-up( episode correlated with the
thermal patterns. /orses that became stiff showed the most intense heat over the
longissimus muscles, whereas horses that would stop and be very reluctant to move
showed the most intense heat over the gluteal region.
0ew, more portable thermographic equipment is now available. 1ecause of this, we have
used thermography more frequently in the evaluation of forelimb lameness and in the
evaluation of various e"ercise-related problems. Thermography is being used in the
evaluation of forelimb lameness to assess the intensity of inflammation as well as to gain
insight into stresses or inflammatory nature of various lamenesses. In addition, we can
evaluate various problems at the barn under the conditions where the horse actually
shows the problem. This has allowed several tac!-related problems to be identified by the
thermal patterns caused by the tac! while the horse is being ridden. It has been our
e"perience that thermography specifically increases the accuracy of diagnosis by
confirming inflammation in palpably sore areas and by providing objective data that
indicate in which area to concentrate further diagnostic testing such as sonography,
radiography, or muscle biopsy. /eat is one of the cardinal signs of inflammation and is
associated with thermographic 'hot spots.( '2old spots,( however, may also be a sign of
injury and reflect the presence of mar!ed swelling or result from decreased circulation in
damaged tissue or of the presence of dense scar tissue. Thermography, when combined
with a thorough clinical e"amination by your veterinarian, is an e"cellent imaging
technique for assessing lameness. It is particularly helpful in determining areas of
inflammation in the upper limbs, but can also be readily used to assess inflammation of
the lower limbs. It has been useful in assessing cases of palmar foot pain and has helped
identify areas other than the navicular bone that may be sources of pain. It has been
useful in the assessment of joint problems as well as tendon and ligament problems.
3ince the modality is non-invasive, it can readily be used. ,ith recent technological
advances, the equipment is completely portable and can readily be ta!en to farms, arenas,
etc.
Tracy A. Turner, DVM, MS, Dipl. ACVS, Department of Clinical and Population
Sciences, University of Minnesota, 13! "ortner Ave, St. Paul, M# !!1$%
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Scintigraphy
by ;reg !oberts& D'#& #S& Dipl" A$'!

Hot too many years ago# a$vance$ imaging techni)!es s!ch as ra$iography# !ltrasonography#
an$ scintigraphy only were available in h!man me$icine or in veterinary !niversity teaching
hospitals( How# these tools can be fo!n$ in veterinary referral centers as well as private practices
thro!gho!t the co!ntry( That is goo$ news for horse owners# beca!se the ability to combine
information from a han$s.on lameness eval!ation with information from a variety of images might
lea$ to an earlier an$ more reliable $iagnosis(
Lameness Eval%ation
+n a lameness eval!ation# a n!mber of steps might be re)!ire$ before the $iagnosis can be
confirme$ an$ treatment prescribe$:
Signalment: age# bree$# gen$er
History: the c!rrent problem an$ the horseEs c!rrent sit!ation &workloa$# environment#
etc('
<hysical examination: observation at rest# $!ring in.han$ movement# on the longe line#
an$ !n$er sa$$le# if appropriateI palpation# manip!lation# an$ flexion tests# if necessary
9egional anesthesia: a blocking agent can be in/ecte$ near sensory nerves &even nerves
insi$e a /oint' to n!mb an area# then the veterinarian observes for improvement in the
horseEs way of going
+maging: scintigraphy can be !se$ as a screening test at this point to be followe$ !p with
ra$iographs or !ltraso!n$ the next $ay
Which steps are performe$# an$ in what or$er# will $epen$ on the nat!re of the lameness# the
$emeanor of the patient# an$ the b!$get of the client( " logical an$ thoro!gh work.!p# however#
might ret!rn a horse to performance sooner an$ less expensively than g!essing what is wrong
an$ treating inappropriately( +n a$$ition# a complete examination might $etect a s!b.clinical
problem &one not yet manifesting signs' before it $evelops into a more serio!s sit!ation(
Scintigraphy is partic!larly !sef!l in this regar$(
Scintigraphy is the process of intraveno!sly a$ministering low levels of a safe ra$ioactive agent#
then obtaining images with a special &gamma' camera for eval!ation an$ $isplay( There are three
phases in the process: the vasc!lar &bloo$' phase# which occ!rs imme$iatelyI the soft tiss!e
phase# which can be vis!ali-e$ five min!tes after the in/ectionI an$ the bone phase# which occ!rs
three to fo!r ho!rs later( The ra$ioactive agent en$s !p in bone tiss!e beca!se it is tagge$ with
phosphoro!s# a normal component of bone(
+n normal tiss!es# the in/ecte$ compo!n$ is $istrib!te$ evenlyI abnormal tiss!es take !p more &or
less' of the compo!n$( This $ifference in !ptake is $etecte$ by the gamma camera an$ translate$
as Jhot spotsJ or Jcol$ spotsJ on a screen or printo!t( Hot spots are ca!se$ by anything that
increases the bloo$ s!pply# while col$ spots are ca!se$ by anything that $ecreases the bloo$
s!pply( Hot spots in soft tiss!e !s!ally relate to inflammation..an in/!ry to a m!scle# ten$on# or
ligament is one example( :ol$ spots in soft tiss!e in$icate a $isr!ption in circ!lation..a bloo$ clot#
for example( Hot spots in bone in$icate active bone t!rnover or remo$eling# while col$ spots in
bone in$icate $iminishe$ bone t!rnover or remo$eling( :a!ses of increase$ bone activity incl!$e
growth in yo!ng horses# fract!res# /oint $isease# an$ cancer# among others( :ancer also is one of
the ca!ses of $ecrease$ bone activity(
Feca!se scintigraphy is base$ on the f!nction of tiss!es# it is a highly sensitive tool# especially for
$etecting early m!sc!loskeletal problems s!ch as navic!lar syn$rome# stress fract!res# an$
$egenerative /oint $isease( +t also is !sef!l when more than one lesion is s!specte$I when the
problem area cannot be pinpointe$I for !pper limb# pelvis# an$ back in/!riesI an$ to eval!ate
healing( However# as $escribe$ earlier# it merely in$icates that there is increase$ or $ecrease$
activity in an area# it $oes not provi$e any information abo!t what might be ca!sing the change in
activity(
Scintigraphy is not !nlike yo!r smoke $etector( Foth are capable of picking !p very small
amo!nts of evi$ence that something is wrong# prompting yo! to $etermine the ca!se( This
limitation is the reason a complete lameness eval!ation..incl!$ing a$$itional imaging
techni)!es..m!st be performe$ on the !nso!n$ horse(
Think of other imaging techni)!es s!ch as ra$iography an$ !ltrasonography as being like yo!r
homeEs alarm system..when it goes off# it tells yo! exactly which $oor or win$ow the b!rglar has
alrea$y broken open to get in( Foth are very specific..if yo! see a fract!re in a bone or a $efect in
a ten$on# there can be no $o!bt of the ca!se of the lameness( F!t these mo$alities are not very
sensitive..it might be weeks before eno!gh $amage is $one to a bone or ten$on for these
techni)!es to be able to $etect it(
$oncl%sion
Fy combining the physical imaging of ra$iography an$ !ltrasonography with the physiological
imaging of scintigraphy# veterinarians are able to $etermine the ca!se of lameness more often
an$ more acc!rately( ,espite these technological a$vances# it still is the responsibility of an
owner to !n$erstan$ when his or her horse is not performing well an$ present the horse to a
veterinarian for a thoro!gh eval!ation(
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Arthroscopic S%rgery: is it +or treatment& *iagnosis or
both<
by Ly*ia )" #iller& D'#

y$ia F( *iller# ,;*#
"rthroscopic s!rgery is the best tool veterinarians have for vis!ally inspecting the con$ition of a
/oint( That gives it a place not only in the treatment of /oint lameness# b!t also in its $iagnosis(
JThe typical lameness work.!p begins with a history.taking# a general physical examination an$
an examination of the m!sc!loskeletal system#J says ,r( *ark *artinelli# ,;*# <h,# ,ipl ":;S
an$ clinical assistant professor of e)!ine s!rgery at the University of +llinois :ollege of ;eterinary
*e$icine(
JThe m!sc!loskeletal examination may incl!$e palpation# observation in motion an$ flexion
tests#J he says( Fase$ on the res!lts# the veterinarian may try to i$entify the location of the
lameness with $iagnostic anesthesia# commonly referre$ to as nerve or /oint blocks(
9a$iographs# or x.rays# may be the next step( +nconcl!sive fin$ings here may sen$ the horse to
scintigraphy# where a comp!ter.generate$ pict!re of Jhot spotsJ &inflame$ areas that have taken
!p more of an intraveno!sly in/ecte$# safe# ra$ioactive compo!n$' may help locali-e the problem(
However# none of these techni)!es ens!re that the /oint is the root of the lameness or in$icate
how severely affecte$ the /oint is( Feca!se arthroscopic s!rgery has many benefits an$ few
$isa$vantages# veterinarians may often recommen$ this proce$!re earlier in the work.!p of a
lameness that appears to be /oint.relate$(
J"rthroscopic s!rgery is minimally invasive an$ has almost no $rawbacks#J says ,r( *artinelli(
Feca!se the horse m!st !n$ergo general anesthesia for the proce$!re# there is some risk
involve$# b!t with to$ayKs mo$ern screening techni)!es# safer compo!n$s an$ improve$
monitoring $!ring s!rgery# that risk is slight( +n a$$ition# whenever s!rgery is performe$ on a
horse there is always the risk of infection# b!t this# too# is minimi-e$ with arthroscopy $!e to high
vol!mes of fl!i$ fl!shing thro!gh the /oint as part of the proce$!re(
:ompare$ to the earlier s!rgical proce$!re for examining a /oint# arthrotomy# arthroscopy
provi$es:
o a better view of the /oint an$ all its components
o $ecrease$ aftereffects of s!rgery &that is# the horse goes home sooner'
o improve$ cosmetic appearance afterwar$s
o )!icker ret!rn to f!ll f!nction
+n me$ical lang!age# JarthJ means /oint( JScopeJ refers to an instr!ment for observing or
examining an$ JotomyJ refers to a s!rgical incision into an organ or part( Together# an
JarthroscopeJ is an instr!ment inserte$ into the cavity of a /oint in or$er to inspect the contents
an$ an JarthrotomyJ is the s!rgical incision of a /oint caps!le in or$er to inspect the contents(
+n an arthroscopic s!rgery# two to three tiny JnicksJ are ma$e thro!gh the skin an$ /oint caps!le in
or$er to insert the arthroscope an$ other instr!ments as nee$e$( The /oint cavity is inspecte$#
any bone chips or loose cartilage are remove$ an$ the area is fl!she$ to remove small fragments
an$ inflammatory pro$!cts( The JnicksJ are !s!ally close$ with one s!t!re each an$ rarely can
signs of this s!rgery be $etecte$ afterwar$s(
0n the other han$# an arthrotomy involves one or more large incisions over the entire /oint to
allow the veterinarian to see insi$e firsthan$# witho!t the ai$ of a magnifying scope that can reach
from one en$ of the /oint to another( Hot only $oes the skin re)!ire an entire row of s!t!res# b!t
the /oint caps!le itself m!st be s!t!re$ back together( 9ecovery is prolonge$ $!e to pain# swelling
an$ weakene$ str!ct!res( +n a$$ition# there may be permanent loss of range of motion an$
scarring(
J"fter arthroscopic s!rgery# most horses $onKt !s!ally know theyKve ha$ anything $one to them#J
says ,r( *artinelli( Horses walk back to their stalls following the proce$!re an$ most go home the
next $ay( " minim!m of two weeks stall rest is !s!ally recommen$e$# b!t the type an$ length of
aftercare $epen$s on the horse# the specific /oint an$ con$ition being treate$# an$ the extent of
the s!rgery( While pain.killers are not !s!ally necessary# some /oint therapy may be in$icate$I
cons!lt yo!r veterinarian before starting or even contin!ing in/ections or oral s!pplements(
Science an$ technology contin!e to provi$e !s with better an$ better tools for prolonging the
athletic life of horses &as well as h!mans'( F!t in or$er to get the most benefit o!t of arthroscopic
s!rgery or any proce$!re# early recognition that there is a problem is vital( L!st as important is
knowing what can be $one to help prevent problems( +n the case of /oint $isease# proper footing#
training an$ con$itioningMtogether with close observation an$ reg!lar veterinary careMare yo!r
best strategies(
poste$: B?=5?@66@( ast !p$ate$: B?=B?@66>(