Communication between the distal interphalangeal joint and the navicular bursa in the horse at Computed Tomography Arthrography

Abstract

Diffusion of drugs injected into the distal interphalangeal joint or the navicular (podotrochlear) bursa can influence diagnosis and treatment of foot pain. Previous anatomical and radiographic studies of the communication between these synovial structures have produced conflicting results and did not identify the location of any communication if present. This anatomic study aimed to assess the presence and site of communication between the distal interphalangeal joint and the navicular bursa in the horse by computed tomography arthrography. Sixty‐six pairs of cadaver forelimbs were injected with contrast medium into the distal interphalangeal joint and imaged by computed tomography arthrography. The presence of a communication, location of the communication and additional structural changes were assessed. Navicular bursa opacification occurred in 7 distal limbs (5.3%) following distal interphalangeal joint injection. One limb showed a communication through the T‐ligament and 6 limbs showed a communication through the distal sesamoidean impar ligament. In 3 cases, the communication through the distal sesamoidean impar ligament was associated with a distal border fragment. Our study showed that communication between the distal interphalangeal joint and navicular bursa is uncommon and inconsistent. Clinically, the presence of a communication could (1) influence the interpretation of diagnostic analgesia of the distal interphalangeal joint or the navicular bursa by facilitating the diffusion of local anaesthetic between these structures; (2) allow the drug and its potential adverse effects to spread from the treated synovial cavity to the non‐targeted synovial cavity; (3) be responsible for the failure of joint drainage in the case of sepsis.

Computed tomographic evaluation of the proximity of needles placed for perineural anesthesia of the palmar digital nerves to synovial structures in the foot: an ex vivo study

“…In one limb, diffusion of the contrast medium from the NB to the DIPJ was noted. In one earlier study using CT arthrography, an occasional direct communication from the DIPJ to the NB was reported in 7/133 (5.3%) cadaver limbs ( 13 ). The authors stated that communication could occur through the proximal sesamoidean ligament or the distal sesamoidean impar ligament.…”

“…Sequential injection of the NB, the DIPJ and the DFTS was performed using 3, 5 and 10 mL, respectively, of 1:1 diluted contrast medium (iohexol 240 mg/mL 1 ) and tap water. The volumes were based on volumes routinely used for intrasynovial anesthesia ( 1 , 13 , 14 ). All injections and needle placements were performed by a single operator (resident of the European College of Sports Medicine and Rehabilitation; MG).…”

Highlights of recent clinically relevant papers

“…This anatomic study by Fanny Hontoir and colleagues in Belgium and the UK aimed to assess the presence and site of communication between the distal interphalangeal joint (DIPJ) and the navicular bursa in the horse by computed tomography arthrography.…”

Objective evaluation for analgesia of the distal interphalangeal joint, the navicular bursa and perineural analgesia in horses with naturally occurring forelimb lameness localised to the foot

“…Further differentiation of the source of lameness can be carried out with intra‐synovial analgesia. However, investigations about communications between the distal interphalangeal joint (DIPJ) or the navicular bursa (NB) tend to conflict 2–7 …”

“…However, investigations about communications between the distal interphalangeal joint (DIPJ) or the navicular bursa (NB) tend to conflict. [2][3][4][5][6][7] In experimental and clinical studies, the results of analgesia of the DIPJ (DIPJ-A) and NB (NB-A) have been subjectively investigated.…”