Radiographic anatomy of soft tissue attachments in the equine metacarpophalangeal and proximal phalangeal region.

The sites of bony attachment of the tendons, ligaments, and fibrous portion of the joint capsules of the equine metacarpophalangeal (fetlock) joint region were determined by gross dissection. These sites were transposed to standard radiographic views of the fetlock joint to yield illustrations that can be used as an aid in the diagnosis of soft tissue pathology from radiographs. Evidence of direct attachment of the common digital extensor tendon to the proximal phalanx was not found. Branches of the superficial digital flexor tendon were found to insert only on the middle phalanx. The recently described sites of insertion of the branches of the superficial digital flexor tendon to the proximal phalanx were found to be sites for attachment of the deep axial palmar ligaments of the proximal interphalangeal joint.     

Vascular Supply of the Tendon of the Equine Deep Digital Flexor Muscle Within the Digital Sheath

The vascular and microvascular anatomy of the equine deep digital flexor tendon (DDFT) within the digital sheath was studied by injecting the vasculature with either colored latex or barium sulphate for radiographic, microangiographic, histologic, and computed tomographic (CT) evaluation. Consecutive 4-mm thick two-dimensional CT slice data were reconstructed to 3-dimen-sional volumetric images to enhance spatial evaluation of the blood supply. Gross dissection and angiographic studies identified three major vascular sources. Above the fetlock, the DDFT was supplied by either a branch of the medial palmar artery (Arteriae digitalis palmaris communis II) or a branch of the medial palmar digital artery (A. digitalis [palmaris propria III] medialis). Below the fetlock, the DDFT was supplied by branches from the lateral and medial palmar branches to the proximal phalanx (Ramus palmaris phalangis proximalis). The most distal aspect of the tendon received small branches from the medial and lateral palmar digital arteries. Using histology and microangiography we observed an extensive and uniform intratendinous vascular network above and below the fetlock, with a relatively avascular region of tendon palmar to the fetlock. The most distal 2.0 to 2.5 cm of the tendon within the sheath was heavily infiltrated with fibrocartilage along its dorsal aspect.     

Joint moments in the distal forelimbs of jumping horses during landing

Tendon injuries are an important problem in athletic horses and are probably caused by excessive loading of the tendons during demanding activities. As a first step towards understanding these injuries, the tendon loading was quantified during jump landings. Kinematics and ground reaction forces were collected from the leading and trailing forelimbs of 6 experienced jumping horses. Joint moments were calculated using inverse dynamic analysis. It was found that the variation of movement and loading patterns was small, both within and between horses. The peak flexor joint moments in the coffin and fetlock joints were larger in the trailing limb (-0.62 and -2.44 Nm/kg bwt, respectively) than in the leading limb (-0.44 and -1.93 Nm/kg bwt, respectively) and exceeded literature values for trot by 82 and 45%. Additionally, there was an extensor coffin joint moment in the first half of the stance phase of the leading limb (peak value 0.26+/-0.18 Nm/kg bwt). From these results, it was concluded that the loading of the flexor tendons during landing was higher in the trailing than in the leading limb and that there was an unexpected loading of the extensor tendon in the leading limb.     

New surgical approach to the plantar fetlock joint through the digital flexor tendon sheath wall and suspensory ligament apparatus in cases of concurrent septic synovitis in two cattle

A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness.     

Endoscopy of the Digital Flexor Tendon Sheath in Horses

An arthroscopic procedure for examination of the digital flexor tendons and tendon sheath was developed in 16 equine limbs and 12 horses. Distension of the tendon sheath and insertion of the arthroscope was accomplished through a cul-de-sac on the palmar or plantar surface of the tendon sheath 1 to 2 cm palmar or plantar to the digital neurovascular structures and between the annular ligament and proximal digital annular ligament. A single arthroscope entry point allowed examination of all regions of the tendon sheath cavity and most surfaces of the digital flexor tendons within the sheath. Distal to the fetlock, surgical procedures could be performed through additional entry portals on the lateral, medial, or palmar surfaces of the tendon sheath. The palmar digital vessels and nerves were avoided by palmar placement of the instrument incisions and insertion of a needle before incising the skin. The fetlock canal and proximal regions of the tendon sheath were examined by redirecting the arthroscope. Flexion of the fetlock aided passage of the arthroscope into the proximal tendon sheath regions. Evaluation of the palmar surface of the superficial digital flexor tendon was limited by the midline attachment of the tendon sheath, otherwise the surfaces of the tendons and tendon sheath could be examined with 25 degrees and 70 degrees arthroscopes. The tendon sheath was more tightly invested to the tendons in the proximal regions, limiting the arthroscope movements and second instrument access.     

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.     

Kinetics and kinematics of the equine hind limb: in vivo tendon loads and force plate measurements in ponies

Loads on the suspensory ligament, deep digital flexor tendon, superficial digital flexor tendon, and long digital extensor tendon of the equine hind limb were determined in ponies by use of implanted strain gauges consisting of silicone rubber tubes filled with mercury. Recordings were made simultaneously with force plate measurements and high-speed film recordings while the ponies were walking. The relationship between strain gauge signals and tendon loads was obtained from tension-strain tests performed after death of the ponies. The suspensory ligament and the 2 digital flexor tendons were loaded during the stance phase, and the extensor tendon was loaded mainly during the swing phase. The loading pattern of the suspensory ligament, with peak loads of 4.6 N/kg of body weight, correlated well with the vertical component of the ground reaction force. Maximal loading of the deep digital flexor tendon was observed during the second half of the stance phase, with peak values of 6.7 N/kg. The superficial digital flexor tendon was loaded maximally at the beginning of the stance phase, with a peak load of 4.1 N/kg, and the long digital extensor tendon was loaded maximally during the swing phase, with a peak load of 0.3 N/kg. Recordings made from this procedure for calibration of the strain gauge signals to tendon load and tendon strain, in combination with the force plate measurements, enabled verification of the results by torque analysis of the lower portion of the hind limb, using the vector of the ground reaction force, limb conformation, and limb geometric configuration. Torque analysis of the lower extremity indicated that the determined tendon loads were in agreement with the recorded ground reaction forces.     

The forelimb in walking horses: 2. Net joint moments and joint powers

The objective was to measure the net joint moments and joint powers for the joints of the equine forelimb during the walk. Videographic and force data were combined with morphometric information using an inverse dynamics method. During stance phase the predominant joint moment was on the palmar aspect of all forelimb joints except the shoulder, where the peak moment was considerably higher than at any other joint. The entire forelimb showed net energy absorption in both stance and swing phases. The elbow was the only joint that showed net generation of energy, which was used to maintain the limb in extension in early stance as the horse's body vaults over the limb and to drive protraction and retraction of the limb during swing. The carpus aligned the limb into a supportive strut, but did not play an important role in energy absorption or generation. A small burst of positive work on the flexor aspect at the start of breakover indicated that the carpus played an active role in initiating breakover during walking. The fetlock functioned elastically to store and release strain energy during stance. The coffin joint acted as an energy damper during most of stance with a small burst of energy generation on the flexor aspect as the joint flexed during breakover. The magnitude of the peak joint power during swing decreased in a proximal to distal sequence. It is concluded that the elbow joint is the main site of energy generation. The shoulder and coffin joints act as energy dampers during stance. The distal joints had very low joint powers and appeared to be driven by inertial forces during the swing phase. This information will be applied to describe how horses compensate for different lamenesses in terms of redistributing the functions of energy generation and absorption between joints.     

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.     

The normal anatomical, radiographical and ultrasonographic appearance of the carpal region of one-humped camel (Camelus dromedarius)

The macroscopic, radiographic and ultrasonographic anatomy of the carpal region of eight clinically normal camels (Camelus dromedarius) was determined with the help of a 7.5-MHz linear transducer. At the dorsal aspect of the carpus and distal radius, the extensor carpi radialis, extensor digitorum communis and extensor digitorum lateralis tendons were easily identified. The ulnaris lateralis tendon was observed laterally. The extensor carpi obliqus tendon was identified with difficulty. At the palmar aspect, the flexor carpi radialis, the flexor digitorum superficialis and the flexor digitorum profundus tendons were observed. Other soft structures examined include the lateral collateral ligament and the medial collateral ligament. Ultrasonographic findings correlated with gross anatomy in the dissected limbs. The results of the present study serve as reference data for ultrasonographic investigation of disorders of camel carpus.     

Effect of heel elevation on forelimb conformation in horses

OBJECTIVE: To determine the conformational changes in the distal forelimb of horses following heel elevation of 15 degrees and greater. An experimental study with repeated, within-horse measurements. PROCEDURE: Five clinically normal, mixed-breed horses were used to determine distal forelimb conformation following heel elevation from 0 to 45 degrees in 15 degree increments. Data were also compared to conformation of the limb in a Kimzey splint. Conformation was determined using lateral to medial radiographic projections. Conformation parameters assessed included measurement of apparent lengths of digital flexor tendons from the origin of their accessory ligaments to the points of insertion, and the joint angles of the distal limb. RESULTS: For angles of heel elevation from 15 to 45 degrees, the degree of joint angulation increased (increasing flexion) with heel elevation for the metacarpophalangeal, and proximal and distal interphalangeal joints. Conversely, the measured apparent lengths of the digital flexor tendons in the distal limb, decreased. CONCLUSION: The data supports the practice of elevating the heel (greater than 15 degrees) for conditions in which decreased fetlock extension may be desired such as with laceration or injury to the digital flexor tendons. Further study is required to determine whether heel elevation greater than 15 degrees reduces in vivo digital flexor tendon tension and also to ensure that the marked flexion of the distal interphalangeal joint with greater heel elevation is not detrimental over a prolonged period that may be required for the rehabilitation of flexor tendon injuries in the horse.     

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.     

Reciprocal apparatus dysfunction as a cause of severe hind limb lameness in a horse.

A 2-year-old Appaloosa mare was admitted because of acute, severe hind limb lameness (grade 4 of 5). The hock could be flexed or extended without influencing the position of the stifle joint, and the fetlock and proximal interphalangeal joints could be extended while the hock was maintained in flexion. The diagnosis was functional loss of the reciprocal apparatus. The differential diagnoses for functional loss of the reciprocal apparatus include disruption of the common calcaneal tendon, the gastrocnemius muscle, the peroneus tertius, or the superficial digital flexor muscle. In this horse, the diagnosis was disruption of the superficial digital flexor muscle. The horse made an excellent recovery following 5 months of stall confinement.     

Superficial digital flexor tendon lesions in racehorses as a sequela to muscle fatigue: a preliminary study

REASON FOR PERFORMING STUDY: Racing and training related lesions of the forelimb superficial digital flexor tendon are a common career ending injury to racehorses but aetiology and/or predisposing causes of the injury are not completely understood. OBJECTIVES: Although the injury takes place within the tendon, the lesion must be considered within the context of the function of the complete suspensory system of the distal limb, including the associated muscles. METHODS: Both muscle and tendon function were investigated in vivo using implanted strain gauges in 3 Thoroughbred horses walking, trotting and cantering on a motorised treadmill. These data were combined with assessments of muscle architecture and fibre composition to arrive at an overview of the contribution of each muscle-tendon unit during locomotion. RESULTS: The superficial digital flexor muscle has fatigue-resistant and high force production properties that allow its tendon to store and return elastic energy, predominantly at the trot. As running speed increases, deep digital flexor tendon force increases and it stabilises hyperextension of the fetlock, thus reinforcing the superficial digital flexor in limb load support. The deep digital flexor muscle has fast contracting properties that render it susceptible to fatigue. CONCLUSION: Based on these measurements and supporting evidence from the literature, it is proposed that overloading of the superficial digital flexor tendon results from fatigue of the synergistic, faster contracting deep digital flexor muscle. POTENTIAL RELEVANCE: Future research investigating distal limb system function as a whole should help refine clinical diagnostic procedures and exercise training approaches that will lead to more effective prevention and treatment of digital flexor tendon injuries in equine athletes.     

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.     

RADIOGRAPHIC APPEARANCE OF THE NAVICULAR BONE AND DISTAL INTERPHALANGEAL JOINT AND THEIR RELATIONSHIP WITH OSSIFICATION OF THE COLLATERAL CARTILAGES OF THE DISTAL PHALANX IN FINNHORSE CADAVER FOREFEET

Radiographic findings in the navicular bone and distal interphalangeal joint as well as the ossification status of the collateral cartilages of the distal phalanx were evaluated in 100 Finnhorse cadaver forefeet. The most common shapes of the proximal articular margin of the navicular bone were convex and straight. Remodeling of the navicular bone was common, especially on the lateral extremity. No bony fragments were identified at the distal flexor margin even though this area appeared irregular in several feet. Several large, rounded or lollipop-shaped synovial invaginations were identified in only six feet. The thickness of the flexor cortex varied considerably, and the corticomedullary junction was uni- or bilaterally indistinct in nine feet. The shape of the sagittal ridge of the flexor cortex was commonly flat but varied. It appeared locally irregular or indistinct in 17 feet, but changes elsewhere along the flexor cortex were rare. Osteophytosis on the dorsal and palmar margins of the distal interphalangeal joint and entheseophytosis on the dorsal aspect of the middle phalanx and on the extensor process of the distal phalanx were common. "Possibly significant" ossification of the collateral cartilages (high side-bones or separate centers of ossification) was present in 36 feet; all grades of ossification in the proximal/ palmaroproximal direction as well as palmar ossification were seen. A statistically significant relationship was found between entheseophytosis on the proximal flexor margin of the navicular bone and "possibly significant" ossification. Osteophytosis on the palmarodistal margin of the middle phalanx was more common in feet with a relatively long distal phalanx, suggestive of palmar ossification. Radiographic changes in the navicular bone or in the distal interphalangeal joint did not otherwise appear to be associated with ossification of the collateral cartilages of the distal phalanx in Finnhorses.     

A description of the motion of the navicular bone during in vitro vertical loading of the equine forelimb

Motion of the navicular bone might play a role in the development of navicular disease in horses but is difficult to asses. In the present study, 3-dimensional motion of this bone was determined using roentgen stereophotogrammetric analysis. Tantalum pellets were inserted, in vitro, in the bones of 6 forelimbs of mature Shetland ponies and kinematics were measured during vertical loading up to 2 kN. The motions of the navicular bone and coffin joint were limited to flexion/extension, there were no substantial out-of-plane motions. There was only little flexion between the navicular bone and the coffin bone, which was correlated (r = 0.66) with coffin joint flexion. There was substantial flexion between the navicular bone and the short pastern, which was highly correlated with coffin joint flexion (r = 0.97). We conclude that the navicular bone, generally, follows the coffin bone during coffin joint flexion, although there are small but consistent motions between the navicular bone and the coffin bone. These motions might play a role in the development of navicular disease in horses.     

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.