Hot Literature: Nuchal bursitis: Getting rid of this pain in the neck in horses

A horse's athletic performance can be greatly affected by neck pain. Diagnosing the cause in these cases is often difficult for equine veterinary practitioners because of the inconsistency in clinical signs, the frequency of concurrent lameness, and the wide variety of underlying causes. A study published in the Journal of the American Veterinary Medical Association reported the results of diagnostic tests and a novel treatment approach for nuchal bursitis in four horses admitted to the Tufts University’s Cummings School of Veterinary Medicine.

The horses were all seen for neck pain and stiffness, abnormal head carriage, and swelling in the poll region. Ultrasonographic and radiographic evaluation revealed cranial nuchal bursitis in two of the horses and caudal nuchal bursitis in the others. The horses ranged from 9 to 14 years of age and participated in various equestrian disciplines.

In each case, ultrasonographic evaluation revealed fluid distention and synovial thickening of the affected bursa. There were also bony changes identified involving the surface of the underlying vertebrae (C1, C2) in two of the horses. Although a septic process was considered a likely differential diagnosis in all of the cases because of the fluid echogenicities and synovial thickening, it was only confirmed by bacterial culture growth in one horse.

Despite the recommendation for more aggressive treatment, all of the owners initially elected conservative medical management consisting of intrabursal anti-inflammatory medication injections and oral antibiotics and anti-inflammatories. This conservative management was unsuccessful in each case. In all four horses, complete resolution of the neck pain, abnormal head carriage, and other signs attributed to the bursitis was achieved after bursoscopic débridement and lavage.

Three bursae are associated with the nuchal ligament in horses-the cranial, caudal, and supraspinous bursae. Cranial and caudal bursae do not exist in all horses, and their presence or absence does not appear to be associated with age or training level. As with other bursa in the body, they are not readily identifiable when nondiseased. Ultrasonography is the most useful diagnostic tool in these cases, and for this treatment technique, ultrasonographic guidance is needed for the initial distention of the bursa and during insertion of the arthroscopic sleeve prior to bursoscopy, débridement, and lavage.

The authors of this paper point out that this technique offers good visibility of the structures, allows for thorough débridement and lavage, and, because of the small incisions needed, results in a good cosmetic appearance as compared with traditional open surgical techniques. As demonstrated in this study, there is still the challenge of identifying septic vs. nonseptic inflammatory processes, especially since there was no history or evidence of a specific injury or trauma to the region. However, all of the horses responded well to this treatment, had no complications, and returned to their previous athletic level.

Garcia-Lopez JM, Jenei T, Chope K, et al. Diagnosis and management of cranial and caudal nuchal bursitis in four horses. J Am Vet Med Assoc 2010;237(7):823-829.

Link to abstract: http://avmajournals.avma.org/doi/abs/10.2460/javma.237.7.823