The Veterinary clinics of North America. Equine practice.
Publisher:
W.B. Saunders,
Frequency: Three no. a year
Country: United States
Language: English
Start Year:1985 -
ISSN:
0749-0739 (Print)
1558-4224 (Electronic)
0749-0739 (Linking)
1558-4224 (Electronic)
0749-0739 (Linking)
Impact Factor
1.1
2022
| NLM ID: | 8511904 |
| (DNLM): | SR0053812(s) |
| (OCoLC): | 11078671 |
| LCCN: | sn 84006968 |
| Classification: | W1 VE929F |
Clinical Updates on Superficial Digital Flexor Tendon Injuries: Insights on Diagnostic and Therapeutic Advancements. Superficial digital flexor tendinopathy is one of the most common orthopedic soft tissue injuries in horses. The veterinary challenge for this condition is less related to identifying the presence of the injury (as it is usually readily evident clinically) but more related to improving the healing process so that the healed tendon is more like normal tendon in biology and function in order to reduce reinjury, which is the key adverse consequence of the injury. Diagnostic imaging has improved in recent years to aid with treatment choices and monitoring the healing process.
Tendon/Ligaments: Structure and Composition. The mid-metacarpal SDFT, intrasynovial DDFT and suspensory ligament are frequently injured soft tissues in the equine athlete. The mid-metacarpal SDFT exhibits a hierarchical structure and encounters repetitive strains at its functional limit. The intrasynovial DDFT possesses fibrocartilage where opposing bony surfaces to facilitate resistance-free gliding and contains chondrocyte-like cells embedded in a proteoglycan-rich ECM. While suspensory ligament enthesis injuries are common, collagen and non-collagen ECM structure-function specializations at the bone-ligament interface are understudied...
Guidelines for Formulating Rehabilitation Strategies for Equine Tendon and Ligament Injuries. Rehabilitation for tendon/ligament injury requires a multimodal approach to reduce pain, restore range of motion, improve proprioception/neuromotor control, and improve strength/endurance. Multiple tools are available to accomplish these goals. The rehabilitation program must be tailored to the individual patient regardless of injury type in order to return the horse to full athletic activity and reduce the risk of reinjury.
Adjunct Therapies for Tendon/Ligament Healing: Therapeutic Laser and Extracorporeal Shockwave Therapy. High-power laser therapy and extracorporeal shock wave therapy (ESWT) can be safely used to treat tendon and ligament injuries in horses, and the potential beneficial effects have been described. The power of low level lasers is not sufficient for treatment of tendon and ligament injuries in horses. ESWT is used more often to treat tendon and ligament injuries than it is for any other type of condition in horses, but there is limited supporting scientific evidence. Further research should focus on establishing dosage and treatment protocols for both laser therapy and ESWT in horses with clinic...
Cellular and Matrix Dynamics of the Equine Tendon. Our understanding of tendon homeostasis and repair following injury has made great strides through basic science, clinical veterinary medicine, and preclinical translational research. We have now gleaned a greater understanding of the cellular and matrix dynamics that are being orchestrated within the tendon, which provide therapeutic opportunities. This article will focus on how utilizing the horse and equine tissues have advanced our understanding of tendinopathy and the cellular and matrix dynamics at play while also identifying continued gaps in our knowledge where the horse as a veterinar...
Current and Emerging Biologic Therapies for Equine Tendon and Ligament Injuries. This review explores the use of biologics in the treatment of tendon and ligament injuries in horses, focusing on current and emerging therapies aimed at enhancing tissue repair and regeneration. It discusses the role of scaffold-based therapies, growth factors, blood-derived and tissue-derived biologics, and gene therapy as biologic regenerative therapies for improving healing outcomes. The review evaluates the mechanisms, efficacy, and challenges of biologics in clinical applications, highlighting recent advances and clinical studies. It provides an overview of current trends and future dire...
Suspensory Ligament Injuries: Diagnosis and Treatment. The location of a suspensory ligament (SL) injury heavily influences the clinical presentation, prognosis, and treatment options. Diagnostic imaging is necessary to provide an accurate diagnosis and is critical to ensure the institution of the most appropriate treatment. The hindlimb proximal SL in particular can be challenging to diagnosis, carries a guarded prognosis, and typically requires aggressive treatment to achieve soundness.
Techniques for Equine Tendon Tenorrhaphy. Equine tendon lacerations are not uncommon secondary to traumatic wounds and degloving lacerations. These wounds are often contaminated and, therefore, basic principles of wound assessment and management are critical to identify the extent of an injury. Ancillary tools to aid physical examination include radiography, ultrasonography, and synoviocentesis (eg, if involving a joint and/or tendon sheath). Prolonged convalescence period, continued external coaptation, and controlled exercise are mainstays of treatment following tenorrhaphy. A poor prognosis for return to full athletic function is e...
Evidence Related to the Effects of Intralesional/Intrasynovial Corticosteroids on Tendon/Ligament Homeostasis and Healing. Inflammation plays a role in acute and chronic equine tendon/ligament injury; anti-inflammatories are often indicated. Local corticosteroids provide consistent and profound short-term effects on pain and inflammation across species. However, there is no demonstrated benefit in the long term, and complications can occur. Alternative biologic anti-inflammatory treatments are available and should be used in horses at risk of complications. Nonetheless, corticosteroids remain an affordable and effective anti-inflammatory that, with continued research, may be indicated on a case-by-case basis as pa...
Nonexertional Rhabdomyolysis. Although horses most commonly develop exertional rhabdomyolysis, there are numerous causes for nonexertional rhabdomyolysis (nonER) that pose a serious health threat to horses. Their etiologies can be broadly categorized as toxic, genetic, inflammatory/infectious, nutritional, and traumatic and a variety of diagnostic tests are available to discern among them. This study discusses causes of nonER as well as diagnostics and treatments that are specific to each etiology. General treatment of acute rhabdomyolysis is covered in detail in the study in this issue on sporadic and recurrent exertional...
Therapeutic Exercises for Rehabilitation of Muscle Injury. Successful rehabilitation of muscle injury requires a comprehensive understanding of the injury process, healing phases, and resources to be employed. The initial phase is characterized by acute inflammatory signs, followed by the regenerative and remodeling phases. Therapeutic exercises can be utilized in all 3 phases, progressing from isometric exercises to aquatic therapies. The classification and phase of injury and the individual response to the applied therapies will guide the progression of the therapeutic exercises through the rehabilitation program.
Traumatic Muscle Injuries. Traumatic muscle injuries are likely to be frequent in athletic horses yet are often overlooked. These injuries usually involve internal (intrinsic) trauma, and particularly occur in athletic horses exercising at higher intensities, at unaccustomed workloads, or performing work requiring sudden acceleration, deceleration, and/or direction changes. These injuries can present with signs ranging from acute pain and lameness in a localized region to unexplained elevations of muscle enzymes on routine blood tests with or without poor performance. They include exercise-induced muscle damage such as ...
Vitamin E and Selenium-Related Manifestations of Muscle Disease. Nutritional deficiencies of vitamin E and selenium can occur alone or concurrently. Prolonged and sustained deficiency of either or both nutrients can lead to profound clinical disease. Selenium deficiency can also result in signs of cardiac disease, upper gastrointestinal dysfunction, and abortion or the birth of weak foals. Deficiencies can usually be readily established by evaluating the dietary intake of individuals and by measurement of blood concentrations of these nutrients. Treatment of clinical disease is not always successful and prolonged morbidity and mortality can be encountered; ...
Clinical Examination of the Muscle System. The equine muscle system is complex and prone to a large range of hereditary and acquired diseases that often have overlapping clinical signs with orthopedic, neurologic, and other disorders. Obtaining a clinical history that fully outlines the client concerns and any known information about the disorder and following with a comprehensive physical examination and screening clinical pathology tests are fundamental to achieve definitive diagnosis. A methodical and comprehensive approach aids accurate diagnosis and development of an optimal treatment and management plan. This article describes th...
Sporadic and Recurrent Exertional Rhabdomyolysis. Horses are particularly susceptible to developing exertional rhabdomyolysis (ER) characterized by muscle stiffness, pain, and reluctance to move. Diagnosis requires establishing abnormal increases in serum creatine kinase activity when horses exhibit clinical signs. The 2 main categories of ER include sporadic ER arising from extrinsic causes and chronic ER that arises from intrinsic continuous or episodic abnormalities in muscle function. This article focuses on treatment of acute ER and causes and management of sporadic ER. Differential diagnoses for chronic ER as well as the pathophysiology...
Myosin Heavy Chain Myopathy and Immune-Mediated Muscle Disorders. Several inflammatory myopathies have an infectious or immune-mediated basis in the horse. Myosin heavy chain myopathy is caused by a codominant missense variant in MYH1 and has 3 clinical presentations: immune-mediated myositis, calciphylaxis, and nonexertional rhabdomyolysis in Quarter Horse-related breeds. An infarctive form of purpura hemorrhagica affects numerous breeds, presenting with focal firm, painful muscle swelling, and subsequent infarction of multiple tissues. While Streptococcus equi equi is often the inciting cause, anaplasmosis, sarcocystis, piroplasmosis, viruses, and vaccines...
Genetics of Muscle Disease. In the field of equine muscle disorders, many conditions have a genetic basis. Therefore, genetic testing is an important part of the diagnostic evaluation. Validated genetic tests are currently available for 5 equine muscle disorders: hyperkalemic periodic paralysis, malignant hyperthermia, glycogen branching enzyme disease, type 1 polysaccharide storage myopathy, and myosin heavy chain myopathy. These diseases should be tested for in the appropriate breeds with clinical signs of disease or as part of breeding management. Genetic testing in veterinary medicine is not regulated, and therefore,...
Myofibrillar Myopathy. Myofibrillar myopathy (MFM) is characterized by segmental disarray of myofibrils and ectopic accumulation of a protein called desmin. Previously thought to be a glycogen storage disease, MFM is now recognized as a stand-alone myopathy. Endurance Arabians with MFM usually present with exertional rhabdomyolysis (MFM-ER) at the end of races, elevated serum muscle enzymes, and myoglobinuria. Warmblood horses with MFM (MFM-WB) usually present with pain-associated behaviors such as exercise intolerance, reluctance to engage hind quarter muscles, shifting lameness and normal serum muscle enzymes. Bot...
The Role of Nutrition in Managing Muscle Disorders. Many myopathies in horses can be managed by exercise regimes and dietary modifications. This includes modifying the amount of nonstructural carbohydrate, fat, amino acids, vitamin E, and selenium based on the horse's specific myopathy, metabolic status, exercise program, and optimal body weight. Because dietary recommendations differ substantially between myopathies, it is imperative to establish a specific diagnosis. A nutritionist will help practitioners select from the myriad of offered products to ensure a balanced diet. This article provides detailed recommendations for a variety of myopa...
Chronic Cough and Hyperpnea: Clinical Approach to Equine Asthma. Exercise intolerance, chronic cough, and hyperpnea are the clinical hallmarks of equine asthma. Diagnosis of severe equine asthma in horses is multistep; determination of the phenotype will help guide future recommendations. Management of equine asthma is largely reduction/elimination of triggering agents/conditions. Immunosuppressive therapies and bronchodilators are the mainstay of treatment of equine asthma. Rescue therapy with short-acting bronchodilators is the first goal when managing a horse with hyperpnea. The second goal is to control/reduce inflammation and airway remodeling. Immunos...
Muscle Rehabilitation Techniques and Prevention of Injury. Rehabilitation following muscle injury is critical in restoring the equine athlete to full function. Rehabilitation protocols should be tailored to each patient's global functional assessment, taking into account sports-specific demands, goals for return-to-performance, and overall prognosis. Rehabilitation protocols are often designed to modulate pain, enhance repair, improve proprioception, increase flexibility, restore muscle strength, joint range-of-motion, and neuromotor control. This article will review mechanisms of muscle injury, various physical modalities commonly employed in the reh...
Anesthesia and Myopathies of Horses. Pre-existing muscle disorders in horses can often be subtle and may only become evident during or after anesthesia. Advancements in veterinary medicine, along with increased knowledge and research in this field, help minimize anesthesia-related problems. Adequate preanesthesia assessment, early disease diagnosis, and proper management are crucial in minimizing risks to the neuromuscular system during general anesthesia.
Unusual Equine Tumors. There are a number of unusual tumors in the horse. Gross tumor characteristics, anatomical location, and signalment may assist with identification. Clinical pathology is often unrewarding with non-specific findings, while fine needle aspirates may not obtain sufficient tissue material to confirm a diagnosis. Although regular staining of biopsy material may be sufficient, immunohistochemistry markers may be required, especially in less differentiated tumors. The prognosis is dependent on the type, location, tumor size as well as on metastatic spread. A selection of unusual and rare tumors that ...
Lymphoma & Myeloproliferative Disease. Lymphoma and myeloproliferative diseases in horses are relatively uncommon. The clinical signs, prognosis, and treatment options depend upon the anatomic location and subtype. Significant gaps in knowledge remain regarding prevalence, pathogenesis of different subtypes, antemortem diagnostic tests, response to treatment, and standardized treatment protocols. However, treatment options are available, accessible on the farm, and could improve quality of life and prolong survival.
Equine Melanoma Updates. Melanomas are very common in older gray horses, with 80% of gray horses having at least 1 melanoma by 15 years of age. Historically considered a benign disease, it is now known that up to 66% of lesions will eventually metastasize. Melanomas may also cause local problems due to abscessation, ulceration, and interference with function of the affected areas. Treatment can be limited by size and location, but surgical resection, where possible, is likely to be the treatment of choice.
Diagnosis and Staging of Equine Neoplasia. The diagnosis of neoplasia in the horse is both simple and extremely challenging, depending on the type of neoplasm and its location. Obtaining an accurate diagnosis of a neoplastic condition is key to formulating an appropriate treatment plan if possible or developing a palliative plan if curative treatment options do not exist. A combination of historical features, clinical examination findings, and diagnostic testing typically allow a working diagnosis of neoplasia to be made, with a definitive diagnosis requiring the identification of neoplastic cells in a sample or tissue.
Tumors of the Urogenital Tract. Neoplasia has been reported to involve the majority of the urinary system of the horse, with tumors affecting the kidneys and bladder most comprehensively described. Primary tumors of the external genitalia are relatively common in the horse and are easily identified on clinical examination while primary tumors of the upper urogenital tract are uncommon. This article will highlight the common tumors, their clinical presentations, and discuss potential medical and surgical treatment options available. The less common neoplasms will be mentioned but not discussed in depth.
Radiotherapy in Equine Practice. Radiotherapy is a valuable treatment option for equine tumors that have a high rate of recurrence or where complete surgical resection may damage vital structures. Teletherapy, brachytherapy, and plesiotherapy have been used successfully for the treatment of a variety of tumors and locations in the horse. Radiobiology, treatment protocols, side effects, and patient management are reviewed, with a focus on linear accelerator-based teletherapy. There is evidence of good success rates for treatment of periocular sarcoids and squamous cell carcinoma but teletherapy treatment is often limited to tu...
Paraneoplastic Syndromes in Horses. This article discusses the reported paraneoplastic syndromes (PNSs) in horses, including the possible pathogenesis, diagnostic methods, and any treatment options. The more commonly reported PNSs in horses include cancer anorexia and cachexia, fever and increased acute phase protein concentrations, and hypercalcemia and monoclonal gammopathy. As these conditions can often be more commonly diagnosed in non-neoplastic conditions, the diagnosis of a PNS and the accompanying neoplasia can be challenging. As signs of a PNS may precede signs of the underlying neoplasia, it is important that the clini...
Squamous Cell Carcinomas in Horses: An Update of the Aetiopathogenesis and Treatment Options. Squamous cell carcinomas are a very common tumor type in horses, and are found in a variety of dermatologic and non-dermatologic locations. Metastasis is common, even at the first presentation of the disease, and a full staging workup is therefore strongly recommended to direct treatment and assist with prognostication. Wide surgical excision remains the treatment of choice in most cases, but recurrence is common, and adjunctive therapy may be indicated to improve the long-term prognosis.