Magnetic resonance imaging findings in the carpus and proximal metacarpal region of 50 lame horses

Reasons for performing study: There is limited information on magnetic resonance imaging (MRI) findings in the carpus and proximal metacarpal region of lame horses. Objectives: To document MRI findings in horses with lameness localised to the carpus and/or proximal metacarpal region. Methods: Clinical records of horses that underwent MRI of the carpus and/or proximal metacarpal region at the Animal Health Trust between January 2003 and September 2010 were reviewed. Magnetic resonance images of all horses and available radiographs, ultrasonographic and scintigraphic images were assessed. When possible, MRI findings were related to the results of other diagnostic imaging techniques. Results: Seventy‐two MR studies of 58 lame limbs in 50 horses from a broad range of work disciplines and ages were reviewed. The most commonly detected primary abnormality was decreased signal intensity in T1‐ and T2‐weighted images in the medial aspect of the carpal bones and/or the proximomedial aspect of the metacarpal bones (n = 29). Nine horses had syndesmopathy between the second and third metacarpal bones. In 6 horses the primary abnormalities were identified in the palmar cortex of the third metacarpal bone (McIII). Significant abnormalities of the suspensory ligament (SL) with associated lesions in the adjacent palmar cortex of the McIII were seen in 4 limbs. Ligament and associated osseous abnormalities between the second and third carpal bones and second and third metacarpal bones were detected in 4 limbs. Conclusions and potential relevance: Magnetic resonance imaging enabled diagnosis of a variety of lesions not detected by conventional imaging in horses from a wide range of work disciplines. The distribution of injury types differed considerably from previous studies.     

Incomplete Longitudinal Fracture of the Proximal Palmar Cortex of the Third Metacarpal Bone in Horses

Seven horses, 2 to 4 years of age, were examined because of moderate-to-severe forelimb lameness, mild effusion of the middle carpal joint (3 horses), and pain on palpation of the origin of the suspensory ligament (4 horses). The lameness was abolished by anesthetic infiltration of the middle carpal joint in six horses. In four of them, a high palmar nerve block also abolished the lameness. A linear radiolucency in the proximal end of the third metacarpal bone (McIII) was interpreted as an incomplete longitudinal fracture. In one horse, distinct intramedullary sclerosis limited to the palmar cortex was indicative of an incomplete fracture confined to the palmar cortex. No osteoproliferative lesions were identified on the dorsal cortex of any of the horses. Surgical treatment with cortical screws in lag fashion accompanied by a rest period was successful in one horse. In four horses, rest for at least 3 months resulted in clinical soundness. In two horses, a shorter rest period resulted in recurrence of the lameness even though the horses were sound when put back into training. Careful clinical and radiographic examinations helped differentiate incomplete longitudinal fractures from lesions involving the carpus and proximal aspect of the suspensory ligament.     

Use of magnetic resonance imaging identify suspensory desmitis and adhesions between exostoses of the second metacarpal bone and the suspensory ligament in four horses

Four horses were examined because of chronic forelimb lameness. In all horses, the cause of the lameness was localized to the metacarpus by means of physical examination and diagnostic anesthesia, and radiography of the affected limb revealed a small exostosis of the second metacarpal bone. Magnetic resonance imaging revealed suspensory desmitis in the region of this exostosis in all 4 horses. In addition, an abnormal area of low signal intensity, suggestive of an adhesion, was seen between the exostosis and the suspensory ligament. In all horses, an adhesion between the suspensory ligament and the exostosis on the second metacarpal bone was identified and transected at surgery, and the exostosis and distal portion of the second metacarpal bone were removed. All horses were able to return to their previous athletic use following a 6-month rest and rehabilitation program for treatment of the suspensory desmitis. Findings in these horses suggest that adhesions between the suspensory ligament and an exostosis of the second metacarpal bone may be a cause of chronic or recurrent forelimb lameness in horses.     

Structural variation of the distal condyles of the third metacarpal and third metatarsal bones in the horse

This study examined 3-dimensional (3D) distribution of sectors with contrasting density in the equine third metacarpal (McIII) and third metatarsal (MtIII) bones with a view to explaining the aetiology of distal condylar fractures. Macroradiography and computed tomographic (CT) imaging were used in the nondestructive study of bones obtained from horses, most of which were Thoroughbreds in race training. Distal condylar regions of McIII and MtIII were also studied in microradiographs of 100 microm thick mediolateral sections cut perpendicular to the dorsal and palmar/plantar articular surfaces. Qualitative and quantitative results from all methods used (radiography, CT and microradiographic stereology) demonstrated a densification (sclerosis) of subchondral bone located in the palmar/plantar regions of the medial and lateral condyles of both McIII and MtIII. Substantial density gradients between the denser condyles and the subchondral bone of the sagittal groove were shown to equate with anatomical differences in loading intensity during locomotion. It is hypothesised that such differences in bone density results in stress concentration at the palmar/plantar aspect of the condylar grooves, which may predispose to fracture.     

Surgical treatment of a second metacarpal bone exostosis with associated desmitis of the body of the suspensory ligament in a horse

This report outlines the diagnosis, surgical treatment and successful outcome following treatment of second metacarpal bone exostosis with concurrent suspensory ligament desmitis, and lameness in a horse. Magnetic resonance imaging was useful in determining the extent of pathology within the suspensory ligament and site of proposed surgical resection. MRI was also utilised as a post-operative tool in determining the timescale for satisfactory healing to enable the horse to return to athletic work.     

Long bone failure after intraosseous regional perfusion

A 5-year-old Australian Stock Horse gelding was initially referred to the Charles Sturt University Veterinary Clinical Centre (CSUVCC) for assessment of a penetrating laceration over the medial splint bone (second metacarpal bone) of the left foreleg. Clinical examination failed to reveal a communication with a synovial structure, but radiographs showed a palisading bone reaction on the proximal aspect of the medial splint bone which was thought to be a characteristic of infection. Soft tissue swelling precluded access to a peripheral vein, so a decision was made to use intraosseous regional limb perfusion. This was achieved through an access portal in the lateral diaphysis of the third metacarpal bone (McIII). Subsequently, the horse developed lameness and further investigation revealed a nondisplaced longitudinal fracture of McIII propagating from the intraosseous regional perfusion access portal.     

Computed tomographic diagnosis of incomplete palmar cortical (fatigue) fracture of the third metacarpal bone in two young adult endurance horses

Two young adult endurance horses were presented for investigation of sudden-onset forelimb lameness during competition. Clinical examination revealed a severe forelimb lameness and pain on palpation of the proximal palmar metacarpal area. Initial radiographic survey of the affected forelimb was unremarkable in both cases. A week of box rest resulted in only a mild improvement in the lameness. A second radiographic examination did not reveal any significant abnormalities. In both cases, scintigraphic examination was suggested, but was declined by the owner, and the lameness had significantly improved after local infiltration of 3 mL of anaesthetic solution in the proximal suspensory region. Radiographic and ultrasonographic examinations of the carpus and proximal suspensory region were unremarkable in Case 2. Case 1 had increased thickness of the medial lobe of the proximal aspect of the suspensory ligament. A computed tomographic examination was performed and an incomplete longitudinal (fatigue) fracture of the proximal third metacarpal bone was detected. After 8 months of box rest and rehabilitation, re-examination revealed resolution of the lameness in both cases. Advanced diagnostic imaging should be considered in young endurance horses with severe lameness during competition or training, in which radiographic and ultrasonographic examinations are unremarkable or do not explain the severity of the lameness. Computed tomography imaging is considered a useful diagnostic imaging technique to detect incomplete longitudinal palmar metacarpal cortical (fatigue) fractures due to its ability to provide excellent bone detail.     

A Comparison of Methods for Proximal Palmar Metacarpal Analgesia in Horses

Three techniques for inducing analgesia of the proximal metacarpal region were evaluated for the frequency of inadvertent injection into the middle carpal and carpometacarpal joints. Using methylene blue solution as a marker dye and 30 fresh cadaver specimens each, three clinicians performed either 30 infiltrations at the origin of the suspensory ligament (method A), 30 palmar and palmar metacarpal nerve blocks at the proximal end of the metacarpus (method B), or 30 palmar and palmar metacarpal nerve blocks at the distal aspect of the accessory carpal bone (method C). The frequency of inadvertent injection into the distal carpal joints was 37, 17, and 0% for methods A, B, and C, respectively. The association between method and injection into the joints was significant (p less than 0.01). Infiltration of the distal carpal joints occurred with injection distances from the carpometacarpal joint of 1.5 to 4.5 cm. Although there was no joint injection with method C, the carpal synovial sheath was inadvertently infiltrated in 68% of the specimens. Injection into the distal carpal joints can occur when deep injections are made into the proximal palmar aspect of the metacarpus because of the distopalmar outpouchings of the carpometacarpal joint between the axial surfaces of the second and fourth metacarpal bones and the abaxial surface of the suspensory ligament.     

Incomplete palmar fracture of the proximal extremity of the third metacarpal bone in horses: ten cases (1981-1986)

In 4 adult horses, simple, nondisplaced, incomplete fracture of the proximal extremity of the third metacarpal bone (MC3) was identified radiographically only on the dorsopalmar projection. Lameness was slight to moderate. Although nerve blocks of the foot and fetlock did not alter the lameness, high palmar regional nerve block improved the gait in 1 of the 2 horses on which it was performed. Pain on palpation or swollen distal accessory (inferior check) ligament, flexor tendons, and suspensory ligament were not found in any horse. The fracture was localized to the palmar surface of the proximal extremity of the MC3 on the basis of the intense uptake of radiopharmaceutical (99MTc-labeled sodium medronate) observed in that area during the soft tissue and delayed bone phases of a nuclear scintigraphic examination (nuclear scan) performed concurrently with radiography. Of 4 horses evaluated 6 months after the initial diagnosis, 3 had medullary sclerosis without radiographic evidence of fracture; results of follow-up nuclear scintigraphy performed in one of these horses at the same time were normal. Incomplete fracture also was suspected in another 6 adult horses with clinical lameness referable to the proximal extremity of the MC3. Although a fracture line could not be seen radiographically, trabecular hypertrophy and/or medullary sclerosis of the proximal extremity of the MC3 were detected on the dorsopalmar projection. Further, during nuclear scintigraphy, an intense uptake of the radiopharmaceutical was observed on the palmar aspect of the proximal extremity of the MC3 in all 6 horses.(ABSTRACT TRUNCATED AT 250 WORDS)     

Magnetic resonance imaging of the metacarpo(tarso)phalangeal region in clinically lame horses responding to diagnostic analgesia of the palmar nerves at the base of the proximal sesamoid bones: Five cases

Injection of local anaesthetic solution around the palmar nerves at the base of the proximal sesamoid bones is typically considered to desensitise structures distal to this location. There has been recent research investigating the potential for proximal diffusion of local anaesthetic solution resulting in desensitisation of structures other than those intended. This case series describes lame horses that respond to this block but have pathology within the suspensory ligament branches, the distal aspect of the third metacarpal bone and/or the proximal sesamoid bones as seen with high field magnetic resonance imaging.     

Standing repair of an articular dorsal medial oblique fracture of the proximal third metacarpal bone in a racing Standardbred

The third metacarpal bone (McIII) is a common site of long bone fractures in racehorses. However, articular fractures of the dorsomedial aspect of McIII are a rare location of such injuries. This report describes the successful standing surgical repair of an articular fracture of the dorso-medial proximal McIII in a 4-year-old Standardbred racing mare using lag screw fixation.     

Ultrasonographic procedure for a complete examination of the proximal third interosseous muscle (proximal suspensory ligament) in the equine forelimbs

Ultrasonography of the proximal third interosseus muscle (PTIOM, suspensory ligament) is routinely performed for the diagnosis of the cause of proximal metacarpal/tarsal pain. As a result of the complex architecture and deep localisation of this ligament, performing and interpreting ultrasonographic images of this structure can be difficult. This paper describes an ultrasonographic procedure that allows complete imaging of the PTIOM in the forelimbs using a combination of approaches including sagittal and palmarocollateral approaches on the weightbearing limb with linear and convex probes. Moreover, the procedure includes images made on the flexed limb, thereby allowing a better contact and a more complete representation of the PTIOM and palmar aspect of the metacarpal bones.     

Distal metacarpal sequestration in a bison.

A 2-year-old 400-kg female American bison was admitted for evaluation and treatment of an open fracture of the right metacarpal bones 3 and 4. Radiography revealed osteolysis of the distal metaphysis and epiphysis, with extensive bony callus formation along the dorsoproximal and proximomedial aspects extending distally to the proximomedial aspect of the proximal phalanx. Evidence of periosteal or bony proliferation at the fracture site or along the distal segment of the third and fourth metacarpal bones was not visible, suggesting that the distal fracture fragment was becoming a sequestrum. Treatment consisted of soft tissue debridement and placement of the limb in a full-limb cast. The cast was changed every 4 weeks until the sequestrum was removed and the bone healed. It is rare for the distal half of a long bone to sequester following fracture. Additionally, it is remarkable that the sequestrum served as a buttress, which prevented collapse of the bone until the sequestrum was replaced by functional bony callus.     

EFFECT OF PERINEURAL ANESTHESIA ON THE ULTRASONOGRAPHIC APPEARANCE OF EQUINE PALMAR METACARPAL STRUCTURES

The purpose of this study was to describe ultrasonographic changes of the equine palmar metacarpal area attributed to the infiltration of local anesthetic solution and to determine whether these changes were noted immediately or at 24 h. The palmar metacarpal region of one forelimb in each of six horses was examined ultrasonographically with a 10-MHz linear array transducer and a 7.5-MHz curvilinear transducer. Transverse and longitudinal images were recorded at 5-cm intervals distal to the accessory carpal bone. High and low palmar and palmar metacarpal nerve blocks were performed with a 2% mepivacaine hydrochloride solution. Ultrasonographic examinations similar to the initial examination then were performed immediately, 1 h and 24 h postinjection. Cross-sectional area and mean pixel value were determined for the superficial and deep digital flexor tendons, the accessory ligament of the deep digital flexor tendon, the suspensory ligament, and the suspensory branches at each level and time period. Subjective ultrasonographic changes also were noted. No significant difference was noted in the cross-sectional area or mean pixel value of any structure at any level or time period compared to baseline. Subjective changes in the tendons and ligaments were not noted. There was mild hypoechoic swelling of the surrounding soft tissues and gas in the region of the injections. Gas could interfere with the evaluation of the origin of the suspensory ligament and the proximal portion of the accessory ligament of the deep digital flexor tendon within the first hour but was not detectable ultrasonographically at 24 h. Based on these findings, if gas interferes with an ultrasonographic examination performed temporally close to perineural anesthesia, a repeat examination at 24 h is recommended.     

Ultrasonographic examination of the palmar aspect of the pastern of the horse: Sesamoidean ligaments

The suspensory apparatus is composed of the third interosseous muscle (TIOM) or suspensory ligament, the proximal sesamoid bones, palmar ligament and distal sesamoidean ligaments (DSL). Of these structures, the suspensory ligament is the most frequently implicated in conditions seen in race and sport horses; nevertheless, DSL lesions are not rare and often associated with other injuries that can modify patient prognosis and management. Ultrasonography has been shown to be valuable in the assessment of DSL desmitis. In contrast to the metacarpal area, the pastern region has been considered technically more difficult to scan because of the small and irregular contact surface and frequent artefacts. Advances in imaging techniques with adapted ultrasound probes and the use of magnetic resonance imaging (MRI) for equine lameness evaluation have revealed that distal sesamoidean ligament injuries are more frequently implicated in lameness than previously suspected.     

Ultrasound appearance of the palmar metacarpal soft tissues of the horse

Using real-time ultrasound imaging, the normal anatomy of the soft tissues of the palmar aspect of the equine forelimb was examined. Sections of frozen specimens were prepared which correlated well with the ultrasound images. The superficial and deep digital flexor tendons, tendon sheaths, inferior check ligament (accessory ligament of the deep digital flexor tendon), suspensory ligament, contours of the apices of the proximal sesamoids and the intersesamoidean ligament, were identified.     

Pathology of the distal condyles of the third metacarpal and third metatarsal bones of the horse

This study examined material from Thoroughbred horses, the majority of which had been in race training, for evidence of pathology in the third metacarpal (McIII) and third metatarsal (MtIII) bones which might be related to the occurrence of distal condylar fractures. Whole bone samples were studied and documented by macrophotography prior to macroradiography and computed tomographic (CT) imaging. Microradiographs were made from 100 microm thick mediolateral sections cut perpendicular to the dorsal and palmar/plantar articular surfaces of distal condylar regions of McIII and MtIII. Blocks were prepared for morphological imaging using the backscattered electron mode of scanning electron microscopy (BSE SEM). Linear defects in mineralised articular cartilage and subchondral bone were found in the palmar/plantar aspects of the condylar grooves adjacent to the sagittal ridge. These were closely related to the pattern of densification of the subchondral bone and were associated with intense focal remodelling of the immediately adjacent and subjacent bone. Parasagittal fractures of the condyles originated in similar defects. A unifying hypothesis for the aetiopathogenesis of these fractures is presented.     

SCINTIGRAPHIC EVALUATION OF THE PROXIMAL METACARPAL AND METATARSAL REGIONS OF HORSES WITH PROXIMAL SUSPENSORY DESMITIS

The aim of the study was to characterize radiopharmaceutical uptake patterns in horses with clinical and ultrasonographic evidence of proximal suspensory desmitis. It was hypothesized that radiopharmaceutical uptake in the proximal palmar (plantar) aspect of the third metacarpal (metatarsal) bone would be greater in lame limbs of horses with proximal suspensory desmitis than in sound limbs and that there would be a positive correlation between the severity of ultrasonographic abnormalities and the degree of radiopharmaceutical uptake. Nuclear scintigraphic evaluation of the proximal metacarpal or metatarsal regions of 126 horses with ultrasonographic evidence of proximal suspensory desmitis was performed. In all horses lameness was substantially improved by perineural analgesia of the palmar metacarpal (subcarpal) or plantar metatarsal (subtarsal) nerves. Scintigraphic images were assessed subjectively, by profile analysis and using region of interest analysis. Associations between the degree of ultrasonographic abnormality and radiopharmaceutical uptake ratios and the presence of radiographic abnormalities and radiopharmaceutical uptake ratios were analyzed. Subjectively, the majority of horses had normal radiopharmaceutical uptake. Profile analysis provided little additional information. However with region of interest analysis there was greater radiopharmaceutical uptake ratios in plantar images in the proximal metatarsal regions of lame limbs compared with nonlame limbs. There was no association between radiological abnormalities and radiopharmaceutical uptake ratios. In forelimbs there was no association between ultrasonographic lesion grade and radiopharmaceutical uptake ratios, however in hindlimbs there was a significant relationship between ultrasonographic grade and radiopharmaceutical uptake ratios.     

Anatomy of the splint bones and their surrounding area particularly in consideration of fascial attachments

This study concerns the vestigial metacarpal and metatarsal bones, so called splint bones. The soft tissues, which stabilize the splint bones were carefully examined. The palmar metacarpal/plantar metatarsal fascia, the metacarpal/metatarsal interosseous ligaments and the fibres, which exit distally from the splint bone, were examined in depth. Cadaveric distal limbs were collected from 5 slaughtered or euthanized horses. The legs were examined both, microscopically and macroscopically. The palmar metacarpal/plantar metatarsal fascia is a very stable structure, which connects the splint bone with its environment. The connection between splint and McIII/MtIII, established through the metacarpal/ metatarsal interosseous ligaments, showed impressive differences between specimens examined. Macroscopic examination of the soft tissue in the distal region showed a band structure, which originates from the distal end of the splint bone and extends in dorsal and distal direction towards the proximal sesamoid bone.