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Shai Halimaar

Shai Halimaar. Case #156122. Shai Halimaar. 7 year old Arabian gelding Historically (06/09), Diagnosed and treated for EPM First presented on 6/2/10 Owner complaint: Right forelimb lameness March 9 th , 2010: first noticed March 10 th : Examined and referred to Dr. Meyer

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Shai Halimaar

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  1. ShaiHalimaar Case #156122

  2. ShaiHalimaar • 7 year old Arabian gelding • Historically (06/09), Diagnosed and treated for EPM • First presented on 6/2/10 • Owner complaint: Right forelimb lameness • March 9th, 2010: first noticed • March 10th: Examined and referred to Dr. Meyer • March 16th: Diagnosed with a suspensory injury • Stall rest and Phenylbutazone until 3/22 • Acupuncture and Chiropractic work • March 23rd: After having been placed out on pasture, again lame RF • Rest, ride (4/11, 4/30, 5/4), lame… then repeat, until…

  3. Presentation at NCSU-VTH • Physical exam within normal limits • Lameness exam • Mild 3/5 RF in a straight line on a hard surface, worse under saddle • Flexion tests were negative, both front limbs • Circling on the left rein on a soft surface • Produced a left front lameness • Circling on the right rein on a soft surface • Accentuated a right front lameness • PD of RF = LF lameness • Subsequent PD of LF = resolved all lameness

  4. Further Workup • Ultrasound of RF suspensory • No abnormalities • Radiographs of left and right front feet: • Breakover point is long, mildly contracted hoof capsules bilaterally • FINAL DIAGNOSIS: • Bilateral forelimb lameness, blocks to a PD • First, corrective farriery; Second, coffin/navicular bursa injections; Third, MRI

  5. Front Foot Rads

  6. 5 months later (08/04/11)… • Corrective shoeing had failed to produce improvement • PE wnl • Lameness exam- no change EXCEPT… • Failed to improve to PD, Basisesamoid, Low-4point, or high suspensory • Nuclear Scintigraphy was recommended

  7. Bone Scan – Soft tissue phase

  8. Bone Phase

  9. Right Carpus Radiographs

  10. Left Carpus Radiographs

  11. R DMPLO L DMPLO

  12. Further Examination • RF middle carpal block • Minor improvement • LF middle carpal block • Marked improvement in LF lameness • Exacerbated the RF lameness • No improvement with RF suspensory or Median/Ulnar block • FINAL DIAGNOSIS: Bilateral Front limb lameness, Carpal Osteoarthritis of the LF Carpometacarpal and middle carpal joints • Bute and handwalking for a week • Intra-articular steroid and hyaluronic acid injections, carpi

  13. 08/16/2010, Recheck • 10 mg of hyaluronic acid and 20mg of triamcinoloneinto the intercarpal joint, bilaterally • 09/07/2010, Recheck • Had been sound at the walk • At the trot, short steps RH and LF • PE: mild abrasion over the LF carpus, all else wnl • Mild bilateral forelimb lameness, 2/5 • Mild RH lameness, 2/5 • Intra-articular injections of triamcinolone bilaterally in the TMT and DIT joints

  14. The Rest of the Story (10/06/10, Recheck) • Owner notes that Hal is comfortable, until under saddle, at which time he is mild RF lame • Bilateral front limb, Distal Flexion: ++ • Lunging • Tracking right: 3/3 RF lameness • Tracking left: 2/5 RF Lameness • R Shoulder block = no improvement • RF basisesamoid block • 80% improvement on hard surface, 100% on soft • With rider, 50% improvement on straight line, little improvement when tracking right • Thoracic spine rads: wnl • Right Fetlock rads: large osteophyte, DM aspect of P1 • RF coffin/fetlock joint treated with triamcinolone/HA

  15. Right Fetlock Radiographs DLPMO DMPLO

  16. Arabian horses were found to be over-represented for severe DJD of the carpometacarpal joint • 74% Arabs vs. 12% non-Arab horses • Mean age of diagnosis in Arab horses was 14.4 years • Trauma was known in 34% of the Arabs • Conformational defects not noted in all but one horse

  17. Absence of a palmar articulation between MC3 and MC2 was observed in 48% of Arabian horses vs. 12% in non-Arabs • Ultrasonographically, the interosseus ligament was visible in the horses without the palmar articulation • Breed differences in carpometacarpal joint articulation may be responsible for the increased frequency of this condition in Arabs • Ultrasound may be a valuable screening tool for predisposed animals

  18. Found Quarter Horses to be significantly over-represented for CMC DJD in their population • Consistent clinical findings • Radiographic findings • Proliferative new bone growth on MC2 extending to MC3, C2, and C3 • Narrowing of the CMC joint space • Subchondral bone lysis of MC2 and/or C2

  19. Outcomes • Left untreated, none of the horses returned to work and 4/5 were euthanized for lameness within 3 years • 9/12 treated horses saw improvement, but only for a mean of 4.6 months • 6/14 of the treated horses were euthanized for lameness within 4 years

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