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.     

奶牛正常腕关节的超声影像学的研究

采用7．5MHz的线扫探头对4只奶牛尸体腕关节和6头奶牛的8个腕关节的正常结构进行了超声检查。一般骨骼的回声为光环或光线，关节囊呈明显的液性暗区，腱质呈实性强回声。桡腕关节囊、腕间关节囊及囊内绒毛可见。腕关节的腕桡侧伸肌腱、臂二头肌腱、指浅屈肌腱和指深屈肌腱都可清楚地看到，腕关节外侧由于腱比较细，加上侧副韧带多，在声像图上较难辨别其结构，腕关节内侧超声声像图不清楚。     

Tenoscopic Anatomy of the Equine Carpal Flexor Synovial Sheath

Objective —To describe the tenoscopic anatomy of the carpal sheath of the flexor tendons (carpal sheath) viewed from a lateral approach.
Study Design —Tenoscopic observation of structures within the carpal sheath subsequently confirmed by dissection.
Animals or Sample Population—12 equine cadaveric forelimbs.
Methods —The limbs were positioned lateral side up with the carpus slightly flexed. After distention of the carpal sheath, a portal for the arthroscope was made approximately 3 cm proximal to the distal radial physis and 2.5 cm caudal to the radius between the tendons of the ulnaris lateralis and lateral digital extensor muscles.
Results —A lateral tenoscopic approach was adequate to identify all structures within the carpal sheath. From proximal to distal, structures identified using this approach were the radial head of the deep digital flexor muscle, accessory ligament of the tendon of the superficial digital flexor muscle, distal radial physis, tendons of the superficial and deep digital flexor muscles, accessory carpal bone, antebrachiocarpal and middle carpal joints, and vincula of the tendon of the deep digital flexor muscle.
Conclusions —A lateral tenoscopic approach offered an easy, repeatable entry into the carpal sheath and allowed good observation of all structures within the sheath except for the medial borders of the tendons of the deep and superficial digital flexor muscles.
Clinical Relevance —Applications of a lateral tenoscopic approach to the carpal sheath include diagnostic procedures, lavage and synovial resection for septic tenosynovitis, desmotomy of the accessory ligament of the tendon of the superficial digital flexor muscle for flexural deformity or tendinitis, and removal of osteochondromas from the distal radial metaphysis.     

PRESUMPTIVE TENOSYNOVIAL OSTEOCHONDROMATOSIS IN A HORSE

A 5 year old Arabian mare was evaluated for a non-painful swelling located dorsal to the right carpus which had been present for 2 years. Radiographically, multiple mineralized bodies were identified dorsal to the distal radius and carpus in the region of the tendon sheath of the extensor carpi radialis muscle. The radiographic appearance of the carpal bones was within normal limits. On ultrasound examination, multiple hyperechoic foci with posterior shadowing were seen adjacent to the extensor carpi radialis tendon. There was minimal distension of the tendon sheath and no abnormalities within the substance of the extensor carpi tendon were identified. Considering the radiographic and sonographic findings, a presumptive diagnosis of tenosynovial osteochondromatosis was made. Histological confirmation of this diagnosis was not obtained as the owner declined further diagnostic evaluation.     

Gross anatomic organization of the capybara's (Hydrochaeris hydrochaeris) brachial plexus

The innervation of the capybara thoracic limb was characterized. The following nerves were observed constituting the right and left brachial plexus: n. dorsalis scapulae (C4 and C5; C4, C5 and C6) which innervates the m. serratus ventralis cervicis and m. rhomboideus; n. suprascapularis (C4, C5 and C6; C5, C6 and C7) supplying the m. supraspinatus and the m. infraspinatus; cranial and caudal nn. subscapulares (C5 and C6; C5, C6 and C7) innervating the m. subscapularis; n. axillaris (C5 and C6; C6, C7 and C8) which supplies the m. triceps brachii (caput mediale); n. radialis (C6, C7, C8 and T1; C6, C7 and C8) which innervates the m. triceps brachii (caput longum and caput mediale) and the m. extensor carpi radialis, m. extensor digitorum communis, m. extensor digitorum lateralis; n. medianus joined to the n. musculocutaneus (C6, C7, C8 and T1; C6, C7 and C8) supplying the m. biceps brachii, m. flexor carpi radialis and m. coracobrachialis; n. ulnaris (C6, C7, C8 and T1; C6, C7 and C8) leading to the m. flexor carpi radialis, the m. flexor carpi ulnaris and the m. flexor digitorum superficialis; n. thoracodorsalis (C6, C7, C8 and T1; C6, C7 and C8) supplying the m. latissimus dorsi; n. thoracicus lateralis (C8, T1; C7, C8, T1) which innervates m. pectoralis profundus (caudal portion); n. thoracicus longus (C6, C7; C7, C8) which is distributed to the m. serratus ventralis thoracis. A communication between the n. radialis and n. ulnaris was observed at the left brachial plexus.     

Quantitative analysis of computer-averaged electromyographic profiles of intrinsic limb muscles in ponies at the walk.

The function of several intrinsic muscles of the fore-and hind limbs of 5 ponies walking normally was evaluated via surface electromyography. Electromyographic signals were band-pass filtered, rectified, linear enveloped, and standardized to the stride duration. Mean data from the muscles of the left and right limbs that were obtained from at least 30 strides in 2 recording sessions were recorded as electromyographic signals-time curves. The timing of muscle activity was determined from these graphs. On the basis of the major peaks in the electromyographic signal, muscle functions were identified. In the forelimb, the extensor carpi radialis muscle was involved in extension of the carpus at the end of the swing phase of the stride, and it provided support to flexion of the cubital joint at the beginning of the swing phase. The common digital extensor muscle extended the distal joints of the forelimb at the end of the swing phase. The ulnaris lateralis muscle provided support to extension of the cubital joint at the beginning of the stance phase, and the flexor carpi radialis muscle flexed the carpus at the beginning of the swing phase. The flexor carpi ulnaris muscle extended the cubital joint at the end of the swing phase. In the hind limb, the long digital extensor muscle flexed the tarsus at the beginning of the swing phase and extended the digital joints preceding the stance phase. The deep digital flexor muscle prevented overextension of the distal interphalangeal joint during the stance phase and flexion of the digital joints during the swing phase.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ultrasonographic examination of the carpal region in cattle--normal appearance

The carpal region was examined ultrasonographically in 18 healthy cattle (14 cows, 4 bull calves) and five bovine cadavers in order to determine the normal appearance of the carpal soft tissues using 7.5 MHz linear transducers.The course of the echogenic flexor and extensor tendons over the carpus and the joint spaces interposed between the articular bone surfaces were successfully imaged in all carpi. The palmar vessels were easily visualized in live animals. The lumina of carpal tendon sheaths and the boundaries of the carpal joint pouches could not be defined. Small anechoic fluid filled areas were visualized only at the level of the joint spaces. After experimental filling, the distended synovial cavities were imaged as well demarcated anechoic areas. The cross-sectional diameters of the extensor tendons, width of the palmar joint pouches and intraluminal diameters of the palmar vessels were measured.The results presented serve as reference data for ultrasonographic investigation of disorders of the bovine carpus.     

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.     

Carpal hyperflexion in a growing dog following neural injury to the distal brachium

A three-month-old dobermann was presented with hyperfiexion of the right carpus. The abnormality had evolved over a three-week period, following circumferential soft tissue trauma to the distal brachium. The carpal joint angle measured at the limit of passive extension was 105 degrees compared with 175 degrees for the left carpus, and prevented placement of metacarpal and digital pads on the ground. Neurological examination revealed marked atrophy of the carpal extensors, an absent extensor carpi radialis reflex and moderate atrophy of the carpal flexors. Spontaneous electromyographic activity consistent with denervation was recorded in the carpal extensor and flexor muscles. Surgical exploration of the distal radial nerve disclosed a region of fibrosis enmeshing the deep branch of the radial nerve. Following relief of the entrapped nerve, carpal hyperflexion, muscle atrophy and the extensor carpi radialis reflex deficit gradually resolved over four months. It is suggested that, In the rapidly growing limb, myoneural dysfunction Induced by trauma was the underlying pathophysiological mechanism for carpal hyperflexion.     

Muscles and fascial elements of the antebrachium and manus of the African elephant (Loxodonta africana,Blumenbach 1797): starring comparative and functional considerations

The structure of the limbs of elephants is unusual among mammals. In African elephants (Loxodonta africana, Blumenbach 1797), the front limbs serve to support the greatest part of the body mass of the largest land animal. In this study, we present new and detailed anatomical data regarding muscular and specific fascial structures of the lower front limb which were examined by means of standard anatomical and histological techniques. The muscles and tendons of the forearm (antebrachium) and hand (manus) are tightly surrounded by thick, highly elastic fascial layers which fuse with the lacertus (lac.) fibrosus and the so‐called ligamentum (lig.) humeroulnare. A well‐developed musculus (m.) brachioradialis occupies the proximolateral aspect of the forearm and its tendon inserts together with the lac. fibrosus on the os carpi intermedium. The lac. fibrosus, the lig. humeroulnare and the m. flexor carpi radialis reveal a large proportion of elastic fibres. These three structures may play an important role in storing strain energy thus promoting energy‐saving locomotion. On the palmar aspect of the carpus, metacarpus and digits, short flexor, abductor, adductor, lumbricales and interossei muscles are present, whereas supinator muscles are absent in all specimens. The short muscles of the hand together with specific dorsal tendons enable precise movements of specific toes.     

Carpal hyperextension in a Percheron mare caused by a palmar carpal ligament tear

A Percheron mare was presented for acute, severe lameness and marked swelling of the right forelimb after being cast. The mare was initially diagnosed with cellulitis of the forelimb but as her condition improved and the affected limb was able to bear more weight it became apparent that the limb was hyperextended at the level of the carpus. Widening of the palmar aspect of the middle carpal joint was observed radiographically. During ultrasonographic examination, excessive fluid in the carpal sheath and perithecal swelling were noted and tearing of the palmar carpal ligament was suspected. A dynamic brace was fabricated to prevent hyperextension of the carpus. After discontinuation of systemic antibiotics, the mare became febrile and forelimb lameness worsened. Cytology of fluid from the middle carpal joint confirmed joint sepsis and the mare was anaesthetised for arthroscopic examination. A tear in the palmar carpal ligament, characterised by focal fibre disruption and fibrillation, was identified during arthroscopic and tenoscopic examination. Communication between the carpal flexor tendon sheath and middle carpal joint was identified during these procedures. Both the middle carpal joint and carpal flexor tendon sheath were lavaged with physiological saline solution. Post operatively, swelling and lameness slowly resolved. Four months after discharge, the mare was sufficiently sound to be maintained at pasture. Viewed from its lateral aspect, the limb no longer appeared to be hyperextended from the carpus.     

Arthroscopic Approaches and Intraarticular Anatomy of the Equine Elbow

Periarticular anatomy and techniques for arthroscopic access to the equine elbow were studied in six joints from cadavers. Caudomedial and craniolateral approaches were evaluated subsequently in 11 anesthetized horses. The caudomedial approach was made between the flexor carpi radialis and flexor carpi ulnaris muscle bellies. Most of the caudal articular surfaces of the humeral condyles, the caudal perimeter of the radius, and the trochlear notch and portions of the anconeal process of the ulna could be identified. The voluminous caudal joint capsule cul-de-sac proximal to the anconeal process was readily entered. A 70 degree arthroscope allowed examination of more of the joint recesses and articular surfaces of the olecranon fossa than a 25 degree arthroscope. A second portal for intraarticular instrument manipulation was made caudal and slightly proximal to the arthroscope entry. Entry more proximal than the level of the radiohumeral articulation carried significant risk of damage to the ulnar nerve and collateral ulnar artery and vein. For examination of the cranial regions of the elbow, a craniolateral portal was established cranial to the lateral collateral ligament. An instrument portal was made through the muscle bellies of the extensor carpi radialis or common digital extensor muscles. The cranial articular surfaces of the humeral condyles were readily exposed by extension of the elbow. The weight-bearing articular surface of the radius could not be seen. Eight horses were euthanatized without recovery from anesthesia and the elbows were dissected for examination. Three horses were allowed to recover from anesthesia and were euthanatized on days 3, 30, and 60.(ABSTRACT TRUNCATED AT 250 WORDS)     

Unusual muscle and tendon disorders of the forelimb in the dog

Five dogs with unusual muscle and tendon disorders of the forelimb are described. In one dog, mineralisation of the tendon of insertion of the supraspinatus muscle was treated surgically but lameness returned following the resumption of exercise. Of two cases of avulsion of the origin of the extensor carpi radialis muscle, one was successfully managed conservatively while the other needed surgical intervention to resolve the lameness. A single case of chronic avulsion/rupture of the tendon of insertion of the extensor carpi radialis muscle was successfully managed conservatively while a case of medial displacement of the biceps brachii tendon was surgically corrected by repair of the transverse humeral ligament. The aetiology, diagnosis and management of the above conditions is discussed.     

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.     

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.     

Surgical repair of synovial fistulae between a carpal hygroma,the tendon sheath of the extensor carpi radialis and the antebrachiocarpal joint in a horse

This paper reports the diagnosis and repair of synovial fistulae between a carpal hygroma and both the antebrachiocarpal (ABC) joint and the extensor carpi radialis (ECR) tendon sheath of the left carpus in a 7-year-old gelding. The communication was confirmed using contrast radiography. Arthroscopy visualised the synovial fistulae and aided in the surgical repair. The gelding made a full athletic and acceptable cosmetic recovery.     

Surgical Anatomy for Desmotomy of the Accessory Ligament of the Superficial Digital Flexor Tendon (Proximal Check Ligament) in Horses

Dissections were performed to study the surgical anatomy for desmotomy of the accessory ligament of the superficial digital flexor tendon (proximal check ligament [PCL]). The surgical approach was initiated by incising the skin cranial to the cephalic vein and caudal to the distal radius. A palpable foramen in the antebrachial fascia that transmits a branch of the cephalic vein was used to advance deeper dissection. After the antebrachial fascia was incised, the fan-shaped PCL was exposed by retracting the en-sheathed tendon of the flexor carpi radialis muscle caudally. Desmotomy was performed gradually to avoid severing branches of the palmar carpal rete that pervade the ligament. Complete transection was evidenced by visualization of the membranous roof of the carpal canal distally, the muscle belly of the radial head of the deep digital flexor centrally, and loose areolar connective tissue along the caudal radius proximally. The vessels of the palmar carpal rete were visible coursing between the severed edges of the PCL. This report highlights relevant anatomic landmarks to facilitate an accurate desmotomy.