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Title: Prevalence and clinical significance of increasing head height asymmetry as a measure of forelimb lameness in horses when trotting in a straight line after palmar digital nerve block.
Author: Kolding SA, Sørensen JN, Kramer J, McCracken MJ, Reed SK, Keegan KG.
Journal: Equine Vet J; 2023 Nov; 55(6):988-994. PubMed ID: 36604754.
Abstract:
BACKGROUND: Some horses increase in forelimb lameness, measured as vertical head height asymmetry, or differences in maximums and minimums of head heights (HDmax, HDmin), after a palmar digital nerve (PDN) block. The prevalence of this finding, or what it means clinically, has not been reported in peer-reviewed literature. OBJECTIVES: To estimate the prevalence of increasing head height asymmetry after a PDN block and determine if this is associated with cause of forelimb lameness. STUDY DESIGN: Retrospective case series. METHODS: Head height asymmetry, normalised to expected vertical head displacement, from inertial-sensor data collections of all horses evaluated for forelimb lameness while trotting in a straight line at two different clinics were screened for cases that had an initial PDN block and then another more proximal block in the same limb during the same lameness evaluation. Medical records of the screened cases (n = 213) were evaluated to determine the cause of lameness. Prevalence of increasing head height asymmetry was calculated. Differences in lameness amplitude between groups of cases that remained unchanged (Group 1), that increased (Group 2), and that decreased (Group 3) in head height asymmetry before and after the initial PDN block were compared (Kruskal-Wallis). Determination of the location of the cause of lameness and final diagnoses of cases were compared between Group 1 and Group 2 (chi-squared tests of independence). RESULTS: The PDN block increased head height asymmetry at a prevalence of 32.5% (95% CI = 24.5%-41.5%) and 13.8% (95% CI = 7.3%-22.9%), in clinic 1 and 2, respectively. Increasing head height asymmetry after an initial PDN block did not predict localization of the cause of forelimb lameness or specific diagnosis (p = 0.1), other than indicating that it is unlikely to be in the foot (p = 0.02). MAIN LIMITATIONS: Study samples consisted primarily of Warmbloods (clinic 1) and Quarter Horses (clinic 2). Analysis of blocking induced changes was limited to straight line trot only. CONCLUSIONS: Increasing head height asymmetry after PDN block is common during forelimb lameness evaluations. Other than indicating that the cause of lameness is more proximal in the blocked forelimb, this does not help determine the final diagnosis. 背景: 掌指神经(PDN)阻滞后，一些马匹的前肢跛行增加(通过测量垂直头高不对称性，或头高最大值和最小值的差异[HDmax, HDmin])。这一现象的普遍程度和临床意义，还没有在同业文献中报道过。目的: 估计马匹掌指神经PDN阻滞后，头高不对称增加的几率，并确定是否与前肢跛行有关。研究设计: 回顾性研究。方法: 马的前肢跛行评估时，从惯性传感器收集的所有数据；头高不对称，标准化为预期的头部垂直位移；在两个不同的诊所，筛选初始PDN神经阻滞，然后在同次跛行评估中，同一肢体有另一个更近端的神经阻滞。对为了确定跛行的原因的筛选病例(n = 213)的医疗记录进行评估。计算头高不对称增加的发生率。比较初始PDN阻滞前后头高不对称性组间(Kruskal-Wallis)跛行幅度不变组(1组)、增加组(2组)、减少组(3组)的差异。跛行原因的确定和病例的最终诊断在1组和2组之间进行比较(独立性卡方检验)。结果: 在诊所1和诊所2中，PDN阻滞增加头高不对称性的发生率分别为32.5% (95% CI = 24.5% - 41.5%)和13.8% (95% CI = 7.3%-22.9%)。初始PDN阻滞后头部高度不对称增加不能预测前肢跛行原因的定位或特异性诊断(p = 0.111)，只能表明不太可能发生在足部(p = 0.015)。主要局限性: 研究样本主要为温血马(临床1)和夸特马(临床2)。神经阻滞引起的变化的分析仅限于直线快步。结论: 在前肢跛行评估中PDN阻滞后头高不对称性增加是常见的。仅表明跛行的原因更接近于阻塞的近端却无助于确定最终诊断。.

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