Lecture 11: Diagnois and Management of Equine Axial Akeleton Disorders

Protection of the spinal cord and nerve roots

- neural arch

weight bearing and soft tissue attachment

- vertebral body

- spinous and transverse processes

flexibility and locomotion (strength, impulsion)

- vertebral articulations

- muscles

- ligaments

ridden exercise

- carry a rider

What is the function of the vertebral column?

- bending

- core stability

- impulsion

- power

- endurance

- flexability

In these pictures how are these horses using their axial column?

- head

- cranial cervical

- lower cervical (OA)

- withers (fractures)

- thoracolumbar

- pelvic / lumbosacral

- tail

What are these regions of the spine going from left to right?

- bad saddle fit

- blanket rubbing

- fly sheet or coolers

What are causes of white hair or alopecia?

- heat

- swelling

- pain

- scarring

- fibrosis

- is it symmetrical (rider, horse, lameness issue?)

When are white hairs or alopecia a problem?

- muscle atrophy

How would you describe this soft tissue change?

- modeling

- OA

- OC

- ankylosis

What are common osseous changes to the spine?

- AKA kissing spine

- narrowing of the space between the spinous processes

- can be developmental

What is spinous process impigment?

- muscular imbalance

- chronic lameness

- compensatory gait

What things to think about as causes for pelvic asymmetry?

-- R/O limb lameness

- spinal eval

- diagnostic local ax

- radiology

- nuclear scintigraphy

- U/S

What are the diagnostic goals for equine spinal issues?

- changes in behavior -- very common

- resists poll flexion

- stiffness

- asymmetric rein tension

- turns or performs better in one direction

- recent fall or trauma

- vague, non-localized forelimb lameness

What are significant things to learn from a history when talking about spinal issues?

- they are interconnected

- high percentages of horses with back pain have had limb lameness. a lower percent of horses with lameness have back pain, but its still significant

- need to do full lameness exam for those with back pain

- need to do a full spinal exam in horses with chronic lameness

How can we relate back pain and limb lameness? what does this mean?

- Behavioral : mental status, temperament, less social

- intrinsic features: conformation, posture, BCS, muscle development and asymmetry

- tack: saddle fit and use, saddle pad, cinch, girth

What happens during the observation stage of the exam for horses with back problems?

- pain with digital pressure

- poor hind limb impulsion

- epaxial muscle hypertonicity

- lateral bending stiffness

What are common clinical signs of back pain in horses?

- skin --> hair, epidermis, dermis

- SQ - fat, masses, vessels

- CT: fascia, ligaments, tendons

- muscle: development, tonicity, masses (should have a handful)

What are you looking for on soft tissue palpation of horses with axial pain?

- longissimus muscle

What muscle is being palpated here?

- T8 - T15

Where does most trunk mobility issues occur with lateral bending?

- T9 - T 16

Where does most trunk mobility issues occur with axial rotation?

- L6 - S1

Where does most trunk mobility issues occur with flexion and extension?

- hard to get a clear image

- poor correlation with clinical signs of pain or stiffness

- might have multiple issues, unknown which findings are relevant or might miss one if not the correct modality

What are challanegs with diagnostic imaging for the horse axial skeleton?

- rads

- myelography

- nuclear scintigraphy

- U/S

- thermography

- CT/MRI?

What are diagnostic options for the equine axial skeleton?

- rectal exam (pelvin, muscles, vessels)

- Blood work (CBC and muscle enzymes)

- Urine (myoglobinuria)

- diagnostic AX

- muscle bx

- electromyography (EMG)

WHat are additional diagnostics that can be done on a horse with back pain?

- systemic meds

- intra articular injections = corticosteroids, HA, DMSO

- anti inflammatories --> phenylbutazone,

What are medical treatment options for back pain in horses?

- stabilization

- arthroscopy

What are surgical treatment options for back pain in horses?

- training aids

- in hand

- long line

- proprioceptive aids

- ground poles

- obstacles

- cavelletti

- lunge

- ridden

- jumping

What are therapeutic exercise options for for back pain in horses?

- thermal

- electrical

- vibration

- photic

- sonic

- acupuncture

What are physical modality options for for back pain in horses?

- stretching

- massage

- soft tissue mobilization

- joint mobilization

- manipulation

What are manual therapy options for for back pain in horses?

- pain management

- limited tissue damage

How do you treat the inflammatory phase of the rehabilitation phases of horse axial skeleton issues?

- enhance tissue healing

- restore function

How do you treat the proliferative phase of the rehabilitation phases of horse axial skeleton issues?

- condition tissues to loading

- structural-function reintegration

- sport-specific demands

- prevent reinjury

How do you treat the remodeling phase of the rehabilitation phases of horse axial skeleton issues?

- pain management = first

- passive or active flexibility

- motor control (mechanoreception and cordiation)

- strength

- optimize athletic performance to prevent reinjury

What are rehabilitation approaches for horses with back pain?

- pain

You should always provide _________ management before continuing with other rehabilitation treatments.

- Anti-inflammatories :NSAIDS, corticosteroids

- Cryotherapy

- Acupuncture

- Muscle relaxants

- Low-level laser therapy

- Spinal mobilization

- Stretching exercises

- Electrical stimulation

What are methods to manage acute pain?

- used to decrease nociceptive pain modulation

- aka electroacupuncture

What is transcutaneous electric nerve stimulation?

- wound management

- acute back pain

- MSK disorders like OA

What is low level laser therapy (red light) indications?

- Moist heat

- Massage therapy --> vibration

- Stretching exercises

- Spinal manipulation

- Acupuncture --> electroacupuncture

- Extracorporeal shock wave therapy

- Intra-articular corticosteroids

What are methods to manage chronic pain?

- around neck and withers

- reduction in HR and increase positive behavioral response

- make them more relaxed when done at allogrooming sites

Why can massage therapy be good for back pain?

- based on placement they can communicate with the peripheral nervous system

Why can acupuncture help with managing chronic pain?

- extension of the cranial cervical region (Occ - C1)

What does this baited stretch do?

- neutral position for middle cervical (C2-C5)

What does this baited stretch do?

- flexion for caudal cervical (C6-T2)

What does this baited stretch do?

- walk over obstacle horses

- back them up over obstacles

- stand on a small barrier (core stability too)

- proprioceptive pads (static or dynamic)

How can you help manage horses with proprioception and balance issues?

- if the back is stiff

What can trunk mobilization tell us?

- arthrocopic removal

What is a surgical treatment for OC fragments in the spine?

- interbody flusion

What is a surgical treatment for cervical vertebral compression myelopathy in the spine?

- spinous process resection

What is a surgical treatment for thoracolumbar impinged spinous processes in the spine?