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Home / Equine Research Bank / Vet Radiol Ultrasound / Risk of intra-articular injection with longitudinal ultrasou...
Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association2019; 61(1); 67-76; doi: 10.1111/vru.12811

Risk of intra-articular injection with longitudinal ultrasound-guided injection of collateral ligaments of the equine distal interphalangeal joint.

Abstract: Desmopathy of the collateral ligaments of the distal interphalangeal joint is a common cause of equine foot lameness and carries a poor prognosis with conservative management. Intralesional injections may improve healing, although accuracy of radiographically guided injections is significantly less than when guided by MRI, which requires special needles. Longitudinal ultrasound-guided injection of the distal collateral ligament has not been evaluated objectively. In this prospective, anatomic study, seven equine cadaver limbs (14 collateral ligaments) were injected with methylene blue dye and radiographic contrast medium using ultrasound to guide the needle longitudinally into the collateral ligaments until contacting bone. The insertion site of the needle proximal to the coronary band was measured on the limb and the needles left in place for radiography and CT to evaluate the needle angulation, location of the contrast medium, and whether the contrast entered the distal interphalangeal joint. The limbs were frozen and sectioned with a band saw to identify the location of the dye. Fifty percentage of injections were in or around the collateral ligaments. However, the percentage of "successful" injections, defined as in the collateral ligament but not in the joint, was only 36%. All legs had dye and contrast in the joint after both ligaments had been injected. There were no significant differences between the needle angle and entry site for "successful" and "unsuccessful" injections. Findings from this study indicates that the success rate is low for injecting the distal portions of the distal interphalangeal joint collateral ligaments using ultrasound guidance alone.
© 2019 American College of Veterinary Radiology.
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Publication Date: 2019-10-01 PubMed ID: 31574572DOI: 10.1111/vru.12811Google Scholar: Lookup
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  • Journal Article

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.

This study assesses the success rate of injecting the distal portions of the distal interphalangeal joint collateral ligaments in horses using ultrasound guidance, finding that the technique is generally less accurate than desirable.

Objective of the Study

  • The main aim of the research was to evaluate the effectiveness and accuracy of longitudinal ultrasound-guided injection into the collateral ligaments of the equine distal interphalangeal joint, a common location of foot lameness in horses. This lameness condition often has a poor prognosis with conservative management, so treatments like intralesional injections are considered for improved healing.

Methodology

  • Seven equine cadaver limbs were selected for the study. 14 collateral ligaments from these limbs were injected with methylene blue dye and a radiographic contrast medium. The purpose of these substances is to trace the path of the injected material and assess its position after injection.
  • The injection was guided by ultrasound and the needle was inserted longitudinally into the collateral ligaments until it touched the bone.
  • Post-injection, the needles were left in place and the limb was subjected to radiography and CT scans. These were used to assess needle angulation, the location of the contrast medium, and whether the contrast entered the distal interphalangeal joint.
  • The limbs were then frozen and physically sectioned to view the actual location of the dye.

Findings

  • Only 50% of injections were in or around the collateral ligaments, meaning the technique had limited precision.
  • Even more critical, when ‘success’ was defined as the injection reaching the collateral ligament but not entering the joint, the rate dropped to 36%, indicating a lack of control over needle precision.
  • All limbs were found to have dye and contrast material in the joint after both ligaments were injected, proving that there was significant leakage.
  • No correlation was found between the needle angle or entry site and the success rate of the injection.

Conclusion

  • The study concludes that the success rate of this technique is quite low. It suggests that using only ultrasound guidance to administer intralesional injections into the distal portions of the distal interphalangeal joint collateral ligaments in horses can often result in inaccurate application of the treatment substance.

Cite This Article

APA
Smith R, Parsons J, Dixon J. (2019). Risk of intra-articular injection with longitudinal ultrasound-guided injection of collateral ligaments of the equine distal interphalangeal joint. Vet Radiol Ultrasound, 61(1), 67-76. https://doi.org/10.1111/vru.12811

Publication

Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association
ISSN: 1740-8261
NlmUniqueID: 9209635
Country: England
Language: English
Volume: 61
Issue: 1
Pages: 67-76

Researcher Affiliations

Smith, Roger
  • Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK.
Parsons, Jennifer
  • Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK.
Dixon, Jonathon
  • Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK.

MeSH Terms

  • Animals
  • Cadaver
  • Collateral Ligaments / diagnostic imaging
  • Collateral Ligaments / drug effects
  • Forelimb / diagnostic imaging
  • Horses
  • Injections, Intra-Articular / adverse effects
  • Injections, Intra-Articular / veterinary
  • Methylene Blue / administration & dosage
  • Prospective Studies
  • Toe Joint / diagnostic imaging
  • Tomography, X-Ray Computed / veterinary
  • Ultrasonography / veterinary

References

This article includes 22 references
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