equis - Articles
Palmar digital nerve: neurectomy
Introduction
- Chronic painful foot conditions that do not respond to other therapies may respond to permanent relief of pain by sectioning of the nerve supplying affected region.
Uses
- Navicular bone fracture Navicular bone: fracture :
- For horses intended for return to athletic activity, where there is residual lameness after prolonged rest, or after a short rest when prolonged rest period is not possible.
- Navicular disease Navicular bone: syndrome .
- Fractures of the palmar process of the distal phalanx .
Contraindications - Navicular bones that are excessively osteoporotic with large medullary cyst formation - neurectomies in horses with these may lead to catastrophic failure of the limb with strenuous use.
Advantages
- Simple surgical procedure.
Alternative techniques - Epineural capping.
- Cryoneurectomy.
- Electrocoagulation.
- Transection.
- Combination of techniques.
Disadvantages
- Of no benefit if source of pain involves the dorsal half of the distal digit or does not respond to palmar digital perineural anesthesia Forelimb: perineural analgesia Hindlimb: perineural analgesia .
- A variety of techniques have been described, all associated with some complications.
- Permanent loss of sensation to the foot could result in inadvertant self trauma.
Alternative techniques
- Definitive diagnosis of source of lameness should be obtained - full lameness workup including diagnostic imaging:
- Examination of horse at rest Musculoskeletal: physical examination - adult .
- Gait evaluation Musculoskeletal: gait evaluation .
- Perineural analgesia, forelimb Forelimb: perineural analgesia .
- Radiography forelimb Forelimb: radiography .
- Response to palmar digital nerve block Forelimb: perineural analgesia essential before considering neurectomy Palmar digital nerve: neurectomy .
- Try conservative or other therapies before undertaking neurectomy Palmar digital nerve: neurectomy .
Check legality of procedure with relevant legislature
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Murray R C et al (1994) Acute effects of perineural administration of sodium hyaluronate on palmar digital neurectomy sites in horses. Am J Vet Res 55 (10), 1484-1489 PubMed.
- Jackman B R et al (1993) Palmar digital neurectomy in horses. 57 cases (1984-1990). Vet Surg 22 (4), 285-288 PubMed.
- Cummings J F et al (1988) Attempts to prevent equine post neurectomy neuroma formation through retrograde transport of two neurotoxins, doxorubicin and ricin. Equine Vet J 20 (6), 451-456 PubMed.
- Fubini S L et al (1988) The use of intraneural doxorubicin in association with palmar digital neurectomy in 28 horses. Vet Surg 17 (6), 346-349 PubMed.
- Said A H et al (1984) Clinicopathologic studies on neurectomy in equids. Equine Vet J 16 (5), 442-446 PubMed.
Other sources of information
- Yovich J V (1982) Palmar digital neurectomy. In: Equine Surgery. Ed: J A Auer. W B Saunders, USA. ISBN 0-397-50937-5.