Chondroids!!

The image above consists of many 2-3cm chondroids that were removed one by one from a horse's guttural pouch. This horse was a young filly at a sale barn that contracted the dreaded strangles infection (see my previous post concerning strangles in horses) yet continued to have a purulent discharge from her nasal passage for weeks. Unfortunately, the filly was not scoped to determine if the original infection resulted in abscessation within the guttural pouch. Over time, the purulent debris in the guttural pouch becomes hardened and resembles smooth, stone like objects known as chondroids. These objects are basically hardened pus that are typically filled with the bacteria that causes strangles in horses. 

The above images consists of the view through the endoscope into the guttural pouch revealing the lodged chondroids. There are two ways to remove these structures: 1) a surgical approach or 2) through an endoscope. The surgical approach is probably easier in the long run but there are more risks involving sensitive structures such as cranial nerves and large blood vessels. The endoscopic approach can be very slow considering that each chondroid is removed via a snare as imaged below. If these chondroids are not removed, the horse may likely remain "infectious" to other horses and will persist with a purulent nasal discharge. Most important message to you is that if your horse has a persistent nasal discharge, I strongly recommend a through endoscopic exam which MUST include evaluation of both guttural pouches!!

Kissing Spines!

The radiographs below are of the dorsal spinous processes of  the vertebral bodies in the top-line of a horse. Essentially, these bones are directly below the saddle and directly below the rider's center of gravity. As such, they represent some of the most stressed areas during riding under saddle. The first two radiographs are of the same horse and the yellow circles correspond to where the spinous processes are in contact with the each other. This is also know as "Kissing spines". This horse presented for a chronic history of a tender back and unwillingness to move forward at the trot and/or canter. The 3rd radiograph is that of a normal horse. There is significant space between the spinous processes. These spinous processes are slightly cranial to the ones depicted in the previous 2 radiographs.  Unfortunately, the diagnosis of kissing spines is not favorable for the horse to have a performance career without chronic back pain. There are therapies aimed at reducing the pain and muscle spasm associated with this condition which include; saddle fitting, shockwave therapy, mesotherapy, acupuncture, chiropractic adjustment, deep message, and cortisone injections. I strongly recommend having radiographs taken of any horse with a chronic history of back pain to determine if this might be the cause!! 

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Patent Bar Horseshoe

The Patent bar horseshoe, is used to keep a horse from bearing weight on an injured leg. The shoe features a bar between the heels, which is raised 1 to 1½ inches to decrease the angle between the pastern and the cannon bone. In doing so, the shoe relieves stress on the flexor tendons and suspensory ligament.

 (The above shoe was constructed by David Boles and Marcus Lybarger)

The tenosynovitis imaged below is that of a horse with a severe injury to its deep digital flexor tendon in the pastern area (see ultrasound pic below). The horse was a grade 4/5 lame at the walk and was not willing to place his heel on the ground. By setting a patent bar shoe on the affected leg, the horse can bear weight on the limb with minimal strain on the injured deep digital flexor tendon. Over time, the heel elevation of the patent bar shoe is lowered until the horse is walking normally on the limb. This process usually takes 2-6 months depending on the extent of the injury. In addition, daily walking is encouraged to minimize the development of adhesions within the injured tendon/ligament. During the rehabilitation period, we recommend daily ice therapy, topical Surpass cream, and a series of extracorporeal shockwave treatment over the injured tendon/ligament. 

Severe tendinitis of the deep digital flexor tendon in the area of the pastern. The image on the left is a longitudinal view and the image on the right is a cross-sectional view of the same lesion. The dark or black area in the center of the image corresponds to fluid accumulation and fiber disruption (core lesion) within the body of the deep digital flexor tendon.