Carpal Lameness Research Articles

Biomechanical and histological variables differ by site but not by lameness in equine digital cushion samples from forelimbs

The equine digital cushion (DC) has been a poorly understood structure regarding its mechanical properties and composition. The objective of this study was to develop a sampling technique and to compare the biomechanical and histologic properties of DC between lame and non-lame forelimbs. Both forefeet from horses with induced carpal lameness were radiographed prior to humane euthanasia. Radiographs were used to guide sample collection of two, post-mortem, midline DC samples, palmar and dorsal, via an 8mm biopsy punch. Samples were subjected to compressive testing to determine elastic modulus. Histological evaluation was used to quantify collagen, adipose, ground substance, elastic fibers, and blood vessels. Comparisons of variables between palmar and dorsal DC sites and lame and non-lame limbs were made using student's t-tests or Wilcoxon signed rank tests with P < 0.05. There were no differences in histologic or biomechanical properties in DCs of lame and non-lame forelimbs. The dorsal DC sampling site had a significantly higher median elastic modulus (median: 0.054 MPa, range: 0.001 – 2.110 MPa) and a larger median percentage of ground substance (median: 15 %, 95 % CI: 3 – 30 %) compared to the palmar DC site (elastic modulus: median: 0.023 MPa, range: 0 – 0.576 MPa; ground substance: median 5 %, 95 % CI: 3 – 25 %) (P = 0.03, <0.001; respectively). This study demonstrated that adequate samples could be collected from the DC for biomechanical and histological analysis. Differences in elastic modulus and ground substance between palmar and dorsal samples may reflect different roles of these sites within the DC.

Morphometric analysis of the intercarpal ligaments of the equine proximal carpal bones during simulated flexion and extension of cadaver limbs

Despite many reported cases of carpal lameness associated with intercarpal ligament injuries in horses, the morphometry, movement pattern and general intrinsic biomechanics of the carpus are largely unknown. Using osteoligamentous preparation of the carpus prepared from 14 equine cadaver forelimbs (aged 9.62±4.25years), locomotory simulations of flexion and extension movements of the carpal joint were carried out to observed carpal biomechanics and, thereafter, the limbs were further dissected to obtain morphometric measurements of the medial and lateral collateral ligaments (MLC and LCL); medial and lateral palmar intercarpal ligaments (MPICL and LPICL); intercarpal ligaments between radial (Cr) and intermediate (Ci) carpal bones (Cr-Ci ICL); and intercarpal ligaments between Ci and ulnar (Cu) carpal bones (Ci-Cu ICL). The Cr, Ci, Cu and Ca are held together by a series of intercarpal ligaments and move in unison lateropalmarly during flexion, and mediodorsally during extension with a distinguishable proximo-distal sliding movement (gliding) of Cr and Ci against each other during movement. The mean length of MCL (108.82±9.64 mm) was significantly longer (p=0.042) than LCL (104.43±7.65 mm). The Cr-Ci ICL has a dorsopalmar depth of 37.58±4.14mm and a midpoint width of 12.05±3.09mm and its fibres ran diagonally from the medial side of the Ci in a proximo-palmar disto-dorsal direction (i.e. palmarodistally) to the lateral side of the Cr. The specialized movement of the Cr-Ci ICL, which appeared to be further facilitated by a longer MCL suggest a biomechanical function by which carpal damage may be minimized in the equine carpus.

Nonarticular osseous cyst-like lesions of the intermedioradial carpal bone may be incidental magnetic resonance imaging findings in dogs.

As magnetic resonance imaging (MRI) becomes more readily available and more frequently utilized in the assessment of canine carpal lameness, both normal variations and early pathologic conditions must be recognized to optimize patient care and provide accurate diagnosis. On cross sectional studies of the canine carpus, cyst-like lesions have been detected at the dorsolateral aspect of the intermedioradial carpal bone. The cross-sectional imaging and histologic properties of these lesions have not been described. The purpose of this observational study is to evaluate the MRI and histologic features of these cyst-like lesions in a cohort of clinically sound dogs. It was hypothesized that the lesions would show features similar to intraosseous ganglion cysts of the human wrist. Twenty-five cadaveric canine carpi were obtained and a total of 13 lesions were detected on MRI. Based on MRI, six carpi with lesions of varying size and one normal carpus were submitted for histological evaluation. Five of the abnormal carpi had nonarticular cyst-like lesions; one specimen with a positive magnetic resonance image for a cyst-like lesion had no cyst-like lesion on histology. Conspicuity of a medium-size lesion as evaluated on radiographs was poor. Given the presence of these nonarticular cyst-like lesions in a population of clinically sound patients, their clinical importance is uncertain. The development of these lesions may relate to altered mechanics or genetic predispositions, requiring additional study.

Clinical findings, diagnosis, prevalence and predisposing factors for lameness localised to the middle carpal joint in young Standardbred racehorses

Lameness related to the middle carpal joint (MCJ) occurs in up to 30% of young Standardbred horses in race training and the incidence increase with radiographic severity of third carpal bone (C3) sclerosis on DPr-DDIO (skyline) view of the carpus. Factors predisposing horses to carpal injury have not been well investigated. To determine the importance of MCJ lameness as a cause of wastage in young Standardbred racehorses, stage of training at which it occurs and predisposing factors, and to describe clinical findings and diagnosis. Standardbred horses (n = 114) entering their first year of race training were examined at approximately 3-month intervals over 12-18 months. For 87 of the horses, a training diary was available and these horses were trained at 3 different stables, each using a different exercise regime. At each examination, forelimb conformation, MCJ effusion, MCJ lameness and radiographic findings were graded, and training history and reasons for lost training days recorded. Nuclear scintigraphy and exploratory arthroscopy were performed on a limited selection of horses. Results for horses that developed MCJ lameness during the study period were compared statistically with results for horses that did not. Carpal lameness occurred in 28% of horses and was present in 56% with forelimb lameness. In most cases lameness was mild, bilateral and with little or no MCJ effusion and was attributed to subchondral bone pain associated with radiographic evidence of C3 sclerosis. Carpal lameness was the most common reason for >1 month's rest during the study period. It occurred at any stage of training but, in most cases, some speed training had begun. Of the variables studied, poor forelimb conformation and more intense speed training were predisposing factors. The information gained should assist in making recommendations regarding training young Standardbreds to reduce the incidence of MCJ lameness. However, further investigations to determine the optimal training regime are warranted.

Interleukin‐6 and Tumour Necrosis Factor in Synovial Fluid from Horses with Carpal Joint Pathology

The carpal joints are common sites of traumatic arthritis and osteoarthritis (OA) in athletic horses. The pro-inflammatory cytokines interleukin (IL)-6 and tumour necrosis factor (TNF) may be of great importance in the development of intra-articular lesions. The aim of the present study was to investigate possible associations between synovial fluid levels of bioactive IL-6 and TNF and different types of joint lesions seen in traumatic arthritis and OA. Synovial fluid was collected from horses with carpal lameness immediately before arthroscopic surgery. Articular cartilage, synovial membranes and intra-articular ligaments were assessed macroscopically at arthroscopy. Synovial fluid levels of IL-6 and TNF were determined by bioassays, and the cytokine levels between different grades of morphologic changes in each type of assessed tissue were compared. The highest levels of IL-6 were detected in joints with chip fractures. All joints with chip fractures also showed some degree of synovitis. Tumour necrosis factor bioactivity was low and not associated with any joint lesion. Hence, TNF is not useful as a biomarker indicating a specific joint lesion in equine traumatic arthritis or OA. We conclude that a dramatic increase of IL-6 in synovial fluid indicates the presence of osteochondral fragmentation, although low or undetectable levels of IL-6 do not exclude chip fractures. The role of IL-6 in the disease process of osteochondral fragmentation needs further investigation.

Magnetic Resonance Imaging of the Equine Carpus

Although it is possible to acquire magnetic resonance images of the equine carpus, there is very limited published description of such images. This paper describes the anatomy of the equine carpus on magnetic resonance images, based on comparison between magnetic resonance images and frozen cadaver sections. The range of abnormalities seen in 42 carpi from horses with and without a history of carpal lameness is summarized.

Glucocorticoid-induced laminitis with hepatopathy in a Thoroughbred filly

A 3-year-old Thoroughbred filly was referred to the Equine Hospital, Korea Racing Association for evaluation of hematuria, inappetite, weight loss and depression. From 25 days prior to admission, the horse was treated for right carpal lameness with 20 mg intramuscular administration of triamcinolone acetonide per day for consecutive 10 days by a local veterinarian. Clinical and laboratory findings included vaginal hyperemia, flare in bladder wall, neutrophilia, lymphopenia, polyuria, polydipsia and laminitis in the end. High activities of aspartate transaminase and gamma glutamyltransferase and high concentration of total bilirubin indicated hepatopathy. Further hematology, serum biochemistry and urinalysis did not reveal any abnormalities. Medical history, physical and clinicopathologic findings suggest that the laminitis and hepatopathy in this horse were most likely induced by repeated administration of exogenous corticosteroid. However, guarded prognosis of treating laminitis undermined the benefit of improvement of hematuria following electroacupuncture stimulation. The combined stimulation of kidney related acupoints (Shen Peng, Shen Shu), lumber related acupoints (Yao Qian, Yao Zhong) and associate acupoints (Guan Yuan Shu, Bai Hui) at 5Hz, 1-2V, for 40 minutes was of value in the treatment of hematuria. This case shows that horses under steroids may exhibit laminitis and steroid hepatopathy. Early recognition and good management of laminitis are important in the limitation of complications.

Sclerosis of the Third Carpal Bone

To assess the significance of radiographic signs of sclerosis of the third carpal bone (C3) in young Standardbred trotters in relation to performance, lameness and bone turnover both carpi in 14 Standardbred trotters were radiographically and scintigraphically examined 6 times, from the beginning of speed training until the beginning of racing, between the mean ages of 20 and 42 months. At the end of the study 8 horses had raced in official qualifying races and 14 limbs in 11 horses had been diagnosed with carpal lameness. All horses but 2 developed sclerosis and all but one had increased bone turnover in the C3 area by scintigraphy. C3 sclerosis increased continuously over time and with increased performance. Carpal lameness was significantly associated with progression of sclerosis but in most cases sclerosis developed without concomitant signs of carpal lameness. No association between carpal lameness and increased scintigraphic uptake was found, but horses that had qualified for racing had significantly higher C3 to carpus ratio of radiopharmaceutical uptake. We conclude that there is a continuous increase in C3 radiographic sclerosis with time in young Standardbred trotters in professional training, but radiographic sclerosis appears to be of limited value as an indicator of clinical carpal disease or level of performance in Standardbred trotters.

Dorsal radiocarpal ligament sprain causing intermittent carpal lameness in high activity dogs.

Five dogs were presented with mild to moderate unilateral thoracic limb lameness attributable to second and third degree sprains of the dorsal radiocarpal ligament. Three were active working dogs and two were racing greyhounds. In four cases the lameness was long-standing and unresponsive to rest; the remaining case was seen as an acute injury. Treatment was by exploratory surgery with postoperative support or by external support alone. All the dogs made a complete recovery with no recurrence of injury.

Computer-assisted three-dimensional gait analysis of amphotericin-induced carpal lameness in horses

Summary Motion of 6 clinically sound horses trotting at a speed of 4 m/s on a treadmill was captured by video cameras before and 9, 16, and 23 days after amphotericin-induced lameness to determine the quantitative variables of three-dimensional computer-assisted image analysis that objectively describe carpal lameness. Amphotericin-B was used to induce lameness, and phenylbutazone (2.2 mg/kg of body weight, PO, once) and butorphanol tartrate (0.1 mg/kg im, q 6 h, to effect) were used to control discomfort. Four 60Hz cameras were symmetrically placed around the treadmill to capture 6 seconds of images from retro-reflective spheres taped to the trotting horses. Images were transferred to a video-based digitizer and a computer work station, where 4 files of two-dimensional data were reduced to 1 file of three-dimensional data. The effect of lameness on motion analyzed was assessed by use of two-way ANOVA. Differences between means were assessed, using the Student-Newman-Keul’s test (P ≤ 0.05). Head and withers excursions, (dorsal vertical displacement of head and withers targets, respectively) during the sound forelimb support phase were increased significantly during all lameness measurement periods. Head excursion, but not withers excursion, during the lame forelimb support phase, was decreased significantly during all lameness measurement periods. Computer determinations of stride length swing phase, stance phase, forelimb abduction, and carpal and fetlock ranges of motion did not consistently characterize the lameness. It was concluded that three-dimensional computer-assisted image analysis could be used for objective lameness evaluation in horses and that head and withers excursions were the most consistent variables for assessing equine carpal lameness.

Effects of hylan on amphotericin-induced carpal lameness in equids

Summary In this double-blind study, the effectiveness of and dose response to intra-articular administration of modified hyaluronan (hylan) was determined in an equine carpal lameness model over a 23-day period, using a computerized three-dimensional motion analysis system, synovial fluid variables, and synovial histologic examination. In 24 clinically sound horses, baseline motion data was acquired from horses trotting at 4 m/s on a high-speed treadmill. Then, to induce lameness, 25 mg of amphotericin B in 5 ml of sterile water was injected into the left middle carpal joint of each horse every other day for 3 treatments. Phenybutazone (2.2 mg/kg of body weight, PO, once) and butorphanol tartrate (0.1 mg/kg, IM, q 6 h, for 36 hours) were used to control signs of discomfort. Horses were assigned at random to 4 equal groups and received intracarpal administration of either 1, 2, 4 ml of hylan (8 mg/ml), or 2 ml of balanced electrolyte solution (control). Intracarpal administration of amphotericin B caused significant (P ≤ 0.01) increase in subjective lameness grades over the 2-week evaluation period, and hylan administration did not significantly (P ≤ 0.01) change the subjective lameness grade. Lameness induction caused significant (P ≤ 0.01) decrease in head and withers excursions during the lame forelimb support phase and significant (P ≤ 0.05) increase in head and withers excursions during the sound forelimb support phase. Synovitis induction was further characterized by significant (P ≤ 0.05) increases in total wbc, polymorphonuclear, and large and small mononuclear cell numbers, and synovial fluid total protein concentrations. Also, subjective scores for synovial sections were significantly (P ≤ 0.05) different from baseline values, but hylan treatment at the 1-, 2-, or 4-ml dose did not significantly (P ≤ 0.05) alter these variables, compared with baseline values or values in control horses. Hyaluronan concentrations were not altered by induction of synovitis or hylan treatment. Although clinical use of hyaluronan for treatment of traumatic joint disease in horses is well accepted, the beneficial effect of hylan was not detectable in this study. Further studies are required to more fully characterize the possible beneficial effects of hyaluronan-based products for treatment of joint disease in equids.

A RADIOGRAPHIC INVESTIGATION OF THIRD CARPAL BONE INJURY IN 42 RACING THOROUGHBREDS

A retrospective study of carpal radiographs from 42 racing thoroughbreds with carpal lameness was performed. Radiographs from 50 carpal examinations were available for review. The radiographic findings pertaining to the third carpal bone were described. Fractures and/or sclerosis occurred almost exclusively within the radial fossa. The occurrence of sclerosis without fracture in 20 of the 50 carpal examinations was higher than anticipated, occurring in both the right and left third carpal bone with equal frequency. The right third carpal bone was more frequently fractured and more severely affected than the left. The sclerotic changes seen in the radial fossa of the third carpal bone may be stress‐induced, possibly preceding more serious changes in the joint such as cartilage damage or gross fracture. Earlier recognition of sclerosis of the third carpal bone may help prevent more serious changes from occurring.