Page 211 - Adams and Stashak's Lameness in Horses, 7th Edition

Examination for Lameness 177

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Annular ligament
of fetlock Annular ligament
of fetlock

Proximal digital Proximal digital
annular ligament annular ligament
Deep digital
flexor tendon Deep digital
flexor tendon

Figure 2.173. The proximal outpouching of the digital flexor Figure 2.175. Injection site for the axial sesamoidean approach
tendon sheath can be used for synoviocentesis when the DFTS is to the DFTS. The needle is inserted on the axial border of the
distended. It is usually performed with the horse weight‐bearing. sesamoid bone through the annular ligament.

palmarodistally adjacent to the origin of the suspensory
ligament. Anesthetic injected into the middle carpal joint
may also desensitize the proximal suspensory ligament
and proximal palmar metacarpal region. 23,24
The sites of injection for the radiocarpal and middle
carpal joints are located in palpable depressions lateral
or medial to the extensor carpi radialis tendon on the
Annular ligament dorsal aspect of each joint (Figures 2.176 and 2.177).
of fetlock The injection is made with a 1‐inch (2.5‐cm), 20‐gauge
needle midway between the distal radius and proximal
row of carpal bones for the radiocarpal joint
Proximal digital (Figure 2.177; Video 2.30) or between the proximal and
annular ligament distal rows of carpal bones for the middle carpal joint
(Figure 2.176; Video 2.31). Because the surfaces of the
Deep digital carpal bones are at an angle, the needle should be
flexor tendon directed slightly proximally to avoid hitting the articular
cartilage. 3,75
The landmarks for the palmarolateral approach to
the radiocarpal joint are the palmarolateral aspect of the
radius, proximolateral aspect of the accessory carpal
bone, and palmarolateral aspect of the ulnar carpal bone
(Figure 2.178). 47,79 A 1‐inch (2.5‐cm), 20‐gauge needle is
inserted in this palpable depression at 90° to the long
axis of the limb, and the needle is directed dorsomedi­
ally (Video 2.32). Another palmarolateral approach is at
the midaccessory carpal bone level in a palpable “V”
between the tendons of the ulnaris lateralis and the lat­
eral digital extensor. 41,48 The needle is inserted perpen­
Figure 2.174. Injection site for the distal outpouching of the dicular to the skin in a small depression 0.5–1 inch
DFTS (distal needle) and the outpouching of the sheath located (8–12 mm) distal to the “V” in the space between the
abaxial and distal to the sesamoid bones between the annular and distal lateral aspect of the radius (vestigial ulna) and the
proximal digital annular ligaments (proximal needle). proximal lateral aspect of the ulnar carpal bone. 47,48