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investigation and treatment of equine back problems - Coggle Diagram
investigation and treatment of equine back problems
presenting signs
poor performance
bucking (transitions or in canter)
rearing
loss of bascule
cold back
sensitivity when brushing
resistance to girthing
hanging on one rein
complicating factors
management issues
temperament
excitability
spasm
cold back
mares in season
regulate (altrenogest) trial
schooling and work regime - bored?
dental problems/bitting
clinical signs suggestive of back pain
aggressive behaviour
difficulty to ride/resists work
modification of jumping style
paravertebral muscle atrophy
poor performances
diagnosis
palpation
evaluation on lunge
may see
• Poor flexion/extension of thoracolumbar spine (appropriate for breed/use) • Frequent tail swishing
• Poor hindlimb separation ⇢ frequently disunited
• Thoracolumbar spinal + sacroiliac joint region pain
diagnostic analgesia
Needs reproducible clinical sign
• 10mls mepivicaine abaxially on left and right side of affected spinous process
• Use 10cm spinal needle
• Ridden assessment commences after 15 mins
• Ideally 2 riders
inertial measurement units and optical motion capture
highly repeatable data
Sacroiliac junction syndrome
Collective term for SIJ region pain
often insidious, poorly definable signs
repetitive strain injury
frequently seen with other causes of back pain/hindlimb lameness
radiography - impractical
scinigraphy
tendency to over-interpret (false positives and negatives)
clinical features and diagnosis
• 86% had concurrent lameness/thoracolumbar pain – poor prognostic indicator
98% poor downward transitions
• 73% canter worse than trot
• 68% poor hindlimb impulsion
• 60% poor flexibility of trunk during exercise
• 55% poor contact +/- above the bit
• 32% had abnormal ultrasound findings
restricted flexibility of the thoracolumbar region (44%),
stiffness during exercise (61%) and poor hindlimb impulsion
(56%). When ridden 65% had a poor contact with the bit, in
increased tension in the longissimus dorsi muscles (40%),
• 43% had scintigraphic changes
81% canter quality was worse than trot, and 35% bucked or
SI block
aims of treatment
alleviate pain and muscle spasm to allow muscle function and development
development of core muscle strength
improve flexibility
prevent recurrence
impinging spinous processes (kissing spines)
diagnostic anaesthesia with supportive radiographic and scintigraphic findings
first tx conservative
intralesional medication
e.g.
Ø Corticosteroids
Ø Triamcinolone acetate (18mg/500kg horse) Ø Methylprednisolone acetate (125mg/500kg horse)
Ø +/- Sarapin (Pitcher plant)
phenylbutazone medication
48h box rest
6 week programme non ridden exercise (rider weight reduces back movement)
Non ridden exercise programme
week 1-2
30 mins long reining at walk twice daily
week 3
30 mins long reining at walk once daily. Lunging 20 minutes of which 5 mins each rein with training aid (Pessoa or EquibandTM)
week 4
As above but increase lunging to 30 mins with 10 mins each rein with training aid
week 5
As above but add trotting poles to lunging.
week 5
as above but increase lunging to 40 min
extracorporeal shockwave therapy
initiates neovascularisation and up regulation of angiogenic growth factors
improvement in blood supply
tissue regeneration
useful for impinging spinous processes and OA of articular facets
1000 pulses each side, 2 days rest, return to work over 5 days, repeat treatment as required
surgery
All cases responded to local anaesthesia
• Conservative treatment (including 3-9 months rest) failed
• Under GA – dorsal 4-5cm of DSP removed
• 8-12 weeks rehab
• Ridden exercise at 3 months
• 72% returned to work
• Further 9% improved
• 3.5% complication rate - infection
• No significant difference in outcome with number of spines removed
facet joint arthritis treatment
• Intrasynovial/peri-synovial corticosteroids (ultrasound guided) • Triamcinolone acetate (18mg/500kg horse)
• Methylprednisolone acetate (125mg/500kg horse)
• Shockwave?
• Specificity of block/medication?
• Similar exercise programme as DSP medication • Development of multifidus muscle
• Address muscle spasm