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Arthroscopy in Equine Lameness

(Tenoscopy, Bursoscopy)

By

Stephen B. Adams

, DVM, MS, DACVS, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University

Last full review/revision Sep 2015 | Content last modified Oct 2015

Arthroscopy is the accepted way to perform joint surgery in horses and is a valuable tool in the diagnosis of joint disease. Arthroscopic surgery can be used to remove bone and cartilage fragments, debride damaged ligaments and menisci, assist the repair of articular fractures with internal fixation, debride or inject subchondral bone cysts, repair cartilage, and debride and flush contaminated or septic synovial cavities. Arthroscopy is a valuable method to evaluate intrasynovial structures and is particularly useful to evaluate soft-tissue structures such as ligaments, cartilage, menisci, and synovial membranes. It should be used in concert with other diagnostic methods, including high-quality radiographs, ultrasonography, and CT and MRI when available. Diagnostic arthroscopy is the most sensitive and specific tool for intra-articular evaluation in horses. Athroscopes of 2.5–5 mm diameter can be placed in all joints of the equine limbs; however, not all areas of every joint can be examined. The arthroscope has also been used to examine, diagnose, and perform surgery on structures within the digital, carpal, and tarsal tendon sheaths (tenoscopy) and in the navicular, calcaneal, and bicipital bursas (bursoscopy).

Advantages of arthroscopy compared with standard surgical procedures include the use of small stab incisions for placement of the arthroscope and instruments, the ability to view numerous areas of the joint, easy operations on more than one joint during the same surgical procedure, less trauma to periarticular soft tissues, less pain, reduced convalescent times, and reduced complications.

Diagnostic and surgical arthroscopy is technically demanding, and extensive experience is necessary to become proficient. Good knowledge of joint anatomy and good hand-eye coordination and spatial awareness are essential characteristics of successful surgeons.

Most arthroscopic procedures are performed with the horse under general anesthesia. Many surgeons prefer dorsal recumbency to allow surgical access to all sides of the joint, to allow surgery on multiple joints and limbs, and to control hemorrhage. Routine aseptic surgical preparation and draping is necessary. Basic equipment required for arthroscopy includes an arthroscope and insertion sleeve, light source and cable, fluid pump for joint distention, egress cannula, and an assortment of hand instruments for intra-articular procedures. A video camera and video screen are highly recommended to decrease the risk of contamination, to improve visualization and depth perception, and to allow capture of images and videos. Triangulation techniques are used to optimize manipulation of intra-articular instruments.

Arthroscopy, bursoscopy, and tenoscopy are often used to evaluate and treat contaminated synovial cavities. The techniques facilitate wound debridement, removal of fibrin and foreign debris, and copious flushing of the cavities without inducing more trauma from a major incision. The normal intrasynovial environment can recover quickly. Bursoscopy of the navicular bursa has greatly reduced the need for the streetnail procedure to treat punctures of the navicular bursa and has reduced the morbidity of calcaneal infections after injury to the hock. Tenoscopy has improved the recovery rate of septic tenosynovitis in horses.

OTHER TOPICS IN THIS CHAPTER

Lameness in Horses
Overview of Lameness in Horses
The Lameness Examination in Horses
Imaging Techniques in Equine Lameness
Arthroscopy in Equine Lameness
Regional Anesthesia in Equine Lameness
Disorders of the Foot in Horses
Osseous Cyst-like Lesions in the Distal Phalanx in Horses
Bruised Sole and Corns in Horses
Canker in Horses
Fracture of Navicular Bone in Horses
Fracture of Distal Phalanx in Horses
Keratoma in Horses
Laminitis in Horses
Navicular Disease in Horses
Pedal Osteitis in Horses
Puncture Wounds of the Foot in Horses
Pyramidal Disease in Horses
Quittor in Horses
Quarter Crack in Horses
Scratches in Horses
White Line Disease in Horses
Sheared Heels in Horses
Sidebone in Horses
Thrush in Horses
Disorders of the Pastern and Fetlock
Fractures of the First and Second Phalanx in Horses
Fractures of the Proximal Sesamoid Bones in Horses
Osteoarthritis of the Proximal Interphalangeal Joint in Horses
Palmar/Plantar Metacarpal/Metatarsal Nonadaptive Bone Remodeling in Horses
Sesamoiditis in Horses
Chronic Proliferative Synovitis in Horses
Digital Sheath Tenosynovitis in Horses
Disorders of the Metacarpus in Horses
Tendinitis in Horses
Suspensory Desmitis in Horses
Inferior Check Desmitis in Horses
Bucked Shins in Horses
Exostoses of the Second and Fourth Metacarpal Bones in Horses
Fractures of the Small Metacarpal (Splint) Bones in Horses
Fracture of the Third Metacarpal (Cannon) Bone in Horses
Disorders of the Carpus in Horses
Fracture of the Carpal Bones in Horses
Subchondral Bone Disease of the Third Carpal Bone in Horses
Tearing of the Medial Palmar Intercarpal Ligament in Horses
Osteoarthritis of the Carpus in Horses
Distal Radial Exostosis and Osteochondroma of the Distal Radius in Horses
Carpal Hygroma in Horses
Rupture of the Common Digital Extensor Tendon in Horses
Disorders of the Shoulder in Horses
Developmental Diseases of the Shoulder in Horses
Fractures of the Shoulder in Horses
Bicipital Bursitis in Horses
Infection of the Shoulder in Horses
Suprascapular Neuropathy in Horses
Osteoarthritis of the Shoulder in Horses
Disorders of the Elbow in Horses
Developmental Orthopedic Disease in the Elbow of Horses
Fractures of the Elbow in Horses
Osteoarthritis of the Elbow in Horses
Collateral Ligament Injury in the Elbow of Horses
Disorders of the Metatarsus in Horses
Bucked Shins/Dorsal Cortical Fractures of the Third Metatarsal Bone in Horses
Exostoses of the Metatarsal Bones in Horses
Diaphyseal Fracture of the Third Metatarsal Bone in Horses
Incomplete Longitudinal Fractures of the Plantar Aspect of the Third Metatarsal Bone in Horses
Focal Bone Reaction and Avulsion Fractures of the Third Metatarsal Bone in Horses
Fractures of the Second and Fourth Metatarsal Bones in Horses
Enostosis-like Lesions of the Third Metatarsal Bone in Horses
Disorders of the Tarsus in Horses
Failure of Ossification of the Distal Tarsal Bones in Horses
Osteoarthritis of the Distal Tarsal Joints in Horses
Osteoarthritis of the Talocalcaneal Joint in Horses
Osteoarthritis of the Tarsocrural Joint in Horses
Synovitis/Capsulitis of the Tarsocrural Joint in Horses
Osteochondrosis of the Tarsocrural Joint in Horses
Osteitis of the Calcaneus in Horses
Fractures of the Distal Tarsal Bones in Horses
Fracture of the Talus in Horses
Fracture of the Fibular Tarsal Bone (Calcaneus) in Horses
Fracture of the Lateral Malleolus of the Tibia in Horses
Tarsal Joint Luxation in Horses
Desmitis of the Collateral Ligaments of the Tarsus in Horses
Rupture of the Fibularis (Peroneus) Tertius in Horses
Stringhalt
Curb in Horses
Disorders of the Tarsal Sheath in Horses
False Thoroughpin in Horses
Luxation of the Superficial Digital Flexor Tendon from the Tuber Calcanei in Horses
Gastrocnemius Tendinitis in Horses
Calcaneal Bursitis in Horses
Capped Hock
Disorders of the Stifle in Horses
Osteochondrosis of the Stifle in Horses
Subchondral Cystic Lesions in Horses
Meniscus and Meniscal Ligament Injuries in Horses
Cranial and Caudal Cruciate Ligament Injuries in Horses
Collateral Ligament Injuries in Horses
Intermittent Upward Fixation of the Patella and Delayed Patella Release in Horses
Fragmentation of the Patella in Horses
Patellar Luxation in Horses
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Lameness
The lameness examination is an important method to identify musculoskeletal abnormalities. Which of the following abnormalities is NOT observed during a physical and lameness exam? 
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