Ultrasound‐guided Injections in Horses With Cranioventral Distension of the Coxofemoral Joint Capsule: Feasibility for a Cranioventral Approach

Abstract

Intrasynovial access to the equine coxofemoral joint (CFJ) is inherently challenging. Blind injection techniques rely upon inconsistently palpable landmarks, and ultrasound guidance requires expertise for needle placement into the coxofemoral articulation. Aspiration is recommended to confirm intrasynovial placement and avoid sciatic nerve anesthesia. The aim of this observational, descriptive, retrospective study was to evaluate the feasibility for an alternative ultrasound-guided approach in horses with cranioventral distention of the CFJ identified during pelvic ultrasound. Thirteen horses with cranioventral CFJ distention, including 12 with severe pathology, were recruited from 2009 to 2014. Seven were excluded as they were not injected or underwent ultrasound-guided injection using a dorsal approach. The remaining six horses underwent a total of nine injections into the cranioventral recess. With the exception of one foal, all were aged horses (15-29 years) of varying breeds and uses, with prominent lameness due to subluxation (three), luxation (two), and severe osteoarthritis (one). The cranioventral recess was imaged adjacent to the proximal femur using a low-frequency curvilinear transducer placed ventral to the cranial joint margins. Using aseptic technique, spinal needles were placed cranial to the transducer and advanced caudomedially into the distended cranioventral recess. Synovial fluid was retrieved in all cases with one needle placement. Findings indicated that, when distended, ultrasound-guided access to the cranioventral CFJ recess is a feasible alternative approach and may reduce the potential for extra-synovial placement. Distention in this sample of horses was accompanied by severe pathology, also supporting the use of this approach for therapeutic interventions.

Sidewinder gait in horses

“…28 Ultrasonographic evaluation of the pelvis includes the coxofemoral joints, sacroiliac joints, and pubic symphysis and can be performed SC and transrectally in the standing horse. [28][29][30][31] Similar to the 1 case here, prognosis for multiple pelvic fractures particularly involving the acetabulum have the worst prognosis for returning to athletic performance. 28 In 1 horse with multiple pelvic fractures from this report, severe sidewinder gait improved over a year but did not completely resolve.…”

“…Characterization of pelvic fractures is essential for determination of prognosis 28 . Ultrasonographic evaluation of the pelvis includes the coxofemoral joints, sacroiliac joints, and pubic symphysis and can be performed SC and transrectally in the standing horse 28‐31 . Similar to the 1 case here, prognosis for multiple pelvic fractures particularly involving the acetabulum have the worst prognosis for returning to athletic performance 28 .…”

Freehand magnetic needle guidance technology for intra‐articular cervical injection in horses

“…Many surgical and medical interventional procedures can be performed by minimally invasive ultrasound-guided techniques in horses, such as the localisation and removal of foreign bodies and fracture fragments in joints, draining of abscesses through needles or surgical procedures such as patellar ligament splitting. The advantages of procedures performed by minimally invasive ultrasound-guided techniques include reduced tissue trauma, reduced procedure time and client cost, and the ability to perform on a standing horse in appropriate cases and situations (Whitcomb et al 2016). The possibility of avoiding vital structures such as nerves, arteries and tissues with variable angles of the needle entry is a huge advantage.…”

Various 3D printed materials mimic bone ultrasonographically: 3D printed models of the equine cervical articular process joints as a simulator for ultrasound guided intra-articular injections

“…Several ultrasound guided techniques for intra-articular injections are reported. Injection techniques of the cervical articular process joints [10,11], coxofemoral joint [12,13], and medial femorotibial joint [14] have been described. Currently, the most common practical approach to learning equine intrasynovial injections involves the use of cadavers.…”

“…Currently, the most common practical approach to learning equine intrasynovial injections involves the use of cadavers. Dye or radiographic contrast is injected into synovial structures and subsequent dissection or radiographic evaluation confirms the site of injection [12,13,15,16]. Although cadavers are anatomically the closest to live animals, their use has several disadvantages.…”