ISSN 2398-2977      

Hindlimb: joint anesthesia

pequis

Introduction

  • Intrasynovial injection of anesthetic can desensitize all structures within and adjacent to the joint Anesthesia: intra-articular.
  • 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

  • Risk of introducing pathogens → septic synovitis.
  • Diffusion of local anesthetic solution and desensitization of extra-articular structures or adjacent nerves → false-positive results.
  • Complete elimination of pain and therefore lameness may not be achieved.
  • Need to delay anesthesia until regional effects of perineural analgesia have worn off and lameness has returned to baseline.
  • Multiple joint entry can → soft tissue thickening or fibrosis.
  • Response to more proximal joint analgesia is much slower than for distal joints adequate time must be allowed for complete action.
  • The deep level of the hip joint and the proximity of the sciatic nerve makes anesthesia of the coxofemoral joint particularly difficult and potentially risky.
  • Subchondral bone pain rarely responds to intra-articular anesthesia (false-negative results), eg subchondral bone cysts Bone: subchondral cysts, osseous cyst-like lesions Bone: osseous cyst-like lesions, some osteochondrosis lesions Bone: osteochondrosis, trabecular densification (third or central tarsal bones), chronic meniscal injuries Stifle: trauma - meniscal perineural analgesia is often required to locate site of pain.

Requirements

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Preparation

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Procedure

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Aftercare

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Poore L A B, Lambert K L, Shaw D J & Weaver M P (2011) Comparison of three methods of injecting the proximal interphalangeal joint in horses. Vet Rec 168 (11), 302 PubMed.
  • David F, Rougier M, Alexander K & Morisset S (2007) Ultrasound‐guided coxofemoral arthrocentesis in horses. Equine Vet J 39 (1), 79-83 PubMed.
  • 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.
  • Hendrickson D A & Nixon A J (1992) A lateral approach for synovial fluid aspiration and joint injection of the femoropatellar joint of the horse. Equine Vet J 24, 399-401 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 Sunders, USA. pp 100-135.
  • David F, Rougier M, Alexander K & Morisset S (2006) Ultrasound-guided coxofemoral arthrocentesis in horses. In: Proc ECVS Seville, Spain. Eds: Schramme M, Tremaine H, Walmsley J & Houlton J. ECVS, Zurich. pp 82-85.
  • Dyson S (2006) Critical Evaluation and Review of Local Anaesthetic techniques for the Upper Hindlimb. In: Handbook of Presentations & Free Communications. BEVA Congress 2006. BEVA, UK. pp 33-34.
  • Redding W R (2006) Critical Evaluation and Review of Local Anaesthetic techniques for the Lower Limb. In: Handbook of Presentations & Free Communications. BEVA Congress 2006. BEVA, UK. pp 28-30.
  • 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.
  • Stashak T S (2002) Intrasynovial Anesthesia. In: Adams Lameness in Horses. 5th edn. Lippincott, Williams & Wilkins, USA. pp 168-180.

Can’t find what you’re looking for?

We have an ever growing content library on Vetlexicon so if you ever find we haven't covered something that you need please fill in the form below and let us know!