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Equine med power point presentation
 

Equine med power point presentation

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    Equine med power point presentation Equine med power point presentation Presentation Transcript

    • Equine Lameness
    • - diagnostic aid used to localize lameness when the site of pain is uncertain. - surgical procedures can performed without the need for general anesthesia. - provide temporary, humane relief of pain.
    • Lidocaine HCl (2%) – 30 – 45 minutes Mepivacaine HCl (2%) – 90 – 120 minutes Bupivacaine HCl – 4 – 6 hours
    • Palmar Digital Nerve Block - “heel block”, PDN - most commonly used - needle is inserted directly above the neurovascular bundle of the foot.
    • Semi-ring Block at the Pastern - anesthetize the dorsal branches of the digital nerve that supply the foot. - above the collateral cartilages at the same site as PDN block.
    • Abaxial Sesamoid Nerve Block - local anesthetic solution is deposited at the base of the proximal sesamoid bones over the neurovascular bundle.
    • Low Palmar Nerve Block (Low 4-Point Block) - medial and lateral palmar nerves are anesthetized. - local anesthetic solution is deposited SC at the distal end of each splint bone to complete the block.
    • High Palmar Nerve Block (High 4-Point Block) - medial and lateral palmar and palmar metacarpal nerves are anesthetized slightly distal to the level of the carpometacarpal joint.
    • Lateral Palmar Nerve Block -
    • low 4-point nerve block high 4-point nerve block
    • ► Complete or partial rupture of a cruciate ligament resulting in severe lameness and joint instability. ► Effusions of the femoropatellar or femorotibial joints are sometimes present. Diagnosis: ♣ Confirmed by arthroscopic examination through Ultrasonography.
    • Treatments: ♣ Conservative treatment for acute injuries [rest, systemic NSAID, and intra-articular corticosteroids]. ♣ Arthroscopic surgery is recommended to debride loose and torn ligament fibers. ♣ Lameness is usually improved by intra-articular anesthesia of the femorotibial joints. Prognosis: ♣ Complete rupture have a grave prognosis. ♣ Moderate to severe injuries have a poor prognosis for return to athletic function. ♣ Mild injuries have a fair prognosis.
    • ► Rupture or sprain of the medial or lateral collateral ligaments of the stifle usually as a result of an acute traumatic episode in which the distal limb is forced medially or laterally. ►Concurrent injury of the menisci or cruciate ligaments is common, particularly in severe injuries.
    • Clinical Signs: ♣ Localized edema and joint effusion is seen, particularly in the acute stages. ♣ Enthesiophyte formation at the origin or insertion of the ligament may be evident radiographically in chronic cases. ♣ If complete ligament rupture has occurred, stressed caudocranial radiographs of the stifle may demonstrate joint widening on the affected side. Signs sually improve within a few days without any significant joint instability.
    • Diagnosis: ♣ Confirmed by Ultrasonography. Treatment: ♣ Mild sprains may be treated conservatively with stable rest and anti-inflammatory medication for 6–8 weeks followed by a controlled, ascending exercise rehabilitation program for a further 6–8 weeks. Prognosis: ♣ Horses with mild sprains and no joint instability have a fair prognosis for return to athletic use. ♣ Severe injuries have a poor prognosis.
    • ► The medial patellar ligament remains hooked over the medial trochlear ridge of the femur and locks the reciprocal apparatus with the limb in extension. ► Horses with recurrent upward fixation or delayed release of the patella may develop chronic, low-grade lameness due to stifle soreness and may be reluctant to work. ► Most commonly seen in young horses and ponies, particularly if they are in poor body condition and poorly muscled older horses that have had trauma to the stifle region, especially if horses are stabled or have been inactive. ► Straight hindlimb conformation may predispose to this condition.
    • Diagnosis: ♣ Based on recognition of typical clinical signs. ♣ Radiography of the stifle should be taken in horses with femoropatellar joint effusion and lameness to establish concurrent or secondary pathology. Management: ♣ To release an upward fixated patella, the horse should be pushed backward while simultaneously pushing the patella medially and distally. Alternatively, pulling the limb forward with a rope around the pastern may unlock the patella. ♣ Stable rest is contraindicated and the horse should be turned out to pasture as much as possible.
    • ♣ If upward fixation of the patella is intermittent and not causing lameness, a conditioning program should be instituted. This involves daily lungeing or riding of the horse, appropriate to its age and type, as well as ensuring an adequate plane of nutrition, good dentistry, and anthelmintic administration. ♣ Remedial hoof trimming to ensure that the foot is well balanced and shoeing with a bevel-edged shoe with or without a lateral heel wedge may be beneficial. ♣ A significant proportion of horses will improve with maturity and conservative treatment although signs may recur if the horse undergoes prolonged stall rest.
    • Treatments: ♣ Conservative treatment ♣ Medial patellar ligament desmotomy is indicated in horses that fail to respond to conservative treatment or in horses with lameness caused by upward fixation of the patella. “Medial patellar ligament desmotomy is most often performed in the sedated horse under local anesthesia or general anesthesia. Following surgery, the horse should be restricted to stable or small pen rest for 2 months to reduce the risk of complications”
    • Complicatios: ♣ Fragmentation of the apex of the patella ♣ Lameness ♣ Local swelling ♣ Patella fracture Prognosis: ♣ Generally considered to be good with rare recurrence of the condition.
    • ► Usually occurs secondary to medial patellar desmotomy for the management of upward fixation of the patella. ► Lesions are believed to occur due to patellar instability as a result of the surgery. ► A proximal limb flexion test usually exacerbates lameness and femoropatellar joint effusion is usually present. Lameness is localized by diagnostic anesthesia of the femoropatellar joint.
    • Diagnosis: ♣ Confirmed by radiography. Treatment: ♣ Arthroscopic debridement of the apex of the patella and removal of the osteochondral fragments is the treatment of choice. Prognosis: ♣ Reasonable but depends on the severity of the condition
    • ► Displacement or misalignment 0f the patella. ► Lateral luxation of the patella is a rare, inherited condition in foals caused by a recessive gene. ► Luxation of the patella in adult horses is unusual and likely to be traumatic in origin. Lateral luxation is more common than medial luxation and may be more likely in horses or foals with hypoplasia of the lateral trochlear ridge of the femur. ► The condition may be unilateral or bilateral and varies in severity from intermittent luxation [that readily reduces] to persistent luxation [that cannot be reduced]. ► Severely affected foals are unable to extend the stifle and adopt a characteristic crouching position. ► If the condition is less severe, foals or horses may be reluctant to flex the stifle and demonstrate a stiff hindlimb gait.
    • Diagnosis ♣ Confirmed by radiography. Treatment: ♣ Surgery Prognosis: ♣ The prognosis in adult horses and horses with concurrent osteoarthritis is poor. ♣ The prognosis for athletic function in foals may be slightly better.
    • ► Usually rare but may be seen in jumping horses. ► The middle patellar ligament is the most commonly affected. ► Lameness is variable but may be severe in acute cases. Clinical signs: ♣ Femoropatellar joint effusion ♣ Periligamentous thickening ♣ Edema
    • Diagnosis: ♣Confirmed by Ultrasonography. Treatment : ♣Prolonged rest [up to six months].
    • ►Gonitis is a term indicating inflammation within the stifle joint. ► Mild to moderate inflammation of the femorotibial and femoropatellar joints of unknown origin. ► Synovitis and capsulitis may result from athletic sprain of the joints. Management: ♣ Mild synovitis usually responds to rest. ♣ Intra-articular and systemic anti-inflammatory drugs.
    • ► Osteoarthritis is a disease of joints with multifactorial causes that results in the progressive degradation and destruction of articular cartilage. ► Osteoarthritis of the femorotibial or femoropatellar joints may follow any of the causes of stifle lameness described and usually results in persistent lameness of varying severity. Diagnosis: ♣ Confirmed with intra-articular anesthesia and radiography.
    • Lesions/Radiologic changes: ♣ Periarticular remodeling with osteophyte formation and remodeling of the joint margins (particularly the medial tibial plateau) ♣ Changes in the subchondral bone ♣ Narrowing of the joint space ♣ Dystrophic mineralization of the soft tissues
    • Prognosis: ♣ Prognosis for athletic soundness in horses with osteoarthritis of the stifle is poor. Treatment: ♣ Usually palliative. ♣ Newer techniques for arthroscopy and regenerative therapy may offer some hope for severely affected joints.
    • FRACTURES OF THE PATELLA ► Fractures of the patella usually result from direct trauma ►Fracture of the patella usually results in marked lameness initially, with swelling and edema over the patella and effusion of the femoropatellar joint. In less severe or nonarticular fractures, lameness may improve within a few days.
    • Diagnosis: ♣ Confirmed by radiography. Management: ♣ Conservative treatment with stable rest for 6-8 weeks for horses with small, nondisplaced, nonarticular fractures . Good prognosis for return to athletic function. ♣ Articular fractures can be removed arthroscopically or via an arthrotomy. Good prognosis. ♣ Larger mid-body sagittal or horizontal fractures require repair by internal fixation.
    • FRACTURES OF THE TIBIAL TUBEROSITY ► Usually result from direct trauma of the little soft tissue covering this joint. ► Usually results in marked lameness initially with localized swelling and edema. Diagnosis : ♣ Confirmed by radiography.
    • Treatments: ♣ Conservative treatment with stable rest for 6–8 weeks. ♣ Larger, intra-articular fractures should be repaired by internal fixation. Prognosis: ♣ Fractures generally have a good prognosis for return to athletic function if appropriately managed.
    • FRACTURES OF THE FEMORAL CONDYLES AND FEMORAL TROCHLEAR RIDGES ►Usually the result of direct trauma. ► Large, intra-articular, displaced fractures in adult horses are atastrophic and have a grave prognosis. ►Usually result in acute onset, moderate to severe lameness with joint effusion.
    • Diagnosis: ♣ Confirmed by radiography. Treatment: ♣ Surgery [arthroscopically and/or arthrotomy]. Prognosis : ♣ Good as there is no significant concurrent soft tissue damage.
    • ► Most cases are traumatic in origin, secondary to falls or being cast (within a stall) in recumbency, although septic arthropathies and developmental disorders of the joint have been occasionally reported. ► Results to osteoarthritis of the coxofemoral joint and lameness. Clinical Signs: ♣ Lameness ♣ Pain on proximal limb flexion or abduction. ♣ In some cases of acute fracture, a hematoma or alteration in the bony architecture are palpable per rectum.
    • Diagnosis: ♣ Diagnostic imaging. ♣ Percutaneous ultrasonography ♣ Radiography ♣ Arthroscopy
    • ► Relatively rare and is usually secondary to trauma. ► Much more common in small ponies and has been frequently described secondary to upward fixation of the patella. ► Fracture of the dorsal acetabular rim may accompany the dislocation and is usually accompanied by a characteristic alteration in limb appearance.
    • Management: ♣ Closed reduction under general anesthesia, although this is only likely to be successful if the reduction is performed soon after the injury. ♣ The prognosis for return to athletic function following coxofemoral luxation is very guarded.
    • ► Major cause of poor performance and gait abnormalities in sport and race horses. ►Once back pain is suspected or established in a horse, identification of the cause requires imaging procedures.
    • KISSING SPINES ► location of these lesions is the vertebral segment between T10 and T18 or L1 and L6. ► Abnormal findings can be easily seen in the dorsal and ventral part of the spinous processes. ► They include kissing and overriding lesions. Different Grades ♣ Grade 1: Narrowing of the interspinal space ♣ Grade 2: Densification of the margins ♣ Grade 3: Bone lysis adjacent to the margins ♣ Grade 4: Severe remodeling.
    • ► Commonly found in racing Thoroughbreds and are rare in Standardbreds. Diagnosis: ♣ Aided by injection of local anesthetic into the affected interspinous spaces. Management: ♣ Local injections of steroids ♣ Mesotherapy, and/or shockwave therapy ♣ Rehabilitation
    • FRACTURES ► Mostly seen in spinous processes of T4–T10 and are sometimes seen in horses that have reared and fallen over backward. ► The summits and centers of ossification are fractured and displaced laterally. ► Recovery is often satisfactory after the pain has subsided. ► No permanent effect on performance, but a persistent deformation of the withers may require use of a special saddle.
    • DESMOPATHIES (Supraspinal ligament injuries) ► Acute or subacute desmopathies induce dorsoventral or transverse thickening of the ligament, reduced echogenicity, and severe alteration of the linear pattern found in the median plane or asymmetrically. ► Alteration of the bone surface of the top of the spinous processes indicates insertional desmopathy (enthesopathy) of the supraspinous ligament.
    • ► located dorsally to the vertebral canal and is composed of the caudal articular process of one vertebra, the synovial joint located at the base of the interspinal space, and the cranial articular process of the following vertebra. ► Abnormal radiographic findings were mainly observed at the thoracolumbar junction and in the lumbar area. ► AP-SIVA lesions are much more likely to be associated with back pain than kissing spines or any other vertebral lesions.
    • ► Vertebral Spondylosis - most common lesion of vertebral bodies and disks. - mainly found in the midthoracic area [mostly between T10 and T14] but can also be observed in the lumbar area. ► Congenital abnormalities with vertebral body deformation (triangular or trapezoidal shape) are rare and usually found in the thoracic vertebrae.
    • ► Vertebral body osteomyelitis can be seen in the thoracolumbar spine in foals. ► Complete or partial paraplegia results from damage to the spinal cord. Prognosis: ♣ The prognosis is grave.
    • ► Commonly caused by damage to the muscles acts to extend and laterally flex the vertebral column. Clinical Signs: ♣ Altered performance ♣ Back pain Treatments: ♣ Conservative treatment, rest and physiotherapy
    • Congenital abnormalities: lumbosacral ankylosis or intervertebral ankylosis Disk degenerative lesions - fissuration or cavitation of the disk, dystrophic mineralization and ventral herniation Intervertebral malalignment (spondylolisthesis) Intertransverse lumbosacral osteoarthrosis Diagnosis: ♣ Ultrasonography
    • ► Acute and severe strain of the sacroiliac ligaments is associated with a history of injury and of severe pain in the pelvic or sacro-iliac region marked hindlimb lameness. ► Subacute or chronic sacroiliac strain and osteoarthrosis of the sacroiliac joint cause typical back soreness. Diagnosis : ♣ Physical examination ♣ Ultrasonography
    • Abnormal Ultrasonographic Findings ♣ Bone modeling of the sacrum and/or ileum ♣ Narrowing of the joint space ♣ Remodeling or periarticular osteophytes of the caudal border of the auricular surface of the sacrum ♣ Remodeling or periarticular osteophytes of the caudal auricular margin of the ileum ♣ Periarticular bone fragmentation ♣ Ventral sacroiliac ligament desmopathy and enthesopathy.
    • Treatment and Management: ♣ Ultrasonographic-guided injections of steroids ♣ Mesotherapy over the painful area ♣ Rehabilitation using progressive warmup at a slow canter and exercises that develop the gluteal muscles.
    • ► Acute or chronic Inflammation of a tendon with varying degrees of tendon fibril disruption. ► Most common in horses used at fast work [racehorses]. ► Seen in the flexor tendons and is more common in the forelimb than in the hindlimb. Lesions: ♣ Central rupture of tendon fibers with associated hemorrhage and edema.
    • Etiology: ♣ Usually appears after fast exercise and is associated with overextension and poor conditioning, fatigue, poor racetrack conditions, and persistent training when inflammatory problems in the tendon already exist. Predisposing Factors ♣ Improper shoeing ♣ Poor conformation ♣ Poor training
    • Clinical Findings : ♣ Acute stage: Severe lameness, involved structures are hot, painful, and swollen. ♣ Chronic stages: Fibrosis with thickening and adhesions in the peritendinous area. The horse may go sound while walking or trotting, but lameness may recur under hard work. Diagnosis: ♣ Ultrasonography
    • Treatment: ♣ Stall-resting ♣ Swelling and inflammation treated with cold packs and systemic anti-inflammatory agents. ♣ Tendon splitting has been recommended when a distinct hypoechoic or anechoic core lesion is present. ♣ Shock wave therapy, intralesional injection of fat-derived stromal cells or cultured bone marrow-derived mesenchymal stem cells, or autologous conditioned plasma. ♣ Superior check ligament desmotomy - adjunctive treatment to minimize recurrence
    • Chronic tendinitis ♣ Superficial point firing and percutaneous tendon splitting. ♣ Annular ligament desmotomy is also used when tendinitis involves the area of the digital tendon sheath. Prognosis for a flat-racing Thoroughbred racehorse to return to racing after a bowed tendon is guarded. Contraindication: ♣ Intratendinous corticosteroid injections
    • ♣ Osteochondrosis ♣ Physeal dysplasia ♣ Acquired angular limb deformities ♣ Flexion deformities ♣ Cuboidal bone malformations
    • ♣ One of the most important and prevalent developmental orthopedic diseases of horses. Osteochondrosis is currently used to describe the clinical manifestation of the disorder. Dyschondroplasia is preferred when referring to early lesions because primary lesions are seen in cartilage. Etiology: ♣ Multifactorial and specific etiology is unknown. ♣ Osteochondrosis multifactorial etiology that includes rapid growth, overnutrition, mineral imbalance, and biomechanics, genetics. ♣ The condition mainly affects articular growth cartilage, but the metaphysis may also be involved. If the physeal metaphyseal cartilage is affected, bone contours and longitudinal growth are disturbed (see Physitis in Horses). Lesions: ♣ Changes at the joint margins, dissecting lesions, and the formation of cartilage flaps or osteochondral fragments (osteochondrosis). ♣ Central articular lesions may lead to the development of subchondral cysts. ♣ Axial skeletal involvement includes vertebral articular facets.
    • Clinical Findings: ♣ Nonpainful distention of an affected joint. ♣ Lameness is more often the first sign observed. ♣ Often the first sign noted in foals is a tendency to spend more time lying down accompanied frequently by joint swelling, stiffness, and difficulty keeping up with other animals, upright conformation of the limbs.
    • Diagnosis: ♣ Based on signalment and signs ♣ Radiographic examination ♣ Ultrasonographic examination ♣ Arthroscopy - most accurate ♣ Scintigraphy - has limitations in growing horses ♣ MRI - ideal for diagnosis of both early and late lesions ♣ Clinical pathology and the evaluation of synovial fluid rarely helpful
    • Treatment and Management: ♣ Conservative treatment ♣ Intra-articular medication with hyaluronic acid and injection of long-acting corticosteroids but is NOT recommended in young, growing horses. ♣ Arthroscopy Prognosis ♣ Prognosis following removal of discrete osteochondral fragments is good. ♣ Prognosis is poor for cases with instability resulting from joint surface loss or in which secondary osteo-arthritis (degenerative joint disease). ♣ Prognosis in cases involving subchondral cysts have is guarded
    • ► Swelling around the growth plates of certain long bones in young horses and can be a component of osteochondrosis. ► Caused by malnutrition, conformational defects, faulty hoof growth, excessive exercise, obesity, and toxicosis. ► Result of overload of the physeal area due to excessive loading or weakened bone and/or cartilage or a combination of these factors. ► Characterized by flaring at the level of the growth plate, giving a typical “boxy” appearance to the affected joints. ► Physeal cartilage appears crushed and thinned microscopically.
    • Treatment: ♣ Reducing food intake ♣ Confining exercise to a yard or a large, well-ventilated loose box with a soft surface ♣ Ensuring that the feet are carefully and frequently trimmed ♣ Correcting the diet Prevention: ♣ Older foal or yearling that is fat or heavy-topped should be watched carefully for clinical signs for early adjustments.
    • ► Associated with postural and foot changes, lameness, and debility. ► May be congenital and therefore identified in newborn foals or acquired at an older age. ► Caused by uterine malposition, teratogenic insults (arthrogryposis), and genetic defects in newborn foals. ► Chronic pain arose from physitis, osteochondrosis, degenerative joint disease, pedal bone fracture, or soft-tissue wounds and infection is the most common cause of acquired tendon contracture. ► The horse walks on its toes or knuckles in the fetlocks or occasionally the pastern joint.
    • Clinical Findings: ♣ Unable to stand ♣ Attempt to walk on the dorsum of their fetlocks ♣ Can stand but knuckle in the fetlocks or carpi ♣ Animals may walk around on their toes with their heels off the ground. ♣ Slower onset is characterized by a “boxy” hoof with an elongated heel and concave toe. ♣ Physitis frequently is evident ♣ Toe abscesses are a frequent complication of the hoof ♣ Locomotion changes
    • Treatment and Management: ♣ Mild cases in newborn foals often require no treatment. ♣ More severe cases require supportive therapy ♣ Use of splints necessitates careful fitting and management ♣ Casts are generally safer if used only for short periods (5–7 days) ♣ High-dose oxytetracycline therapy is commonly used (40–60 mg/kg).
    • ♣ Conservative management in early cases in older foals and weanlings through nutritional correction, proper hoof trimming, and analgesia. ♣ Desmotomy of the accessory ligament of the deep digital flexor tendon (inferior check desmotomy) is the most successful and commonly used procedure for flexural deformity of the distal limb ♣ Superior check ligament desmotomy may be included for horses with fetlock deformities.
    • ♣ For carpal deformities, sectioning of the tendons of insertion onto the ulnaris lateralis and flexor carpi ulnaris is performed. ♣ In hindlimbs, tenotomy of the medial head of the deep digital flexor is performed ♣ In severe cases, tenotomy of the deep digital flexor tendon can be used as a salvage procedure. ♣ Nutritional correction, proper foot trimming, and analgesia are integral to recovery
    • Prognosis: ♣ The prognosis is fair to good for horses that are diagnosed early and managed properly.
    • ► The visual representation of an object, such as a body part or celestial body, for the purpose of medical diagnosis or data collection using any of a variety of usually computerized techniques.
    • ► Provide important pathologic and physiologic information necessary to treat specific conditions. Imaging can be divided into anatomic and physiologic methods. ► Imaging may also help prevent injury through early detection of the physiologic changes associated with injury.
    • ♣ Radiology ♣ Ultrasonography ♣ CT ♣ MRI
    • RADIOLOGY ► Most commonly used to evaluate lameness in horses. ► Goal of radiology is to examine the region sufficiently to fully evaluate the anatomic structure. ► Allows assessment of bony tissues and reflects chronic changes. ► Contrast radiography provides information about articular cartilage and surfaces
    • ► Pathologic diagnoses are usually made by radiography in conjunction with clinical examination. ►Advantages of CR include fewer retakes, a lower radiation requirement, and postprocessing techniques that eliminate contrast problems. ► Diagnostic films require preparation, positioning, and production.
    • ► Preparation involves readying the object to be radiographed and requires cleanliness and removal of foreign materials. ► Positioning is critical. The object must be evaluated from a sufficient number of angles to insure adequate evaluation. ► The production of good radiographs requires the correct exposure of the film.
    • ULTRASONOGRPAHY ► Can be used to assess any soft tissues. ► The area to be examined should be evaluated in 2 planes 90° apart. ► Selection of a probe should take into account the depth, contour, and location of the tissue to be examined.
    • ► The deeper the tissue to be evaluated, the lower the wavelength of the probe used; the higher the wavelength, the greater the detail that can be achieved. ► Examination of complex anatomic areas requires a convex linear probe. ► Examination of the pelvic region internally requires a rectal linear probe.
    • ► Most useful in the evaluation of tendons and ligaments but can also be used to evaluate muscle and cartilage. ► It is a good idea to compare the right and left sides before making an ultrasonographic diagnosis. ► Assessment of anatomic changes serves as the basis for any pathologic diagnosis, as well as being important in determining prognosis.
    • MRI Two types of MRI available: ♣ Low-field magnets - some low-field scanners can be used to examine the standing, sedated horse. ♣ High-field magnets - produce a stronger signal and higher resolution pictures in a shorter time and require the horse to be anesthetized ♣ MRI provides sliced images of the anatomic region of interest -- axial (transverse), sagittal (longitudinal), and dorsal planes
    • CT ► A technology that uses very small x-ray beams from many different angles around the body (called a slice) that are reconstructed by computer to produce an image. ► The CT scanner provides the clearest images possible of the limbs, joints, nasal passages, skull, sinus cavities, and neck that improve the clinician's ability to accurately define and identify the extent of abnormalities of these regions.
    • ► Provide images that reflect physiologic processes and assess metabolism or circulation. Types/ Methods: ♣ Thermography ♣ Scintigraphy
    • THERMOGRPAHY ► The pictorial representation of the surface temperature of an object. ► Noninvasive technique that measures emitted heat and is useful for detecting inflammatory changes that may contribute to lameness.
    • SCINTIGRAPHY ► The production of two-dimensional images of the distribution of radioactivity in tissues after the internal administration of a radiopharmaceutical imaging agent ► Polyphosphonate radiopharmaceuticals are given IV and distribution is then measured by a gamma camera. ► Scintigraphy is useful for detecting lesions in bone and ligaments.