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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