Page 218 - Adams and Stashak's Lameness in Horses, 7th Edition

184 Chapter 2

VetBooks.ir Calcaneal Medial
bursa
femoral
condyle

Medial
Long digital collateral
extensor tendon
ligament
Tarsocrural joint Medial
Tibial patellar
Distal tuberosity ligament
intertarsal joint
Head of Middle
Tarsometatarsal fourth patellar
joint metatarsus ligament
Superfical
digital flexor
tendon

Figure 2.192. Lateral view of the injection sites for the
Figure 2.191. Injection sites for the calcaneal bursa are located femoropatellar joint. With one approach the needle is inserted
either above or below the retinaculum of the superficial digital flexor perpendicular to the limb, and with the other approach it is angled
tendon. These injection sites can be difficult to find without effusion. from distally to proximally under the patella.

Femoropatellar Joint
The femoropatellar joint is the largest of the com­
partments, and it can be entered from the cranial (on
either side of the middle patella ligament) or lateral
(caudal to the lateral patella ligament) aspects. In one
cranial approach, a 3.5‐inch (3.8‐ or 8.9‐cm), 18‐ to 20‐
gauge needle is inserted approximately 1–1.5 inches
(3–4 cm) proximal to the tibial crest between the middle
and medial patella ligaments and is directed proximally Lateral femoral
under the patella (Figure 2.192). This approach is best condyle
performed with the limb in a partial weight‐bearing Lateral
(slightly flexed) position. 2,75 Alternatively, the needle can patellar
be directed parallel to the ground with the limb fully ligament
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weight‐bearing. The femoropatellar joint can also be Tibial
entered just distal to the apex of the patella on either tuberosity
side of the middle patellar ligament with the limb
weight‐bearing. The joint capsule is superficial at this
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location, and a 1.5‐inch (3.8‐cm), 18‐ to 20‐gauge nee­ Lateral digital
dle is directed at right angles to the skin. extensor muscle
The lateral approach to the femoropatellar joint is
performed with the horse weight‐bearing (Figure 2.193).
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The lateral cul‐de‐sac of the joint is located caudal to the
lateral patellar ligament and approximately 2 inches Figure 2.193. Lateral approach to the femoropatellar joint in the
(5–6 cm) proximal to the lateral tibial condyle. A 1.5‐ lateral cul‐de‐sac of the joint located caudal to the lateral patellar
inch (3.8‐cm), 18‐ to 20‐gauge needle is inserted into the ligament and approximately 2 inches (5–6 cm) proximal to the lateral
recess perpendicular to the long axis of the femur until tibial condyle.
the nonarticular portion of the lateral trochlea is con­
tacted. Synovial fluid can be retrieved in most cases, and
this approach is usually well tolerated by the horse. just caudal to the medial patellar ligament, 1 cm proxi­
mal to the tibia, and directed perpendicular to the long
axis of the limb. The needle may need to be repositioned
Medial Femorotibial (MFT) Joint slightly cranially or caudally to help obtain synovial
The site for injection of the MFT joint is located in the fluid. The medial meniscus will be contacted (penetrated)
space between the medial patellar and medial collateral if the needle is inserted too far caudally or too close to
ligaments just above the palpable proximomedial edge the proximal tibia. 34,79 This approach may be performed
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of the tibia in the weight‐bearing limb (Figure 2.194). from the same side (facing the stifle) or from the oppo­
A 1.5‐inch (3.8‐cm), 18‐ to 20‐gauge needle is inserted site side, reaching under the horse’s belly.