Treatment of equine lameness

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The treatment of horse pallor is a complex subject. The lameness of the horse has various causes, and care must be tailored to the type and level of injury, as well as the financial capacity of the owner. Treatment can be applied locally, systemically, or intradeny, and strategies for treatment may change as healing takes place. The end goal is to reduce pain and inflammation associated with injury, to encourage injured tissue to heal with normal structure and function, and to restore the horse to the highest possible level of performance after recovery.

Video Treatment of equine lameness

Proses penyembuhan

Tulang

The bone heals with callus formation over damaged areas. Speed ​​and quality of healing is directly related to blood supply and fracture stability. Rest is needed immediately after injury to reduce fracture site movement. Stability can be increased through the use of surgical implants or casting, depending on the location of the extent to which the fracture. Shockwave therapy is sometimes used in cases of splint fracture or stress fractures in the cannon bone, to increase blood flow to the area. Fractures in joints, such as chip fractures on the knee, hock, or fetlock, require arthroscopic surgery to prevent secondary arthritis in the joint.

In some cases, callus may place pressure on the surrounding soft tissue structures. The callus from the fracture of the spine may push on the adjacent suspensory ligament, leading to an imbalance of secondary suspensory desentralitis. Treatment usually involves the removal of invading calluses.

On average, bones heal better than soft tissue. It takes less time to heal and, unlike soft tissue that is always weaker after healing, the bones heal up to 100% strength. However, healing fractures on horses is complicated by their size, frivolity, and the desire to stand. The horses are at risk of re-injury in the fracture area, especially when trying to get up after lying down, or when recovering from anesthesia after fracture repair. Forced recumbency is not an option for horses, making healing more difficult. Weight bearing on one front or back of the leg increases the limbolis lever's support potential. In addition, the cost of foundry or surgical fixation makes the treatment financially unlikely for some owners. While limb fracture is no longer a death sentence for horses, it is still considered a very serious injury. In general, horses are more likely to survive if smallish and have a good temperament that will tolerate the inactive month required for healing. Open fractures, comminuted (highly fragmented), or located higher on extremities tend to have a worse prognosis.

Sinovial joints

Lameness is most often associated with injury to synovial joints, or joints containing articular cartilage, joint capsules, and synovial membranes. Joint disease can affect joint capsule and synovial membrane, articular cartilage, subcondral bone (bone under cartilage), meniscus, or any ligaments associated with joints. Damage to one of these tissues causes inflammation, which is particularly problematic in the joints. While articular cartilage degeneration is a common disease process in worker animals, resulting in osteoarthritis, cartilage is aneural (not nerve-prone) and produces no pain. Pain associated with osteoarthritis is secondary to joint pain due to joint distension and reduced range of motion, or pain from underlying bone, which may become damaged after erosion of articular cartilage.

Inflammatory products, such as inflammatory mediators and cytokines, destroy articular cartilages and have been shown to weaken intra-articular ligaments. Therefore, the treatment of joint disease should not only overcome the primary injury that produces inflammation, but also an inflammatory cycle that causes further tissue damage. Cryotherapy, lavage joints, systemic anti-inflammatory, or intra-articular drugs are used to reduce joint inflammation. In cases of severe joint pathology such as osteochondral chip, intra-articular fracture, osteochondritis dissecans lesion, or ligament or meniscal injury, arthroscopy may be necessary to ensure the normal functioning of the joint. Debris inside the joint, such as from a chip fracture, can cause long-term damage to the synovium and articular cartilage that causes osteoarthritis, and should therefore be discarded. After an acute injury, the joints often benefit from specialized physical therapy, such as swimming, to prevent loss of motion associated with joint capsule fibrosis.

Treatment of joint cartilage injuries is difficult and often unfavorable. Partial-thickness defects do not heal. The body will try to repair full-thickness cartilage defects using scar tissue or fibrocartilage, both of which are poor substitutes for healthy and normal articular cartilage. Current treatments include microsratures produced arthroscopy in a subchondral plate. These microfractures encourage an inflammatory response in the defects, which recruit stem cells into the area. Unfortunately, these cells differentiate into fibrocartilage, rather than normal cartilage (hyaline), which causes repair of the inferior tissue in the site of injury. Bone marrow aspirate concentrate (BMAC) has shown some benefits when grafted to the following areas of microtrauma. However, the primary treatment for degenerative joint disease involves reducing the inflammatory process known to accelerate the degeneration of articular cartilage.

Tendons and ligaments

Tendons mainly consist of collagen type I elastic. However, adult tendons contain cells that have limited ability to regenerate. After injury, the tendon puts collagen type III, or scar tissue, which is stronger than the collagen type I but is more rigid and less elastic. This makes it less distensible and more likely to injure back when the horse begins to stretch the tendon during heavy work. Certain treatments may improve the quality of the final tendon fiber, and then increase the likelihood that the horse will return to full performance after injury.

Healing soft tissue injuries are often monitored using ultrasound to assess lesion size and fiber patterns. Monitoring soft-tissue injury with ultrasound allows for a more scientific determination of when to introduce rehearsals to a horse rehab program, and for quick intervention if the injury worsens. Recently, a new ultrasound technique called Doppler color ultrasonography has been used to assess a horse tendon injury. Color Doppler measures the level of blood flow to the lesion, allowing a more accurate healing assessment.

Maps Treatment of equine lameness

Rest and walk by hand

Rest is almost always recommended for limp treatment as it reduces the power placed on the damaged tissue, allowing normal healing to occur. The type and severity of the injury determines the duration and resting level required. Aggressive activity limits may be required in cases of fracture. Horses remain bonded for several months of healing, to prevent them lying down and potentially injuring bones while trying to stand up. In other cases, rest can be contraindicated. Animals with a history of upright fixation of the patella, polysaccharide storage myopathy, and recurrent rhabdomyolysis are often best maintained with regular exercise schedules. Rest may be counterproductive if lameness is secondary to osteoarthritis. In this case, mild exercise improves joint mobility and lameness can worsen with confinement. Breaks can vary from tight cages ("field stops"), to small grasslands or out of grasslands, to reduce the intensity of the exercise. Horses are often unpredictable when resting on old kiosks, which greatly increases the risk of back injury when walking the hand begins. Sedation or additional restraint forms may be needed to help control the horse during the initial period of intensity increase of this exercise. While rest can be implemented as the only form of treatment, special care often improves overall recovery, and is recommended if the client wants the animal to return to full athletic function.

Soft tissues and bones strengthen with exercise and weaken if not actively used. Horses undergoing long-term breaks require slow progressive rehabilitation programs to try to prevent back injury to native tissue or injury to new areas that are now weakened by prolonged use. In some cases of soft tissue injury, low-impact sports, such as walking or walking under tactics, can be more beneficial if introduced in the initial healing phase rather than following a tightly rested kiosk. Tendons and ligaments heal with the formation of scar tissue, which is less elastic and does not have a regular pattern of regular fibrils. Exercise helps to encourage proper fiber alignment, and then leads to a tissue closer to its original elasticity.

In the case of acute injury, the joints benefit from rest to allow for a reduction in the inflammatory process within the joint. Walking is often recommended during kiosk breaks to help prevent the formation of adhesions and fibrosis in damaged joints, to maintain various movements, and prevent the atrophy of articular cartilage. Hand walking is used in the case of cellulitis to reduce the formation of edema in the tissues. Cellulitis leads to extreme levels of swelling, which can persist after elimination of underlying causes and produce long-term imbalances. Therefore, edema reduction is a very important part of treatment, and walking is often done several times each day.

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Cryotherapy, thermotherapy, and compression

Cold-to-skin application (cryotherapy) is used to relieve pain and inflammation of acute soft-tissue injury. At the cellular level, cold application decreases the formation of exudate and diapedesis of inflammatory cells, thereby reducing edema. Cryotherapy has also been shown to reduce metabolism and thus the oxygen demand of the tissues, helping to prevent the destruction of hypoxic tissues. Cold is often applied to the site of injury by spraying cold water into areas (hydrotherapy), ice sheets, or medical devices such as Game Ready systems that provide cold and compression therapy. A cold saltwater spa is also available, and is used to bathe the patient's wounds in cold, hypertonic, and cold water. It combines the benefits of cryotherapy with the osmotic effects of salt, resulting in better analgesia and reduced inflammation.

Heat (therapeutic) is usually applied at least 48-72 hours after the initial injury. It is used to improve blood flow and then healing, and to increase extended tissue. Increased blood flow can also encourage fluid reabsorption, which reduces swelling, and encourages phagocytic cells to enter the site of injury. Linimen is sometimes used to increase heat to an area. Both heat and cold have been shown to decrease muscle spasms and pain.

Often compression is used simultaneously in the form of pressure wrapping, to reduce edema and swelling. Pressure packs are usually used during active inflammation. Rinsing is especially important in cases of severe swelling, such as cellulitis, which can cause continuous lag if edema continues after the initial cause has been successfully treated. Sanitary napkins can also help reduce pain, by stimulating the mechanepeptor. Labor is often used to keep wounds clean, but has been shown to increase the risk of granulation tissue formation (the formation of proud beef). Casting can be used to completely paralyze the joint, which is important in the case of destabilizing injury, but increases the risk of adhesion formation in joints, and cartilage and joints cartilage atrophy. In cases of secondary joint pain for capsulitis or synovitis, which does not destabilize, complete immobilization of joints should be avoided.

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Shared supplement

Various neutraceuticals (supplements) are available for equine joint health. Although these products are evaluated for safety, they are not required to prove efficacy, and the actual scientific support of their benefits for osteoarthritis in horses is poor. These include studies of supplements containing glucosamine, chondroitin sulfate, and methylsulfonylmethane (MSM). Since they are not regulated, a joint supplement is not required to load what has been listed on the label. In addition, oral joint supplements may have questionable bioavailability. However, this product is still popular, with anecdotal support for its use, and has little disadvantage to use except the cost to its owner.

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Use of NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are a mainstay of treatment of inequality, providing analgesia (pain relief) and reducing inflammation. The term NSAIDs is used to refer to specific drug classes that inhibit the conversion of arachadonic acid into prostaglandins and thromboxane. Reduced prostaglandins help reduce pain, decrease vasodilation (and subsequent edema formation), and reduce the effects of inflammatory mediators such as interleukin-1. The most commonly used NSAID in the United States is phenylbutazone, although flunixin meglumine and firocoxib are also commonly used for orthopedic pain.

Although widely used, NSAIDs have the potential to cause severe toxicity, including GI ulceration, renal tubular disease, renal papillary necrosis, and right dorsal colitis. This is seen most often when NSAIDs are used long-term, if they are used at higher doses than recommended, or if two different NSAIDs are used in combination (a method known as "stacking"). Stacking has proved useless in reducing the pain and a much greater chance of producing toxicity. Some NSAIDs can decrease proteoglycan synthesis, especially in cases of diseased cartilage, which can aggravate joint disease. However, these side effects do not occur in all drugs in the NSAID class, including phenylbutazone.

Diclofenac is a topical NSAID. This has clear benefits over traditional NSAIDs in topical applications that reduce the amount of drug circulating systemically, and therefore reduce the risk of negative side effects. Diclofenac has been shown to reduce the lameness secondary to joint pain in horses.

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Corrective cutting and pruning

Corrective pruning and shoeing are used to alter the forces placed on the nails and soft tissues of the lower fingers and toes. The goal is to reduce the load or load on structures at risk of damage from past conformations, movements or injuries, or to treat areas that are healing and no longer able to handle normal forces. Evaluation of horse conformation, balance of nails, and shoeing is often the first step in the treatment of inequality. Proper and balanced trim is a key component of poor treatment and prevention. Some cases of lameness, such as angular extremity deformity and navicular syndrome, are best managed with special pruning and shoe-mounting. In very complex cases, a farrier focusing on pruning and corrective pruning may be recommended for the duration of treatment.

Adjustment of pruning or shoe-making can be done to help support the nail, allowing pressure to be distributed over healthy tissue to reduce strength over damaged or diseased tissue. Applications of different types of therapeutic shoes, pads, and wedges, can be used to help alter stress placed on the structures of the feet or lower extremities. Hospital plates - special shoes that keep all parts clean but can be opened to allow daily care - sometimes recommended for injuries on the bottom of the nails such as nail or cancer abscess.

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Intramuscular or intravenous therapy

Glycosaminoglycans polisulfate (Adequan)

Polysulfated glycosaminoglycans (PSGAGs) are drugs originally labeled for intra-articular use, but are usually administered intramuscularly to horses. They have a chondroprotective effect and are given to prevent or slow cartilage damage in cases of osteoarthritis, and are often used in cases of cartilage damage to joints. PSGAG has been shown to have some beneficial effects on the joints: they inhibit enzymes that break down cartilages, inhibit prostaglandin E2 production, increase glycosaminoglycan production, and can increase hyaluronic acid production.

This level of effect on horses after intramuscular injection has relatively little support in the current literature. However, there is much anecdotal evidence about its benefits for synovitis and osteoarthritis, and PSGAG is very commonly used by veterinarians in the United States who are involved in the practice of racehorse and horses. PSGAG is sold under the trade name Adequan. It is a mixture of low molecular weight glycosaminoglycans made from cow and lung trachea. It is labeled for use every 4 days, for a total of 7 doses.

Hyaluronic acid

The intravenous formulations of hyaluronic acid (HA) are available under the trade names Legend and Hyonate. In the osteochondral fragmentation model, intravenous HA has been shown to reduce lameness, improve synovial membrane, and decrease protein and prostaglandin E2 levels in joints. In addition, it proved to have a positive effect on the Quarter Horses racing, leading to a larger number of starts, longer careers, and more money earned, but these horses are also treated with IA corticosteroids at the starting point of their careers, potentially confusing results. Other studies in Thoroughbreds found no improvement when using IV hyaluronic acid. However, there is a lot of anecdotal support from various disciplinary coaches, and remains a popular therapy.

Polyglycan

Polyglycan is a combination of sodium hyaluronate, sodium chondroitin sulfate, and N-acetyl-D-glucosamine. It is labeled as a medical device, which will be used for joint surgery after surgery, but is used by some unregistered sea horse practitioners, given IV or IM.

Pentosan polysulfate

Pentosan polysulfate, like Adequan, has been shown to improve the signs of osteoarthritis. In the non-horse model, Pentosan has been shown to increase proteoglycan synthesis, stimulating the production of hyaluronic acid in osteoarthritic joints (benefits not shared by PSGAGs), reducing inflammatory cytokines, and repairing damaged articular cartilages. Pentosan is made of hemicellulose beechwood, and has been shown to improve joint function in sheep models, and improve cartilage in horses. Anecdotal evidence suggests that it may lead to a significant increase in inequality within the racehorse.

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Intrasynovial therapy (joint injection) and lavage together

Corticosteroids

Intra-articular corticosteroids (IAs) are powerful anti-inflammatories. They stabilize the lysosome membrane, inhibit the movement of inflammatory cells and reduce their function, and then decrease the level of inflammatory mediators in the joints. In addition, levels of hyaluronic acid in synovial fluids have been found to increase after IA corticosteroid injection. The most common intra-articular steroids used in the United States are methylprednisolone acetate, triamcinolone acetonide, and betamethasone esters.

Corticosteroids have been implicated as damaging the joints if used repeatedly, although studies have shown these results to be drug specific. Methylprednisolone appears to be most associated with these negative effects, and can lead to decreased proteoglycan synthesis, decreased synovial vascularization, and damage to articular cartilage. Proteoglycan in the joints is reduced, especially in younger animals, even when steroids are used in conjunction with chondroprotective drugs such as PSGAGs. The administration of betamethasone has not been shown to have any adverse effects on articular cartilage. Triamcinolone acetonide is potentially chondroprotective, produces more proteoglycans, reduces synovial protein and inflammatory cell levels, and increases cartilage. Due to the chondroprotective potential effect, triamcinolone is usually selected to treat high-motion joints. Some practitioners choose to use methylprednisone to treat low-motion joints, especially the distal upstream, for the sole purpose of destroying cartilage and reducing the time for natural ankylosis. However, there is no evidence to support the use of methylprednisolone to produce a combined fusion of the hock.

In addition, there are concerns inducing laminitis in horses treated with IA triamcinolone. It has been proven that up to 18 mg triamcinolone can be used safely. Horses are at increased risk of laminitis if they have pituitary pars intermedia dysfunction, but in general the benefits of using corticosteroids outweigh the risks.

Hyaluronic Acid

Hyaluronic acid (hyaluronan, HA) is a natural component of the synovial fluid and the extracellular matrix of articular cartilage. It is produced by synovial membranes and makes viscous synovial fluid, lubricates the joints, and affects the articular cartilage compressibility. It may also have an effect on the content of the solute and the concentration of white blood cells in the joint fluid.

HA generally intra-articular injection (IA) into the sick joint, but the exact mechanism of action is unknown. HA concentrations and molecular weights are sometimes lower in sick joints, but this is not always the case. Exogenously administered HA has a half-life of 96 hours in the normal joint but shorter in the sick joint. It is hypothesized that some of the HA localizes in the joints and increases the metabolism of synoviocytes. High molecular weight HA has been shown to offer better protection of articular cartilage than low molecular weight, and longer duration of health in horses with arthritis.

Glycosaminoglycans polysulfates (PSGAGs)

The intra-articular use of PSGAGs has been shown to improve lameness, signs of arthritis, joint effusion, and quality of synovial fluid. However, mixed results have been reported in its ability to completely repair cartilage damage at the time of injection. The use of IA from PSGAGs may have an increased risk of infection of Staphylococcus aureus in joints when compared with intra-articular injections of other substances, although this may be prevented by simultaneous administration of aminoglycoside antibiotics.

Anastesi

Intraarticular anesthesia is most commonly used to block joint or adjacent structures for evaluation of slimness. The use of local anesthesia to relieve long-term pain is not practical, because of its short duration.

With lavage

Together lavage involves placing two large drill needles into a sore joint and doused with sterile saline. Lavage helps eliminate inflammatory mediators, which are common in cases of synovitis, as well as any destructive debris such as articular cartilage. This procedure can be performed standing, but a more thorough lavage using a larger volume of saline may be used when performed under general anesthesia. Joint lavage is a regular component of arthroscopic surgery. This is particularly helpful in patients with severe limp secondary to acute synovitis.

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Other Drugs

Bisphosphonate

Tiludronate disodium (Tildren) and Clodronate disodium (Osphos) are FDA-approved bisphosphonates used to reduce bone reabsorption by inhibiting osteoclasts. They are most commonly used for the treatment of navicular disease and osteoarthritic conditions such as bone spavin. Tildren are administered intravenously, either systemically injected into the jugular vein, or locally through the use of perfusion of regional extremities. Osphos are given intramuscularly, divided into 3 different injection sites. Both drugs are approved for use in the United States in 2014.

Vasodilator

Isoxsuprine and pentoxifylline are the two vasodilators commonly used in horse medicine. Isoxsuprine has been shown to have red cell deformability and vasodilator properties. Pentoxifylline has been shown to decrease blood viscosity, reduce platelet aggregation, and increase deformability of red blood cells. These properties are thought to increase blood flow to digits, and make it a popular drug for the treatment of navicular disease and laminitis. However, some studies suggest that oral and pentoxifylline isoxsuprine has little effect on digital blood flow. The lack of efficacy of isoxsuprine may be due in part to poor oral bioavailability (2.2%) and a high first pass effect. While pentoxyfylline has better bioavailability after oral dosing, its absorption may decrease with repeated administration. Pentoxyfilline has been shown to reduce lameness in horses with experimentally induced laminitis and has an inhibitory effect on the metalloproteinase matrix (MMP), which may be useful for the treatment of laminitis despite the uncertain effect on digital blood flow.

Methocarbamol

Methocarbamol, sold under the tradename Robaxin, is a muscle relaxant commonly used in horses to treat muscular pain due to flexibility, tetanus, or bonding. Oral and injectable forms are on the market. Its use is governed by many horse-ruling regulatory bodies, as it is thought to have a CNS depressant effect and produce guaifenesin metabolites, which are pre-anesthetic animal drugs. Guaifenesin has been found in horse plasma receiving oral, but not intravenous, methocarbamol, possibly because of the high first-pass effect of the drug.

Tetracyclic

Tetracycline is a class of antibiotics with anti-inflammatory properties. They have various applications for use in treating equine horses. As expected, tetracycline antibiotics are used to treat the cause of an imbalance infection if the infectious organism is sensitive to the antibiotic. Tetracycline is the first choice to treat Borrelia burgdorferi, the causative agent of Lyme disease. In addition, tetracycline has been shown to have anti-matrix activity metalloproteinase (MMP). Because of the possible link between MMP and laminitis, tetracycline is sometimes given to prevent or treat laminitis associated with endotoxaemia.

High doses of tetracyclines, much larger than those used to treat bacterial infections, are used intravenously in foals to treat bending deformation of the extremities. The most commonly used tetracycline is oxytetracycline, and it is most effective when administered to foals when very young. The mechanism of action is unknown.

Gabapentin

Gabapentin, sold under the trade name Neurontin, is used to treat neuropathic pain in horses. It may be administered orally or intravenously, although oral bioavailability is poor (~ 16%), and may produce sedation and increased drinking. Gabapentin has been used for femoral neuropathy after surgery, laminitis, and headshaking on horses.

DMSO

Dimethyl sulfoxide (DMSO) is a chemical solvent. It is used topically to reduce the inflammation associated with acute injury - especially by reducing edema - or it may be mixed with other substances to increase its absorption through the skin. DMSO triples the ability of corticosteroid skin penetration. DMSO has also been shown to reduce the formation of free radicals, increase blood flow to an area, and is bacteriostatic.

DMSO is highly beneficial in the treatment of joint inflammation, as it has a major anti-inflammatory effect and can increase the hydrocortisone effect 10-fold when mixed together. Generally, DMSO medical level should be used, and applied when wearing gloves.

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Regenerative Medicine

Regenerative drugs use horse cells or proteins themselves to improve healing.

Stem cells

Stem cells are able to renew themselves and differentiate cells with different tissue types, making it an attractive possibility for treating wounds through tissue regeneration. Mesenchymal stem cells (MSC) are currently used in horses. The raw gold source for stem cells comes from the bone marrow, although other sources, such as fat, are also available.

Bone marrow is often taken from the sternum, hip, or ileum. The sternum and ileum contain the same stem cell quality, but ileum is usually more difficult to use in horses older than 5 years, as the marrow cavity shrinks. The marrow is collected using Jamshidi needles in an anesthetized horse. Unlike humans, horses usually tolerate the procedure well, with little pain. The sample was cultured by the laboratory for several weeks before being sent back to the horse, and then injected to the injury site.

MSCs derived from adipose are taken from the fat from the abdomen, chest, or tail head. Unlike bone marrow cells, adipose-derived cells are not cultured and expanded, but are processed by digesting fat to produce a stromal vascular fraction. This stromal vascular fraction, the nucleated cell population, contains only 2-4% of MSC. Currently, peer-reviewed data are severely limited to stem cells derived from adipose.

Stem cell therapy is very safe, but currently expensive, requires harvesting and processing of cells. In addition, autologous stem cells (taken from patients) require 2-3 weeks to expand the number in culture, delaying treatment of acute injury. The allogenic (non-self) stem cells can be harvested from other horses prematurely to divert immediate injury treatment, but there are some concerns of graft-vs-host disease.

Stem cells have been used to treat various injuries on horses. The most widely performed studies on stem cells are used for the treatment of tendons and meniscal injuries. Horses with tendonitis treated with stem cells derived from bone marrow had significantly lower rates of back injury compared to those without treatment. Stem cell treatment in damaged tendons is thought to increase the collagen makeup of tendons during healing. It has been shown to reduce the presence of type III collagen, which is relatively inelastic and therefore more susceptible to back injury, and increases the presence of type I collagen found in normal tendon fibers. The suspensory ligament wound also has a good response to stem cell therapy.

The results using MSC for osteoarthritis, when using the joint model, have been shown to produce little effect on the treated joint. However, use in joints can be guaranteed in cases of meniscal injury. In sheep, joints treated with bone marrow MSC after damage to the meniscus are shown to have regenerated meniscus and reduced osteoarthritis. Horses with meniscal damage had a higher return percentage to work after treatment with MSC bone marrow, when compared with results from previous studies on horses treated with arthroscopic surgery alone.

In addition, studies on the use of stem cells to produce better healing laminates in laminite horses are also being carried out.

Plasma-rich platelets (PRP)

Platelets in the growth factor of release of blood after they are activated. These growth factors lead to the formation of new blood vessels, inflammatory infiltration cells, and the formation of connective tissue, which will ultimately increase the speed and quality of healing. The purpose of platelet-rich plasma (PRP) is to concentrate these growth factors, which can then be injected into the lesion. While PRP does not contain stem cells, the PRP can pull the stem cells around to place the injury. PRP has been used in lesions, tendons and ligaments of lesions, fractures, bone cysts, and joints to treat osteoarthritis.

To produce PRP, the patient's blood is centrifuged to separate plasma from red blood cells. Plasma is then further processed to produce the final product about 8 times the concentration found in the blood. This final product can be produced in less than an hour, making it possible to treat the lesion immediately. PRP is most efficacious when used in acute lesions within 10 days of the original injury. Because PRP contains white blood cells, product injections have been linked to inflammation after treatment. The concentrations of platelets and white blood cells vary between preparations and the individual patients they take, which can affect the concentration levels of anabolic and catabolic molecules in PRP. To overcome the negative effects of white blood cells in PRP preparation, horses are usually prescribed NSAIDs for 3 days after treatment, and several days of cryotherapy.

Interleukin-1 protein receptor antagonist (IRAP)

Interleukin-1 (IL-1) is a cytokine that has been shown to produce a signal cascade that leads to cartilage degradation, and which is known as an important factor in the formation of osteoarthritis. Interleukin 1 protein antagonist receptor (IL-1Ra, or IRAP) inhibits IL-1, and has been shown to reduce disease processes, including an increase in lymphocytes and histologic morphology of cartilage and synovium. However, there has been no clinical trials of its efficacy. Because IL-1 targets cartilage, IRAP is ideal for treating joint injury, and is used to treat osteoarthritis, traumatic joint injury, or after surgery. It is not recommended for use on tendon or bursae sheaths, or in joints with damage to bone, meniscus, or ligaments unless this injury has been successfully treated using arthroscopy.

To produce IRAP, blood is collected into a syringe of chromium sulfate-soaked beads and incubated for 24 hours. During this time, white blood cells in the blood produce anti-inflammatory cytokines, including IRAP. The resulting serum, known as autologous conditioning serum (ACS), is then centrifuged to produce sufficient ACS for 4-6 doses. The product is injected into the affected joint. This is repeated every 7-10 days for 2-3 treatments. The new product, known as IRAP II, has been shown to have higher beneficial cytokine levels, and lower rates of pro-inflammatory TNF cytokines, when compared with the original product IRAP.

Bone marrow aspirate concentrate (BMAC)

BMAC is a centrifuged bone marrow form containing stem cells and platelets. Because it is only centrifuged, and not cultured, BMAC contains significantly fewer stem cells than the bone marrow culture. Like PRP, platelets concentrated in BMAC contain growth factors, although at lower concentrations than PRP. BMAC also contains large amounts of white blood cells, although especially lymphocytes rather than pro-inflammatory neutrophils are seen in some PRP formulations. BMAC has the advantage of being readily available, requiring only 10-20 minutes of centrifugation, allowing immediate treatment of injury. It is also much cheaper when compared to stem cells that are cultivated.

BMAC has been used arthroscopically for transplantation into full-thickness cartilage defects. Studies have shown this graft to improve the filling of this defect, and it contains mainly collagen type II, collagen that composes hyaline cartilage, with an increase in collagen orientation in the defect. BMAC has also been used for intralesional treatment of tendons and ligament injuries.

The old method of bone marrow aspiration therapy does not include centrifugation. This risk injects bone into the structure of the affected soft tissue, which can slow healing, and is rarely used today.

Extracorporeal shock wave therapy

Extracorporeal shock wave therapy (ESWT) is a modality that uses high intensity pressure waves to introduce energy to the wound area. ESWT is commonly used to treat orthopedic problems in horses, including tendon and ligament injuries, kissing of the spine, navicular syndrome, and arthritis. The evidence for this usage is weak. It also seems to reduce pain and in 2014 becomes increasingly used along with medications to manage pain.

Practitioners decide on the strength and number of specific impulses based on the location of personal injury and experience. There are currently no protocols set for any injury, and those specifications require further research to make definitive recommendations. In general, smaller injuries require fewer impulses than larger areas, and deeper tissues or tougher tissues (such as bones) require impulses with more force than soft or shallower ones. The delivery location is key when treating an injury.

Mesotherapy

Mesotherapy is a process of injecting drugs intradermally, in several lines, along both sides of the spine. This treatment is most often used to treat neck and back pain, and is considered to break the pain cycle associated with chronic pain. Often a combination of corticosteroids, local anesthesia, or sarapin is used.

Physical therapy

Passive flexibility

Passive flexion can be used to help maintain various movements in joints, especially after joint surgery that can affect joints for adhesion and formation.

High speed treadmill

The high speed treadmill offers options to adjust the speed, distance, slope, and load level (through the weighted saddle) of the horse. Heart rate can be monitored to assess the impact of training on the cardiovascular system. The training factors that are particularly pressing for certain injuries, such as the level of the horse's tilt with a tendon injury, can be gradually adjusted to slowly increase the strength placed on the recovery tissue. This allows for individual rehabilitation. However, horses require more work on the treadmill when compared to working under the saddle to produce the same level of oxygen consumption, and therefore the treadmill is not a suitable substitute for regular training with the rider while conditioning the animal for performance.

Underwater treadmill

Aquatic therapy has been shown to increase muscle strength, especially in the core, back, and stifles, and to improve cardiovascular and proprioception conditions in horses. Underwater treadmill is a popular tool for horse rehabilitation, and can offer targeted therapies based on water depth. At a lower depth, the horses will lift their feet out of the water to clean it in the flight phase with its pace. In this case, the depth can be adjusted to increase the range of certain joint motions, offering the option of adjusting treatment with certain injuries. Higher depths can increase pelvic flexion and lift the back, helping to strengthen the normally used muscles on horseback, conditioning them without increasing the weight of the rider. High water levels can also reduce body mass, similar to effects seen with swimming, and may be beneficial for joint injury or fractures. However, animals will develop muscle and cardiovascular fitness more quickly so they will develop skeletal strength. This can make horses look better prepared for heavy work than they really are, and getting back to work early can put bones, joints, tendons, and ligaments at a much greater risk of injury. Therefore, care should be taken to build bone strength before the animal is placed into regular work under the saddle.

Swimming

The buoyancy effect of water makes swimming close to the non-heavy bearings. This allows the horse to maintain the condition while reducing trauma to the joints, making it very useful for animals recovering from limb-related joints. However, load-bearing rehabilitation is also important before the animal returns to normal exercise, because swimming does not maintain the tone of the joints. In addition, swimming encourages the horse to maintain a perforated position, upside down with head up, back dropped, and legs kicking out behind him. It is therefore less suitable for horseback riding that is expected to develop the power to carry backup with the back end involved, and may also be related to back or lump problems.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy (HBOT) is a treatment in which animals are placed in pressurized chambers and filled with 100% oxygen. This high pressure environment increases the amount of oxygen carried in the solution in the blood, thus providing a much larger amount of tissue. HBOT has been shown to improve the healing of human infections, because it creates oxygen-free radicals that damage bacterial DNA, increasing tissue oxygen levels that can be toxic to anaerobic bacteria, and can increase antibiotic transfer to bacteria. HBOT has been shown to improve wound healing and is effective in treating ischemic tissue damage and compartment syndrome. Approved uses for HBOT in humans include clostridial myositis, thorn injury, carbon monoxide poisoning, compartment syndrome, treatment for chronic wounds, osteomyelitis and abscesses, skin flaps or graft, and burns.

Although widely used in human medicine, its use in horses is relatively new and several studies have been published about its benefits. The effect has been proven quite temporarily in horses, with arterial blood oxygen levels remaining high for only 10 minutes after treatment. However, it has been used to treat a variety of conditions, including infections (fungi and bacteria, including cellulitis), carbon monoxide or smoke inhalation, neurological diseases (head injuries, horse-doll syndrome, and peripheral neuropathy), gastrointestinal illness (ileus) rhabdomyolysis during activity, and laminitis. Some studies have had disappointing results for their use. It has been shown to be detrimental to the survival of skin grafts on horses, and only minimal effects on horses with induced endotoxemia. HBOT is considered very safe, with little contraindication, although its cost and availability make it less widely used than most other forms of treatment.

Neurectomy

Neurectomy refers to a surgical procedure in which certain nerves are cut off, thereby preventing sensation to certain areas. This is used when other treatment methods fail to reduce the pain. In the United States, this procedure usually refers to palmar or plantar digital nerve cuts to prevent leg sensation. Often used to treat chronic leg pain, such as navicular syndrome, which is refractory to other treatment methods. Approximately 92% of horses react to surgery, and a third of horses experience postoperative complications, including neuroma formation, unresolved lameness, or early recurrence of inequality. Surgery is generally less successful when lameness is caused by injury to the digital flexor tendon, so magnetic resonance imaging is recommended to determine the cause of preoperative lameness to avoid neuraxomy in these horses.

Neurectomy is also used to treat chronic rear cortical ligament desendina. Suspension injuries, and subsequent ligament swelling, are thought to produce compartment syndromes that suppress lateral lateral plantar nerves, leading to neuritis. This pressure can continue even after the ligament heals, resulting in chronic pain. In this case, the branches in the lateral nerve of the plantaris are disconnected. This procedure has been shown to have good results in the case of proximal suspensory chronic desmitis on the back (78% success rate), assuming the horse has no other musculoskeletal problems.

Arthrodesis

Arthrodesis is a procedure in which joints converge, either surgically or chemically.

Chemical Arthrodesis

Chemical arthrodesis destroys joint cartilage, produces ankylosis, and can also reduce the immediate pain due to neurolysis. Often intra-articular injections of monoiodoacetate (MIA) or ethyl alcohol are used. Ethyl alcohol has several advantages over MIA, including decreased pain (MIA produces severe pain for several hours after injection), lower costs, and easy access. Chemical Arthrodesis is generally done to treat osteoarthritis in the lower hock joints. This joint has little movement and can be fused without affecting the movement of the horse. Chemical arthrodesis has the potential to greatly improve chronic congestion that does not respond to anti-inflammatory IA, but carries the risk of severe complications, including joint sepsis, cellulitis, and severe thinness. Chemical Arthrodesis is cheap, simple, and relatively noninvasive, but potentially catastrophic if the proximal intertarsal joints communicate with tarsokrural high motion joints. For this reason, contrast studies are often recommended prior to treatment to ensure no communication occurs between the joints. Chemical arthrodesis has the potential to damage joint cartilage without combining joints, which causes increased pain and lameness. Chemical arthrodesis is less successful when used in the pastern joint, and often surgical arthrodesis is preferred.

Surgical arthrodesis

Surgical arthrodesis can be produced by internal fixation, intra-articular drilling, intra-articular laser treatment (which destroys chondrocytes), or joint cartilage removal surgery to produce ankylosis. Surgical arthrodesis is used as a technique for treating pain in low joints, such as lower hock joints. When used on lower hock joints, it has a high success rate to return to function, but is more expensive and invasive than chemical arthrodesis. Pastoral osteoarthritis is also treated with surgical arthrodesis, and may cause increased comfort and return to athletic function. Surgical arthrodesis can also be used in high-motion joints. Because it produces a gait change, the horse can not be used for athletic activity after surgery. It is used as a rescue procedure to save horses with injuries that interfere with joint stability, such as septic arthritis, suspensory instrument failure, subluxation, fracture or collateral ligament rupture, or may be used to treat chronic osteoarthritis.. It is most commonly used to treat diseases in coffins, fetlocks, carpal, and shoulder joints.

Tenotomy and ligament desmotomy

Transactions of soft tissue structures may be necessary to provide the horse with the best chance of regaining health. These procedures include tendon cutting (tenotomy) or ligaments (ligament desmotomy).

Digital elastic woven tendon tension

The inner digital flexor tendon (DDFT) runs behind the leg and attaches to the underside of the coffin bone. Contraction of the deep flexor muscle muscle will flex the number. At rest, DDFT implements constant traction to the underside of the coffin bone, which is opposed by the lamina holding the coffin bone to the nail wall.

DDFT tenotomy is usually recommended in cases of laminitis and chronic bone rotation coffin or unresponsive to other forms of treatment. DDFT transection reduces the pull at the bottom of the coffin bone, and then reduces the pressure placed on the nail lamina. A horse will not be athletically useful following the tenotomy of DDFT, with the best case scenario of an animal returning to the health of the meadow or perhaps comfortable enough to enjoy light pleasures. It is therefore considered a rescue procedure to improve the quality of life of horses, often as a last resort to avoid euthanasia. This procedure can be performed under local anesthesia. The DDFT is cut at mid-cannon or mid-pastern levels, although mid-cannons are preferred to avoid the flexor tendon sheath. DDFT Tenotomy can also be used to handle cases of limb bumps deformity in foals, but also a procedure to save and prevent animals from future athletic use.

This procedure is quite painful and requires good analgesia in the days following surgery. Proper nail trimming and shoe mounting are essential after surgery. The horse is at risk of subluxation of the coffin, which can neutralize by raising the heel of a horse. The toe can also be lifted off the ground when the horse weighs its heels, which may be fought by adding a heel extension to the shoe.

Examination of the inferior ligament ligament

The inferior check ligament, also known as the distal check ligament or accessory ligament of the deep digital flexor tendon, runs from the palmar aspect of the knee to the digital flexor tendon in about half the length of the canine bone. The main purpose of the ligaments is to support and prevent over-extension of the deep digital flexor tendon. Check the lower desmotomy ligament of the ligament transect to reduce the pull of the digital flexor tendon.

Inferior check ligament desmotomy is primarily used to treat defects of secondary bending limbs for internal digital flexor contractors. DDF contractures force the extremities to maintain a constant flexion position in the fetlock and coffin joints, and if not corrected it can damage the animal's athletic potential. Inferior check ligament transections reduce the pull of the DDF tendon, and allow the digit joints to their normal position. The ligament desmotomy check is considered superior to the digital flexor tenotomes because the animal has reduced pain and a greater chance of returning to full function after surgery. It has the greatest success rate when contractures have not progressed to the point where the dorsal surface of the nail wall is outside the vertical. Horses treated at a young age (about 6 months) have a better prognosis than those treated for about 12 months.

Like DDFT tenotomy, inferior ligament check desmotomy may also be used to treat laminitis, and less aggressive than DDFT tenotomy. It is also used to treat the navicular syndrome that is suspected to occur due to a damaged-foot axis, especially in cases of erect legs, and when DDFT contractures occur secondary to chronic weight loss in the extremities.

Examination of superior ligament desmotomy

The superior check ligament, also known as the proximal check ligament or the accessory ligament of the superficial digital flexor tendon, runs from the distal aspect of the fingers and inserts into the shallow digital flexor tendon just above the knee. It supports the superficial digital flexor tendon (SDFT), helping prevent over stretching. Superior examination of the ligament desmotomy of the ligament transect to allow for greater relaxation of the SDFT.

This surgical procedure is used in cases of foals with bending limb defects due to superficial digital flexor contracture. This can be used in conjunction with the inferior check desmotomy if DDFT is also contracted. Superior examination of desmotomous ligaments is also used in the case of superficial digital flexor tendinitis in the racehorse and horse of upper-level performance, if tendinitis is recurrent, diffuse, or when the core lesion is & gt; 10% of the cross-sectional area of ​​the tendon. It may be used in conjunction with the decentralization of split and annular tendons. In the racehorse with moderate to severe tendinitis of the SDFT, 69% returned to racing following the superior ligament check desmotomy, and were able to do it faster than the horse who had not undergone the procedure.

In contrast to the desmotomy of inferior ligament checks, superior ligament transection checks require general anesthesia.

Palmar annular ligament desmotomy

The annular palmar ligament lies behind the fetlock, covering the SDFT and DDFT when wrapping joints. Injury to the flexor tendon causes inflammation, edema, and secondary compression of surrounding tissues, similar to carpal tunnel syndrome. This makes it harder for the SDFT to slide over the joint surface, and the annular palmar ligament can thicken and attach to the tendon or SDFT sheath, which further reduces the function of the SDFT and worsening inequality. Transmission of the annular palmar ligaments aims to release the pressure placed on this soft-tissue structure. It is used in cases of tendinitis SDFT or DDFT, and in chronic tendosynovitis of the SDFT. This works best when used to treat tendinitis in the SDFT when paired with a superficial ligament desmotomy.

Tendon Sharing

Tendon splitting is used when large core lesions are present in the tendon, which contains edema and damaged tissue. With ultrasound guides, needle knives or scalpels inserted through the skin and into the lesions to dry them, reducing pressure on injury and improving vascularization. Tendon splitting has been shown to reduce the size of the lesion and improve the organization of the fibers during healing. This technique is not suitable for minor lesions, as it may worsen it, and is best done within 2 weeks of injury. It is considered more efficacious when combined with the despair of the shallow check ligament.

Counterirritants

Counterirritation is a collection of techniques used to promote inflammation, either through the use of caustic substances or cautery, in order to increase blood flow to the injured area. Counterirritation has been used by horsemen for thousands of years, but its use is currently controversial. Although practicing less frequently these days, it is still considered valid therapy by some practitioners, especially those on the racetrack. The termokautereri (pin firing) has been declared "unethical" by the Royal College of Veterinary Surgeons, although it is considered an acceptable therapy by the American Association of Equine Practitioners "when applied wisely and along with appropriate analgesia and aftercare... in the case proven fireproof against conventional treatment. "

Blistering

Blistering agents are chemicals used to irritate tissues, causing inflammation, increased circulation, necrosis, and scarring. They can be applied topically or injected. The most commonly used topical (topical) coating agent contains iodide, mercury iodide, or turpentine, which is rubbed or brushed onto the skin covering the site of the injury, and while they cause skin scaling, they tend to produce only low levels of pain. Stronger blister solutions can be made using red mercury iodide. This requires the use of a cradle of the neck, and the horse is at risk of laminitis and lymphangitis if it does not run regularly. Blistering is used for various lameness problems, including splints, curbs, shin pain, tendonitis, suspensory desmitis, and sesamoiditis.

Internal blistering is more common in the United States. Usually, a substance containing iodine or almond oil is injected into an attractive spot to treat suspensory splints, curbs and deserts, with varying results. One of the more common uses used for internal blistering is for the treatment of fixation onto the patella. Irritant is injected into the patella ligament, which causes inflammation and scarring. The bruising ligament becomes shorter, making it easier for the patella to detach from the medial troklear ridge and reduce the patella locking.

Enable

"Firing", or thermal injury, including thermocautery and cold firing. In both cases, the shooting was done after the initial inflammation associated with the injury had subsided. The horse was drugged, and the area was cut and blocked with local anesthesia. The most common form of firing is the firing pin, which uses a special machine with a hot tip to penetrate the skin and into the tendon or periosteum. Some apps are applied in the line above the injury site. As expected, horses require analgesia following this procedure. Usage for pin shooting includes tendonitis, suspensory desmitis, sesamoiditis, splints, curbs, and other soft tissue injuries. Cold firing is a method similar to firing pin, but uses liquid nitrogen to produce the effect. Often used to treat bone-related inequalities, such as shin pain or splints, and usually only after other treatments fail. The shooting forces are resting from injury, and while some argue this is the real reason that leads to an increase in inequality, others claim that unquestionable success in its use has been seen. The firing pin is not taught in veterinary schools today.

Prevention of laminitis

Limb-support limbs occur in horses with a heavy and unilateral discharge that causes them not to bear the burden on one leg. The contralateral leg (opposite) then endures all the weight, which reduces blood flow to the nail and presses the lamina, which leads to laminitis. Although limb-support limbitis is a risk for any weightless horse, occurring in about 16% of cases, it is uncommon in children and children. Usually occurs weeks to months after the initial cause of lameness, and greatly increases the likelihood of patient euthanasia. Limb-supportive extremities are a major cause for euthanasia from Barbaro's racing horse.

In cases of severe unilateral laziness, aggressive pain management using a combination of drugs in various classes such as opioids, alpha-2 agonists, ketamine, topical NSAIDs, and local anesthesia should be considered. Epidurals can also help in backside imbalance. Horses at risk for contralateral laminitis may be prophylactically treated with aggressive icing and supportive shoe mounting.

References

Source of the article : Wikipedia