Dr. Hagerman returned mid-May from participation in a lecture and wet lab towards international certification in Equine Locomotor Pathology with ISELP. In it she studied the Hind Distal Limb and Proximal Suspensory. This is a timely subject as many horses have lameness issues related to these areas. The first day was an intensive dissection and anatomy lecture to review the fine details of the horse's limb. The following day was case presentation and discussion. The last half day was hands-on ultrasound techniques.
Take Home Tidbits:
The phase of the stride effected will be able to lead you to the part of the leg injured as each part of the leg is stressed at different phases of the stride. Diagnoses should always match clinical signs in this way.
Even though the pastern joint is very small, it has 8 ligaments associated with it. The coffin joint has 6 ligaments associated with it. Some ligaments are obliqued in order to stabilize rotational forces.
Off angle non-weight bearing ultrasound exam of the proximal suspensory is the best way to differentiate the ligament fibers from the fat within the ligament and assess true swelling and damage.
Venous compression and measurement of the interosseous fascia is a good way to assess swelling and compartmental syndrome in the proximal suspensory.
Adhesions involving the proximal suspensory can cause pastern ligament damage due to lack of elasticity of the suspensory overstressing the lower limb.
Horses with suspensory ligament pain can be sore after a fetlock flexion test and will be lame when the effected limb is on the outside of the circle on the longe line.
In the pastern area, the ergot ligament crosses the nerve bundle and looks the same as the nerve. This is important to recognize when doing a neurectomy.
The deep flexor tendon originates on the lateral side of the stifle, which is why stifle lameness can mimic foot lameness.
The digital cushion of the foot is too soft to be a support structure of the foot, it is a tactile/proprioceptive organ.
Enthesiophytes of the navicular bone seen on radiographs are actually a strain of the collateral ligament of the navicular bone.
Exam detail on the straight, longe line, with flexion tests can be greatly enhanced with the use of slow motion cameras.
Therapeutic shoeing can support healing during rest and rehabilitation programs.
It is important to do rehabilitation on specific substrates (soft or hard surfaces) depending on the injury.