Podotrochlear bursa endoscopy in the horse: a cadaver study

Frequency of Penetration of the Digital Flexor Tendon Sheath and Distal Interphalangeal Joint Using a Direct Endoscopic Approach to the Navicular Bursa in Horses

Objective

To evaluate the frequency of inadvertent penetration of the digital flexor tendon sheath (DFTS) and/or distal interphalangeal joint (DIPJ) when using a direct endoscopic approach to the navicular bursa, and to evaluate an alternate direct approach to the navicular bursa.

Study Design

Cadaveric study.

Sample Population

Equine cadaver limbs (n = 40 for direct; n = 12 for alternate approach).

Methods

Four surgeons performed the direct endoscopic approach to the navicular bursa on 10 limbs each. Frequencies of inadvertent synovial penetration and iatrogenic damage were compared between surgeons. Use of an alternate direct approach, adopting a straight parasagittal trajectory, was evaluated by 2 surgeons.

Results

Inadvertent synovial penetration occurred in 45% of limbs (DFTS 37.5%; DIPJ 17.5%; and both structures 10%). Successful bursa entry was achieved on the first attempt in 45% of limbs. Significant variation in frequency of inadvertent synovial penetration was observed between surgeons (range 10–80%). Inadvertent synovial penetration did not occur when using the alternate direct technique. Iatrogenic damage to navicular bone fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using the direct endoscopic approach and in 0% of limbs using the alternate direct approach.

Conclusion

Because of the considerable risk of inadvertent penetration of the DFTS and/or the DIPJ when making a direct endoscopic approach to the navicular bursa, it is advisable to investigate for inadvertent penetration when treating navicular bursa sepsis using a direct approach. The alternate direct technique may reduce the risk of inadvertent penetration; however, the view within the bursa may be restricted.

The cranial nuchal bursa: anatomy, ultrasonography, magnetic resonance imaging and endoscopic approach

REASONS FOR PERFORMING STUDY

Although an uncommon condition, cranial nuchal bursitis can affect the performance of the equine athlete. The anatomy is not well described and there are no reports of diagnostic imaging for endoscopic approaches.

OBJECTIVES

To describe the anatomy, ultrasonographic and magnetic resonance features of and endoscopic approach to the cranial nuchal bursa in horses.

STUDY DESIGN

Experimental cadaver study.

METHODS

Four cranial nuchal bursae were dissected, 4 specimens were frozen to prepare anatomical sections and 2 were injected with latex to document surface landmarks and topographical anatomy and to identify the possible sites for endoscopic access. Six cadaveric specimens were used to describe the ultrasonographic and magnetic resonance features of the cranial nuchal bursa before and after intrabursal injection. Sixteen cadaver specimens were evaluated with a rigid arthroscope and gross dissection to determine the endoscopic appearance of the bursa.

RESULTS

The cranial nuchal bursa could be identified consistently in all cadavers, using ultrasonographic and magnetic resonance on both pre- and post injection specimens. Cranial and caudal endoscopic approaches and instrument portals were developed for the cranial nuchal bursa. Using either approach, the entire extent of the bursa could be evaluated, but separate approaches for left and right compartments of the bursa were needed owing to the lack of manoeuvrability when examining the contralateral compartment.

CONCLUSIONS

The cranial nuchal bursa can be identified on ultrasonographic and magnetic resonance images. An endoscopic approach to the cranial nuchal bursa is clinically feasible and offered an easy, repeatable entry into the cranial nuchal bursa, which allowed adequate observation of the structures within the bursa. This may be of help for diagnosis and treatment of conditions affecting the cranial nuchal bursa in horses.

Tenoscopy of the navicular bursa: a new therapeutic approach for horses affected by "palmar pain syndrome." Endoscopic technique review and personal experiences

Tenoscopy of the navicular bursa has been recently introduced as a diagnostic and therapeutic treatment in cases of palmar foot pain syndrome. A deep digital flexor tendon transthecal approach was suggested in 1999, and the endoscopic technique has been reviewed. Smith and coworkers have recently reported good and promising results. An anatomic cadaver limb study was performed, and the endoscopic technique was evaluated. Subsequently, a 14-year-old Argentine mare, affected by palmar foot pain syndrome, was treated. Clinical data, MRI and endoscopic findings, and a 6-month follow-up evaluation are reported.