Management of hindlimb proximal suspensory desmopathy by neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy: 155 horses (2003–2008)

Dyson, Sue; Murray, Rachel C.

doi:10.1111/j.2042-3306.2011.00445.x

Cited by 54 publications

(90 citation statements)

References 30 publications

(75 reference statements)

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“…The majority of horses in the current study had SI joint region pain and hindlimb lameness, a high proportion of which had hindlimb proximal suspensory desmopathy, as previously documented (Dyson and Murray , ). Although clear improvement in baseline lameness in hand was seen in some horses after perineural analgesia of the deep branch of the lateral plantar nerve, ridden exercise highlighted the presence of a significant component of residual pain, sometimes paradoxically worse after abolition of the baseline lameness.…”

Section: Discussionsupporting

confidence: 70%

Clinical features and diagnosis of sacroiliac joint region pain in 296 horses: 2004–2014

Barstow

Dyson

2015

Equine Veterinary Education

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122

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Summary There has been no large‐scale study of the clinical signs of sacroiliac (SI) joint region pain and its association with lameness and/or thoracolumbar pain. Horses with a positive response to infiltration of local anaesthetic solution around the SI joint regions (SI block) and/or abnormal radiopharmaceutical uptake (RU) in the region of the SI joints were included. History, clinical signs, diagnostic imaging findings, response to SI block, and concurrent lameness and/or thoracolumbar pain were recorded. Horses (n = 296) were divided into 2 groups: SI joint region pain only (Group 1, n = 43) and SI joint region pain and concurrent source(s) of pain (Group 2, n = 253). Clinical signs in Group 1 included increased tension in the longissimus dorsi muscles (40%), restricted flexibility of the thoracolumbar region (44%), trunk stiffness during exercise (61%) and poor hindlimb impulsion (56%). When ridden 65% had a poor contact with the bit, in 81% canter quality was worse than trot, and 35% bucked or kicked out with a hindlimb during canter. In both Groups 1 and 2 clinical signs were seen in a significantly greater proportion of horses during ridden work than lungeing (P<0.0001). Following SI block, 98% of horses showed dramatic improvement in clinical signs, including greater overall movement through the trunk, increased hindlimb impulsion and better quality canter. Abnormal RU in the SI joint regions was seen in 85/180 (47%) horses. Of horses with a positive response to SI block that underwent scintigraphy, only 43% had abnormal RU. Per rectum ultrasonographic examination of the SI joint region revealed abnormalities in 41/129 (32%) horses. Clinical signs of SI joint region pain are worse when horses are ridden. Sacroiliac joint region diagnostic analgesia is a useful, safe but nonspecific block. Ultrasonography and scintigraphy can provide additional information in some horses, but negative results do not preclude SI joint region pain.

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Section: Discussionsupporting

confidence: 70%

Clinical features and diagnosis of sacroiliac joint region pain in 296 horses: 2004–2014

Barstow

Dyson

2015

Equine Veterinary Education

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122

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“…In contrast, the mean age of 155 horses with hindlimb proximal suspensory desmitis was 8.4 years, and the majority did not have radiographic changes in the cannon bone (Dyson et al 2012). This suggests that PSD in younger horses is less likely to be accompanied by radiographic lesions.…”

Section: Discussionmentioning

confidence: 61%

“…Ultrasonography is commonly used to examine the suspensory ligament but interpretation of results is somewhat subjective and the technique is prone to a variety of artefacts (Dyson 2003, Zauscher et al 2013). On radiographs the principal changes seen at the origin of the suspensory ligament on dorsopalmar/dorsoplantar views are increased radiopacity of the proximal MCIII/MTIII, which is compatible with new bone formation at the origin of the fibres of the suspensory ligament and enthesophyte formation at the palmar/plantar aspect of the cannon bone (Dyson 2011, Dyson et al 1995, Dyson et al 2012. Dorsopalmar/dorsoplantar views often show changes in radiopacity at the origin of the suspensory ligament in chronically lame horses, but these changes are rare in acute cases, and much more frequent in hindlimbs than in forelimbs (Dyson 2003, Dyson et al 1995, Gomez 2003.…”

Section: Introductionmentioning

confidence: 95%

Comparison of radiographic changes of the proximal third metacarpal and metatarsal bones in horses with and without proximal suspensory desmitis

Trump

Siegenthaler

Kircher

et al. 2014

PHK

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Summary: Medical records of horses examined from 1994 to 2011 at the Equine Hospital, Vetsuisse Faculty, University of Zurich, because of proximal suspensory desmitis (PSD) were reviewed. Radiographic changes visible on dorsopalmar and dorsoplantar projections of the proximal third metacarpal/metatarsal bone (MCIII/MTIII) were analysed with respect to localisation, degree of increased radiopacity, length, width and pattern of radiopacity in relation to sex, age, breed, duration and degree of lameness and affected limb of the horses. Results were compared with those from sound control horses. Horses with PSD had increased radiopacity, which was significantly more prevalent medially than laterally in the forelimbs (p < 0.05) and more prevalent laterally than medially in the hindlimbs (p < 0.05). The width of the area of increased radiopacity was significantly greater in the forelimbs than in the hindlimbs (p < 0.05). The pattern of increased radiopacity was diffuse in 102 (85.7 %) horses and multifocal in the remaining 17 (14.3 %). 35.3 % (n = 6) of multifocal changes were detected on one of the front limbs, whereas 74.7 % (n =11) were diagnosed on the hind limbs. Mildly increased diffuse radiopacity, with a distribution pattern comparable to cases with PSD was detected in 15 of 60 control horses. In comparison to control cases, the degree of increased diffuse radiopacity was significant more pronounced in horses with PSD (p < 0.001). The multifocal pattern of increased radiopacity could not be detected in any of the control horses. The results aid in the interpretation of radiographic changes seen in horses with PSD. Whereas a diffuse increased radiopacity of the proximal MCIII/MTIII needs to be interpreted with caution, as a mild degree may be seen in sound horses, the multifocal distribution pattern seems to be unique feature of horses with PSD.Keywords: proximal suspensory desmitis / PSD / radiographic changes / suspensory ligament / desmitis Vergleich von röntgenologischen Veränderungen im Bereich des proximalen Metakarpus und Metatarsus bei Pferden mit und ohne Desmopathie des FesselträgerursprungsIn der vorliegenden Studie wurden die Patientendaten von Pferden, die im Zeitraum von 1994 bis 2011 in der Pferdeklinik des Departements für Pferde der Vetsuisse-Fakultät, Universität Zürich wegen einer Desmitis des Fesseltägerursprungs vorgestellt wurden, retrospektiv evaluiert. Die im dorso-palmaren, bzw. dorso-plantaren Strahlengang sichtbar vermehrte Röntgendichte im Bereich des proximalen Metakarpus III/Metatarsus III wurde nach ihrer Lokalisation, Ausdehnung (Länge und Breite), Schweregrad der Veränderungen und Erscheinungsbild ausgewertet. Zudem wurden das Geschlecht, das Alter, die Rasse, die Dauer der klinischen Symptomatik, die erkrankte Gliedmaße und der Lahmheitsgrad ausgewertet. Die Ergebnisse wurden mit einer Kontrollgruppe verglichen. Für die Kontrollgruppe wurden 30 Röntgenbilder eines Karpus und 30 Röntgenbilder eines Tarus je in der dorsopalmaren/plantaren Projektion nach dem gleichen Schema ausge...

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“…If the foot is not the site of pain producing the lameness, removal of sensation from the foot may allow a full lameness work up to be carried out during the next hour because of the increased degree of lameness. We believe that this effect is due to lack of proprioception from the foot, and the horse overloading the limb until the pain is perceived, with exacerbation of the lameness. Clinicians can become obsessed with the idea that horses have only one source of pain causing lameness, but in the current authors' experience, this is often not the case (Dyson and Murray , ; Girodroux et al . ; Zimmerman et al .…”

Section: General Principlesmentioning

confidence: 90%

Where does it hurt? Problems with interpretation of regional and intra‐synovial diagnostic analgesia

Pilsworth

Dyson

2015

Equine Veterinary Education

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Summary Detailed clinical evaluation and diagnostic analgesia are crucial for accurate lameness diagnosis. This review discusses the ways in which local analgesic techniques can cause confusion and highlights how important it is to recognise that the majority of methods are less specific than was formerly thought. Interpretation of responses must be done together with the results of clinical examination and careful assessment of diagnostic images. With the knowledge of false negative and false positive results of local analgesic techniques and the recognition that there may be more than one focus of pain contributing to lameness, it is still possible to reach accurate diagnoses, provided that a logical, thoughtful approach is utilised.

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Management of hindlimb proximal suspensory desmopathy by neurectomy of the deep branch of the lateral plantar nerve and plantar fasciotomy: 155 horses (2003–2008)

Cited by 54 publications

References 30 publications

Clinical features and diagnosis of sacroiliac joint region pain in 296 horses: 2004–2014

Clinical features and diagnosis of sacroiliac joint region pain in 296 horses: 2004–2014

Comparison of radiographic changes of the proximal third metacarpal and metatarsal bones in horses with and without proximal suspensory desmitis

Where does it hurt? Problems with interpretation of regional and intra‐synovial diagnostic analgesia

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