Hemarthrosis in Horses

Symptoms, Causes and Risks

• Symptoms of hemarthrosis include fatigue, joint heat, swelling and inflammation, fluid surrounding the joint (synovial effusion) and an intensification of discomfort when flexing the affected joint. Serious injury and fractures to the joints of horses causes them to break down, as well as causing damage to the capsule, cartilage and ligaments. The most common fractures include those to the proximal sesamoid bones and the condylar (distal portion of the cannon bone). Medial collateral ligament injuries may also lead to hemarthrosis. This level of deterioration leads to a severe weakening of the joint̵7;s ability to continue to sustain repeated activity, which may increase the probability of hemarthrosis, or bleeding inside the joint. Serious joint damage and bleeding are typical in racehorses, competition and sport horses. Thoroughbred racehorses generally suffer from joint damage and bleeding due to prolonged over-extension of the forelimb and suspensory ligament.

Diagnosis and Treatment

• Arthroscopic surgery enables veterinary surgeons to effectively diagnosis hemarthrosis in horses and assesses the soft tissues of the joint through minimally invasive procedures, which leads to the likelihood of faster healing and recovery times. Arthroscopy combines diagnostic efforts with surgical therapy by allowing the surgeon to stop the bleeding, repair the joint, insert orthopedic implants and administer antibiotics to manage infections. Treatment for hemarthrosis depends on the underlying cause; however, typically it involves using an equine sling to reduce postoperative weight-bearing and reduce the risk of laminitis. Other rehabilitative treatments may include pain management, physical therapy beyond turnout, shock wave therapy, nonsteroidal anti-inflammatory drugs (NSAIDS) and corticosteroids. The goal of treatment protocol is to re-establish the joint to normal function quickly to reduce potential complications, such as progressive joint deterioration and lameness.

Complications

• Complications following a traumatic injury of the joint in which hemarthrosis is present typically involves preoperative transport to the hospital, intra-operative repair of the fracture, post-surgical recovery from anesthesia and unforeseen post-operative complications related to healing and rehabilitative efforts. Post-operative difficulties may occur from infection, soft tissue damage and support limb laminitis. Laminitis or ̶0;founder̶1; is an acute inflammation of the hoof̵7;s sensitive tissue or ̶0;laminae.̶1; According to Dr. Gary Baxter, a professor in equine surgery at Colorado State University's College of Veterinary Medicine, support limb laminitis is typical in the hind or foreleg opposite the injured limb and often presents in multiple feet due to the inability for horses to shift their weight and achieve adequate circulation. The most effective preventative measure against laminitis is encouraging normal weight bearing as soon as possible.

Prognosis

• Repair and healing rates of equine fractures have improved considerably with the latest treatments. However, even simple joint fractures can result in critical complications. Prognosis following surgery and treatment relies on multiple factors, including size, weight, conformation and temperament; whether it̵7;s a sport horse or racehorse, and the type, location and configuration of the fracture. According to a 1998 study published in the "Journal of the American Veterinary Medical Association," more than 90 percent of horses that sustain common fractures, which include non-displaced lateral condylar injuries of the forelimb or hindlimb, return to racing after surgery. However, those that experience fractures of the forelimb or suffer from displaced joint fractures may be less likely to return to racing following surgical treatment.