Page 207 - Adams and Stashak's Lameness in Horses, 7th Edition

Examination for Lameness 173

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Common or
long digital
extensor tendon

First
phalanx

Dorsal branch of
suspensory ligament
Extensor Second Coronary band
process phalanx Collateral ligament
of pastern joint

Third phalanx

Figure 2.166. Dorsolateral approach to the PIP joint. The needle is inserted at distal border of the P1 condyle beneath the extensor tendon.

performed with the limb weight‐bearing or held, the
approach through the collateral sesamoidean ligament
must be performed with the fetlock joint flexed, and the
distal palmar/plantar and dorsal approaches are usually
performed in the standing limb. The dorsal and proxi­
mal palmar/plantar approaches are usually reserved for
horses with significant effusion to avoid damage to the
Branch of articular cartilage and inadvertent hemorrhage, respec­
superficial digital tively. Which technique to use is often based on personal
flexor tendon preference, although some are easier to perform in the
Eminence of forelimb than the hindlimb.
second phalanx
Deep digital
flexor tendon Proximal Palmar/Plantar Pouch
Distal condyle The boundaries of the palmar/plantar pouches of
of first phalanx the fetlock joint are the apical border of the pro ximal
sesamoid bones distally, the distal ends of the splint
bones proximally, the third metacarpal/ metatarsal
bone dorsally, and the branch of the suspensory liga­
ment palmar/plantarly (Figure 2.168). In the normal
horse, these pouches appear as a depression, and
attempts to retrieve synovial fluid may be difficult.
However, they are usually easily identified in horses
with fetlock effusion. When performing this approach
in the standing patient, a 1‐inch (2.5‐cm), 20‐gauge
needle is inserted from lateral to medial and directed
distally at a 45° angle to the long axis of the limb
Figure 2.167. Palmar/plantar approach to the PIP joint. The limb
is held to relax the palmar structures, and the needle is inserted in a (Video 2.22). The disadvantages of this approach are
V‐shaped depression formed by the palmar aspect of P1 dorsally, the possibility of contaminating the synovial fluid
the distal eminence of P1 distally, and the lateral branch of the sample with blood because of the highly vascular
SDFT as it inserts on the eminence of P2 palmarodistally. synovial membrane and the inability to aspirate