Collateral Ligaments Of Distal Interphalangeal Joint Research Articles

Influence of morphometric parameters on the size of collateral ligaments of the distal interphalangeal joint of equines.

The physiological measurements of collateral ligaments of distal interphalangeal joint (CL-DIPJ) differ in the literature. The factors that influence these differences are not well described. The aims of this study are to compare CL-DIPJ sizes in equines with different withers height, as well as to correlate body weight and hoof size to the size of these ligaments. In total, 52 horses were used in the study. They were divided into two groups according to wither height: Group 1 (G1) - 21 animals with up to 147cm - and group 2 (G2) - 21 animals with greater than 148cm. CL-DIPJ was ultrasonographically measured in order to find the mean of dorso-palmar (DPD) and latero-medial (LMD) diameters and the cross-sectional area (CSA). Hoof width and length were measured, and the results were used to calculate the hoof surface area. Withers height and body weight were also measured. Groups were statistically compared by Student's t test and Pearson's correlation application to each group. Groups were different in body size, HS and CL-DIPJ size when p<.05, except for the LMD of the medial collateral ligament of left thoracic limb. Withers height and body weight did not show significant correlations to CL-DIPJ size in G1, but they had little influence on the size of CL-DIPJ on G2. No correlation between the hoof size and the CL-DIPJ was noted in any of the two groups. In conclusion, the CL-DIPJ were larger in taller horses and their sizes were correlated to their height and weight, but they were not correlated to hoof size.

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

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.

Percutaneous Release of the Finger Joints and Mini-Open Intrinsic Release With Tenolysis: A Cadaveric Study

To evaluate the effectiveness and safety of minimally invasive distal intrinsic release and extensor tenolysis combined with percutaneous release of proximal and distal interphalangeal joint collateral ligaments. The procedures were performed on 5 cadaveric upper extremity specimens, followed by a full anatomical dissection to assess completeness of the targeted releases and any damage to surrounding structures. Complete distal intrinsic release, dorsal capsule release, and distal interphalangeal collateral ligament release was performed on all specimens. We achieved complete release of all proximal interphalangeal joint collateral ligaments in 38 of 40 specimens (95%). We noted damage to nontargeted structures in 2 instances (5%). Minimally invasive and percutaneous techniques can effectively release several structures known to cause finger stiffness with minimal damage to surrounding structures. If similar results are seen in clinical trials, this could be a quick and easy way to increase the mobility of a stiff finger with potentially minimal morbidity.

Magnetic Resonance Imaging-Guided Treatment of Equine Distal Interphalangeal Joint Collateral Ligaments: 2009-2014.

To determine the outcome of treating distal interphalangeal joint collateral ligament (DIJCL) desmopathy using magnetic resonance imaging (MRI)-guided ligament injection. Medical records of 13 adult horses diagnosed with DIJCL desmopathy using low-field MRI and treated by MRI-guided ligament injection of mesenchymal stem cells and/or platelet-rich plasma (PRP) were reviewed. Information collected included signalment, MRI diagnosis, treatment type, time to resolution of lameness, and level of exercise after treatment. Collateral ligament inflammation was diagnosed as a cause of lameness in 13 horses. MRI was used to guide the injection of the injured DIJCL. All lameness attributed to DIJCL desmopathy resolved with the resulting level of performance at expected (10) or less than expected (3). Injection of the DIJCL can be safely completed in horses standing in a low-field magnet guided by MRI as previously demonstrated in cadaver specimens. The positive response in all horses suggests that administration of stem cells or PRP along with rest and appropriate shoeing may be a safe and useful treatment for DIJCL desmopathy.

Ultrasonography of the Collateral Ligaments of the Distal Interphalangeal Joint in Horses: Technique and Reference Images

This study describes ultrasound (US) technique and reference images of the equine distal interphalangeal joint collateral ligaments (CLs), and evaluates the portion of the CLs assessable by US in a series of normal forelimbs. Transverse and longitudinal US images were obtained on five healthy horses and on 25 equine cadaver forelimbs. On six limbs, a needle was placed under US-guidance at the distal limit of visualization of each CL, and the portion of CL visible at US was evaluated on computed tomographic (CT) images. The normal CLs appear as oval structures located abaxial to the fossae of the middle phalanx in the transverse sections, obtained at the level of the coronary band. A centrodorsal hypoechoic image appears with increasing proximodistal probe inclination, demonstrating different fiber orientations within the ligament. Two main fascicles, a deep and a superficial, distally divergent, are visible on longitudinal images obtained in the central part of the ligament. The proportion of CL visible at US examination was more than 50% of the total ligament length in nine of the 12 CLs assessed by CT. Awareness of the estimated portion of distal interphalangeal joint CLs visible at US and detailed knowledge of the US technique and CLs morphology are essential to efficiently use US examination on clinical cases.