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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

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

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.

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