Beyond the needle

Joint injections play an invaluable part in equine medicine, but complications can and do happen. Michael Duggan MRCVS outlines what may occur

- Michael Duggan

INTRASYNOVIAL injections are a cornerstone of equine sports medicine, widely used for the diagnosis of lameness and subsequent management of joint inflammation and osteoarthritis.

These injections can be intra-articular (into the joint) or intrathecal (into a tendon sheath or bursa). They target different anatomical structures, but the techniques, precautions, and potential complications are similar. When performed correctly, these procedures are generally safe, effective and well tolerated.

However, even with meticulous technique, complications can and do occur. Synovial sepsis (vet clinic, 18 April 2024) is a feared and potentially life-threatening complication following intrasynovial injection and early identification and treatment are essential for a positive outcome.

There is a wide array of medications and supportive treatments used to manage synovial inflammation, which can be divided into two broad categories - pharmaceuticals and orthobiologics.

Pharmaceuticals are typically medications such as corticosteroids. The term orthobiologic refers to a relatively new collective for therapeutics of biological origin with a role in treating musculoskeletal disorders, which includes platelet rich plasma (PRP), autologous conditioned serum, autologous protein solution, stem cell preparations and alpha-2-macroglobulin, among others.

Other medications that might be injected are local anaesthetics, often used in lameness localisation as "joint blocks", or, as your vet may refer to them, intrasynovial diagnostic anaesthesia.

No matter what your role in the equine industry, being aware of what lies "beyond the needle" is key to understanding the treatment options available and decision-making processes that your vet will take in collaboration with you.

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