Comparison of three methods of injecting the proximal interphalangeal joint in horses

Intra-articular injection in the hind limb joints of dromedary camels (Camelus dromedarius) using anatomical and arthrographic-guided landmarks

Background and Aim:

A healthy joint is an important structure for the proper movement of the camel limb. Intra-articular (IA) injection is frequently used in veterinary practice for diagnostic and therapeutic purposes of joint injuries. Thus, the current study aimed to describe the injection of the hindlimb joints in dromedary camels based on the anatomical and arthrographic-guided landmarks.

Materials and Methods:

Eighteen orthopedically sound adult camels (mean±standard deviation age: 78±12 months) of both sexes were included in this study. Three camels were euthanized to identify anatomical features in the hindlimb joints and related structures. IA injections were performed in the hindlimbs of 5 camel cadavers to evaluate the optimal IA injection site, which was confirmed by arthrography. The optimized IA injection technique was applied in 10 live camels and confirmed by arthrocentesis and arthrography. For each joint, injection criteria (number of attempts, difficulty of injection, and successful injection) were assessed, scored, and statistically compared to the other joints.

Results:

The summation of IA injection criteria scores was significantly higher (p<0.05) in the femorotibial, femoropatellar, tibiotarsal, fetlock, pastern, and coffin joints in comparison to the hip joint.

Conclusion:

Anatomical and arthrographic-guided techniques offer considerable advantages for the characterization of anatomical landmarks and selection of the appropriate IA injection site in the hindlimb in dromedary camels. Furthermore, a reference approach for camels was established that is different from the approach for cattle and horses.

Assessment of intrasynovial injection in horses by contrast-enhanced ultrasonography using air bubbles created by agitation of solution

BACKGROUND

Accuracy of intrasynovial injections can be challenging to assess in a clinical setting in horses. Contrast-enhanced ultrasonography (CEUS) using injectate agitated with air has been used to determine the success rates of synovial injections in human rheumatology.

OBJECTIVES

To assess the diagnostic sensitivity and specificity of CEUS and to describe its clinical use.

STUDY DESIGNS

Cadaveric study followed by a prospective descriptive observational study.

METHODS

Part 1: CEUS was performed following injection of agitated methylene-blue solution targeting 13 different anatomical synovial structures from three equine cadavers. Contrast was seen as hyperechoic dots, patches or lines on ultrasonography. CEUS was classified as positive if contrast was considered to be intrasynovial and negative if contrast was considered to be extrasynovial. A second synoviocentesis was performed to determine if the injection was intrasynovial based on the presence or absence of methylene-blue. Estimates of sensitivity and specificity were calculated. Part 2: CEUS was performed following injection of agitated solutions targeting synovial structures as part of routine investigation and treatment of clinical cases.

RESULTS

Part 1: CEUS was correctly classified as positive or negative in all intrasynovial and extrasynovial injections respectively. The sensitivity estimate was 100% (CI 93%-100%) and the specificity estimates was 100% (CI 16%-100%). Part 2: The technique was used safely for 26 injections (14 horses; 19 different synovial structures) administered to localise or treat lameness. Traumatic intersynovial communications or synovial membrane defects were identified using CEUS in 3 horses.

MAIN LIMITATIONS

The low number of extrasynovial injections in Part 1 resulted in an imprecise specificity estimate.

CONCLUSIONS

In horses, CEUS performed following intended intrasynovial injection can be useful for identifying unsuccessful injections.

Intra-articular injection techniques of the buffalo (Bubalus bubalis) hindlimb digit using anatomical and contrast arthrography-guided landmarks

This study was designed to evaluate and compare the optimal sites for intra-articular (IA) injection into the digits of buffalo by discrimination of the injection criteria. Forty-eight cadaveric hind digits of adult buffalos and nine live ones were assigned for three trial investigations. In the first division, eighteen sound cadaveric limbs were used to describe the anatomical features of the hind digit. In the second division, thirty cadaveric limbs (ten for each approach) were injected with an equal volume of iopamidol through relevant joint pouches to compare the dorsal, lateral and plantar IA approaches for each joint. The former technique was applied to nine live, healthy adult buffaloes to evaluate the accuracy of IA injection of the hind digit in vivo. Injection criteria were assessed, scored and statistically compared among the three approaches. The summation of injection criteria scores showed a significant increase (P < 0.05) in the dorsal and lateral approaches for IA injection of the fetlock, pastern and coffin joints in the buffalo digit compared to the plantar one. However, median and range of injection criteria scores between the dorsal and lateral approaches were slightly less significant. In conclusion, the present study established a reference for IA injection of the buffalo digit that could aid the diagnosis and treatment of digit-related lameness.

Evaluation of four techniques for injection of the proximal interphalangeal joint in horses

OBJECTIVE

To describe a dorsoproximal midline (DPM) standing technique for proximal interphalangeal joint (PIPJ) injection and to compare it to established dorsolateral flexed (DLF), palmaroproximal (PP), and dorsolateral standing (DLS) techniques.

STUDY DESIGN

Ex vivo study.

SAMPLE POPULATION

Sixty cadaver equine thoracic limbs.

METHODS

Limbs were divided into four groups (n = 15 each group), DLF, DPM, PP, and DLS. For each technique, three operators injected radiopaque contrast and methylene blue into the PIPJ in five limbs. The number of attempts required was recorded. Successful injection was confirmed by radiographic presence of contrast media within the PIPJ. Iatrogenic cartilage damage was assessed by gross examination. Statistical analysis was performed by Wilcoxon signed-rank test (P < .05).

RESULTS

The overall success rates were 86.6% to 93.3%. Although there was no difference in success rate, the frequency of needle repositioning was influenced by injection technique (P = .009). Dorsolateral standing had the highest mean ± SD value of attempts required to insert the needle in the joint space (2.62 ± 1.94). Injection technique influenced cartilage damage (P = .025), with the highest frequency recorded for DLS.

CONCLUSION

All four techniques for injecting the PIPJ were highly successful; DLS was associated with the highest number of needle repositionings and the highest incidence of iatrogenic injury to cartilage.

CLINICAL SIGNIFICANCE

Dorsolateral flexed should be considered as an alternative to the DLS technique to reduce iatrogenic cartilage injury when injecting the PIPJ. Dorsoproximal midline and DLF techniques have success rates comparable to traditional techniques, with lower incidence of iatrogenic cartilage damage in cadaver limbs.