Equine Diagnostic Radiography & Ultrasonography
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1 Equine Diagnostic adiography & Ultrasonography Dr. ussell Tucker DACV Prof Emeritus, WSU 90 ~30 DLPMO ~ projects medial forward lateral backward ~30 PL to DM projection 1
2 EQUINE DISTAL LIMB TENDONS & LIGAMENTS DMPLO (PL-DMO) ~ projects lateral forward medial backward Anatomic Abbreviations: SDF = Superficial Digital Flexor DDF = Deep Digital Flexor ICL = Inferior Check Ligament SL = Suspensory Ligament AL = Annular Ligament DAL = Digital Annular Ligament DDAL = Distal Digital Annular Ligament SDSL = Straight Distal Sesamoidean Ligament ODSL = Oblique Distal Sesamoidean Ligament PL = Plantar Ligament CL = Collateral Ligament Scanning Planes 1. Longitudinal Oblique Preparation Sedated & Placed in Stocks Clip & Shave Both Legs or Clean & Wet Hair (diluted 30% alcohol) Scan in Direction of Hair Standoff Pads or Offsets sonolucent material for scanning irregular surfaces & superficial structures 2
3 Extended FOV 5 cm proximal distal Elasticity Imaging DDF lesion Metacarpus Proximal MCIII longitudinal Metacarpus Mid-Distal MCIII longitudinal 4 cm footprint 12 MHz linear probe, using ACC bone as reference - with 5 focal zones activated & uniform gain across FOV Metacarpus Distal MCIII & Inter-Sesamoid longitudinal Suspensory Branch Insertion transverse longitudinal Insertion onto abaxial fossa of proximal sesamoid bone 3
4 Suspensory Branch Insertion TANSVESE IMAGES transverse Orthogonal to Longitudinal Images Zones 1a, 1b --- 3a, 3b on front limbs Zones 1a, 1b --- 4a, 4b on rear limbs longitudinal Use cm distal to LANDMAKS Distal Accessory Carpal Bone (DACB) Tuber Calcaneous Bone or MT4 head MCIII 4 cm distal to accessory carpal bone MCIII 8 cm distal to accessory carpal bone A 4 cm footprint 12 MHz linear probe, using ACC bone as reference - with 5 focal zones activated & uniform gain across FOV 1A 4 MCIII 12 cm distal to accessory carpal bone MCIII 16 cm distal to accessory carpal bone 4
5 MCIII 20 cm distal to accessory carpal bone MCIII 24 cm distal to accessory carpal bone Suspensory branched ~proximal pouch of fetlock joint MCIII 24 cm distal to accessory carpal bone Suspensory Branch Insertion MCIII 24 cm distal to accessory carpal bone 1 cm may require stand off pad Proximal sesamoids axial surfaces MCIII 24 cm distal to accessory carpal bone EA LIMBS Orthogonal to Longitudinal Images Zones 1a, 1b --- 3a, 3b on front limbs Zones 1a, 1b --- 4a, 4b on rear limbs Use cm distal to LANDMAKS Distal to 4 th Metatarsal Head (MT4) Distal to point of Tuber Calcaneus Palmar Annular Ligament Thickness ~ requires dynamic imaging to visualize 5
6 Distal Tarsus - DDF exiting tarsal canal MTIII 4 cm distal to Tarsus * need to image slightly medially for entire DDF MTIII 8 cm distal to Tarsus MTIII 12 cm distal to Tarsus MTIII 24 cm distal to Tarsus Tendon & Ligament Pathology Compare Sides T vs LT Sequential Scanning Protocol ecord in at least 2 anatomic planes Sagittal (longitudinal) (axial) Oblique Planes may be required *Carefully document & describe lesions Identical to front legs ~may require stand off pad for PaAL 6
7 Tendon & Ligament Scanning Clip or Not? Shave or Not? Fiber pattern important Try 30% diluted alcohol Image 2 orthogonal planes Sagittal (longitudinal) (axial) Oblique scan planes Compare legs LH abnormal proximal suspensory H norm prox suspensory Compare size & echogenicity & fiber patterns Compare to other limb or medial vs lateral LH medial Susp LF vs F ICL size Loss of fiber pattern LH lateral Susp Lesion Characterization & Descriptions Cross-sectional area egion of involvement Length of lesion Echogenicity Focal or diffuse Fiber pattern Change over time DDF Cross Sectional Area of Lesions Trace the tendon 1 = total tendon Trace the lesion 2 = lesion Calculate X-sec % OI 1 / OI 2 = 38 % 25 mm 2 7
8 5 yr THB gelding F lame ~ swelling above fetlock 5 yr THB gelding F lame ~ swelling above fetlock F Suspensory med branch cm outline/ 1.92 cm2 - hypoechoic & fiber loss Lat Branch F Suspensory lat branch (norm) cm outline/1.47 cm2 - uniform fiber pattern DMPLO projects medial sesamoid caudally Med Branch Hypoechogenicity Acute & Healing Phases Hyperechogenicity Healing & Chronic Phases Calculate Abnormal % % change over time Echogenicity of Lesions 1. Fiber Loss & Disruption Acute & Healing Phases 2. Fiber eplacement Healing & Chronic Phases 3. Fiber estructuring % change over time Type I replaces Type III collagen Longitudinal orientation May require 6-12 months to occur Forever decreased strength Fiber Integrity of Lesions Focal vs Diffuse Focal vs Diffuse lesions DLPMO Common digital extensor tendon over medial carpus 8
9 Core Lesions ~ contained w/in interior 10cm Peripheral Lesions ~ extend to edge 12cm Lesion: Proximal to Distal cm DACB SDF Tear 15cm 22cm Acute Inflammatory Stage ~ edema & hemorrhage (hypoechoic) Healing 3-6 months SDF DDF Initial scan DDF Type I replaces Type III collagen ~ restores fiber orientation 90 days lay off POGESSIVE EHABILITATION Month 0-2 Stall rest & hand walk 30 min/d Mon 1, 45 min/d Mon 2 Month 2-3 Stall rest & hand walk min/d, jog 5 min/d Month 4-6 Stall rest & hand walk min/d, jog 10 min/d Amount Cellularity Fibrin Adhesions Tendon sheath Synovium Peri-tendinal effusions 9
10 Fluid & Effusion Composition 10 yr gelding THB - chronic F fetlock swelling & lameness Dynamic Imaging for Adhesions Lat F collateral transverse Accurate & Detailed Lesion Descriptions Questions??? Critical for follow-up exams Exact location of lesion Size & characteristics Compare to other limb 10
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