Podcast
Questions and Answers
What factor most significantly influences the prognosis of intravenous regional perfusion?
What factor most significantly influences the prognosis of intravenous regional perfusion?
Which of the following is NOT a type of joint disease in horses?
Which of the following is NOT a type of joint disease in horses?
What clinical finding may indicate joint disease in horses?
What clinical finding may indicate joint disease in horses?
How long may a hairline fracture go undetected on imaging?
How long may a hairline fracture go undetected on imaging?
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What method can be used to localise the site of pain in a horse suspected of joint disease?
What method can be used to localise the site of pain in a horse suspected of joint disease?
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Which of the following is NOT a common radiographic finding associated with osteoarthritis?
Which of the following is NOT a common radiographic finding associated with osteoarthritis?
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What is the main aim of the management strategy for osteoarthritis?
What is the main aim of the management strategy for osteoarthritis?
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Which NSAID concern is specifically mentioned in the context of osteoarthritis management?
Which NSAID concern is specifically mentioned in the context of osteoarthritis management?
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Which of the following therapies is recommended for chronic management of osteoarthritis?
Which of the following therapies is recommended for chronic management of osteoarthritis?
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What is a potential risk when administering corticosteroids intra-articularly for osteoarthritis?
What is a potential risk when administering corticosteroids intra-articularly for osteoarthritis?
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Which type of bone pathology is characterized by deformations due to improper growth?
Which type of bone pathology is characterized by deformations due to improper growth?
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Which clinical finding is most likely associated with a fracture in horses?
Which clinical finding is most likely associated with a fracture in horses?
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What is a common diagnostic consideration when assessing suspected bone pathologies in horses?
What is a common diagnostic consideration when assessing suspected bone pathologies in horses?
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Which type of bone pathology is associated with infections like osteitis?
Which type of bone pathology is associated with infections like osteitis?
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In conducting an orthopedic examination, which aspect is NOT typically assessed?
In conducting an orthopedic examination, which aspect is NOT typically assessed?
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What should be considered when interpreting diagnostic findings for bone pathologies?
What should be considered when interpreting diagnostic findings for bone pathologies?
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Which of the following is a developmental bone pathology?
Which of the following is a developmental bone pathology?
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Which symptom is most relevant when assessing for bone pathologies?
Which symptom is most relevant when assessing for bone pathologies?
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What is a common radiographic finding associated with osteochondrosis and OCD?
What is a common radiographic finding associated with osteochondrosis and OCD?
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Which of the following factors may predispose a horse to osteochondrosis?
Which of the following factors may predispose a horse to osteochondrosis?
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What surgery is commonly indicated for large defects in osteochondrosis?
What surgery is commonly indicated for large defects in osteochondrosis?
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What is a long-term consequence of untreated osteochondrosis?
What is a long-term consequence of untreated osteochondrosis?
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Which management strategy involves dietary modification for treating osteochondrosis?
Which management strategy involves dietary modification for treating osteochondrosis?
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Which of the following statements about intra-articular medications is correct?
Which of the following statements about intra-articular medications is correct?
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What might a mineralised cartilage flap in osteochondrosis indicate?
What might a mineralised cartilage flap in osteochondrosis indicate?
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In which situation is surgical intervention for OCD lesions often indicated?
In which situation is surgical intervention for OCD lesions often indicated?
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What is the primary purpose of hyaluronic acid in the context of osteoarthritis treatment?
What is the primary purpose of hyaluronic acid in the context of osteoarthritis treatment?
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Which adjunctive treatment specifically targets the inflammatory protein IL-1?
Which adjunctive treatment specifically targets the inflammatory protein IL-1?
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Pentosan polysulphate sodium is primarily administered via which route?
Pentosan polysulphate sodium is primarily administered via which route?
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What is the role of bisphosphonates in managing osteoarthritis?
What is the role of bisphosphonates in managing osteoarthritis?
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Which treatment might be beneficial for cartilage repair in cases with soft tissue injuries?
Which treatment might be beneficial for cartilage repair in cases with soft tissue injuries?
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Platelet Rich Plasma therapy is especially supported for use in which patient demographic?
Platelet Rich Plasma therapy is especially supported for use in which patient demographic?
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Which treatment for osteoarthritis integrates into the joint capsule and provides a cushion-like effect?
Which treatment for osteoarthritis integrates into the joint capsule and provides a cushion-like effect?
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Which age group is primarily associated with osteoarthritis?
Which age group is primarily associated with osteoarthritis?
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Which nutraceutical is known for its common use in joint supplements alongside glucosamine?
Which nutraceutical is known for its common use in joint supplements alongside glucosamine?
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What is a key clinical sign of septic arthritis?
What is a key clinical sign of septic arthritis?
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What imaging technique is useful for detecting cartilage lesions not visible on radiographs?
What imaging technique is useful for detecting cartilage lesions not visible on radiographs?
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During a synoviocentesis, what appearance indicates a normal joint fluid?
During a synoviocentesis, what appearance indicates a normal joint fluid?
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What condition is characterized by joint effusion but often does not present with lameness?
What condition is characterized by joint effusion but often does not present with lameness?
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What is the main purpose of scintigraphy in joint disease diagnosis?
What is the main purpose of scintigraphy in joint disease diagnosis?
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Which test is essential for diagnosing septic arthritis?
Which test is essential for diagnosing septic arthritis?
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What does a high presence of neutrophils in joint fluid indicate?
What does a high presence of neutrophils in joint fluid indicate?
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Which of the following is a characteristic of osteoarthritis?
Which of the following is a characteristic of osteoarthritis?
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What is the diagnostic advantage of arthroscopy?
What is the diagnostic advantage of arthroscopy?
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Study Notes
Learning Objectives
- Students should be able to describe the types and clinical findings of bone and joint pathologies in horses.
- Students should be able to determine an appropriate diagnostic approach to bone/joint pathologies in horses, including imaging options and interpretation of findings.
- Students should be able to describe how different bone/joint diseases are managed in horses and determine the prognosis.
Bone Pathologies in Horses: Categories
- Developmental: Angular Limb Deformities, Physitis, Osteochondrosis
- Congenital: Skeletal dysplasia, Chondrodysplasia, Traumatic fracture, Periosteal reaction, Sequestrum, Subchondral bone injury, Cysts
- Infectious: Osteitis, osteomyelitis
- Metabolic: Fibrous osteodystrophy
- Neoplasia: Keratoma
- Other: Marie's Disease
Diagnosis of Bone Pathologies: History
- Owner observations
- Signalment (age, sex, breed)
- Lameness
- Duration (worsening or improving)
- Effect of exercise
- Recent trauma/wound
- Current diet
- Medication/previous problems/surgery
Diagnosis of Bone Pathologies: Observation
- Obvious clinical signs (e.g., hard swellings in physitis weanlings)
Diagnosis of Bone Pathologies: Clinical Examination
- Orthopaedic examination (symmetry, muscular atrophy, posture, limb palpation—heat, pain, swelling)
- Gait assessment (presence of wounds/lacerations, depth assessment, discharge/nature, fragments of bone, fracture palpability, other clinical disease)
Approach to Diagnosis of Bone Pathologies: Radiography
- Assess each structure in terms of Röntgen signs (size, shape, contour/margins, number, position, opacity—air, fat, water, soft tissue, bone, metal)
- Identify pathology or features of normal anatomy
- Be aware of incidental findings, normal variations vs abnormalities, composite shadows/superimposition, artefacts, or pathological lesions
- Look for soft tissue swelling, and acquire orthogonal views
- Radiograph contralateral limb for comparison.
Radiographic Findings with Bone Disease
- Periosteal New Bone Formation: Blunt trauma can lead to sub-periosteal hemorrhage, lifting periosteum, stimulating production of periosteal new bone, creating less dense, irregular outlines (that become more radiopaque with smooth outlines), and potentially showing signs of healing fractures, infection, inflammation, neoplasia, or osteoarthritis.
- Sclerosis (Endosteal New Bone Formation): Densification, localised new bone formation, increased bone mass, increased radio-opacity, protection of weakened areas, or walling off infection.
- Bone Lysis: Destruction of bone area, signs of infection, presence of neoplasia or keratoma.
- Osteophyte Formation: Spur of bone on a joint margin, intra-articular disease like osteoarthritis, and joint instability.
- Enthesophyte Formation: New bone development on tendon/ligament/joint capsule to bone attachment, a response to stress on these structures, or soft tissue injury
Aggressive vs Non-Aggressive Bone Lesions
- Characteristics of aggressive bone disease (e.g., malignant bone tumors, bone infection):
- Destruction of the cortex
- Irregular margin of reaction of periosteal reaction
- Lack of distinctness/boundary of the bone lesion to normal bone.
Diagnosis of Bone Pathologies: Ultrasonography
- Useful for assessing bone surface—smooth, uniform, hyperechoic line (only surface; not internal).
- Useful for areas difficult to radiograph (e.g., pelvis).
- Allows assessment of fractures (non-displaced break, displaced fragment with visualization of hyperechogenic bony bony structure from underlying bone), presence or absence of concurrent soft tissue damage and depth of wounds.
Diagnosis of Bone Pathologies: Nuclear Scintigraphy
- Radioisotope (Technetium 99m) is injected intravenously.
- Increased radiopharmaceutical uptake (IRU) in areas with increased osteoblastic activity.
- High in sensitivity but low in specificity imaging modality.
- Indications include fracture suspicion with negative radiographs or obscure lameness, those that are difficult to localize with diagnostic analgesia and episodic lameness, and horses with poor performance or inaccessible pelvic regions.
- Requires careful interpretation and knowledge of "normal" areas with increased bone turnover.
Diagnosis of Bone Pathologies: Computed Tomography
- 3D image from a series of 2D radiographic images, taken around a single axis of rotation.
- Advantages include non-superimposed structures, facilitating complex structure examination (e.g., skull), and the use of multiple planes to help delineate fracture orientation—useful for fracture repair planning.
Diagnosis of Bone Pathologies: Magnetic Resonance Imaging
- Allows better imaging of soft tissue structures, but less detailed examination of bone structures—lower resolution compared to radiography, CT, or ultrasound.
- Dynamic imaging modality, identifying intra-osseous fluid.
- Only distal limb possible in horses.
Bone Pathologies: Common Conditions, Treatment & Prognosis
- (This section is addressed throughout the notes)
Developmental Bone Disease
-
Angular limb deformities, physitis, osteochondrosis, cuboidal bone malformation (premature foals)
-
Sequelae to developmental bone disease predisposes animal to degenerative joint disease later in life. Early intervention is important to reduce long-term damage to a joint.
Angular Limb Deformities
- Valgus (lateral deviation of limb)
- Varus (medial deviation of limb)
- Carpus and fetlocks most commonly affected
Physitis
- Inflammation of growth plate
- Irregularly thickened growth plate
- Metaphyseal sclerosis
- Periosteal bone formation
Infectious Causes of Bone Disease: Osteitis and Osteomyelitis
- Inflammation of bone caused by pyogenic organisms.
- Inflammation, necrosis, removal of bone, compensatory production of new bone.
- Bone involved (pedial osteitis).
Radiographic Findings for Osteitis and Osteomyelitis
- Soft tissue swelling
- New bone formation
- Bone resorption
- Possible consequence: Sequestrum, involucrum, area of sclerosis to wall off infection, sinus
Septic Arthritis
- Contamination of synovial cavity with bacteria (from trauma, iatrogenic procedures, hematogenous spread, local soft-tissue infections).
Septic Arthritis: Pathogenesis
- Inflammatory response (vasodilation, neutrophil influx, release of cytokines/enzymes).
- Fibrin clots trapping bacteria.
- Cartilage destruction and extension to subchondral bone.
- Pain and swelling in affected joint—possibly leading to degenerative osteoarthritis.
Septic Arthritis: Treatment
- Joint lavage (ASAP)
- Arthroscopic debridement and lavage
- Systemic antibiotics (based on culture/sensitivity)
- Intra-articular antibiotics
- Intravenous regional perfusion
- Analgesics
Septic Arthritis: Prognosis
- Early, aggressive management for best outcome.
- Concurrent damage worsens prognosis (osteomyelitis, soft tissue damage).
- Care – most present NWB lame; low-grade lameness if open and draining; untreated—chronic lameness, DJD -> euthanasia.
Osteochondrosis/OCD
- Developmental disorder.
- Defect in endochondral ossification; focal ischaemic necrosis of cartilage initiated by necrosis of cartilage canal blood vessels.
- Osteochondritis dissecans (OCD): Fragment separates from adjacent subchondral bone.
- Osseus cyst-like lesions (OCLLS).
- Retention of a focal area of degenerate cartilage within the subchondral bone (subchondral bone cyst).
- Leads to osteoarthritis
- Predisposing factors: Trauma, body size, growth rate, nutrition (high plane of nutrition & high phosphorus diet, copper deficiency) and genetics (predisposition).
- Environment is important.
Osteochondrosis/OCD: Radiographic Findings
- Flattening of joint surface
- Mineralised cartilage flap/ subchondral bone defect
- OCLL/subchondral bone cysts
- Joint effusion.
Osteochondrosis/OCD: Ultrasonography
Osteochondrosis and OCD Management
- Long-term consequences (predisposition to osteoarthritis); free-floating fragments, extensive cartilage damage, fragments lodged in synovial membrane).
- Conservative management (Dietary modification, Rest, Analgesia.)
- Intra-articular medication with chondroprotectants +/- corticosteroids.
- Surgery (Arthroscopic debridement, cartilage flap removal.)
Osteoarthritis
- Degenerative joint disease
- Afflicted joints (small tarsal joints, tarsometatarsal joints, distal intertarsal joints, proximal intertarsal joints, distal interphalangeal joints, proximal interphalangeal, MCP, carpal joints, stifles, cervical spine).
Osteoarthritis: Radiographic Findings
- New bone formation/ periarticular osteophytes
- Enthesophytes
- Erosion of subchondral bone surface
- Subchondral sclerosis
- Subchondral cyst formation
- Reduced joint space/joint narrowing
- Increased synovial mass
- Mineralisation of tissues
Osteoarthritis: Radiography
Osteoarthritis: Management
- Aims (analgesia, control inflammation, limit damage to articular tissues, promote healing, improve quality of life, return to athletic function).
- Physical Therapy (Acute: rest, cold therapy; Chronic: gentle exercise, hydrotherapy).
- Anti-inflammatory/Analgesia (NSAIDs).
- Corticosteroids (intra-articular).
- Adjunctive Treatments (Hyaluronic Acid, Pentosan polysulphate sodium, Bisphosphonates…)
Useful Resources
- (A list of relevant research articles and publications is presented)
Synoviocentesis
- Essential for septic arthritis diagnosis.
- Detects inflammation within the joint (synovitis).
- Aseptic Collection is critical.
- Essential Tests (cytology and sensitivity).
- Contrast study (contrast agent injection into joint & radiographs, leaks if wound communicates with joint).
- Pressure test.
Synoviocentesis: Appearance
- Normal appearance: Pale yellow/transparent, high viscosity, low in white blood cells, low total protein.
- Abnormal appearance: Serosanguinous/turbid/low viscosity, High in white blood cells and high total protein; >90% Neutrophils.
Arthroscopy
- Direct visualisation of joints
- Diagnostic and therapeutic
Joint Disease: Common Conditions, Treatment & Prognosis
Osteoarthritis (Degenerative Joint Disease): Which joints are commonly affected in horses?
- Small tarsal joints ("Bone Spavin")
- Tarsometatarsal joints
- Distal intertarsal joints
- Proximal intertarsal joints
- Distal interphalangeal joints
- Proximal interphalangeal joint
- Metacarpophalangeal joints
- Carpal joints
- Stifles
- Cervical spine (articular facets.)
Joint Lavage
- Removes bacteria, debris, inflammatory mediators
- Uses large volume of sterile polyionic solution to dilute
Arthroscopic Debridement and Lavage
- Superior visualization
- Removal of debris, foreign materials, adhesions.
- Synovial biopsy for culture and sensitivity
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Description
Test your knowledge on equine joint diseases and their management. This quiz covers various aspects such as prognosis, clinical findings, diagnostic methods, and treatment options for conditions like osteoarthritis. Ideal for veterinary students and professionals alike.
