Injection of the insertion of the collateral ligament of the distal interphalangeal joint in standing horses using the palmar radiographic-guided approach.
Authors: Kirkpatrick C J, Ernst N S, Trumble T N
Journal: Journal of equine veterinary science
Summary
# Editorial Summary Collateral ligament injuries at the distal interphalangeal joint represent a significant source of lameness in horses, and intralesional injection has emerged as a potential treatment to improve return to performance; however, the precision required to target these small structures has limited clinical adoption. Kirkpatrick and colleagues tested a palmar radiographic-guided injection technique in 20 standing sedated horses (10 medial and 10 lateral collateral ligaments), using new methylene blue dye and an 18-gauge spinal needle to verify accurate needle placement via lateromedial and dorsopalmar radiographs before injection. The technique achieved successful dye deposition in the collateral ligament insertion in 19 of 20 cases (95%), though only 20% of injections remained confined to the insertion alone—30% also penetrated the distal interphalangeal joint space and 45% extended into periligamentous structures. These findings establish the palmar radiographic-guided approach with a staggered limb stance as a reliable and repeatable method for targeting collateral ligament insertions in sedated horses, offering clinicians a practical pathway for delivering intralesional therapeutics, though practitioners should anticipate that accurate needle placement will frequently result in injection spread beyond the primary target structure. The high success rate suggests this technique warrants clinical evaluation in lame horses to determine whether the therapeutic benefit justifies the unavoidable periligamentous diffusion and potential intra-articular leakage.
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Practical Takeaways
- •The palmar radiographic-guided approach offers a practical, effective method for injecting DIPJ collateral ligament lesions in standing horses under sedation and nerve block
- •High accuracy rate (95%) suggests this technique can be reliably incorporated into clinical practice for treating CL injuries as a lameness source
- •Some spread to periligamentous structures and joint space occurs naturally; clinicians should understand this distribution pattern when planning treatment protocols
Key Findings
- •95% (19/20) of injected collateral ligament insertions successfully received dye using the palmar radiographic-guided approach
- •45% of injections resulted in dye distribution to both the CL insertion and periligamentous structures
- •The palmar radiographic-guided technique with staggered stance positioning is a reliable and repeatable method for accurate needle placement in standing sedated horses