Evaluation of four techniques for injection of the proximal interphalangeal joint in horses.
Authors: Mereu Matteo, Hawkes Claire, Cuddy Laura C, Perez Olmos Juan F, Pazzola Michele, McNally Turlough P
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Proximal Interphalangeal Joint Injection Techniques Proximal interphalangeal joint injections are routine therapeutic interventions in equine practice, yet the comparative efficacy and safety of different needle approach angles remain poorly characterised. Mereu and colleagues conducted an ex vivo cadaver study using 60 equine forelimbs to evaluate four injection techniques—dorsolateral flexed (DLF), dorsoproximal midline (DPM), palmaroproximal (PP), and dorsolateral standing (DLS)—assessing both successful joint penetration and iatrogenic cartilage damage through radiographic confirmation and gross pathological examination. All four techniques achieved high success rates between 86.6% and 93.3%, but technique significantly influenced needle handling difficulty; the dorsolateral standing approach required the most needle repositionings (mean 2.62 ± 1.94 attempts) and resulted in statistically greater cartilage damage compared to alternatives. The dorsolateral flexed technique emerged as a superior alternative to the conventional dorsolateral standing approach, offering comparable accuracy with measurably reduced risk of articular surface trauma, whilst the dorsoproximal midline technique, a less established approach, demonstrated promise as a viable option. Practitioners should reconsider routine use of the dorsolateral standing technique, particularly given that safer alternatives exist without compromising injection success; adoption of either dorsolateral flexed or dorsoproximal midline techniques may reduce cumulative articular damage in horses receiving repeated intra-articular medications.
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Practical Takeaways
- •Consider switching from dorsolateral standing to dorsolateral flexed technique to reduce accidental cartilage damage during PIPJ injections while maintaining high success rates
- •The newer dorsoproximal midline standing technique offers a viable alternative with comparable efficacy and potentially less joint damage, which may reduce post-injection complications
- •All four techniques are highly successful (>86% success), so choice can prioritize minimizing cartilage trauma rather than success rate alone
Key Findings
- •Overall success rates for PIPJ injection ranged from 86.6% to 93.3% across all four techniques tested
- •Dorsolateral standing (DLS) technique required the highest mean needle repositionings (2.62 ± 1.94 attempts) compared to other methods
- •DLS technique resulted in the highest frequency of iatrogenic cartilage damage (P = .025)
- •Dorsoproximal midline (DPM) and dorsolateral flexed (DLF) techniques achieved comparable success rates with lower cartilage damage incidence