Mental health and well-being in parents of excessively crying infants: Prospective evaluation of a support package.

BACKGROUND: During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well-being and mental health of parents who judge their infant to be crying excessively. The resulting "Surviving Crying" package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use. METHODS: Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty-two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards. RESULTS: Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep. CONCLUSIONS: The findings suggest that the Surviving Crying package may be effective in supporting the well-being and mental health of parents of excessively crying babies. Further, large-scale controlled trials of the package in NHS settings are warranted.

Implementation lessons learnt when trialling palliative care interventions in the intensive care unit: relationships between determinants, implementation strategies, and models of delivery-a systematic review protocol.

BACKGROUND: Heterogeneity amongst palliative care interventions in the intensive care unit (ICU) and their outcomes has meant that, even when found to be effective, translation of evidence into practice is hindered. Previous evidence reviews have suggested that the field of ICU-based palliative care would benefit from well-designed, targeted interventions, with explicit knowledge translation research demonstrating valid implementation strategies. Reviewing effectiveness studies alongside process evaluations for these interventions will give insight into the implementation barriers or constraints identified, and the implementation strategies adopted. METHODS: A systematic review to identify and synthesise knowledge on how models of integrating palliative care into the ICU have been implemented and provide critical recommendations for successful future development and implementation of complex interventions in the field. The search will be carried out using MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO. The search strategy will combine terms related to palliative care, intensive care, and implementation. Only full-text articles will be considered and conference abstracts excluded. There will be no date or language restrictions. The Implementation Research Logic Model will be used as a framework for synthesis. Findings will be reported following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DISCUSSION: This review will provide understanding of implementation facilitators, barriers, and strategies, when employing palliative care interventions within the ICU. This will provide valuable recommendations for successful future development of complex interventions using implementation frameworks or theories. This can increase the potential for sustained change in practice, reduce heterogeneity in interventions, and therefore help produce measurable and comparable outcomes. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic reviews PROSPERO (CRD42022311052).

High-field magnetic resonance imaging investigation of distal border fragments of the navicular bone in horses with foot pain.

REASONS FOR PERFORMING STUDY: Distal border fragments of the navicular bone can be seen in lame and nonlame horses and their clinical significance remains open to debate. OBJECTIVES: To describe the magnetic resonance imaging (MRI) appearance of distal border fragments and the adjacent navicular bone. To investigate the relationship between fragments and other abnormalities of the navicular bone and the distal sesamoidean impar ligament (DSIL). METHODS: Horses were included if pain causing forelimb lameness was localised to the foot and high-field MR images were acquired. The size and location of distal border fragments were recorded. Abnormalities in the adjacent navicular bone were graded to obtain a fragment grade. A total navicular bone grade was assigned. The DSIL was also graded. A Chi-squared test was used to test for associations between the presence of a fragment and specific lesions involving the distal border of the navicular bone, the total grade of the navicular bone, and the grade of the DSIL. RESULTS: 427 horses were included and 111 fragments observed. There was a significant association between the presence of a fragment and the total navicular bone grade, osseous cyst-like lesions, increased number and size of the synovial invaginations of the distal border, increased signal intensity on fat suppressed images and size of distal border entheseophytes. CONCLUSIONS: There is an association between distal border fragments and other pathological MRI abnormalities of the navicular bone. POTENTIAL RELEVANCE: Distal border fragments are part of navicular disease, but their contribution to pain and lameness remains to be clarified.

Anatomical, magnetic resonance imaging and histological findings in the accessory ligament of the deep digital flexor tendon of forelimbs in nonlame horses.

REASONS FOR PERFORMING THE STUDY: Detailed magnetic resonance imaging (MRI) and histological appearances of the accessory ligament of the deep digital flexor tendon (AL-DDFT) have not been documented previously in detail. OBJECTIVES: To: 1) describe anatomical connections between the AL-DDFT and adjacent structures; 2) describe high-field and low-field MRI and histological appearances of the AL-DDFT in the forelimb of horses with no carpal or proximal metacarpal pain; and 3) assess the relationship between age, breed, gender, height, weight and MRI findings. METHODS: Ten forelimbs were dissected to determine anatomical relationships among the AL-DDFT and adjacent structures. High- and low-field MR images of the AL-DDFT and related structures from 29 cadaver limbs of nonlame horses were analysed subjectively and objectively. The relationship between age, breed, gender, height, weight and MRI findings was assessed using a Chi-squared test. Twelve ALs-DDFT were examined histologically. Histological and MRI findings were compared subjectively. RESULTS: Fibrous bundles were seen between the AL-DDFT and the lateral aspect of the superficial digital flexor tendon (n = 9) and the DDFT (n = 2). The AL-DDFT had low to intermediate signal intensity in most limbs in most high-field and low-field MRI sequences. In 69% of limbs, oblique bands of higher signal intensity than the rest of the ligament were identified in high-field images of the AL-DDFT. The cross-sectional area of the AL-DDFT in the proximal 7 cm of the metacarpal region ranged from 68.1-299 mm(2) . There was no significant relationship between age, gender, weight or height and either the cross-sectional area of the AL-DDFT or the presence of oblique higher signal intensity bands. Histological examination revealed that the AL-DDFT had thick collagen bundles arranged in large crimps and sometimes crossing in oblique directions. The cellularity was greater than in the deep digital flexor tendon in all limbs. CONCLUSION AND POTENTIAL RELEVANCE: The large variability in the MRI appearance and size of the AL-DDFT in nonlame horses should be borne in mind when interpreting MR images of lame horses.

An investigation of the relationships between angles and shapes of the hoof capsule and the distal phalanx.

REASONS FOR PERFORMING STUDY: There is little scientific evidence to support the premise that poor foot conformation predisposes to foot pain and lameness. OBJECTIVES: To determine relationships between external characteristics of the hoof capsule and angles of the distal phalanx; to determine variability in shape of the distal phalanx; and to investigate association between distal phalanx angles and the injury causing lameness. MATERIALS AND METHODS: Feet were documented photographically and radiographically. Linear and angle measurements were obtained for the hoof capsule and distal phalanx and compared statistically. Horses were categorised according to injury group, and angles and linear ratios were compared between groups. RESULTS: There was modest correlation between hoof wall and heel angles and angles of the distal phalanx. There was variation in shape of the distal phalanx. There was no significant association between injury type and angles of the distal phalanx, although there was a trend for the angle of the dorsal aspect of the distal phalanx with the horizontal to be smaller in horses with injuries of the podotrochlear apparatus or deep digital flexor tendon compared with other groups. CONCLUSIONS: There are variations in shape of the distal phalanx largely due to differences in orientation of the concave solar border and the solar border to the horizontal. Variations in shape of the distal phalanx were not accurately correlated with external characteristics of the hoof capsule. There were weak associations between injury groups and angles of the distal phalanx. CLINICAL RELEVANCE: Further work is required to elucidate risk factors for foot-related lameness.

Exploring factors having an impact on attitudes and motivations towards volunteering in the undergraduate nursing student population - A comparative study of the UK and Ghana.

This study explores attitudes and motivations towards volunteering in nursing students in Ghana compared with nursing students in the United Kingdom (UK). Ghana traditionally follows a western model of nurse education, with students studying programmes commensurate in theory and practice, making Ghana a suitable location for a comparative study. We explored similarities and differences in attitudes and motivation towards volunteering to challenge and inform our common place practice towards nursing pedagogy. Ghanaian students displayed positive attitudes towards volunteering, although these did not translate into increased motivation to volunteer while at university. Students reported financial constraints as reasons for not volunteering as did UK students, although Ghanaian students used available resources for daily living expenses, whereas UK students prioritised available resources to pay down student debt. Structured volunteering was absent from both Ghanaian and UK nursing programmes, despite its potential to increase the variety of social groups or situations to which students are exposed, to increase self-confidence and to encourage greater reflection on practice through doing. Structural challenges within countries may provide a better explanation of variation in student motivation towards volunteering, than cross-cultural variation in attitudes towards volunteering between countries.

Comparison between radiological and magnetic resonance imaging lesions in the distal border of the navicular bone with particular reference to distal border fragments and osseous cyst-like lesions.

REASONS FOR PERFORMING STUDY: There are no data concerning the accuracy of conventional and computed or digital radiography for evaluation of the equine foot. OBJECTIVES: To compare conventional film-screen and computed radiography with magnetic resonance imaging (MRI) for detection of distal border fragments of the navicular bone; and to establish which type of fragment was more likely to be detected radiologically. METHODS: Horses were included if forelimb lameness was localised to the foot and both radiography and high-field MR images had been acquired. Horses were divided into 2 groups based on acquisition of conventional (Group A) or computed (Group B) radiographs. The presence of distal border fragments was recorded. From MR images, distal border fragments were graded based on their size and changes in signal intensity in the adjacent navicular bone. Sensitivity and specificity of conventional and computed radiography for detection of fragments were calculated using MRI as the gold standard. A Chi-squared test was used to test for associations between specific radiological and MRI findings in the distal border of the navicular bone. RESULTS: In Group A 46 and 18 fragments were identified on MR and radiographic images, respectively; in Group B 45 and 17 fragments were seen. There was no significant difference between computed and conventional radiography. Grades 4 and 5 fragments or large-sized fragments were identified most frequently; low-grade fragments were unlikely to be observed. There was a significant correlation between radiological and MRI abnormalities of the distal border of the navicular bone. CONCLUSIONS: Conventional and computed radiography had similar, rather low sensitivity for identification of distal border fragments of the navicular bone, but specificity was high. Large-sized and high-grade fragments were most likely to be identified radiologically. POTENTIAL RELEVANCE: Fragments observed radiologically are likely to be associated with other pathological abnormalities of the distal border of the navicular bone.

Is there an association between ossification of the cartilages of the foot and collateral desmopathy of the distal interphalangeal joint or distal phalanx injury?

REASONS FOR PERFORMING STUDY: Associations between degree of ossification of the cartilages of the foot and injuries to other structures of the foot have been suggested, but have not been investigated by large scale studies. OBJECTIVES: To describe the frequency of grade >3 ossification of the cartilages of the foot (possibly significant ossification, PSO), mediolateral symmetry of ossification and left-right symmetry between feet; and to investigate associations between PSO and injury of either the collateral ligaments (CLs) of the distal interphalangeal (DIP) joint or the distal phalanx. HYPOTHESES: Possibly significant ossification of the cartilages of the foot is associated with CL and distal phalanx injury. Distal phalanx injury is associated with a mediolateral difference in ossification grade of > or =2. METHODS: Horses were examined for lameness localised to the foot by perineural analgesia, and underwent radiographic and magnetic resonance imaging examinations. Age, breed, occupation, duration of lameness, lame(st) limb, primary cause of lameness, and presence or absence of CL injury were recorded. Dorsopalmar (dorsoplantar) radiographs were examined and ossification of the cartilages of the foot graded using a modification of a previously published scale. RESULTS: One foot from each of 462 horses was included for analysis. There was left-right symmetry of ossification between feet, and significant association between grades of each foot, with lateral > or =medial cartilages. Possibly significant ossification occurred in the maximally ossified cartilage in 59 (12.8%) feet. There were significant associations between PSO of the maximally ossified cartilage of the foot and injuries of both the CLs of the DIP joint and the distal phalanx. There was no association between distal phalanx injury and marked asymmetry of the ossified cartilages of the foot. CONCLUSIONS AND CLINICAL RELEVANCE: Extensively ossified cartilages of the foot are significantly associated with CL or distal phalanx injury. Markedly asymmetric ossification did not increase the likelihood of distal phalanx injury and should be considered at a prepurchase examination.

Clinical significance of osseous spurs on the dorsoproximal aspect of the third metatarsal bone.

REASONS FOR PERFORMING STUDY: Osseous spurs on the dorsoproximal aspect of the third metatarsal bone (MtIII) are common, but their clinical significance is unknown. OBJECTIVES: To verify the sites of insertion of the dorsal metatarsal ligament and the tendons of tibialis cranialis and fibularis tertius in order to determine if periarticular osteophytes and entheseophytes could be differentiated radiologically; and to determine the frequency of occurrence of osseous spurs on the dorsoproximal aspect of MtIII. HYPOTHESES: The frequency of osseous spurs on the dorsoproximal aspect of MtIII would be higher in lame than in clinically normal horses and higher in horses with distal hock joint pain or proximal suspensory desmitis than in horses with other causes of hindlimb lameness. METHODS: A retrospective study of data from the clinical work up and tarsal radiographs of 455 horses was performed. Horses were divided into: Group 1, clinically normal horses; Groups 2-5, according to the diagnosis of hindlimb lameness. Radiographs were examined for the presence of an osseous spur on the dorsoproximal aspect of MtIII; pathology of the distal tarsal joints was graded. The associations between the presence of a spur and lameness, diagnosis group and the grade of distal tarsal joint abnormalities were analysed statistically using Chi-squared tests. RESULTS: An osseous spur was present in 25% of horses; 13% of horses with bilateral radiographs had bilateral spurs. There was no significant difference in frequency of the presence of a spur between lame and nonlame horses, or between horses with other causes of hindlimb lameness and horses with proximal suspensory desmitis and/or distal tarsal joint pain. The presence of an osseous spur was significantly associated with the grade of radiological abnormality in the distal tarsal joints (tarsometatarsal joint P = 0.018: centrodistal joint P = 0.027). In many horses it was not possible to differentiate accurately between osteophytes and entheseophytes. CONCLUSIONS AND POTENTIAL RELEVANCE: The presence of an osseous spur on the dorsoproximal aspect of MtIII in the absence of other radiological abnormalities may be an incidental finding. Osseous spurs occur more frequently in hocks with radiological abnormalities in the distal tarsal joints and may be an indicator of distal tarsal joint osteoarthritis. The clinical significance must be established by intra-articular analgesia.

The distal sesamoidean impar ligament: comparison between its appearance on magnetic resonance imaging and histology of the axial third of the ligament.

REASONS FOR PERFORMING STUDY: There is limited knowledge about the interpretation of alterations in the distal sesamoidean impar ligament (DSIL) detected using magnetic resonance imaging (MRI) and their correlation with histopathology. HYPOTHESES: There would be: 1) a correlation between histopathology and MRI findings; and 2) a relationship between MR abnormalities at the origin and the insertion of the DSIL, between insertion and body; and origin and body. METHODS: Fifty limbs from 28 horses were examined using high-field MRI and histopathology. MR abnormalities of the DSIL, its origin on the navicular bone and its insertion on the distal phalanx were graded. Sections of the axial third of the DSIL were examined histologically and graded according to fibre orientation, integrity of fibroblasts, collagen architecture and vascularity. Associations between MRI and histology findings were tested by Spearman rank correlation and Chi-squared tests. RESULTS: There were significant correlations between the presence of a cystic structure in the distal third of the navicular bone, or a distal border fragment, or increased signal intensity in fat suppressed images at the insertion of the DSIL on the distal phalanx and the histological grade of the body of the DSIL. There were significant associations between a cystic structure in the distal third of the navicular bone and the presence of either a distal border fragment or entheseous new bone at the insertion of the DSIL, swelling of the DSIL and increased signal intensity in the DSIL in fat suppressed images; between distal elongation of the flexor border of the navicular bone and the presence of one or more distal border fragments and between swelling of the body of the DSIL and irregularity of its palmar border or increased signal intensity in fat suppressed images in the DSIL. CONCLUSIONS AND CLINICAL RELEVANCE: The presence of a cystic structure in the distal third of the navicular bone detected using MRI, a distal border fragment or increased signal intensity at the insertion of the DSIL are suggestive of significant alterations in the infrastructure of the DSIL.

Distribution of radiodense contrast medium after perineural injection of the palmar and palmar metacarpal nerves (low 4-point nerve block): an in vivo and ex vivo study in horses.

REASONS FOR PERFORMING STUDY: Evidence-based information is limited on distribution of local anaesthetic solution following perineural analgesia of the palmar (Pa) and palmar metacarpal (PaM) nerves in the distal aspect of the metacarpal (Mc) region ('low 4-point nerve block'). OBJECTIVES: To demonstrate the potential distribution of local anaesthetic solution after a low 4-point nerve block using a radiographic contrast model. METHODS: A radiodense contrast medium was injected subcutaneously over the medial or the lateral Pa nerve at the junction of the proximal three-quarters and distal quarter of the Mc region (Pa injection) and over the ipsilateral PaM nerve immediately distal to the distal aspect of the second or fourth Mc bones (PaM injection) in both forelimbs of 10 mature horses free from lameness. Radiographs were obtained 0, 10 and 20 min after injection and analysed subjectively and objectively. Methylene blue and a radiodense contrast medium were injected in 20 cadaver limbs using the same techniques. Radiographs were obtained and the limbs dissected. RESULTS: After 31/40 (77.5%) Pa injections, the pattern of the contrast medium suggested distribution in the neurovascular bundle. There was significant proximal diffusion with time, but the main contrast medium patch never progressed proximal to the mid-Mc region. The radiological appearance of 2 limbs suggested that contrast medium was present in the digital flexor tendon sheath (DFTS). After PaM injections, the contrast medium was distributed diffusely around the injection site in the majority of the limbs. In cadaver limbs, after Pa injections, the contrast medium and the dye were distributed in the neurovascular bundle in 8/20 (40%) limbs and in the DFTS in 6/20 (30%) of limbs. After PaM injections, the contrast and dye were distributed diffusely around the injection site in 9/20 (45%) limbs and showed diffuse and tubular distribution in 11/20 (55%) limbs. CONCLUSIONS AND POTENTIAL RELEVANCE: Proximal diffusion of local anaesthetic solution after a low 4-point nerve block is unlikely to be responsible for decreasing lameness caused by pain in the proximal Mc region. The DFTS may be penetrated inadvertently when performing a low 4-point nerve block.

"You have to find a caring man, like your father!" gendering sickle cell and refashioning women's moral boundaries in Sierra Leone.

Most research on sickle cell disorders has tended to be gender-blind. This qualitative study undertaken in 2018, explores if and how sickle cell disorders become gendered in Sierra Leone through the analytical framework of a feminist ethics of care. It argues that women have to navigate moral blame when they have children with the condition. At the same time women refashion moral boundaries so that gendered norms around childhood and parenting for such children become suspended, in favour of creation of careful spaces. Parental fears of physical and sexual violence mean that gendered sexual norms are enforced for teenage boys as they are encouraged into early adulthood. In contrast, girls are kept in enforced ignorance about the consequences of sickle cell for reproduction and are encouraged to delay motherhood. This is because, as women relate, relationships and giving birth are fraught with embodied dangers and risks of violence.

Nuclear scintigraphic assessment of the thoracolumbar synovial intervertebral articulations.

REASONS FOR PERFORMING STUDY: The results of nuclear scintigraphic examination of the thoracolumbar synovial intervertebral articulations (facet joints) have to date been poorly documented. OBJECTIVES: To establish an objective scintigraphic grading system for the facet joints; to investigate the relationship between the presence or absence of clinical signs of back pain and increased radiopharmaceutical uptake (IRU); and to compare the results of scintigraphy and radiography. METHODS: Nuclear scintigraphic images of the 13th thoracic (T13) to first lumbar (L1) vertebrae were graded subjectively (visual assessment of the image) and objectively (using region of interest analysis) from 31 clinically normal horses in full work (Group N) and 65 horses with clinical evidence of thoracolumbar region pain and osteoarthritis of > or = 1 facet joint (Group B). Sensitivity and specificity of IRU for detection of back pain and radiographic abnormalities were assessed. A Spearman correlation was performed to test for an association between the grade of IRU and the classification of radiographic abnormality. RESULTS: The objective scintigraphic grades were matched by 96.7% of subjective grades. IRU was seen more commonly in Group B (61.5%) than in Group N (25.8%), and moderate or intense IRU was only seen in Group B. The strongest association between radiographic abnormalities and scintigraphy was seen in horses with intense IRU. CONCLUSIONS: Moderate or intense IRU in a facet joint is more likely to be seen in horses with back pain than in clinically normal horses. POTENTIAL RELEVANCE: Nuclear scintigraphy is a potentially useful tool in the evaluation of a horse with thoracolumbar region pain.

Osteoarthritis of the thoracolumbar synovial intervertebral articulations: clinical and radiographic features in 77 horses with poor performance and back pain.

REASONS FOR PERFORMING STUDY: Back pain is well recognised as a cause of poor performance in horses, but the role of lesions of the thoracolumbar synovial intervertebral articulations (facet joints) has not been well documented. OBJECTIVES: To describe the clinical features, radiographic appearance and location of facet joint lesions and determine if there was any breed, gender, age, bodyweight or work discipline predilection. METHODS: Data from 77 horses examined at the Animal Health Trust January 1997-September 2007 with evidence of thoracolumbar pain and radiographic changes of the facet joints were reviewed. The presence of either other osseous abnormalities of the thoracolumbar region or other problems potentially contributing to poor performance were recorded. Facet joint lesions were graded radiographically and their location determined. Influence of breed, gender and discipline on the presence of lesions, effect of location on the type of lesion and the influence of impinging dorsal spinous processes on the clinical features were assessed using Chi-squared tests. RESULTS: There was no effect of breed, gender, age or bodyweight on occurrence of facet joint lesions. Showjumpers were significantly less affected than horses from other disciplines. There were commonly 2-5 affected facet joints, usually in the caudal thoracic and cranial lumbar spine (T15-LI). Sclerosis, periarticular new bone and narrowing of the joint space were the most frequent radiographic lesion types. Clinical features were significantly different between horses with and without impinging dorsal spinous processes. Severity of clinical signs was related to the presence of other osseous abnormalities, not the number of facet joints involved or the lesion grade. CONCLUSIONS: Osteoarthritis of the facet joints of the thoracolumbar spine can occur alone, in horses with back pain, or in association with other osseous abnormalities. POTENTIAL CLINICAL RELEVANCE: Osteoarthritis of the thoracolumbar facet joints probably contributes to back pain, but further investigation of the prevalence of osteoarthritis in horses without clinical signs of back pain is merited.

Radiographic and scintigraphic evaluation of spondylosis in the equine thoracolumbar spine: a retrospective study.

REASONS FOR PERFORMING STUDY: Clinical, radiographic and scintigraphic signs associated with spondylosis of the equine thoracolumbar spine have been poorly documented. OBJECTIVES: To establish an objective radiographic and scintigraphic grading system for spondylosis lesions; to estimate the prevalence of spondylosis in a population of horses with back pain; and to compare the results of radiography and scintigraphy. METHODS: Radiographic images of the thoracolumbar spine from 670 horses with clinical signs of back pain were graded. Scintigraphic images from horses with spondylosis lesions underwent subjective and objective analysis. Sensitivity and specificity of scintigraphy for detection of spondylosis relative to radiography for identification of spondylosis were calculated, and Chi-squared analysis was performed to test for an association between location and severity of lesions. RESULTS: Twenty-three of 670 horses (3.4%) with back pain had radiographic evidence of spondylosis. Of these horses, 14 (61%) had more than one lesion and 44% (n=22) of lesions occurred between T11-T13 vertebral bodies. Only 33% (n=28) of locations with radiographic changes had increased radiopharmaceutical uptake. CONCLUSION: Spondylosis occurs at a low prevalence in horses with back pain. It may be present alone or in association with other osseous abnormalities. The clinical significance of spondylosis needs further investigation. POTENTIAL RELEVANCE: Spondylosis is uncommon but may be a contributor to back pain in the horse.

Lesions of the deep digital flexor tendon in the digit: a correlative MRI and post mortem study in control and lame horses.

REASONS FOR PERFORMING STUDY: Lameness associated with lesions of the deep digital flexor tendon (DDFT) in the digit is now recognised as an important cause of lameness, but there is currently limited information about the pathological nature of the lesions. OBJECTIVES: To compare: signal intensity changes on magnetic resonance images with histopathology; and histopathological changes in the DDFT from horses with no history of foot-related lameness (Group C) and horses with lesions of the DDFT confirmed using magnetic resonance imaging (MRI) (Group D). METHODS: Transverse sections of the DDFT were harvested from 3 sites in all horses: (1) immediately proximal to the navicular bursa (E1); (2) at the level of the navicular bone (E2); and (3) close to the tendon's insertion (E3). If lesions were identified at E1 or had been identified further proximally using MRI, additional sections were obtained until, in most cases, the proximal limit of the lesion was identified. All DDFTs were graded histopathologically using predefined criteria. The MR images were reviewed to determine the location and sequences in which increased signal intensity was seen. RESULTS: No haemorrhage or inflammatory cell infiltration was seen in any horse. At level E1, septal thickening, ghosting of blood vessels and blood vessel occlusion were common in Group D, but were not seen in Group C. Less commonly, there was core necrosis, only seen in Group D. At level E2, septal and vascular changes were most obvious in Group D. Core necrosis, dorsal splitting, crevicing and fibrillation were seen only in Group D. Septal and vascular changes were present in both Groups C and D at level E3, but fibrocartilaginous metaplasia, splitting, crevicing and fibrillation, or core necrosis or fibroplasia were seen only in Group D. Core lesions in Group D often extended proximal to E1, and ranged in length from 0.5-13 cm. Core necrosis was generally associated with increased signal intensity in fat suppressed images. CONCLUSIONS: Lesions of the DDFT in the digit appear to be primarily degenerative, and may be a sequel to vascular compromise. Increased signal intensity on fat suppressed MR images is not necessarily associated with frank fluid or evidence of inflammation, but may reflect major matrix changes in the tendon. POTENTIAL RELEVANCE: Further information about the causes of these lesions is required to develop preventative strategies.

Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint: part 1.

REASONS FOR PERFORMING STUDY: Osseous abnormalities associated with collateral ligament (CL) injury of the distal interphalangeal (DIP) joint have been documented using magnetic resonance imaging (MRI) but there is currently limited information about the frequency of osseous pathology associated with CL injury. OBJECTIVES: To determine the frequency of occurrence of osseous abnormality coexistent with CL injury of the DIP joint and describe the distribution and character of osseous lesions; and to establish if there was an association between osseous abnormality and increased radiopharmaceutical uptake (IRU). HYPOTHESES: There would be a higher incidence of osseous abnormality at the insertion of an injured CL than at the origin; and a relationship between the presence of osseous abnormality and duration of lameness. MATERIALS AND METHODS: Magnetic resonance images of 313 feet of 289 horses with foot pain and a definitive diagnosis of collateral desmopathy of the DIP joint were analysed retrospectively for presence and type of osseous abnormality in the middle and distal phalanges. Scintigraphic images were examined and the presence of IRU in the middle or distal phalanges recorded. RESULTS: Osseous abnormalities were detected in 143 (45.7%) feet, 27 (18.8%) of which had osseous and CL injury alone, while the remaining 116 had CL related osseous injury and multiple injuries within the hoof capsule. Entheseous new bone and endosteal irregularity of the middle and distal phalanges were the most frequent types of osseous abnormality. There was a higher incidence of osseous abnormalities medially than laterally and at the ligament insertion than at the origin. There was a significant association between presence of IRU and osseous injury. CONCLUSIONS: A variety of osseous lesions of differing severity are associated with CL injury. Normal radiopharmaceutical uptake does not preclude significant osseous pathology associated with CL injury. CLINICAL RELEVANCE: Further studies are necessary in order to determine if osseous abnormalities associated with CL injury influence prognosis for return to performance.

Osseous abnormalities associated with collateral desmopathy of the distal interphalangeal joint. Part 2: treatment and outcome.

REASONS FOR PERFORMING STUDY: There are currently few long-term follow-up data relating to recovery from injury of a collateral ligament (CL) of the distal interphalangeal (DIP) joint and limited information about the effect of associated osseous injury on prognosis. OBJECTIVES: To describe long-term follow-up results for horses with CL injury, with and without associated osseous injury; and to determine the effect of extracorporeal shock wave therapy (ECSWT) or radial pressure wave therapy (RPWT) on outcome. HYPOTHESES: Prognosis for return to performance for horses with CL-related osseous injury would be worse than for horses with CL injury alone. METHODS: Magnetic resonance images from 313 feet of 289 horses with foot pain and a definitive diagnosis of collateral desmopathy of the DIP joint were analysed retrospectively for presence of osseous abnormality associated with the ligament origin or insertion and the middle and distal phalanges. Horses were assigned to groups according to the combination of their injuries. Type of treatment was recorded and follow-up information obtained. Thirty-two horses with additional sources of lameness were excluded from analysis of outcome. RESULTS: Follow-up data were available for 182 horses, 55 of which had follow-up information for up to 2 years after presentation. Twenty-seven percent of horses with CL injury alone and 34% of horses with CL related osseous injury returned to their previous performance level. Prognosis for a combination of injuries to multiple soft tissue and osseous structures within the hoof capsule was substantially worse. There was no effect of ECSWT or RPWT on outcome. CONCLUSIONS: The presence of mild to moderate CL related osseous injury does not appear to influence prognosis compared with CL injury alone. CLINICAL RELEVANCE: Further studies of a larger number of horses are necessary in order to ascertain if specific types of osseous pathology influence return to performance levels.

Diffusion of contrast medium after perineural injection of the palmar nerves: an in vivo and in vitro study.

REASONS FOR PERFORMING STUDY: Proximal diffusion of local anaesthetic solution after perineural anaesthesia may lead to the desensitisation of structures other than those intended. However, there is no evidence-based study demonstrating the potential distribution and diffusion of local anaesthetic solution after perineural analgesia in the distal limb. OBJECTIVE: To document the potential diffusion of local anaesthetic solution using a radiopaque contrast model and to evaluate the influence of walking compared with confinement in a stable after injection. METHODS: Radiopaque contrast medium was injected subcutaneously over one palmar nerve at the base of the proximal sesamoid bones in 6 nonlame mature horses. Horses were assigned randomly to stand still or walk after injection. Radiographs were obtained 0, 5, 10, 15, 20 and 30 min after injection and were analysed to determine the distribution and diffusion of the contrast medium. RESULTS: In 89% of injections an elongated pattern of the contrast medium was observed suggesting distribution along the neurovascular bundle. After 49% of injections a fine radiopaque line extended proximally from the contrast 'patch', and in 25% of injections a line extended distally. There was significant proximal and distal diffusion with time when sequential radiographs of each limb were compared. The greatest diffusion occurred in the first 10 min. Walking did not significantly influence the extent of either proximal or distal diffusion. CONCLUSIONS AND POTENTIAL RELEVANCE: Significant proximal diffusion occurs in the first 10 min after perineural injection in the distal aspect of the limb and should be considered when interpreting nerve blocks. Distribution of local anaesthetic solution outside the fascia surrounding the neurovascular bundle or in lymphatic vessels may explain delayed or decreased effects.