Intra-articular pressure, elastance, and range of motion in flexion of the equine metacarpophalangeal joint

Abstract

SUMMARY A study was done to determine whether intra-articular pressure is increased in equine metacarpophalangeal joints with increasing degrees of synovial distention, and to correlate elastance of the soft tissue forming the dorsal pouch of the metacarpophalangeal joint to maximal range of motion in flexion. Sixty-seven metacarpophalangeal joints in 36 horses were categorized by palpation and visual inspection of the palmar pouch into 1 of 4 increasing grades of distention. Intra-articular pressures were then measured, using 2 pressure transducers attached to 22-gauge needles, from the dorsal and palmar pouches simultaneously while horses stood squarely under mild sedation. Intra-articular pressure ranged from −13 to +78 mm of Hg. Mean (± sem) palmar pouch pressure was subatmospheric (−2.53 ± 2.78 mm of Hg) in joints in which the palmar pouch was not discernible (grade 0), and was markedly increased (+37.13 ± 2.775 mm of Hg) in joints in which the palmar pouch was distended laterally beyond the lateral branch of the suspensory ligament (grade 3). Grade of distention was positively correlated with intra-articular pressure (r = 0.758; P < 0.001). Significant compartmentation (P < 0.002) was observed between the dorsal and palmar pouches in all horses. In 25 of the aforementioned horses (42 joints), which were active or retired Thoroughbred racehorses with variable degree of metacarpophalangeal joint injury/disease, a third needle was inserted into the dorsal pouch, and 0.5-ml increments of saline solution were added every 10 seconds to perform a pressure/volume (elastance) study of the dorsal pouch. The elastance study for each joint ended when leakage into the palmar pouch was detected by the pressure transducer placed in that region. A flexed lateral radiographic view was taken of each metacarpophalangeal joint in maximal flexion. The maximal angle of flexion was measured from the radiograph, and this angle was subtracted from 180° to acquire the range of motion in flexion. Range of motion in flexion has strong negative correlation (r = −0.68; P < 0.0001) with elastance (stiffness) of the dorsal pouch, and moderate negative correlation with the initial baseline pressure in the palmar (r = −0.47; P < 0.0015) and dorsal pouches (r = −0.48; P < 0.0001). To adjust for the possible correlations resulting from repeated measures on limbs within horses, a normal linear mixed model was used to assess the effect of limb (right vs left), range of motion in flexion, and volume of saline solution added on the dependent variable (Δ mm of Hg) in the elastance study. There was no significant limb effect, but a highly significant effect regarding volume of saline solution added (P < 0.00001) and range of motion in flexion (P < 0.00001). Loss of range of motion in flexion of this joint is associated with shortening or loss of the initial low elastance (flat) phase of the elastance profile. Measuring the elastance of the dorsal pouch or measuring maximal range of motion in flexion provides an objective measure of the degree of metacarpophalangeal joint stiffness secondary to joint disease.