Lameness Evaluation Research Articles

Osteogenic sarcoma of the femur in a mare

A seven-year-old mare Was presented for evaluation of a left rear leg lameness and weight loss of five months duration. Physical exam revealed a non-weight bearing lameness of the affected leg with marked swelling of the stifle. Hematology and clinical chemistr ies were unremarkable. Radiographs revealed an invasive mass on the distal femfir. A bone biopsy was performed standing under local anesthesia and sedation. Osteosarcoma was diagnosed histologically using hematoxylin and eosin staining. Thoracic radiographs and nuclear scintigraphy were performed to access for metastatic disease. Radiographs were within normal limits. The scintigraphy showed several undef ined areas of increased uptake of the radionucleotide. A postmortem examination was performed. Osteosarcoma was confined to the distal femur evolving both condyles. Osteogenic sarcoma is a malignant bone tumor with proliferating spindle cell stroma producing osteoid or immature bone. ~ The incidence of osteosarcom a is relatively high in dogs, cats, and humans.l3 In man, osteosarcoma is one of the most commonly seen primary sarcomas of bony tissue. ~'4's Osteosarcoma occurs more frequently in dogs than cats, with the incidence of osteosarcoma about twice

Effects of intra-articular chlorhexidine diacetate lavage on the stifle in healthy dogs

Summary Eight dogs were determined to be orthopedically normal on the basis of prelavage physical examination, stifle radiography, synovial fluid analysis, and force plate analysis (peak vertical force normalized for body weight, and time on the force plate). Each dog had 1 stifle randomly assigned to be lavaged with 100 ml of a commercially available 0.05% (w/v) chlorhexidine diacetate solution, and the contralateral stifle was lavaged with lactated Ringer’s solution. Difference was not detected between the chlorhexidine diacetate and lactated Ringer’s solution-treated joints, with regard to results of synovial fluid analysis and clinical lameness evaluations on days 4 and 8 after lavage. Chlorhexidine diacetate caused a more intense synovitis than did lactated Ringer’s solution, as determined by histologic evaluation of synovial membrane specimens after necropsy on day 8; however, a difference in the intensity of toluidine blue staining of articular cartilage was not found between treatments. Chlorhexidine diacetate, as a 0.05% (w/v) solution, cannot be recommended as a joint lavage fluid until the duration of inflammatory changes in the synovial membrane are determined or until the chemical constituents of chlorhexidine diacetate causing the synovitis can be identified and removed.

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.

Fate and effect of autogenous osteochondral fragments implanted in the middle carpal joint of horses

SUMMARY Four autogenous osteochondral fragments removed from the lateral trochlear ridge of the talus were arthroscopically placed as loose bodies in a randomly selected middle carpal joint in each of 10 horses. The contralateral middle carpal joint, subjected to a sham procedure, served as control. Postoperative treatment was consistent with that for clinical arthroscopic patients. Lameness evaluation, radiographic examination, carpal circumference measurement, and synovial fluid analysis were performed before and at scheduled intervals after surgery. After a 2-month confinement, horses were subjected to an increasing level of exercise. Horses were euthanatized at intervals through 6 months. Gross and microscopic evaluations were performed on remaining fragments, articular cartilage, and synovial membrane of each middle carpal joint. Increased joint circumference, effusion, lameness, and degenerative joint disease distinguished implanted from control joints over the 6-month period. Implanted joints were characterized by grooved, excoriated cartilage surfaces, and synovium that was thick, erythematous, and irregular. At 4 weeks, implants were found to have adhered to synovium at their subchondral bone surface. The bone within fragments was undergoing necrosis, while cartilage was preserved. At 8 weeks, fragments were radiographically inapparent, grossly evident as pale plaques on the synovial surface, and composed of dense fibrous connective tissue. Synovial membrane specimens from implanted joints had inflammatory change characterized by mononuclear cell infiltration 2 months after implantation. Physical damage was apparent within articular cartilage of implanted joints at 2 months, and was significant (P < 0.05) at 6 months after surgery. Chondrocyte degenerative change was significant (P < 0.05) at 6 months after surgery. Focal reduction in safranin-O uptake was observed in cartilage layers adjacent to physical defects. Osteochondral loose bodies of the size implanted in the middle carpal joint of horses in this study were resorbed by the synovium within 2 months. Synovitis and significant articular cartilage damage were associated with the implanted fragments. Regardless of origin, free osteochondral fragments within the middle carpal joint should be removed, and methods to prevent residual postoperative debris should be implemented to reduce potential for articular pathologic change.

Force Plate Analysis of Triple Pelvic Osteotomy for the Treatment of Canine Hip Dysplasia

Triple pelvic osteotomy was performed in 15 dogs with bilateral hip dysplasia. Ten dogs were treated bilaterally and five dogs were treated unilaterally. Ten untreated dogs with normal hips served as controls. Force plate analysis, lameness evaluation, and radiography were performed before surgery and at weeks 5, 10, 15, and 28. Three dogs treated unilaterally were euthanatized and the hips were examined grossly and microscopically. Force plate data indicated that young dysplastic dogs transmitted significantly less vertical force through the hip joints than normal dogs. The force transmitted through treated hips reached or approached control levels by week 28 and was significantly greater than the force transmitted through untreated hips. Clinical lameness resolved in 92% of limbs and progression of radiographically detectable degenerative joint disease was minimal. Gross and microscopic degenerative changes in the articular cartilage were similar in the treated and untreated hips. The synovial membrane was less reactive in treated hips.

The Use of High-speed Treadmills for Lameness and Hoof Balance Evaluations in the Horse

Examination for lameness remains the most important component of the clinical evaluation for poor performance. Although conventional examinations can be used to diagnose many causes of lameness, treadmill video gait analysis and dynamic hoof balance evaluations have proved to be useful not only for evaluating lameness but also for maintenance of long-term soundness. Treadmill lameness evaluations offer a major advantage compared to conventional evaluations because of the stationary position of the exercising horse relative to the people performing the examination. Lameness is suspected if asymmetric motion is observed or asymmetric sounds of the feet contacting the tread surface are heard during the treadmill evaluation. Localization of lameness to the front or hind legs is the first step in the treadmill gait analysis protocol. In trotting and pacing horses, asymmetric movements associated with foreleg lameness generally are confined to the front end. In contrast to the pacing gait, asymmetric movements associated with hindlimb lameness can involve both the front and rear of the horse at the trot. The evaluation is continued to determine which side of the horse is abnormal. Viewed from the front, horses with primary forelimb lameness appear to have an asymmetric downward rotation of the torso, head, and neck away from the stiffer lame front leg toward the flexed normal leg as it contacts the tread surface. The lame hind leg can appear to be stiff relative to the opposite normal leg. This results in uneven side-to-side oscillations of the pelvis rotating away from the abnormal stiff-appearing hind leg toward the normal, flexed hind leg as it contacts the tread surface. Both front- and hind-leg lamenesses cause dissociation of the normal foot-fall sequence, resulting in the alteration of the normal two beat gait at the trot or the pace to a three-beat gait. The final step of the lameness examination involves the use of diagnostic regional anesthesia to determine the anatomic location of the lameness. Treadmill video gait analysis can be used to evaluate differences in the horse's gait before and after each anesthetic block. Optimal foot balance during exercise is critical for long-term maintenance of musculoskeletal soundness. Combining slow-motion video gait analysis with treadmill exercise provides an excellent method for evaluating hoof balance at a variety of speeds. Optimal hoof balance can be achieved by using the technique of successive trimming and re-evaluation. The principles of hoof balancing include establishing dorsopalmar or dorsoplantar hoof balance.(ABSTRACT TRUNCATED AT 400 WORDS)

The Role of Scintigraphy in the Lameness Evaluation

Bone scanning to help diagnose orthopedic disease has been used in human patients for over two decades. The value of this diagnostic tool has been well established in helping to identify a variety of musculoskeletal conditions. It has only recently been used by veterinarians for more accurate characterization of equine musculoskeletal disease. The technique offers the major advantage of increased sensitivity over standard radiographic imaging. The case material illustrated here shows that except for consistent identification of bone cysts, most of the pathologic changes to the horse's musculoskeletal system that might cause lameness are detected on bone scans. Many acute bone diseases can be diagnosed by scintigraphy that cannot be discerned by radiographs until the condition has become chronic: Because of their body size, these conditions may not be diagnosed at all in horses. Scintigraphy in horses offers the other major advantage of affording accurate imaging of the upper limbs, pelvis, and vertebral column without general anesthesia. Therefore, it has a final advantage of increased safety over conventional radiography because it eliminates the need to perform general anesthesia to study these areas. In the author's experience, if abnormal uptake of isotope in the upper limbs, pelvis or spine is not observed, general anesthesia to radiograph those areas is not warranted. A second major benefit of scintigraphic imaging is to differentiate mixed lameness conditions in which the component of bone disease must be separated from that of soft tissues to arrive at a rational course of treatment or prognosis. Finally, for athletic horses suspected of having lameness due to localized myositis, scintigraphy not only allows confirmation of muscle inflammation but also identifies the muscle bellies injured reasonably accurately so that specific local treatment may be given. Nuclear imaging of equine skeletal disease is an option that should be employed more frequently by equine practitioners for diagnosis of difficult lameness cases. The technique is safe and comparatively inexpensive when one considers the total expense of multiple examinations or radiographic surveys of patients without conclusively diagnosing the source or sources of skeletal pain. This is particularly true when a horse owner becomes dissatisfied and enlists the services of one or more other veterinarians. The equine specialist will maintain better client rapport if he or she suggests referral of the horse to a veterinary medical teaching center or private clinic where scintigraphic imaging can be done rather than having the client become frustrated and seek another opinion elsewhere.(ABSTRACT TRUNCATED AT 400 WORDS)

Thermography as an Aid to the Clinical Lameness Evaluation

Thermography has been shown to be a practical aid in the clinical evaluation of lameness. This modality specifically increases the accuracy of diagnosis. Thermography represents skin temperature, usually pictorially. The techniques involve contacting and noncontacting modalities. Noncontacting thermography, which detects infrared radiation, is the most accurate. In order to be accurate, thermography must be performed in a temperature-controlled, draft-free area. The area should be protected from sunlight to avoid erroneous heating of the skin, and the hair length should be uniform. Thermography detects heat before it is perceptible during routine physical examination; therefore, it is useful for early detection of laminitis, stress fractures, and tendinitis. It offers a noninvasive means of evaluating the blood supply to an injured part and offers one of the only reliable means to evaluate blood flow to the foot of horses with navicular syndrome. Thermography also is useful for the early identification of stress injuries to the contralateral limb of convalescing orthopedic patients. Thermography is an excellent adjunct to clinical and radiographic examination. It is complementary to other imaging techniques such as ultrasonography and scintigraphy.

Evaluation of the effects of a regular training program in two thoroughbred yearlings using an exercise stress test

Summary The purpose of this study was to evaluate the effects of a regular training program in two Thoroughbred yearlings (one filly, one colt) using an exercise stress test. The training program consisted of treadmill exercise incorporating long/slow distance work, speed work and work on inclines with gradually increasing bouts of intensity at the trot and gallop. The parameters measured during the exercise stress test were: peak aerobic power (VO 2 max) (mg/kg/min); peak CO 2 production (VCO 2 max) (mg/kg/min); peak respiratory quotient (RQ) (VCO 2 /VO 2 ) peak heart rate (b/min); peak lactate (mmol/l); peak hematocrit (%RBC); peak total serum protein (mg/dl); CPK (pre-post test) (iu). Post-test recovery rates were recorded for oxygen consumption (% total increase); venous lactate concentration (% total increase); heart rate (% total increase). The exercise tests were performed at the beginning and end of the training period. Musculoskeletal strength was evaluated based on the number of steps completed (of the exercise test). Routine physical and lameness evaluations were performed at the start of the program. With the exception of a mild bout of pneumonia and the formation of a hoof abscess in the filly, both yearlings handled the training program well. The individual peak results of the exercise stress tests of each of the yearlings is compared to mean values calculated from exercise stress tests performed by other yearlings admitted to TUSVM Large Animal Hospital for performance evaluations. Comparison of the parameters measured between the first and second exercise test demonstrates an increase in peak aerobic power, and a shift from anaerobic to predominantly aerobic energy metabolism following a regular exercise program.

Representation of Marcha batida, Marcha picada and Tölt on Mangalarga-Marchadores horses as an diagnostic aid for lameness evaluation in gait horses

Representation of Marcha batida, Marcha picada and Tölt on Mangalarga-Marchadores horses as an diagnostic aid for lameness evaluation in gait horses

SCINTIGRAPHIC EVALUATION OF SKELETAL DISEASE AND ITS APPLICATION TO THE HORSE

Bone scintigraphy is a valuable aid in the evaluation of lameness in horses. This review describes the principles of bone radiolabeling, scanning, and scan interpretation. Examples are used to illustrate how bone imaging can contribute significantly to a diagnosis after equivocal physical examination or radiographic findings.

Locomotion analysis technology for evaluation of lameness in horses.

Locomotion analysis technology for evaluation of lameness in horses.

Quantification of equine ground reaction force patterns

A method was developed to quantify the ground reaction force pattern of the horse. A number of selected force amplitudes and peak-time positions in the normalized stance phase of left and right contralateral limbs were used to calculate symmetry indices. Data from each limb were compared with those of a ‘standard horse’ resulting in limb indices. The combination of amplitude and peak-time symmetry and limb indices yielded one H(orse)INDEX. These indices were useful for comparison of different horses and for the evaluation of lameness and treatment.

The embryology of the domestic animals—Developmental mechanisms and malformations

The poor soft tissue conspicuity of CT can be improved by using intra-arterial CT Angiography (CTA), and intra-articular and intra-bursal contrast enhanced CT (CTAR). This retrospective study describes a combination protocol of CT and CTA of the horse's foot, and CTAR of the distal interphalangeal joint and navicular bursa. It is hypothesized this would provide a comprehensive overview of the range and severity of distal limb pathology. Radiology reports of all horses admitted for distal limb CT over a 5 year period were reviewed. All horses with a complete four stage CT examination and radiology report with lameness isolated to the foot were included. Twenty seven imaging findings using a four grade semiquantitative severity scoring system contributing towards six main diagnostic categories were described. One hundred and five examinations on 56 horses revealed a diagnosis of navicular bone disease in 64%, deep digital flexor tendinopathy in 43%, distal interphalangeal osteoarthritis in 35%, navicular bursitis in 31%, distal interphalangeal collateral ligament desmopathy in 26%, and hoof capsule and distal phalanx pathology in 10%. Only 25% of the navicular bone disease cases were considered clinically significant. The majority of deep digital flexor tendon lesions (77%) and distal interphalangeal joint osteoarthritis (51%) were considered significant. Approximately one third of navicular bursa (37%) and collateral ligament (33%) abnormalities were considered significant. Navicular bursa abnormalities were associated with navicular bone and deep digital flexor tendon lesions. The findings support the hypothesis and the use of this protocol for evaluation of foot lameness.

Circulatory and blood gas changes accompanying the development and treatment of induced laminitis

Summary A peripheral vasodilatory agent, isoxsuprine hydro-chloride, was evaluated in a controlled study for its efficacy in the treatment of acute equine laminitis. Eight healthy, adulthorses of variable age and sex were used in the trial. Acute laminitis was induced in 5 of the horses by oral carbohydrate overload. Intravenous isoxsuprine therapy (1.8 mg/kg) was initiated in 3 of the horses receiving carbohydrate overload at first sign of clinical lameness and repeated at 12-hour intervals. Intravenous saline placebos were administered on a similar schedule to 2 control horses which also received a carbohydrate overload. The remaining 3 horses served as further controls. Local and systemic responses to induction of laminitis and isoxsuprine administration were assessed by subjective evaluation of clinical lameness in a double blind trial; nuclear scintigraphy and radiography of the distal forelimbs; and assessment of physical, hematological and biochemical parameters. Pronounced tachycardia, hypotension and sweating accompanied the intravenous infusion of isoxsuprine. The 3 horses treated with isoxsuprine following the induction of laminitis showed a more rapid improvement in soundness than horses receiving saline placebos. No horse developed rotation of the third phalanx in response to the diet Nuclear scintigraphy indicated that blood perfusion patterns within the hoof of laminitic horses altered with isoxsuprine therapy, but an overall increase or decrease in perfusion was not apparent. Alterations in serum enzyme and electrolyte profiles with the onset of laminitis generally concurred with findings previously reported for this model of the disease. No change in coagulation profiles accompanied the onset of laminitis or isoxsuprine administration. Blood gas analysis indicated an increase in median palmar vein oxygen partial pressure (PO 2 ) levels with onset of laminitis. A concurrent decrease in the median palmar arteriovenous oxygen partial pressure difference (AVO 2 ) was significant at the P 2 values between thoseanimals receiving isoxsuprine and those receiving saline placebo therapy. Results of the trialindicated that isoxsuprine may be beneficial in the treatment of acute laminitis. Further controlled studies are appropriate.

Meningeal sarcoma mimicking a sciatic neuropathy in a dog

ABSTRACTA 5‐year‐old Golden Retriever presented for lameness evaluation and removal of a dynamic compression plate on the left femur exhibited neurologic signs compatible with a left sciatic peripheral neuropathy. Radiographs revealed a healed fracture of the left femur and a slightly narrowed intervertebral disc space with ventral spondylosis at T12–13. An EMG demonstrated fibrillation potentials and positive sharp waves in the left hind limb muscles innervated by the peroneal nerve. Surgery was performed to remove the bone plate and explore the left sciatic nerve. The proximal 3 cm of the left peroneal nerve was surrounded by thick fibrous connective tissue and its diameter was smaller than the more distal segment. The dog's condition remained static for 4 weeks and then gradually progressed to paraparesis in 2 weeks. A neurologic examination at that time indicated a caudal lumbar spinal cord lesion and a myelogram confirmed an intradural mass at the level of the 4th lumbar vertebra. The dog was destroyed and a necropsy performed. The histologic diagnosis was meningeal sarcoma.