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1.
Equine temporomandibular joint (TMJ) diseases are increasingly recognized as a problem for the well‐being and performance of horses. Diagnosis is confounded by overlap of clinical signs associated with pathology of the oral cavity, poll, and cervical vertebrae. Arthrocentesis for intra‐articular analgesia, sampling of synovial fluid, and medication is needed for diagnostic and therapeutic purposes. Ultrasound features of the normal TMJ and a blind arthrocentesis technique have been described, but a systematic approach to ultrasound‐guided (USG) arthrocentesis has not been reported. Ultrasound guidance allows visualization of the TMJ that may prove beneficial in cases when pathology, abnormal anatomy, or clinician inexperience make blind arthrocentesis difficult. We hypothesized that USG arthrocentesis would result in fewer needle repositions than blind arthrocentesis. We also aimed to assess synovial fluid parameters for normal equine TMJs. A prospective randomized method comparison with crossover experimental design compared the number of needle positionings required for accurate injection of the TMJ using each technique. Arthrocentesis technique and operator experience were tested using cadavers and two operators. Injection success was confirmed using CT. The radiologist then applied both techniques in normal live horses. No statistically significant difference was noted between arthrocentesis techniques or operators (P > .05). No complications were observed in live horses following either technique. Synovial fluid parameters were largely within the normal range expected for other synovial joints. Either blind or USG arthrocentesis of the equine TMJ can be performed with minimal prior operator experience. Ultrasound‐guided arthrocentesis is an alternative method and can be considered in cases with altered anatomy.  相似文献   

2.
Objective To develop an ultrasound‐guided technique for retrobulbar nerve block in horses, and to compare the distribution of three different volumes of injected contrast medium (CM) (4, 8 and 12 mL), with the hypothesis that successful placement of the needle within the retractor bulbi muscle cone would lead to the most effective dispersal of CM towards the nerves leaving the orbital fissure. Study design Prospective experimental cadaver study. Animals Twenty equine cadavers. Methods Ultrasound‐guided retrobulbar injections were performed in 40 cadaver orbits. Ultrasound visualization of needle placement within the retractor bulbi muscle cone and spread of injected CM towards the orbital fissure were scored. Needle position and destination of CM were then assessed using computerized tomography (CT), and comparisons performed between ultrasonographic visualization of orbital structures and success rate of injections (intraconal needle placement, CM reaching the orbital fissure). Results Higher scores for ultrasound visualization resulted in a higher success rate for intraconal CM injection, as documented on the CT images. Successful intraconal placement of the needle (22/34 orbits) resulted in CM always reaching the orbital fissure. CM also reached the orbital fissure in six orbits where needle placement was extraconal. With 4, 8 and 12 mL CM, the orbital fissure was reached in 16/34, 23/34 and 28/34 injections, respectively. Conclusion and clinical relevance The present study demonstrates the use of ultrasound for visualization of anatomical structures and needle placement during retrobulbar injections in equine orbits. However, this approach needs to be repeated in controlled clinical trials to assess practicability and effectiveness in clinical practice.  相似文献   

3.
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4.
Reasons for performing study: Arthrosis of the articular process joints (APJs) in the caudal thoracolumbar region of horses may cause back pain and subsequent reduced performance or lameness. Ultrasound‐guided injections of the APJs of the equine back have been described only briefly in the literature. Objectives: To evaluate factors affecting the accuracy of intra‐articular injections of the APJs in the caudal thoracolumbar region. Methods: One‐hundred‐and‐fifty‐four injections with blue dye were performed on APJs including the T14–L6 region in 12 horses subjected to euthanasia for reasons unrelated to back problems. The backs were subsequently dissected to verify the location of the injectate in relation to the APJs. Results: Twenty‐seven percent of the injections were found to be intra‐articular and a total of 77% found to be within 2 mm of the joint capsule including the intra‐articular deposits. Application of a medial approach and 18 gauge needle were significantly associated with an intra‐articular injection or deposition close to the joint capsule. Operator, APJ (location) and back number (chronological) did not significantly affect the accuracy of injection. Conclusions and potential relevance: Injection of the vertebral APJ in the thoracolumbar region using ultrasound guidance is a reliable method, as most of the injections were either in or within 2 mm of the joint. Based on the findings of this cadaver study, the medial approach is expected to be the most accurate in live horses. Further investigations are required to evaluate the diagnostic and therapeutic potential of this method in clinical practice.  相似文献   

5.
The standard technique for placing a needle into the canine lumbar subarachnoid space is primarily based on palpation of anatomic landmarks and use of probing movements of the needle, however, this technique can be challenging for novice operators. The aim of the current observational, prospective, ex vivo, feasibility study was to compare ultrasound‐guided vs. standard anatomic landmark approaches for novices performing needle placement into the lumbar subarachnoid space using dog cadavers. Eight experienced operators validated the canine cadaver model as usable for training landmark and ultrasound‐guided needle placement into the lumbar subarachnoid space based on realistic anatomy and tissue consistency. With informed consent, 67 final year veterinary students were prospectively enrolled in the study. Students had no prior experience in needle placement into the lumbar subarachnoid space or use of ultrasound. Each student received a short theoretical training about each technique before the trial and then attempted blind landmark‐guided and ultrasound‐guided techniques on randomized canine cadavers. After having performed both procedures, the operators completed a self‐evaluation questionnaire about their performance and self‐confidence. Total success rates for students were 48% and 77% for the landmark‐ and ultrasound‐guided techniques, respectively. Ultrasound guidance significantly increased total success rate when compared to the landmark‐guided technique and significantly reduced the number of attempts. With ultrasound guidance self‐confidence was improved, without bringing any significant change in duration of the needle placement procedure. Findings indicated that use of ultrasound guidance and cadavers are feasible methods for training novice operators in needle placement into the canine lumbar subarachnoid space.  相似文献   

6.
Intra‐articular injections of the scapulohumeral joint (SHJ) in horses are difficult to perform because of the thick muscles covering the area and a reduced articular space. Ultrasonographic guidance was demonstrated to be helpful to perform intra‐articular injections. This technique applied to the SHJ can be performed in the field with a portable machine. The joint space is firstly imaged in transverse and proximodistal scans. After aseptic preparation of the shoulder area, the probe is placed to image the SHJ space in transverse section and the needle is inserted cranially in the ultrasound beam. The progression of the needle is followed towards the SHJ space, limiting joint injuries and side effects.  相似文献   

7.
An accurate method for guiding injections into the canine hip would facilitate diagnostic localization of lameness and targeted treatments. Ultrasound‐guided hip injections are commonly used in humans and large animals. Aims of this prospective study were to describe ultrasound (US) anatomy of the adult canine hip and determine the feasibility and accuracy of intra‐articular placement of injectate using US‐guidance. Seven adult dogs were used to describe US anatomy, five dog cadavers were used to assess the feasibility of the injection technique and 11 dog cadavers were used to assess accuracy of injections. For the accuracy test, 22 joints were injected with iodinated contrast medium by three operators with different experience. With dogs in lateral recumbency, the hyperechoic femoral head surface was identified by following the femoral neck from the greater trochanter or the acetabular rim was localized by following caudally the ilium from the iliac wing.  An anechoic gap between the femoral head and acetabular surface represented the joint. The capsule was visible as a triangular echoic structure and the femoral head articular cartilage appeared as an anechoic band. The needle was inserted axial to the greater trochanter and directed in a dorsolateral–ventromedial direction toward the joint space and then pushed through the capsule. Based on postinjection radiography, accuracy was 81.8% at first attempt and 100% at second attempt. This study indicated that US‐guided injection is a feasible and accurate technique for injecting the adult canine hip. Future studies in live dogs are needed to assess safety and efficacy.  相似文献   

8.
Objective: To compare ultrasound‐guided lateral and medial approaches for periarticular injections of the thoracolumbar intervertebral facet joints (IFJ). Study Design: Experimental cadaveric study. Sample Population: Adult equine cadavers (n=4). Methods: IFJ (T12–T13 to L5–L6) were identified by ultrasound (transducer perpendicular to the spine axis) and insertion of a 13 cm, 18 g spinal needle monitored until bone contact using medial (right side) and lateral (left side) approaches. Number of needle insertions at each site, needle repositioning, and insertion depth were recorded. On bone contact 2 mL latex was injected. Intraarticular deposition, distance of latex from the closest articular margin, and presence of latex in the multifidus muscle were established by dissection. Results: Of 96 attempts, only 1 site require reinsertion of the needle; however, 46% of the injections required needle repositioning. Mean ± SD insertion depth was 8.5 ± 1.1 cm. Most injections (86%) were intraarticular and 96% were at or within 0.5 cm of the closest articular margin. Needle insertion relative to the transducer (lateral, medial) had no effect on the distance from the latex to the closest articular margin and all injections were performed into the multifidus muscle. Conclusions: Ultrasound‐guidance facilitated accurate periarticular injection of thoracolumbar IFJ irrespective of using a medial or lateral approach.  相似文献   

9.
Objective To compare the success rates of central venous catheter placement (CVCP) in dogs using electrocardiograph (ECG)‐guided and external landmark (‘blind’) techniques. To report success rates determined retrospectively of CVCPs in dogs using external landmarks at a tertiary referral institution. Study design Prospective blinded comparison of techniques. Retrospective analysis of case records. Animals Adult Beagles weighing 11.9 ± 2.6 kg were used in the experimental group (n = 38). Various breeds of dogs were in the retrospective clinical group (n = 33). Methods Laboratory dogs were anesthetized and CVCPs were placed using a modified Seldinger technique. Catheter tip position was first based on external landmarks and then the catheter was repositioned using an ECG‐guided placement. The ECG‐guided technique used the V‐lead with the positive electrode attached to the guide wire. Catheter placement was determined by moving the catheter cephalad and caudad to the point of maximum p‐wave amplitude and then withdrawing the catheter 1–2 cm from this point. Catheter position with each technique was determined using a lateral thoracic radiograph. Retrospective data were collected from the medical records of dogs that had CVCPs using anatomical landmarks and corresponding thoracic radiographs. Results The number of successful CVCP attempts was the same for both prospective groups (21/38). There was no statistically significant difference in success between the ECG‐guided technique and the blind technique. From the retrospective investigation 10/33 of the cases that fit the criteria had correct CVCPs. Conclusions and clinical relevance The odds of correctly placing a central venous catheter by ECG‐guidance were the same as the external landmark technique. The ECG‐guided technique may be useful in situations where external landmarks are not readily available.  相似文献   

10.
Desmopathy of the collateral ligaments of the distal interphalangeal joint is a common cause of equine foot lameness and carries a poor prognosis with conservative management. Intralesional injections may improve healing, although accuracy of radiographically guided injections is significantly less than when guided by MRI, which requires special needles. Longitudinal ultrasound‐guided injection of the distal collateral ligament has not been evaluated objectively. In this prospective, anatomic study, seven equine cadaver limbs (14 collateral ligaments) were injected with methylene blue dye and radiographic contrast medium using ultrasound to guide the needle longitudinally into the collateral ligaments until contacting bone. The insertion site of the needle proximal to the coronary band was measured on the limb and the needles left in place for radiography and CT to evaluate the needle angulation, location of the contrast medium, and whether the contrast entered the distal interphalangeal joint. The limbs were frozen and sectioned with a band saw to identify the location of the dye. Fifty percentage of injections were in or around the collateral ligaments. However, the percentage of “successful” injections, defined as in the collateral ligament but not in the joint, was only 36%. All legs had dye and contrast in the joint after both ligaments had been injected. There were no significant differences between the needle angle and entry site for “successful” and “unsuccessful” injections. Findings from this study indicates that the success rate is low for injecting the distal portions of the distal interphalangeal joint collateral ligaments using ultrasound guidance alone.  相似文献   

11.
In human medicine, spinal pain and radiculopathy are commonly managed by computed tomography (CT)‐guided facet joint injections and by transforaminal or translaminar epidural injections. In dogs, CT‐guided lumbosacral epidural or lumbar facet joint injections have not been described. The aim of this experimental, ex vivo, feasibility study was to develop techniques and to assess their difficulty and accuracy. Two canine cadavers were used to establish the techniques and eight cadavers to assess difficulty and accuracy. Contrast medium was injected and a CT scan was performed after each injection. Accuracy was assessed according to epidural or joint space contrast opacification. Difficulty was classified as easy, moderately difficult, or difficult, based on the number of CT scans needed to guide insertion of the needle. A total of six translaminar and five transforaminal epidural and 53 joint injections were performed. Translaminar injections had a high success rate (100%), were highly accurate (75%), and easy to perform (100%). Transforaminal injections had an moderately high success rate (75%), were accurate (75%), and moderately difficult to perform (100%). Success rate of facet joint injections was 62% and was higher for larger facet joints, such as L7‐S1. Accuracy of facet joint injections ranged from accurate (37–62%) to highly accurate (25%) depending on the volume injected. In 77% of cases, injections were moderately difficult to perform. Possible complications of epidural and facet joint injections were subarachnoid and vertebral venous plexus puncture and periarticular spread, respectively. Further studies are suggested to evaluate in vivo feasibility and safety of these techniques.  相似文献   

12.
Ultrasound‐guided intraarticular injection of cervical articular process joints is a well‐established procedure in both humans and horses for neck pain resulting from osteoarthritis, but the technique has not been described in dogs. Aims of this study were to describe the ultrasonographic anatomy and landmarks for cervical articular process joint injections in the dog, develop a technique for articular process joint injections using these landmarks, and determine the accuracy of injections and factors that may influence it. Eleven canine cadavers were used and bilateral joint spaces from C2–3 to C7‐T1 were injected under ultrasound guidance with a blue radiopaque solution. A computed tomographic scan was acquired following each injection, and an injection score was assigned and compared with other patient‐specific factors. Of the 132 injections performed, 110 (83.3%) were intraarticular, 20 (15.1%) were periarticular within 5 mm, and 2 (1.5%) were periarticular beyond 5 mm from the joint. There was no significant difference in mean scores between dogs. Only C2–3 had a significantly lower mean score than any other joint. There was no significant correlation between injection score and any other factors measured. The transverse processes of the cervical vertebrae served as excellent ultrasonographic landmarks for identifying the cervical articular process joints in dogs regardless of the size of the dog or location along the vertebrae. Accuracy of ultrasound‐guided intraarticular process joint injection was 83% in dogs and similar to published techniques in horses. Further studies are needed to examine the safety and efficacy of this procedure in live animals.  相似文献   

13.
Sacroiliac lesions are commonly suspected in sport‐ and racehorses. Injection of the sacroiliac (SI) area can be performed for diagnostic purposes and/or for treatment of SI pain. Because of the deep location of the SI joint, blind injections may be unsafe. The purpose of this paper is to present how to perform ultrasonographic guided injection of the SI area using cranial and caudal approaches. With this technique drugs can be injected close to the SI joint and technical errors (needle implantation in the sciatic nerve, injection in the vertebral canal or in the rectum) can be avoided.  相似文献   

14.
Definitive diagnosis of a deep digital flexor tendon insertional lesion within the right fore foot was made by magnetic resonance imaging (MRI) examination and the lesion subsequently treated by injection with platelet‐rich plasma. MRI was used to guide positioning of the needle to achieve highly accurate injection. The volume injected was found to approximate the calculated lesion volume. On the basis of experience with this case, MRI‐guided injection of insertional deep digital flexor tendon lesions of the foot of horses under general anaesthesia is practicable. This technique is likely to be more accurate than the other techniques described (computed tomography, ultrasonography) and carries no risk of exposure to radiation (radiography).  相似文献   

15.
Desmitis of the collateral ligament of the distal interphalangeal joint is a cause of lameness in performance horses. The objective of this prospective, experimental, ex vivo feasibility study was to evaluate the success of ultrasound‐guided injection of the collateral ligaments of the distal interphalangeal joint in the equine forelimb. Seventy‐six ultrasound‐guided dye injections of the collateral ligament of the distal interphalangeal joint were performed on horses’ cadaver limbs. The hooves were sectioned transversely to verify the location of the dye relative to the collateral ligaments and surrounding structures. Evaluations of transverse sections were performed independently by two experienced observers. A scoring system was used to assess injection of the collateral ligament of the distal interphalangeal joint at the proximal, middle, and distal aspect over the length of the ligament. The collateral ligament was injected at any point in 97.4% of cases. The ligament was injected over the entire scored length in 43.2% of cases (32/74), over two scored length areas in 45.9% of cases (34/74), and in one area in 10.8% of cases (8/74). The distal interphalangeal joint and the common digital extensor tendon were also injected in 81.6% (62/76) and 43.4% (33/76) of the cases, respectively. Use of the ultrasound had a positive and negative predictive value of 98% and 9%, respectively. In this study, ultrasound guidance was useful for confirming injection of the collateral ligament of the distal interphalangeal joint but did not prevent injecting the distal interphalangeal joint and the common digital extensor tendon.  相似文献   

16.
Epidural injections are commonly performed blindly in veterinary medicine. The aims of this study were to describe the lumbosacral ultrasonographic anatomy and to assess the feasibility of an ultrasound‐guided epidural injection technique in dogs. A cross sectional anatomic atlas of the lumbosacral region and ex vivo ultrasound images were obtained in two cadavers to describe the ultrasound anatomy and to identify the landmarks. Sixteen normal weight canine cadavers were used to establish two variations of the technique for direct ultrasound‐guided injection, using spinal needles or epidural catheters. The technique was finally performed in two normal weight cadavers, in two overweight cadavers and in five live dogs with radiographic abnormalities resulting of the lumbosacral spine. Contrast medium was injected and CT was used to assess the success of the injection. The anatomic landmarks to carry out the procedure were the seventh lumbar vertebra, the iliac wings, and the first sacral vertebra. The target for directing the needle was the trapezoid‐shaped echogenic zone between the contiguous articular facets of the lumbosacral vertebral canal visualized in a parasagittal plane. The spinal needle or epidural catheter was inserted in a 45° craniodorsal–caudoventral direction through the subcutaneous tissue and the interarcuate ligament until reaching the epidural space. CT examination confirmed the presence of contrast medium in the epidural space in 25/25 dogs, although a variable contamination of the subarachnoid space was also noted. Findings indicated that this ultrasound‐guided epidural injection technique is feasible for normal weight and overweight dogs, with and without radiographic abnormalities of the spine.  相似文献   

17.
Ultrasound-guided injections can be used for a wide variety of conditions in the horse, including both diagnostic and therapeutic applications. Benefits of ultrasound guidance include more accurate deposition of injectate compared with blind approaches. Improved identification of vital structures, including nerves and blood vessels, allows their avoidance and thus reduces procedure-associated complications. Validation of such ultrasound-guided techniques has shown that they can be easily learnt by inexperienced veterinarians, assuming a proper knowledge of the sonographic anatomy. In many cases they can be employed in the field with a high level of accuracy, using widely available equipment, and with complete adherence to the sterility principles. Many ultrasound-guided injection techniques of the axial skeleton in the horse have been described in past years, enabling the equine veterinarian to perform more accurate treatments of specific anatomical areas. The goal of this review is to discuss diagnostic and therapeutic ultrasound-guided injection techniques of the skull and cervical spine in the horse, including those for the retrobulbar space, maxillary and inferior alveolar nerves, atlanto-occipital and atlanto-axial junctions, and cervical articular process joints, as well as the 1st cervical nerve, the C2 and C3 nerve plexus, and the 6th, 7th, and 8th cervical nerve roots.  相似文献   

18.

Objectives

(1) To report the clinical and synovial effects of a platelet‐rich product (PRPr) in normal equine joints, (2) to assess the persistence of platelets within synovial fluid after intra‐articular injection, (3) to compare responses to different preparations of that product, and (4) to evaluate a gravity filtration system for PRPr preparation in horses.

Study Design

Experimental.

Methods

A platelet‐rich saline product (PRPr) was prepared from 7 normal horses using a proprietary preparation device and was divided into 3 treatments: resting, CaCl2‐activated (23 mM, final), and bovine thrombin‐activated (10 U/mL, final). Each horse had 3 concurrent randomly assigned intra‐articular PRPr treatments administered in their metacarpophalangeal/metatarsophalangeal joints; the fourth limb was injected with saline (0.9% NaCl) solution as a control. Clinical assessments, cytologic analysis of synovial fluid and hemograms were performed at 6, 24, 48, and 96 hours after injection. PRPr composition and growth factor content were analyzed.

Results

The gravity filtration system produced a moderately concentrated PRPr. At 6 and 24 hours, when compared to control values, all PRPr treatments caused a significant increase in synovial WBC concentration (P < .0059) and neutrophil percentage (P < .0005). Bovine thrombin‐activated PRPr injection consistently caused increased effusion scores and periarticular signs. At all time points, the synovial WBC concentration after thrombin‐activated PRPr was significantly greater (P < .001) than for the control, CaCl2‐activated or resting PRPr. Intact platelets could be observed in synovial fluid for up to 5 days after intra‐articular PRPr injection.

Conclusions

Resting and CaCl2‐activated PRPr may be safely used to treat equine joints, but bovine thrombin activation is not recommended at 10 U/mL. A PRPr can be prepared using a gravity filtration system, eliminating the need for centrifugation.  相似文献   

19.
Horses with intracranial lesions and severe ataxia are not good anesthesia candidates; however, only one method to obtain cerebrospinal fluid (CSF) from the cervical region in a standing horse has been reported. This method is not performed routinely due to the difficulty for sample acquisition. Our hypothesis is that standing cervical centesis can be performed in horses without complication. Ultrasound‐guided centesis of the CSF between C1 and C2 in 11 clinically normal horses and two horses with neurologic signs were performed. Horses were sedated and ultrasound was used to identify the subarachnoid space and spinal cord between C1 and C2. With ultrasound guidance, a needle was introduced into the dorsal aspect of the subarachnoid space using a lateral approach. Ten milliliters of CSF was obtained and analyzed. Two normal horses in this study had moderate red blood cell contamination in the CSF (940 and 612 RBC/μl). One horse had 11 RBC/μl and the remaining horses had <4 RBC/μl. The total procedure time was approximately 2 min. No reaction was observed and no complications were detected up to 48 h after the procedure. Ultrasound‐guided centesis between C1 and C2 is a rapid procedure that causes minimal to no reaction in standing, sedated horses used in this study. The use of ultrasound to guide a standing C1–2 centesis of the subarachnoid space provides an additional route to obtain CSF for analysis in the equine patient.  相似文献   

20.
OBJECTIVE: To evaluate the accuracy of a new technique for perineural injection of the lateral palmar nerve and to determine frequency of inadvertent injection into the carpal synovial sheath with this technique. STUDY DESIGN: Prospective experimental study. ANIMALS: Thirty equine cadaver forelimbs. METHODS: Each of 3 clinicians injected 0.5 mL of a 1% aqueous solution of new methylene blue as a marker at the medial aspect of the accessory carpal bone of 10 limbs. Immediately after each injection, the lateral palmar nerve was identified by dissection of and inspected for proximity of dye, and the carpal synovial sheath was inspected for the presence of dye. RESULTS: New methylene blue solution was observed to surround the nerve (29 limbs) or to lie within 2 mm of it (1 limb). Dye was not found in the carpal synovial sheath of any specimen. CONCLUSIONS: Using this technique, perineural injection of the lateral palmar nerve can be consistently achieved, and the carpal synovial sheath is unlikely to be penetrated by the needle during the procedure. CLINICAL RELEVANCE: The technique described provides an accurate and simple method for perineural injection of the lateral palmar nerve proximal to the origin of its deep branch. This technique can be used to anesthetize the lateral palmar nerve for diagnosis of pain originating in the palmaroproximal aspect of the metacarpus without risk of inadvertently desensitizing structures within the carpal synovial sheath.  相似文献   

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