Page 215 - Adams and Stashak's Lameness in Horses, 7th Edition

Examination for Lameness 181

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Infraspinatus tendon Infraspinatus tendon
Glenoid Glenoid

Lateral Lateral
tuberosity tuberosity
of humerus
Deltoid tuberosity of humerus
Bicipital Bicipital Deltoid tuberosity
bursa Biceps brachii bursa
muscle
Biceps
brachii
muscle
Figure 2.184. Site for the distal approach to the bicipital bursa is
located is 2.5 inches (5–6 cm) distal to lateral tuberosity of the Figure 2.185. Site for the proximal approach to the bicipital
humerus. bursa is located in the intertubercular groove, which can be
palpated medial to the edge of the cranial prominence of the lateral
tuberosity of the humerus.
tuberosity and directed proximomedially (toward to
opposite ear) to a depth of 2–3 inches (5–7 cm). 48,75

Proximal Approach
The proximal approach is performed in the intertu­
bercular groove, which can be palpated medial to the
edge of the cranial prominence of the lateral tuberosity of
the humerus. 48,67 A 1.5‐inch (3.8‐cm), 20‐gauge needle is
inserted into the intertubercular groove in a plane paral­
lel to the bearing surface of the foot at about a 45° angle Medial
to the sagittal axis of the horse until the needle strikes malleolus
of tibia
cartilage (Figure 2.185). The primary advantages of the
proximal approach compared to the distal approach are
a slightly improved accuracy of entering the bursa and Sustentaculum
not needing a 3.5‐inch (8.9‐cm) spinal needle. tali Tarsocrural joint
Distal intertarsal
joint
Tarsal (Hock) Joints Superfical Tarsal sheath
There are four joint spaces associated with the tarsus: digital flexor
tarsocrural (TC), proximal intertarsal (PIT), distal inter­ tendon Deep digital
flexor tendon
tarsal (DIT), and TMT. The TC joint is considered a
high‐motion joint, whereas the PIT, DIT, and TMT joints Figure 2.186. Medial view of the injection site for the dorsome-
are low‐motion joints. Numerous studies have been dial pouch of the tarsocrural joint.
done to determine the consistency of communication
between these joints. The TC and PIT joints communi­ Tarsocrural Joint
cate consistently and are usually considered as one joint
as far as intra‐articular injection. Reports of communi­ The TC joint is the largest joint pouch in the tarsus
cation between the DIT and TMT joints vary from 8% and is easy to enter, especially if synovial effusion is pre­
to 38%. 4,20,42 To complicate things further, the PIT and sent. The joint may be entered dorsally (dorsomedial) or
DIT and the PIT and the TMT joints may also commu­ plantarly depending on the clinical situation. For the
nicate occasionally. Because of these findings, the dorsomedial approach, a 1‐inch (2.5‐cm), 20‐gauge nee­
42
interpretation of intra‐articular anesthesia in the tarsus dle is inserted 1–1.5 inches (2–3 cm) distal to the medial
is not always straightforward. In addition, the commu­ malleolus of the tibia, medial, or lateral to the cranial
nication patterns may differ in the diseased tarsus com­ branch of the medial saphenous vein (Figure 2.186;
pared with a normal tarsus, and diffusion of medication Video 2.34). The needle is advanced in a plantarolateral
may occur between the TMT and DIT joints regardless direction at approximately a 45° until synovial fluid
of the communication pattern. Corticosteroids injected flows from the needle. The dorsomedial approach is
into the TMT joint were consistently found within the usually performed in the weight‐bearing limb from the
DIT joint in all horses sampled. 70 opposite side of the horse, but can be performed from