Ultrasonographic anatomy of the dorsal and abaxial aspects of the equine fetlock

Auxiliary osseous findings in fetlocks of non-racing sports horses with sagittal groove disease of the proximal phalanx on low-field magnetic resonance imaging

BACKGROUND

Sagittal groove disease of the proximal phalanx in equine athletes is commonly considered a bone stress injury. Repetitive hyperextension of the fetlock under high load is thought to contribute to its development. Concurrent changes are often reported in the dorsal sagittal ridge of the third metacarpus/metatarsus (MC3/MT3).

OBJECTIVES

To describe the spectrum of associated osseous abnormalities that are present in the fetlock in a large group of horses diagnosed with sagittal groove disease on low-field magnetic resonance imaging (MRI).

STUDY DESIGN

Retrospective, cross-sectional.

METHODS

MRI images of horses diagnosed with sagittal groove disease at Equitom Equine Clinic between March 2014 and March 2023 were evaluated using semi-quantitative grading schemes and a sagittal groove disease MRI classification system.

RESULTS

MRIs of 132 limbs were evaluated, predominantly from warmbloods used for showjumping (n = 83) and dressage (n = 18). Osseous densification and bone oedema-like signal grades were higher in the dorsal sagittal ridge than palmarly/plantarly (p < 0.001 and p < 0.05, respectively). Grades of both osseous densification and bone oedema-like signal in the dorsal sagittal ridge did not significantly differ between the different sagittal groove disease MRI classifications (both p > 0.05).

MAIN LIMITATIONS

Inclusion based on original MRI reports, absence of control group, small numbers within some grading groups hindering statistical analyses.

CONCLUSIONS

Findings support the aetiological theories of chronic bone-stress due to loaded fetlock hyperextension however the severity of osseous changes of the dorsal sagittal ridge does not appear to be associated with the severity of sagittal groove disease classification.

Hand-Held Point-of-Care Ultrasound: A New Tool for Veterinary Student Self-Driven Learning in the Time of COVID-19

The coronavirus pandemic abruptly halted all in-person clerkships, or clinical rotations, for clinical veterinary students across the United States. Online clerkships in radiology offered the opportunity to expand the student's ability to interpret medical images but did not allow for the development of physical hands-on imaging skills recognized as core competencies in veterinary medicine. The present report highlights the value of providing veterinary students with a smartphone-associated Butterfly iQ point-of-care ultrasound during a 3-week self-driven virtual clerkship. During the virtual rotation, the student was able to develop the skills required to generate sufficient quality images using three horses residing on her property. The affordability, portability, ease of use of the Butterfly iQ and availability of animals made it possible to develop hands-on imaging skills when distance learning was required.

Cartilage Degeneration of the Metacarpal Condyle and Enthesopaties of The Collateral Ligaments of Equine Metacarpophalangeal Joint

Articular degeneration can be characterized by fibrillation and eburnation of the articular layers of the metacarpophalangeal (MP) joint. Structural changes within the articular joint predispose the development of osteophytes, enthesophytes and, in many cases is associated with changes the collateral ligaments of the MP joint. The aim of the present study was to investigate the relationship between degenerative processes of the articular cartilage and the enthesopathies of collateral ligaments (superficial or deep portion) of the equine MP joint, using radiographic, ultrasonographic and anatomopathological exam, as well as establishing their sensitivity. Thirty equine forelimbs were selected from animals that died due to various clinical conditions with an average age of 5.7 years which came from a private clinic or sent to the Laboratory of Veterinary Pathology of UFSM. The specimens were placed in a hydraulic press and submitted to radiographic evaluation of the MP joint (lateromedial, flexed lateromedial, dorsopalmar, dorsolateral-palmaromedial oblique 45⁰ and dorsomedial-palmarolateral oblique 45⁰ projections). Transversal and longitudinal ultrasound images of the dorsal and collateral aspect of the MP joint were obtained using a Sonosite Edge machine with a 5 to 10 MHz linear transducer. Subsequently, the specimens were sent for gross and histopathological examination. A highly positive correlation (P value <.001) was observed between ultrasonographic and macroscopic techniques, showing a relationship between the cartilaginous degenerations of the MP joint and the medial and lateral LC enthesopathies.

Comparison of ultrasonography and radiography with arthroscopy for diagnosis of dorsoproximal osteochondral fragmentation of the proximal phalanx in 56 Thoroughbred racehorses

BACKGROUND

Osteochondral fragmentation of the proximal phalanx (DPP1 fragment) is a common finding in the racehorse. Whilst radiographic assessment has been reported to lack diagnostic sensitivity, ultrasonographic examination has been documented to be extremely sensitive for identification of bone fragments in the metacarpophalangeal joint.

OBJECTIVES

To determine the sensitivity and specificity of ultrasonography as an imaging modality for diagnosis of DPP1 fragmentation and to compare it with radiography in the Thoroughbred racehorse.

STUDY DESIGN

Retrospective cohort study.

METHODS

Medical records (radiographs and ultrasonographic examinations) of 56 Thoroughbred racehorses in training (average age 26.4 months [SD ±5.9]) with a history of forelimb fetlock joint effusion and arthroscopically confirmed DPP1 fragmentation were evaluated. Inter-observer agreement was calculated between three blinded reviewers for both ultrasonographic and radiographic findings. Median values were used for statistical analyses. Ultrasonographic and radiographic identification of DPP1 fragmentation was considered correct if in agreement with arthroscopic findings. The McNemar test was used to compare correct proportions between radiography and ultrasonography. Analyses were performed to evaluate correct identification of presence of fragment(s), location of fragment(s) and presence and location of fragment(s) within the joints, with values P < .05 considered significant.

RESULTS

Eighty-one fetlock joints from 56 Thoroughbreds were evaluated. In total, 99 individual DPP1 fragments were confirmed arthroscopically. Ultrasonography was shown to have high levels of sensitivity (94%, 95% CI 89%-99%) and specificity (97%, 95% CI 92%-100%) for identification of DPP1 fragments, with transverse ultrasonographic images being more sensitive than sagittal ultrasonography (P = .001). Ultrasonography was also shown in this population to have significantly greater sensitivity than radiography (47%, 95% CI 37%-56%) (P < .001).

CONCLUSIONS

Ultrasonography is an extremely sensitive and specific imaging modality for evaluation of DPP1 fragmentation, with transverse ultrasonographic imaging being the most sensitive technique. Radiographic evaluation was less sensitive than ultrasonography in this study.

Diagnostic Imaging and Cytological Analysis Aid the Clinical Investigation of Long Digital Extensor Tendon Subtendinous Bursitis in a Horse

The fetlock joint is a high mobility structure that accommodates enormous loading during locomotion. An injury of the superficial constituent such as subtendinous bursitis may occur due to repeated trauma. An 8-year old school riding horse was presented with dorsomedial distension in the left hindlimb fetlock region. The lesion was noted following routine exercise. The horse demonstrated no lameness and a negative response to the fetlock flexion test. Radiographic findings revealed a smooth surface cortical thickening on the medial aspect of the distal third metatarsal bone. Furthermore, the ultrasonography showed synovial thickening and proliferation, fibrous thickening with an irregular border in the inner synovial lining, and local protuberance of the fibrous layer within the bursa beneath the long digital extensor tendon. Cytological examination of the fluid from the distended lesion discovered multiple nucleated cells, including synoviocytes, nondegenerate neutrophils, lymphocytes, and macrophages. Eventually, the horse suffered subtendinous bursitis of long digital extensor tendon in the left hindlimb fetlock region. Intrabursa administration of 10 mg triamcinolone acetate alongside 25 mg hyaluronan (HA) and subsequent pressure bandaging were performed in the affected fetlock area. The distension was substantially reduced after the 4-week recovery period post medical administration. In summary, the horse was diagnosed with long digital extensor subtendinous bursitis that can occur accidentally. The diagnostic imaging and cytological analysis of accumulated fluid benefited a critical evaluation and facilitated the selection of the appropriate therapeutic plan for this defect.

Ultrasound and clinical findings in the metacarpophalangeal joint assessment of show jumping horses in training

Background

Physical exercise is known to cause significant joint changes. Thus, monitoring joint behavior of athletic horses is essential in early disorders recognition, allowing the proper management.

Objectives

The aims of this study were to determine the morphological patterns, physical examination characteristics and ultrasound findings of show jumping horses in training and to establish a score-based examination model for physical and ultrasound follow-ups of metacarpophalangeal joint changes in these animals.

Methods

A total of 52 metacarpophalangeal joints from 26 horses who were initially in the taming stage were evaluated, and the horses' athletic progression was monitored. The horses were evaluated by a physical examination and by B-mode and Doppler-mode ultrasound examinations, starting at time zero (T0), which occurred concomitantly with the beginning of training, and every 3 months thereafter for a follow-up period of 18 months.

Results

The standardized examination model revealed an increase in the maximum joint flexion angles and higher scores on the physical and ultrasound examinations after scoring was performed by predefined assessment tools, especially between 3 and 6 months of evaluation, which was immediately after the horses started more intense training. The lameness score and the ultrasound examination score were slightly higher at the end of the study.

Conclusions

The observed results were probably caused by the implementation of a training regimen and joint adaptation to physical conditioning. The joints most likely undergo a pre-osteoarthritic period due to work overload, which can manifest in a consistent or adaptive manner, as observed during this study. Thus, continuous monitoring of young athlete horses by physical and ultrasound examinations that can be scored is essential.

An experimentally induced osteoarthritis model in horses performed on both metacarpophalangeal and metatarsophalangeal joints: Technical, clinical, imaging, biochemical, macroscopic and microscopic characterization

Osteoarthritis is a common cause of pain and economic loss in both humans and horses. The horse is recognized as a suitable model for human osteoarthritis, because the thickness, structure, and mechanical properties of equine articular cartilage are highly comparable to those of humans. Although a number of equine experimental osteoarthritis models have been described in the literature, these cases generally involve the induction of osteoarthritis in just one joint of each animal. This approach necessitates the involvement of large numbers of horses to obtain reliable data and thus limits the use of this animal model, for both economic and ethical reasons. This study adapts an established equine model of post-traumatic osteoarthritis to induce osteoarthritis-associated lesions in all 4 fetlock joints of the same horse in order to reduce the number of animals involved and avoid individual variability, thus obtaining a more reliable method to evaluate treatment efficacy in future studies. The objectives are to assess the feasibility of the procedure, evaluate variability of the lesions according to interindividual and operated-limb position and describe the spontaneous evolution of osteoarthritis-associated pathological changes over a twelve-week period. The procedure was well tolerated by all 8 experimental horses and successfully induced mild osteoarthritis-associated changes in the four fetlock joints of each horse. Observations were carried out using clinical, radiographic, ultrasonographic, and magnetic resonance imaging methods as well as biochemical analyses of synovial fluid and postmortem microscopic and macroscopic evaluations of the joints. No significant differences were found in the progression of osteoarthritis-associated changes between horses or between the different limbs, with the exception of higher synovial effusion in hind fetlocks compared to front fetlocks and higher radiographic scores for left fetlocks compared to the right. This model thus appears to be a reliable means to evaluate the efficacy of new treatments in horses, and may be of interest for translational studies in human medicine.

Osteochondroma of the First Phalanx in Tbourida Horses

This study aimed at describing anatomo-histopathological and imaging features, using computed tomography and magnetic resonance imaging on six ex vivo forelimbs of Tbourida horses, that presented a particular bone exostosis on the dorsal and proximal part of the first phalanx, diagnosed by X-ray. Gross anatomy of the bone exostosis revealed an irregular surface with poly-lobulated tissue masses showing a cauliflower shape. The diameter/depth varied from 0.5 to 5.1 cm with a mean of 3.9 ± 0.9 cm. The capsule of the metacarpophalangeal joint was hypertrophic and showed many invaginations in the inner part, in contact with the bone exostosis. Computed tomography revealed cortical and medullary continuity of the bone exostosis, with the underlying bone, and remodeling of the cortical surface of the dorsal and proximal part of the first phalanx. Magnetic resonance imaging showed an increased signal intensity of the bone exostosis on the T1- and T2^*-weighted gradient fast echo. Histological examination of the bone exostosis revealed a cap of hyaline cartilage, including large foci of endochondral ossification with a base of cancellous bone surrounding marrow spaces, which confirmed the diagnosis of osteochondroma. The capsule of the metacarpophalangeal joint showed a large amount of recently formed connective tissue fibers in its inner part, interspersed with mature connective tissue. The hyperextension of the metacarpophalangeal joint during a Tbourida show, which occurs on a hard ground surface, and the use of hobbles in horse stabling are most likely responsible for the outgrowth of an osteochondroma of different shapes and sizes, and fracture complications in some cases.

DYNAMIC SONOGRAPHY OF THE EQUINE METACARPO(TARSO)PHALANGEAL DIGITAL FLEXOR TENDON SHEATH

Palmar/plantar annular desmitis is a common disease that may be associated with adhesions and structures affecting the flexor tendons, which requires tenoscopy to diagnose. The purpose of this descriptive study was to develop a dynamic sonographic technique for evaluating the motion of normal equine flexor tendons in relation to the palmar/plantar annular ligament and to compare findings with horses previously diagnosed with palmar/plantar annular desmitis. Ten healthy adult horses were examined prospectively and the images of four horses diagnosed with palmar/plantar annular desmitis were retrospectively evaluated. Dynamic sonography was performed at the level of the metacarpo/metatarsophalangeal joint by maximally extending and flexing the interphalangeal joints. Palmar/plantar annular ligament thickness (mm), size of any gap between the flexor tendons, and subjectively increased angulation of the long linear echoes of the superficial digital flexor tendon were measured. The presence of gliding motion between the palmar/plantar annular ligament and superficial digital flexor tendon was determined by consensus. Twenty-eight healthy control limbs (16 hind/12 fore) and four with palmar/plantar annular desmitis (3 hind/1 fore) were evaluated. Controls had unrestricted gliding motion between the palmar/plantar annular ligament and flexor tendons and zero to 13° of angulation of the long linear echoes. The four affected horses had restricted gliding motion and between 20-35° angulation of the long linear echoes. Dynamic ultrasound is a feasible technique for detecting restricted flexor tendon and palmar/plantar annular ligament gliding motion, as well as subjectively increased angulation of the long linear echoes of the flexor tendon in affected horses compared with controls and warrants further investigation.

Anatomic and histologic features and ultrasonographic appearance of the collateral ligaments of the metacarpophalangeal and metatarsophalangeal joints in cadaveric limbs from horses without lameness

OBJECTIVE

To describe the anatomic and histologic features of the collateral ligaments (CLs) of the metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints in cadaveric limbs obtained from nonlame horses and to compare the histologic findings with the ultrasonographic appearance of the CLs.

SAMPLE

Medial and lateral CLs of the MCP and MTP joints of 28 limbs (16 forelimbs and 12 hind limbs) from 9 adult nonlame horses euthanized for reasons unrelated to the study.

PROCEDURES

26 limbs of 8 horses were examined by ultrasonography immediately after euthanasia. Postmortem gross and histologic examinations were performed for all 28 limbs. Histologic and ultrasonographic images were graded and compared.

RESULTS

Ultrasonographically, the mean ± SD depth and width of the superficial CL were 5.1 ± 0.7 mm and 20.5 ± 1.7 mm, respectively. On histologic examination, only 125 of 319 (39%) specimens obtained from 56 medial and lateral CLs appeared normal. Histopathologic findings varied from mild changes in cellular density and collagen fiber orientation to severe fibrocartilaginous metaplasia. The degree of CL lesion severity increased distally, and the lateral CL was affected more frequently than was the medial CL. Ultrasonographically detectable abnormalities were not correlated with the histologic findings.

CONCLUSIONS AND CLINICAL RELEVANCE

In horses, histologic abnormalities within the CLs of the MCP and MTP joints may be an adaptive response to joint hyperextension and compression and might predispose horses to desmopathy and ligament failure in the event of trauma. Ultrasonography did not detect morphologic changes of the CL matrix. For an accurate diagnosis of subclinical lesions, more sensitive imaging techniques (eg, MRI) should be considered.

Clinical, radiographic, ultrasonographic and computed tomographic features of nonseptic osteitis of the axial border of the proximal sesamoid bones

REASONS FOR PERFORMING STUDY

Lysis of the axial aspect of equine proximal sesamoid bones (PSBs) is a rare condition reported to have septic or traumatic origins. Limited information exists regarding imaging of nonseptic axial osteitis of a PSB.

OBJECTIVES

To report the clinical, radiographic, ultrasonographic, computed tomographic and intra-arterial contrast-enhanced computed tomographic abnormalities in horses with axial nonseptic osteitis of a PSB.

STUDY DESIGN

Retrospective clinical study.

METHODS

Eighteen horses diagnosed with nonseptic osteitis of the axial border of a PSB between 2007 and 2012 were reviewed retrospectively. Case details, clinical examination, radiographic, ultrasonographic, computed tomographic and intra-arterial/intra-articular contrast-enhanced computed tomographic features were recorded, when available. Radiographic, ultrasonographic and computed tomographic evaluations of the fetlock region had been performed on 18, 15 and 9 horses, respectively. The effect of the degree of lysis on the grade and duration of lameness was determined.

RESULTS

All horses had chronic unilateral lameness, 4 with forelimb and 14 with hindlimb signs. On radiographs, lysis was identified in both PSBs in 14 horses, one PSB in 3 horses and in one horse no lysis was identified. The degree of osteolysis was variable. Ultrasonography identified variably sized irregularities of the bone surface and alteration in echogenicity of the palmar/plantar ligament (PL). All horses undergoing computed tomographic examination (n = 9) had biaxial lysis. The lesions were significantly longer and deeper on computed tomographic images compared with radiographic images. Intra-arterial contrast-enhanced computed tomography may reveal moderate to marked contrast enhancement of the PL. There was no significant effect of the degree of lysis on the grade and duration of lameness.

CONCLUSIONS

Lesions of nonseptic axial osteitis of a PSB can be identified using a combination of radiography and ultrasonography. Computed tomography provides additional information regarding the extent of the pathology.

Descrição do movimento da articulação metacarpofalangiana de equinos pela metodologia baseada em videogrametria

Caracterizou-se, mediante análise cinemática tridimensional baseada na videogrametria, o ângulo dorsal da articulação metacarpofalangiana de equinos em sete equinos da raça Puro Sangue Árabe. A análise tridimensional do movimento foi realizada em esteira rolante. O programa Dvideo foi utilizado para a obtenção das coordenadas tridimensionais do sistema de calibração e dos marcadores reflexivos posicionados na extremidade proximal do terceiro osso metacárpico, articulação metacarpofalangiana e extremidade distal da primeira falange. A articulação metacarpofalangiana apresentou extensão máxima durante o momento de apoio, no qual a face lateral do terceiro osso metacarpiano se apresentava de forma perpendicular ao solo. Foram observados dois picos de flexão durante a fase de elevação. Concluiu-se que a instrumentação utilizada para a análise cinemática tridimensional permitiu a investigação quantitativa da variação angular do movimento de extensão e flexão da articulação metacarpofalangiana de equinos por meio de imagens digitalizadas.

In search of clinical truths: equine and comparative studies of anatomy

The importance of correlating anatomical studies with diagnostic and therapeutic approaches in practice has long been recognised. Such studies in the horse have, until recently, lagged behind this discipline in human medicine and surgery. Clinical techniques by which this correlation is achieved include radiography, ultrasound, computed tomography and magnetic resonance imaging. This review presents published literature on the subject and, in addition, describes the part played by plastination, a recently developed technique for the preservation of biological specimens. In this, tissue fluids and part of the lipids are replaced by certain polymers yielding specimens that can be handled without gloves, do not smell or decay, and even retain microscopic properties of the original sample. The technique has proved to be a useful tool to correct previously presented anatomical descriptions and is one now favoured by human surgeons. Studies of the horse employing this technique include those of the temporomandibular joint and tarsus. The aim of the review is to stimulate further correlations of anatomical structure and equine medical and surgical procedures, thereby advancing knowledge and understanding in practice and teaching.

Alterações radiográficas e ultra-sonográficas iniciais em osteoartrite experimental eqüina

Avaliaram-se oito articulações metacarpofalangeanas (MCF) de eqüinos adultos pelos exames radiográfico e ultra-sonográfico após indução cirúrgica de uma instabilidade articular, para mimetizar as alterações iniciais da osteoartrite (OA) naturalmente adquirida. Foram mensurados a circunferência articular, a amplitude do movimento articular e o grau de claudicação dos membros torácicos (avaliação clínica). Dez dias após a intervenção cirúrgica os animais foram exercitados em um andador por um período de 60 dias. Os exames radiográfico e ultra-sonográfico foram realizados antes da intervenção cirúrgica e após 25, 40 e 70 dias, e a avaliação clínica, semanalmente, durante todo o período experimental. Observaram-se alterações ultra-sonográficas aos 25 dias após a instabilidade articular, enquanto as alterações radiográficas somente foram visualizadas aos 40 dias. Houve aumento significativo (P<0,05) da circunferência articular da articulação MCF operada (25,75cm± 1,1) a partir do sétimo dia, em relação à articulação controle (24,88cm± 1,0) e diminuição da amplitude do movimento da articulação operada (96,38º± 10,7) a partir do 25º dia, em relação ao seu valor basal (109,24º± 10,3) e em relação ao controle (108,75º± 8,3). O grau de claudicação aumentou significativamente (P<0,05) durante o período do estudo, com valor médio do escore de 1,5 para o membro operado em relação ao membro contralateral. Em conclusão, os sinais iniciais da OA cirurgicamente induzida foram melhor e mais precocemente detectados pela ultra-sonografia quando comparado ao exame radiografico. As mensurações da circunferência articular e da amplitude do movimento articular são úteis na avaliação das doenças articulares.

Ultrasonographic examination of the distal limb of cattle

Ultrasonography has proven its worth in both small animal and equine musculoskeletal work. It allows visualization of soft tissue that is not possible with anything barring magnetic resonance imaging. In bovine practice, ultrasound has been used to great effect in reproductive work and has also shown itself to be of value in the evaluation of the thorax, abdomen, and the udder. Ultrasound examination of the bovine limb is certainly feasible because of the availability of small portable and affordable equipment. The restraint necessary is dependent on the animal. Cattle, because of their size and inherent dislike of restraint, pose a challenge for ultrasonographic examination. However, if proper restraint is used, it seems possible that ultrasonography may become a helpful tool in the evaluation of soft tissue injuries. It should prove to provide valuable information that may be used to offer better advice with regard to treatment and prognosis.

Ultrasonographic examination of the proximal scutum in the horse

Normal and abnormal ultrasonographic images are presented of the proximal scutum (proximal sesamoid bones and palmar ligament) in the horse. Comparison between anatomical sections, MRI (magnetic resonance imaging) and ultrasound scans enabled the authors to establish the normal ultrasonographic anatomy of the palmar fetlock. Nine cases of proximal scutum injuries were identified ultrasonographically, of which 4 are illustrated. On normal limbs, the facies flexoria of the proximal sesamoid bones appeared as a thin and regular hyperechoic line and the palmar ligament was regularly echogenic. Lesions of the proximal scutum, that could be documented ultrasonographically, included rupture of the palmar ligament, avulsion fractures of the proximal sesamoid bones and palmar ligament desmopathy. Thinning or degeneration of the palmar ligament, concurrent with osteolysis of the proximal sesamoid bones, were indicative of palmar ligament enthesopathy. Ultrasonographic examination provided essential information for an accurate diagnosis of proximal scutum damage.