Assessment of intrasynovial injection in horses by contrast-enhanced ultrasonography using air bubbles created by agitation of solution.

Authors: Ogden Nadine K E, Cullen Matthew D, Stack John D

Journal: Equine veterinary journal

DOI: 10.1111/evj.13388 PubMed: 33222248Log in to save

Summary

# Editorial Summary: Contrast-Enhanced Ultrasonography for Assessing Intrasynovial Injections in Horses Determining whether an intrasynovial injection has reached its target can be difficult in clinical practice, yet accuracy is critical for therapeutic success and avoiding complications from periarticular deposition of medication. Ogden and colleagues adapted a human rheumatology technique—contrast-enhanced ultrasonography (CEUS) using air-agitated injectate—to assess injection placement in equine synovial structures. Their cadaveric validation demonstrated perfect sensitivity (100%) and specificity (100%) for distinguishing intrasynovial from extrasynovial injections, with contrast appearing as hyperechoic dots, patches or lines on ultrasound; the technique then proved safe and practical when applied to 26 clinical injections across 14 horses, where it additionally identified three cases with traumatic intersynovial communications or synovial membrane defects that might otherwise have gone undetected. For farriers and veterinarians performing intrasynovial medication, this method offers real-time confirmation of needle placement and could prevent the complications and reduced efficacy associated with missed injections, whilst also providing a diagnostic tool for detecting structural pathology within synovial structures.

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Practical Takeaways

•CEUS with agitated solution provides a reliable real-time method to confirm successful intrasynovial injection placement and identify failed injections in live horses
•This technique can detect unexpected synovial pathology such as intersynovial communications that may affect injection success and treatment planning
•Consider adopting CEUS as a quality control measure for therapeutic synovial injections to improve clinical outcomes and client confidence

Key Findings

•Contrast-enhanced ultrasonography (CEUS) using agitated solution achieved 100% sensitivity (CI 93%-100%) and 100% specificity (CI 16%-100%) for confirming intrasynovial injection placement in cadaveric study
•CEUS successfully identified 3 cases of traumatic intersynovial communications or synovial membrane defects in clinical cases
•The technique was applied safely across 26 injections targeting 19 different synovial structures in 14 horses for lameness localization and treatment

Conditions Studied

lamenesssynovial joint diseaseintersynovial communicationssynovial membrane defects

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