INTRAARTERIAL CONTRAST-ENHANCED COMPUTED TOMOGRAPHY OF THE EQUINE DISTAL EXTREMITY

A technique for regional delivery of contrast medium to the foot of the horse to increase the diagnostic utility of computed tomography (CT) for the characterization of soft tissue structures within the hoof capsule was developed. An intraarterial catheter was placed under ultrasound guidance into the medial palmar artery at the level of the carpus to facilitate a steady-state infusion of iodinated contrast medium. Two 5 mm collimated contiguous acquisition CT scans were performed in 10 horses without lameness or radiographic evidence of distal sesamoid bone degeneration. CT examination was performed before and during regional arterial infusion of iodinated contrast medium administered at a rate of 2 ml/s. Cross-sectional area and mean pre- and post-contrast attenuation of the deep digital flexor tendon and the collateral ligaments of the distal interphalangeal joint were quantified from CT images. Soft tissue anatomy of the foot was also qualitatively characterized from pre- and postcontrast images. Catheterization was successful and without complication in all horses. The evaluated tendons and ligaments were clearly visible and had a small (8-20 Hounsfield Unit) but significant (P < 0.05, paired t-test) increase in attenuation during the steady-state infusion of contrast medium. This study should enhance the diagnostic potential of CT by providing baseline quantitative data for comparison with horses affected with soft tissue injuries in the distal extremity causing lameness that is alleviated with a palmar digital nerve block.     

Temporary transarticular stabilization with a locking plate for medial shoulder luxation in a dog.

This report describes the temporary fixation of a traumatic shoulder luxation in a large-breed dog using a 3.5-mm Locking Round-Hole Reconstruction Plate (LRHRP) to provide stable internal splinting, allowing healing of the injured ligaments, joint capsule, glenohumeral ligaments, tendons, and muscles for restoration of joint stability. The use of a temporary plate with a locking system should be considered as an option in the treatment of canine shoulder joint luxations with severe tissue damage.     

The canine shoulder: selected disorders and their management with physical therapy

The shoulder joint is the most mobile of all main limb joints. While its primary motion is in a sagittal plane, the shoulder has a significant amount of abduction and adduction, and internal and external rotation. Its stability is ensured by the joint capsule, by its specialized bands (medial and lateral glenohumeral ligaments), and by large tendons located inside (eg, tendon of origin of the biceps brachii muscle) or immediately outside the joint (eg, supraspinatus, infraspinatus, teres minor, and subscapularis). Sprains or strains of all supporting structures of the canine shoulder have now been reported and the shoulder pathology resembles the pathology of the human shoulder that includes strains and tears of the rotator cuff muscles, adhesive capsulitis, and calcific tendonitis.     

ULTRASONOGRAPHY OF THE DORSAL AND LATERAL ASPECTS OF THE EQUINE CARPUS: TECHNIQUE AND NORMAL APPEARANCE

The normal ultrasonographic appearance of the dorsal and lateral soft tissue structures and anatomic landmarks of the equine carpus useful in clinical imaging are described.
Both limbs of 5 cadavers and 5 clinically sound adult horses were imaged using a 7.5 MHz sector transducer. At the dorsal aspect of the carpus and distal radius, the extensor carpi radialis- and the common digital extensor tendon and their tendon sheaths were easily identified. These two tendons are the most prominent structures in this region. Smaller and more difficult to identify are the tendon and tendon sheath of the extensor carpi obliquus-, the lateral digital extensor- and the ulnaris lateralis muscle. The ultrasonographic appearance and course through the carpal region of the tendons and tendon sheaths mentioned are described. Other soft tissue structures examined include the lateral collateral ligament, the carpal joint capsule and the distal articular cartilage of the radius. Ultrasonographic findings correlated well with gross anatomy in the cadavers limbs.     

COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE NORMAL CANINE STIFLE

Computed tomographic (CT) imaging of eight normal cadaveric canine stifles was performed before and after intra-articular administration of iodinated contrast medium. Transverse CT images were reconstructed in dorsal, parasagittal, and oblique planes. The following ligamentous structures were identified on transverse CT images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, and the medial and lateral collateral ligaments. The following ligamentous structures were identified on transverse computed tomographic arthrography (CTA) images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, meniscofemoral ligament, cranial meniscotibial ligaments, caudal meniscotibial ligaments, intermeniscal (transverse) ligament, and the medial and lateral collateral ligaments. The patellar tendon was identified on transverse and reconstructed dorsal and sagittal CT and CTA images in all stifles. Multiplanar reconstructions enabled further evaluation of the continuity of the cranial and caudal cruciate ligaments and menisci. The medial and lateral collateral ligaments were not clearly identified on CT or CTA multiplanar reconstructed images.     

ULTRASONOGRAPHY OF THE EQUINE SHOULDER: TECHNIQUE AND NORMAL APPEARANCE

This study was intended to document normal ultrasonographic appearance of the equine shoulder and anatomic landmarks useful in clinical imaging. Both forelimbs of five equine cadavers and both forelimbs of six live adult horses were used. To facilitate understanding of the images, a zoning system assigned to the biceps brachii and to the infraspinatus tendon was developed. Ultrasonography was performed with a real-time B-mode semiportable sector scanner using 7.5- and 5-MHz transducers. On one cadaver limb, magnetic resonance imaging (MRI) was performed using a system at 1.5 Tesla, T1-weighted spin-echo sequence. Ultrasonography images were compared to frozen specimens and MRI images to correlate the ultrasonographic findings to the gross anatomy of the shoulder. Ultrasonography allowed easy evaluation of the biceps brachii and the infraspinatus tendon and their bursae, the supraspinatus muscle and tendons, the superficial muscles of the shoulder, and the underlying humerus and scapula. Only the lateral and, partially, the caudal aspects of the humeral head could be visualized with ultrasound. Ultrasonographic appearance, orientation, and anatomic relationships of these structures are described. Ultrasonographic findings correlated well with MRI images and with gross anatomy in the cadavers' limbs.     

ULTRASONOGRAPHY OF THE EQUINE TARSUS

Ultrasonography was used to delineate the sonographic anatomy of the equine tarsus with emphasis on the flexor tendons and plantar ligament at the plantar surface of the tarsus, the medial collateral ligaments and the dorsomedial joint capsule of the tibiotarsal joint. The cross-sectional gross anatomy of these tendons and ligaments was evaluated in 6 cadaver limbs. Using a 5.5 MHz mechanical sector scanner, the examined tendons and ligaments were easily identified as hyperechoic structures in 10 limbs of normal live horses. The normal ultrasonographic appearance of the dorsomedial tibiotarsal joint capsule was studied in 8 cadaver limbs. The inner surface of the tibiotarsal joint capsule was covered with villi; short and pointed in the mid region, resembling a small nodular mass proximally and a straggly beard distally. In 4 lame horses diagnostic ultrasound aided the diagnosis of plantar swellings, medial collateral joint ligamentous injury and hypertrophic synovitis.     

ULTRASONOGRAPHIC ANATOMY OF THE NORMAL CANINE STIFLE

Ultrasonographic examination of the normal canine stifle joint was performed to characterize its normal anatomy. Stifles of four normal adult dogs were imaged in sagittal and transverse planes and each anatomic structure visualized was recorded. Normal anatomic structures consistently seen included the patellar tendon, medial and lateral menisci, the cranial cruciate ligament and femoral condyle cartilage. The caudal cruciate ligament was visualized in two dogs. Collateral ligaments and meniscal ligaments were not visualized. The dogs were then euthanized and each stifle was isolated. Following removal of superficial muscles and skin, each stifle was imaged in a water bath to definitively identify the structures that had previously been visualized on the live dogs. The ultrasonographic appearance of the isolated stifle specimens was similar to that found in live dogs. The results of this study indicate that ultrasound can be used to image the normal anatomy of the canine stifle. The echogenicity of the patellar ligament, cruciate ligaments, menisci and articular cartilage was similar to that previously reported in equine stifles and human knees.     

Evaluation of computed tomographic anatomy of the equine metacarpophalangeal joint

OBJECTIVE: To determine the detailed computed tomography (CT) anatomy of the metacarpophalangeal (MCP) joint in healthy horses. SAMPLE POPULATION: 10 cadaveric forelimbs from 10 adult horses without orthopedic disease. PROCEDURES: CT of the MCP joint was performed on 4 forelimbs. In 1 of the limbs, CT was also performed after intra-articular injection of 30 mL of contrast medium (40 mg of iodine/mL). Transverse slices 1-mm thick were obtained, and sagittal and dorsal planes were reformatted with a slice thickness of 2 mm. The CT images were matched with corresponding anatomic slices from 6 additional forelimbs. RESULTS: The third metacarpal bone, proximal sesamoid bones, and proximal phalanx could be clearly visualized. Common digital extensor tendon; accessory digital extensor tendon; lateral digital extensor tendon; superficial digital flexor tendon (including manica flexoria); deep digital flexor tendon; branches of the suspensory ligament (including its attachment); extensor branches of the suspensory ligament; collateral ligaments; straight, oblique, and cruciate distal sesamoidean ligaments; intersesamoidean ligament; annular ligament; and joint capsule could be seen. Collateral sesamoidean ligaments and short distal sesamoidean ligaments could be localized but not at all times clearly identified, whereas the metacarpointersesamoidean ligament could not be identified. The cartilage of the MCP joint could be assessed on the postcontrast sequence. CONCLUSIONS AND CLINICAL RELEVANCE: CT of the equine MCP joint can be of great value when results of radiography and ultrasonography are inconclusive. Images obtained in this study may serve as reference for CT of the equine MCP joint.     

Radiographic anatomy of the soft tissue attachments of the equine stifle

REASONS FOR PERFORMING STUDY: Radiography is a very important aspect of equine stifle imaging. The precise radiographic anatomy of the soft tissue structures of the equine stifle has not been described previously. OBJECTIVE: To describe the anatomical relationship between sites of attachment of soft tissue structures of the equine stifle and their locations on standard radiographic views. METHODS: The sites of bony attachments of the tendons, ligaments and fibrous portion of the joint capsules of equine stifles were determined by gross dissection. These sites of attachment were transposed onto one set of bones deprived of soft tissue and mapped using radiopaque markers. This specimen was then radiographed in the standard radiographic projections (lateromedial, caudocranial and caudal 60 degrees lateral-craniomedial oblique) to determine the position of the attachment sites on the radiographs. RESULTS: Two radiographic maps were drawn per radiographic projection, one for the attachment sites of the ligaments and tendons and one for the attachment sites of the joint capsules. CONCLUSIONS AND POTENTIAL RELEVANCE: The radiographic maps of the precise position of the soft tissue attachments of the tendons, ligaments and joint capsules of the equine stifle should assist interpretation of equine stifle radiographs.     

COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE INTERCARPAL LIGAMENTS OF THE EQUINE CARPUS

Injuries of the intercarpal ligaments are an important cause of lameness in performance horses. The purpose of this prospective cadaver study was to determine whether computed tomography (CT) arthrography would be a feasible method for visualizing and characterizing intercarpal ligaments in the horse. One cadaver limb from each of eight nonlame horses was collected immediately after euthanasia. For each limb, overlapping 2.0 mm CT images were acquired before and after injection of iodinated contrast medium into the antebrachiocarpal joint, middle carpal joint, and carpal sheath. Spin echo magnetic resonance imaging (MRI) sequences were acquired in three planes using a 1.5 Tesla MRI scanner in three limbs. Following MRI, colored resin was injected into the synovial structures of these three limbs, limbs were frozen, and anatomic sections were obtained in three planes. Findings from CT arthrograms were compared to findings from precontrast CT, MRI, anatomic slices, and arthroscopy. Medial and lateral palmar intercarpal ligaments, radiocarpal and transverse intercarpal ligaments, and palmar carpal ligament were visible in CT arthrograms of all limbs. The proximal and distal entheses of all ligaments were readily identifiable. Findings indicated that CT arthrography is feasible for visualizing intercarpal ligaments and may be a useful adjunct imaging technique for diagnosing lameness due to suspected carpal ligament injury in horses.     

Computed tomographic and radiographic morphology of the pastern and coffin joints of One-Humped Camel (Camelus dromedarius)

The objective of the current study was to describe the structures of the pastern and coffin joints in dromedary camel using x-ray, bone and soft tissue windows computed tomography (CT) and three-dimensional volume rendering (3DVR) of CT imaging. 3DVR of CT was obtained at the slight flexed dorsal view, plantar view, dorsolateral view and lateral view which explained all the surfaces and structures of the digit bony parts even the parts of the articular surface. The processed images of 3DVR of CT showed different patterns of the cortical, cancellous, subchondral bones and medullary cavity of the bones of the digits. The present study showed clearly all the hard and soft tissues in the pastern and coffin joints of the camel in CT images; however, the plantar ligaments of the pastern joint and ligaments of the navicular cartilage identified on CT images. The CT soft tissue window visualized the joint cavity and their pouches and tendon sheath of the flexor tendons better than the bone window CT. The radiographic, CT and 3D images could be used as a normal reference for the interpretation of some clinical diseases in the pastern and coffin joints of the camel.     

MRI FINDINGS IN 232 HORSES WITH LAMENESS LOCALIZED TO THE METACARPO(TARSO)PHALANGEAL REGION AND WITHOUT A RADIOGRAPHIC DIAGNOSIS

Two hundred and thirty‐two horses with lameness localized to the metacarpo(tarso)phalangeal (MCP/MTP) region without a radiographic diagnosis were evaluated. All horses had high‐field magnetic resonance (MR) imaging of the MCP/MTP region performed for the lame limb and the contralateral limb for comparison. There were 46 horses that had bilateral abnormalities in the forelimbs; 27 of these horses were not lame in the contralateral limb at the time of examination. Bilateral hind limb abnormalities were observed in 37 horses; 22 horses were not lame in the contralateral limb. Soft tissue abnormalities alone were observed in 218 limbs (162 horses). Subchondral bone and articular cartilage abnormalities alone were observed in 43 limbs (34 horses). A combination of soft tissue, subchondral bone, and cartilage abnormalities were observed in 64 limbs (36 horses). The distribution of primary abnormalities was as follows; oblique distal sesamoidean ligament desmitis (73 limbs in 56 horses), straight distal sesamoidean ligament desmitis (44 limbs in 38 horses), chronic subchondral bone injuries (15 limbs in 12 horses), suspensory ligament branch desmitis (14 limbs in 12 horses), collateral ligament desmitis (12 limbs in 12 horses), tendonitis of the superficial and deep digital flexor tendons (10 limbs in 10 horses), osteochondral defects greater than 1 cm (nine limbs in six horses), osteochondral defects less than 1 cm (eight limbs in seven horses), bone marrow lesions (six limbs in five horses), intersesamoidean ligament desmitis (five limbs in four horses). MR imaging is useful in diagnosing bone and soft tissue injuries when radiographs and ultrasound fail to yield a diagnosis.     

COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE NORMAL CANINE ELBOW

Comprehensive evaluation of canine elbow joint dysfunction includes assessment of articular cartilage, which can noninvasively be performed with contrast arthrography. Aims of this prospective study were to compare positive contrast computed tomographic (CT) arthrography and histomorphometry measures of cartilage thickness in normal canine elbows, and to determine the optimal contrast medium concentration. Thirty‐two canine cadaver elbows were examined using multidetector CT, before and after intra‐articular administration of iohexol at one of three different concentrations. Articular cartilage thickness was measured on both the CT arthrography images and corresponding histologic specimens. Mean difference (bias) between the CT arthrography and histomorphologic measurements was 0.18 and 0.19 mm in the sagittal and dorsal planes, respectively. Mean bias and precision of CT arthrography measurements made in the sagittal or dorsal reformations were not significantly different from one another. Computed tomographic arthrography measurements from elbows with 75 mg I/ml were significantly larger and had greater bias compared to other contrast medium groups (150 and 37.5 mg I/ml). There was no significant difference in CT arthrography measurement precision between different contrast medium concentrations. Histomorphologic thickness of the articular cartilage overlying the cranial aspect of the ulna (mean 0.32 mm) was significantly thinner than cartilage of the radius (0.36 mm) or humerus (0.36 mm). Findings from this cadaver study indicated that CT arthrography delineates articular cartilage of the normal canine elbow; yields cartilage thickness measures slightly greater than histomorphometry measures; and provides high measurement precision regardless of image plane, contrast medium concentration, or anatomic zone.     

ULTRASONIC ANATOMY OF THE TENDONS AND LIGAMENTS IN THE DISTAL METACARPAL-METATARSAL REGION OF THE EQUINE LIMB

In a two-phase study, ultrasound was used to delineate the normal sonographic anatomy of soft tissues of the equine distal limb. The study was limited to the soft tissues of the palmar surface of the limb just proximal to the fetlock joint. In the first phase, cadavers were evaluated with a B-mode ultrasound machine, † Then the limbs were radiographed and dissected to compare their gross, radiographic, and ultrasonographic appearances. In the second phase, nine normal adult horses were ultrasonographically scanned. The sonographic appearance of the normal animals was compared with that of the cadavers. Front and rear limbs of all horses had similar ultrasonographic appearances. Flexor tendons and the suspensory ligament were easily identified as having linear, uniformly intense ecogenicity. The borders of the digital sheath and of the proximal palmar pouch of the fetlock joint had a less organized and less intense ecogenic appearance than the flexor tendons and suspensory ligament, and they were poorly delineated unless distended with fluid. Ultrasonography was used in three lame horses and aided the diagnoses of synovial proliferation in the fetlock joint, tendosynovitis, and bowed tendon. Diagnostic ultrasonography was effective in identifying and characterizing soft-tissue structures of the distal equine limb. It is a valuable, noninvasive diagnostic aid.     

Determination of passive mechanical properties of the superficial and deep digital flexor muscle-ligament-tendon complexes in the forelimbs of horses

OBJECTIVE: To determine the relative contributions of the muscles, tendons, and accessory ligaments to the passive force-length properties of the superficial (SDF) and deep digital flexor (DDF) myotendinous complexes. SAMPLE POPULATION: 8 cadaveric forelimbs from 6 adult Thoroughbreds. PROCEDURE: In vitro, limb configurations during slack position and myotendinous lengths during subsequent axial loading of forelimbs were recorded before and after transection of accessory ligaments. Expressions were derived to describe the force-length behavior of each muscle, tendon, and accessory ligament-tendon unit; linear stiffness was computed for these components. The elastic modulus was established for the SDF and DDF tendons. RESULTS; Linear stiffness was 2.80 +/- 0.38 kN/cm for the SDF muscle, 3.47 +/- 0.66 kN/cm for the DDF muscle, 2.73 +/- 0.18 kN/cm for the SDF tendon, 3.22 +/- 0.20 kN/cm for the DDF tendon, 6.46 +/- 0.85 kN/cm for the SDF accessory ligament, 1.93 +/- 0.11 kN/cm for the SDF accessory ligament-tendon unit, and 2.47 +/- 0.11 kN/cm for the DDF accessory ligament-tendon unit. The elastic modulus for the SDF and DDF tendons was 920 +/- 77 and 843 +/- 56 MPa, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Both the muscle-tendon and ligament-tendon portions of SDF and DDF myotendinous complexes had important roles in supporting the forelimb of horses. Although muscle tension can be enhanced by elbow joint flexion and active contraction, the accessory ligaments transmitted more force to the distal tendons than did the muscles under the conditions tested.     

COMPUTED TOMOGRAPHIC ANATOMY OF THE EQUINE TARSUS

The purpose of this study was to provide a detailed computed tomographic (CT) anatomic reference for the equine tarsus. CT examinations of the tarsal regions from four clinically and radiographically normal adult horses, which were euthanized for reasons not related to musculoskeletal disease, were included in the study. Limbs were removed at the level of midtibia, and 3-mm contiguous transverse CT images were obtained, starting at a level proximal to the tuber calcanei and continuing distally into the proximal metatarsus. Soft tissue and bone windows were used to image different anatomic features, including bones, joints, and various soft tissue components of the tarsus. Each transverse slice was compared with bone models and dissected specimens to assist in the accurate identification of specific structures. The results of the study consist of nine CT images of the equine tarsus. Each image incorporates labeled soft tissue and bone-window images, a directional compass indicating cranial (Cr) or dorsal (D) and lateral (L), and a reconstructed scout image indicating the level through which the transverse slice was made.