The effect of CO2 laser neurectomy on neuroma formation and axonal regeneration.

In an attempt to prevent neuroma formation and digital reinnervation after sharp palmar digital neurectomy in 10 adult horses with navicular disease, 18,426 W/cm2 of CO2 laser energy was applied to the proximal nerve stump. Clinical follow-up was 4 to 23 months. In two horses, palmar digital nerve biopsies were taken at month 4 (four nerves) and month 7 (two nerves). Nine horses were sound immediately and at all follow-up examinations. None had clinical evidence of painful neuroma or digital reinnervation. Histologically, there was minimal scar tissue at the surgical site; axonal sprouts were comingled with fibrous tissue.     

Histologic Evaluation of Palmar Digital Nerves after Perineural Injection of 2% Ammonium Chloride in Miniature Horses

Neurolytic compounds are widely used by equine practitioners for the management of lameness, mostly related to the foot. The present study aimed to evaluate the neurotoxicity of 2% ammonium chloride (2% AC) applied adjacent to the palmar digital nerves in six miniature horses. The 2% AC and 0.9% saline solution were randomly injected into three and one palmar digital nerve of each horse, respectively. Nerve samples were collected by neurectomy performed under general anesthesia at 5, 12, 19, 35, 47, and 62 days after treatment, with one horse per day of surgery. The inflammatory reaction to perineural injection was evaluated by an increase of pastern superficial skin temperature through thermography 24 hours after treatments. Histological lesions were classified as absent, mild, moderate, and severe Wallerian degeneration. An increase of 2.43 ± 0.79°C and 1.69 ± 0.55°C was observed in the 2% AC and control groups, respectively (P > .05). Moreover, histologic lesions were observed after perineural injection of 2% AC (severe, n = 5/18; moderate, n = 4/18; mild, n = 5/18; and absent, n = 4/18) and saline solution (moderate, n = 3/6; mild, n = 1/6; and absent, n = 2/6) (P = .46). The 2% AC demonstrated to be as safe as 0.9% saline solution, producing mild to severe Wallerian degeneration for up to 62 days after injection with no interference in further neurectomy.     

Effects of cryotherapy on the palmar and plantar digital nerves in the horse

The duration of anesthetic effect and the histopathologic changes resulting from a controlled freeze of the palmar and plantar digital nerves in the horse were evaluated. Two techniques were compared: (i) nerves were frozen by direct application of the cryoprobe after surgical exposure and (ii) nerves were frozen by percutaneous application of the cryoprobe to the overlying skin. Return of skin sensation and ability to detect a stimulus were used to determine return of nerve function. The duration of anesthetic effect was significantly (P less than 0.005) longer for nerves frozen after surgical exposure than for those frozen by the percutaneous technique (mean 156 days vs 47.5 days). At the termination of the study, horses were euthanatized and all nerves were examined histologically. Neuromas-in-continuity were observed in 10 of 28 frozen nerves. Classification was based on the involvement of the supporting fibrous connective tissues of the nerve, endoneurium, perineurium, and epineurium. The direct technique of freezing the nerve after surgical exposure was repeatable and could be used to provide temporary neurectomy in the horse. The percutaneous technique caused a temporary loss of pain perception, but could not be relied on to interrupt nerve function for longer than a few weeks.     

Preliminary studies on long distance, retrograde transport of horseradish peroxidase in equine peripheral nerves

As a prelude to studies on retrograde axonal transport of neurotoxin (ie, so-called suicide transport) as a means to prevent post neurectomy neuroma formation, preliminary studies were conducted with an innocuous enzymatic marker, horseradish peroxidase (HRP). The proximal stumps of resected medial and lateral palmar digital nerves in six ponies were injected via a tuberculin syringe and needle with 50 micron 1 of a 30 per cent solution of HRP in order to assess long distance retrograde axonal transport. The dorsal root ganglion of the cervical spinal enlargement (ie, C6, C7, C8, T1, T2) were removed at post injection intervals of two, four, six, eight, 10 and 12 days. These were sectioned serially and reacted by the tetramethylbenzidine method to demonstrate transported enzyme in the ganglionic cell bodies which give rise to sensory fibres of the palmar digital nerves. Enzyme, retrogradely transported over axon lengths of 115 cm, was first demonstrated in spinal ganglia four days after injections of the palmar digital nerves. The calculated transport velocity of 287 mm/day, although almost certainly an underestimate, greatly exceeded rates of 72 to 120 mm/day recorded previously with HRP in the peripheral nerves of small laboratory animals. The intensity of the HRP reaction product in ganglionic neurons was strong at four days and it remained unabated in ganglia examined at six, eight, 10 and 12 days post injection. The major sources of the sensory fibres of the palmar digital nerves appeared to be the ganglia of the C8 and T1 spinal segments which contained more than 90 per cent of all labelled neurons.(ABSTRACT TRUNCATED AT 250 WORDS)     

Palmar digital neurectomy in 24 horses using the guillotine technique

OBJECTIVE: To determine the effectiveness and incidence of complications of palmar digital neurectomy using the guillotine technique in horses presented for lameness originating from sites innervated by these nerves. DESIGN: Retrospective study of 24 clinical cases. ANIMALS: Twenty-four horses undergoing a palmar digital nerve neurectomy between June 1997 and June 2001. METHODS: The records of all horses undergoing a uniaxial or biaxial, unilateral or bilateral neurectomy during the defined time period were retrieved. Information retrieved from the record included breed, age, gender, discipline for which the horse was used, history, results of lameness examination, results of perineural anaesthesia, radiographic findings, surgery report, postoperative care, complications and outcome. RESULTS: Seventeen geldings and seven female horses of mixed breeds, ranging in age from 1 to 16 years, that were used for a variety of non-racing, but competitive, athletic disciplines, underwent neurectomy using the guillotine technique during the specified time period. In 23 horses perineural anaesthesia was performed at the University Veterinary Centre to isolate the lameness. Anaesthesia resolved lameness in 18 horses. In five horses there was some residual lameness isolated to sites remote from the distal extremity. The most common radiographic finding was an increase in the number and or size of the synovial fossae of the navicular bone. Twenty-two horses underwent bilateral biaxial neurectomies and two horses with painful trauma-induced neuromas underwent unilateral, uniaxial neurectomy. There were no postoperative complications. All horses were rested for 3 months before returning to work. At least 1 year after surgery, 22 horses were in full work and two horses were not in work because of unrelated problems. Of the horses in work, 17 were considered free of lameness. The other five were competing, but receiving medication for residual lameness associated with sites remote from the distal extremity. CONCLUSION: Results of this study suggested that palmar digital neurectomy using the guillotine technique provided reliable and consistent resolution of lameness originating from sites innervated by these nerves. There were no significant complications.     

Determination of functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave treatment in horses

OBJECTIVE: To determine functional and morphologic changes in palmar digital nerves after nonfocused extracorporeal shock wave (ESW) treatment in horses. ANIMALS: 6 horses. PROCEDURES: The medial and lateral palmar digital nerves of the left forelimb were treated with nonfocused ESWs. The medial palmar digital nerve of the right forelimb served as a nontreated control nerve. At 3, 7, and 35 days after treatment, respectively, 2 horses each were anesthetized and nerves were surgically exposed. Sensory nerve conduction velocities (SNCVs) of treated and control nerves were recorded, after which palmar digital neurectomies were performed. Morphologic changes in nerves were assessed via transmission electron microscopy. RESULTS: Significantly lower SNCV in treated medial and lateral nerves, compared with control nerves, was found 3 and 7 days after treatment. A significantly lower SNCV was detected in treated medial but not lateral nerves 35 days after treatment. Transmission electron microscopy of treated nerves revealed disruption of the myelin sheath with no evidence of damage to Schwann cell bodies or axons, 3, 7, and 35 days after treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Nonfocused ESW treatment of the metacarpophalangeal area resulted in lower SNCV in palmar digital nerves. This effect likely contributes to the post-treatment analgesia observed in horses and may result in altered peripheral pain perception. Horses with preexisting lesions may be at greater risk of sustaining catastrophic injuries when exercised after treatment.     

Evaluation of Stainless Steel Nerve Caps for Palmar Digital Neurectomy

Stainless steel nerve caps for application to the proximal nerve stump during palmar digital neurectomy were examined. Six experimental horses and three clinical patients underwent palmar digital neurectomy using the capping technique. Good results were obtained on the experimental horses; however, when the caps were used on the clinical patients, lameness appeared in two of three horses after hard work. The caps were considered unacceptable for clinical use.     

Palmar digital neurectomy using the GaAlAs diode laser

Palmar digital neurectomy is typically performed as a treatment for palmar foot pain that is unresponsive to medical treatment and therapeutic shoeing. Although it is useful for the elimination of pain related to navicular disease or wing fractures of the distal phalanx, a number of potential complications can occur after this procedure, including painful neuroma formation, persistence of skin sensation, reinnervation, and rupture of the deep digital flexor tendon. Over the years, surgical techniques have been developed to minimize complications associated with digital neurectomy, including sharp dissection (the guillotine method), epineural capping, and cryosurgical treatment of the nerve, using a double freeze-thaw cycle. Alternatively, lasers may be used to divide the palmar digital nerve with coagulation of the nerve endings. The thermal effects of the laser theoretically help to minimize the potential for painful neuroma formation and reinnervation by sealing the cut surface of the nerve endings, preventing adhesion formation with surrounding soft tissues, and delaying the reanastomosis of the proximal and distal nerve segments.     

The Use of Intraneural Doxorubicin in Association with Palmar Digital Neurectomy in 28 Horses

Painful neuroma formation after palmar digital neurectomy in the horse is common. Experimentally, injection of doxorubicin (Adriamycin) into the proximal transected nerve stump has been shown to prevent axon sprouting and neuroma formation for up to 5 months. This procedure was used in 28 horses with navicular disease, preexisting painful neuroma, or wing fractures of the distal phalanx. At 1 month, 16 horses had incisional complications. At 1 year, 15 horses were sound. Eight horses were lame, although three were improved. Three horses required a second surgical procedure, two of which became sound. Follow-up was not available in two horses. The technique used in this study has an unacceptable rate of wound complications and no benefit over other palmar digital neurectomy techniques currently in use.     

Neurofibroma of the ulnar nerve in the carpal canal in a dog: treatment by marginal neurectomy

Peripheral nerve sheath tumours arising in the plexus or peripheral nerves can be treated by limb amputation. There are few reports of these tumours affecting peripheral nerves in the distal regions of the limbs. Here we describe a case of neurofibroma affecting the palmar branch of the ulnar nerve in an Irish setter. Surgical treatment in the region of the carpus by ulnar neurectomy resulted in resolution of chronic thoracic limb lameness. At 11 months following the surgery, clinical examination and MRI did not detect any evidence of recurrence. Neurectomy may be a feasible option for management of selected cases of distally located peripheral nerve sheath tumours.     

Peroneal nerve paralysis in the cat and dog: an experimental study

The effects of peroneal neurectomy at different nerve levels in the dog and cat are described. The resultant limb paralyses were considerably improved by the application of a muscle relocation technique, transferring either the long digital flexor or caudal tibial muscle. The results of combined peroneal and tibial neurectomy as well as nerve root sectioning (L6, L7) are also described.     

Evaluation of Tissue Adhesive to Contain Axonal Regeneration in Horses

Bilateral palmar and plantar digital neurectomies were completed in 10 horses (a total of 80 neurectomies) using one of three methods: (1) simple transection (guillotine method); (2) epineural capping; (3) n-butyl cyanoacrylate injected into the epineural sheath to act as a nerve sealant. Horses were regularly evaluated clinically for tenderness in and around the surgical site, as well as skin sensation at the coronary band in the heel region, during the 12-week course of the study. None of the surgical sites exhibited any signs of drainage or infection. Horses were then euthanatized, the nerve stumps were dissected from surrounding tissues, and the length and width of the tissue mass that had formed on the end of the nerve was recorded. Longitudinal and transverse sections of the nerve endings were examined histologically for numbers of proliferating axon sprouts (neuroma formation); whether the axons had penetrated the epineurium; degree of Schwann cell proliferation; degree of chronic inflammation; extent of foreign body reaction; extent of retrograde degeneration of the nerve bundles; and amount of fibro vascular proliferation. The proportion of legs exhibiting tenderness or heel sensation did not differ significantly between the three different treatments at any of the six different times they were examined. There was no difference between the three treatments in the length or width of the fibrous tissue scar on the ends of the nerves or in the number of sprouting axons from the ends of the nerves. Of 80 nerves examined, only two nerves were not confined to the epineurium. Both these nerves had been treated by simple transection. Statistically there was more chronic inflammation and foreign body reaction in the acrylic treated nerves, but no difference in Schwann cell proliferation or retrograde degeneration between the three treatments. There was slightly less fibrovascular proliferation in the transected nerves than in those subjected to epineural capping or acrylic, but the difference was not statistically significant. The use of the tissue adhesive n-butyl cyanoacrylate to prevent the continuous growth of axons after digital neurectomy seems to offer little advantage over more traditional methods of neurectomy.     

Diffusion of radiodense contrast medium after perineural injection of the palmar digital nerves

Limited information exists on distribution of local anaesthetic solution following palmar digital nerve blocks. The aim of this study was to demonstrate potential distribution of local anaesthetic solution following perineural injection of the palmar digital nerves using 2 different volumes of contrast medium and 2 different injections sites. Twelve mature horses were used. Perineural injection of the palmar digital nerves were performed at the level of or 2 cm proximal to the proximal aspect of the ipsilateral ungular cartilage, using 1.5 or 2.5 ml radiopaque contrast medium. In total, 96 injections were performed. Four standard radiographic views of the pastern were obtained immediately after injections and 10 and 20 min later. Images were analysed subjectively and objectively. After distal injections, the contrast medium was more localised around the injection site; after proximal injections the contrast patch had greater proximal–distal length. The greatest proximal diffusion was to 31.7% of the length of the proximal phalanx (from the level of the proximal interphalangeal joint) after distal injections and to 70% after proximal injections. The larger volume resulted in significantly greater proximal diffusion than the smaller volume at the distal, but not at the proximal injection site (P<0.01). There was significant proximal diffusion with time after proximal and distal injections (P<0.01). In most limbs, numerous radiopaque lines of various thickness extended proximally from the contrast patches; subjectively, their number and thickness were greater at the distal injection site. In conclusion, palmar digital nerve blocks at the level of the ungular cartilage using ≤2.5 ml local anaesthetic solution may improve proximal interphalangeal joint and pastern region pain. If using a more proximal site, distal fetlock region pain may be improved. Due to diffusion into lymphatic vessels, too small a volume at the distal injection site may not provide sufficient analgesia.     

Diffusion of contrast medium after four different techniques for analgesia of the proximal metacarpal region: an in vivo and in vitro study

Reasons for performing study: There is limited information on potential diffusion of local anaesthetic solution after various diagnostic analgesic techniques of the proximal metacarpal region. Objective: To document potential distribution of local anaesthetic solution following 4 techniques used for diagnostic analgesia of the proximal metacarpal region. Methods: Radiodense contrast medium was injected around the lateral palmar or medial and lateral palmar metacarpal nerves in 8 mature horses, using 4 different techniques. Radiographs were obtained 0, 10 and 20 min after injection and were analysed subjectively. A mixture of radiodense contrast medium and methylene blue was injected into 4 cadaver limbs; the location of the contrast medium and dye was determined by radiography and dissection. Results: Following perineural injection of the palmar metacarpal nerves, most of the contrast medium was distributed in an elongated pattern axial to the second and fourth metacarpal bones. The carpometacarpal joint was inadvertently penetrated in 4/8 limbs after injections of the palmar metacarpal nerves from medial and lateral approaches, and in 1/8 limbs when both injections were performed from the lateral approach. Following perineural injection of the lateral palmar nerve using a lateral approach, the contrast medium was diffusely distributed in all but one limb, in which the carpal sheath was inadvertently penetrated. In 5/8 limbs, following perineural injection of the lateral palmar nerve using a medial approach, the contrast medium diffused proximally to the distal third of the antebrachium. Conclusions and potential relevance: Inadvertent penetration of the carpometacarpal joint is common after perineural injection of the palmar metacarpal nerves, but less so if both palmar metacarpal nerves are injected using a lateral approach. Following injection of the lateral palmar nerve using a medial approach, the entire palmar aspect of the carpus may be desensitised.     

Sensory nerve conduction velocities in forelimb of ponies

Normal nerve conduction velocity values in 10 ponies were determined for sensory nerve fibers in the median and ulnar nerves. A percutaneous signal-averaging technique was developed and used. Medial and lateral palmar digital nerves on the abaxial surface of the proximal sesamoid bones were used as the sites for percutaneous stimulation, whereas recording sites included the medial and lateral palmar nerves just distal to the carpus and the median and ulnar nerves in the middle of the radius. Sensory nerve conduction velocities can be evaluated simply and clinically in the limbs of horses, using percutaneous signal-averaging techniques.     

Nerve distribution in the metacarpus and front digit of the horse.

The nerve distribution to the digit of the horse was studied with the compound microscope in serial transverse sections of fetal limbs and plotted on life-size outlines of the horse's foot. It was learned that there is much variation in the topography of the branches of the principal nerves. There is no mirror-image nerve distribution on the 2 sides of the foot. The dorsal branch of the ulnar nerve does not extend below the fetlock. The communication between the palmar metacarpal nerves and branches of the dorsal branch of the digital nerves is only a crossing of nerves without exchange of fibers. The palmar metacarpal nerves usually do not innervate structures distal to the pastern joint. The innervation of the deep structures of the equine foot was tabulated.     

Hemodynamic Function during Neurectomy in Halothaneanesthetized Horses with or without Constant Dose Detomidine Infusion

Nine horses were premediated with acepromazine, and anesthesia was induced with guaifenesin and thiamylal. Anesthesia was maintained in four horses with halothane in oxygen, and in five horses with halothane in oxygen plus a constant dose infusion of detomidine. Both maintenance regimens produced a MAC equivalent of 1.4 at the ambient barometric pressure. Hemodynamic and respiratory measurements were made after the horses were anesthetized, during surgical manipulations involving skin or tissues other than nerves, during manipulation and transection of digital nerves, and after surgery while the limbs were being bandaged. Heart rate was significantly higher in horses anesthetized with halothane only than in horses that also received detomidine; there were no other differences in hemodynamic function or recovery characteristics. Respiratory rate was significantly higher than baseline during soft tissue and nerve manipulations; arterial blood pressure was significantly higher after surgery began and highest during neurectomy; cardiac output and cardiac index were significantly decreased during surgery; systemic vascular resistance was significantly increased during neurectomy and bandaging and highest during neurectomy. The data suggest that the increase in blood pressure often associated with surgical stimulation is caused by increased vascular resistance and may be accompanied by a decrease in cardiac output.     

Development and verification of saphenous, tibial and common peroneal nerve block techniques for analgesia below the thigh in the nonchondrodystrophoid dog

OBJECTIVE: To document simple and reliable local, infiltrating nerve blocks for the saphenous, tibial and common peroneal nerves in the dog. STUDY DESIGN: Laboratory technique development; in vivo blind, controlled, prospective study. ANIMALS: Twenty canine cadavers and 18 clinically normal, client-owned dogs. METHODS: A peripheral nerve blockade technique of the tibial, common peroneal, and saphenous nerves was perfected through anatomic dissection. Injections were planned in the caudal thigh for the tibial and common peroneal nerves, and in the medial thigh for the saphenous nerve. Cadaver limbs were injected with methylene blue dye and subsequently dissected to confirm successful dye placement. Clinically normal dogs undergoing general anesthesia for unrelated, elective procedures were randomly assigned to treatment (bupivacaine; n = 8) or control (saline; n = 8) nerve blocks of the nerves under study. Upon recovery from general anesthesia, skin sensation in selected dermatomes was evaluated for 24 hours. RESULTS: Cadaver tibial, common peroneal, and saphenous perineural infiltrations were successful in nonchondrodystrophoid dogs (100, 100, and 97%, respectively.) Intraneural injection was rare (1%; 1/105; tibial nerve) in cadaver dogs. In the treatment group of normal dogs, duration of loss of cutaneous sensation in some dermatomes (saphenous, superficial and deep peroneal nerve) was significantly different than control dogs; the range of desensitization occurred for 1-20 hours. No clinical morbidity was detected. CONCLUSIONS: This technique for local blockade of the tibial, common peroneal, and saphenous nerves just proximal to the stifle is easy to perform, requires minimal supplies and results in significant desensitization of the associated dermatomes in clinically normal, nonchondrodystrophoid dogs. CLINICAL RELEVANCE: This technique may be an effective tool for post-operative analgesia to the femoro-tibial joint and distal pelvic limb. Other applications, using sustained-release drugs or methods, may include anesthesia/analgesia in high-risk patients or as a treatment for chronic pelvic limb pain or self-mutilation.     

Diagnostic analgesia of the equine digit

Analgesia usually occurs within 5 min after administration of local anaesthetic solution into joints or around nerves in the distal portion of the limb. Gait should be assessed within 10 min after diagnostic regional analgesia of the distal portion of the limb because rapid diffusion of anaesthetic solution can result in anaesthesia of other nerve branches, thus confusing results of the examination. A palmar digital nerve block (PDNB) anaesthetises most of the foot, including the distal interphalangeal (DIP) joint (coffin joint), rather than just the palmar half of the foot, as was once commonly believed. To avoid partially anaesthetising the proximal interphalangeal joint (pastern joint), the palmar digital nerves should be anaesthetised near or distal to the proximal margin of the collateral cartilages. Clinicians should be aware that an abaxial sesamoid nerve block (ASNB) may ameliorate or abolish pain within the metacarpo/metatarso‐phalangeal joint (fetlock joint). Mepivacaine administered into the DIP joint desensitises the DIP joint and probably the palmar digital nerves to also cause anaesthesia of the navicular bursa, the navicular bone, the toe region of the sole, the digital portion of the deep digital flexor tendon (DDFT) and the distal portions of the collateral ligaments of the DIP joint. When a large volume of mepivacaine HCl (e.g. 10 ml) is administered, the heel region of the sole may also be desensitised. Only a small percentage of horses with disease of the collateral ligament(s) of the DIP joint show a significant improvement in lameness after intra‐articular analgesia of the DIP joint, and no horse is likely to improve after intrabursal analgesia of the navicular bursa. A PDNB, however, improves lameness substantially in most horses that are lame because of disease of the collateral ligament(s) of the DIP joint, and all affected horses are likely to become sound after an abaxial sesamoid nerve block. The degree of improvement in lameness associated with injury to one or both collateral ligaments of the DIP joint after PDNB is determined by the extent of the injury and the level at which the palmar digital nerves are anaesthetised. The further proximal the level of the injury within the collateral ligament, the less likely that lameness is ameliorated by analgesia of the DIP joint or a PDNB. Verschooten's technique appears to be the most accurate technique for centesis of the navicular bursa. Even though analgesia of the DIP joint results in analgesia of the navicular bursa, analgesia of the navicular bursa does not result in analgesia of the DIP joint. Pain arising from the DIP joint can probably be excluded as a cause of lameness when lameness is attenuated by analgesia of the navicular bursa. Analgesia of the digital flexor tendon sheath (DFTS) is likely to desensitise only structures that are contained within or border on the sheath itself (i.e. the superficial and deep digital flexor tendons, the straight and oblique distal sesamoidean ligaments, the annular ligaments of the fetlock and pastern, and the portion of the DDFT that lies within the foot). Because lameness caused by disease of the DDFT within the foot may fail to improve appreciably after analgesia of the palmar digital nerves, the DIP joint, or the navicular bursa, a portion of the DDFT within the foot and distal to the DFTS probably receives its sensory supply from more proximal deep branches of the medial and lateral palmar digital nerves that enter the DFTS. Performing intrathecal analgesia of the DFTS on horses with lameness that is unchanged after anaesthesia of the palmar digital nerves but resolves after an ASNB, may be useful in localising lameness to that portion of the DDFT that lies within the foot. Resolution of lameness after intrathecal analgesia of the DFTS justifies suspicion of a lesion within the digital portion of the DDFT or within structures contained within the DFTS. The belief that concurrent or sequential intra‐articular administration of medication substantially increases the risk of joint infection or that inflammation caused by the local anaesthetic solution may dampen the therapeutic response to intra‐articular medication appears to be unfounded.     

Effect of anaesthesia of the palmar digital nerves on proximal interphalangeal joint pain in the horse

REASONS FOR PERFORMING STUDY: Anaesthesia of the palmar digital nerves is claimed to attenuate lameness in some horses that are lame because of pain in the proximal interphalangeal (PIP) joint. OBJECTIVE: To determine the response of horses with pain in the PIP joint to anaesthesia of the palmar digital nerves. METHODS: Horses were video recorded trotting before and after induction of pain in the PIP joint and 10 mins after anaesthesia of the palmar digital nerves. The palmar digital nerves were anaesthetised 3 times at different sites, and the video recorded gaits were scored subjectively. RESULTS: The median lameness score of gaits after administration of 2% mepivacaine 1 cm proximal to the cartilages of the foot was not significantly different from the median lameness score before anaesthesia of the palmar digital nerves (P > or = 0.05), although that of 1 of 6 horses improved markedly. The median lameness score was significantly (P < or = 0.05) improved after mepivacaine was administered 2 and 3 cm proximal to the cartilages of the foot. CONCLUSIONS: The PIP joint is unlikely to be anaesthetised when the palmar digital nerves are anaesthetised at the proximal margin of the cartilages of the foot. POTENTIAL RELEVANCE: Pain within the PIP joint cannot be excluded as a cause of lameness when lameness is attenuated by anaesthesia of the palmar digital nerves at any site proximal to the proximal margin of the cartilages of the foot.