Okay, so today let’s solve the mystery of horse navicular. Renee Tucker here with Tucker Biokinetic University. But the information is available now, and yet I don’t hear vets telling the truth about this. True, we did not learn this in vet school. What I’m salty about is that vets should know this. I talk about the two primary causes of navicular, which are: I might have been a little salty on this podcast…you’ll have to let me know. The study, “ An ultrasound-guided, tendon-sparing, lateral approach to injection of the navicular bursa,” was published in the Equine Veterinary Journal.In this episode of “Horse Mysteries Solved…” Now validated, the technique is currently used on a regular basis at the Equine Teaching Hospital of Lyon (Clinéquine, VetAgro Sup) in Lyon, France, Nottrott said. To succeed in reaching the navicular bursa via ultrasound, practitioners must recognize the importance of good hoof positioning, correct transducer (ultrasound probe) alignment, and competent anatomic structure knowledge, all of which are essential for success, he said. “So, this could further minimize inadvertent tissue trauma, and no contrast medium needs to be injected to localize and verify the needle tip within the navicular bursa,” he added. With the ultrasound-guided technique, the practitioner can follow the needle on the screen in real time, so needle repositioning is less frequent-an average of 1.1 times per horse in the current study, he said. The frequent repositioning of the needle might cause trauma to surrounding soft tissues.” “This means that several X rays need to be taken before the navicular bursa is reached successfully, which exposes the staff to radiation. “That study showed that repositioning the needle is required several times (three times per horse on average), and a radiographic contrast medium has to be injected each time to be visualized on a ‘one-moment’ X ray,” he said. The technique described in a 2013 study that also aimed for a lateral approach to avoid the DDFT had good results, but requires multiple X rays to check the needle position. When they didn’t get the agent into the navicular bursa, it was usually related to a poor ultrasound image, he said. They successfully placed the contrast agent into the navicular bursa in 91% of the 114 total limbs in 78% of the cases, the agent made it to the navicular bursa alone without affecting other structures, Nottrott said. This allowed them to trace the needle’s pathway when they opened the cadaver hoof to explore the effects of their work. In the cadavers, they also injected a second agent-methylene blue-as they pulled the needle out of the foot. Then, they carried out the same procedure in 26 live horses’ forelimbs (52 injections). To test their correct needle position, they injected the tissue with a radiocontrast agent and then verified that agent’s placement using radiographs. They then used an ultrasound probe positioned just below the fetlock to guide the needle placement into the navicular bursa in 62 hooves. Nottrott and his fellow researchers tested the technique using cadaver forelimbs placed in the flexed position. Efforts to reach the navicular bursa through the back of the pastern (to avoid the hoof capsule) require passing the needle through the DDFT. It also means avoiding trauma to the deep digital flexor tendon (DDFT), he added. “Plus, the ultrasound technique requires less repositioning of the needle and would theoretically take less time than an X ray-guided technique, meaning reduced risk of infection and probably lower levels of stress for the horse.” “By eliminating the need for radiographic control of needle position used in current techniques, we are no longer exposing staff to the radiation,” said Nottrott. This led not only to successful injection but also to reduced risks for both horse and veterinarian. Then by accessing the foot laterally through the tissue above the hoof on the side, the scientists were able to “see” the needle via ultrasound entering the navicular bursa without interference from the hoof wall. Scientists recently tried a new technique, however, by first placing the hoof in a 60° flexed position-a navicular or Hickman block position (a special block in which the horse rests a hoof while the veterinarian takes a navicular bone X ray).
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