Comparison of 2 methods of centesis of the bursa of the biceps brachii tendon of horses.
Authors: Schumacher J, Livesey L, Brawner W, Taintor J, Pinto N
Journal: Equine veterinary journal
Summary
# Editorial Summary: Bicipital Bursa Centesis in Horses Bicipital bursitis is a significant cause of forelimb lameness in horses, yet therapeutic injection of the bicipital bursa remains technically challenging for many practitioners. Schumacher and colleagues compared the success rates of proximal versus distal needle approaches using inexperienced clinicians injecting radiopaque contrast medium into the bicipital bursae of horses, with ultrasonographic and radiographic verification of needle placement. The proximal approach achieved successful bursal centesis in only 39% of attempts, whilst the distal approach succeeded in just 28% of cases—a sobering finding that underscores the anatomical difficulty of the procedure. Ultrasonography proved invaluable for confirming placement accuracy post-injection, and adding air to the contrast medium significantly improved both ultrasonographic visualisation and radiographic definition compared to saline alone. For practitioners attempting bicipital bursa therapy, these results suggest that radiographic confirmation (rather than relying solely on fluid aspiration) should be considered standard practice, and that preliminary training or use of ultrasound guidance during needle placement may be necessary to improve first-attempt success rates in clinical settings.
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Practical Takeaways
- •Bicipital bursa centesis is technically challenging for inexperienced clinicians regardless of approach used; expect low first-attempt success rates and plan accordingly
- •Use ultrasound imaging before and after attempted centesis to confirm bursal location and validate successful needle placement
- •When performing centesis for diagnostic or therapeutic purposes, mix air with radiopaque contrast to improve imaging confirmation of bursal injection
Key Findings
- •Proximal approach to bicipital bursa centesis achieved 39% accuracy while distal approach achieved only 28% accuracy in inexperienced clinicians
- •Ultrasonographic imaging accurately predicted location of injected solution in all 12 shoulders examined
- •Addition of air to radiopaque contrast medium improved ultrasonographic confirmation and radiographic definition compared to contrast medium alone