A silver-impregnation and immunocytochemical study of innervation of the distal sesamoid bone and its suspensory ligaments in the horse

Recent advances in conservative and surgical treatment options of common equine foot problems

Foot problems are very common causes of lameness in horses. With the recent diagnostic advances to evaluate and treat foot pathology as well as to monitor response to therapy, it is now possible to more accurately evaluate the effectiveness of many of these treatments. This review details some of the recent advances of the most common conservative and surgical treatment options for foot problems in horses, including an overview of evidence on the efficacy to support the use of these treatment options and on factors that may affect prognosis.

Insight into the pathomorphology of the distal border of the equine navicular bone

Pathological changes of the equine navicular bone are found in a variety of forms in numerous old and also relatively young horses. Therefore, investigations on this small bone are of major practical significance. The current article presents a view of the alterations observed on the distal aspect of the bone and analyzes their origin and importance. As a result of pressure subjected by the deep digital flexor tendon and adaptive remodelling of the bone tissue, distal border of the navicular bone extends and becomes sharpened. Osseous distal border fragments may be a consequence of this phenomenon. However, the origin of fragments is also associated with the development of entheseophytes on the margins, which can result from stress induced by the distal impar sesamoid ligament. The authors are not unanimous about the clinical importance of fragments, but it seems that the most dangerous are large-sized ones, especially when occurring together with other lesions. An important issue is also the alterations of the nutrient foramina located on the distal border, due to the main role of this surface in blood supply. Changes in the size and shape of pathological synovial invaginations can be a sign of circulatory disturbances and abnormal turnover of the bone tissue. Some researchers link synovial invaginations to cases of lameness, but their importance is still enigmatic. Majority of studies focus on warmblood horses, and a lower interest in coldblood horses can be seen. Nonetheless, certain data are a strong argument that the breed and morphotype can affect the frequency of adverse changes.

Effects of intrabursal administration of botulinum toxin type B on lameness in horses with degenerative injury to the podotrochlear apparatus

OBJECTIVE

To determine the safety and short-term efficacy of intrabursal administration of botulinum toxin type B (BTXB) to alleviate lameness in horses with degenerative injury to the podotrochlear apparatus (PA).

ANIMALS

10 Quarter Horses with degenerative injury to the PA.

PROCEDURES

Degenerative injury to the PA was confirmed with diagnostic analgesia and imaging. Then, BTXB (3.8 to 4.5 U/kg) was injected into the podotrochlear (navicular) bursa of each horse. Three horses were used in a safety evaluation. Subsequently, video recordings of lameness evaluations were obtained for 7 client-owned horses 5 days before (baseline) and 7 and 14 days after BTXB treatment and used to determine the effect of BTXB injection on lameness; 1 horse was removed from the study 8 days after BTXB treatment. Three investigators who were unaware of the treated forelimbs or time points separately reviewed the recordings and graded the lameness of both forelimbs of the horses.

RESULTS

Improvement in lameness of the treated forelimbs was detected at 1 or both time points after BTXB administration in all horses. However, all horses had some degree of lameness at the end of the study. Two horses developed transient increases in lameness 48 to 72 hours after treatment; lameness resolved uneventfully.

CONCLUSIONS AND CLINICAL RELEVANCE

Intrabursal injection of BTXB temporarily alleviated chronic lameness in horses with degenerative injury to the PA, without causing serious short-term adverse effects. Further investigation into the potential use of BTXB in horses affected by degenerative injury to the PA is warranted.

Laminitic pain: parallels with pain states in humans and other species

Laminitis poses a threat to all horses, and is widely considered as being one of the most important diseases of horses and a global equine welfare problem. The effects of laminitis lead to debilitation, development of pronounced digital pain, and great suffering in the afflicted animal. The precise pathophysiological processes that result in laminitic pain are poorly defined, and hence the delivery of effective palliative care is clinically challenging. Knowledge and understanding of pain states in other animal species may further aid the elucidation of equine laminitic pain mechanisms, guide the search for treatable causes of this multifactorial problem, and thereby help achieve enhanced therapeutic and palliative care. However, parallels drawn from pain states in other animals must consider species differences in both anatomy and physiology, and the specific nature of the laminitic disease process.

Neurovascular invasion at the osteochondral junction and in osteophytes in osteoarthritis

BACKGROUND

Normal adult articular cartilage is thought to be avascular and aneural.

OBJECTIVE

To describe neurovascular structures at the osteochondral junction and in osteophytes in tibiofemoral osteoarthritis (OA) displaying a range of severity of cartilage changes.

METHODS

Articular surfaces were obtained from 40 patients at total knee joint replacement surgery for tibiofemoral OA (TKR) and seven patients post mortem (PM). Antibodies directed against CD34 (vascular endothelium), protein gene product 9.5 (pan-neuronal marker), substance P and calcitonin gene-related peptide (sensory nerves) and C-flanking peptide of neuropeptide Y (sympathetic nerves) were used to localise blood vessels and nerves by immunohistochemistry. Severity of OA cartilage changes was graded histologically.

RESULTS

TKR and PM samples displayed a range of OA cartilage changes including tidemark breaching by vascular channels. Sympathetic and sensory nerves were both present within vascular channels in the articular cartilage, in both mild and severe OA. Perivascular and free nerve fibres, and nerve trunks were observed within the subchondral bone marrow and within the marrow cavities of osteophytes. Sensory and sympathetic nerves displayed similar distributions in each region studied.

CONCLUSION

Vascularisation and the associated innervation of articular cartilage may contribute to tibiofemoral pain in OA across a wide range of structural disease severity.

Lameness in 46 horses associated with deep digital flexor tendonitis in the digit: diagnosis confirmed with magnetic resonance imaging

REASONS FOR PERFORMING STUDY

The differential diagnosis of foot pain has long proved difficult and the use of magnetic resonance imaging (MRI) offers the opportunity to further the clinical understanding of the subject.

OBJECTIVES

To determine the incidence of deep digital flexor tendon (DDFT) injuries in a series of 75 horses with lameness associated with pain localised to the digit, with no significant detectable radiographic or ultrasonographic abnormalities, using MRI; and to describe a variety of lesion types and relate DDF tendonitis with anamnesis, clinical features, response to local analgesic techniques and nuclear scintigraphic and ultrasonographic findings.

METHODS

All horses undergoing MRI of the front feet between January 2001 and October 2002 were reviewed and those with DDFT injuries categorised according to lesion type; horses with primary tendonitis (Group I) and those with concurrent abnormalities of the navicular bone considered to be an important component of the lameness (Group II). The response to perineural analgesia of the palmar digital nerves and palmar (abaxial sesamoid) nerves, intra-articular analgesia of the distal interphalangeal (DIP) joint and analgesia of the navicular bursa were reviewed. The result of ultrasonography of the pastern and foot was recorded. Lateral, dorsal and solar pool and bone phase nuclear scintigraphic images were assessed subjectively and objectively using region of interest (ROI) analysis.

RESULTS

Forty-six (61%) of 75 horses examined using MRI had lesions of the DDFT considered to be a major contributor to lameness. Thirty-two horses (43%) had primary DDFT injuries and 14 (19%) a combination of DDF tendonitis and navicular bone pathology. Lesions involved the insertional region of the tendon alone (n = 3), were proximal to the navicular bone (n = 23) or were at a combination of sites (n = 20). Lesion types included core lesions, focal and diffuse dorsal border lesions, sagittal plane splits, insertional injuries and lesions combined with other soft tissue injuries. Many horses had a combination of lesion types. Lameness was abolished by palmar digital analgesia in only 11 of 46 horses (24%). Twenty-one of 31 horses (68%) in Group I showed > 50% improvement in lameness after intra-articular analgesia of the DIP joint, whereas 11 of 12 horses (92%) in Group II had a positive response. Twelve of 18 horses (67%) in Group I had a positive response to analgesia of the navicular bursa. Nineteen horses had lesions of the DDFT extending proximal to the proximal interphalangeal joint seen using MRI, but these were identified ultrasonographically in only 2 horses. Scintigraphic abnormalities suggestive of DDFT injury were seen in 16 of 41 horses (41%), 8 in pool phase images and 8 in bone phase images.

CONCLUSIONS AND POTENTIAL RELEVANCE

DDFT injuries are an important cause of lameness associated with pain arising from the digit in horses without detectable radiographic abnormalities. Lameness is not reliably improved by palmar digital analgesia, but may be improved by intra-articular analgesia of the DIP joint in at least 68% of horses. Ultrasonography is not sensitive in detecting lesions of the DDFT in the distal pastern region, but a combination of pool and bone phase scintigraphic images of the digit is helpful in some horses. Further follow-up information is required to determine the prognosis for horses with lesions of the DDFT in the digit and to establish whether this is related to lesion severity and/or location.

Injection of corticosteroids, hyaluronate, and amikacin into the navicular bursa in horses with signs of navicular area pain unresponsive to other treatments: 25 cases (1999-2002)

OBJECTIVE

To determine history, clinical and radiographic abnormalities, and outcome in horses with signs of navicular area pain unresponsive to corrective shoeing and systemic nonsteroidal anti-inflammatory drug administration that were treated with an injection of corticosteroids, sodium hyaluronate, and amikacin into the navicular bursa.

DESIGN

Retrospective study.

ANIMALS

25 horses.

PROCEDURE

Data collected from the medical records included signalment, history, horse use, severity and duration of lameness, shoeing regimen, results of diagnostic anesthesia, radiographic abnormalities, and outcome.

RESULTS

17 horses had bilateral forelimb lameness, 7 had unilateral forelimb lameness, and 1 had unilateral hind limb lameness. Mean duration of lameness was 9.2 months. All horses had been treated with corrective shoeing and nonsteroidal anti-inflammatory drugs for at least 6 months; 18 had previously been treated by injection of corticosteroids and sodium hyaluronate into the distal interphalangeal joint. Fourteen horses had mismatched front feet, and 21 horses had signs of pain in response to application of pressure over the central aspect of the frog. Palmar digital nerve anesthesia resulted in substantial improvement in or resolution of the lameness in all horses. Twenty horses (80%) were sound and returned to intended activities 2 weeks after navicular bursa treatment; mean duration of soundness was 4.6 months. Two horses that received numerous navicular bursa injections had a rupture of the deep digital flexor tendon at the level of the pastern region.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that navicular bursa treatment may provide temporary improvement in horses with signs of chronic navicular area pain that fail to respond to other treatments.

Effects of topical perineural capsaicin in a reversible model of equine foot lameness

Capsaicin is a local substance P depleter with dramatic analgesic effects. We tested the hypothesis that the topical application of capsaicin ointment over the palmar digital nerves would attenuate the clinical effects of a reversible model of equine foot lameness. Seven healthy adult horses shod unilaterally with adjustable heart bar shoes were studied in a crossover design for 2 weeks. Grade 5.0/5.0 lameness (nonweight bearing) was induced by tightening the adjustable heart bar shoe. One hour later, capsaicin ointment was applied over the medial and lateral palmar digital nerves 3 cm proximal to the coronary band, or horses were left untreated. One week later, treatment assignments were reversed, and the experiment was repeated. The heart rate was markedly lower in treated than in untreated trials at 20 and 40 minutes after capsaicin and between 1.6 and 3.6 hours after capsaicin (P < .05). The lameness score was markedly decreased in capsaicin-treated horses at 40 minutes and from 1.3 to 4 hours after treatment (P < .05). We conclude that the topical application of capsaicin ointment over the palmar digital nerves provided measurable pain relief for up to 4 hours after treatment (P < .05). The clinical application of this analgesic technique in horses with spontaneous clinical or induced laminitis or other sources of foot pain remains to be shown.

Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 1: forelimb foot and carpus

This paper tests the hypothesis that the local analgesic agent mepivacaine diffuses between adjacent equine synovial structures in the forelimb and with greater frequency than latex, gelatine dye or contrast media. We report the incidence of diffusion of mepivacaine between the distal interphalangeal joint (DIPJ) and navicular bursa (NB) of the forelimbs and between the intercarpal (IC) and radiocarpal (RC) joints of 31 fresh equine cadavers. The DIPJ of one forelimb and the NB of the contra lateral forelimb and the RC joint of one forelimb and the IC joint of the contra lateral forelimb were injected with mepivacaine. After flexion and extension of the joints, synovial fluid was obtained from the synovial structures adjacent to the injected synovial structures. The concentration of mepivacaine in these samples was determined using an enzyme linked immunosorbent assay. For samples obtained by dilution of synovial fluid, the concentration of mepivacaine was determined by comparing the concentrations of urea in the diluted synovial fluid and the concentration of serum urea. Mepivacaine diffused from the DIPJ to the NB or from the NB to the DIPJ in 25/25 (100%) limbs. Mepivacaine diffused from the IC to RC joints in 24/25 (96%) limbs and from the RC to IC joints in 21/25 (84%) limbs. It was detected at concentrations >0.3 mg/l in 9/25 (36%) of IC joints after RC joint injection and in 25/25 (100%) of the NB after DIPJ injection; at concentrations >100 mg/l in 2/25 (8%) of IC and RC joints and 12/25 (48%) of NB following DIPJ injection; and at concentrations >300 mg/l in 1/25 (4%) in the IC joints following RC joint injection and in 11/25 (44%) of DIPJ following NB injection. The results show greater diffusion of mepivacaine between adjacent synovial structures than assumed from previous anatomical, latex injection and contrast arthrographic studies. This study showed that commonly performed intrasynovial analgesic techniques in the forelimb of the horse are not as specific as previously reported.

Podotrochlear bursa endoscopy in the horse: a cadaver study

OBJECTIVES

To evaluate podotrochlear bursa (navicular bursa) endoscopy as a diagnostic technique in horses and to correlate observations to radiographic and pathologic findings.

STUDY DESIGN

Descriptive study.

SAMPLE POPULATION

Seventeen equine cadaver forelimbs.

METHODS

Five standard radiographic views of the navicular region and a bursographic study with lateromedial and caudal tangential radiographic views were taken of each forelimb. Radiographic scoring of the navicular bone (0, excellent; 1, good; 2, fair; 3, poor) was performed using a previously reported technique. Endoscopic examination was performed using a 30 degrees wide-angle forward oblique-viewing, 4-mm outside diameter (OD), arthroscope. Four examiners using recorded videotapes made independent evaluations of bursal endoscopy. The specimens were then dissected and examined to verify radiographic and endoscopic findings.

RESULTS

The distribution of radiographic scores (RS) were 0 (5 limbs), 1 (7), 2 (2), and 3 (3). Abnormal endoscopic findings (fibrillation of the deep digital flexor tendon, a defect in the navicular bone fibrocartilage, and synovial hyperplasia) were identified in 3 limbs (2 with an RS of 1, and 1 with an RS of 3). The endoscopic observations made in the two RS 1 bursae were not confirmed on gross examination, whereas they were in the RS 3 specimen, which also had the only abnormal bursogram. Evaluation of the bursa on the side ipsilateral to the arthroscope portal was difficult. Complications of the technique included inadvertent penetration of the distal interphalangeal joint and the digital sheath, and superficial scoring of the navicular bone fibrocartilage.

CONCLUSIONS

Podotrochlear bursa endoscopy is feasible and may be a useful technique in identifying early abnormalities associated with podotrochleosis.

CLINICAL RELEVANCE

In horses with podotrochleosis, endoscopic examination of the podotrochlear bursa may improve identification of pathologic changes within the bursa.

Morphological and immunohistochemical examination of nerves in normal and injured collateral ligaments of rat, rabbit, and human knee joints

BACKGROUND

Knee joints possess an abundant nerve supply that relays sensory and motor information on such aspects as proprioception, nociception, and vasoregulation. Although synovial innervation has been well documented, little is known of the nerves that supply the collateral ligaments.

METHODS

The morphology of rabbit and human collateral ligament nerves was examined by silver impregnation. Immunohistochemistry was performed on rabbit and rat collateral ligaments to determine the presence of peptidergic nerves in these tissues. A 6-week gap injury was performed on three rabbit medial collateral ligaments, and the localisation of peptidergic nerves in these tissues was determined.

RESULTS

Irrespective of species or type of ligament examined, the greatest density of nerve fibres was found in the epiligament. Nerve fibres commonly accompanied blood vessels along the long axis of the ligament and then entered the substance of the tissue before ramifying in the deeper layers. Substance P and calcitonin gene-related peptide-immunoreactive nerve fibres were found in the collateral ligaments of the rat and rabbit. Injured ligaments showed a higher than normal level of immunoreactivity in and around the healing zone; however, the nerve fibres appeared tangled and truncated.

CONCLUSIONS

Like other structures in knee joints, collateral ligaments possess a complex nerve supply. The presence of peptidergic nerves suggests that ligaments may be susceptible to neurogenic inflammation and may be centres of articular nociception.

Sensory innervation of the navicular bone and bursa in the foal

The sensory innervation of the navicular bone (os sesamoideum distale) and its suspensory ligaments [ligamenta sesamoidea collateralia (CSL) and ligamentum sesamoideum distale impar or distal sesamoidean impar (DS-impar) ligament] and the navicular bursa (podotrochlearis) was examined in the neonatal foal using immunocytochemistry. With antisera raised to substance P (SP) and human calcitonin gene-related peptide (CGRP), immunoreactive nerves were demonstrated to innervate the CSL and navicular bursa. Within CSL, and SP- and CGRP-like nerves were present in the synovial lining of the navicular bursa, appearing to reach the surface lining. These nerves appeared to enter the CSL and navicular bursa via the abaxial regions of the foot. Both peptides were present in the deep digital flexor tendon (DDf) along the palmar border of the navicular bursa, as well as in the DS-impar ligament. More nerve fibres were present in the dorsal part of CSL bordering the distal interphalangeal joint than was observed palmarly in CSL along the navicular bursa. Both peptides were observed to innervate the cartilage canals within the navicular bone. In terms of relative densities of immunoreactive SP- and CGRP-like peptides, the CSL dorsally and the DS-impar ligament had the highest relative densities of nerve fibres followed by the navicular bone, the palmar aspect of CSL and the DDf tendon bordering the navicular bursa. These results are discussed in relationship to local anaesthetic injections into the navicular bursa.