Abstract
Background: Humeral stress fractures in racehorses can progress
to catastrophic fracture if unrecognized. Scintigraphy is the current
gold standard diagnostic technique but is limited by accessibility and
cost. Radiographs are inconclusive until sufficient bone modeling occurs
to be visible. It was hypothesized that ultrasound could be used to
visualize caudoproximal humeral stress fractures. Objectives:
Examine horses with caudoproximal humeral stress fractures with
ultrasound. Study Design: Clinical case series.
Methods: Seven racehorses that had a clinical history
consistent with the presence of a humeral stress fracture were examined
using humeral ultrasound and radiography with or without scintigraphy
from June 2013 through June 2021. Clinical and imaging findings are
described. Results: Seven Thoroughbred racehorses aged 2-4
years had a history of acute onset of a severe lameness with 4 returning
to training 3-12 months after layup for an unrelated reason. Nine of 10
humeral stress fractures (2 bilateral, 3 left, 2 right) were identified
with ultrasound. Ultrasound abnormalities included a step defect (5
humeri, 5 horses), periosteal callus/roughening (7 humeri, 4 horses)
and/or an abnormally convex contour of the caudal aspect of the humeral
neck (6 humeri, 5 horses). Radiographs revealed periosteal (8 humeri, 6
horses) and/or endosteal (6 humeri, 4 horses) proliferation adjacent the
caudoproximal aspect of the humeral cortex. Scintigraphy of 5 horses
identified increased radiopharmaceutical uptake in the caudoproximal
aspect of 7 humeri. Serial recheck radiography and ultrasound (5 horses)
revealed bone remodeling. Horses were returned to intended use as
racehorses (4) or riding horses (2) or were retired (1). Main
Limitations: Small case series. Conclusions: Ultrasound is
useful for caudoproximal humeral stress fracture detection and can be
utilized to monitor healing.