CLINICAL EXAM IMAGING AND TREATMENT OF THE NECK

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1 Arbeitsgruppe Pferd Advanced applications of ultrasound imaging in horses Bonn Germany sept.2010 CLINICAL EXAM IMAGING AND TREATMENT OF THE NECK Philippe HEILES DVM MSc Les Bréviaires France

2 Anatomy Cervical spines

3 Anatomy Cervical muscles and nuchal ligament From R. Barone Lot of muscles with different orientations Large insertion of the nuchal ligament on the occiput

4 Anatomy Principal motor muscles of the neck

5 Anatomy Bones 2 different parts: Different motion Anatomical differences From R. Barone

6 Functional Anatomy External occipital crest Nuchal area Occipital condyles Mobility of the head: Atlanto-occipital : Flexion/extension Atlanto-axial: Rotation > Lateroflexion

7 Functional Anatomy Caudal and Middle area Mobility: Lateroflexion +/- rotation Extension and flexion

8 Functional Anatomy Caudal and Middle area Mobility: Lateroflexion +/- rotation Extension and flexion

9 Anatomy Cervical vertebra Cranial articular process Caudal articular process Vertebral foramen fossa Transverse formamen Transvers process: Dorsal tubercule Ventral tubercule head

10 Anatomy Cervical spines Dorso-lateral view Cranial Caudal Ventral view

11 Potential Relation with spinal chord Capsule Cranial Joint Synovial fluid Synovial fold Spinal chord Caudal Cervical Vertebrae

12 Anatomy Potential Relation with nerves and vascular structures

13 Potential Relation with Spinal Chord /Human 1. Hernial disc 2. Hernia 3. Nerve root 4. Spinal chord MRI

14 Biomecanic considerations Cervical spines

15 Biomecanic considerations Cervical region: large range of motion

16 Neck Problems Why should we examine the neck: From the rider point of view:. Reluctance for the horse to stay in a good frame. Abnormal or asymmetric neck lateral deviation from its higher or lower part. Defect of longitudinal flexion. Head shaking. Sudation Practitionners:. Uncoordination / Ataxia. Front Lameness

17 How? Static exam: Neck Problems. Inspection (Amyotrophy, asymmetry, abnormal standing ). Palpation (Spasms, heat ). Mobilisation: active lateroflexion

18 Static exam: Neck Problems. Observation (Amyotrophy, assymetry, abnormal standing ). Palpation (Spasms, heat ). Active Lateroflexions (pain amount of motion)

19 Dynamic exam: Neck Problems. Figure 8 at the walk, different tests (abnormal bending, ataxia, paresia, hypermetria ). On straight line and circles (abnormal bending, head shaking, stiffness )

20 Dynamic exam: Neck Problems. Figure 8 at the walk, different tests (abnormal bending, ataxia ). On straight line and circles (abnormal bending, head shaking, stiffness, lameness with reduction of protraction )

21 Dynamic exam: Interest of exam under tack orion

22 DIAGNOSTIC IMAGING OF THE NECK. Xray Exam. Ultrasound exam. Thermography. Bone scan. CT Scan. MRI

23 RADIOGRAPHY Normal images - Lateral views Base of occiput / skull To Base of neck >> 3 to 4 lateral images

24 RADIOGRAPHY Normal images - Lateral views From E. Cauvin. PVE 2008

25 RADIOGRAPHY Normal images - Lateral views Myelography From E. Cauvin. PVE 2008

26 RADIOGRAPHY: Normal images Neck Xray Beam Plate

27 RADIOGRAPHY Abnormal images / Articular process A.P. hypertrophy

28 RADIOGRAPHY Abnormal images / Articular process A.P. hypertrophy

29 RADIOGRAPHY Abnormal images: articular process OC and A.P. fragmentation

30 RADIOGRAPHY Abnormal images Malalignement and stenosis: Defect of axis and canal compression

31 RADIOGRAPHY: Abnormal images. Ligament injury (desmitis). Calcification of Sup. ligt

32 ULTRASOUND EXAM: Normal images Supraspinous ligament / Semispinalis muscles Semi Spimalis M Spinous ligt

33 ULTRASOUND EXAM Normal images Lateral aspect of the articular process Joint Capsule

34 ULTRASOUND EXAM Normal images Lateral aspect of the articular process Joint Capsule. Shape of surface. Size of the joint. Thickness of capsule

35 ULTRASOUND EXAM: Normal images Ventral aspect of the main joint and disc Disc Scalene muscle insertion

36 ULTRASOUND EXAM: abormal images Supraspinous ligament desmopathy

37 ULTRASOUND EXAM: abormal images Supraspinous ligament desmopathy

38 ULTRASOUND EXAM: abormal images C1 /C2 Occiput / Atlas synovitis Atlas/axis fracture atlas Occiput atlas axis

39 ULTRASOUND EXAM: abormal images C1 /C2 osteome of the atlas

40 ULTRASOUND EXAM: abormal images C1 /C2 Articular processes : degenerative changes Synovitis

41 THERMOGRAPHY Courtesy of Jim WALSMITH DVM

42 BONE SCAN

43 DIAGNOSTIC IMAGING OF THE NECK Lesions RX US.malalignement stenosis ++ -.fragmentation AP hypertrophy AP +/- ++.synovits disc esion l + (late) -.fracture desmopathy muscle esions l MRI! SCANNER!

44 CERVICAL SPINES TREATMENT. NSAIDS / Steroids / Diuretics. Local injections:. Mesotherapy. Muscles injections. Articular process injections. Differential diagnosis with infectious diseases

45 CERVICAL SPINES TREATMENT. GENERAL TREAMENTS NSAIDS / Steroids / DMSO Tildren ND. LOCAL INJECTIONS. Mesotherapy. Muscles injections. Articular process injections. PHYSIOTHERAPY. ESWT

46 CERVICAL SPINES TREATMENT US Guided injection technic of the articular process Needle Joint Cranial Caudal Cervical spines axis

47 CERVICAL SPINES TREATMENT US Guided injection technic of the articular process Needle Joint Cervical spines axis Probe axis

48 CERVICAL SPINES PATHOLOGY REHABILITATION

49 Case log #1

50 Case log #1 Figure 8 with neck extension

51 Case log #1 Cervical spines Longe line Trot

52 Case log #1 Cervical spines

53 Case log #2 Cervical spines Blocks:. LPD. FR fetlock. Shoulder Severe front right lameness with defect of anterior phase of the stride

54 Case log #2 Cervical spines C5 Mild sclerosis of C5/C6 and dorsal remodeling of the caudal aspect of the vertebral canal

55 Case log #2 Cervical spines After local block of C6/C7 AP

56 Case log #2 Cervical spines 6 weeks after Cervical spines treatment

57 Case log #3 Cervical spines

58 Conclusion. Neck discomfort can be well identified by riders. Source of discomfort can be difficult to diagnose. Musculo skeletal. Neurological. Internal medical disorders. Relation with image lesions not always objective. Many treatments options

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