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 |
The pathophysiology of developmental and acute laminitis. This review implies that although we know more regarding the enigma of developmental and acute laminitis today than previously, there is still more to investigate. As these investigations are conducted and interpreted, new and more effective preventive and therapeutic regimens are likely to be developed, tested, and made available. As this occurs, the impact of laminitis should undoubtedly decrease. Unfortunately, due to the lack of clinical symptoms in the developmental phase and the shortness of the acute phase, it is also evident that the two sequelae of acute laminitis, subacute and chroni...
Historical perspectives on laminitis. This article attempts to provide a historical perspective regarding equine laminitis. It is designed to cover, as completely as possible, the historical record of, and the research advances made, in regards to acute and chronic laminitis. With respect to the historical record, the names given to this disease, the postulated etiologies, and the various treatment protocols are discussed. This article demonstrates the historical longevity of this disease and establishes a background for the current understanding of the disease's pathologic mechanisms and treatments.
Pharmacologic and alternative therapies for the horse with chronic laminitis. This article deals with treatment of the chronically foundered horse. The first section of this article is focused on aspects of the traditional pharmacologic approaches to management of digital pain and sepsis, dietary management, and thyroid supplementation. A second section introduces the concepts, principles, and agents that are used in homeopathic treatments for laminitis. Lastly, a third section of this article reviews the use of acupuncture and traditional Chinese medicine approaches to treatment of chronic laminitis.
The pharmacologic basis for the treatment of developmental and acute laminitis. Each horse with laminitis is presented to the veterinarian at a different stage in progression of the condition and with varying severity. The pathogenic timing is often unknown and is difficult to determine. Because timing and severity are related to both the lesion's severity and responsiveness to treatment, these factors are critical to treatment selection and success. It is erroneous to assume that each horse with laminitis should receive each treatment. It is therefore important to ascertain as logically and objectively as possible the pathophysiological stage of development of each horse...
The mechanisms and consequences of structural failure of the foot. Many of the difficulties in managing the horse with chronic laminitis are associated with the foot's mechanical failure. The occurrence of digital collapse cannot be viewed in isolation as the primary therapeutic focus. The circulatory, metabolic, and growth pattern changes induced by the foot's mechanical collapse often serve as major limiting factors to successful rehabilitation. From the discussion above, it is obvious that a significant amount of research is needed to better understand the biomechanical pathologies of the failed foot.
Trimming and shoeing the chronically affected horse. Several of the technical approaches applied to the foot overlap with regard to intent. Frog or solar support, for example, may be provided either to stabilize the distal phalanx within the hoof capsule or in an effort to unload regional pain arising from the solar surface of the foot. It is likewise obvious that some techniques such as lowering the heels to achieve phalangeal realignment and raising the heels to relieve deep digital flexor tendon tension are contradictory. In these instances, it is not that one technique is always correct but that differences exist among horses. Currently, it ...
Clinical presentation, diagnosis, and prognosis of chronic laminitis. This article focuses on the initial assessment of the horse affected with chronic laminitis. Variations in the clinical presentation and primary considerations in making a differential diagnosis are included. The elements of a clinical history essential to sound, therapeutic management, and prognosis are summarized. The physical and radiographic assessment of the digital lesions and diagnostic approaches to the common systemic aspects of the disease are presented and discussed.
Clinical presentation, diagnosis, and prognosis of acute laminitis. The purpose of this article is to describe the clinical features present in the patient affected with acute laminitis. The variations in the stance and characteristic lameness of the acute disease are described in relation to the disease severity and limb involvement. The elements of establishing a diagnosis including clinical history, physical and radiologic evaluation, and differential diagnosis are discussed. Difficulties and criteria used in establishing a prognosis of the acute phase patient are defined.
The digital pathologies of chronic laminitis. This review indicates that the patient-to-patient uniqueness commonly seen in chronic laminitis represents the variable presence of the digital pathologies. Although some degree of mechanical failure is always present, the secondary metabolic and growth dysplasias, vascular pathologies, and sepsis may or may not be evident. The presence and severity of these pathologies appear to have a more significant impact on the prognosis of individual cases than does the displacement of the distal phalanx. It should be reiterated that it is often the combined presence of these individual pathologies that...
Treatment of acute laminitis. Supportive therapy. Over the last decade, both the farriery and veterinary professions have greatly increased their collective experience and understanding of the treatment of acute laminitis. Many horses that would have not been considered candidates for treatment 10 to 15 years ago are now saved, and some progress to successful careers as athletes. Unfortunately, the difficulties over prediction of the course of the disease persist, which continues to complicate treatment decisions. By its nature, supportive therapy is designed to make the horse more comfortable and limit further laminar injury by countering ad...
Laminitis in the horse. This article serves as an introduction to this issue on laminitis. As such, it contains the general perspectives and terminology that will be used in all subsequent articles. This article separates the clinical problem of laminitis into developmental, acute, subacute, and chronic phases and defines the criteria, duration, clinical goals, and implications of these phases. The basis for the significance of laminitis to the horse industry and the horseman is reviewed. Lastly, the organization of this issue is described.
The pathophysiology of chronic laminitis. Pain and anatomic pathology. The potential pathologic manifestations of chronic laminitis are just as varied, and possibly more so, than the list of possible inciting agents of the disease itself. The extent to which rehabilitation and return to normal function can be attained, cannot always be accurately determined by physical examination. It should be remembered that significant physiologic and pathologic alterations occur in chronic laminitis; thus, even if radiographically the patient returns to a normal appearance, residual morphologic and structural defects are likely to remain.
Anatomy of the thoracolumbar vertebral region. A thorough understanding of the structure and function of the equine vertebral column can provide a clearer understanding of thoracolumbar spinal disorders. Three primary functions of the vertebral column include protection of the spinal cord, support for weight bearing, and flexibility for locomotion. Osseous structures provide structural support and vary from one vertebral region to another as functional requirements change. The spinal musculature produces complex vertebral movements while the spinal ligaments provide stability to the vertebral column. Proprioception and nociception are two ...
Back problems. Neuroanatomy and neurological examination. Components of the equine nervous system are described including classical anatomy and newer sensory innervation maps that are useful for localizing lesions to and within the nervous system. The key components in a neurological examination that help differentiate primary neurologic disease from musculoskeletal disorders are explained. Gait deficits associated with neurologic dysfunction are listed as well as diagnostic aids and an overview of differential diagnoses.
Osseous spinal pathology. Pathologic changes have been observed at the spinous processes, intervertebral articulations, and sacroiliac joints in horses. Varying severity of degenerative articular changes are found in many articular processes, intertransverse, lumbosacral, and sacroiliac joints. Pathologic lesions tend to affect multiple vertebral locations within a specimen. Further studies need to be conducted to evaluate the clinical significance of the numerous vertebral and pelvic pathologic findings found in a sample of Thoroughbred racehorses that died because of unrelated injuries. Increased knowledge of osseous...
Physical therapy for the equine back. Before a physical therapy and rehabilitation program is suggested, the end requirement must be considered. All physiotherapeutic machines are subject to laboratory screening. In the United States, the approval of the Food and Drug Administration is required; in the United Kingdom, certification by the National Physics Laboratory has been required by law since January 1996. Laboratory experiments are continually conducted to examine and evaluate the effects on tissues of varied electrical waveforms, low-intensity electrical currents, sound waves, and light rays delivered by a variety of therape...
Back problems. Chiropractic evaluation and management. A thorough knowledge of equine spinal anatomy, biomechanics, and potential pathology is required to understand the principles and theories behind chiropractic and to apply its techniques properly. Chiropractic provides additional diagnostic and therapeutic means that may help equine practitioners to identify and treat the primary cause of lameness or poor performance. Specialized training in the evaluation and treatment of vertebral joint dysfunction and neuromusculoskeletal disorders places chiropractic in the forefront of conservative treatment of spinal-related disorders. Nevertheless, limi...
Back problems. Radiology and scintigraphy. Radiology and, more recently, scintigraphy are important ancillary diagnostic aids in the diagnosis of a horse with suspected back pain. Although the image quality is restricted by the size of the patient, radiographs have been used for several decades. With the introduction of modern fast-screen film systems, the quality of the images has greatly improved. These imaging techniques allow assessment of the anatomy and physiology of structures in the spine that are difficult or impossible to palpate. This article reviews the techniques and limitations of imaging the equine back, in addition to c...
Equine back rehabilitation. This article introduces the importance of considering all related physical findings, evaluating the whole horse and determining the root cause in order to achieve the best treatment results, prevent recurrence, and return the patient to full function. The roles of shoeing, turnout, teeth, training aids and devices, compensatory lameness, working surface (footing), longing, ponying, hot walkers, and swimming are discussed in relationship to back dysfunction and rehabilitation. Postural analysis and measures for muscle and postural corrections are also presented. Ground and under saddle rehabili...
Spinal muscle pathology. Clinical signs that are easily referred to spinal muscle pathology include atrophy of epaxial muscles, focal swelling and palpable tenderness, as well as enlarged muscles with increased tone. Less easily recognized signs include rigidity of the spine, shortened stride, hindlimb lameness, and indicators of poor performance. Muscle biopsy is one option in evaluating sore backs and is best used when physical examination and imaging procedures do not reveal a likely diagnosis or when conventional treatments are unsuccessful. Rhabdomyolysis of spinal muscles may be due to nutritional myodegeneratio...
Physical examination of horses with back pain. The diagnosis of back pain is often a diagnosis of exclusion of other problems in the face of poor performance. It requires careful observation, thought, an open mind, and experience. The signs of back pain can be extremely variable and range from subtle to obvious. Obvious forelimb or hind limb lameness is not usually a sign of back pain. The most common differential diagnosis may be back pain secondary to degenerative joint disease of the hocks, fetlocks, or stifle. These diseases can mimic signs of back pain including lack of impulsion, shortening of the stride length, and change in the str...
Spinal biomechanics and functional anatomy. Knowledge of the normal functional behavior and mechanical properties of the vertebral column is important to understand the pathogenesis of back lesions, to identify the clinical manifestations of back pain, and to ensure a rational approach to physical therapy. The purpose of this article is to present a synthesis of in vivo and in vitro data obtained from different but complementary investigations. Presently, in vivo studies are limited; few gait-specific kinematic and electromyographic investigations are in process. Higher stresses to reach the maximal range of intervertebral motion can be...
Ultrasonographic evaluation of back lesions. With progressive advances in ultrasonographic equipment, evaluation of a number of axial skeletal structures is now possible. Ultrasonography is presently the best technique for evaluation of the SSpL and lumbosacral intervertebral discs. It is a useful adjunct to radiography for assessment of spinous processes and AP injuries.
Medical management of back pain. The most common causes of back pain and their medical treatment are discussed. These include: dermatologic problems and conditions resulting from saddle trauma; discomfort and stiffness owing to injured paraspinal muscles; pain associated with supraspinous ligament damage; osseous pain and nerve dysfunction related to the spine and sacroiliac area; and neurologic diseases that can manifest as back pain. Bitting problems, cervical pain, and coexisting lameness are also considered.
Thermographic diagnostics in equine back pain. Infrared thermographic imaging (ITI) is the most sensitive objective imaging currently available for the detection of back disease in horses. It is, however, only a physiological study primarily of vasomotor tone overlying other superficial tissue factors. Interpretation requires extreme care in imaging protocol and in understanding the significance of altered sympathetic nervous tone and the sympathetic distribution. Most discussions on back pain have centered on nociception and inflammatory events. ITI provides information and localization for more significant than diagnosing areas of hot sp...
Spinal ligament pathology. Young elite athletes, particularly horses used for jumping, are at a relatively high risk for injury to the ligaments associated with the axial skeleton. Extreme back flexion appears to be a contributing factor to ligament damage. Back pain due to injury of the ligaments of the axial skeleton has often been considered to be secondary to lower limb injury, to the extent that a separate definitive diagnosis, treatment, and prognosis were unnecessary. Diagnostic imaging, ultrasound in particular, has demonstrated ligamentous damage that can be the limiting factor in return to previous athletic us...
Back problems. Historical perspective and clinical indications. This article is presented as an introduction to the complex subject of back pain and its management in horses. It considers some of the historical perspectives and deals with some of the limiting factors when attempting to evaluate back pain. The clinical indications of a back problem are considered, as is the important distinction of primary versus secondary back pain. Finally, a list of considerations capable of causing back pain and impaired performance is included.
Tack and saddle fit. Examining the fit of the saddle is perhaps the most important aspect of examining a horse with a suspected back problem. If the back problem is corrected and a poorly fitting saddle is placed on the back, the problems will return. An ill-fitting saddle contributes to direct and compensatory lower leg lameness making it even more imperative to correct the fit. A correctly fitting saddle enhances both the horse and rider's ability to perform with accuracy, lightness, and freedom of movement.
Acupuncture as a treatment modality for back problems. Concepts of acupuncture in traditional Chinese medicine are presented for clarity and contrast to Western medical concepts. Various acupuncture techniques and methods are discussed including dry needling, electroacupuncture, acupuncture using hypodermic needles, and injecting various solutions into the acupuncture sites. Potential complications and precautions are also presented. A type of chronic back pain is discussed that is possibly associated with a radiculopathically induced, hypersensitivity myofascial syndrome that presents as a fibromyalgia-like syndrome. Effective acupuncture treatme...
Musculoskeletal system neoplasia. Tumors of the musculoskeletal system are rare in horses; however, they must be taken seriously. Diagnosis requires observation of clinical signs, radiographic findings, and histological examination. Veterinarians must realize prognosis is not favorable for most tumors; however, some of these tumors can be treated or at least ameliorated. Tumors discussed in this article include: osteoma and osteosarcoma; osteoblastoma; chondrosarcoma; fibroma and fibrosarcoma; plasma cell myeloma; synovioma; rhabdomyosarcoma and tumors metastatic to the musculoskeletal system.