Equis ISSN 2398-2977

Forelimb: joint anesthesia

Contributor(s): Dennis R Gieser, Laura Quiney

Introduction

  • Intrasynovial injection of anesthetic can desensitizes structures within and adjacent to the joint.
  • Elimination of pain or lameness by intrasynovial anesthesia localizes source of pain to that joint, including surrounding structures.
  • Approach to joints for synovial fluid collection Synovial fluid: collection is the same.

Uses

  • More precise localization of source of pain following regional anesthesia.
  • Establish the significance of imaging findings.
  • Collection of joint fluid for gross or more specialized (chemical testing, culture, microscopic examination) analysis prior to anesthesia.

Advantages

  • Minimally invasive technique.
  • Useful to localize source of pain.
  • Directs imaging, diagnosis, prognosis and treatment.
  • Can be combined with intrasynovial medication.
  • Septic synovitis is a relatively rare occurrence with appropriate aseptic and procedural techniques.
  • Majority of intrasynovial injection techniques are easy to perform.
  • Usually well tolerated by horses, however fractious horses can complicate the procedure.

Disadvantages

  • Not necessarily joint specific:
    • False-positive results: diffusion of local anesthetic and desensitization of extra-articular structures or nerves.
    • False-negative results: pain arising from the subchondral bone will not usually be desensitized by intra-articular local anesthesia.
  • Risk of introducing pathogens → septic synovitis.
  • Need to delay anesthesia until regional effects of perineural analgesia has worn off and lameness has returned to baseline.
  • Multiple joint entry can → soft tissue thickening or fibrosis.

Requirements

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Preparation

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Procedure

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Aftercare

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Schneeweiss W, Puggioni A & David F (2012) Comparison of ultrasound-guided vs. 'blind' techniques for intra-synovial injections of the shoulder area in horses: Scapulohumeral joint, bicipital and infraspinatus bursae. Equine Vet J 44 (6), 674-678 PubMed.
  • Schumacher J, Schumacher J, Schramme M C, DeGraves F J, Smith R & Coker M (2004) Diagnostic analgesia of the equine forefoot. Equine Vet Educ 16 (3), 159-165 VetMedResource.
  • Schumacher J, Schumacher J et al (2003) The effects of local anaesthetic solution in the navicular bursa of horses with lameness caused by distal interphalangeal joint painEquine Vet J 35 (5), 502-505 PubMed.
  • Schumacher J, Steiger R, Schumacher J et al (2000) Effects of analgesia of the distal interphalangeal joint or palmar digital nerves on lameness caused by solar pain in horses. Vet Surg 29 (1), 54-58 PubMed.
  • Drevemo S, Johnston C, Roepstorff L & Gustas P (1999) Nerve block and intra-articular anaesthesia of the forelimb in the sound horse. Equine Vet J Suppl 30, 266-269 PubMed.

Other sources of information

  • Moyer W, Schumacher J & Schumacher J (2011) Eds Equine Joint Injection and Regional Anesthesia. In: Academic Veterinary Solutions. Chadds Ford, USA.
  • Bassage L H & Ross M W (2011) Diagnostic Analgesia. In: Diagnosis and Management of Lameness in the Horse. Eds: Ross M.W & Dyson S J. Elsevier Saunders, USA. pp 100-135.
  • Schumacher J, Schramme M C, Schumacher J, Smith R K W & Coker M (2003) A Review of Recent Studies Concerning Diagnostic Analgesia of the Equine Foot. In:P roc 49th AAEP Convention. pp 312-316.
  • Schumacher J, Livesey L, Schramme M C, Schumacher J & DeGraves F (2003) Effect of Anesthesia of the Palmar Digital Nerves on Lameness Caused by Pain in the Proximal Interphalangeal Joint. In: Proc 49th AAEP Convention. pp 287-290.


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