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Topic:Imaging Techniques

Imaging techniques in horses encompass a range of diagnostic tools used to visualize the internal structures and systems of equine patients. These techniques assist in the diagnosis, monitoring, and treatment planning of various conditions affecting horses. Common imaging modalities include radiography (X-rays), ultrasonography, magnetic resonance imaging (MRI), and computed tomography (CT). Each technique offers unique advantages in terms of resolution, depth of penetration, and the type of tissues that can be examined. For instance, radiography is frequently used for assessing bone structures, while ultrasonography is often employed for soft tissue evaluation. MRI and CT provide detailed cross-sectional images, aiding in the assessment of complex anatomical regions. This page compiles peer-reviewed research studies and scholarly articles that explore the application, advancements, and comparative efficacy of imaging techniques in equine veterinary medicine.
Impact of Different Diagnostic Procedures on Diagnosis, Therapy, and Outcome in Horses with Headshaking: Recommendations for Fast-Track Advanced Diagnostic and Therapeutic Protocols.
Animals : an open access journal from MDPI    November 13, 2022   Volume 12, Issue 22 doi: 10.3390/ani12223125
Kloock T, Hellige M, Kloock A, Feige K, Niebuhr T.Most horses affected by headshaking (HS) are diagnosed with idiopathic trigeminal-mediated headshaking (i-TMHS) when no underlying disease is found. Diagnosis is made by the exclusion of differentials considering history, clinical signs, and diagnostic investigations. Therefore, in horses presented with headshaking, many diagnostic procedures and therapies are conducted. Retrospectively, the digital patient records of 240 horses with HS were analysed regarding the impact of diagnostic procedures on diagnosis, therapy, and outcome. Horses were extensively examined using a standardised protocol ...
Application of Two-Dimensional Entropy Measures to Detect the Radiographic Signs of Tooth Resorption and Hypercementosis in an Equine Model.
Biomedicines    November 13, 2022   Volume 10, Issue 11 2914 doi: 10.3390/biomedicines10112914
Górski K, Borowska M, Stefanik E, Polkowska I, Turek B, Bereznowski A, Domino M.Dental disorders are a serious health problem in equine medicine, their early recognition benefits the long-term general health of the horse. Most of the initial signs of Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) syndrome concern the alveolar aspect of the teeth, thus, the need for early recognition radiographic imaging. This study is aimed to evaluate the applicability of entropy measures to quantify the radiological signs of tooth resorption and hypercementosis as well as to enhance radiographic image quality in order to facilitate the identification of the signs of E...
A Review of Radiomics and Artificial Intelligence and Their Application in Veterinary Diagnostic Imaging.
Veterinary sciences    November 8, 2022   Volume 9, Issue 11 620 doi: 10.3390/vetsci9110620
Bouhali O, Bensmail H, Sheharyar A, David F, Johnson JP.Great advances have been made in human health care in the application of radiomics and artificial intelligence (AI) in a variety of areas, ranging from hospital management and virtual assistants to remote patient monitoring and medical diagnostics and imaging. To improve accuracy and reproducibility, there has been a recent move to integrate radiomics and AI as tools to assist clinical decision making and to incorporate it into routine clinical workflows and diagnosis. Although lagging behind human medicine, the use of radiomics and AI in veterinary diagnostic imaging is becoming more frequent...
Comparison of skeletal scintigraphy and standing 18 F-NaF positron emission tomography for imaging of the fetlock in 33 Thoroughbred racehorses. Spriet M, Arndt S, Pige C, Pye J, O'Brion J, Carpenter R, Blea J, Dowd JP.This retrospective, methods comparison study aimed to compare skeletal scintigraphy and F-NaF positron emission tomography (PET) for the detection of abnormalities in the fetlocks of Thoroughbred racehorses. Thirty-three horses (72 limbs) imaged with both scintigraphy and F-NaF PET, for investigation of lameness or poor performance related to the fetlock, were included. Seven observers, including experienced racetrack practitioners, surgery and imaging residents, and a board-certified veterinary radiologist, independently reviewed all data for evidence of increased radiopharmaceutical uptake...
The effect of manually facilitated flexion of the thoracic spine on the interspinous space among horses with impinging dorsal spinous processes of the thoracic vertebrae.
Veterinary journal (London, England : 1997)    September 29, 2022   Volume 289 105909 doi: 10.1016/j.tvjl.2022.105909
O'Sullivan S, McGowan CM, Junnila J, Hyytiäinen HK.Impinging dorsal spinous processes (IDSP) are typically diagnosed and graded using radiography, during which the effect of the horses' thoracolumbar posture on the interspinous spaces is not commonly considered. Posture can be altered from a spontaneous, relatively extended, or lordotic, position by manual facilitation of thoracic flexion ('thoracic lift'). This study aimed to ascertain if the thoracic vertebral interspinous space distances were increased by using facilitated thoracic flexion to alter the posture in horses diagnosed with IDSP. Seven horses of mixed breed and sex, median age 9....
The application of videodermoscopic examination in assessing the skin and its products in pure Arabian horses in the summer and winter seasons.
Polish journal of veterinary sciences    September 27, 2022   Volume 25, Issue 3 403-409 doi: 10.24425/pjvs.2022.142024
Pomorska-Zniszczyńska A, Szczepanik MP, Kalisz G, Adamczyk N, Tarach M, Sobuś M, Abramowicz B.Videodermoscopic examinations have only recently started to be used in veterinary medicine and usually involve a small group of animals. The aim of this study was to compare specific dermoscopic parameters in selected areas of the body of Arabian horses in the summer and winter seasons. The research was conducted between 2018-2019. The procedure was performed on the left side of the horse's body in seven areas: head, neck, chest, flank, rump, mane, and tail. 42 purebred Arabian horses aged 1-25 (median), 39 mares and 3 stallions were qualified for the study. An Italian Video-Dermascope 7 (Medi...
Videodermoscopic examination of the skin and its products in purebred Arabian horses in the summer season.
Journal of equine science    September 21, 2022   Volume 33, Issue 3 37-44 doi: 10.1294/jes.33.37
Pomorska-Zniszczyńska A, Szczepanik M, Adamczyk N, Tarach M.Videodermoscopy is a method that enables the examination of many parameters of the skin and its structures. The aim of this study was to assess specific dermoscopic parameters in purebred Arabian horses during the summer. The study involved 21 clinically healthy purebred Arabian horses (18 mares and three stallions) that had not been used for breeding and were 1 to 25 years old. The videoderoscopic evaluation was performed on seven selected areas of the body: forehead, mane, neck, chest, flank, rump, and tail. The tests were carried out with Vidix and Olympus cellSens specialised software. Vid...
Imaging flow cytometry to characterize the relationship between abnormal sperm morphologies and reactive oxygen species in stallion sperm.
Reproduction in domestic animals = Zuchthygiene    September 14, 2022   Volume 58, Issue 1 10-19 doi: 10.1111/rda.14241
Bulkeley E, Santistevan AC, Varner D, Meyers S.Low levels of intracellular reactive oxygen species (ROS) are essential for normal sperm function and are produced by sperm mitochondria as a byproduct of metabolism, but in excess, ROS can cause catastrophic cellular damage and has been correlated with infertility, poor sperm motility and abnormal morphology in humans. Stallion sperm motility is fueled predominantly by oxidative phosphorylation-produced ATP, requiring high basal rates of mitochondrial function. Consequently, whether elevated ROS production by stallion sperm is an indicator of dysfunctional or highly motile cells has been deba...
2D-SWE of the Metacarpophalangeal Joint Capsule in Horses.
Veterinary sciences    September 4, 2022   Volume 9, Issue 9 doi: 10.3390/vetsci9090478
Guerri G, Palozzo A, Straticò P, Varasano V, Celani G, Di Francesco P, Vignoli M, Petrizzi L.(1) Two-dimensional shear wave elastography (2D-SWE) employs an ultrasound impulse to produce transversely oriented shear waves, which travel through the surrounding tissue according to the stiffness of the tissue itself. The study aimed to assess the reliability of 2D-SWE for evaluating the elastosonographic appearance of the distal attachment of the fetlock joint capsule (DJC) in sound horses and in horses with osteoarthritis (OA) (2). According to a thorough evaluation of metacarpophalangeal joint (MCPJ), adult horses were divided in a sound Group (H) and in OA Group (P). Thereafter, a 2D-S...
Equine skeletal scintigraphy: Comparing normal bone-to-soft tissue ratio 2 and 4 hours after injection with either hydroxymethylene diphosphonate or methylene diphosphonate.
The Veterinary record    August 24, 2022   Volume 191, Issue 10 e2077 doi: 10.1002/vetr.2077
Pelli AC, Winter K, Offhaus J, Brehm W, Gerlach K.In equine skeletal scintigraphy, there is no information about the possible influence of different phosphonate compounds on image quality. This prospective randomised study determined bone uptake changes and image quality for hydroxymethylene diphosphonate (HDP) and methylene diphosphonate (MDP) in equine patients at different time points. Scintigraphic images of the radius and the tibia of 20 horses were acquired at 2 and 4 hours after injection of either technetium-labelled HDP or MDP. Three regions of interest were identified-in the bone diaphysis, adjacent soft tissue and background area-t...
Longitudinal monitoring of fetlock lesions in Thoroughbred racehorses using standing 18F-sodium fluoride positron emission tomography.
American journal of veterinary research    August 18, 2022   Volume 83, Issue 10 ajvr.22.03.0062 doi: 10.2460/ajvr.22.03.0062
Pye J, Spriet M, O'Brion J, Carpenter R, Blea JA, Dowd JP.To assess the repeatability of equine 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) findings, and to evaluate the ability of PET to monitor the progression of areas of increased radiopharmaceutical uptake (IRU) in the fetlocks of Thoroughbred racehorses. Methods: 25 racehorses with clinical signs related to fetlock injuries. Methods: This study is a prospective, longitudinal clinical study. Twenty-five racehorses (54 fetlocks) underwent three 18F-NaF PET scans 6 weeks apart. The first 18F-NaF PET scan was performed at the start of a 12-week period of rest from racing (lay-up...
Application of the Two-Dimensional Entropy Measures in the Infrared Thermography-Based Detection of Rider: Horse Bodyweight Ratio in Horseback Riding.
Sensors (Basel, Switzerland)    August 13, 2022   Volume 22, Issue 16 6052 doi: 10.3390/s22166052
Domino M, Borowska M, Zdrojkowski Ł, Jasiński T, Sikorska U, Skibniewski M, Maśko M.As obesity is a serious problem in the human population, overloading of the horse's thoracolumbar region often affects sport and school horses. The advances in using infrared thermography (IRT) to assess the horse's back overload will shortly integrate the IRT-based rider-horse fit into everyday equine practice. This study aimed to evaluate the applicability of entropy measures to select the most informative measures and color components, and the accuracy of rider:horse bodyweight ratio detection. Twelve horses were ridden by each of the six riders assigned to the light, moderate, and heavy gr...
Palmar/plantar oblique projections improve radiographic detection of fractures of the palmar/plantar processes of the equine distal phalanx. Fairburn AJ, Sherlock CE, Mair TS.Radiography is a standard diagnostic test for horses with suspected fractures of the palmar/plantar processes (PP) of the distal phalanx, however published studies evaluating the diagnostic utility for radiography are currently lacking. The objectives of this retrospective, diagnostic case-control study were to determine the sensitivity of radiographs for the detection of PP fractures, and determine the diagnostic utility of the palmar/plantar oblique projections of the PP for the identification of PP fractures compared to standard radiographic series. The medical records of horses undergoing...
Standardized uptake values and attenuation correction in 18 F-sodium fluoride PET of the equine foot and fetlock. Sannajust K, Spriet M, Anishchenko S, Beylin D.Maximal standardized uptake values (SUV ) are commonly used for the interpretation of PET studies. Limited information regarding the SUV of F-NaF PET in horses is currently available in the literature. The goals of this retrospective secondary analysis study were to provide reference values for F-NaF SUV in the equine distal extremity and assess the effect of attenuation correction. Nonattenuation corrected (NAC) and CT-based attenuation corrected (CTAC) SUV were obtained from 19 feet and 19 fetlocks. Twenty regions of interest (ROIs) were defined for the foot and 22 for the fetlock. Areas p...
Machine Learning Prediction of Collagen Fiber Orientation and Proteoglycan Content From Multiparametric Quantitative MRI in Articular Cartilage.
Journal of magnetic resonance imaging : JMRI    July 21, 2022   Volume 57, Issue 4 1056-1068 doi: 10.1002/jmri.28353
Mirmojarabian SA, Kajabi AW, Ketola JHJ, Nykänen O, Liimatainen T, Nieminen MT, Nissi MJ, Casula V.Machine learning models trained with multiparametric quantitative MRIs (qMRIs) have the potential to provide valuable information about the structural composition of articular cartilage. To study the performance and feasibility of machine learning models combined with qMRIs for noninvasive assessment of collagen fiber orientation and proteoglycan content. Retrospective, animal model. An open-source single slice MRI dataset obtained from 20 samples of 10 Shetland ponies (seven with surgically induced cartilage lesions followed by treatment and three healthy controls) yielded to 1600 data points...
An optimized workflow for microCT imaging of formalin-fixed and paraffin-embedded (FFPE) early equine embryos.
Anatomia, histologia, embryologia    July 18, 2022   Volume 51, Issue 5 611-623 doi: 10.1111/ahe.12834
Handschuh S, Okada CTC, Walter I, Aurich C, Glösmann M.Here, we describe a workflow for high-detail microCT imaging of formalin-fixed and paraffin-embedded (FFPE) equine embryos recovered on Day 34 of pregnancy (E34), a period just before placenta formation. The presented imaging methods are suitable for large animals' embryos with intention to study morphological and developmental aspects, but more generally can be adopted for all kinds of FFPE tissue specimens. Microscopic 3D imaging techniques such as microCT are important tools for detecting and studying normal embryogenesis and developmental disorders. To date, microCT imaging of vertebrate e...
Equine Suture Exostosis: A Review of Cases from a Multicenter Retrospective Study.
Veterinary sciences    July 17, 2022   Volume 9, Issue 7 365 doi: 10.3390/vetsci9070365
Verwilghen D, Easley J, Zwick T, Uhlhorn M, Grulke S, Simhofer H, Townsend N, Liyou O, Bodeus F, Zani DD, Vlaminck L, Pearce C, Staszyk C....Suture exostosis is an intriguing and not uncommon pathology that has to be included in the differential diagnosis for horses with swelling of the head. Although several singular case reports have been published, no large case series is available. The aim of this study is to report a multicentric retrospective collection of suture exostosis cases. Data concerning horses with suture exostosis in the facial region were collected retrospectively. Information regarding breed, age, gender, history, imaging findings, initiated treatment, response to treatment and follow up was recorded. One hundred ...
Special Diagnostic Techniques in Equine Neurology (Radiography, Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging).
The Veterinary clinics of North America. Equine practice    July 7, 2022   Volume 38, Issue 2 171-188 doi: 10.1016/j.cveq.2022.04.001
Garrett KS.Diagnostic imaging is often an important part of the diagnostic approach to neurologic disease. Advanced imaging techniques such as myelography, computed tomography (CT), and magnetic resonance imaging (MRI) provide more information than radiography and ultrasonography but are more limited in their availability. The clinician should be cognizant of the findings of the clinical examination when interpreting diagnostic imaging findings.
Percutaneous doxycycline sclerotherapy in a horse with a mandibular aneurysmal bone cyst.
Veterinary surgery : VS    June 22, 2022   Volume 51, Issue 8 1265-1272 doi: 10.1111/vsu.13844
Perez JA, Weber KL, Bender SJ, Wulster KB, Parente EJ.To describe the use and outcome of sclerotherapy with intralesional doxycycline foam in a horse with a mandibular aneurysmal bone cyst. Methods: Case report. Methods: Client-owned 1 year old Standardbred filly. Methods: The horse presented for progressive mandibular swelling. A 10 mg/mL doxycycline foam was prepared for intralesional injection. Three doses were injected into the lesion under computed tomographic guidance at 6 and 15 weeks after initial treatment. Volume reduction was monitored after each treatment with 3D volumetric rendering and region of interest segmentation using commer...
Ultrasound biomicroscopy of the equine iridocorneal angle.
Equine veterinary journal    June 15, 2022   Volume 54, Issue 6 1153-1158 doi: 10.1111/evj.13585
Knickelbein KE, Lassaline ME, Kim S, Thomasy SM.The iridocorneal angle (ICA) is the major pathway of aqueous humour outflow from the anterior chamber of the eye. Ultrasound biomicroscopy (UBM) has been utilised to characterise the morphology of this drainage pathway in numerous species. UBM may allow for early recognition of aqueous humour outflow obstructions in horses, allowing for earlier recognition of risk for glaucoma, a vision-threatening and painful disease. UBM morphology of the normal equine ICA has yet to be described. Objective: To determine the ultrasonographic morphology of the equine ICA by UBM in standing sedated horses. Met...
Detection of subtle cartilage and bone tissue degeneration in the equine joint using polarisation-sensitive optical coherence tomography.
Osteoarthritis and cartilage    June 15, 2022   Volume 30, Issue 9 1234-1243 doi: 10.1016/j.joca.2022.04.006
Goodwin M, Klufts M, Workman J, Thambyah A, Vanholsbeeck F.To explore the ability of polarisation-sensitive optical coherence tomography (PS-OCT) to rapidly identify subtle signs of tissue degeneration in the equine joint. Polarisation-sensitive optical coherence tomography (PS-OCT) images were systematically acquired in four locations along the medial and lateral condyles of the third metacarpal bone in five dissected equine specimens. Intensity and retardation PS-OCT images, and anomalies observed therein, were then compared and validated with high resolution images of the tissue sections obtained using Differential Interference contrast (DIC) optic...
Characterization of Equine Chronic Tendon Lesions in Low- and High-Field Magnetic Resonance Imaging.
Veterinary sciences    June 15, 2022   Volume 9, Issue 6 297 doi: 10.3390/vetsci9060297
Doll CU, von Pueckler K, Offhaus J, Berner D, Burk J.In equine medicine, experience regarding MRI of chronic tendon lesions is limited, and evidence on the suitability of different sequences in 3 T high-field MRI is scarce. Therefore, macroscopically healthy and altered tendons were examined by histology and in 0.27 T low- and 3 T high-field MRI, focusing on T1-weighted (T1w) sequences to visualize chronic lesions. In high-field MRI, tendons were positioned parallel (horizontal) and perpendicular (vertical) to the magnetic field, acknowledging the possible impact of the magic angle effect. The images were evaluated qualitatively and signal inten...
The impact of different bone tracers and acquisition times on image quality of equine bone scintigraphy. Mageed M, Dyab S, Swagemakers JH, Gerlach K.The impact of different acquisition times (AqT) and technetium-99 m-labeled ( Tc) diphosphonates on the image quality of bone scintigraphy is poorly documented in horses. The aim of this prospective experimental study was to evaluate the impact of varying Tc-disphosphonates and AqT on semiquantitative and qualitative image parameters of bone scintigraphy in horses. Twenty-four horses undergoing bone scintigraphy were divided equally and randomly into methylene- (MDP), hydroxymethylene- (HDP), and dicarboxypropane diphosphonate (DPD) groups. Lateral scintigraphic images of the antebrachium we...
Focused cardiac ultrasound examination in the emergency and critical care horse: Training for non-specialist veterinarians and evaluation of proficiency.
Journal of veterinary internal medicine    June 3, 2022   Volume 36, Issue 4 1471-1480 doi: 10.1111/jvim.16446
Eberhardt C, Schwarzwald CC.Focused cardiac ultrasound examination (FoCUS) is rapidly emerging for point-of-care cardiac assessment using hand-carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available. Objective: To gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device. Methods: Three healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS). Methods: Prospective educational study. An eFoCUS protocol and 1-day tra...
A Descriptive Study of the Carpal Joint of Healthy Donkeys Using Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging.
Veterinary sciences    May 23, 2022   Volume 9, Issue 5 249 doi: 10.3390/vetsci9050249
Salem M, El-Shafaey ES, Farag AMM, El-Khodery S, Al Mohamad Z, Abass M.This study was conducted to establish a detailed anatomic reference for the carpal joint of apparently healthy donkeys using ultrasonography (US), computed tomographic (CT), and magnetic resonance imaging (MRI). Ten orthopedically sound adult donkeys were used for US examination of the carpal joint in each forelimb. Additionally, the carpi of ten donkey cadavers were subjected to CT and MRI examinations. The carpal joint was divided into four zones to simplify examination. US assessment of the carpal joint included transverse and longitudinal sonograms. CT was performed using three planes: axi...
The effect of training on infrared thermographic images of the forelimb and hindlimb joints of healthy racehorses.
Polish journal of veterinary sciences    May 17, 2022   Volume 25, Issue 1 83-92 doi: 10.24425/pjvs.2022.140844
Soroko M, Górniak W, Godlewska M, Howell K.The aim of this study was to evaluate the influence of training on body surface temperature over the joints in racehorses, measured by infrared thermography. The study involved monitoring of 14 Thoroughbred racehorses in 6 imaging sessions over a period of 3 months. Temperature measurements of the forelimb and hindlimb joints were made before and just after training. Joint temperature of limbs increased significantly after training. Environmental temperature had a statistically significant influence on surface temperature over the joints. The lowest surface temperatures were recorded over the ...
Post-mortem Computed Tomographic Angiography in Equine Distal Forelimbs: A Feasibility Study.
Frontiers in veterinary science    May 11, 2022   Volume 9 868390 doi: 10.3389/fvets.2022.868390
Blaettler C, Kaessmeyer S, Grabherr S, Koch C, Schweizer D, Van der Vekens E.In-depth understanding of pathophysiological processes occurring in the vasculature of the equine distal limb is of great importance to improve both diagnostic and therapeutic approaches to diseases. To gain further insights, a model allowing high-resolution 3D-visualization of the vasculature is necessary. This pilot study evaluated the feasibility of restoring vascular perfusion in frozen-thawed distal equine cadaver limbs without prior preparation using computer tomographic imaging (CT). Five frozen-thawed, radiographically normal forelimbs were perfused with a lipophilic contrast agent thr...
Leveraging MRI characterization of longitudinal tears of the deep digital flexor tendon in horses using machine learning. ELKhamary AN, Keenihan EK, Schnabel LV, Redding WR, Schumacher J.While MRI is the modality of choice for the diagnosis of longitudinal tears (LTs) of the deep digital flexor tendon (DDFT) of horses, differentiating between various grades of tears based on imaging characteristics is challenging due to overlapping imaging features. In this retrospective, exploratory, diagnostic accuracy study, a machine learning (ML) scheme was applied to link quantitative features and qualitative descriptors to leverage MRI characteristics of different grades of tearing of the DDFT of horses. A qualitative MRI characteristic scheme, combining tendon morphologic features, alt...
Selection of Filtering and Image Texture Analysis in the Radiographic Images Processing of Horses’ Incisor Teeth Affected by the EOTRH Syndrome.
Sensors (Basel, Switzerland)    April 11, 2022   Volume 22, Issue 8 2920 doi: 10.3390/s22082920
Górski K, Borowska M, Stefanik E, Polkowska I, Turek B, Bereznowski A, Domino M.Equine odontoclastic tooth resorption and hypercementosis (EOTRH) is one of the horses' dental diseases, mainly affecting the incisor teeth. An increase in the incidence of aged horses and a painful progressive course of the disease create the need for improved early diagnosis. Besides clinical findings, EOTRH recognition is based on the typical radiographic findings, including levels of dental resorption and hypercementosis. This study aimed to introduce digital processing methods to equine dental radiographic images and identify texture features changing with disease progression. The radiogr...
Development of an Ultrasound Technique to Evaluate the Popliteal Complex in the Horse.
Animals : an open access journal from MDPI    March 22, 2022   Volume 12, Issue 7 800 doi: 10.3390/ani12070800
Møller-Jensen M, Blomquist MH, Mortensen CL, Olsson IKC, Cuevas-Ramos G.The popliteal tendon and muscle are major stabilizers of the human and dog knee, more specifically the postero-lateral corner. Injury to this complex causes posterior knee pain, and it is generally associated with other injured structures such as the lateral collateral ligament, lateral meniscus, and/or the cranial cruciate ligament. The popliteal complex is poorly reported in the horse, and its specific function has not been determined. Nevertheless, it is likely that it is similar to that of other species, and that injury to it could have similar clinical repercussions. Lameness due to stifl...