Proximal suspensory desmopathy in hindlimbs: Magnetic resonance imaging, gross post‐mortem and histological study

Dyson, Sue; Pinilla, Mauricio; Bolas, Nick; Murray, Rachel C.

doi:10.1111/evj.12756

Cited by 17 publications

(18 citation statements)

References 15 publications

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“…Studies have compared low-and high-field MRI of cadaver specimens and found that although image resolution varies, the appearance of normal tissue is by and large similar when excluding magic angle artifact. 21,22 With the exception of cartilage disease, gross pathology was also detected with both modalities 22 In this survey, abnormalities previously reported in the context of the imaging diagnosis of suspensory ligament disease such as adhesion formation, 16,23 ultrasonographic divergence, 24 or changes to the MRI appearance of muscle/adipose tissue bundles 23 were given low prevalence and/or significance ratings, suggesting that these are either uncommon, not perceived to be important, or not being recognized. Given the recently suggested association of muscle/adipose tissue signal change with lameness and histopathological measures of disease, 23 which had not been observed as a feature of proximal suspensory desmitis in previous high-field MRI studies, 13,14,17 a better understanding of this feature, its prevalence, and significance is required.…”

Section: Discussionmentioning

confidence: 72%

Standing low‐field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study

Labens

Schramme

Murray

et al. 2019

Vet Radiology Ultrasound

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High‐field MRI of the proximal metacarpal/metatarsal region has been associated with great diagnostic potential and clinical reports of standing low‐field MRI of the forelimb suggest the same. To better understand diagnostic outcomes with standing low‐field MRI of the proximal suspensory region, a prospective survey study was conducted and users of a widely available system questioned on their experience, operating procedures, and interpretation of standing low‐field MRI findings. Response data included scores on a modified Likert scale from which weighted ratings were calculated for statistical analyses. Depending on the question, responses were obtained from 17 to 29 of the 38 invited facilities. Users indicated that standing low‐field MRI was most frequently performed in the face of equivocal diagnostic findings; compared to Sports horses, general purpose riding horses were thought less likely to have detectable abnormalities and standing low‐field MRI was rated most useful for the detection of primary bone pathology in the proximal metacarpal region. Standing low‐field MRI signal change involving both the suspensory ligament and adjacent bone concurrently was rated most relevant and abnormalities solely affecting the muscle/adipose tissue bundles least relevant for diagnosing suspensory ligament injury. Transverse scans and in decreasing order T1‐weighted gradient echo, short‐tau inversion recovery FSE, T2*‐weighted gradient echo, and T2‐weighted FSE sequences were most frequently acquired and judged most useful by the majority of users experienced in imaging of the target area. This survey supports the relevant impact of standing low‐field MRI on clinical case management, particularly in the context of imaging the proximal metacarpal region.

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Section: Discussionmentioning

confidence: 72%

Standing low‐field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study

Labens

Schramme

Murray

et al. 2019

Vet Radiology Ultrasound

View full text Add to dashboard Cite

show abstract

“…One potential limitation to consider is that complete antemortem diagnosis may best be obtained with MRI 15 . Magnetic resonance imaging can be used to more reliably detect adhesions between the PSL and adjacent anatomical structures as well as to provide excellent delineation between ligament, muscle, and adipose tissue within the body of the PSL 15 . Ultrasound has been shown to be reliable for detection of PSD compared with histopathology 13 .…”

Section: Discussionmentioning

confidence: 99%

Outcome following neurectomy of the deep branch lateral plantar nerve and plantar fasciotomy for hindlimb proximal suspensory desmopathy in western performance horses: 21 cases

et al. 2020

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Objective: To report the outcome of horses used in western performance disciplines after deep branch lateral plantar neurectomy/fasciotomy surgery for hind limb proximal suspensory desmopathy (PSD). Study design: Retrospective analysis. Sample population: Twenty-one client-owned horses. Methods: Medical records were reviewed (2009-2019) for horses involved in western performance disciplines that had been treated with deep branch lateral plantar neurectomy and plantar fasciotomy for lameness due to hind limb PSD. Follow-up was obtained by reexamination and/or verbal interviews with owners >2 years postoperatively. Results: Sixteen quarter horses and five paints were used for western pleasure (14/21), barrel racing (2/21), cutting (1/21), steer wrestling (1/21), working cow horse (1/21), team roping (1/21) and reining (1/21). A median duration of 8 months was required before horses were able to resume training or athletic work. Nine horses were able to return to a similar or higher level of athletic use, nine horses returned to a lower level of athletic performance, and three horses could not return to intended function. Owner satisfaction with outcome after the procedure was high (16/21), average (3/21), and low (2/21). Conclusion: Deep branch lateral plantar neurectomy and plantar fasciotomy allowed most horses to resume some athletic function as western performance horses. Clinical significance: These results provide evidence of potential outcomes when considering surgical treatment of hind limb PSD in western performance horses.

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“…All limbs selected for the study had no history of preexisting pathology of the hind limb PSL. In horses with PSLD, adhesions may form between PSL and proximoplantar aspect of the metatarsal bone or the surrounding tissue . In addition, chronic inflammation of the metatarsal fascia results in thickening of this structure, which can impede the cutting capacity of the instrument used to incise it.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Metzenbaum scissors and Y‐shaped fasciotome for deep metatarsal fasciotomy for the treatment of proximal suspensory ligament desmopathy in horses

et al. 2018

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Objective: To quantitate the iatrogenic injury associated with deep plantar metatarsal fasciotomy performed with Metzenbaum scissors compared with a Y-shaped fasciotome. Study design: Experimental ex vivo surgical study. Study population: Cadaveric hind limbs (n = 20) from 10 sound thoroughbred racehorses. Methods: A plantar metatarsal fasciotomy was performed, extending from the proximal extent of the deep metatarsal fascia, distally. Hind limbs were randomly assigned to 2 groups, undergoing fasciotomy with straight Metzenbaum scissors (n = 10) or a Y-shaped fasciotome (n = 10). Magnetic resonance imaging was performed before and after surgery to identify the maximal depth of any iatrogenic trauma. Gross examination of the surgical site included measuring the length of the incision in the deep metatarsal fascia and localizing iatrogenic trauma sustained by the plantar aspect of the proximal suspensory ligament (PSL) during the procedure. Results: Iatrogenic injury to the PSL was identified in 6 of 10 and 9 of 10 specimens prepared with the fasciotome and Metzenbaum scissors, respectively (P = .03), and was most commonly located in the distal third of the fascial incision. Differences between the length of incision (P = .02) and the maximal depth of signal (P = .03) for incisions created with Metzenbaum scissors or a fasciotome were identified. Conclusion: The use of a fasciotome resulted in longer fascial incisions and less severe iatrogenic trauma to the PSL compared with using Metzenbaum scissors. Clinical significance: A Y-shaped fasciotome may be the preferred surgical instrument for successful desmopathy of the PSL fasciotomy because a greater release of compartmental pressure is possible through a longer incision with minimal iatrogenic trauma to the underlying PSL.

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Proximal suspensory desmopathy in hindlimbs: Magnetic resonance imaging, gross post‐mortem and histological study

Abstract: Adhesion formation between the SL and adjacent structures was detected by high-field MRI with reasonable accuracy. Muscle and adipose tissue pathology was identified either alone or in association with collagenous tissue pathology.

Cited by 17 publications

References 15 publications

Standing low‐field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study

Standing low‐field MRI of the equine proximal metacarpal/metatarsal region is considered useful for diagnosing primary bone pathology and makes a positive contribution to case management: A prospective survey study

Outcome following neurectomy of the deep branch lateral plantar nerve and plantar fasciotomy for hindlimb proximal suspensory desmopathy in western performance horses: 21 cases

Comparison of Metzenbaum scissors and Y‐shaped fasciotome for deep metatarsal fasciotomy for the treatment of proximal suspensory ligament desmopathy in horses

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