Fractured Supraglenoid Tuberosity
The supraglenoid tuberosity [Figure 1] is located at the distal end of the scapula, cranial and just proximal to the glenoid cavity. This bony outcrop is the attachment site for the biceps brachii (Farrow, 2006) and coracobrachialis muscles (Ahern et al., 2017). Fracture of the supraglenoid tuberosity [Figure 2] is an injury that results from a fall or collision with a solid object (Ross and Dyson, 2003), also, forces produced by the biceps brachii muscle may result in avulsion fractures (Ahern et al., 2017). The supraglenoid tubercle is a centre of ossification, the physis closes between 12-24 months of age, and is a common place for fracture to occur through. The fracture may be simple and only involve the tubercle, without an articular element, or it may pass through the suprascapular notch resulting in one large fracture or separation of physes (Ross and Dyson, 2003), larger fractures can affect the articular surface of the glenoid cavity (Mair et al., 2013). Supraglenoid tuberosity fractures are uncommon and usually occur in horses under two years old, if this injury occurs in a horse under one year of age it will likely involve the physis (Ahern et al., 2017). Injury may result in damage to the suprascapular nerve (Ross and Dyson, 2003), which innervates both the supraspinatus and infraspinatus muscles (Rooney, 1998).
Clinical Signs & Diagnosis
- Neurogenic atrophy results when there is damage to the suprascapular nerve, atrophy of the infraspinatus and supraspinatus develops within 7 days, disuse atrophy may also develop more slowly (Ross and Dyson, 2003).
- A thickening of the region of the supraglenoid tuberosity is palpable, crepitus is rare (Ross and Dyson, 2003).
- The cranial phase of the stride is distinctly shortened (Baxter, 2011), or reluctance to extend the leg, with initial severe lameness improving within up to 72 hours (Ahern et al., 2017).
- Mediolateral radiographs of the region (Ahern et al., 2017) are used to confirm diagnosis where fracture fragments are usually cranio-distally displaced due to the force of biceps brachii (Ross and Dyson, 2003) that arises from the supraglenoid tubercle (Dyce et al., 2010).
Treatment & Prognosis
- Horse unlikely to return to athletic function with conservative treatment (Ross and Dyson, 2003), unless fracture is minimally displaced or non-articular (Baxter, 2011), conservative management can result in osteoarthritis and residual lameness of the scapulo-humeral joint (Ahern et al., 2017).
- Having the supraglenoid tubercle surgically removed works best for fractures that are chronic or involving the articular surface, pain caused by movement of the fracture is decreased and further damage to the joint is prevented, resulting in better prognosis than conservative management (Baxter, 2011).
- Large articular fractures can benefit from internal fixation as they can support screws, a combination of lag screws, tension band wires and interfragmentary compression is used. Prognosis is best with a combination of transection of the biceps brachii (Baxter, 2011).
- Plate fixation is a more recent treatment option, a technique where the locking compression plate immobilises the fracture by the use of lateral plates situated transversely across the scapular neck without biceps brachii tenotomy results in the best prognosis where 75% of horses will return to athletic function (Ahern et al., 2017).
Figure 2. Mediolateral radiographs of 4 horses with fractured supraglenoid tuberosities (Ahern et al., 2017).
References
AHERN, B. J., BAYLISS, I. P. M., ZEDLER, S. T., GETMAN, L. M. & RICHARDSON, D. W. 2017. Supraglenoid tubercle fractures repair with transverse locking compression plates in 4 horses. Veterinary Surgery, 46, 507-514.
BAXTER, G. M. 2011. Manual of Equine Lameness, UK, Wiley-Blackwell.
DYCE, K. M., SACK, W. O. & WENSING, C. J. G. 2010. Textbook of Veterinary Anatomy, Missouri, Saunders.
FARROW, C. S. 2006. Veterinary Disgnostic Imaging the Horse, Missouri, Mosby Elsevier.
MAIR, T., LOVE, S., SCHUMACHER, J., SMITH, R. & FRAZER, G. 2013. Equine Medicine, Surgery and Reproduction, United Kingdom, Saunders Elsevier.
ROONEY, J. R. 1998. The Lame Horse, USA, The Russell Meerdink Company, Ltd.
ROSS, W. M. & DYSON, J. S. 2003. Diagnosis and Management of Lameness in the Horse, Missouri, Saunders.
Figure 1. Illustration of parts of the forelimb stay apparatus, showing the supraglenoid tubercle of the scapula (Baxter, 2011).