Multimodal approach to rehabilitating a traumatic brachial plexus lesion in a Thoroughbred yearling

Abstract

Forelimb peripheral neuropathy is uncommon and is usually caused by traumatic injury to the brachial plexus or nerves arising from it. Common clinical signs include instability of the shoulder, dropped elbow, inability to fully bear weight and difficulty in protraction. A 16-month-old Thoroughbred colt was found non-weight bearing in the field. The horse was referred to the Veterinary Teaching Hospital of the University of Perugia, Italy, after two days of treatment with anti-inflammatory drugs and stable rest without improvement. At admission, the horse was unable to bear weight on the limb. Diagnostic imaging was unremarkable and a diagnosis of brachial plexus injury with major involvement of suprascapular and radial nerves was made. The horse was treated with a combination of drugs, electrical modalities, physical therapy sessions and holistic techniques. Pharmacological treatment included gabapentin, dexamethasone, phenylbutazone and mesotherapy of the shoulder and neck area. Physical treatments, electrical modalities and holistic therapies included neuromuscular electrical stimulation, acupuncture, kinesiology taping, eccentric loading and dynamic mobilization exercises. The horse was discharged from the hospital after 26 days, having fully regained the ability to bear weight on the limb and the ability to walk normally, although a degree of shoulder instability was still present. Follow-up of the case showed that the horse made a full athletic recovery and raced successfully a year after discharge. This multimodal approach to severe peripheral neuropathy responsible for severe lameness resulted in a fast and efficient option for initial recovery while reducing the risk of complications such as contralateral limb laminitis.