Indications: - Anatomical Deformities:

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Indications: - Anatomical Deformities: - The ligaments present an echogenic aspect, however there are some who have helicoidal fibers whose image can give anechogenic areas that should not be

1 Indications: - Anatomical Deformities: - The ligaments present an echogenic aspect, however there are some who have helicoidal fibers whose image can give anechogenic areas that should not be confused with injuries. In other cases there are different fascicles belonging to the same ligament that require evaluations separately. - These lesions of the ligaments are desmopathies with thickening and hypoechogenic or anechogenic areas. The chronic desmopathies are characterized by increased size, thickening of the adjacent tissues and architecture loss from the fibers. - In fractures caused by avulsion they appreciate fragments with separate borders and practically always the propensity of the ligament. - In enthesopathies (insertion desmopathies) they tend to see changes in the bone where inserted, there can be lysis, proliferation and surface irregularity. - Hypertrophy of the synovial membrane indicates synovitis especially in cases of sepsis, and are usually accompanied by an increase in synovial fluid. - Thickening of the capsule: capsulitis, if acute: hypoechogenic. Generally, combinations in arthritis and arthrosis, with injuries to other structure joints. - The bones on the margins of the joints are hyperechogenic and have a smooth and soft surface. The presence of osteophytes suggests osteoarthritis. They usually occur in the lateral and medial compartments. - The cartilage appears as a anechogenic line immediately superimposed to the subchondral bone. In case of presence of liquid, the interface between the fluid and cartilage surface appears as an echogenic line. - The Subchondral bone appears as a hyperechogenic line. Lysis is seen as discontinuities on the line and is always meaningful. - Radiographic anomalies. You can complete or confirm the information provided by using radiology. - Increase of synovial fluid: the pressure of the probe should be lowered to not collapse the recesses. Totally anechogenic. It is normal the presence of a moderate amount of synovial fluid in all of the joints except in the dorsal recess

2 of the Distal Interphalangeal Articulate and in the subextensor recess of the lateral femorotibial joint. If there is an appearance of homogeneously echogenic: suspect sepsis, if it is a heterogeneously echogenic: suspect hemarthrosis. Hyperechogenic points or lines are compatible with joint debris or fibrin. Osteochondral fragments give hyperechogenic lines acoustic shadowing. - Localization of lameness in an articular structure - Visualization of the meniscus - Ultrasound-guided Arthrocentesis - Procedure (encheiresis), probe, gloves, sterilization, level needles, direction of the probe - Microconvex probes - Slow movements - Wet needle that doesn't give a signal - Leaves marks PREPARATION: - - Sedation: Normally not necessary, depends on the area y the character - Hair clipped. Halter Clean (remains of hair y grease/oils) - Contact: warm water, gel. Alcohol for use in an ultrasound-guided. - Ergonomics (comfort zone) - Adequate pump - Adequate frequency - Area - Size - Gain - Orientation importance of imagery - Dorsal, proximal, cranial y medial: To the left of the screen -- Interpretation: - Normal - Abnormal, without clinical significance - Abnormal, with clinical significance - Comparison with a contralateral extremity ARTICULATIONS: -- Fetlock - Digitals - Stifle - Tarsus FETLOCK: Anatomical characteristics: Strong dorsal or articulate capsule Collateral ligaments with two layers Recesses: dorsal and palmar - Structures to evaluate: - Dorsal sagittal and parasagital planes:

3 - Technique: linear probe with pad, frequency 7, Sagittal Crest (without tendons) - Proximal P1 - Condyles - Metaphysis Mc type III - Capsule articulation (Capsulitis) - Articular surface. Measurement of cartilage (0.8 mm - 0.5), thinner distal; subcondral bone regularity. Normal small amount of liquid - Tendon Extensor and subtendinous bursitis - Synovitis -- Dorsal Transversal - Technique: linear probe pad, frequency 7, Dorsal digital extensor tendons and lateral digital extensor (accessory) - Metaphysis-condyle, always irregular, penetration of vessels - Subchondral bone - Cartilage articulate - Osteochondrales fragments * In flexion: (distal part of the metacarpal condyles) - Technique: linear probe, with pad. Angular proximal - Cross-sectional - Between the legs hoof, 90 - Thickness measurement (0.3 mm) and regularity - Look for lysis of the subchondral bone - Most frequent site of pathology: medial condyle * Collateral - Technique: linear probe, with pad - Longitudinal (collateral ligament) - Two layers: superficial + deep (oblique dorsoproximal-palmarodistal) - Transversal (collateral ligament), echogenic surface part, anechogenic deep part - Comparison lat-lat DISTAL INTERPHALANGEAL JOINT: - Collateral Joints - Linear probe with or without pad - Transversal cut - Collateral fossa of the P2, a las 10 y a las 2 - Coronary band - Dorsolateral or dorsomedial - Dorsal recess - Lower frequency, longitudinal cut - With pad - Really thick skin - Discriminating fluid and membrane

4 PROXIMAL INTERPHALANGEAL JOINT: - Longitudinal cut with linear probe pad of the collateral ligament, and collateral ligament of the sesamoid (longitudinal),,,, probe lightly the oblique dorsal proximal-distal palmar in relation to the axis of the bone (p1-p2). Real collateral much shorter and more palmar, fibers of the collateral sesamoid ligament are much longer and more dorsal. - Dorsal recess, articular margins (longitudinal cut). - Alteration detections, osteophitis never sagittal, always parasagittal - Intraarticular injection - STIFLE JOINTS: - Cranial transversal (linear, without pad) - Intermediate femoropatellar ligament, distal intradesmal fat. - Pad grease infrapatellar. - Cartilage of the medial femoral trochlea (fine) and lateral (thicker). Groove of the trochlea. - Pad, medial femoropatellar ligament, triangular in shape, direction cranial and proximal to the medial angle of the patella. Parapatelar fibrocartilage. - Search for fractures by avulsion of the medial angle of the patella. - Longitudinal cut only in cases of doubt. - Lateral femoropatellar ligament, transversal cut, no pad, figure 8 on the lateral crest of the femoral trochlea, before lateral recess of the femoropatellar. Careful with the pressure. - Lips of the femoral trochlear, transversal cut, without pad. - Search for OCD-(etiology of osteochondrosis). Femorotibial: --- Medial Area, cut longitudinal, without pad. - Medial collateral ligament medial meniscus - Seek medial remodeling of the tibial plateau - Anechogenic lines in MM in the direction of the beam, normal. - Craniomedial liquid area, increased by distension, between the ligament and meniscus. - Cranial Horn of the medial meniscus, concave skin with the pad. - Medial recess without pad (pressure control with the probe). - Synovial Villi normal, always in the distal area and cranial. Femorotibial: Lateral area, longitudinal cut, without pad. --- Sulcus Extensorius between the tibial tuberosity and the peroneus head. - View the peroneus tertius+digital extensor tendon longitudinal. - Rotate towards the caudal to see the cranial horn of the lateral meniscus, - Then follow it to the meniscus flow, difficult to see; - Probe 45º to see the lateral collateral ligament to the popliteal tendon. - Follow the proximal lateral collateral ligament to the side of the femur and the distal epicondyle, look at the peroneus head and the tibioperoneal joint. - Transversal cut, without pad, Extensor sulcus between the tibial tuberosity and the fibular head. Visualize tendon transversal cut of the peroneus tertius+lateral digital extensor tendon, superficial to the Tibialis cranialis.

5 - Lateral recess fluid between PT-LDET and TC Cranial approach in flexion. Linear probe or convex, without pad. - Hoof between the knees - Proximal angled probe, close to the tibial plateau - Transversal cut of the medial condyle (probe slightly towards the medial) - Distal angled probe: insertion of the cranial horn into the medial meniscus (probe slightly towards the axial). - Transversal cut of the lateral condyle. Insertion of the cranial horn into the medial meniscus. Popliteus medial hides meniscus lateral. Can be done with the convex. - Artrocentesis ecoguided. - Medial femorotibial recess. - Different sites, lateral image, injection from the contralateral. - Microconvex probe, longitudinal orientation, 1 cm proximal to probe (needle enters from the left of the screen), slightly distal. Lateral femoropatelar recess, Transversal, without pressure, don't move probe, needle 1 cm caudal to probe (needle enters from the right of the screen) slightly to the direction of the cranial. - Recess of the lateral femorotibial (break period subextensorius) - Transversal - Little pressure - Caudal 15 mm to probe (needle enters from the right) TARSAL JOINT (Hock) - (Photos by MB Withcomb) - Approaches depending on the clinical examination results of the anatomical deformities. - Dorsal. - Pad. - Longitudinal, lateral trochlea lip trochlea of the tarsus, cartilage, thicker, and more distal. - Longitudinal, medial lip, thinner. - Longitudinal Transversal, medial malleolus, search for OCD (osteochondrosis). - Medial - Pad, linear, longitudinal cut. Long Medial Collateral Ligament, from the Medial Malleolus of the tibia. Gives fibers to the Distal Tubercle of the talus, and finish by inserting metatarsals II and III. - Follow surface ligament to: - Short Medial Collateral Ligament - Taro-crural joint - Distal tuberosity of the talus, Proximal Intertarsal Joint, Distal Intertarsal Joint, Art Tarsometatarsal, II MT - Fascicle Calcaneus of the Medial Collateral Ligament (LCM), probe oblique. Longitudinal cut, attachment in the Sustentaculum Tali. - Lateral

6 - Pad, linear probe, cranial proximal-distal caudal tilt - Lateral Malleolus side of the tibia - Caudal part of the Malleolus, Long Collateral Ligament that goes to the Calcaneus, Proximal 4T and the MT IV - Lateral Digital extensor - LCL short (deep) from the cranial area of the Lateral Malleolus, to the Talus+Calcaneus, probe more oblique The more common fracture is the avulsion of the Short LCL in the proximal attachment Malleolar Bibliography: - Denoix, Jean M. (2009)Ultrasonographic examination of joints in horses: a live demonstration, in Proc. 11th intern Cong WEVA, 2009, Guarujá, Brazil - Withcomb, MB, (2006), Ultrasonography of equine tarsus, in Proc. AAEP San Antonio, Smith, Roger (2008) Using ultrasound to image joints, in Proc. 10Th intern Cong WEVA, 2008, Moscow, Russia Author: José Manuel Romero Guzmán EQUIVET Madrid

Proceedings of the 12th International Congress of the World Equine Veterinary Association WEVA

www.ivis.org Proceedings of the 12th International Congress of the World Equine Veterinary Association WEVA November 2-5, 2011 Hyderabad, India Reprinted in IVIS with the Permission of WEVA Organizers