Page 185 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

160 CHAPTER 1

VetBooks.ir 1.299 1.300

Fig. 1.300 Arthroscopic view of the mid-carpal
joint of a Thoroughbred racehorse with chronic
osteochondral chip fractures and secondary cartilage
pathology of the distal radiocarpal bone. The medial
palmar intercarpal ligament is elongated, loose on
palpation and shows areas of chronically damaged
Fig. 1.299 Dorsopalmar radiograph of the carpus fibres. (Photo courtesy Graham Munroe)
showing comminution and displacement laterally of C4.

carpal fractures is associated with poor outcome; surgi- cartilage damage. Herniated ligament fibres can act as
cally managed cases are still guarded as secondary joint a source of inflammation and pain within the joint.
disease often occurs early, requiring long-term medical
management. Fractures involving the accessory carpal Clinical presentation
bone have a fair outcome. Comminuted or multiple Horses present with effusion and lameness localised
carpal bone fractures (Fig. 1.299) generally have a to the middle carpal joint.
poor outcome, requiring euthanasia or arthrodesis.
Differential diagnosis
INTERCARPAL LIGAMENT INJURY Osteochondral fragmentation; OA; carpal bone
fracture.
Definition/overview
Injury to the intercarpal ligaments (including the Diagnosis
medial and lateral palmar intercarpal ligaments) has Physical examination may point towards involve-
been recognised following the use of arthroscopy. ment of the middle carpal joint. Local analgesia of
The palmar intercarpal ligaments provide dorsal the middle carpal joint is required to confirm the
stability to the middle carpal joint. location of the lameness. Radiography is often unre-
warding. Ultrasonography of the palmar intercarpal
Aetiology/pathophysiology ligaments has been described and may be enhanced
Tearing of the medial (or less commonly lateral) pal- by concurrent joint effusion. MRI can visualise both
mar intercarpal ligament can be due to a traumatic ligament and associated bone pathology (if present).
carpal injury and is often associated with other carpal Arthroscopy of the mid-carpal joint is usually diag-
pathology, including osteochondral fragmentation and nostic (Fig. 1.300).