Ultrasonographic procedure for a complete examination of the proximal third interosseous muscle (proximal suspensory ligament) in the equine forelimbs
Authors: Denoix J.‐M., Coudry V., Jacquet S.
Journal: Equine Veterinary Education
Summary
# Editorial Summary The proximal suspensory ligament (proximal third interosseous muscle) presents considerable diagnostic challenges due to its deep anatomical position and complex three-dimensional architecture, yet ultrasonography remains the gold standard for investigating proximal metacarpal pain in performance horses. Denoix and colleagues established a comprehensive scanning protocol combining weightbearing and flexed-limb positions with both linear and convex probes, employing sagittal and palmarocollateral approaches to capture the ligament's full extent across the forelimbs. This systematic methodology enables clinicians to visualise previously difficult-to-access regions, particularly the palmar metacarpal cortex, which is critical for detecting lesions associated with lameness. For equine practitioners—particularly veterinarians and physiotherapists managing proximal suspensory pathology—this standardised examination technique reduces the risk of missing significant structural changes and improves consistency in ultrasound interpretation, ultimately supporting more accurate diagnosis and targeted rehabilitation planning.
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Practical Takeaways
- •Use a standardized protocol combining weightbearing sagittal, weightbearing palmarocollateral, and flexed limb positions to avoid missing proximal suspensory ligament pathology
- •Employ both linear and convex probes during the examination, as each probe type provides complementary information about this anatomically complex structure
- •Include flexed limb imaging as part of routine proximal suspensory ligament ultrasound to maximize tissue visualization and diagnostic accuracy
Key Findings
- •A combined ultrasonographic approach using sagittal and palmarocollateral views with both linear and convex probes provides complete visualization of the proximal suspensory ligament
- •Imaging the flexed limb improves contact and allows more complete representation of the proximal suspensory ligament and palmar metacarpal bones
- •The complex architecture and deep localization of the proximal suspensory ligament requires systematic multiplanar imaging for accurate diagnosis