Septic inflammation of the bicipital bursa

Septic bursitis should be suspected in cases of moderate to severe lameness with wounds or swelling around the shoulder. Though not evident in this study, early diagnosis and aggressive treatment should improve the prognosis and help prevent the catastrpophic complication (25% of the cases) of weight-bearing laminitis in the opposite leg.
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<b>Septic inflammation of the bicipital bursa: clinical, imaging, and surgical findings in nine horses</b>
J Am Vet Med Assoc. 2023 May 23;1-8. doi: 10.2460/javma.23.02.0074. Online ahead of print.
Authors
Pius Spiesshofer 1 , Isabelle Kilcoyne 2 , Mathieu Spriet 2 , Scott A Katzman 2 , Verena K Affolter 3 , Betsy Vaughan 2
Affiliations

1 1William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, CA.
2 2Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA.
3 3Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California-Davis, Davis, CA.

PMID: 37225156
DOI: 10.2460/javma.23.02.0074

Abstract

Objective: To describe the etiologies, clinicopathologic findings, diagnostic modalities employed, treatments, and outcome associated with cases of septic bicipital bursitis.

Animals: 9 horses.

Clinical presentation and procedures: Medical records of horses diagnosed with septic bicipital bursitis between 2000 and 2021 were reviewed. Horses were included if synoviocentesis of the bicipital bursa revealed a total nucleated cell count of ≥ 20,000 cells/µL with a neutrophil proportion of ≥ 80%, a total protein concentration of ≥ 4.0 g/dL, and/or the presence of bacteria on cytology, or positive culture of the synovial fluid. Information retrieved from medical records included signalment, history, clinicopathologic variables, diagnostic imaging findings, treatment, and outcome.

Results: Trauma was the most common inciting cause (n = 6). Synoviocentesis using ultrasonographic guidance was performed in all cases and showed alterations consistent with septic synovitis. Radiography identified pathology in 5 horses, whereas ultrasonography identified pathology in all horses. Treatment consisted of bursoscopy (n = 6) of the bicipital bursa of which 1 was performed under standing sedation, through-and-through needle lavage (3), bursotomy (2), or medical management alone (2). Five (55.6%) horses survived to discharge. Long-term follow-up was available for 3 horses and all were serviceably sound, with 2 in training as pleasure horses and 1 case continuing retirement.

Clinical relevance: Ultrasonography was the most informative imaging modality and paramount in obtaining synovial fluid samples for definitive diagnosis of septic bicipital bursitis. Bursoscopy performed under standing sedation is a feasible treatment option. Horses treated for bicipital septic bursitis have a fair prognosis for survival and may return to some level of athletic performance.