Non-Septic Synovitis/Bursitis/Tenosynovitis

inflammation without infection; injury of synovial tissue, fibrous capsule, and/or ligaments of the joint

What is non-septic synovitis/bursitis?

true

T/F: If synovitis is treated appropriately, a horse may recover full function.

osteoarthritis, lameness, and loss of use

If synovitis is left untreated, what may result?

skin-protective covering, tendons and ligaments, joint capsule, synovial lining, and cartilage

What are the components of the joint?

secretes synovial fluid and filters blood, allowing only certain components into joint

What is the purpose of the synovial lining?

covers bone ends, provides shock absorption, reduces concussion and friction

What support does cartilage provide?

acute injury via joint instability and/or inflammation or repetitive injury from wear and tear

How does synovitis occur?

heat, pain, swelling, reduced range of motion, positive flexion test, lameness

What are clinical signs of synovitis?

reduce pain and inflammation, prevent cartilage degradation, lubricate joint, return function

What are treatment goals for synovitis?

rest, cold therapy and bandaging, controlled exercise, NSAIDs, surgery (when appropriate), sodium hyaluronate, polysulfated glycosaminoglycans, steroids, IRAP

What are treatment options for synovitis?

acute phase

Cold therapy and bandaging is very important in what phase of injury?

Phenylbutazone, Banamine, Equioxx, Surprass

What are examples of NSAIDs used for synovitis?

Bute and banamine

Which NSAIDs are non-selective?

gastrointestinal damage and ulcers, irreversible kidney damage

What are significant side effects seen with long term use or with high doses of nonselective NSAIDs?

sodium hylauronate

glycosaminoglycan that naturally occurs in articular cartilage, principal lubricant of synovial soft tissues and responsible for viscoelasticity of fluid

inhibits inflammatory cells and mediators, may improve range of motion by improving fluid viscosity and soft tissue lubrication

What is the function of sodium hylauronate?

Hyvisc, Map-5, and Legend

What are the 3 brands of hylauronate?

inhibits degratory substances (PGE2 synthesis, cytokine release, metalloproteases), stimulates HA production by synoviocytes and proteoglycan synthesis by chondrocytes

What is the function of polysulfated glycosaminoglycans (PSGAGS- Adequan)?

IM

How are PSGAGS administered?

They down-regulate complement, which is part of the immune system- not able to fight infection

Why is there increased incidence of septic arthritis when PSGAGS are given in the joint?

125mg Amikacin

If PSGAGS is given in the joint, what should be given with it?

corticosteroids

most potent anti-inflammatory agent used to treat osteoarthritis and synovitis, but inhibits many anti-inflammatory processes

negative effects on chondrocyte metabolism in the first 7-10 days

Why is corticosteroid use controversial?

inhibits proteoglycan synthesis, diminishes organization of cartilage collagens; generally when administering high concentrations

What are the negative effects of steroids on chondrocyte metabolism?

inhibition of metalloproteinases and cytokines, generally when administering low concentrations

What are the positive chondroprotective effects of steroids?

triamcinolone in high motion joints, methylprednisolone (depo medrol) in low motion joints

Which are the most common formulation used in high and low motion joints?

harvest whole blood in sterile fashion in special syringe with glass beads, incubate for 24 hours, inject serum into joint and amplifies the horse's own anti-inflammatory products

What is IRAP/Prostride?

Autologous conditioned serum

What is IRAP also called?

Polacrylamide hydrogels

recent addition to treatment options that is hydrophilic, homogenous, biocompatible, and viscoelastic; integrate into tissues through blood vessel ingrowth, collagen deposition and water exchange

hyaluronic acid, PSGAGS-enzyme inhibition, corticosteroids

What are the 3 most commonly used intra-articular preparations in the horse?

synovitis, and in combination with steroids for DJD

What is hyaluronic acid indicated for?

synovitis and DJD

What is PSGAGS indicated for?

short acting for synovitis and long acting for DJD

What are corticosteroids indicated for?

corticosteroids

Of the 3, which is the most potent?

lymphatic drainage

When performing physical therapy, what does massage of the limbs promote?

reduces pain and stiffness

How does passive range of motion contribute to physical therapy?

promotes blood flow and influx of growth factors

How does therapeutic laser contribute to physical therapy?

olecranon bursitis- due to repeated trauma, often from shoe while laying down

What is "shoe boil" and how does it occur?

No, usually not

Does olecranon bursitis/shoe boil cause lameness?

prevent further trauma, drain, inject steroids, surgical excision if chronic or unresponsive

What is the treatment for shoe boil?

calcaneal bursitis- caused by acute trauma, such as kicking the stall or trailer

What is "capped hock" and how does it occur?

rest, cold therapy, anti-inflammatory meds, and bandaging

What is the treatment for capped hock?

False

T/F: Capped hock typically causes lameness

Tarsal sheath tenosynovitis/"thoroughpin

can be idiopathic: mild effusion w/out lameness; primary injury of deep digital flexor tendon or sustantaculum tali

digital sheath tenosynovitis- primary sheath injury, injury to structures in sheath, restriction by palmar/plantar annular ligament

What are "wind puffs" and how do they occur?

tenoscopy to debride tears in tendons or relieve adhesions, palmar/plantar annular ligament demotomy to relieve pressure

What is the treatment for wind puffs?