“The radiographs are clear, it’s probably just a soft tissue injury”. It’s a common saying but should it always be followed just by ‘rest and anti-inflammatories’?
Veterinary diagnostic imaging has made an immense leap forward in recent years, with plain radiography standard in all practices, abdominal ultrasound common in most, and increasing access to advanced imaging modalities such as CT. Unfortunately, without very specific training, none of these are very sensitive for the detection and diagnosis of musculoskeletal injuries, and the only alternative has been MRI with associated high costs and a lengthy anaesthetic.
Recently, the MSK Vets teamed up with Dr Fabrizio Tucciarone of Mobile Vet Referral to bring an emerging technology to general practice, namely Musculoskeletal Ultrasonography. This non-invasive imaging modality not only allows for timely and affordable diagnosis of musculoskeletal injuries, but it can also generally be done conscious saving on unnecessary anaesthetics.
The old adage “common things happen commonly” has been proven since the start of this new relationship, and with the clinic’s ability to detect subtle lameness through gait analysis, we now have the opportunity to follow up suspicions with early ultrasound investigation. This has seen multiple cases of iliopsoas strain, commonly presenting with ‘hip pain on extension and suspicion of dysplasia’ due to the extension of the muscle groups. It is often possible to determine between genuine hip pain and iliopsoas strain by gently extending the hip to comfort and then directly manipulating the muscle groups at the same time. Pressure while in extension often provokes a profound pain response. Ordinarily this would be followed by supportive care with pain relief and physiotherapy, but now we can directly image the main body and insertions of the iliopsoas muscles and determine severity, extent, and whether acute or chronic. If there are specific lesions then light anaesthesia can be induced, a quantity of Platelet Rich Plasma derived, and then this is injected intra-lesionally by ultrasound guidance. These injuries will still require rehabilitation support, but this more proactive approach can help kick start healing for a speedier and more satisfactory resolution.
Other common injuries equally amenable to ultrasound guidance are shoulder tendinopathies, especially of the biceps and supraspinatus. These can be frustrating injuries to identify as they are often associated with orthopaedic issues such as elbow dysplasia which tend to take precedence in therapy (though the significant pain focus may actually be the tendon injury). Ultrasound can also be used for the assessment of brachial plexus injuries and has some utility for the detection of stifle pathology. The dynamic nature of the ultrasound assessment means that soft tissue injuries can be visualised both in situ, and in relation to their surrounding structures. This was amply demonstrated in a recent case where a forelimb lameness thought to be associated with shoulder arthritis was actually due to impingement of the biceps tendon by a local osteophyte.
The collaboration between the MSK Vets and Mobile Vet Referrals marks an exciting new chapter in the early investigation and management of musculoskeletal injuries and while we may still need some rest and anti-inflammatories, we can be a lot more proactive in our approach, scientific in our applications of therapy, and discerning about what we can expect in terms of outcome.
- Animal Therapy, Issue 33.
