Diagnosis and Treatment Plans for Joint Disease
How Your Veterinarian Diagnoses Lameness
Diagnosing equine lameness can be a tricky business, relying heavily on the
knowledge, experience and even the dexterity of your veterinarian.
Finding a slight lameness early and correctly locating the involved joint are
of paramount importance for effective treatment. A complete examination
will include an examination for lameness that does not involve joints, but this discussion is
limited to lameness attributable to joint disease.
A clinical lameness examination by your veterinarian generally includes the following:
- Case history and inspection of conformation
- Inspection at a walk and at a trot
- Palpation of the suspected joints for swelling and pain
- Diagnostic anesthesia and possibly a radiographic X-ray examination
- Flexion test - In many cases lameness can be so slight that it is
difficult to determine its origin. During a flexion test, each
joint is bent as far as possible, with a smooth and not-too-strong force. The joint remains bent under even pressure for at
least 60 seconds. The horse is then immediately put into a trot.
An inflamed joint will react with increased pain, exaggerating
any lameness. If done properly, the flexion test will not cause
pain in a healthy joint. As a rule, the most suspicious leg is
tested last.
A veterinarian will usually first talk to the owner, trainer and/or groom to determine
when and how the problem developed. Information about breeding, training and
feeding procedures will be reviewed. Any history of lameness, injury or
prior treatments should be discussed.
Severe lameness, initially or
after the flexion test, may indicate a fracture. If there are no reasons to
suspect a fracture, the radiograph may not be necessary. As a rule,
radiography is advisable before treatment begins.
Local anesthesia of the joint is performed in order to confirm which joint is
affected. The amount of joint inflammation can vary from one joint to another
and also with different types of horses, depending on their activities.
Treatment Plan
Primary goals of treatment are to reduce symptoms of inflammation
(swelling and pain) and to return the joint's biochemical environment to its
normal state. Quickly stopping the chain reaction of destruction is critical to
ensuring long-term joint function. Treatments administered in the joint quickly reach the affected area and restore the synovial barrier.
HYLARTIN® V (sodium hyaluronate)
Injection also stimulates production of
high molecular weight hyaluronate within the joint.
When a horse has been diagnosed with noninfectious joint inflammation,
HYLARTIN V
can be administered on the same day. However, if diagnostic
anesthesia has been performed, it should be allowed to wear off before
HYLARTIN V is injected.
A good result can be expected only if HYLARTIN® V
is injected directly into the inflamed joint. Injections will be administered under
sterile conditions. After treatment, a
disinfectant dressing should be applied over the injection sites.
A recommended post-treatment management program includes:
- At least 2 days of stall rest
- A few days of light exercise or hand-walking
- Gradually increasing exercise during the second week
- A return to a regular training program
After treatment of joint inflammation, it is important that the horse receive a
medical exam before resuming hard training. This will reduce the
risk of recurrence due to incomplete healing.
The lameness may not be completely resolved after one treatment. If that
happens, the diagnosis should be reconsidered. A question to ask is: Is the
problem strictly in the joint or are there factors outside the treated joint
contributing to symptoms?
If the diagnosis is confirmed, another treatment with HYLARTIN V
injection may be administered. Clinical experience has shown that a second injection of
HYLARTIN V
is likely to succeed if the first injection made a significant clinical
improvement but didn't eliminate all symptoms. The second injection should
be administered 1 to 2 weeks after the first treatment. Rest is the single most important
element in the treatment of joint inflammation. The joint must be allowed to regain its
chemical equilibrium and the cartilage to heal from any injury.
As with all intra-articular injections, occasional mild side effects may include heat,
transient edema and pain around the injection site. Most of these reactions are mild and should subside in 24–48 hours.
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