Digital Radiography sometimes is not enough!

The radiograph posted below corresponds to a 20yo thoroughbred gelding that presented for chronic lameness in the left hind limb. Physical exam revealed moderate effusion (swelling) within the left stifle (specifically, the medial femorotibial and femoro-patellar joint spaces). The gelding was a grade 4/5 lame at the trot and resented flexion of the left stifle/hock. Radiographic exam (3 standard views ) of the left stifle revealed mild to moderate arthritis of the medial femorotibial joint space, however, these findings did not explain the severity of the lameness and the degree of swelling associated with the stifle joint.

Due to the lack of findings in the radiographic exam, the left stifle joint was examined via ultrasound. Several significant findings were noted (below image). These included significant fluid within the stifle joint (medial femorotibial joint), bulging medial meniscus, and a smoothly-defined bone fragmment/protuberance of unknown origin. The "bulging" meniscus  was consistent with significant inflammation of the meniscus which could explain the accumulation of fluid within the joint and the degree of lameness recorded during the exam.

The bone fragment/protuberance that was first visualized with the ultrasound required additional radiographic views that are not typically taken of the stifle joint. An osteochondroma was diagnosed based on the ultrasound and the additional radiographic views. Also called osteocartilaginous exostoses, osteochondromas are overgrowths of cartilage and bone near the end of the bone and near the growth plate. The stifle was treated with a cortisone derivative and sodium hyaluronate. Two weeks post-injections, the effusion was significantly diminished and the gelding's lameness was reduced from a grade 4 to a 1 out of 5. This case is a good example of the benefit of digital radiography and ultrasound when evaluating a complex anatomical structure such as the equine stifle.

Stem Cell Therapy: See it to believe it!

The above image corresponds to the pastern area of a middle aged quarterhorse that presented to PHD Veterinary services for recent forelimb lameness. The gelding was very sensitive to palpation over the back of the pastern area and there was some swelling noted in this area. An ultrasound exam revealed a significant disruption (black area) of the straight sesamoidian ligament. The lesion extended nearly the length of the ligament and was approximately 20% of the cross-sectional area. The client elected for stem cell therapy followed by rest and shockwave treatment.

Six months later the lesion has nearly completely resolved (above image). The gelding was treated with fat-derived stem cells  that were harvested, processed, and injected at the barn. Stem Logix (http://stemlogix.com/equine-stem-cell-horses.htm) provided the technology for stem cell harvesting and processing all within 2-4 hours of harvesting the fat sample. Dr. Porter injected the stem cells via an ultrasound guided technique. This case provides an example of the regenerative capabilities of stem cell therapy in horses. In addition to soft tissue injuries, stem cell therapy is being used in horses with chronic arthritis that is no longer responding to traditional treatment with cortisone and other anti-inflammatory products. Contact Dr. Porter with questions regarding stem cell treatment.

"To cut or not to cut?"

The above radiograph belongs to an aged stallion that presented to PHD Veterinary services with non-weight bearing lameness of 3 week duration in the left front limb. Historically, there was evidence of "white line disease" that had resulted in a partial hoof-wall resection however the stallion's condition was worsening on a daily basis. Radiographic exam (top radiograph) revealed greater than 20 degrees of coffin bone rotation and zero sole depth. The tip of the coffin bone was essentially about to come through the bottom of the foot. The decision was made to surgically transect the deep digital flexor tendon (DDF) in an attempt to reduce the "pull" of the tendon on the coffin bone. This procedure can be very effective in saving the life of a laminitic horse and eventually returning the horse to pasture soundness. The procedure is easily performed in the standing horse with sedation and a local block. Follow-up care is critical and requires collaboration with a farrier that is well-versed in shoeing laminitic horses (especially after transecting the DDF tendon). If the horse is not shod appropriately, the benefit of the surgery will be zero. Special thanks to Adam Whitehead for working with us on this case and all the other successful DDF transections that he has collaborated with. 

Two months after surgery, the coffin bone was properly aligned with the pastern bone and there is a significant amount of foot growth (sole depth). Note the specialized shoe-type and placement which is critical for this procedure to be a success! The stallion has not only returned to pasture soundness but was active as a breeding stallion within 3-4 months after the surgery. I strongly recommend having radiographs taken of your laminitic horse to determine what is the best approach to managing the case. Making the decision to cut or not to cut the DDF tendon should be considered sooner than later!

"Chronic Cough Surprise"

These images are from a quarter horse gelding in north-central Florida that presented for a chronic cough. Endoscopy revealed multiple fungal granulomas (bottom image) and the horse was treated with anti-fungals plus a pythium vaccine. Thirty days later (top image), the cough was resolved and the throat was much improved. The horse will continue treatment for another 30 days in hopes of shrinking the remaining granulomas. Pharyngeal or throat inflammation is a common cause of coughing in horses and should be evaluated with an endoscopy exam. Fortunately, fungal granulomas within the pharynx are relatively uncommon!