Summary Reasons for performing study: Sacroiliac joint osteoarthritis has been recognised as a significant cause of poor performance in competition and racehorses. Reliable diagnostic tools are currently lacking. The diagnosis has been based typically on exclusion of other possible causes of poor performance, back pain and hindlimb lameness. Objectives: To develop a safe, reliable and minimally invasive periarticular or intra‐articular injection technique of potential use for diagnosis and therapy of sacroiliac joint disease in horses. Methods: Twenty‐six horses were used to develop and assess a medial approach to the sacroiliac joint with a 15 gauge, 25 cm long spinal needle. In Part I, the cadaveric study, the spinal needle was introduced cranial to the contralateral tuber sacrale and advanced along the medial aspect of the ipsilateral iliac wing until the dorsal surface of the sacrum was encountered. One ml methylene blue (MB) was injected in both sacroiliac joint regions of the sacropelvic specimens. The location of MB‐stained tissues relative to the sacroiliac joints was recorded after dissection and disarticulation of the sacroiliac joint. In Part II, the in vivo study, 18 horses were used to validate the in vivo application of the sacroiliac joint injection technique. Horses were restrained in stocks and sedated in preparation for needle placement. One ml MB was injected bilaterally prior to euthanasia. Stained tissues were identified and recorded at necropsy. Successful joint injections were characterised as having MB located intra‐articularly or ≤2 cm periarticularly from the sacroiliac joint margin and localised to the middle or caudal third of the sacroiliac joint. Results: Intra‐articular MB was not observed in any specimen. However, MB‐stained tissue was identified periarticularly in all injection sites (n = 48). Based on the predetermined success criteria, 96% of the methylene blue depots were located at the middle or caudal third of the sacroiliac joint. Dye‐stained tissue was located ≤2 cm from the sacroiliac joint margins in 88% of the specimens. Median distance of the MB from the sacroiliac joint margins was 1.0 cm (range 0.2–3.8 cm). The overall success rate considering both location and distance of the MB‐stained tissue relative to sacroiliac joint margins was 83% (40 of 48 joints). Conclusions: The injection technique provides a reliable, easy to perform and consistent access to the medial periarticular aspect of the sacroiliac joint. Potential relevance: The described injection technique has the potential for both diagnostic and therapeutic applications in the medical management of equine sacroiliac joint disease. Further investigation is necessary to evaluate clinical efficacy and potential adverse effects.
Summary Local anaesthetic techniques and diagnostic imaging tools are currently used in conjunction with thorough physical and lameness examinations to diagnose sacroiliac disease (SID) in the horse. The deep and inaccessible location of the sacroiliac joint (SIJ), however, often renders diagnostic imaging modalities, such as radiography, nuclear scintigraphy and ultrasonography, unreliable in identifying sacroiliac problems. The equine clinician therefore often has to rely on positive results of local anaesthetic techniques to confirm a diagnosis of SID. Regional infiltration techniques have been described but result in a diffuse distribution of large volumes of local anaesthetic solution throughout the entire lumbosacroiliac region, which is nonspecific to the SIJ and has the potential to produce false positive results. Several periarticular injection approaches to the SIJ have recently been described. A combination of periarticular SIJ injections with the use of modest amounts of local anaesthetic solution provides increased SIJ specificity, but may lead to false negative results in cases where the pain originates from surrounding soft tissues. This article clarifies terminology related to sacroiliac injections, reviews current injection techniques, highlights the advantages and disadvantages of each approach, and investigates injectate volume considerations.
The purpose of this study was to establish the normal percutaneous ultrasonographic appearance of anatomic structures within the equine sacroiliac region. Percutaneous ultrasonography was performed in a cranial-to-caudal direction in 10 normal adult live horses. The following structures were examined in detail: supraspinous ligament, lumbar and sacral spinous processes, thoracolumbar fascia and its caudal extension, tubera sacralia, ilial wings, dorsal and lateral portions of the dorsal sacroiliac ligaments, lateral part of the sacrum, and the lateral sacral crest. After ultrasonography, all animals were euthanized and detailed dissection of the lumbosacropelvic region was performed in six horses. Four lumbosacropelvic specimens were frozen and sectioned transversely for evaluation of cross-sectional anatomy. Gross anatomic findings were correlated with ante-mortem ultrasonographic images. On percutaneous ultrasonography, all horses had tubera sacralia with a mild-to-moderate roughened surface with occasional irregular hyperechoic mineralizations located within the apophyseal cartilage of younger horses. At the level of the tuber sacrale the caudal extension of the thoracolumbar fascia joined the dorsal portion of the dorsal sacroiliac ligament and assumed two different configurations relative to the dorsal portion of the dorsal sacroiliac ligament, with the predominant configuration of the thoracolumbar fascia located medial to the dorsal portion of the dorsal sacroiliac ligament. The less frequently encountered configuration had the thoracolumbar fascia positioned dorsal to the dorsal portion of the dorsal sacroiliac ligament. Caudal to the tuber sacrale the dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia consolidated to form a single, fused structure with a common insertion on the sacral spinous processes. A large variability in linear fiber pattern, echogenicity (small focal hypoechoic areas), ligament height, and cross-sectional measurements was identified in the fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia of normal horses. Diagnosing mild-to-moderate desmitis of the fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia based solely on ultrasonography may therefore be difficult. To correlate ultrasonography with histology, samples of a fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia with bilateral hypoechoic lesions were submitted for histology and revealed diffuse mild-to-moderate loss of fiber density, multifocal fibrocyte degeneration, and cartilagenous metaplasia with multifocal, mild myofiber mineralization, which was compatible with age-related changes. As controls, sections of ultrasonographically normal fused dorsal portion of the dorsal sacroiliac ligament and thoracolumbar fascia from three horses demonstrated similar but milder histologic findings, which were considered normal.
Internal fixation of antebrachial fractures is feasible and reasonably well tolerated in captive polar bears.
The objectives of this study were to evaluate the likelihood of successful arthrocentesis of the equine elbow joint using the caudolateral approach and to determine if the deep branch of the radial nerve (DBRN) varies in its proximity to the site of centesis. Methylene blue (MB) was injected into 71 elbow joint specimens immediately caudal to the lateral collateral ligament using a 3.8-cm needle advanced to its hub. The elbow joints were dissected, staining of the synovial structures assessed and the proximity of DBRN to the site of centesis evaluated. The articular cartilage of all 71 joints was stained with MB. The location of DBRN did not vary substantially among the specimens and did not course close to the site of centesis. Direct communication was found between the bursa of the tendon of the ulnaris lateralis muscle and the elbow joint in 41 of 71 specimens (57.8 per cent). The caudolateral approach for centesis of the equine elbow joint, performed by inserting a needle 3.8-cm, was found to be reliable. Radial nerve paralysis reported to be caused by injection of local anaesthetic solution using the caudolateral approach may be due to diffusion of the solution from the dorsal pouch rather than from leakage at the site of centesis.
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