Chapter 83 - Management of Bursitis Flashcards
1
Q
What is the primary function of bursae in the musculoskeletal system?
A
Bursae reduce frictional wear on muscles, tendons, or ligaments as they move against bony structures.
2
Q
what type of tissue layer makes up the outer wall of a bursa?
A
The outer wall consists of a fibrous layer.
3
Q
What is the role of the inner synovial membrane in a bursa?
A
The synovial membrane secretes synovial fluid and reduces friction by enabling smooth movement of tendons within the bursa.
4
Q
Describe a tendon sheath and its relationship to bursae.
A
A tendon sheath is a type of bursa that completely envelops a tendon, acting as a lubricated wrap around it.
5
Q
What is the source of the synovial fluid within bursae?
A
Synovial fluid is secreted by the synovial membrane of the bursa.
6
Q
What characteristic does synovial fluid in bursae share with synovial fluid in joints?
A
It has similar lubricative properties.
7
Q
What are congenital bursae, and where are they typically located?
A
Congenital bursae are naturally occurring bursae located in consistent anatomical locations, often subtendinous or subligamentous.
8
Q
List ten examples of congenital bursae.
A
Navicular,
Atlantal
trochanteric bursae,
Bicipital, infraspinatus, atlantal and supraspinatus bursae, subtendinous bursa of the common and long digital extensor tendons over MCP/MTP joint and the subtendinous bursa of the long digital extensor at the proximoateral level of the tibia
9
Q
What is the cause of acquired bursae formation?
A
Acquired or false bursae commnly form superficial to the extensor tendon at the dorsum of the fetlock in horses that jump fixed fences - these may become infected
10
Q
How does a bursa differ when a large portion of a tendon must be protected?
A
The bursa completely ensheathes the tendon, acting as a tendon sheath.
11
Q
What are the two main layers of a bursa wall?
A
An outer fibrous layer and an inner synovial membrane (parietal layer).
12
Q
What does the inner synovial membrane cover within the bursa or sheath?
A
It covers the tendon or ligament surface inside the bursa or sheath (visceral layer).
13
Q
What substance fills bursae and what produces it?
A
Synovial fluid, produced by the synovial membrane, fills bursae.
14
Q
How does synovial fluid benefit tendon movement within a bursa?
A
It lubricates layers, reducing frictional damage to the tendon during movement.
15
Q
What term is used to describe naturally occurring bursae?
A
True or congenital bursae.
16
Q
Where are congenital bursae typically located?
A
They are typically found in consistent anatomical locations, either subtendinous or subligamentous.
17
Q
What conditions lead to the formation of acquired bursae?
A
Persistent mechanical irritation or pressure over bony prominences.
18
Q
What are alternative terms for acquired bursae?
A
False, functional, or facultative bursae.
19
Q
Where do acquired bursae often develop in horses?
A
They may develop over the carpus, olecranon, and calcaneal tuberosity.
20
Q
How does an acquired bursa begin to form?
A
It starts as a subcutaneous fluid accumulation due to tearing of subcutaneous tissue and hemorrhage.
21
Q
What happens to an acquired bursa if trauma persists?
A
The fluid is not reabsorbed, leading to a seroma and eventual encapsulation by fibrous tissue.
22
Q
What type of membrane eventually forms in an acquired bursa?
A
A synovial-like membrane.
23
Q
What diagnostic techniques are often required to evaluate bursitis?
A
Diagnostic anesthesia, radiography, ultrasonography, contrast radiography, cytology, bacterial culture, and possibly tenoscopy or bursoscopy.
24
Q
What is the typical cell count and protein level in normal synovial fluid?
A
Less than 500 nucleated cells/μL, less than 10% neutrophils, and less than 2.5 g/dL of total protein.
25
What nucleated cell count in synovial fluid indicates infection?
More than 30,000 cells/μL suggests infection, while over 100,000 cells/μL is pathognomonic for infection.
26
What is a typical protein concentration in septic synovial fluid?
Greater than 4 g/dL.
27
What treatment is generally attempted first for non-infected acquired bursae?
Conservative treatments, such as rest, anti-inflammatories, pressure bandaging, and removal of trauma sources.
28
When might surgical removal of an acquired bursa be necessary?
If the bursa is a well-established fibrous structure or there is evidence of synovial infection.
29
How is acute nonseptic bursitis typically managed?
With systemic, topical, and/or intrasynovial anti-inflammatory drugs, along with rest (2- months) and pressure bandaging.
30
What are key steps in treating infected bursae?
Wound debridement, synovial lavage and drainage, and administration of antimicrobials.
31
What minimally invasive procedure is recommended for bursitis treatment?
Bursoscopy, as it is both diagnostic and therapeutic.
32
Define a carpal hygroma.
A facultative subcutaneous bursa that develops over the dorsal carpus due to repetitive trauma or falls.
33
What behavior in horses can contribute to the formation of a carpal hygroma?
"Knee banging" on stable doors, drinking troughs, feeders, or fences.
34
How is a carpal hygroma typically presented?
As a nonpainful, fluctuant, uniform soft tissue swelling on the dorsal aspect of the carpus.
35
When might a carpal hygroma become painful?
If it becomes septic.
36
What imaging technique helps distinguish carpal hygroma from other carpal conditions?
Contrast radiography or ultrasonography.
37
What conservative treatment may be attempted for carpal hygroma?
Aspiration, corticosteroid (methylprednisolone acetate) or atropine 7 mg doseinjection, and firm bandaging (min 2w).
38
What surgical options are available for treating persistent carpal hygromas?
Surgical drainage ~(S-incision or elliptical) with a Penrose drain, synovial lining curettage, or complete surgical extirpation.
39
What type of bandage is recommended after surgical hygroma treatment?
A pressure bandage with a splint or sleeve cast to prevent carpal flexion and support healing.
40
Why is an S-shaped incision recommended during hygroma removal?
It provides optimal access for dissection of the fluid-filled sac from surrounding tissues.
41
What is the purpose of an Esmarch bandage in hygroma surgery?
To facilitate the removal of the hygroma by reducing blood flow in the area.
42
How long should bandaging be maintained post-hygroma surgery?
Bandaging should be continued for at least 2 weeks initially, with a total of 8 weeks of stall confinement for healing.
43
What complications can arise from bandaging a carpal hygroma post-surgery?
Risk of iatrogenic sepsis and pressure sores, especially over the accessory carpal bone.
44
How is infection of a carpal hygroma suspected clinically?
Increased skin temperature, localized pain upon pressure, and lameness.
45
What fluid analysis result is indicative of carpal hygroma infection?
Synovial fluid with elevated nucleated cell counts and protein levels.
46
What advice should owners receive about the cosmetic outcome of hygroma surgery?
A blemish is likely to remain despite successful healing.
47
What is olecranon bursitis commonly known as?
It is commonly known as "capped elbow" or "shoe boil."
48
What causes olecranon bursitis in horses?
It is primarily caused by chronic trauma to the subcutaneous tissue over the point of the elbow.
49
How can repetitive trauma lead to olecranon bursitis in horses?
Repetitive trauma can occur when the horse’s limb hits the ground or if the hoof hits the olecranon while recumbent, causing tissue inflammation and bursitis.
50
Which horses are more prone to olecranon bursitis?
Gaited and Standardbred horses are more prone due to their movement patterns, which can cause the hind foot to strike the elbow.
51
Why should the skin incision be planned carefully during the treatment of olecranon bursitis?
To avoid placing the incision directly over the olecranon tuberosity, reducing the risk of re-injury and promoting better healing.
52
What type of suture material is commonly used for closing deep tissues in olecranon bursitis surgery?
Absorbable USP size 2/0 suture material is used.
53
Why are tension-reducing suture patterns used in olecranon bursitis treatment?
Tension-reducing patterns, like vertical mattress sutures, help minimize stress on the skin and reduce the risk of suture line rupture.
54
What post-surgical care is recommended to prevent excessive tension on a sutured olecranon bursa?
The horse is crosstied for 2-3 weeks to restrict movement and reduce tension at the surgical site.
55
How can recurrence of olecranon bursitis be prevented?
By avoiding repeated trauma to the elbow, such as using padding or protective boots.
56
What is a capped hock?
It is an acquired bursitis caused by chronic trauma to the subcutaneous tissue over the point of the hock (tarsus).
57
What are common causes of capped hock in horses?
Kicking against hard surfaces like walls or trailer gates.
58
How does initial swelling complicate the diagnosis of capped hock?
Acute injury can lead to extensive edema, which may mask the extent of the injury.
59
Why might a capped hock not be a concern unless it becomes septic?
Because a capped hock is generally seen as a cosmetic issue unless infection occurs, leading to lameness or other complications.
60
What conservative treatments can be used for a capped hock?
Ice, dimethyl sulfoxide, or diclofenac liposomal cream, combined with bandaging, are typically used.
61
How can corticosteroid injections help treat capped hock?
They reduce inflammation and can be effective in treating acute cases by resolving the bursa swelling.
62
What surgical approach is taken if conservative treatments for capped hock fail?
En bloc resection of the bursa may be performed to improve appearance and reduce swelling.
63
What precaution should owners be aware of regarding surgical treatment of capped hock?
Wound dehiscence is common, and some cosmetic blemishes may remain even after healing.
64
Why is a Robert Jones bandage applied after surgery on a capped hock?
It stabilizes the area and reduces motion at the tarsus, aiding in proper healing.
65
How can recurrence of capped hock be prevented?
Hock boots should be worn in stalls or trailers to protect the area from trauma.
66
What is false thoroughpin in horses?
It’s an effusion of the tarsal sheath resulting in a fluid-filled structure in the lower leg not connected to the tarsal sheath or calcaneal bursa.
67
What are possible causes of false thoroughpin?
Synoviocoele, synovial herniation, or organizing hematomas/seromas.
68
What might the presence of synovial membrane mesenchymal cells in a false thoroughpin cavity lead to?
Formation of synoviocytes that line and secrete fluid into the cavity, expanding the bursa.
69
How can imaging assist in diagnosing false thoroughpin?
Contrast radiography and ultrasonography can help identify the origin of the swelling.
70
Is false thoroughpin always associated with lameness?
No, it may or may not be a cause of lameness, so other potential causes must be ruled out.
71
What is a common treatment approach if conservative management fails?
Endoscopic exploration can reveal the cause and allow for removal of fibrinoid deposits or repair of capsular tears.
72
Where are congenital bursae most commonly located in horses?
Between ligaments and bones, such as the atlantal and supraspinous bursae.
73
What causes inflammation of congenital bursae?
Chronic trauma or ill-fitting tack are common causes.
74
What might mineralization near the poll indicate?
Possible nuchal bursitis, though it could be an incidental finding.
75
What is a common medical treatment for primary nuchal bursitis?
Corticosteroid injections under ultrasonographic guidance.
76
What advanced technique is used when conservative treatment fails in nuchal bursitis?
Bursoscopic débridement and lavage.
77
What bacteria are historically linked with septic atlantal and supraspinous bursitis (3)?
1. Brucella abortus,
2. Brucella suis, and 3. Actinomyces bovis.
78
Why are horses with poll evil a health concern?
Brucella infection in horses poses a zoonotic risk.
79
What diagnostic steps should be taken for horses suspected of poll evil or fistulous withers?
Serologic testing for Brucella, along with radiographic imaging of the affected region.
80
What surgical approach is used to manage infected supraspinous bursae?
Standing excision of the dorsal spinous processes if affected.
81
How can dye injection aid in the surgery of infected bursae?
It highlights infected tissue for thorough removal during surgery.
82
What postoperative care is recommended following supraspinous bursa surgery?
Broad-spectrum antibiotics, stent bandages, and suction drains to manage drainage and prevent infection.
83
How long should skin sutures remain post-surgery for bursal conditions?
14 to 20 days, depending on healing and infection risk.
84
Why is a continuous suction drain used in some surgeries?
It prevents fluid accumulation, reducing infection risk and promoting healing.
85
How can hock boots benefit a horse with a history of capped hock?
They prevent trauma to the tarsal area, reducing recurrence of bursitis.
86
What is the primary goal of surgical management in recurrent or infected bursitis cases?
To remove all affected tissue, reduce infection risk, and promote functional healing.
87
What is bicipital bursitis, and which tendon does it affect?
Bicipital bursitis is the inflammation of the bicipital bursa, affecting the biceps brachii tendon
88
What are the common causes of biceps brachii tendon lesion?
Direct trauma to the point of the shoulder
Dislocation of the biceps brachii tendon associated with cogneital hypoplasia of the minor tubercle
89
How can a slip or fall initiate bicipital bursitis?
A backward slip that flexes the shoulder and extends the elbow can increase tension on the biceps tendon, causing trauma.
90
What are the clinical signs of bicipital bursitis?
painful swelling over the cranial aspect of the should
dropped elbow posture
reluctance to advance the limg
signs of pain when scapulohumeral joint is flexed or extended
pain when pressure is applied to biceps tendon
91
How can congenital hypoplasia contribute to bicipital bursitis?
Hypoplasia of the minor tubercle may lead to dislocation of the biceps tendon, resulting in bursitis.
92
What is the treatment of traumatic nonseptic bicipital bursitis?
involves intrasynovial administration of a corticosteroid, parenteral administration of a nonsteroidal antiinflammatory drug, and 2 to 3 months of stall rest with 15 minutes of hand walking twice daily, the time of which increases as gait improves.36 Passive manipulation of the affected limb may be beneficial for resolution of the bursitis.
93
Which diagnostic tool is primarily used to diagnose congenital bicipital bursitis?
Ultrasonography (7.5 - 5mHz probe), because of the difficulty in obtaining diagnostic radiographic images of the shoulder, ultrasonography is often the imaging modality of choice.
94
What specific test is recommended when septic bicipital bursitis is not due to a wound?
Testing serum titers for Brucella abortus infection.
95
What preliminary procedure is done before injecting anesthetic into a suspected bicipital bursa?
Synovial fluid is aspirated for cytology and culture.
96
What are some diagnostic imaging methods used to In case the bursoscopuy is not enough for chronic infection of biceps bursa severance of the biceps bachii tendon may be performed - describe
GA - LR - a craniolateral curved incision started several centimeters proximal to the level of the cranial aspect of the greater tubercle of the humerus is extended cranially over the greater tubercle and distally to the lateral aspect of the deltoid tuberosity (Figure 83-9). Fasciae overlying the supraspinatus and brachiocephalic muscles are incised. The brachiocephalic muscle is incised along the same line to provide exposure to the craniolateral aspect of the greater tubercle. The fascia forming the bicipital bursa is incised to expose the biceps tendon and bicipital bursa. A portion or all of the biceps tendon can be removed and other diseased tissue including synovium can be débrided and removed. A suction drain is placed in the wound, or the distal portion of the wound can be left open for spontaneous drainage. The fibrous capsule surrounding the bursa is closed with 2-0 polydioxanone in a simple interrupted pattern; the brachiocephalic muscle and subcutaneous tissues are each closed separately using polydioxanone in a continuous pattern, USP size 0 for the muscle and 2-0 for subcutaneous tissue. Skin is reapposed using USP size 0 or 2-0 nonabsorbable suture material in an interrupted vertical mattress pattern. A sterile stent bandage can be applied over the incision.
97
What signs indicate fluid distension in the bicipital bursa during an ultrasound?
Increased space between the tendon and humerus, and outpouching of lateral and medial recesses.
98
What is the time of recovery in case of concomitant biceps tendonitis?
Therapy for concomitant biceps tendonitis is similar but the time for healing is extended, 6 to 9 months being required for healing
99
what is the result of severance of the biceps brachii tendon? is it good?
dramatic improvement in lameness is generally noticed immediately after anesthetic recovery, presumably from removal of painful tendon and from relief of pressure on the inflamed bursa and humeral tubercles.40 Aftercare of horses treated by open bursal drainage, partial synovectomy, and biceps brachii tenectomy involves several months of stall confinement followed by several months of pasture turnout.
100
Where is the infraspinatus bursa located?
It lies between the tendon of the infraspinatus muscle and the caudal eminence of the greater tubercle.
101
What activities are thought to strain the infraspinatus tendon? what can cause infraspinatus bursitis
Fast trotting in horses with narrow chests and closely spaced forelimbs.
Severe abducion of the shoulder
102
Why might adduction of the limb cause pain in horses with infraspinatus bursitis?
It places pressure on the bursa, which is already inflamed.
103
What is a common treatment for nonseptic infraspinatus bursitis?
Intrabursal corticosteroid injection and rest.
104
How is septic infraspinatus bursitis diagnosed?
Through ultrasonographic examination and cytology of aspirated bursal fluid.
105
What is an effective treatment for septic infraspinatus bursitis?
High-volume bursoscopic lavage with antimicrobial drugs.
106
How does the lameness of septic infraspinatus bursitis compare to bicipital bursitis?
Both have similar signs, including a decreased cranial stride phase and shoulder pain.
107
What does cytology of bursal fluid in septic cases reveal?
Radiographs may not show the condition unless fractures are present.
108
What anatomical structures surround the navicular bursa?
The deep digital flexor tendon (DDFT), fibrocartilaginous distal scutum, and distal sesamoid bone.
109
What diagnostic technique is preferred for aseptic navicular bursitis?
Magnetic resonance imaging (MRI).
110
How is simple bursal distension different from navicular bursitis?
It may be incidental and not a primary cause of lameness.
111
What are signs of chronic navicular bursitis?
Thickened synovial membrane, fibrous tissue formation, and fibrous adhesions.
112
Which imaging technique enhances detection of adhesions in the navicular bursa?
MRI bursography.
113
How can intrasynovial tears in the DDFT lead to navicular bursitis?
Disrupted collagen in the synovial environment causes persistent inflammation.
114
What two substances are typically injected to treat navicular bursitis?
Corticosteroids and hyaluronan.
115
How does intrabursal injection of corticosteroids aid horses with podotrochlear disease?
It reduces inflammation and lameness in the affected structures.
116
What is a "street nail procedure" in navicular bursitis treatment?
It's a surgical approach involving fenestration of the DDFT to access the bursa.
117
What is the prognosis following a street nail procedure compared to bursoscopy?
Bursoscopy generally has a better prognosis due to reduced reinfection risk.
118
What can ultrasonography- or radiography-guided synoviocentesis diagnose?
Septic navicular bursitis through analysis of synovial fluid.
119
What is a common cause of septic bursitis in all bursae?
Penetrating injuries or hematogenous spread of bacteria.
120
How does an ultrasonographic exam indicate tendon architecture disruption?
Non-uniform echogenicity and irregular tendon surface patterns.
121
How often should ultrasonographic exams be repeated for traumatic bursitis?
Every 2 to 3 months to monitor healing progress.
122
What is a typical corticosteroid dosage when injecting the navicular bursa?
Less than 10 mg of triamcinolone, with higher doses yielding better results.
123
What does a positive response to DIP joint injection indicate in navicular disease?
It suggests that corticosteroid diffusion to other tissues may relieve symptoms.
124
How can DDFT surface tears contribute to navicular pain?
Collagen disruption in the bursa leads to inflammation and persistent pain.
125
Why is the bursoscopic lavage preferred over traditional lavage for septic bursitis?
Bursoscopy allows for thorough irrigation, débridement, and reduced risk of reinfection.
126
what benefit does a “key-hole” bursoscopic incision have over traditional methods?
It reduces wound size and accelerates healing with less risk of secondary infection.
127
Figure 83-1. A padded, donut-shaped boot that fits around the pastern prevents the foot or shoe from contacting the olecranon and developing a shoe boil.
128
Figure 83-2. After local anesthetic solution is injected subcutaneously around the base of the olecranon bursa (A), an elliptical, vertical skin incision is made over the lateral aspect of the mass (B). The mass is freed from skin and subcutaneous tissue using Mayo scissors to create a plane of dissection for removal of the mass en bloc (C). Care should be taken when planning the skin incision that when skin edges are reapposed they lie lateral to, not directly over, the olecranon tuberosity (D).
129
Figure 83-3. Example of a capped hock.
130
figure 83-4 - A large, spherical, biaxial swelling (false thoroughpin) is present in the caudodistal aspect of the crus between the tibia and the tendons of insertion of the gastrocnemius and the superficial digital flexor tendon, just proximal to the calcaneal tuberosity.
131
Figure 83-5. Clinical signs of supraspinous bursitis include singular or multiple draining tracts of the withers.
132
What is a throughpin?
effusion of the tendon sheath of the lateral (deep) digital flexor tendon at the level of the tarsus (tarsal sheath) is referred to as throughpin
133
What is the treatment of false throughpin when ID as cause of lameness?
rest and antiinflammatory and if fails than go for endoscopic exploration
134
What should be done if a capsular tear is ID in the tarsal sheath and is responsible for the false thoroughpin?
and enlargement of this tear to resolve the one-way valve effect
135
what are the two congeintal bursae that protect ligaments?
atlantal (nuchal) and supraspinous bursa
136
name the anatomic location of atlantal (nuchal) bursa and supraspinous bursa
The atlantal bursa (cranial nuchal bursa) lies between the:
nuchal ligament and the dorsal arch of the atlas.
A second bursa (caudal nuchal bursa) is sometimes found dorsal to the spine of the axis
The supraspinous bursa is most commonly located between the funicular portion of the nuchal ligament and the most prominent spines of the thoracic vertebrae of the withers;
137
Figure 83-6. Treatment of “fistulous withers” involves removal of the diseased portion of the dorsal spinous process with an oscillating saw or osteotome.
138
Figure 83-7. Extension of the shoulder joint, as described by elicits signs of resentment in horses with bicipital bursitis.
139
Figure 83-8. Fluid distension of the bursa is indicated by an increase in space between the tendon and the humerus and outpouching of the lateral and medial recesses of the bursa on either side of the tendon. (A) Normal left bicipital bursa; (B and C) left bicipital bursa containing excessive fluid (arrows). Note that the lateral head of the bicipital tendon has a larger cross-sectional area than the medial head. The lateral lobe of the tendon is “teardrop”-shaped and the medial lobe has an elongated rectangular shape. *, Lateral lobe of the bicipital tendon.
140
Figure 83-11. Sagittal magnetic resonance short tau inversion recovery (STIR) image of the left foot of a horse with navicular bursitis. The proximolateral pouch of the navicular bursa is severely distended with synovial fluid causing accumulation of hyperintense (white) fluid signal.
141
Figure 83-12. A contrast bursogram of the navicular bursa results in a flow of contrast medium along the penetrating solar wound that has resulted in a double tract, one entering the navicular bursa and one entering the distal interphalangeal joint. Looking for leakage after distending the navicular bursa with contrast medium from a site distant to the wound is preferable to performing direct fistulography to determine if the bursa has been breached.
142
Figure 83-13. Position of arthroscope for treatment of septic navicular bursitis following a penetrating wound of the lateral sulcus of the frog.
143
Figure 83-14. The bursa of the long digital extensor tendon (arrow) can act as a reservoir of sequestered bacteria and inflammatory products in foals with sepsis of the lateral compartment of the femorotibial joint.
144
Figure 83-15. The calcaneal bursae include the subcutaneous calcaneal bursa (A), the intertendinous calcaneal bursa (B), and the gastrocnemius calcaneal bursa (C). The intertendinous and gastrocnemius calcaneal bursae always communicate and can be referred to collectively as the subtendinous calcaneal bursa.
145
what is the maximum bolume of synogival fluid in the navicular bursa?
5 to 6 mL
146
does it exist direct communication between the DIP joint and the navicular bursa?
No direct communication exists between the navicular bursa and the distal interphalangeal (DIP) joint, but medication and local anesthetics have been shown to diffuse into the bursa from the joint
147
significantly higher proportion of horses with distal tendonitis of the DDFT returned to use for a significantly longer period of time when intrabursal injection of methylprednisolone and hyaluronan was combined with ____ months of rest and rehabilitation than if they were returned to work 2 days after intrabursal injection.
significantly higher proportion of horses with distal tendonitis of the DDFT returned to use for a significantly longer period of time when intrabursal injection of methylprednisolone and hyaluronan was combined with **6 months of rest** and rehabilitation than if they were returned to work 2 days after intrabursal injection.
148
what are the % of horses that return to work sound and waht % returns to previous performance following bursoscopic debridement?
61% of 92 horses returned to work sound, and 42% returned to previous performance following bursoscopic débridement of lesions.
149
what is a trochanteric bursitis (whirlbone lamess)
The trochanteric bursa is a congenital bursa that lies between the cranial portion of the greater trochanter and the flat tendon of the accessory head of the middle gluteal muscle
150
Whirlbone lameness refers to lameness caused by what?
Whirlbone lameness refers to lameness caused by inflammation of this bursa and/or the fibrocartilage of the greater trochanter and the tendon of the middle gluteal muscle
151
Whirlbone lameness is most often diagnosed in ___________________ horses where it is often considered to be a consequence of tarsal pain
Whirlbone lameness is most often diagnosed in Standardbred horses where it is often considered to be a consequence of tarsal pain but may be in any breed due to kick or fall
152
a tentative diagnosis of trochanteric bursitis is usually based on
clinical signs: medial break over on the affected limb, medial advancement of the limb even to the extent of crossing the midline, followed by lateral movement of the limb to land on the lateral aspect of the toe and branch of the shoe
Signs of pain may be evident when pressure is applied to the greater trochanter
153
Does rest benefit horses with whirlbone lameness?
No, rest is not beneficial for whirlbone lameness.
153
Treatment of whirlbone lameness - Throchanteric bursitis
treatment of the primary lameness that may have initiated the condition. Rest is claimed to be of no benefit in treatment of horses with whirlbone lameness.1
154
What are the calcaneal bursae and wich communicate with which?
The calcaneal bursae include the subcutaneous calcaneal bursa, the intertendinous calcaneal bursa, and the gastrocnemius calcaneal bursa (Figure 83-15). Subcutaneous and intertendinous calcaneal bursae often communicate (39%9
155
In how many % do SUBCUT and INTERTENDINOUS BURSAE communicate?
39%
155
What the causes of aseptic bursisits?
1. as luxation and subluxation of the superficial digital flexor tendon (SDFT) from the tuber calcanei,
2. tendonitis or enthesopathy of the gastrocnemius tendon,
3. desmitis or enthesopathy of the plantar ligament or retinaculum insertion sites on tuber calcanei
155
Effusion of the calcaneal bursa is palpable proximal and/or distal to the insertion sites of the retinaculum of the _______(1w) to the top of the tuber calcanei
Effusion of the calcaneal bursa is palpable proximal and/or distal to the insertion sites of the retinaculum of the SDFT to the top of the tuber calcanei
156
can be distension without lamess of the calcaneal bursa be ossible?
yes, mild unilateral or bilateral distension may be seen as an incidental finding without lameness.
156
differential diagnosis of of intertendinous and gastrocnemius calcaneal bursae?
intertendinous and gastrocnemius calcaneal bursae must not be confused with distention of the tarsal sheath (thoroughpin) or synoviocoele of the tarsal sheath (false thoroughpin).
157
How do you confirm diagonosis of calcaneal bursitis beside lameness check and exacerbated flexion tarsal test?
Postive response to intrasynovial anesthesia
158
Radiography and ultrasonography are required to determine whether structural abnormalities are present in the tuber calcanei such as (name them 4):
the gastrocnemius tendon,
the SDFT,
its retinaculum,
or the plantar ligament
159
Radiographic exam of calcanae bursae should be with which projection?
flexed skyline image of the calcaneus
160
Treatment of acute bursitis of calcanae
Acute bursitis of unknown origin can be treated with intrasynovial triamcinolone and hyaluronan combined with a period of rest
161
Osteolytic lesions within the calcaneus, lesions within the gastrocnemius tendon, SDFT and its retinaculum, and other soft tissue injuries within the bursa may benefit from
endoscopic debridement
162
What has been associated with poorer prognosis in tuber calcanei?
Osseous lesions of the tuber calcanei
163
Septic bursitis is usually a result of
Septic bursitis is usually the result of a penetrating wound to the subtendinous calcaneal bursae
164
What is the advised bandage after bursoscopy of calcaneal bursae?
External coaptation using a splinted Robert Jones bandage or full-limb cast may be useful to limit motion after surgery, improve patient comfort, and allow primary healing of sutured wounds.
165
What are the % of horses with wounds involving intertendinous and gastrocnemius calcaneal bursae indicate as survival?
75% of horses with wounds involving the intertendinous and gastrocnemius calcaneal bursae survived, but only 44% of horses with septic osteitis of the tuber calcanei did.
More recent, 87% of horses survived long term of which 91% were able to return to the same or higher level of performance as before the injury.
166
what specific structure is associated with increased mortality in calcaneal bursae infection?
The study confirmed that osseous involvement was associated with increased mortality
167
Where is located the cunean bursa?
medial surface of the distal tarsus between the medial collateral ligament of the tarsus and the medial branch of the tibialis cranialis (cunean) tendon.
168
cunean bursitis is very typical in which horses?
Cunean bursitis is purported to be primarily a disease of harness horses such as Standardbreds
169
how do you perform diagnosis of cunean bursitis?
Diagnosis of cunean bursitis is difficult because the disease is not associated with heat, swelling, or pain on pressure to the area.
170
What is the survival rate for horses with wounds in calcaneal bursae?
75% survival rate.
171
What percentage of horses with septic osteitis of the tuber calcanei survive?
Only 44%.
172
What does a multicenter study show about horses treated for septic calcaneal bursitis?
87% survived long-term, and 91% returned to previous performance levels.
173
What effect can traumatic luxation of the SDFT have?
It can lead to subtendinous calcaneal bursitis.
