Page 219 - Adams and Stashak's Lameness in Horses, 7th Edition

Examination for Lameness 185

Lateral Femorotibial (LFT) Joint
The site for injection of the LFT joint is slightly cau­
VetBooks.ir Medial dal to the palpable edge of the lateral patellar ligament
just above the proximolateral edge of the tibia with
femoral
the limb weight‐bearing (Figure 2.196; cranial needle).
condyle
A 1.5‐inch (3.8‐cm), 18‐ to 20‐gauge needle is inserted
at right angles to the long axis of the femur and directed
from lateral to medial to a depth of 1 inch (2–3 cm). An
Medial alternative approach is to insert the needle just proximal
collateral Medial to the tibia in the space between the lateral collateral
ligament patellar ligament of the LFT joint and the tendon of origin of the
ligament long digital extensor tendon (Figure 2.196; caudal nee­
Tibial dle). 34,48 The palpable head of the fibula helps to identify
tuberosity Middle these structures. The needle is inserted slowly to a depth
patellar of approximately 1 inch (2–3 cm) until the joint capsule
ligament is entered. 48

Single Approach for All Three Joints
All three joints in the stifle can be injected from one
cranial site 1.5 cm proximal to the tibia between the lat­
Figure 2.194. Medial approach to the medial femorotibial joint eral and middle patellar ligaments with the stifle slightly
75
just caudal to the medial patellar ligament and proximal to the flexed. Local skin and subcutaneous anesthesia at the
tibial crest. injection site is helpful for this technique. A 3.5‐inch
(8.9‐cm), 18‐ to 20‐gauge spinal needle is inserted and
directed caudomedially parallel to the tibial crest toward
the MFT joint. The needle is then withdrawn to the sub­
cutaneous tissue and redirected caudolaterally parallel
Medial to the tibial crest toward the LFT joint and anesthetic is
femoral deposited. The needle is again withdrawn to the subcu­
condyle taneous tissue and redirected proximally under the
patella into the femoropatellar joint.

Medial Trochanteric Bursa
collateral Medial
ligament patellar The trochanteric bursa is located beneath the tendon
ligament of insertion of the middle gluteal muscle on the cranial
Tibial
tuberosity Middle
patellar
ligament

Lateral femoral
Figure 2.195. With the cranial approach to the MFT joint, the condyle
needle is directed in a cranial‐to‐caudal direction in the depression Lateral
between the medial patella ligament and the tendon of insertion of patellar
the sartorius muscle to enter the proximal outpouching of the joint.
ligament
Another approach to the MFT joint is located 0.5–1 Tibial
inch (1–2 cm) proximal to the medial tibial plateau in tuberosity
the depression between the medial patella ligament and Lateral digital
the tendon of insertion of the sartorius muscle. A 1.5‐ extensor
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inch (3.8‐cm), 20‐gauge needle is directed in a cranial‐ muscle
to‐caudal direction parallel to the ground and parallel to
a plane that bisects the limb (Figure 2.195). The needle
enters a medial outpouching of the MFT joint and Figure 2.196. Injection sites for the lateral femorotibial joint.
avoids inadvertent penetration of the medial meniscus One is just proximal to the tibia in the space between the lateral
and the medial femoral condyle. In addition, synovial patellar ligament and the tendon of origin of the long digital extensor
fluid is more easily obtained with this approach com­ tendon, and the alternative is caudal to the long digital extensor
pared with the medial approach to the MFT joint. tendon and cranial to the lateral collateral ligament.