Distal interphalangeal joint lameness in a horse associated with damage to the insertion of the lateral collateral ligament

Palmar/plantar approach for radiographic-guided injection of the equine distal interphalangeal joint collateral ligament insertion

There are limited radiographic-guided injection techniques of the insertion of the distal interphalangeal joint (DIPJ) collateral ligaments. The objective of this study was to develop and evaluate a palmar/plantar radiographic-guided injection of the collateral ligament insertion in cadavers. Fifty limbs were used to develop the technique and 24 additional limbs were used to evaluate accuracy. An 18 G, 9 cm spinal needle was placed in the depression between the palmar digital neurovascular bundle and arch of the ungular cartilage with dorsodistal advancement towards the distal phalanx collateral fossa. Radiographs verified ideal needle location on the proximal border of the distal phalanx at the collateral fossa. Dye was injected. Hoof walls were partially removed and collateral ligaments were dissected with needles in place to determine needle and dye location. Accuracy of needle placement into the insertion of the DIPJ collateral ligament was 41/48 (85 per cent), with lower accuracy of dye within the ligament (34/48; 71 per cent). Dye entered the DIPJ in 2/48 injections, but dye entered periligamentous structures in 22/48 (46 per cent) injections. A palmar/plantar radiographic-guided injection of the insertion of the DIPJ collateral ligament had high accuracy rate with low injection rate of the DIPJ in cadavers.

Recent advances in conservative and surgical treatment options of common equine foot problems

Foot problems are very common causes of lameness in horses. With the recent diagnostic advances to evaluate and treat foot pathology as well as to monitor response to therapy, it is now possible to more accurately evaluate the effectiveness of many of these treatments. This review details some of the recent advances of the most common conservative and surgical treatment options for foot problems in horses, including an overview of evidence on the efficacy to support the use of these treatment options and on factors that may affect prognosis.

Kinetics of the forelimb in horses circling on different ground surfaces at the trot

Circling increases the expression of distal forelimb lameness in the horse, depending on rein, diameter and surface properties of the circle. However, there is limited information about the kinetics of horses trotting on circles. The aim of this study was to quantify ground reaction force (GRF) and moments in the inside and outside forelimb of horses trotting on circles and to compare the results obtained on different ground surfaces. The right front hoof of six horses was equipped with a dynamometric horseshoe, allowing the measurement of 3-dimensional GRF, moments and trajectory of the centre of pressure. The horses were lunged at slow trot (3 m/s) on right and left 4 m radius circles on asphalt and on a fibre sand surface. During circling, the inside forelimb produced a smaller peak vertical force and the stance phase was longer in comparison with the outside forelimb. Both right and left circling produced a substantial transversal force directed outwards. On a soft surface (sand fibre), the peak transversal force and moments around the longitudinal and vertical axes of the hoof were significantly decreased in comparison with a hard surface (asphalt). Sinking of the lateral or medial part of the hoof in a more compliant surface enables reallocation of part of the transversal force into a proximo-distal force, aligned with the limb axis, thus limiting extrasagittal stress on the joints.

The difference in kinematics of horses walking, trotting and cantering on a flat and banked 10 m circle

REASONS FOR PERFORMING STUDY

Locomotion adaptation mechanisms have been observed in horses, but little information is available in relation to banked and nonbanked curve locomotion, which might be important to optimise training environments.

OBJECTIVES

To determine if adaptation mechanisms in horses existed when moving on a banked compared to a flat curve and whether adaptation was similar in different gaits.

METHODS

Eight infrared cameras were positioned on the outside of a 10 m lungeing circle and calibrated. Retroreflective markers were used to define left and right metacarpus (McIII) and proximal phalanges (P1), metatarsus (MtIII), head and sacrum. Data were recorded at 308 Hz from 6 horses lunged at walk, trot and canter on a flat and 10° banked circle in a crossover design. Measurements extracted were speed, stride length, McIII inclination, MtIII inclination, relative body inclination and duty factor. Data were smoothed with a fourth order Butterworth filter with 30 Hz cut-off. ANOVA was used to determine differences between conditions and limbs.

RESULTS

Adaptation mechanisms were influenced by gait. At canter inside forelimb duty factor was significantly longer (P<0.05) on a flat curve compared to a banked curve; at walk this was reversed. McIII inclination, MtIII inclination and relative body inclination were significantly greater (P<0.05) at trot and canter on a flat curve, so more inward tilt was found relative to the bearing surface.

CONCLUSION

Adaptation to curved motion is gait specific. At faster gaits it appears that horses negotiate a banked curve with limb posture closer to body posture and probably with demands on the musculoskeletal system more similar to straight canter.

Collateral desmitis of the distal interphalangeal joint in 18 horses (2001-2002)

REASONS FOR PERFORMING STUDY

There have been no previously published case series of horses examined using either scintigraphy or MRI to diagnose collateral ligament injuries not detectable using ultrasonography or radiography, nor have other concurrent soft tissue lesions been described.

OBJECTIVES

To describe the clinical features of horses with desmitis of the collateral ligaments of the distal interphalangeal (DIP) joint and to evaluate the results of radiographic, ultrasonographic, scintigraphic and magnetic resonance imaging (MRI) examinations.

METHODS

Horses were examined between January 2001 and January 2003 and were selected for inclusion in the study if there was unequivocal evidence of collateral desmitis of the DIP joint based on ultrasonography or MRI. Subject details, case history, results of clinical examination and responses to local analgesic techniques were reviewed. The results of radiographic, ultrasonographic, scintigraphic and MRI examinations were assessed.

RESULTS

Eighteen horses were identified with desmitis of a collateral ligament of the DIP joint, 3 horses (Group 1) based on ultrasonography alone, 7 (Group II) with positive ultrasonographic and magnetic resonance images and 8 (Group III) with no lesion detectable using ultrasonography, but lesions identified using MRI. Seventeen horses had forelimb injuries and one a hindlimb injury. The medial collateral ligament was injured most frequently (13 horses). In the majority of horses, no localising clinical signs were seen. Lameness was invariably worse in circles compared with straight lines. Lameness was improved by palmar digital analgesia in 16 horses (87%), but only 6 were nonlame. Intra-articular analgesia of the DIP joint produced improvement in lameness in 6/15 horses (40%). In 16 horses, no radiographic abnormality related to the DIP joint or collateral ligament attachments was identified. Eight of 14 horses (57%) had focal, moderately or intensely increased radiopharmaceutical uptake (IRU) at the site of insertion of the injured collateral ligament on the distal phalanx. Alteration in size and signal in the injured collateral ligament was identified using MRI. In addition, 5 horses had abnormal mineralisation and fluid in the distal phalanx at the insertion of the ligament. Eleven horses had concurrent soft tissue injuries involving the deep digital flexor tendon, distal sesamoidean impar ligament, navicular bursa or collateral ligament of the navicular bone.

CONCLUSIONS AND POTENTIAL RELEVANCE

Collateral desmitis of the DIP joint should be considered as a cause of foot lameness. Although some injuries are detectable ultrasonographically, false negative results occur. Focal IRU at the ligament insertion on the distal phalanx may be indicative of injury in some horses. MRI is useful for both characterisation of the injury and identification of any concurrent injuries. Further follow-up information is required to determine factors influencing prognosis.

Three-dimensional kinematics of the equine distal forelimb: effects of a sharp turn at the walk

REASONS FOR PERFORMING STUDY

Sharp turns are suspected to increase expression of several distal forelimb lamenesses even at the walk but the biomechanical consequences of such a movement remain unknown.

OBJECTIVE

To quantify the effects of a sharp turn at the walk on the 3-dimensional movements of the distal segments of the forelimb.

METHODS

Kinematics of the distal segments were measured in 4 healthy horses invasively with an ultrasonic system. Three-dimensional rotations of the digital joints were calculated by use of a joint coordinate system. Data obtained for a turn at the walk were compared to those obtained in a straight line.

RESULTS

During the stance phase in a turn, the inside forelimb underwent an adduction that induced lateromotion and medial rotation in the distal interphalangeal joint and medial rotation in the proximal interphalangeal joint. These movements were maximal at heel-off and decreased during breakover as the hoof underwent a sudden lateral rotation.

CONCLUSIONS

Walking in a sharp turn affects the kinematics of the digital joints outside the sagittal plane.

POTENTIAL RELEVANCE

This knowledge offers the opportunity to derive hypotheses on biomechanical factors that could contribute to the pathogenesis of digital injuries and on consequences for rational shoeing.

Medial collateral ligament desmitis of the distal interphalangeal joint in the hindlimb of a horse: treatment with cast immobilisation

A 12-year-old show-jumping mare was presented for investigation of a chronic hindlimb lameness of 16 weeks duration. Perineural anaesthesia and ultrasonography localised the lesion to the medial collateral ligament of the distal interphalangeal joint of the left hindlimb. Treatment consisted of a heavily padded distal limb cast for 6 weeks, strict box rest and a strictly regulated hand walking program. Serial ultrasonographic examinations were performed throughout the rehabilitation period. Collateral ligament desmitis of the distal interphalangeal joint is a commonly diagnosed condition of the forelimb; however, hindlimb collateral ligament desmitis has been rarely reported. Ultrasonographic examination in this case was an invaluable diagnostic and follow-up tool. Immobilisation of the foot by means of a heavily padded distal limb cast allowed excellent healing of the ligament and is presented as a novel treatment for collateral ligament desmitis. At the time of writing the mare had returned to her previous level of exercise and was showing no signs of lameness.

INJURY OF THE COLLATERAL LIGAMENTS OF THE DISTAL INTERPHALANGEAL JOINT DIAGNOSED BY MAGNETIC RESONANCE

We describe the clinical, imaging, and necropsy findings of two horses with severe injury of the collateral ligaments of the distal interphalangeal (DIP) joint diagnosed using magnetic resonance (MR) imaging. In MR images it was possible to examine the collateral ligaments of the DIP joint from the origin at the middle phalanx to the insertion on the distal phalanx. Both horses in this report had abnormal high signal intensity within the collateral ligaments of the DIP joint, and one horse had abnormal high signal intensity within the bone of the distal phalanx on short tau inversion recovery (STIR) and T2-weighted imaging sequences. High signal intensity on STIR and T2-weighted images represents abnormal fluid accumulation indicative of inflammation, within ligament, tendon, or bone on these imaging sequences. Abnormalities were confirmed on necropsy in both horses. Injury of the collateral ligaments of the DIP joint should be considered as a source of pain in horses with lameness localized to the foot.