Topic:Intra-Articular Injection
Intra-articular injection in horses involves the administration of therapeutic agents directly into a joint space. This technique is used to manage joint diseases, such as osteoarthritis, by delivering medications like corticosteroids, hyaluronic acid, or biologic therapies directly to the affected area. The procedure aims to reduce inflammation, alleviate pain, and improve joint function. Intra-articular injections are commonly performed under sterile conditions to minimize the risk of infection. This page compiles peer-reviewed research studies and scholarly articles that explore the methods, efficacy, and safety of intra-articular injections in equine medicine, as well as their impact on joint health and performance in horses.
Effect of glucocorticoids on serum osteocalcin concentration in horses. The effects of dexamethasone (0.2 mg/kg of body weight; IV, IM, and PO) and methylprednisolone acetate (120 mg given intra-articularly) on serum osteocalcin and cortisol concentrations were studied in 6 horses. Serum osteocalcin and cortisol concentrations were serially monitored after each treatment. A significant (P < 0.05) decrease in serum osteocalcin and cortisol concentrations was observed from 12 to 24 and 2 to 48 hours, respectively, after IV and IM administrations of dexamethasone. Serum osteocalcin and cortisol concentrations were significantly decreased from 6 to 48 and 3 to 72 h...
Determination of triamcinolone acetonide in equine serum and urine by liquid chromatography-atmospheric pressure ionization mass spectrometry. Urine and serum samples collected from four standard-bred mares after 30-mg intraarticular administrations of triamcinolone acetonide were analyzed using combined high-performance liquid chromatography-atmospheric pressure ionization mass spectrometry. Maximum triamcinolone acetonide concentrations of 32.3, 14.8, 24.3, and 29.4 ng/mL in the urine and 2.7, 1.9, 2.3, and 2.5 ng/mL in the serum samples were observed. The peak concentrations of the drug were detected approximately 22 h (urine) and 12 h (serum) after administration. The drug elimination profiles for both urine and serum are present...
Use of sodium monoiodoacetate to fuse the distal hock joints in horses. Intra-articular injection of sodium monoiodoacetate (MIA) was investigated as an agent for chemical arthrodesis of the distal hock joints in the horse. Five horses diagnosed with either spavin (three horses), a small tarsal bone fracture or a failed surgical arthrodesis, had 150 mg of MIA injected into the tarsometatarsal (TMT) joint of the affected hock(s). Eight joints were treated in the five horses. Follow-up evaluation by clinical and radiological examination took place over 9 to 14 months. Two of the five horses were sound at the conclusion of the study and one horse, although lame after...
Experimentally-induced synovitis as a model for acute synovitis in the horse. The use of extremely small dosages of intra-articular E. coli lipopolysaccharide (LPS) endotoxin can create a model of synovitis that mimics acute synovitis in horses. Dosages of 5000 ng, 25 ng, 0.5 ng, 0.25 ng, 0.17 ng and 0.125 ng per joint were injected into various joints of a total of 6 horses. The dose response of LPS on clinical signs and synovial fluid parameters was evaluated at baseline and 12, 24, 36 and 48 h after LPS injection. Peripheral venous blood analysis was performed at baseline and at 0, 4, and 12 h after LPS injection. Dosages greater than 0.5 ng/joint resulted in clinica...
Comparison of the cranial and a new lateral approach to the femoropatellar joint for aspiration and injection in horses. The genual joint in horses is complex, making synovial fluid aspiration and injection of the femoropatellar joint difficult. Horses commonly have signs of resentment to needle penetration at this site. We compared the safety and efficacy of a new technique, using a lateral approach to the femoropatellar joint, with that of the standard cranial approach in 12 horses. A significantly greater amount of fluid was obtained with the lateral approach (2.0 +/- 0.5 ml, mean +/- SEM) than with the cranial approach (0.9 +/- 0.2 ml). Significant differences were not observed in color, nucleated cell count...
Effect of betamethasone and exercise on equine carpal joints with osteochondral fragments. Osteochondral fragments were created arthroscopically on the distal aspect of both radial carpal bones in 12 horses. On day 14 after surgery, one middle carpal joint of each horse was injected with 2.5 mL Betavet Soluspan (3.9 mg betamethasone sodium phosphate and 12 mg betamethasone acetate per milliliter) and the contralateral joint was injected with 2.5 mL saline as a control. Intra-articular treatments were repeated on day 35. On day 17, six horses began exercising 5 days per week on a high-speed treadmill. The other six horses were kept in box stalls throughout the study as nonexercised c...
The anatomic features of the normal tarsus of the live horse as perceived by the sense of sight. A description is given of 75 features present in the normal tarsus of the standing horse which are apparent due to visible skin contours overlying them. Depending on whether or not the pelvic limb is supporting full weight or resting, some contours alter their configuration. Therefore the contour of each underlying feature is described separately for each stance of the limb. It is considered that visual inspection and identification of the apparent superficial features of the normal equine tarsus form the basis of orientation and clinical inspection. Furthermore, these features provide referen...
Surface oximetry for intraoperative assessment of colonic viability in horses. Surface oximetry was used to evaluate viability of the ascending colon in 60 horses with naturally occurring colonic volvulus or displacement. Tissue surface oxygen tension (PsO2) was measured on the serosal surface of the pelvic flexure after anatomic correction of the colonic obstruction. Horses with PsO2 > 20 mm of Hg were predicted to have viable colon; whereas, horses with PsO2 < or = 20 mm of Hg were predicted to have nonviable colon. Results of surface oximetry were compared with final outcome. For surface oximetry, sensitivity (ability to accurately identify colon that was nonvia...
Arthroscopic approach and intra-articular anatomy of the plantar pouch of the equine tarsocrural joint. Arthroscopic examination of structures within the plantar pouch of the tarsocrural joint was accomplished via portals in both the plantaromedial and plantarolateral aspects of the joint. Flexion and extension of the tarsus while examining the joint through either portal allowed observation of the proximal and plantar aspects of the lateral and medial trochlear ridges, the trochlear groove, the caudal aspect of the distal tibia, and the deep digital flexor tendon (DDFT) in its sheath. From a plantarolateral portal, the plantar talocalcaneal ligament and the plantar aspect of the lateral malleol...
Proximal suspensory desmitis in the hindlimb: 42 cases. Proximal suspensory desmitis of the hindlimb was diagnosed using local analgesic techniques and ultrasonography in 42 horses. Subtarsal analgesia resulted in substantial improvement in lameness in 36 of 41 horses in which local analgesic techniques were used. In the remaining five horses lameness was improved by perineural analgesia of the tibial nerve (three) or the tibial and fibular nerves. Intra-articular analgesia of the tarso-metatarsal joint produced a similar degree of improvement in two of 24 horses in which lameness had been improved by subtarsal analgesia. Ultrasonographic abnormali...
The molecular weight of therapeutic hyaluronan (sodium hyaluronate): how significant is it? Various molecular weight hyaluronic acid (HA) preparations have been injected into joints for the treatment of human and equine osteoarthritis. A therapeutic advantage has been claimed for commercial products with a molecular weight in the range found in normal synovial fluid (SF), compared to lower molecular weight products. But a correlation between molecular weight and efficacy is not borne out by an analysis of the available literature on clinical results. SF viscosity, HA concentration, HA molecular weight and rate of synthesis in joint disease. It is proposed that the beneficial effect o...
Influence of intra-articular sodium hyaluronate and polysulphated glycosaminoglycans on the biochemical composition of equine articular surface repair tissue. The influence of repeated intra-articular injections of sodium hyaluronate and polysulphated glycosaminoglycan on the repair of full-thickness osteochondral defects was examined in the midcarpal joints of ponies. The study showed no significant difference between treated and control groups with regard to total collagen content, uronic acid content or the relative proportions of Type I and Type II collagen in the repair tissue, indicating that the drugs did not affect the biochemical composition of the repair tissue 11 weeks after defect induction.
Immunocytochemical and dye distribution studies of nerves potentially desensitized by injections into the distal interphalangeal joint or the navicular bursa of horses. To determine whether the distal interphalangeal (DIP) joint directly or indirectly communicates with the navicular bursa (bursa podotrochlearis) and to identify sensory nerves in these synovial structures that might be desensitized by intra-articular injections of anesthetics, Evans blue dye in physiologic saline solution, Luxol fast blue dye with mepivicaine, or commercial latex was injected into the DIP joint (5 ml) or the navicular bursa (3 ml) of 152 digits obtained from horses or ponies at necropsy. The digits were frozen, cut with a band saw, and examined for distribution of dye or latex...
Clinical use and characteristics of the corticosteroids. Corticosteroids possess potent anti-inflammatory activity and are commonly injected intra-articularly for local relief of inflammatory lesions in performance horses. However, the suppression of anabolic activity in the joint may lead to an increased rate of joint breakdown. Complications associated with intra-articular corticosteroid therapy include septic arthritis, which is usually due to inadvertent joint contamination at the time of corticosteroid injection, and steroid arthropathy, which is characterized by an accelerated rate of joint destruction and radiographic evidence of severe degen...
Effects of exercise and polysulfated glycosaminoglycan on repair of articular cartilage defects in the equine carpus. Our aim was to determine if mild to moderate postoperative exercise and intra-articular polysulfated glycosaminoglycan result in improved repair of large, experimentally induced osteochondral defects in a weight-bearing surface of equine joints. Arthroscopic debridement was used to produce full-thickness defects in a weight-bearing area of the radial carpal bones in 18 ponies. The ponies were randomly assigned to two groups balanced for age: nine animals in the exercise and nine in the no exercise group. Six ponies in each group were medicated weekly for 5 weeks with an intra-articular injecti...
Effects of exercise and polysulfated glycosaminoglycan on the development of osteoarthritis in equine carpal joints with osteochondral defects. This study assessed the effects of postoperative exercise and intra-articular polysulfated glycosaminoglycan (PSGAG) on the repair of osteochondral defects in the carpal joints of ponies. Eighteen ponies with normal carpi had osteochondral defects (mean dimensions 2.4 cm x 0.9 cm) created arthroscopically on the dorsal aspect of the distal articular surface of the radial carpal bone. The ponies were randomized (while balancing for age [range, 2 to 15 years; median, 5.0 years]) to two groups--nine ponies were exercised and nine were stall confined. Beginning at surgery, six ponies in each group...
Effects of hylan on amphotericin-induced carpal lameness in equids. In this double-blind study, the effectiveness of and dose response to intra-articular administration of modified hyaluronan (hylan) was determined in an equine carpal lameness model over a 23-day period, using a computerized three-dimensional motion analysis system, synovial fluid variables, and synovial histologic examination. In 24 clinically sound horses, baseline motion data was acquired from horses trotting at 4 m/s on a high-speed treadmill. Then, to induce lameness, 25 mg of amphotericin B in 5 ml of sterile water was injected into the left middle carpal joint of each horse every other ...
Effect of intramuscularly administered polysulfated glycosaminoglycan on articular cartilage from equine joints injected with methylprednisolone acetate. Intra-articularly administered, long-acting corticosteroids are a beneficial treatment for many equine joint disorders because they alleviate inflammation and signs of pain, but they also exert detrimental effects on the biochemical composition and morphologic features of articular cartilage. Chondroprotective drugs have been shown to mitigate some of the deleterious effects of intra-articularly administered corticosteroids on articular cartilage of laboratory animals. Twenty-one ponies were assigned at random to receive 1 of 3 treatments in the right middle carpal joint. Group-1 ponies (n = 8...
Intraarticular hyaluronan injections in the treatment of osteoarthritis: state-of-the-art review. Viscosupplementation (restoring the rheological properties of a tissue matrix) by injection of hyaluronan into the joints has been in use for 2 decades, mostly for osteoarthritis (OA) of the knee, using doses of 20-25 mg of hyaluronan of 500,000 to 2,500,000 M(r), in sequences of 2 to 10 weekly injections. Pain relief appears in a few days, progresses over a few weeks, and often lasts several months. Some data suggest the benefit can last 6 months to one year. Tolerance is universally reported as very good. Those responding to hyaluronan are 65-80%, compared to 30-35% responding to control. Co...
In vivo investigation of communication between the distal intertarsal and tarsometatarsal joints in horses and ponies. The frequency of communication between the tarsometatarsal and distal intertarsal joints was investigated in 27 horses and 12 ponies. After the injection of diluted latex into the tarsometatarsal joints using the plantarolateral approach, the horses and ponies were walked for 200 meters. Latex was found in the distal intertarsal joints of 19 of 73 tarsi (26% communication) at necropsy. In 3 tarsi, latex was also found in the proximal intertarsal and tarsocrural joints.
Use of scintimetry to assess effects of exercise and polysulfated glycosaminoglycan on equine carpal joints with osteochondral defects. Combined blood pool and delayed images produced by use of 99mTc-methylene diphosphonate (99mTcMDP) were evaluated as an objective measurement of the response of equine joints with osteochondral defects to postoperative exercise and intra-articularly administered polysulfated glycosaminoglycan (PSGAG). Osteochondral defects (approx 2.4 x 0.9 cm) were induced arthroscopically in the dorsodistal radial carpal bones of 18 ponies. These ponies were randomized (while balancing for age [range 2 to 15; median, 5.0; mean, 5.1 years]) to 2 treatment groups. Nine ponies were assigned to be exercised, and...
Keratan sulfate as a marker of articular cartilage catabolism and joint treatment in ponies. Keratan sulfate (KS) is a glycosaminoglycan, distribution of which is confined mostly to hyaline cartilage. As such, it is a putative marker of hyaline cartilage catabolism. In experiment 1, a focal osteochondral defect was made arthroscopically in 1 radial carpal bone of 2 ponies, and in 2 other ponies, chymopapain was injected into the radiocarpal joint to induce cartilage catabolism. Sequential and concurrent plasma and synovial fluid concentrations of KS were measured, up to 13 months after induction of cartilage injury, to determine whether changes in KS concentrations reflected cartilage...
Effects of intra-articularly administered endotoxin on clinical signs of disease and synovial fluid tumor necrosis factor, interleukin 6, and prostaglandin E2 values in horses. In each of 4 horses, sterile synovitis was induced by intra-articular injection of 3 micrograms of Escherichia coli endotoxin (lipopolysaccharide, LPS) into one antebrachiocarpal joint; an equal volume (2 ml) of phosphate-buffered saline solution (PBSS) was injected into the opposite, control carpus. Blood and 1.5 ml of synovial fluid were obtained at postinjection hours (PIH) 0, 2, 4, 8, 12, 18, 42, 66, and 144. Synovial fluid sample collection was accomplished by use of an indwelling, intra-articular catheter through PIH 12, and by arthrocentesis subsequently. Joint fluid samples were analyz...
A comparison of responses to analgesia of the navicular bursa and intra-articular analgesia of the distal interphalangeal joint in 59 horses. Analgesia of the distal interphalangeal (DIP) joint and of the navicular bursa was performed independently in the lame or lamer forelimb of 59 horses, in which lameness was significantly improved by perineural analgesia of either the palmar digital or palmar (abaxial sesamoid) nerves. In 3 horses no improvement was detected. Lameness was improved by analgesia of the DIP joint but there was no response to analgesia of the navicular bursa in 3 horses. In 12 horses, lameness was improved by analgesia of the navicular bursa but intra-articular analgesia resulted in no change. Forty-one horses resp...
Eosinophilic synovitis following the intra-articular injection of bacterial antigen in horses. Purified streptococcal M protein was injected into one intercarpal joint in three horses hyperimmunised with Streptococcus equi M protein vaccine. The contralateral joints were injected with pH adjusted polyionic solution. All antigen-injected joints developed a severe suppurative synovitis (mean synovial fluid nucleated cell count = 102,200 x 10(6) cells litre-1). Eosinophils were found in the synovial fluid and in synovial membrane biopsy specimens of two of the horses. Immune complexes were not demonstrated in the synovial membrane. Two horses are described that developed synovial fluid eos...
Effects of intraarticular corticosteroid and sodium hyaluronate injections on synovial fluid production and synovial fluid content of sodium hyaluronate and proteoglycans in normal equine joints. Hyaluronate and cartilage proteoglycan fragments in synovial fluid from normal equine joints were determined after repeated intraarticular injections of beta-methasone, methylprednisolone, hyaluronate, saline and a combination of beta-methasone + hyaluronate and methylprednisolone + hyaluronate. The experimental intraarticular treatments were given at the beginning of the study and after one and two weeks. Synovial samples were obtained at the onset of the study and after 1, 2, 3, 4, 6, and 8 weeks. The synovial volume was determined and showed no significant changes after the repeated arthroc...
Kinematic gait analysis in equine carpal lameness. Gait analysis plays a major role in the clinical evaluation of equine lameness. It is generally accepted that the clinician expresses the grade of lameness as a subjective score. In this study lameness was objectively assessed using a standardized transient lameness model, in which lameness was induced by intra-articular injection of bacterial endotoxin into the radiocarpal joint of ponies. Lameness was scored by an experienced clinician, and locomotion was recorded simultaneously using a CODA-3 apparatus. The obtained kinematic gait parameters correlated well with the clinical lameness score ...
An investigation of injection techniques for local analgesia of the equine distal tarsus and proximal metatarsus. A positive radiographic contrast agent was injected into the tarsometatarsal (TMT) joints of both hindlimbs of 10 horses. Lateromedial radiographic views were obtained at 5, 15 and 30 mins after injection. Injection was successful in 19 of 20 limbs. Communication between the centrodistal (CD) and TMT joints was identified in 7 limbs (35%). Contrast agent extended around the tendons of tibialis cranialis (TC) and fibularis tertius (FT) in 18 limbs, and in 7 limbs some contrast entered the tarsal sheath. Slight to moderate plantar and/or distal extension of contrast agent was identified in 13 li...
Septic arthritis in 15 standardbred racehorses after intra-articular injection. Case histories, results of synovial fluid analyses, treatment regimens and outcome are described for 15 adult Standardbred horses with confirmed post-injection septic arthritis. Joint sepsis followed injection of corticosteroids, hyaluronic acid, polysulphated glycosaminoglycan, or local anaesthetic. The median interval from injection to appearance of clinical signs was 2.5 days, and median interval from injection to referral was 9 days. The median initial synovial leucocyte count on admission was 57 x 10(9)/litre, but there was a wide range of values (18-258 x 10(9)/litre). The median synovia...