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Discussion on Research Study: Diagnosing Hip Dislocation with Ultrasound

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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 23987
Registered: 1-1997
Posted on Tuesday, Oct 27, 2009 - 5:05 am:   Edit PostPrint Post

This is a great study that solves one of the diagnostic problems with ruling out diseases of the upper rear limb: the subluxated hip. Though a rarity the very poor prognosis makes early diagnosis important. However it is very difficult to image the hip radiographically even with big in-hospital machines. It requires general anesthesia and recovery for the severely lame horse very difficult.

Interestingly this study did not find any reliable clinical signs of hip subluxation other than acute onset of a severe lameness. I was surprised that crepitus was not present. The procedure does require a bit more ultrasound than what is typically found in the field and requires "dynamic" imaging which means imaging the joint while the horse is rocked onto the leg and off.

Vet Radiol Ultrasound. 2009 Jul-Aug;50(4):423-8.
Ultrasonographic diagnosis of coxofemoral subluxation in horses.

Brenner S, Whitcomb MB.
Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.

The clinical and ultrasonographic features of seven horses with coxofemoral subluxation are presented. Affected horses included five adult geldings (11-20 years), one large pony (6 years) and a 3-month-old filly. All were lame at the walk except for the pony with grade 3/5 lameness. Lameness was acute in all horses, but three horses progressed after initial improvement. Crepitus, muscle atrophy, and pelvic asymmetry were inconsistent findings. Ultrasonographic diagnosis of subluxation required dynamic visualization of femoral head displacement from the acetabulum while placing weight on the affected limb and subsequent replacement into its normal position upon limb resting. Acetabular rim fractures and joint effusion were visible regardless of weight bearing status in six horses each. No fractures were identified in the pony; the only patient with a good outcome. Six horses had a poor outcome with severe chronic lameness, four of which were euthanized. Postmortem ventrodorsal radiographs obtained in two horses confirmed subluxation only on extended limb projections, but not on hip-flexed projections. Acetabular rim fractures were not visible radiographically in either horse but were confirmed at necropsy. Subluxation was due to an elongated but intact ligament of the head of the femur in both horses. Osteoarthrosis was evident ultrasonographically, radiographically, and at necropsy. Dynamic ultrasonography was readily performed in the standing horse and produced diagnostic images with a low frequency curvilinear transducer. The apparent poor prognosis for horses with subluxation and acetabular fracture illustrate the importance of this imaging technique to identify affected horses.
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Sullivan's Cutting Horses
Member
Username: sully

Post Number: 114
Registered: 6-2004
Posted on Wednesday, Dec 30, 2009 - 12:57 am:   Edit PostPrint Post

Hello Dr. O,
I came across this article and would like some help. I have a horse that moves funny. I had my Veterinary watch as she was being ridden. From what she tells me, it only seems to affect her on the right lead. She has an extra beat in there, almost like a gaited horse without the smoothness. Her exact words "the dangest thing". She did lameness tests with her and could not find anything wrong. She thinks this could be in the hip. This mare came home from training because of this. Another vet had found fluid in her stifle and said to give her 2-4 months off and try again. I had her stifle ultra sounded and the fluid was gone. I sent her to a local trainer and he spent 2 weeks doing ground work with her. The first time he rode her this did not show up. It was from the 2nd ride on that she started moving funny again and also shying at things that had not bothered her before and thats when he called and I had my vet watch her while she was being rode. Could this be whats wrong with her? and is there any where close to South Dakota that could diagnose her? To look at her, you cannot see anything that looks wrong until you see her being ridden at a canter on her right lead. She also seemed sore above her hip when palpated. When this first showed up at the trainers, they had a chiropractor look at her and he thought her hip had been capped. When I asked what that even meant, he said like she had been run through a gate that had been slammed shut and caught her in the hip area. Any ideas on where I could go from here? She seems just fine out in pasture, would not even know she has a problem.
Thank you,
Nancy


Happy New Years :-)
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 24268
Registered: 1-1997
Posted on Wednesday, Dec 30, 2009 - 5:22 am:   Edit PostPrint Post

Hello Nancy,
I don't think what you are describing sounds much like coxofemoral subluxation. Horses with this condition are very lame.

What you need to do is find someone who can accurately label that "funny" movement that your horse is doing and then judge if this is the horse's normal gait or a change in gait due to pain. It does sound like your veterinarian believes this is more natural gait than lameness but I remain uncertain. As to where to take the horse to next, you should contact that same local veterinarian for a lameness referral.

For more on diagnosing lameness check out Diseases of Horses » Lameness » Localizing Lameness in the Horse. It will explain what you should be looking for.
DrO
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