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Home / Equine Research Bank / Equine Vet J / Distal interphalangeal joint capsule enthesopathy of the mid...
Equine veterinary journal2025; doi: 10.1111/evj.70096

Distal interphalangeal joint capsule enthesopathy of the middle phalanx and articular cartilage loss.

Abstract: Significant distal interphalangeal joint (DIPJ) pathology, particularly affecting soft tissue and articular cartilage, is often not identifiable on radiographs but can be accompanied by joint capsule enthesopathy on the middle phalanx (P2), which can be readily identified. Objective: To explore frequency and correlations between DIPJ capsule enthesopathy identified on magnetic resonance imaging (MRI) and radiographs and DIPJ articular cartilage abnormalities and other concurrent soft tissue or osseous pathology within the foot found on MRI. Methods: Retrospective descriptive case series. Methods: Cases identified with DIPJ capsule enthesopathy on MRI and radiographs were retrospectively reviewed. Abnormalities were graded using a 4-point scale. Descriptive statistics and Spearman's rank correlations were used to analyse the relationship between the presence and grade of DIPJ capsule enthesopathy, lameness, and DIPJ intra-articular and collateral ligament abnormalities seen on MRI. Results: MRI and radiographic studies of 21 feet with DIPJ capsule enthesopathy were analysed. DIPJ articular cartilage lesions were identified in 20/21 limbs (95%). There was no significant correlation between the degree of DIPJ capsule enthesopathy and the severity of articular cartilage lesions. DIPJ proliferative synovitis and osteophytes were present in the majority of limbs (91% and 95%), respectively. DIPJ collateral ligaments were abnormal in 52% of the limbs. With MRI-based assessment, DIPJ capsule enthesopathy grade was moderately positively correlated with DIPJ collateral ligaments' findings severity (r = 0.53, p = 0.01). Conclusions: Retrospective character, no histopathology, studied cases limited to one referral centre, low case numbers and statistical power. Conclusions: The presence of DIPJ capsule enthesopathy on radiographs is a reliable finding to rule in DIPJ damage and support further case management, particularly in cases where advanced imaging is unavailable or desired.
© 2025 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2025-09-19 PubMed ID: 40968698DOI: 10.1111/evj.70096Google Scholar: Lookup
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Summary

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Overview

  • This study investigates the connection between distal interphalangeal joint (DIPJ) capsule enthesopathy—detected on MRI and radiographs—and articular cartilage damage along with other soft tissue or bone abnormalities in the foot.

Background

  • The distal interphalangeal joint (DIPJ) is a joint at the tip of the fingers or toes, important for fine movement and weight-bearing.
  • Pathologies affecting the soft tissues and articular cartilage of DIPJ are often difficult to detect on standard radiographs (X-rays), making diagnosis challenging.
  • Joint capsule enthesopathy, an abnormality at the site where the joint capsule attaches to the bone (enthesis) of the middle phalanx (P2), might serve as an indicator of underlying joint damage.
  • Magnetic resonance imaging (MRI) offers greater sensitivity than radiographs in detecting soft tissue and cartilage abnormalities.

Objectives

  • To evaluate how frequently DIPJ capsule enthesopathy is detected on MRI and radiographs.
  • To explore correlations between DIPJ capsule enthesopathy and:
    • DIPJ articular cartilage abnormalities
    • Other soft tissue or osseous pathologies in the foot
    • Lameness (clinical symptom)
    • Collateral ligament abnormalities of DIPJ

Methods

  • The study is a retrospective descriptive case series, analyzing past cases.
  • Cases were selected based on the presence of DIPJ capsule enthesopathy identified on both MRI and radiographs.
  • Abnormalities were graded using a 4-point severity scale for standardized assessment.
  • Statistical analyses included descriptive statistics and Spearman’s rank correlation to assess relationships between:
    • DIPJ capsule enthesopathy grades
    • DIPJ articular cartilage lesions
    • Lameness
    • DIPJ collateral ligament abnormalities

Results

  • 21 feet with DIPJ capsule enthesopathy were analyzed using MRI and radiographic studies.
  • Articular cartilage lesions in the DIPJ were found in 20 out of 21 limbs (~95%), indicating a strong association with cartilage damage.
  • No significant correlation was found between the grade of DIPJ capsule enthesopathy and severity of cartilage lesions, suggesting that enthesopathy presence does not directly predict cartilage lesion severity.
  • Proliferative synovitis (inflammation of synovial membrane) was observed in 91% of limbs.
  • Osteophytes (bony growths) were found in 95% of limbs, indicating degenerative joint changes.
  • Abnormalities in DIPJ collateral ligaments were present in 52% of limbs.
  • A moderate positive correlation (r=0.53, p=0.01) was found between DIPJ capsule enthesopathy grade and severity of collateral ligament abnormalities, indicating a relationship between these soft tissue changes.

Conclusions

  • The study suggests that the presence of DIPJ capsule enthesopathy on radiographs is a reliable indicator (“rule in”) of DIPJ damage.
  • DIPJ capsule enthesopathy may serve as an important diagnostic sign, especially when advanced imaging modalities like MRI are unavailable or not feasible.
  • Although enthesopathy presence correlates with certain soft tissue abnormalities (e.g., collateral ligament issues), it does not directly correlate with cartilage lesion severity.
  • The study’s retrospective nature, low number of cases (21 limbs), lack of histopathological confirmation, and data from a single referral center limit the generalizability and power of conclusions.
  • Nevertheless, radiographic identification of DIPJ capsule enthesopathy can aid clinicians in case management decisions and improve detection of joint pathology.

Implications for Clinical Practice and Further Research

  • Radiographs are traditionally less sensitive for soft tissue joint pathologies, so recognizing DIPJ capsule enthesopathy could improve diagnostic confidence for DIPJ problems.
  • Clinicians can consider enthesopathy findings as an indication to monitor or further investigate DIPJ health.
  • Future research with larger sample sizes, prospective design, and histological confirmation would strengthen understanding of the relationship between capsule enthesopathy and joint degeneration.
  • Additional studies could explore therapeutic implications, such as whether identifying capsule enthesopathy early impacts treatment outcomes for DIPJ disorders.

Cite This Article

APA
Samol MA, Barrett MF, Frisbie DD. (2025). Distal interphalangeal joint capsule enthesopathy of the middle phalanx and articular cartilage loss. Equine Vet J. https://doi.org/10.1111/evj.70096

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Samol, Monika A
  • Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Barrett, Myra F
  • Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Frisbie, David D
  • Department of Clinical Sciences, Orthopedic Research Center at the Translational Medicine Institute, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.

References

This article includes 32 references
  1. Pilsworth R, Dyson S. Where does it hurt? Problems with interpretation of regional and intra‐synovial diagnostic analgesia.. Equine Vet Educ 2015;27:595–603.
  2. Rovel T, Audigié F, Coudry V, Jacquet‐Guibon S, Bertoni L, Denoix J‐M. Evaluation of standing low‐field magnetic resonance imaging for diagnosis of advanced distal interphalangeal primary degenerative joint disease in horses: 12 cases (2010–2014).. J Am Vet Med Assoc 2019;254:257–265.
  3. Frisbie DD, Werpy NM, Kawcak CE, Barrett MF. Distal Limb. Joint disease in the horse.. St. Louis, MO: Elsevier; 2016. p. 281–301.
  4. Butler JA, Colles CM, Dyson SJ, Kold SE, Poulos PW. Clinical radiology of the horse.. 1st ed. Oxford: Wiley; 2000.
  5. McIlwraith CW. Traumatic arthritis and posttraumatic osteoarthritis in the horse.. In: McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren PR, editors. Joint disease in the horse. St. Louis, MO: Elsevier; 2016. p. 33–48.
  6. Dyson SJ. Radiography and radiology.. In: Ross MW, Dyson SJ, editors. Diagnosis and management of lameness in the horse. St. Louis, MO: Elsevier; 2011. p. 168–182.
  7. Gutierrez‐Nibeyro SD, Werpy NM, Gold SJ, Olguin S, Schaeffer DJ. Standing MRI lesions of the distal interphalangeal joint and podotrochlear apparatus occur with a high frequency in warmblood horses.. Vet Radiol Ultrasound 2020;61:336–345.
  8. Murray RC, Mair TS, Sherlock CE, Blunden AS. Comparison of high‐field and low‐field magnetic resonance images of cadaver limbs of horses.. Vet Rec 2009;165:281–288.
  9. Bischofberger AS, Fürst AE, Torgerson PR, Carstens A, Hilbe M, Kircher P. Use of a 3‐Telsa magnet to perform delayed gadolinium‐enhanced magnetic resonance imaging of the distal interphalangeal joint of horses with and without naturally occurring osteoarthritis.. Am J Vet Res 2018;79:287–298.
  10. Nelson BB, Kawcak CE, Barrett MF, McIlwraith CW, Grinstaff MW, Goodrich LR. Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging.. Equine Vet J 2018;50:564–579.
  11. Baker ME, Kershaw LE, Carstens A, Daniel CR, Brown H, Roberts S. T2 mapping of cartilage in the equine distal interphalangeal joint with corresponding histology using 0.27 T and 3.0 T magnetic resonance imaging.. Equine Vet J 2023;55:843–852.
  12. American Association of Equine Practitioners. Lameness exams: evaluating the Lame horse.. .
  13. Akoglu H. User's guide to correlation coefficients.. Turkish J Emerg Med 2018;18:91–93.
  14. Barrett MF, Frisbie DD, King MR, Werpy NM, Kawcak CE. A review of how magnetic resonance imaging can aid in case management of common pathological conditions of the equine foot.. Equine Vet Educ 2017;29:683–693.
  15. Werpy NM, Ho CP, Pease AP, Kawcak CE. The effect of sequence selection and field strength on detection of osteochondral defects in the metacarpophalangeal joint.. Vet Radiol Ultrasound 2011;52:154–160.
  16. Fowlie JG, O'Neill HD, Nickels FA, Mattson S. Acute severe lameness associated with proliferative bone on the dorsal middle phalanx (19 cases). Equine Vet Educ 2025:eve.14148.
  17. Selberg K, Werpy N. Fractures of the distal phalanx and associated soft tissue and osseous abnormalities in 22 horses with ossified sclerotic ungual cartilages diagnosed with magnetic resonance imaging. Vet Radiol Ultrasound 2011;52:394–401.
  18. Denoix J‐M. The equine distal limb: an atlas of clinical anatomy and comparative imaging. .
  19. Ruohoniemi M, Karkkainen M, Tervahartiala P. Evaluation of the variably ossified collateral cartilages of the distal phalanx and adjacent anatomic structures in the Finnhorse with computed tomography and magnetic resonance imaging. Vet Radiol Ultrasound 1997;38:344–351.
  20. Te Moller NCR, Van Weeren PR. How exercise influences equine joint homeostasis. Vet J 2017;222:60–67.
  21. Baccarin RYA, Seidel SRT, Michelacci YM, Tokawa PKA, Oliveira TM. Osteoarthritis: a common disease that should be avoided in the athletic horse's life. Anim Front 2022;12:25–36.
  22. Beasley B, Selberg K, Giguère S, Allen K. Magnetic resonance imaging characterisation of lesions within the collateral ligaments of the distal interphalangeal joint – 28 cases. Equine Vet Educ 2020;32:11–17.
  23. Dyson S, Brown V, Collins S, Murray R. Is there an association between ossification of the cartilages of the foot and collateral desmopathy of the distal interphalangeal joint or distal phalanx injury?. Equine Vet J 2010;42:504–511.
  24. Dyson SJ, Murray R, Schramme MC. Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001–December 2003) and response to treatment. Equine Vet J 2005;37:113–121.
  25. Dyson SJ, Murray R, Schramme M, Branch M. Collateral desmitis of the distal interphalangeal joint in 18 horses (2001–2002). Equine Vet J 2004;36:160–166.
  26. Dyson S, Blunden T, Murray R. The collateral ligaments of the distal interphalangeal joint: magnetic resonance imaging and post mortem observations in 25 lame and 12 control horses. Equine Vet J 2008;40:538–544.
  27. Crema MD, Roemer FW, Marra MD, Burstein D, Gold GE, Eckstein F. Articular cartilage in the knee: current MR imaging techniques and applications in clinical practice and research. Radiographics 2011;31:37–61.
  28. Van Zadelhoff C, Schwarz T, Smith S, Engerand A, Taylor S. Identification of naturally occurring cartilage damage in the equine distal interphalangeal joint using low‐field magnetic resonance imaging and magnetic resonance arthrography. Front Vet Sci 2020;6:508.
  29. Hontoir F, Nisolle J‐F, Meurisse H, Simon V, Tallier M, Vanderstricht R. A comparison of 3‐T magnetic resonance imaging and computed tomography arthrography to identify structural cartilage defects of the fetlock joint in the horse. Vet J 2014;199:115–122.
  30. Bolz NM, Sánchez‐Andrade JS, Torgerson PR, Bischofberger AS. Diagnostic performance of multi‐detector computed tomography arthrography and 3‐tesla magnetic resonance imaging to diagnose experimentally created articular cartilage lesions in equine cadaver stifles. Animals 2023;13:2304.
  31. Kijowski R. Clinical cartilage imaging of the knee and hip joints. Am J Roentgenol 2010;195:618–628.
  32. McIlwraith CW, Nixon AJ, Wright IM. Arthroscopic surgery of the distal and proximal interphalangeal joints. Diagnostic and surgical arthroscopy in the horse. St. Louis, MO: Elsevier; 2015. p. 316–343.

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