Diseases of the axial skeleton Flashcards
What are the parts of the axial skeleton?
- cervical spine
- thoracic spine
- lumbar spine
- lumbosacral joint
What clinical signs are associated to diseases of the axial skeleton?
- Poor muscling
- Pain on palpation
- Abnormal dynamic responses
- Resentment of ridden exercise
- Poor quality canter (vs trot)
What imaging is mostly used to assess diseases of the axial skeleton?
Radiography is the mainstay of diagnostic imaging…
Laterolateral views are most commonly acquired and are excellent for disease affecting the dorsal spinous processes.
CARE – you can find dorsal spinous process disease in a large proportion of horses with no back pain!!
How are the xrays on the second row different to the first?
- Kissing spines vs normal
- Sclerosis on left xray
- Right not as severe
What other methods can we use to get a definitive diagnosis for DSP impingement?
Gamma scintigraphy (bone scan)
Response to local anaesthesia
Assess and reassess under saddle
Response to local anti-inflammatories
Think of as a “long term block”
What are management options for DSPs?
Medical management and rehabilitation is probably the starting point for most cases:
* Local injection of corticosteroids
* Rehabilitation program to restore strength and function
This can be curative in some cases, can be repeated in cases with good responses. Frequency of injection often reduces with time as they become stronger.
Surgical management
Interspinous ligament desmotomy
Disadvantages:
- Doesn’t change underlying anatomy
- not enough evidence it has clinical merit
Advantages:
- Short rehabilitation period
Subtotal (cranial wedge) ostectomy
Disadvantages:
* Invasive procedure
* Post-operative pain
* Long rehabilitation period
Advantages:
* Permanent anatomy change
* Better long-term outcomes
What other joint in the axial sekelton causes disease?
Articular process joints in the cervical spine
How is APJ disease treated?
Corticosteroid injections done ultrasound guided
What clinical signs are associated to lumbosacaral and sacroiliac disease?
The “typical” horse with LSI dysfunction:
* Can buck under saddle
* Becomes disunited at canter (not leading with same side front foot than back foot)
* Has poor hind limb engagement
* Occasionally has overt lameness
How can you diagnose pain in the sacroiliac joint?
Nerve block
* Inject local anaesthetic into the sacroiliac joint bilaterally
- can be done blind or ultrasound guided
* Ideally observe the horse ridden before and after blocking
Not a risk-free procedure:
* The sacroiliac joint is extremely close to some important structures
* Inadvertent blockade of the cranial gluteal nerve is possible
* Horse can become recumbent for 3-4 hours!!
* <5%
What other imaging can be used to diagnose lower spine disease?
Scintigraphy
What should be included in a rehabilitation program?
Core stability is the goal…
Techniques to improve engagement and muscle recruitment can be started early in the rehab process
* Sternal lifts
* LSI dorsiflexion
* Tail pulls
Could use water treadmill exercise
Huge topic of research currently:
* Adds resistance to cranial phase of stride
* Increases limb retraction (stride height)
* Increases ROM of the axial skeleton
* Buoyancy (if deep enough…)
Recommended for improving:
* Strength
* Coordination
* Stability
* Postural control
Clinical use:
* Can be prescribed as an intensive course or incorporated into ongoing training
Lunging with some devices can be used to encourage dorsiflexion and muscle recruitment:
* Pessoa systems
* Equiband (band behind glutes will remind horse to engage core)
* Home-made equivalents!!
Exercises
* Hill work (trot up and walk down)
* Pole exercises (raised)
* Working on a range of surface types
* “cross training”
