EQUINE VETERINARY EDUCATION / AE / OCTOBER 2014
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Materials and methods
Ultrasonographic anatomy The accessory ligament of the suspensory ligament of both hindlimbs of 12 mature horses, with no history of hindlimb lameness, was assessed ultrasonographically using a 10 MHz linear and virtual convex transducer (Logiq E, GE)1, from both the plantar, plantarolateral and plantaromedial aspects.
Injury of the accessory ligament of the suspensory ligament and proximal suspensory desmopathy Case records of 5 horses examined between 2011 and 2013 with a prospective diagnosis of proximal suspensory desmopathy and injury of the accessory ligament of the suspensory ligament in a hindlimb were reviewed. Clinical features, other concurrent injuries, response to perineural and intra-articular analgesia and diagnostic imaging features were recorded. All horses were subjected to a clinical examination including assessment of lameness in hand, on the lunge on both soft and firmsurfaces and ridden. Lameness was graded under each circumstance under which the horse was examined on a scale of 0–8 (Dyson 2011). Proximal and distal limb flexion tests were each performed for one minute. All horses underwent perineural analgesia of the plantar (at the junction of the proximal 3/4 and distal 1/4 of the metatarsus) and plantar metatarsal nerve blocks (‘low 4-point block’) and perineural analgesia of the deep branch of the lateral plantar nerve. If there was residual lameness perineural analgesia of the tibial nerve was performed. In horses with persistent poor quality canter when ridden, mepivacaine was infiltrated around the sacroiliac joint regions. On a subsequent occasion intra-articular analgesia of the tarsometatarsal joint was performed in all horses. Computed radiographic examination of the tarsus and
proximal metatarsal region of the lame limb(s) was performed using lateromedial, dorsal 5° proximal-plantarodistal oblique, dorsomedial-plantarolateral oblique and dorsolateral- plantaromedial oblique images. An ultrasonographic
examination of the plantar soft tissue structures of the tarsus and metatarsal region was performed bilaterally.
Results
Ultrasonographic anatomy The control horses were 5–13 years of age (mean 7 years; median 7 years) and comprised Warmbloods (n = 6), Thoroughbred cross (n = 4) and Thoroughbred (n = 2). Bodyweight ranged from 525 to 637 kg and height from 153 to 171 cm. The accessory ligament of the suspensory ligament was easiest to identify in longitudinal images at its insertion on the suspensory ligament and could then be followed proximally to its osseous attachments (Fig 1b). The ease with which this could be done varied among horses; it was often necessary to evaluate short lengths of the ligament sequentially, with slightly altered angulation of the transducer. The ligament comprised linear parallel echoes which were consistently shorter than those of the lateral digital flexor tendon. Vessels on the plantar aspect of the ligament were a variable feature distally and resulted in anechogenic artefacts in the ligament. The plantar and dorsal borders were approximately parallel but the plantar border was always better defined than the dorsal border. It was possible but challenging to follow the course of the ligament proximally in a transverse plane. The ligament was consistently similar in appearance in the left and right hindlimbs of each horse.
Injury of the accessory ligament of the suspensory ligament and proximal suspensory desmopathy There were 4 Warmbloods and one Thoroughbred cross, used for dressage (n = 3), eventing (n = 1) and general purpose riding (n = 1) (Table 1). Two horses were 5 years of age, one 7 years of age and 2 were 12 years of age. Horses ranged in bodyweight from 550 to 674 kg (mean 599 kg) and in height from 156 to 172 cm (mean 162 cm). The horses had a history of either reduced quality of performance (n = 4) (Cases 2–4)or tension and a tendency to bolt (n = 1) (Case 1). The duration of clinical signs ranged from 3 weeks to 3 months.
TABLE 1: Summary of breed, work discipline, age and concurrent injuries of 5 horses with hindlimb proximal suspensory desmopathy and injury of the accessory ligament of the suspensory ligament
Work Breed discipline Age (years) 1 TBX Eventing 12 2 WBL Dressage 12 Foot pain
Lameness only seen after blocking RF foot
Foot pain
3 WBL General purpose
5 4 WBL Dressage 5 5 WBL Dressage 7
PSD and desmitis of proximal aspect of ALDDFT
PSD and desmitis of proximal aspect of ALDDFT
-
PSD and medial and lateral SL branch injuries
Desmitis of proximal aspect of ALDDFT
PSD and desmitis of proximal aspect of ALDDFT
-
PSD and injury of AL of SL;
SL branches abnormal
PSD and injury of AL of SL
PSD and injury of AL of SL
PSD and injury of AL of SL
-
PSD and injury of AL of SL
PSD
LF = left forelimb; RF = right forelimb; LH = left hindlimb; RH = right hindlimb. TBX = Thoroughbred cross; WBL = Warmblood; PSD = proximal suspensory desmopathy; AL of SL = accessory ligament of the suspensory ligament; SI = sacroiliac; ALDDFT = accessory ligament of the deep digital flexor tendon.
© 2014 EVJ Ltd Saddle slip SI joint region pain - Saddle slip LF
Lameness only seen after blocking RF foot
RF Foot pain LH
PSD and injury of AL of SL
RH PSD Comments
Saddle slip SI joint region pain
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