Comparison of 2 methods of centesis of the bursa of the biceps brachii tendon of horses.

The research article compares two methods of centesis of the bicipital bursa in horses, examining the effectiveness of using an 8.9 cm long spinal needle and a 3.8 cm long hypodermic needle. The study further evaluates the usefulness of ultrasonographic imaging in determining the location of the administered solution during centesis.

Methods

• The research was broken into two trials, each involving six clinicians who had no prior experience in performing this specific procedure.
• In Trial 1, the clinicians attempted to inject a solution composed of an aqueous radiopaque contrast medium and physiological saline solution into the bicipital bursa of two horses. They used a previously described distal approach for one bursa and a proximal approach for the other.
• Both the bicipital tendon and bursa were examined ultrasonographically before and after the injection. In addition, both shoulders were examined radiographically to identify the location of the medium.
• Trial 2 repeated the experiment of Trial 1, but with a slight variation where the radiopaque contrast medium was mixed with air instead of physiological saline solution. This trial involved six different horses.

Results

• The study found that the accuracy of centesis using the proximal approach was 39%, while the distal approach achieved an accuracy of 28%.
• Ultrasonographic examination of the shoulder allowed the accurate prediction of the location of solution and air in all 12 shoulders examined.

Conclusions

• The study concludes that clinicians with no prior experience with bicipital bursa centesis are unlikely to successfully perform the procedure using either approach.
• Radiographic examination may be necessary after injecting a radiopaque contrast medium to assess the success of centesis, especially if bursal fluid isn’t obtained during the procedure.
• The study further suggests that injecting air along with the radiopaque contrast medium provides a more accurate ultrasonographic confirmation of centesis, along with better radiographic definition, as compared to an injection without air.