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Walter LJ, Stack JD, Winderickx K, Davies HMS, Simon O, Franklin SH. Review of the clinical diagnosis of sacroiliac dysfunction in horses - Challenges and limitations. Vet J 2024; 305:106106. [PMID: 38556191 DOI: 10.1016/j.tvjl.2024.106106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/06/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
Sacroiliac dysfunction (SID) is a condition seen in horses associated with poor performance that affects hind limb gait and impulsion. The condition comprises pain and dysfunction but there lacks clarity around the aetiopathogenesis and whether SID encompasses abnormal joint pathology, abnormal joint movement, abnormal regional biomechanical function, joint laxity and pain, or various combinations of these that may vary over time. Clinical assessment remains challenging for equine clinicians due to the deep location of the sacroiliac joint (SIJ) and surrounding structures which limits access for palpation, diagnostic imaging and joint-specific injection. There is no recognised single reference standard diagnostic test for SID. Clinical diagnosis has been based on ruling out other causes of hind limb lameness, along with combinations of ultrasonography, scintigraphy and periarticular anaesthesia of the SIJ. Recent studies have highlighted the lack of specificity of injections targeting the SIJ, with significant dispersal of injectate into surrounding structures including around the lumbosacral joint (LSJ). Advanced imaging modalities such as computed tomography offers promise for assessment of the structure and pathology of the SIJ and surrounding bony structures. However, there is a need to improve the understanding of the significance of anatomic variation of the sacroiliac region structures, with recent studies reporting detailed anatomic variation in groups of horses with and without SID. There are also limitations around functional assessment of the joint which is still largely reliant on a thorough clinical examination. This review aims to present an update on clinical approaches to the diagnosis of horses with SID, and to consider the challenges and limitations.
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Affiliation(s)
- L J Walter
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, 5371 SA, Australia.
| | - J D Stack
- Phillip Leverhulme Equine Hospital, Department of Equine Clinical Science, University of Liverpool, Wirral CH64 7TE, UK
| | - K Winderickx
- Lingehoeve Diergeneeskunde, Veldstraat 3a, Lienden 4033 AK, the Netherlands
| | - H M S Davies
- Department of Veterinary BioSciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - O Simon
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, 5371 SA, Australia
| | - S H Franklin
- School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, 5371 SA, Australia
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Marcelino L, Falk E, Johansson J, Rydén J, Uhlhorn M, Ley CJ. Radiation from the equine perineal region is low compared with the elbow and head 24 hours after bone scintigraphic examination. Vet Radiol Ultrasound 2024; 65:68-75. [PMID: 38178311 DOI: 10.1111/vru.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 11/11/2023] [Accepted: 11/18/2023] [Indexed: 01/06/2024] Open
Abstract
The timing of follow-up radiography and ultrasound in horses that undergo skeletal scintigraphy for lameness investigation varies internationally and between equine hospitals. The prospective, one-group, pretest, posttest study aimed to estimate radiation levels from horses three and 24 h after injection of hydroxydiphosphonate labeled with metastable technetium (99mTc-HDP) and investigate which anatomical locations of the horse had higher radiation levels. Included were 46 horses referred for lameness investigation between June and December 2021. Radiation levels from the horse surface were measured using an electronic device from six anatomical locations (head, elbow, dorsum, ventrum, stifle, and perineum) at two time points and adjusted to three and 24 h after injection of 99mTc-HDP using the radioactive decay law. The radiation measured was significantly different in the various locations of the horses for both time points. At 3 h after injection of 99mTc-HDP, the ventrum had the highest radiation dose. At 24 h, the radiation emitted from the perineal region was significantly lower (P < .0001) than from the elbow and head, which had the highest values. There was a negative correlation between age and the radiation detected at 24 h postinjection (P = .02). Radiation from the perineal region was low compared with other regions of the horse 24 h postscintigraphy. Additional care should be taken around the ventrum area during the scintigraphy examination and around the elbow and head at 24 h postscintigraphy to minimize radiation to personnel.
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Affiliation(s)
- Leticia Marcelino
- Department of Diagnostic Imaging, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Emma Falk
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jessica Johansson
- Department of Diagnostic Imaging, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jesper Rydén
- Department of Energy and Technology, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Margareta Uhlhorn
- Department of Diagnostic Imaging, University Animal Hospital, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Charles J Ley
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Horne CR, Tufts S. Advances in Imaging Techniques to Guide Therapies and Monitor Response to the Treatment of Musculoskeletal Injuries. Vet Clin North Am Equine Pract 2023; 39:489-501. [PMID: 37482520 DOI: 10.1016/j.cveq.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Continual advancements in diagnostic imaging have allowed for more accurate and complete diagnoses of injuries in the performance horse. The use of several different imaging tools has further allowed the equine sports medicine clinician to more carefully direct treatment options, monitor response to therapy and guide rehabilitation recommendations. The advancements in diagnostic imaging and novel treatment options have led to the improvement in the overall prognosis of many injuries that affect the horse and their performance. The purpose of this section is to review the advancements made in diagnostic imaging of the horse and to aid the practitioner in the selection of the appropriate modality and how best to use them to guide treatment and monitoring decisions.
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Affiliation(s)
- Caitlyn R Horne
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA.
| | - Sara Tufts
- North Carolina State University College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA
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Nagy A, Dyson S. Response to comments on Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians' experiences. Equine Vet J 2023; 55:925-926. [PMID: 37386738 DOI: 10.1111/evj.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Annamaria Nagy
- University of Veterinary Medicine Budapest, Equine Department and Clinic, Üllö, Hungary
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Greco A, Meomartino L, Gnudi G, Brunetti A, Di Giancamillo M. Imaging techniques in veterinary medicine . Part II: Computed tomography, magnetic resonance imaging, nuclear medicine. Eur J Radiol Open 2022; 10:100467. [PMID: 36570419 PMCID: PMC9768321 DOI: 10.1016/j.ejro.2022.100467] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
Radiography and ultrasonography are the most used techniques in veterinary clinical practice, due to organizational, managerial and, mostly, economic reasons. However, in the last decades, Computed tomography (CT), Magnetic Resonance Imaging (MRI) and, to a lesser extent, Nuclear Medicine (MN) are increasingly used. As we said in the previous article, all the Diagnostic Imaging techniques are actually "indispensable" in Veterinary Medicine, where many patients do not show any symptoms.This second part describes Computed Tomography (CT), Magnetic Resonance (MRI) and Nuclear Medicine techniques in Veterinary Medicine are described.
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Affiliation(s)
- Adelaide Greco
- Centro Interdipartimentale di Radiologia Veterinaria, Università degli Studi di Napoli “Federico II”, Via F. Delpino, 1, 80137 Napoli, Italy
| | - Leonardo Meomartino
- Centro Interdipartimentale di Radiologia Veterinaria, Università degli Studi di Napoli “Federico II”, Via F. Delpino, 1, 80137 Napoli, Italy,Corresponding author.
| | - Giacomo Gnudi
- Dipartimento di Scienze Mediche Veterinarie, Università di Parma, Via del Taglio, 10, 43126 Parma, Italy
| | - Arturo Brunetti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli “Federico II”, Via Pansini, 5, 80131 Napoli, Italy
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milano, Italy
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Mageed M, Dyab S, Swagemakers JH, Gerlach K. The impact of different bone tracers and acquisition times on image quality of equine bone scintigraphy. Vet Radiol Ultrasound 2022; 63:593-600. [PMID: 35666549 DOI: 10.1111/vru.13107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The impact of different acquisition times (AqT) and technetium-99 m-labeled (99m Tc) diphosphonates on the image quality of bone scintigraphy is poorly documented in horses. The aim of this prospective experimental study was to evaluate the impact of varying 99m Tc-disphosphonates and AqT on semiquantitative and qualitative image parameters of bone scintigraphy in horses. Twenty-four horses undergoing bone scintigraphy were divided equally and randomly into methylene- (MDP), hydroxymethylene- (HDP), and dicarboxypropane diphosphonate (DPD) groups. Lateral scintigraphic images of the antebrachium were obtained 3 h post 99m TC-diphosphonate injection using three AqT (60, 90, 120 s). The images were analyzed semiquantitatively using the bone-soft tissue ratio (B:ST), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image contrast. Furthermore, a blinded qualitative analysis was performed using a visual grading analysis. The results showed that DPD images had a significantly higher B:ST ratio than MDP images (P < .01) but not HDP images in all AqT (P > .08). However, DPD and HPD images acquired at 60 s had significantly higher CNR (P < .05) than those acquired at 90 and 120 s. The qualitative analysis revealed no significant differences between 99m Tc-diphosphonates at AqT 60 and 90 s. However, MDP images acquired at 120 s had significantly lower image quality compared to DPD and HDP (P = .01 and .03, respectively). In conclusion, the bone tracers affected the semiquantitative image parameters but not the qualitative analysis findings. Increasing AqT did not necessarily improve the image quality. Therefore, decreasing the AqT enabled a reduction in personnel radiation exposure.
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Affiliation(s)
- Mahmoud Mageed
- Tierklinik Lüsche GmbH, Independent researcher, Bakum, Germany
| | | | | | - Kerstin Gerlach
- Department for Horses, Faculty of Veterinary Medicine, University of Leipzig, Leipzig, Germany
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7
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Dyson S, Thomson K. The recognition of pain and learned behaviour in horses which buck. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harding PG, Tually P, Cullimore AM, Peremans K. Single‐photon emission computed tomography of the pelvis and lumbar spine contributes to the diagnosis of injury in two horses. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P. G. Harding
- Ascot Equine Veterinarians Ascot Western AustraliaAustralia
| | - P. Tually
- TeleMedVET Ascot Western Australia Australia
| | | | - K. Peremans
- Department of Medical Imaging Faculty of Veterinary Medicine University Ghent Merelbeke Belgium
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Quiney L, Stewart J, Routh J, Dyson S. Gross post-mortem and histological features in 27 horses with confirmed lumbosacral region pain and five control horses: A descriptive cadaveric study. Equine Vet J 2021; 54:726-739. [PMID: 34118082 DOI: 10.1111/evj.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a lack of understanding of the pathological and/or physiological nature of lumbosacral region pain. OBJECTIVES To describe the gross variations of the osseous and soft tissues of the lumbosacral region and report the histological findings of sections of nerve tissue in affected and control horses. STUDY DESIGN Descriptive post-mortem case series. METHODS All horses had undergone full clinical and gait assessment, including ridden exercise. Horses with a substantial response to infiltration of local anaesthetic solution around the sacroiliac joint regions were included in the affected group (n = 27). Horses for which the source(s) of pain was confirmed by diagnostic anaesthesia to be distant to the lumbosacral region were included in the control group (n = 5). The pelvic regions were isolated and the soft tissues were assessed grossly. Sections of the lumbosacral plexus and cranial gluteal, sciatic and obturator nerves were examined histologically. The osseous specimens were evaluated for anatomical variants and abnormalities. Data were analysed using descriptive statistics. RESULTS Gross discolouration of the sciatic or obturator nerves was observed in 7 (26%) affected and no control horses. Grade 3/3 histological abnormality scores were assigned in 22% of nerve sections from affected horses compared with 3% from control horses. Several osseous variants (bifid sacral spinous processes, straight-shaped sacroiliac joint surface, short arrow-shaped sacral alae, left-right asymmetry of sacral alae, sacral curvature, absence of the fourth to fifth and ankylosis of the fifth to sixth lumbar articular process joints, left-right asymmetry of caudocranial position of the fourth to fifth and lumbar-sacral articular process joints) and abnormalities (sacroiliac enthesopathy, extra ventral sacroiliac joint surface, lumbosacral symphyseal periarticular modelling, lumbosacral intertransverse joint pitting lesions) were more frequently observed in affected horses. MAIN LIMITATIONS Both control and affected horses may have had preclinical abnormalities. CONCLUSIONS Lumbosacral region pain may reflect the presence of a number of pathological changes. Neural pain may play an important role in some horses.
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Affiliation(s)
- Laura Quiney
- Centre for Equine Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - Jennifer Stewart
- Centre for Preventative Medicine, Animal Health Trust, Newmarket, Suffolk, UK
| | - Jennifer Routh
- Centre for Equine Studies, Animal Health Trust, Newmarket, Suffolk, UK
| | - Sue Dyson
- Centre for Equine Studies, Animal Health Trust, Newmarket, Suffolk, UK
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Affiliation(s)
- S. Dyson
- The Cottage Market Weston, Diss UK
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11
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Haussler KK, King MR, Peck K, Adair HS. The development of safe and effective rehabilitation protocols for horses. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K. K. Haussler
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
| | - M. R. King
- Gail Holmes Equine Orthopaedic Research Center Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences Colorado State University Fort Collins Colorado USA
| | - K. Peck
- Department of Physical Therapy Creighton University Omaha Nebraska USA
| | - H. S. Adair
- Department of Large Animal Clinical Science University of Tennessee Knoxville Tennessee USA
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12
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Dyson S, Nagy A, Murray R. Letter to the Editor: Regarding recent paper by Pezzanite et al. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Dyson
- The Cottage Market Weston, Suffolk UK
| | - A. Nagy
- Equine Clinic University of Veterinary Medicine Üllő Dóramajor Hungary
| | - R. Murray
- Rossdales LLP Exning, Newmarket, Suffolk UK
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Mageed M, Wegert J, Dyab S, Gerlach K. Furosemide administration onehour before bone scintigraphy examination in horses does not improve the image quality or reduce the radiation dose rate. Vet Radiol Ultrasound 2020; 62:126-132. [PMID: 33040424 DOI: 10.1111/vru.12917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022] Open
Abstract
This prospective, cross-sectional, pilot study aimed to investigate the effects of furosemide as a diuretic on the image quality of bone scintigraphy performed using 99m Tc-HDP and to investigate the impact of furosemide on the radiation dose rate. Thirty-one horses undergoing bone scintigraphy were included. The horses were divided into the control (n = 14) and furosemide group (n = 17), which received 1 mg/kg furosemide intravenously 1 h post 99m Tc-HDP administration. The image quality was assessed subjectively and semi-quantitatively. The bone-to-soft tissue (B:S) ratio was calculated from the counts per pixel of regions of interest (ROI) positioned over the left radial diaphysis (bone ROI) and its caudal soft tissue area (soft tissue ROI). The radiation rate dose (μSv/h) of both groups was measured at 0, 3, 6, 12, 18, and 24 h post 99m Tc-HDP administration at a distance of 0, 30, and 100 cm from the head, kidney, and pelvis. The results showed no significant differences in the B:S ratio or the radiation dose rate observed between the groups. However, the radiation dose rate decreased by 56% at 3 h post 99m Tc-HDP administration and keeping a distance of 30 cm reduced the radiation dose rate by 65%. Administering furosemide does not improve the image quality or reduce the radiation dose rate. The authors recommend commencing with bone scintigraphy 3 h post 99m Tc-HDP administration and keeping at least a distance of 30 cm from the horse to reduce the staff radiation dose.
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Affiliation(s)
- Mahmoud Mageed
- Tierklinik Lüsche GmbH, Tierklinik Lüsche GmbH, Essenerstr. 39a, Bakum, 49456, Germany
| | - Julius Wegert
- Tierklinik Lüsche GmbH, Tierklinik Lüsche GmbH, Essenerstr. 39a, Bakum, 49456, Germany
| | - Shahlaa Dyab
- Tierklinik Lüsche GmbH, Tierklinik Lüsche GmbH, Essenerstr. 39a, Bakum, 49456, Germany
| | - Kerstin Gerlach
- Departement for Horses, University of Leipzig, Leipzig, Germany
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Walker L, Martinelli MJ, Rantanen N, Drumond B, Trostle S. Attenuation From Shoes and Pads in Equine Nuclear Scintigraphy, With Relevance to Solar Views. Front Vet Sci 2020; 7:516718. [PMID: 33195506 PMCID: PMC7542681 DOI: 10.3389/fvets.2020.516718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/19/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lea Walker
- California Equine Orthopedics, San Marcos, CA, United States
- *Correspondence: Lea Walker
| | | | - Norman Rantanen
- California Equine Orthopedics, San Marcos, CA, United States
| | - Bianca Drumond
- California Equine Orthopedics, San Marcos, CA, United States
| | - Steven Trostle
- Blue Ridge Equine Clinic, Earlysville, VA, United States
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15
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Nagy A, Dyson S. Recumbency following diagnostic analgesia of the sacroiliac joint regions: 15 horses. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A. Nagy
- Centre for Equine Studies Animal Health Trust Newmarket Suffolk UK
| | - S. Dyson
- Centre for Equine Studies Animal Health Trust Newmarket Suffolk UK
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Nagy A, Quiney L, Dyson S. Long‐term outcome of 84 horses with sacroiliac joint region pain with (n = 69) or without (n = 15) other orthopaedic problems. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Nagy
- Animal Health Trust Centre for Equine Studies Newmarket Suffolk
| | - L. Quiney
- MV Imaging, Bellshill South Lanarkshire UK
| | - S. Dyson
- Animal Health Trust Centre for Equine Studies Newmarket Suffolk
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Dyson S. Technological advances in equine medicine: Are we losing our clinical skills? Or failing to develop appropriate clinical skills? EQUINE VET EDUC 2019. [DOI: 10.1111/eve.12988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S. Dyson
- Centre for Equine Studies; Animal Health Trust; Newmarket Suffolk UK
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