FEASIBILITY FOR ULTRASOUND‐GUIDED INJECTION OF THE COLLATERAL LIGAMENTS OF THE DISTAL INTERPHALANGEAL JOINT IN HORSES

Desmitis of the collateral ligament of the distal interphalangeal joint is a cause of lameness in performance horses. The objective of this prospective, experimental, ex vivo feasibility study was to evaluate the success of ultrasound‐guided injection of the collateral ligaments of the distal interphalangeal joint in the equine forelimb. Seventy‐six ultrasound‐guided dye injections of the collateral ligament of the distal interphalangeal joint were performed on horses’ cadaver limbs. The hooves were sectioned transversely to verify the location of the dye relative to the collateral ligaments and surrounding structures. Evaluations of transverse sections were performed independently by two experienced observers. A scoring system was used to assess injection of the collateral ligament of the distal interphalangeal joint at the proximal, middle, and distal aspect over the length of the ligament. The collateral ligament was injected at any point in 97.4% of cases. The ligament was injected over the entire scored length in 43.2% of cases (32/74), over two scored length areas in 45.9% of cases (34/74), and in one area in 10.8% of cases (8/74). The distal interphalangeal joint and the common digital extensor tendon were also injected in 81.6% (62/76) and 43.4% (33/76) of the cases, respectively. Use of the ultrasound had a positive and negative predictive value of 98% and 9%, respectively. In this study, ultrasound guidance was useful for confirming injection of the collateral ligament of the distal interphalangeal joint but did not prevent injecting the distal interphalangeal joint and the common digital extensor tendon.     

Anatomic variations and degenerative changes in the collateral cartilages and middle and distal phalanges of the forelimb in Ardenner colts

The anatomic variations and the degenerative changes in the collateral cartilages and middle and distal phalanges in 6 Ardenner colts were characterized by radiography, scintigraphy, and magnetic resonance imaging (MRI). The radiographic changes were assessed between the ages of 16.5 and 25 months. An anatomic variation of the middle and distal phalanges was demonstrated in some of the colts. MRI examination of the 6 colts revealed an association between the deep digital flexor tendon cross-sectional area and body weight as well as foot circumference. Also, a thin collateral sesamoidean (suspensory navicular) ligament was observed subjectively. The presence of an extensive ossification of the collateral cartilages of the foot was found in these young horses. The ossification was characterized by the existence of 2 separate ossification centers, which had a tendency to unite. The radiographic interphalangeal degenerative lesions seen appear as bone remodeling of the dorsal edges of the middle and distal phalanx, on the insertion sites of collateral ligaments of the distal interphalangeal joint, the digital extensor tendon, and the distal interphalangeal joint capsule.     

Ankylosis of the distal interphalangeal joint in a horse after septic arthritis and septic navicular bursitis.

A 6-month-old 300-kg Quarter Horse filly was treated for septic arthritis of the distal interphalangeal joint and septic navicular bursitis that developed as a result of a deep puncture to the foot. Initial treatment consisted of establishing ventral drainage for the navicular bursa, lavage of the distal interphalangeal joint, and administration of broad-spectrum antimicrobial drugs and non-steroidal anti-inflammatory drugs. Because of continuing sepsis in the distal interphalangeal joint, subsequent treatment included packing the defect in the bottom of the foot with cancellous bone in an attempt to prevent ascending contamination of the joint, placing the limb in a short limb cast, and inserting a Penrose drain into the joint for passive drainage of septic exudate. The goal of treatment was to encourage ankylosis of the distal interphalangeal joint. Because of the filly's persistent lameness and laxity of the lateral collateral ligament in the contralateral carpus, the palmar nerves of the affected foot were injected with a long-acting local anesthetic at the level of the proximal sesamoid bones to encourage weight-bearing. Ankylosis of the distal interphalangeal joint was complete 9 months after the puncture, but a grade-2 lameness remained and the horse had a varus deformity resulting from ligamentous laxity of the lateral collateral ligament in the contralateral carpus.     

Communication between the distal interphalangeal joint and the navicular bursa in the horse at Computed Tomography Arthrography

Diffusion of drugs injected into the distal interphalangeal joint or the navicular (podotrochlear) bursa can influence diagnosis and treatment of foot pain. Previous anatomical and radiographic studies of the communication between these synovial structures have produced conflicting results and did not identify the location of any communication if present. This anatomic study aimed to assess the presence and site of communication between the distal interphalangeal joint and the navicular bursa in the horse by computed tomography arthrography. Sixty‐six pairs of cadaver forelimbs were injected with contrast medium into the distal interphalangeal joint and imaged by computed tomography arthrography. The presence of a communication, location of the communication and additional structural changes were assessed. Navicular bursa opacification occurred in 7 distal limbs (5.3%) following distal interphalangeal joint injection. One limb showed a communication through the T‐ligament and 6 limbs showed a communication through the distal sesamoidean impar ligament. In 3 cases, the communication through the distal sesamoidean impar ligament was associated with a distal border fragment. Our study showed that communication between the distal interphalangeal joint and navicular bursa is uncommon and inconsistent. Clinically, the presence of a communication could (1) influence the interpretation of diagnostic analgesia of the distal interphalangeal joint or the navicular bursa by facilitating the diffusion of local anaesthetic between these structures; (2) allow the drug and its potential adverse effects to spread from the treated synovial cavity to the non‐targeted synovial cavity; (3) be responsible for the failure of joint drainage in the case of sepsis.     

Medial collateral ligament desmitis of the distal interphalangeal joint in the hindlimb of a horse: treatment with cast immobilisation

A 12‐year‐old show‐jumping mare was presented for investigation of a chronic hindlimb lameness of 16 weeks duration. Perineural anaesthesia and ultrasonography localised the lesion to the medial collateral ligament of the distal interphalangeal joint of the left hindlimb. Treatment consisted of a heavily padded distal limb cast for 6 weeks, strict box rest and a strictly regulated hand walking program. Serial ultrasonographic examinations were performed throughout the rehabilitation period. Collateral ligament desmitis of the distal interphalangeal joint is a commonly diagnosed condition of the forelimb; however, hindlimb collateral ligament desmitis has been rarely reported. Ultrasonographic examination in this case was an invaluable diagnostic and follow‐up tool. Immobilisation of the foot by means of a heavily padded distal limb cast allowed excellent healing of the ligament and is presented as a novel treatment for collateral ligament desmitis. At the time of writing the mare had returned to her previous level of exercise and was showing no signs of lameness.     

Retrospective analysis of distal limb conformation and lameness in mature horses after desmotomy of the accessory ligament of the deep digital flexor tendon for management of a flexural deformity

Mature horses that present with flexural deformity of the distal interphalangeal joint and lameness isolated to the foot may obtain long‐term benefits from desmotomy of the accessory ligament of the deep digital flexor tendon (ALDDFT). This retrospective analysis of medical records and radiographs included 13 horses, aged ≥2 years, presented for lameness isolated to the hoof region and diagnosed with flexural deformity of the distal interphalangeal joint. Radiographic angles of the hoof and distal interphalangeal joint and lameness scores were compared before and after desmotomy of the ALDDFT. Follow‐up data including the ability to perform the intended use were obtained at least one year after surgery. There was improvement in the angle between the dorsal aspect of the third phalanx and the weightbearing surface of the hoof, improved alignment between the dorsal hoof wall and dorsal aspect of the third phalanx, and improved alignment of the distal interphalangeal joint. Lameness was decreased in 9/13 horses and 10/13 horses were performing at their level of intended use. Evidence of improved hoof conformation and lameness following desmotomy of the ALDDFT in lame horses with flexural deformity of the distal interphalangeal joint would indicate this procedure should be considered in mature horses.     

MAGNETIC RESONANCE IMAGING FINDINGS OF DESMOPATHY OF THE COLLATERAL LIGAMENTS OF THE EQUINE DISTAL INTERPHALANGEAL JOINT

We report the use of a low-field magnetic resonance (MR) imaging system for the detection of desmopathy of the collateral ligament of the distal interphalangeal joint and the long-term outcome. Twenty horses were studied and their medical records and MR images were reviewed retrospectively. Long-term follow-up information was obtained by telephonic questionnaires of owners, trainers, or referring veterinarians. Desmopathy of the medial collateral ligament (80%) and enthesopathy of the affected collateral ligament (80%) were common MR imaging features. Treatment consisted of stall rest followed by a rehabilitation period. Additional treatments included shoeing, extracorporeal shock wave therapy, application of a half limb or foot cast, and medication of the distal interphalangeal joint. Twelve (60%) horses returned to their previous level of exercise and maintained their previous level, whereas eight horses had a poor outcome. Low-field MR imaging in the standing patient can be used to detect collateral ligament desmopathy of the distal interphalangeal joint without a need for general anesthesia.     

Arthroscopic Approach and Intra-articular Anatomy of the Palmaroproximal or Plantaroproximal Aspect of Distal Interphalangeal Joints

An arthroscopic approach to the palmaroproximal or plantaroproximal pouch of the distal interphalangeal joint was developed in six cadaver limbs and seven limbs of three clinically normal horses. The dorsal aspect of the proximal border and the proximal articular margin of the distal sesamoid (navicular) bone, the palmar aspect of the distal articular margin of the middle phalanx, the collateral sesamoidean ligaments of the distal sesamoid bone, and the joint capsule attachments were readily accessible. Distending the joints with fluid gave access to portions of the articular surface between the distal sesamoid bone and the middle phalanx in all joints, and to a small portion of the distal phalanx in two hind distal interphalangeal joints. Two horses allowed to recover from anesthesia were not lame on days 30 and 37, respectively. Problems encountered initially were difficulty entering the joint, hemarthrosis, and minimal iatrogenic cartilage damage.     

Risk of intra‐articular injection with longitudinal ultrasound‐guided injection of collateral ligaments of the equine distal interphalangeal joint

Desmopathy of the collateral ligaments of the distal interphalangeal joint is a common cause of equine foot lameness and carries a poor prognosis with conservative management. Intralesional injections may improve healing, although accuracy of radiographically guided injections is significantly less than when guided by MRI, which requires special needles. Longitudinal ultrasound‐guided injection of the distal collateral ligament has not been evaluated objectively. In this prospective, anatomic study, seven equine cadaver limbs (14 collateral ligaments) were injected with methylene blue dye and radiographic contrast medium using ultrasound to guide the needle longitudinally into the collateral ligaments until contacting bone. The insertion site of the needle proximal to the coronary band was measured on the limb and the needles left in place for radiography and CT to evaluate the needle angulation, location of the contrast medium, and whether the contrast entered the distal interphalangeal joint. The limbs were frozen and sectioned with a band saw to identify the location of the dye. Fifty percentage of injections were in or around the collateral ligaments. However, the percentage of “successful” injections, defined as in the collateral ligament but not in the joint, was only 36%. All legs had dye and contrast in the joint after both ligaments had been injected. There were no significant differences between the needle angle and entry site for “successful” and “unsuccessful” injections. Findings from this study indicates that the success rate is low for injecting the distal portions of the distal interphalangeal joint collateral ligaments using ultrasound guidance alone.     

双峰驼跖趾关节解剖结构

采用大体解剖学方法，研究了成年双峰驼的８个跖趾关节，并与马、牛、羊、猪、犬等动物的对等器官进行了比较。结果发现，双峰驼跖趾关节的形态结构有以下显著特征：（１）跖骨远端关节面后部有矢状嵴，近趾节骨近端关节面后部有与之相对应的矢状沟，这种结构与跖行动物和趾行动物相类似；（２）籽骨上没有对应近趾节骨近端的关节面；（３）籽骨间韧带只连接同一趾上的２个籽骨，与牛的将２趾的４个近籽骨连在一起的结构不同；（４）轴侧侧副韧带不像牛的那样与对侧的同名韧带共同起始于跖骨远端滑车间切迹，而是分别起始于此切迹的轴侧韧带窝及韧带结节；（５）轴侧侧副韧带仅为１层，而远轴侧侧副韧带分为２层；（６）籽骨直韧带、趾间趾节骨籽骨韧带及趾间近韧带均缺如。     

Ultrasonography of the Collateral Ligaments of the Distal Interphalangeal Joint in Horses: Technique and Reference Images

This study describes ultrasound (US) technique and reference images of the equine distal interphalangeal joint collateral ligaments (CLs), and evaluates the portion of the CLs assessable by US in a series of normal forelimbs. Transverse and longitudinal US images were obtained on five healthy horses and on 25 equine cadaver forelimbs. On six limbs, a needle was placed under US-guidance at the distal limit of visualization of each CL, and the portion of CL visible at US was evaluated on computed tomographic (CT) images. The normal CLs appear as oval structures located abaxial to the fossae of the middle phalanx in the transverse sections, obtained at the level of the coronary band. A centrodorsal hypoechoic image appears with increasing proximodistal probe inclination, demonstrating different fiber orientations within the ligament. Two main fascicles, a deep and a superficial, distally divergent, are visible on longitudinal images obtained in the central part of the ligament. The proportion of CL visible at US examination was more than 50% of the total ligament length in nine of the 12 CLs assessed by CT. Awareness of the estimated portion of distal interphalangeal joint CLs visible at US and detailed knowledge of the US technique and CLs morphology are essential to efficiently use US examination on clinical cases.     

ACCURACY OF LOW‐FIELD MAGNETIC RESONANCE IMAGING VERSUS RADIOGRAPHY FOR GUIDING INJECTION OF EQUINE DISTAL INTERPHALANGEAL JOINT COLLATERAL LIGAMENTS

Desmopathy of the distal interphalangeal joint collateral ligament is a common cause of lameness in the horse and carries a variable prognosis for soundness. Intralesional treatment has been proposed for improving outcome; however, limited reports describe methods for injecting this ligament. The purpose of this study was to compare accuracy of low‐field magnetic resonance imaging (MRI) vs. radiography for injecting the collateral ligament of the distal interphalangeal joint. Equine cadaver digit pairs (n = 10) were divided by random assignment to injection of the ligament by either technique. An observer unaware of injection technique determined injection success based on postinjection MRI and/or gross sections acquired from the proximal, middle, and distal portions of the ligament. McNemar's test was performed to determine statistical difference between injection techniques, the number of injection attempts, and injection of the medial or lateral collateral ligament. Magnetic resonance imaging guided injection was successful more frequently than radiographic‐guided injection based on postinjection MRI (24 of 30 vs. 9 of 30; P = 0.0006) and gross sections (26 of 30 vs. 13 of 30; P = 0.0008). At each level of the ligament (proximal, middle, and distal), MRI‐guided injection resulted in more successful injections than radiographic guidance. Statistical significance occurred at the proximal aspect of the collateral ligament based on postinjection MRI (P = 0.0143) and the middle portion of the ligament based on gross sections (P = 0.0253). Findings supported future testing of standing, low‐field MRI as a technique for delivering intralesional regenerative therapy in live horses with desmopathy of these collateral ligaments.     

Conditions of the interphalangeal joints

The various conditions of the interphalangeal joint are presented; these include degenerative joint disease and osteochondral chip fractures of the proximal interphalangeal joint, fractures of the middle phalanx affecting proximal and/or distal interphalangeal joints, subluxation and osteochondrosis of the proximal interphalangeal joint, and arthrosis of the distal interphalangeal joint.     

Current concepts of navicular disease

Navicular disease is unlikely to be a single disease. The close anatomical and functional relationships between the navicular bone, collateral sesamoidean ligament, distal sesamoidean impar ligament, deep digital flexor tendon, navicular bursa and distal interphalangeal joint result in the frequent occurrence of combinations of injuries. There are a number of different pathological processes that affect the navicular bone, which probably have different aetiopathogeneses. While there is strong evidence that biomechanical forces may result in failure of functional adaptation and excessive modelling, it is likely that each disease or injury type has a multifactorial cause.     

Lag screw fixation of an extensor process fracture in a foal with flexural deformity.

A 4-month-old colt with stage I flexural deformity of the distal interphalangeal joint was diagnosed as having a type IV nondisplaced fracture of the extensor process of the 3rd phalanx. An inferior check ligament desmotomy and internal fixation of the fracture were performed. Favorable long-term results for internal fixation of extensor process fractures are presented.     

Collateral desmitis of the distal interphalangeal joint in conjunction with concurrent ossification of the cartilages of the foot in nine horses

The purpose of this study was to describe the frequency of occurrence of severe ossification of the collateral cartilages (sidebone) coexistent with collateral desmitis of the distal interphalangeal joint (DIPJ) in lame horses. Sidebone was diagnosed and graded on standard radiographs and soft tissue injuries of the foot were diagnosed using standing low‐field magnetic resonance imaging (MRI). Of 15 horses with forelimb lameness and severe sidebone, 9 had evidence of concurrent collateral desmitis of the DIPJ. All 15 horses had damage to other structures (including the deep digital flexor tendon, distal sesamoidean impar ligament, collateral sesamoidean ligament, navicular bone and distal phalanx) within the affected feet as identified on MRI. The clinical and pathophysiological significance of concurrent collateral desmitis of the DIPJ and sidebone is currently uncertain. However, this study shows that injuries to multiple structures within the foot are common and that collateral desmitis of the distal interphalangeal joint is frequently seen in lame horses in conjunction with severe ossification of the collateral cartilages.     

A study of naturally occurring cases of ovine foot abscess in New Zealand

A study was made of various aspects of 53 naturally occurring cases of foot abscess in sheep in New Zealand. Radiographic techniques were used to follow the progress of the lesion and from this it was concluded that foot abscess could be defined as an infection of the distal interphalangeal joint. The term foot abscess was considered preferable to the term "infective bulbar necrosis". The attack rate of foot abscess was reported to be higher for rams than for ewes and the condition was less prevalent during summer. Once infection was established in the distal interphalangeal joint a relatively uniform and thus predictable series of events took place that inevitably resulted in some permanent damage and deformity to the digit. If rupture of the axial collateral ligaments occurred, the joint became unstable and the degree of permanent deformity was greater. Treatment with antibiotics did not appear to markedly affect the progress of the lesion or the outcome, once infection had become established in the joint. Although the prognosis for complete recovery was poor, in most cases the foot healed sufficiently after a period of about two months to allow the animal to walk normally.     

双峰驼指关节解剖

运用大体解剖学方法对双峰驼三十个指关节进行解剖研究,发现如下特征:籽骨间韧带只连接同一指上的两枚籽骨,无连于籽骨与对侧近指节骨近端的指关节籽骨韧带,也无籽骨直韧带;第二指近指节骨与第四指的近指节骨之间无韧带连接;近指节间关节缺掌侧韧带;远指节无远籽骨,但有软骨板,还有一对背侧韧带。     

Influence of the position of the foot on MRI signal in the deep digital flexor tendon and collateral ligaments of the distal interphalangeal joint in the standing horse

Reasons for performing study: Hyperintense signal is sometimes observed in ligaments and tendons of the equine foot on standing magnetic resonance examination without associated changes in size and shape. In such cases, the presence of a true lesion or an artifact should be considered. A change in position of a ligament or tendon relative to the magnetic field can induce increased signal intensity due to the magic angle effect. Objectives: To assess if positional rotation of the foot in the solar plane could be responsible for artifactual changes in signal intensity in the collateral ligaments of the distal interphalangeal joint and in the deep digital flexor tendon. Methods: Six isolated equine feet were imaged with a standing equine magnetic resonance system in 9 different positions with different degrees of rotation in the solar plane. Results: Rotation of the limb induced a linear hyperintense signal on all feet at the palmar aspect of one of the lobes of the deep digital flexor tendon and at the dorsal aspect of the other lobe. Changes in signal intensity in the collateral ligaments of the distal interphalangeal joint occurred with rotation of the limb only in those feet where mediolateral hoof imbalance was present. Conclusions: The position and conformation of the foot influence the signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint. Potential relevance: The significance of increased signal intensity in the deep digital flexor tendon and in the collateral ligaments of the distal interphalangeal joint should be interpreted with regard to the position and the conformation of the foot.