My Horse University and eXtensionrsquos HorseQuest welcome you to this live Webcast

Lameness in the Performance Horse

Ann Rashmir-Raven DVM MSDiplomate American College of Veterinary Surgeons

Michigan State University College of Veterinary Medicine

Meet our presenter

Ann Rashmir-Raven DVM MSDiplomate American College of Veterinary Surgeons

College of Veterinary Medicine Michigan State University

Narelle StubbsMichigan State University

Question facilitator

bull 1 Lamenessbull 9-14 events100 horses bull $43200 per eventbull 25 case fatality ratebull 110 days lost per event

bull 2 Colicbull 42 events100 horsesbull $16000 per eventbull 11 case fatality ratebull 24 days lost per event

National Animal Health Monitoring System National estimate of economic costs

(NAHMS Study)

Lamenessbull Prevention

ndash Conditioningndash Nutritionndash Shoeingndash Saddle fit

bull Diagnosisndash Lameness evaluationndash Diagnostic nervejoint blocksndash Xraysradiographsndash Ultrasoundndash Bone scanndash MRIndash Gait analysisndash Thermography

bull Treatment choices-whatrsquos newndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodiesbull What you should know about

bull ButeBanamineKetofenbull Cosequinbull Adequanbull Hyaluronic acidbull Shock wave

Preventionbull Pick a great horse

ndash Good conformationndash Personalityability suited to intended usendash Bank blood at prepurchase exambull Conditioningndash Riding surfacendash Amount and type of riding and riding schedulendash Forget the ldquoone last timerdquondash Your in controlbull Nutritionbull Farrieryndash Saddle fit

Pick a good farrier that can consistently address common problems

bullLong toelow heel is a common problem in performance horses

Photos courtesy of Dr Tia Nelson

Barefoot horse in stockyard before amp after trimming

Before amp after trimming

Photos courtesy of Dr Tia Nelson

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Meet our presenter

Ann Rashmir-Raven DVM MSDiplomate American College of Veterinary Surgeons

College of Veterinary Medicine Michigan State University

Narelle StubbsMichigan State University

Question facilitator

bull 1 Lamenessbull 9-14 events100 horses bull $43200 per eventbull 25 case fatality ratebull 110 days lost per event

bull 2 Colicbull 42 events100 horsesbull $16000 per eventbull 11 case fatality ratebull 24 days lost per event

National Animal Health Monitoring System National estimate of economic costs

(NAHMS Study)

Lamenessbull Prevention

ndash Conditioningndash Nutritionndash Shoeingndash Saddle fit

bull Diagnosisndash Lameness evaluationndash Diagnostic nervejoint blocksndash Xraysradiographsndash Ultrasoundndash Bone scanndash MRIndash Gait analysisndash Thermography

bull Treatment choices-whatrsquos newndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodiesbull What you should know about

bull ButeBanamineKetofenbull Cosequinbull Adequanbull Hyaluronic acidbull Shock wave

Preventionbull Pick a great horse

ndash Good conformationndash Personalityability suited to intended usendash Bank blood at prepurchase exambull Conditioningndash Riding surfacendash Amount and type of riding and riding schedulendash Forget the ldquoone last timerdquondash Your in controlbull Nutritionbull Farrieryndash Saddle fit

Pick a good farrier that can consistently address common problems

bullLong toelow heel is a common problem in performance horses

Photos courtesy of Dr Tia Nelson

Barefoot horse in stockyard before amp after trimming

Before amp after trimming

Photos courtesy of Dr Tia Nelson

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

bull 1 Lamenessbull 9-14 events100 horses bull $43200 per eventbull 25 case fatality ratebull 110 days lost per event

bull 2 Colicbull 42 events100 horsesbull $16000 per eventbull 11 case fatality ratebull 24 days lost per event

National Animal Health Monitoring System National estimate of economic costs

(NAHMS Study)

Lamenessbull Prevention

ndash Conditioningndash Nutritionndash Shoeingndash Saddle fit

bull Diagnosisndash Lameness evaluationndash Diagnostic nervejoint blocksndash Xraysradiographsndash Ultrasoundndash Bone scanndash MRIndash Gait analysisndash Thermography

bull Treatment choices-whatrsquos newndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodiesbull What you should know about

bull ButeBanamineKetofenbull Cosequinbull Adequanbull Hyaluronic acidbull Shock wave

Preventionbull Pick a great horse

ndash Good conformationndash Personalityability suited to intended usendash Bank blood at prepurchase exambull Conditioningndash Riding surfacendash Amount and type of riding and riding schedulendash Forget the ldquoone last timerdquondash Your in controlbull Nutritionbull Farrieryndash Saddle fit

Pick a good farrier that can consistently address common problems

bullLong toelow heel is a common problem in performance horses

Photos courtesy of Dr Tia Nelson

Barefoot horse in stockyard before amp after trimming

Before amp after trimming

Photos courtesy of Dr Tia Nelson

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Lamenessbull Prevention

ndash Conditioningndash Nutritionndash Shoeingndash Saddle fit

bull Diagnosisndash Lameness evaluationndash Diagnostic nervejoint blocksndash Xraysradiographsndash Ultrasoundndash Bone scanndash MRIndash Gait analysisndash Thermography

bull Treatment choices-whatrsquos newndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodiesbull What you should know about

bull ButeBanamineKetofenbull Cosequinbull Adequanbull Hyaluronic acidbull Shock wave

Preventionbull Pick a great horse

ndash Good conformationndash Personalityability suited to intended usendash Bank blood at prepurchase exambull Conditioningndash Riding surfacendash Amount and type of riding and riding schedulendash Forget the ldquoone last timerdquondash Your in controlbull Nutritionbull Farrieryndash Saddle fit

Pick a good farrier that can consistently address common problems

bullLong toelow heel is a common problem in performance horses

Photos courtesy of Dr Tia Nelson

Barefoot horse in stockyard before amp after trimming

Before amp after trimming

Photos courtesy of Dr Tia Nelson

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Preventionbull Pick a great horse

ndash Good conformationndash Personalityability suited to intended usendash Bank blood at prepurchase exambull Conditioningndash Riding surfacendash Amount and type of riding and riding schedulendash Forget the ldquoone last timerdquondash Your in controlbull Nutritionbull Farrieryndash Saddle fit

Pick a good farrier that can consistently address common problems

bullLong toelow heel is a common problem in performance horses

Photos courtesy of Dr Tia Nelson

Barefoot horse in stockyard before amp after trimming

Before amp after trimming

Photos courtesy of Dr Tia Nelson

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Pick a good farrier that can consistently address common problems

bullLong toelow heel is a common problem in performance horses

Photos courtesy of Dr Tia Nelson

Barefoot horse in stockyard before amp after trimming

Before amp after trimming

Photos courtesy of Dr Tia Nelson

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Barefoot horse in stockyard before amp after trimming

Before amp after trimming

Photos courtesy of Dr Tia Nelson

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Pick a good farrierbull What do you think

about this horsersquos feet

Photo courtesy of Dr Tia Nelson

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Common problems and their appropriate fixesldquoRaised heelsrdquo but the base of support was not moved back

Move heels of foot to widest part of frog Heels of shoe are too tight pinching frog and no expansion

Open heels of shoeCenter of balance too far forward

Place shoe so widest part of foot is in middle of shoe

Photos courtesy of Dr Tia Nelson

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Photos courtesy of Dr Tia Nelson

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Posteriorsupport at the heels

Photos courtesy of Dr Tia Nelson

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Thermographybull Can be utilized to determine problems with saddle fitbull Thermography is a noninvasive diagnostic imaging technique

used to detect variations in body-surface temperature by measuring emitted infrared radiation

bull If used as part of the lameness examination thermographic examination should be performed before proceeding with the moving examination

bull Thermagraphic signal should be symmetricbull Any change in heat seen with thermography is generally the

result of changes in blood flowbull A baseline examination is later compared with the findings of

postexercise thermography

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

13

SADDLE FITSADDLE FITbull Potential problemsPotential problemsbull SADDLE IS ASYMETRICALSADDLE IS ASYMETRICALbull RIDER IS ASYMETRICALRIDER IS ASYMETRICALbull HORSE IS ASYMETRICALHORSE IS ASYMETRICAL

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

14

ENGLISH SADDLE ENGLISH SADDLE Thermographic image-post ride Thermographic image-post ride

Courtesy of Dr Jim Waldsmith

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

15

WESTERN SADDLE WESTERN SADDLE Thermographic image-post rideThermographic image-post ride

Courtesy of Dr Jim Waldsmith

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Lameness Evaluation-Standingbull Observe for changes in symmetry

posture abnormal foot wear etcbull Muscles ligaments tendons and

joints are palpated and assessed for discomfort or stiffness

bull Secondary (compensatory) problems (such as a sore back) are detected during this part of the evaluation

bull The presence of certain secondary problems may provide clues as to the type of primary problem(s) that exist

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

bull Hoof testers are a key aspect of the lameness examination in a performance horsendash Response

bull Too much Foot painbull Too little Neurectomy

Lameness Evaluation-Standing

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Forelimb lameness Evaluation of front limb lameness

straight line From the front and from the rear

circles

The ldquohead bobrdquo is commonly used in the evaluation of front limb lameness

ldquoDown on the soundrdquo in the front limb The weight if the headneckshoulder is

carried on the most comfortable leg If the horse is bilaterally lame (lame in both

front or both hind legs) you will have to watch the horse in a circle to better see the lameness Stress on the inside leg is greater Stress on the inside of the outside leg is greater

bull Front leg lameness video

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Hindlimb lameness Hindlimb lameness is also evaluated in a straight

line and in circles The ldquohip hikerdquo is commonly used in the

evaluation of hind limb lameness The hip is elevated when the lame leg is on the ground

The ldquohead bobrdquo can also be used for hind limb lameness but the head will be downforward when the lame hind leg is on the ground ldquoDown on the soundrdquo no longer applies

bull Hind limb lameness video

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Even subtle lameness can affect performance

Many subtle lamenesses and some hindlimb lamenesses are best evaluated with the horse under saddle

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

bull Flexion testingbull The horse is trotted for a

baseline lameness bull Then the limbs are individually

held in a flexed position as shown

bull When the leg is released the horse trots away and any exacerbations in lameness are noted

bull Flexing the joints in this manner may reveal problems that are not otherwise readily apparent

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Nerve and joint blocks These techniques are perhaps the most

important tools used to identify the location of lameness

Temporarily numbs sensation to specific segments of the limb one area at a time until the lameness disappears

This procedure isolates the area of pain causing the lameness

Joint blocks can also help determine whether the condition is treatable by intra-articular medications

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Gait Analysis

Courtesy of Dr Hilary Clayton McPhail CenterMichigan State University

State-of-the-art system10 cameras with 6 imbedded force plates

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Gait analysis of Piaffebull Piaffe in slow motion

video

Courtesy of Dr Hilary Clayton

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Gait analysis of the lame horsebull Maybe most useful in

distinguishing between the subtly lame horse and the subtly neurologic horsendash Currently ldquotreatment

responserdquoCourtesy of Dr Hilary Clayton

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

RadiographsXraysbull First choice for imaging

bonendash Tarsushock example

bull Detects bone changes when 30 difference from normal has occurred

bull Digital radiographs have a wider latitude than conventional radiography

bull Limited contrast compared to MRI

Normal Arthritis Arthritis

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

27

Diagnostic Ultrasound

ndash Suspensory ligament (Desmitis)

ndash markedly enlarged (28cmsup2)ndash Large hypoechoic core lesion 26

cross-sectional area

First choice for imaging soft tissues

Commonly used to image the fetus in human pregnancy

Classical sound waves that operate at frequencies far above human hearing generally spanning 1MHz

Utilizes the transfer and propagation of sound waves into soft tissue to provide an image

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

ULTRASOUNDS

ldquoBowed Tendonsrdquo Superficial digital flexor tendonitis

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Ultrasound can be used to follow tendon healing and ensure the horse in not returned to work too quickly

lesion should be ldquofilled inrdquo

Tendon injury results in capillary hemorrhage and inflammation

Inflammatory cells arrive at the injury site and hydrolytic enzymes in the inflammatory exudate are released causing further

damage

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Some contribution factors tendonitis improper shoeing uniform training regimen level of fitness lack of adequate warm up preexisting unresolved lameness

Same limb or opposite limb

conformation stride characteristics reperfusion injury nature of the working surface age

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Bone Scan images

bull Gamma camera detects radioactivity patterns emitted by horse following injection of radioactive material

bull Three phases allow assessment of blood supply soft tissue injury and alterations in bone metabolism

bull Indications for bone scintigraphyndash Diagnosis of occult or intermittent lamenessndash Bone survey for multiple limb lamenessndash Early detection of skeletal injury ndash fracturendash Localization of pain but inability to identify

cause using radiography and ultrasonographyndash Poor performance of ill-defined causendash Suspected thoracolumbar or pelvic region

pain

Nuclear Scintigraphy (ldquoBone Scanrdquo)

Normal front foot Abnormal front foot

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Magnetic Resonance Imaging (MRI) Michigan State University

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Magnetic Resonance Imaging (MRI)

bull MRI provides the ability to see bone pathology and soft tissue structures frequently not seen by other imaging techniques

bull State of the art imaging for bone and soft tissue can see pathologic and physiologic changes unparalleled contrast and definition of soft tissues

bull Can see damage (edema) in bonebull Soft tissue injurybull Suspensory ligamentbull Deep digital flexor tendonbull Superficial digital flexorbull Soft tissues of the foot

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Common causes of lameness in the performance horse(Abbreviated list)

bull Arthritis bull Hock stifle fetlock coffin joint etc

bull Soft tissue diseasebull Superficial and deep digital flexor tendonitis (Bowed)bull Suspensory ligament (desmitis)

bull Navicular syndrome ndash true navicular disease (bone affected)ndash navicular ligamentsndash navicular bursitisndash heel painndash deep digital tendon adhesionndash any other undiagnosed foot lamenessndash MRI

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Navicular Disease Diagnosisbull Hoof testersbull Palmar digital nerve

blockbull Usually have a positive

fetlock flexion testbull X-rays (5 views)

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Front to back (AP)

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Front view (AP)

Normal

Increased channels

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Enlarged vascular channels

bull Channels can become so large they are actually cyst-like

Normal

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Classical treatment of navicular syndromebull Shoeing changesbull Isoxsuprinebull Butebull Coffin joint injections with hyaluronic acid and steroids

ndash Steroids are a potent anti-inflammatory agentbull AdequanTM in the musclebull LegendTM (a form of hyaluronic acid) in the veinbull Neurectomy (chemical or surgical)

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Lameness treatment choices-Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries

ndash Irapndash Stem cellsndash Platelet rich plasmandash Tildrenndash Rehabilitation and physical therapybull Treatment choices-oldies but goodies

bull What you should know aboutndash ButeBanamineKetofenndash Cosequinndash Adequanndash Hyaluronic acidndash Shock wave

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

irapTM Therapybull Controlled studies in horses with arthritis show positive effectsbull IL-1 is bad it is an important mediator of arthritisbull IL-1Ra =Interleukin-1 Receptor Antagonist Protein (Orthokinetrade) is good it

interferes with IL-1

bull Resultsuarr IL-1Ra (140 fold) Anti-inflammatoryuarr IL-4 (21 fold)uarr IL-10 (22 fold)No change IL-1 betaNo change TNF alpha Pro-inflammatory

Frisbee D Kawcak C Werpy N Park R McIlwraith W Clinical biochemical and histological effects of intra-articular administration of autologous conditioned serum in horses with experimentally induced osteoarthritis Amer Jour Vet Research Vol 68 No 3 2007

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

bull How does irap workndash The irap syringe contains medical grade glass

beads that stimulate the white blood cells to produce the anti-inflammatory and regenerative cytokines

ndash The whole blood is incubated overnight and then centrifuged to collect the special irapTM serum which is then re-injected into the patient

irapTM Therapy

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Bone marrow derived

Stem cells-disease of tendon ligament joint osteochondrosiscysts

Fat derived

bullConcentrate and deliver active fibroblasts (healing cells) to the site where healing is needed

bullDemonstrated improved healing and fiber patterns

bullHorses involved in jumping barrel racing and other non-race disciplines have returned to performance at levels comparable to pre-injury

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Tildren (Non-nitrogenous bisphosphonate)

bull Tildren (Tiludronate) in addition to decreasing osteoclast function it also has the added benefit of decreasing nitric oxide and cytokine formation by macrophages

bull Can be ordered by your veterinarian

bull 50 horses with navicular disease (Denoix) the 1mgkg total dose was more effective in reducing lameness in horses than 05mgkg total dose

bull horses with more acute history of lameness responded better than those with chronic disease

bull distal tarsal (hock) arthritisbull thoracolumbar disease (back pain)

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Rehabilitation and physical therapybull Rehabilitation of the equine athlete

is a critical step in the return to athletic performance

bull Narelle Stubbs will be presenting a free one hour webinar through My Horse University March 23rd at 7pm

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

bull BanamineBute given in the muscle can cause severe tissue sloughs

bull Use orally or have veterinarian give intravenously

bull Avoid using both at the same time

bull Toxicity preventionbull Problem likely too severe to be

working if that much drug is needed

bull New FEI rule

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Chondroprotectants

Chondroitin Sulfate and Glucosaminebull Enhances articular cartilage metabolismbull Anti-inflammatory effectsbull Basic building blocks for cartilage repairbull ldquoProtects cartilagerdquobull Not all created equallybull The quality of 14 out of 23 products

evaluated was adequate ndash Oke S Evaluation of glucosamine levels in

commercial equine oral supplements for joints Equine Vet J 2006 Jan38(1)93-5

Anti-arthritis medications

bull Polysulfated Gylcosaminoglycan (Adequanreg)bull Sodium Hyaluronate bull Corticosteroids

Adequanreg bullAnti-inflammatory affectsbullInhibits ldquobadrdquo enzymes

bullPGE2 synthesis cytokine release metalloproteases elastase cathepsins

bullStimulatesbullHA production by synoviocytesbullProteoglycan and collagen synthesis by chondrocytes

bullUsed in the vein and in the joint

Sodium Hylauronatebull Used in horses and humansbull Reduced pain and increased joint mobilitybull Compare favorably with NSAIDS and corticosteroidsbull Analgesic anti-inflammatory

ndash Inhibits cells and cell mediators of arthritisbull May improve range of motion by improving

ndash Synovial fluid viscosityndash Soft tissue lubricationndash Used in the vein and in the joint

bull Not all Sodium Hyaluronate products are created equally

ndash

Hylauronic acidMolecular weight is likely key

Hylartin V 35x106 3-18 mg

20mg

Hyvisc 21x106 4-18 20mg

Map-5 75x105 5-20 20mg(topical)

Legend 3x105 40-100

20mg IA or 40 IV

If being used in the joint ask for the best not the least expensive

Corticosteroids are Controversialbull Overuse is commonbull Neg effects on chondrocyte metabolism

ndash Inhibit proteoglycan synthesis (will see depletion in vivo)ndash Diminish organization of cartilage collagens (even in normal

cartilage)ndash Generally in high concentrations

bull Pos chondroprotective effectsndash Inhibition of bad enzymes and cytokinesndash Generally in low concentrations

Compounded DrugsHorse Deaths Raise Drug Safety ConcernsCritic Points to a Lack of Federal Oversight For Drug Compounding By AVNI PATELApril 24 2009 Compounded drugs responsible for the death of 21 polo ponies in Florida

Give us your feedback

bull You will receive a survey by email in 1-2 days Please take a few minutes to give us your feedback on this webcast It will help us to better serve you

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Adequanreg bullAnti-inflammatory affectsbullInhibits ldquobadrdquo enzymes

bullPGE2 synthesis cytokine release metalloproteases elastase cathepsins

bullStimulatesbullHA production by synoviocytesbullProteoglycan and collagen synthesis by chondrocytes

bullUsed in the vein and in the joint

Sodium Hylauronatebull Used in horses and humansbull Reduced pain and increased joint mobilitybull Compare favorably with NSAIDS and corticosteroidsbull Analgesic anti-inflammatory

ndash Inhibits cells and cell mediators of arthritisbull May improve range of motion by improving

ndash Synovial fluid viscosityndash Soft tissue lubricationndash Used in the vein and in the joint

bull Not all Sodium Hyaluronate products are created equally

ndash

Hylauronic acidMolecular weight is likely key

Hylartin V 35x106 3-18 mg

20mg

Hyvisc 21x106 4-18 20mg

Map-5 75x105 5-20 20mg(topical)

Legend 3x105 40-100

20mg IA or 40 IV

If being used in the joint ask for the best not the least expensive

Corticosteroids are Controversialbull Overuse is commonbull Neg effects on chondrocyte metabolism

ndash Inhibit proteoglycan synthesis (will see depletion in vivo)ndash Diminish organization of cartilage collagens (even in normal

cartilage)ndash Generally in high concentrations

bull Pos chondroprotective effectsndash Inhibition of bad enzymes and cytokinesndash Generally in low concentrations

Compounded DrugsHorse Deaths Raise Drug Safety ConcernsCritic Points to a Lack of Federal Oversight For Drug Compounding By AVNI PATELApril 24 2009 Compounded drugs responsible for the death of 21 polo ponies in Florida

Give us your feedback

bull You will receive a survey by email in 1-2 days Please take a few minutes to give us your feedback on this webcast It will help us to better serve you

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Sodium Hylauronatebull Used in horses and humansbull Reduced pain and increased joint mobilitybull Compare favorably with NSAIDS and corticosteroidsbull Analgesic anti-inflammatory

ndash Inhibits cells and cell mediators of arthritisbull May improve range of motion by improving

ndash Synovial fluid viscosityndash Soft tissue lubricationndash Used in the vein and in the joint

bull Not all Sodium Hyaluronate products are created equally

ndash

Hylauronic acidMolecular weight is likely key

Hylartin V 35x106 3-18 mg

20mg

Hyvisc 21x106 4-18 20mg

Map-5 75x105 5-20 20mg(topical)

Legend 3x105 40-100

20mg IA or 40 IV

If being used in the joint ask for the best not the least expensive

Corticosteroids are Controversialbull Overuse is commonbull Neg effects on chondrocyte metabolism

ndash Inhibit proteoglycan synthesis (will see depletion in vivo)ndash Diminish organization of cartilage collagens (even in normal

cartilage)ndash Generally in high concentrations

bull Pos chondroprotective effectsndash Inhibition of bad enzymes and cytokinesndash Generally in low concentrations

Compounded DrugsHorse Deaths Raise Drug Safety ConcernsCritic Points to a Lack of Federal Oversight For Drug Compounding By AVNI PATELApril 24 2009 Compounded drugs responsible for the death of 21 polo ponies in Florida

Give us your feedback

bull You will receive a survey by email in 1-2 days Please take a few minutes to give us your feedback on this webcast It will help us to better serve you

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Hylauronic acidMolecular weight is likely key

Hylartin V 35x106 3-18 mg

20mg

Hyvisc 21x106 4-18 20mg

Map-5 75x105 5-20 20mg(topical)

Legend 3x105 40-100

20mg IA or 40 IV

If being used in the joint ask for the best not the least expensive

Corticosteroids are Controversialbull Overuse is commonbull Neg effects on chondrocyte metabolism

ndash Inhibit proteoglycan synthesis (will see depletion in vivo)ndash Diminish organization of cartilage collagens (even in normal

cartilage)ndash Generally in high concentrations

bull Pos chondroprotective effectsndash Inhibition of bad enzymes and cytokinesndash Generally in low concentrations

Compounded DrugsHorse Deaths Raise Drug Safety ConcernsCritic Points to a Lack of Federal Oversight For Drug Compounding By AVNI PATELApril 24 2009 Compounded drugs responsible for the death of 21 polo ponies in Florida

Give us your feedback

bull You will receive a survey by email in 1-2 days Please take a few minutes to give us your feedback on this webcast It will help us to better serve you

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Corticosteroids are Controversialbull Overuse is commonbull Neg effects on chondrocyte metabolism

ndash Inhibit proteoglycan synthesis (will see depletion in vivo)ndash Diminish organization of cartilage collagens (even in normal

cartilage)ndash Generally in high concentrations

bull Pos chondroprotective effectsndash Inhibition of bad enzymes and cytokinesndash Generally in low concentrations

Compounded DrugsHorse Deaths Raise Drug Safety ConcernsCritic Points to a Lack of Federal Oversight For Drug Compounding By AVNI PATELApril 24 2009 Compounded drugs responsible for the death of 21 polo ponies in Florida

Give us your feedback

bull You will receive a survey by email in 1-2 days Please take a few minutes to give us your feedback on this webcast It will help us to better serve you

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Compounded DrugsHorse Deaths Raise Drug Safety ConcernsCritic Points to a Lack of Federal Oversight For Drug Compounding By AVNI PATELApril 24 2009 Compounded drugs responsible for the death of 21 polo ponies in Florida

Give us your feedback

bull You will receive a survey by email in 1-2 days Please take a few minutes to give us your feedback on this webcast It will help us to better serve you

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Give us your feedback

bull You will receive a survey by email in 1-2 days Please take a few minutes to give us your feedback on this webcast It will help us to better serve you

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Upcoming Webcasts

Rehabilitating the Lame HorseMarch 23 2010 | 7pm ET

Equine Emergency First AidApril 20 2010 | 7pm ET

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
• Give us your feedback
• Upcoming Webcasts
• Slide 57

Thank you for attending this live web presentation

For more information about My Horse University please visit us at

wwwmyhorseuniversitycom

infomyhorseuniversitycom | wwwmyhorseuniversitycom | 517-353-3123

• Slide 1
• Meet our presenter
• National Animal Health Monitoring System National estimate of economic costs (NAHMS Study)
• Lameness
• Prevention
• Slide 6
• Slide 7
• Pick a good farrier
• Slide 9
• Slide 10
• Slide 11
• Thermography
• SADDLE FIT
• ENGLISH SADDLE Thermographic image-post ride
• WESTERN SADDLE Thermographic image-post ride
• Lameness Evaluation-Standing
• Slide 17
• Forelimb lameness
• Hindlimb lameness
• Even subtle lameness can affect performance
• Slide 21
• Nerve and joint blocks
• Gait Analysis
• Gait analysis of Piaffe
• Gait analysis of the lame horse
• RadiographsXrays
• Diagnostic Ultrasound
• Slide 28
• Slide 29
• Some contribution factors tendonitis
• Bone Scan images
• Magnetic Resonance Imaging (MRI) Michigan State University
• Magnetic Resonance Imaging (MRI)
• Common causes of lameness in the performance horse (Abbreviated list)
• Navicular Disease Diagnosis
• Slide 36
• Front view (AP)
• Enlarged vascular channels
• Classical treatment of navicular syndrome
• Lameness treatment choices- Whatrsquos new for Navicular Disease Arthritis Tendon and Ligament injuries
• irapTM Therapy
• Slide 42
• Bone marrow derived
• Slide 44
• Tildren (Non-nitrogenous bisphosphonate)
• Rehabilitation and physical therapy
• Slide 47
• Chondroprotectants
• Anti-arthritis medications
• Adequanreg
• Sodium Hylauronate
• Hylauronic acid Molecular weight is likely key
• Corticosteroids are Controversial
• Compounded Drugs
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• Upcoming Webcasts
• Slide 57