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SyncThermology Blog

Identifying Early Stage Pathology

Tuesday, June 05, 2018  ‹ Back To Latest News List

Detecting injury and disease at an early stage is an attractive idea but the reality of putting this into practice can be a challenge. Often clients notice subtle gait changes or report a behavioural problem before clinical signs occur. Even though clients would like to identify problems in their animals earlier, the cost of doing so is not always viable and the use of diagnostic anaesthesia/ diagnostic imaging for subtle signs of potential pathology is not always viable. The use of physiological imaging to identify disease and injury and an earlier stage provides an economic screening modality to veterinary practices that can help guide the targeted investigation.


Historically we have mainly been referred cases post initial investigation or as a last resort, but over the past 12 months we have received an increasing amount of referrals in the earlier stages when suitable signs of discomfort or lameness have been detected. We are also regularly correlating previous cases where results at the time were deemed insignificant, only to find out that the initial localised area has been later investigated and a diagnosis has been reached. As the correlated cases and the acceptance for the technology increases we are able to better gauge the scope of physiological imaging when being used to assist early stage disease or injury detection. The case below provides an excellent example of what we now see regularly at SyncThermology. Thank you to the practices that work with us to correlate these exciting cases and improve early stage detection.


Canine case - Coby


Coby is a 4 year old Alaskan Malamute who fell into a ditch in May 2015. After the accident his owner noticed he was uncomfortable and then shortly after a low grade intermittent lameness developed in the right fire limb, occasionally presenting in the left fore. Coby was initially investigated and X-Rays of hips, shoulders, elbows and stifle joints showed no significant findi finding so he was referred to us for physiological imaging. During our work-up, the lameness was observed in both forelimbs, Coby found it very difficult to stand still during screening and needed support and encouragement. When stood still, there was a tendency for the left hind to be placed out to the left and he was guarded when working round his back legs.


Results

Sync’s vet Ciara found diffuse hyperthermic asymmetry of the right scapular region and on cranial views of the chest there was hyperthermic asymmetry of the right shoulder joint regio. It was suspected that the primary issues was with the right shoulder as there was weight transfer off the right fore to the left hind limb. Clinical correlation was advised.


Conclusion

Arthroscopy was performed on both shoulders and although they were found to be within normal limits, instability of the medial glenohumeral ligament in the right shoulder was detected, the ligament showed a small amount of wear which was thought to be causing the lameness. Coby was injected with a long acting steroid into each shoulder joint, rested and prescribed tramadol to ease any discomfort during his rehabilitation. His owner reported that lameness subsided and Coby is now back to his normal activities.  


Equine case - Nimmy


Nimmy is an 11 year old Warmblood x Thoroughbred mare that we originally assessed in February 2016 when her owner reported tendencies to ‘nap’ when turning on a tight circle to the left. When jumping she also favoured the LF on landing. There were also some additional areas of concerns unrelated to the LF so a full body scan was completed. Numerous areas of interest were reported on but the most significant finding was identified as inflammation of the RF foot. Inflammation significantly increased post exercise on dorsal and palmer views so assessment of the feet to rule out deep foot pathology was advised by our interpreting vet, alongside other observations.


At the time of the first scan in February 2016, Nimmy was sound so the findings in the RF were not considered significant but in May 2016 the owner noted she was not comfortable weight bearing on the RF for extended periods of time, for example when putting studs in. In June 2016 Nimmy became lame in front, seemingly both front feet. Coorns/bruising was suspected but it didn’t improve with treatment. Nimmy’s owner arranged for her front feet x-rayed in July 2016, these were clear so a period of rest followed. By mid August 2016 she appeared sound so gentle exercise commenced. After a successful start she became lame again in November 2016 following her first dressage competition. The treating vet completed nerve blocks which were inconclusive so in December 2016 an MRI of the forefeet was completed. MRI identified a 10 cm lesion of the RF deep digital flexor tendon (DDFT), the LF was normal.


Images show T1 HR transverse scan of the right fore foot showing a core lesion of the medial lobe of the deep digital flexor tendon.


FURTHER INVESTIGATION: In January 2017 a RF Navicular Bursoscopy was performed by Bruce Bladon at Donnington Grove Equine Hospital which revealed a synovial mass in the medial navicular bursa, associated with a long split of the medical lobe of the tendon and an erosion of the lateral lobe of the deep digital flexor tendon. The synovial mass was removed and the torn fibres debrided from the DDFT. Bone marrow was also collected for culture of stem cells which would be injected in the Navicular Bursa 1 month after surgery. Following a period of box rest, then in hand walking and restricted turnout Nimmy was allowed unrestricted turnout in April 2017. Further stem cells and steroids were injected over July/August 2017, however a routine appointment found the horse still 1-2/10 lame in November 2017 so an MRI was booked for December 2017 which showed guarded improvement.


Pathology was detected with physiological imaging during the early stages of investigation when the patient was presenting subtle changes. Isolating abnormality for further investigation was a success. Thank you to Bourton Vale, Donnington Grove and Nimmy’s owner for sharing data and reports.