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Diseases of the Sesamoid Bones
Diseases of the Sesamoid Bones in Horses
Introduction
The sesamoid bones are an integral part of the suspensory apparatus helping to support the fetlock and pastern. They are embedded in the suspensory ligaments and articulate onto the back of the distal cannon. During flexion and extension they move up and down and help redirect the force of the suspensory ligaments around the fetlock. There are several common diseases of the suspensory and sesamoid bones.
Of special interest is the radiographic diagnosis of sesamoiditis in the front and hind fetlocks of yearling Thoroughbred survey films, taken as part of a pre sale evaluation. Sesamoiditis has been shown to be the most common radiographic abnormality of front and hind fetlocks of yearling Thoroughbred survey films. The purpose of this study was to evaluate survey radiographs of yearlings. The radiographic findings were then correlated with the number of starts, total earnings, and average earnings per start for the 2- and 3-year-old years. This article describes the results of this study, conditions of the sesamoid bones, and their diagnosis, treatment, and prognosis.
For more information on the localization of lameness to the ankle and other conditions of the fetlock.
Sesmoiditis
Sesamoiditis is a common diagnosis made from radiographic changes but the disease is poorly understood and thought to be over diagnosed. Sesamoid changes are the most common abnormality found in the prepurchase exam of race horses. Changes occurred primarily at the non articular abaxial border near the suspensory insertion. Many of these variations may be normal. There was no difference in normal sesamoid horses and the racing performance of horses with one to two abnormal linear defects, lucency at the distal abaxial border, or irregular abaxial border in both the two and 3-year-old racing years. Studies do support that radiographically severe sesamoiditis, greater than two distinctly abnormal vascular channels, in a yearling affects future performance and earning potential in its 2- and 3-year-old racing careers.
Diagnosis
Horses with painful sesamoids may show signs of pain on palpation over the sesamoids and improvement with a low volar block proximal to the fetlock. Blocking the fetlock joint shows slight but not complete improvement. It is important that the vascular channels be differentiated from non displaced fractures as further work on the fractured sesamoid will result in displacement. The radiographic changes looked for are:
- loss of fine trabecular detail,
- increased size of the bone,
- increase number of vascular channels,
- development of enthesiophytes at the site of attachment of the ligaments.
Treatment
Treatment consists of rest and correction of long toes and low heels but the prognosis is guarded for return to previous work loads. Most beneficial has been using training techniques that lessen the work load on the suspensory and sesamoids like swimming. Race horses are usually not removed completely from training as the condition recurs when put back in. Decreased training regimens, swimming for conditioning, and time to allow fibrosis, allows some horses to continue to perform but at a lower level with the help of icing and intrarticular medications. Specific intra-articular treatment with hyaluronic acid and/or corticosteroids have made remarkable improvements in the short term performance of some horses.
Fractures of the Proximal Sesamoid Bones
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