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Nuchal bursa: bursitis

pequis

Synonym(s): Nuchal bursitis


Introduction

  • Cause: often unknown but possible causes are direct or indirect trauma, wounds and direct penetrations, hematogenous spread of infection, eg brucellosis.
  • Signs: palpable swelling and/or pain within the poll or cranial neck region. Abnormal movement of the neck or head and resistance to manipulation. Abnormal head and/or neck carriage at rest or ridden.
  • Diagnosis: clinical signs, ultrasonography, radiography, centesis and laboratory analysis of samples.
  • Treatment: systemic and intrabursal antibiotics in septic cases; systemic and intrabursal anti-inflammatory medications in non-septic cases; bursoscopy in both types of case.
  • Prognosis: guarded to poor with medical treatment, especially in septic cases, fair to good with bursoscopy.

Pathogenesis

Etiology

  • Three bursae are associated with the nuchal ligament in the horse.
  • They are positioned underneath the ligament and over the spinous processes.
  • They include:
    • Cranial or atlantal nuchal bursa which is dorsal to the atlas (C1) and ventral to the funicular portion of the nuchal ligament.
    • Caudal nuchal bursa lies between the spinous process of the axis (C2) and the funicular portion of the nuchal ligament.
    • Supraspinous bursa is usually found over the dorsal spinous process of the second thoracic vertebra (T2) and beneath the funicular and lamellar parts of the nuchal liagment.
    • These structures are variably present.
  • Septic bursitis of the cranial nuchal bursa has been called 'poll evil'.
  • Sepsis of the supraspinous bursa has also been known as 'fistulous withers' Spine: supraspinous bursa - bursitis.
  • In individual cases the actual etiology may be obscure but known causes include:
    • Direct or indirect trauma, either acutely from falls, or recurrent chronic issues from specific equitation techniques.
    • Wounds and direct penetrations.
    • Hematogenous spread of infection, including brucellosis.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Garcia-Lopez J M et al (2010) Diagnosis and management of cranial and caudal nuchal bursitis in four horses. JAVMA 237 (7), 823-829 PubMed.
  • Hawkins J F & Fessler J F (2000) Treatment of supraspinous bursitis by use of debridement in standing horses: 10 cases (1968-1999). JAVMA 217 (1), 74-78 PubMed.

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