An optimised injection technique for the navicular bursa that avoids the deep digital flexor tendon.
Abstract: Injection of the navicular bursa is commonly performed from the palmar aspect of the limb, which results in penetration of the deep digital flexor tendon (DDFT). Objective: To report a radiographic guided injection from the lateral aspect of the limb that avoids puncture of the DDFT and to assess synovial and soft tissue penetration by the needle. Methods: Prospective clinical and cadaveric study. Methods: Prospective analysis of cadaver limbs and clinical cases in which the navicular bursa was injected from the lateral aspect. Cadaver limbs were placed in a stand to simulate weight bearing and injection was performed in limbs without synovial distension or with distension of either the distal interphalangeal (DIP) joint, digital flexor tendon sheath (DFTS) or navicular bursa. In cadaver and clinical limbs, contrast was injected and the needle position assessed with radiographs. Cadaver (but not clinical) limbs were also examined using magnetic resonance imaging with the needle in situ. Results: Successful navicular bursal injection was achieved in all limbs (n = 71). Relative risk of DIP joint puncture was 19 times higher (95% confidence interval 1.3-285.4, P<0.001) when the DIP joint was distended (9 of 10 limbs) than in normal limbs (0 of 10 limbs). Relative risk of DFTS puncture was 2.7 times higher (95% confidence interval 1.0-7.2, P = 0.06) when the DFTS was distended (8 of 10 limbs) than in normal limbs (3 of 7 limbs). Synovial fluid was aspirated from 47% of bursae from clinical cases. Conclusions: The lateral injection technique for the navicular bursa avoids penetration of the DDFT, although risk of synovial penetration must be considered when there is potential DIP joint or DFTS infection.
© 2015 EVJ Ltd.
Publication Date: 2015-02-25 PubMed ID: 25537027DOI: 10.1111/evj.12402Google Scholar: Lookup
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- Journal Article
- Research Support
- Non-U.S. Gov't
Summary
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The paper describes a new technique for injecting the navicular bursa in a horse’s leg that avoids damaging the deep digital flexor tendon (DDFT). The technique involves injecting from the side of the limb rather than from the back, as is traditionally done.
Introduction and Objectives
- This study aims to introduce a new approach for injecting the navicular bursa (a fluid-filled sac found in the horse’s hoof) to avoid injuring the deep digital flexor tendon (DDFT). This is carried out by using a lateral (side) approach instead of the traditional palmar (back) approach.
- The main objective was to assess whether this method could avoid the puncture of the DDFT and to check for potential penetration into the synovial and soft tissue by the needle.
Methods
- The research was a combination of a clinical study involving actual patients and a cadaveric study using horses’ legs after euthanasia.
- The navicular bursa was injected from the side in both real clinical cases and cadaver limbs, and the positions of the needles evaluated with radiographs.
- Contrast agents were injected to better visualize the needle position.
- None of the cadaver limbs used for testing were distended, meaning they did not have excess fluid causing swelling. However, the study also explored injection in limbs with distension of the distal interphalangeal (DIP) joint, the digital flexor tendon sheath (DFTS), or the navicular bursa.
- For the cadaver limbs, magnetic resonance imaging (MRI) with the needle still in place was also used.
Results
- All injections into the navicular bursa were successful across all tested limbs (n = 71).
- It was found that there was a much higher risk of puncturing the DIP joint when it was distended than when it was normal.
- The study also revealed a higher risk of puncturing the DFTS if it was distended, though this was not as severe as for the DIP joint.
- Approximately half of the clinical cases resulted in syvovial fluid being aspirated.
Conclusions
- The lateral approach to navicular bursa injection can successfully avoid penetrating the DDFT.
- The research found that this method may also increase the risk of synovial penetration, especially when the DIP joint or DFTS is distended, meaning there is a higher risk of injecting into a swollen or infected area.
Cite This Article
APA
Daniel AJ, Goodrich LR, Barrett MF, Werpy NM, Morley PS, McIlwraith CW.
(2015).
An optimised injection technique for the navicular bursa that avoids the deep digital flexor tendon.
Equine Vet J, 48(2), 159-164.
https://doi.org/10.1111/evj.12402 Publication
Researcher Affiliations
- Clinical Sciences Department, Colorado State University, Fort Collins, USA.
- Clinical Sciences Department, Colorado State University, Fort Collins, USA.
- Orthopaedic Research Center, Colorado State University, Fort Collins, USA.
- Clinical Sciences Department, Colorado State University, Fort Collins, USA.
- Department of Environmental and Radiological Health Science, Colorado State University, Fort Collins, USA.
- College of Veterinary Medicine, University of Florida, Gainesville, USA.
- Clinical Sciences Department, Colorado State University, Fort Collins, USA.
- Clinical Sciences Department, Colorado State University, Fort Collins, USA.
- Orthopaedic Research Center, Colorado State University, Fort Collins, USA.
MeSH Terms
- Animals
- Bursa, Synovial / diagnostic imaging
- Cadaver
- Contrast Media
- Foot Diseases / diagnostic imaging
- Foot Diseases / drug therapy
- Foot Diseases / veterinary
- Hoof and Claw / diagnostic imaging
- Horse Diseases / diagnostic imaging
- Horse Diseases / drug therapy
- Horses
- Injections / methods
- Injections / veterinary
- Radiography
- Tendons / anatomy & histology
Citations
This article has been cited 2 times.- Cota LO, Malacarne BD, Dias LA, Neto ACP, Kneipp MLA, Cavalcante MA, Cunha MSLD, Paz CFR, Carvalho AM, Faleiros RR, Xavier ABDS. Mechanical nociceptive assessment of the equine hoof after navicular bursa anesthetic infiltration validated by bursography.. PLoS One 2022;17(6):e0269532.
- Froydenlund TJ, Meehan LJ, Morrison LR, Labens R. A Rare Case of Deep Digital Flexor Tendinopathy following Centesis of the Navicular Bursa.. Front Vet Sci 2017;4:169.
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