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A Case of Quadruple Limb Lameness in a Horse

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A Case of Quadruple Limb Lameness in a Horse GHENT UNIVERSITY FACULTY OF VETERINARY MEDICINE Academic year 2016 - 2017 A case of quadruple limb lameness in a horse by Hannah JONES Promoters: Prof. Dr. F. Pille Case Report Dr. M. Dumoulin as part of the Master's Dissertation © 2017 Hannah JONES Disclaimer Universiteit Gent, its employees and/or students, give no warranty that the information provided in this thesis is accurate or exhaustive, nor that the content of this thesis will not constitute or result in any infringement of third-party rights. Universiteit Gent, its employees and/or students do not accept any liability or responsibility for any use which may be made of the content or information given in the thesis, nor for any reliance which may be placed on any advice or information provided in this thesis. GHENT UNIVERSITY FACULTY OF VETERINARY MEDICINE Academic year 2016 - 2017 A case of quadruple limb lameness in a horse by Hannah JONES Promoters: Prof. Dr. F. Pille Case Report Dr. M. Dumoulin as part of the Master's Dissertation © 2017 Hannah JONES Preface I would like to thank my promotor and co-promotor for helping me find an interesting case and providing me with the needed information. Furthermore I want to say a very big thank you to my family and boyfriend for helping me work on this thesis and for their endless support throughout the entire study! Contents Abstract.................................................................................................................................................... 6 Samenvatting ........................................................................................................................................... 7 Introduction .............................................................................................................................................. 8 1. Anatomy of the distal limb ............................................................................................................ 8 2. Podotrochleitis – Navicular bone disease .................................................................................... 9 Case study ............................................................................................................................................. 11 1. Anamnesis .................................................................................................................................. 11 2. Clinical examination, inspection and palpation ........................................................................... 11 2.1 Day 1 ........................................................................................................................................ 11 2.2 Day 2 ........................................................................................................................................ 13 2.3 Day 3 ........................................................................................................................................ 14 3. Conclusion .................................................................................................................................. 15 4. Therapy ....................................................................................................................................... 15 5. Outcome ..................................................................................................................................... 15 Discussion ............................................................................................................................................. 16 1. Incidence and clinical presentation ............................................................................................. 16 2. Diagnosis .................................................................................................................................... 16 2.1 Local anaesthesia .................................................................................................................... 16 2.2 Medical Imaging ....................................................................................................................... 17 3. Treatment ................................................................................................................................... 18 3.1 Conservative therapy ............................................................................................................... 18 3.2 Surgical treatments .................................................................................................................. 21 4. Prognosis ....................................................................................................................................... 22 5. Conclusion ..................................................................................................................................... 22 References ............................................................................................................................................ 23 Abstract Navicular syndrome is a common cause of lameness in middle-aged horses. It primarily affects the front legs, but in some cases the hind legs can be affected too. Discomfort in the region of the navicular apparatus can be caused by pain in this region, by derogation of the navicular bone itself, or by the surrounding soft tissues. This thesis describes a case of a horse that was presented to the department of Surgery at the Faculty in Merelbeke (UGent). The clinical examination pointed out that the horse was very stiff and lame. Radiographic imaging was done foremost due to the severity of the symptoms, to see if there were any subtle or obvious changes in the hoof. Since this was not the case for this horse, local analgesia was safe enough to use to locate the region from where the pain originated. Because palmar digital nerve block on all four legs was positive, and the intrabursal anaesthesia of the most lame limb was positive as well, the horse was diagnosed with navicular syndrome. The owners decided to try a conservative therapy, before going over to advanced medical imaging such as magnetic resonance imaging. The therapy consisted of an intrabursal injection with a corticosteroid (methylprednisolone) combined with corrective shoeing and trimming. After 5 months the owners were contacted to check up on the horse. It had responded very well to the treatment and was still sound. Samenvatting Hoefkatrol of podotrochleïtis is een veel voorkomend probleem, vooral beschreven bij warmbloeden van middelbare leeftijd. In de vakliteratuur wordt podotrochleïtis vaak vermeld als een probleem dat voornamelijk voorkomt in de voorvoeten. Desondanks worden er op de Faculteit in Merelbeke (UGent) jaarlijks een 30-35 gevallen van paarden die aan de vier voeten mank zijn gediagnosticeerd, waarvan er een deel zelfs wordt aangeboden met de zwaarste kreupelheid komend uit de achtervoeten. Podotrochleïtis is een aandoening waarbij het probleem zich lokaliseert in de regio podotrochlearis van de hoef. Het kan gaan om simpelweg pijn in die regio, vroege of al meer uitgesproken botveranderingen van het straalbeen, of aantasting van de omgevende weke delen. In deze thesis wordt een casus besproken van een paard met viervoetsmanker conditie. Het dier werd kreupel en stijf bij de vakgroep Heelkunde en Anesthesie van de huisdieren aan de Faculteit in Merelbeke (UGent) gebracht. Het werd enkele dagen gehospitaliseerd om de uitgebreide klinische onderzoeken en herhaaldelijke lokale anesthesieën correct te kunnen uitvoeren. Het gebruik van lokale anesthesie wordt erg gewaardeerd als diagnostische methode om aan te kunnen tonen waar de pijn in het lidmaat vandaan komt. Lokale anesthesie in de bursa is erg specifiek; wordt de bursa positief bevonden, kan men vervolgens nog aanvullende diagnostische methodes, zoals medische beeldvorming, gebruiken om het onderzoek verder toe te spitsen op de oorzaak van de pijn in die regio. Bij het paard in deze casus werden er nauwelijks radiografische veranderingen aangetroffen. Het is vaak zo dat op radiografische opnames niet veel veranderingen te zien zijn, of dat deze niet significant genoeg zijn om de pijn in de regio podotrochlearis te verklaren. Andere medische beeldvormingstechnieken, zoals magnetic resonance imaging (MRI), geven vaak betere beeldkwaliteit, van zowel het straalbeen als van de omgevende weke delen. De eigenaars van het paard besloten om eerst een therapeutische behandeling te proberen, vooraleer over te gaan naar MRI. Op basis van de positieve lage anesthesie op alle vier de benen, en een positieve bursa anesthesie van het meest manke lidmaat, werd het paard conservatief behandeld voor hoefkatrol. Het paard werd lokaal behandeld in de bursa podotrochlearis met een middellang-werkend glucocorticoïd (methylprednisolone). Om laminitis te voorkomen werd deze behandeling in 2 stappen uitgevoerd, eerst de voorvoeten en enkele dagen nadien de achtervoeten. Ook werd er een correctief beslag aangebracht op alle 4 de hoeven. Een rustperiode werd aangeraden waarna de werklast gradueel kon worden opgebouwd. Er zijn meerdere behandelingen beschreven voor podotrochleïtis, maar het gaat hier voornamelijk om tijdelijke oplossingen die het paard een hoger comfort kunnen geven. De uitkomst van de gekozen behandeling of combinatie van verschillende behandelingen dient afgewacht te worden. Het effect van de behandeling is individu afhankelijk en kan moeilijk voorspeld worden. Vijf maanden na de lokale behandeling werden de eigenaren gecontacteerd, waaruit bleek
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