Radiological techniques in the diagnosis of navicular disease

Ultrasonography of the podotrochlear apparatus in the horse using a transcuneal approach: technique and reference images

The purpose of this paper is to describe the technique for ultrasonographic examination of the podotrochlear apparatus in the horse using a transcuneal approach. In this study, ultrasound scans were performed in 3 normal cadaver limbs and 5 sound horses and images were compared to anatomic sections to establish the normal ultrasonographic anatomy of the podotrochlear apparatus. Detailed description of transverse and sagittal reference ultrasonographic images of this region is provided. This new imaging technique allows the assessment of the distal sesamoid bone flexor surface, the distal portion of the deep digital flexor tendon, the impar distal sesamoidean ligament, and the entheses of the distal phalanx.

A comparison of the palmaroproximal-palmarodistal view of the isolated navicular bone to other views

A collection of 69 isolated navicular bones, normal or affected with navicular disease, was examined radiographically using dorsopalmar, lateromedial and palmaroproximal-palmarodistal views. Radiographic findings on each view were recorded. A radiographic diagnosis of normality or navicular disease was made, first on each view separately and afterwards based on the combination of the 3 views. Forty-four navicular bones were considered radiographically normal and 25 navicular bones had distinct signs of radiographic navicular disease. The dorsopalmar and the lateromedial views of each navicular bone were assessed together and compared with the palmaroproximal-palmarodistal view. In not a single bone was the palmaroproximal-palmarodistal view considered indispensable to make the final diagnosis.

A study of 118 cases of navicular disease: radiological features

Dorsoproximal-palmarodistal oblique, lateromedial and palmaroproximal-palmarodistal oblique radiographic projections were used with standard techniques to examine 118 horses with clinical signs of navicular disease. All radiological features which have previously been reported as significant changes in the navicular bones of horses with navicular disease were recorded. Comparisons were made between these features in lame limbs and sound limbs in unilaterally lame horses and most lame limbs and least lame limbs in bilateral but asymmetrically lame animals. Their relationship to the degree of lameness was also analysed. No relationships were identified between the characteristics of distal border synovial invaginations, flattening and/or thinning of the flexor cortex and limb distribution or severity of lameness. Defects in the flexor cortex, proximal border remodelling, medullary trabecular disruption and medullary sclerosis appeared to be related to limb affliction and severity of lameness while proximal border enthesophytes, and poor flexor corticomedullary demarcation presented evidence of a relationship to the grade of lameness. Poor flexor corticomedullary demarcation and fragmentation of the distal border were related to the severity of lameness in bilateral but asymmetrically affected horses. The presence of peri-articular osteophytes and mineralisation of the flexor digitorum profundus were too infrequently recognised to permit meaningful data evaluation.

Problems associated with the use of radiography in the examination of a horse for a purchaser

The radiography of horses on behalf of a purchaser has become an inevitable part of a veterinarian's work. Radiography should, in theory, pose no more problems than a general clinical examination. In practice, difficulties arise when insufficient or inadequate films are taken or the films are misinterpreted. Radiographs of a diagnostic quality need to be taken and interpreted by a veterinarian who is reasonably well versed in radiological interpretation. Occasionally a lesion will be overlooked or misinterpreted and the radiographs will be retained so that the veterinarian's judgement can be challenged. Nevertheless, if the examination is properly conducted it is the prospective purchaser who must accept the inherent limitations of the technique, not the examining veterinarian. There is an urgent need for discussions to clarify and agree on the scope of the radiographic examination which should be performed. There is also a need for further research into the significance of minor radiographic variations from normality in equine limbs and into the natural history of the diseases which affect this most vital area.