References
Diagnosis and treatment of sacroiliac joint region pain in horses
Abstract
The sacroiliac joint and pain deriving from this complex region remains poorly understood in horses, although our understanding grows as the body of literature grows. A deeper understanding can be derived from the richer body of literature in human sacroiliac joint pain as the disease processes and biomechanics appear similar in both species. A highly specific and sensitive diagnostic test for this condition does not exist, so equine clinicians have to make presumptive diagnosis based on presenting signs, findings of clinical examination, diagnostic imaging and the response to blocking of the sacroiliac joint region. Many horses with sacroiliac joint region pain have concurrent orthopaedic injury or disease. Treatment is largely based on fundamentals, anecdotal evidence and translation of non-surgical techniques used in humans. Treatment for other orthopaedic conditions can conflict with rehabilitation for sacroiliac joint region pain, necessitating compromise.
The sacroiliac joints are low motion synovial articulations formed where the ventral aspect of the iliac wing articulates with the fused transverse processes of the sacrum. The sacroiliac joints, in conjunction with substantial soft tissues, are responsible for transferring forces between the hindlimbs and axial skeleton. Allowing for the anatomical and biomechanical differences between bipeds and quadrupeds, many similarities between horses and humans exist with reference to sacroiliac joint pain. It is therefore prudent to take advantage of the relative abundance of human research on the subject. Similarities between the species include variable and often subtle clinical signs of sacroiliac joint region pain (Szadek et al, 2009; Barstow and Dyson, 2015; Maher et al, 2017), complex and inaccessible anatomy, presence of significant articular and periarticular degenerative or pathological changes seen in normally functioning individuals (Haussler et al, 1999; Eno et al, 2015) and the overlap in diagnostic imaging findings in painful and pain-free individuals (Archer et al, 2007; Thawrani et al, 2019). In humans and horses there is no reference or ‘gold-standard’ diagnostic test for sacroiliac joint pain (Szadek et al, 2009; Simopoulos et al, 2015) and in humans the issue is contentious. However, there is growing evidence indicating that a positive response to sacroiliac blocking is diagnostic in humans. In humans advanced cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), is undertaken to rule out other disease or injuries in the region (Thawrani et al, 2019). Equine veterinarians and human doctors similarly lack consensus regarding optimal treatment of individuals with sacroiliac joint pain, but substantial evidence supports sacroiliac joint injections with corticosteroids and physiotherapeutic interventions in human patients.
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