Magnetic resonance imaging changes of the navicular bursa following navicular bursoscopy in seven horses
Authors: Hoaglund E. L., Barrett M. F.
Journal: Equine Veterinary Education
Summary
Navicular syndrome involves damage to multiple foot structures, and surgical bursoscopy—wherein the navicular bursa is debrided to remove diseased tissue—is a recognised treatment option for horses with concurrent deep digital flexor tendon and navicular bone pathology. This retrospective case series examined seven horses (ten limbs total) using pre- and post-operative MRI to characterise bursal changes following bursoscopy, with all cases presenting multilateral foot lesions affecting the impar ligament, collateral sesamoidean ligament, distal interphalangeal joint, and associated structures. Paradoxically, all bursae developed proliferative tissue or showed progression of existing bursal changes on post-operative imaging, yet despite these radiographic findings becoming more pronounced, lameness improved or resolved in nearly all horses during their rehabilitation period, with concurrent lesions remaining largely unchanged. Return to previous work levels was achieved in only two of the seven horses, suggesting that whilst bursoscopy may provide short-term functional improvement through pain relief, the procedure does not address the underlying degenerative cascade or reliably restore athletic capacity. For practitioners, this highlights the importance of managing client expectations regarding navicular cases—imaging improvements should not be conflated with functional recovery, and a multimodal approach addressing pain, biomechanics, and ongoing management remains essential for optimising outcomes.
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Practical Takeaways
- •Navicular bursoscopy may improve short-term lameness despite MRI showing bursal proliferation and worsening appearance—manage client expectations about imaging vs. clinical recovery.
- •Poor return-to-work rates (29%) suggest bursoscopy alone is insufficient; multimodal treatment of concurrent foot lesions (DDFT, navicular bone, ligaments) should be considered.
- •Post-operative rehabilitation protocols may be critical to functional recovery even when imaging appears to worsen—prioritize structured rehabilitation rather than relying on imaging resolution.
Key Findings
- •All 7 horses (10 limbs) developed proliferative bursal tissue following navicular bursoscopy despite surgical debridement.
- •Almost all horses improved to resolved lameness at recheck MRI despite worsening navicular bursa appearance and relatively unchanged concurrent lesions.
- •Only 2 of 7 horses (29%) returned to their previous level of work, indicating poor long-term functional outcomes.
- •Navicular syndrome was confirmed as multifactorial with concurrent lesions in multiple foot structures affecting all treated limbs.