EQUINE VETERINARY EDUCATION / AE / JANUARY 2020
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* 1 3 3 3 4 4
Fig 3: Parasagittal ultrasound scan of the sacroiliac joint (cranial is to the left) of a horse (female) with a grade 2 osteoarthrosis. Moderate periarticular proliferation is imaged on the sacral and iliac wings (arrow heads). The ventral sacroiliac ligament presents a heterogeneous echogenicity. 1: sacral wing; 2: iliac wing; 3: ventral sacroiliac ligament; 4: cranial gluteal artery and vein; *sacroiliac joint space.
Fig 5: Parasagittal ultrasound scan of the sacroiliac joint (cranial is to the left) of a horse (gelding) with a grade 4 osteoarthrosis. Joint margins present severe irregularities of the bone surface with an altered shape of the sacral and iliac wings (arrow heads). The ventral
2 1 2
*
sacroiliac ligament presents a severely
heterogeneous echogenicity. 1: sacral wing; 2: iliac wing; 3: ventral sacroiliac ligament; 4: cranial gluteal artery and vein; *sacroiliac joint space.
2 * 1 3 4
Fig 4: Parasagittal ultrasound scan of the sacroiliac joint (cranial is to the left) of a horse (gelding) with a grade 3 osteoarthrosis. The sacral and iliac wings present marked alteration of their shape (arrow heads). 1: sacral wing; 2: iliac wing; 3: ventral sacroiliac ligament; 4: cranial gluteal artery and vein; *sacroiliac joint space.
assessment of the area (Denoix and Coudry 2005). Musculature and symmetry of the pelvis are better assessed at walk than on the standing horse, because of the symmetrical left and right movements of the area at walk (Denoix and Coudry 2005). Inspection of the pelvis may highlight nonspecific signs such as unilateral or bilateral muscle atrophy (gluteus medius muscle). Atrophy in the femoral area (gluteofemoralis muscle) is uncommon but more specific for sacroiliac disease (Denoix and Coudry 2005; Denoix 2016). Nevertheless, a lot of horses affected with sacroiliac injuries do not present any atrophy (Denoix et al. 2005). Pelvic asymmetry can also be associated with a wider sacroiliac joint space (Erichsen et al. 2002; Denoix 2016). Palpation and pressure on the sacroiliac area are useful to
evaluate pain. Racing trotters are commonly more sensitive than other discipline horses over the lumbosacroiliac area (Denoix and Coudry 2005; Denoix et al. 2005). The most common clinical features of affected horses are lack of engagement and/or propulsion, mild chronic hindlimb lameness, poor action and back stiffness (Tucker et al. 1998; Erichsen et al. 2002; Dyson and Murray 2003; Haussler 2004; Denoix et al. 2005; Engeli et al. 2006; Haussler 2010; Denoix 2016). Each discipline displays specific manifestations. Sport horses usually demonstrate asymmetry at canter (or disunited canter) with difficulties changing leads, alteration of jump style or refusing jumps, poor engagement, reluctance and lack of power on short turns or fighting the rider. Thoroughbreds show stiff or short gaits and trotters have commonly irregular gaits at high speed and/or on turns and a curved or oblique attitude in the sulky (Denoix et al. 2005; Denoix 2016). These troubles are commonly worse when the horse is ridden (Dyson and Murray 2003) or driven (Denoix 2016). Obvious lameness and acute pain are not typically observed in horses affected by chronic sacroiliac injuries (Denoix and Coudry 2005), unless an acute pelvic fracture or a luxation is present (Haussler 2004; Denoix 2016). For these reasons, ultrasonographic examination of the pelvis should be routinely performed in horses suspected of back or pelvis pain or with low-grade hindlimb lameness. The clinical significance of sacroiliac joint disorders is
difficult to assess because of high prevalence in the presumed normal horse population (Haussler and Stover 1998; Haussler 2004). In our centre, grade 1 and 2 lesions of the sacroiliac joint margins are observed ultrasonographically in more than 50% of horses presented for a locomotor check-up. Grade 3 or 4 lesions are found in horses presenting athletic manifestations. Sacroiliac pain is not easily evaluated in horses and differential diagnosis with lumbosacral pain is difficult (Denoix et al. 2005). It can occur alone or in conjunction with thoracolumbar pain as well as hindlimb or forelimb lameness (Dyson and Murray 2003; Tomlinson et al. 2003).
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