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Referral Of Cases of Suspected Synovial Sepsis

Horses with synovial sepsis represent a significant portion of our referred orthopaedic case load. Where there is a wound or other traumatic injury adjacent to joints or other synovial structures, it is safer to assume that the synovial cavity is involved and to treat the case appropriately from the start, rather than to discover synovial sepsis after a period of time has been allowed to elapse. It is well recognised that the prognosis is dramatically reduced when synovial sepsis is allowed to become established.

The ‘golden’ rules for referral of cases are as follows:
1.

Always presume the worst when a wound is anywhere in the vicinity of a synovial structure, so referral for synovial lavage should be regarded as an emergency.
2.

All penetrating foot injuries near the frog should be regarded as potentially life threatening.
3.

Although closed synovial sepsis is classically regarded as a disease of foals, it is not rare in adults either.
4.

It is best to obtain a sample of synovial fluid for culture, before treating a horse with antibiotics. However, if this will result in a significant delay to the initiation of treatment, give broad spectrum antibiotics. We recommend the use of penicillin and gentamycin.
5.

Always be wary of masking the clinical severity of a case of suspected synovial sepsis by administering analgesic medication, including non-steroidal anti-inflammatory drugs. However, this may be disregarded if there are overriding humane considerations or if you are concerned about weight-bearing laminitis in another limb.
6.

All cases of suspected synovial sepsis should be sent without delay.


The success rate in promptly referred cases is high, following treatment, in most cases, by arthroscopic surgery, performed under general anaesthesia. A prolonged course of penicillin and gentamycin is often required. The alternative to prompt aggressive treatment is often persistent lameness, weight bearing laminitis and euthanasia. It is clear that the cost of treating horses with established synovial sepsis is usually greater and the prognosis significantly worse.


Beaufort Cottage Equine Hospital  •  Cotton End Road  •  Exning  •  Newmarket  •  Suffolk  •  CB8 7NN  •  UK
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