Comparison of three methods of injecting the proximal interphalangeal joint in horses.
Authors: Poore L A B, Lambert K L, Shaw D J, Weaver M P
Journal: The Veterinary record
Summary
# Editorial Summary: PIP Joint Injection Techniques Accurate intra-articular injection of the proximal interphalangeal joint remains technically challenging in equine practice, yet comparative data on injection approaches are limited. Poore and colleagues evaluated three injection techniques—dorsal, dorsolateral and palmaroproximal—by having five inexperienced veterinary students attempt injections into cadaver limbs using radiographic contrast medium as a tracer, with radiographic confirmation of successful placement. The dorsolateral approach proved most reliable at 48 per cent accuracy with fewer needle repositionings required, whilst the palmaroproximal technique, despite theoretical accessibility advantages, resulted in inadvertent digital flexor tendon sheath injection in nearly two-thirds of attempts and achieved only 36 per cent accuracy. Although conducted on cadavers with novice operators, these findings suggest that even experienced practitioners should consider the dorsolateral approach as their preferred technique, as it minimises both the number of manipulations needed and the risk of serious iatrogenic complications such as tenosynovitis from contrast extravasation.
Read the full abstract on PubMed
Practical Takeaways
- •The dorsolateral approach is the most reliable method for pastern joint injection in clinical practice, with the highest success rate and fewer complications
- •Avoid the palmaroproximal approach due to high risk of tendon sheath contamination, which could cause iatrogenic infection
- •Proper training and technique selection are critical—even experienced practitioners should prioritize the dorsolateral approach to maximize first-attempt success
Key Findings
- •Dorsolateral approach achieved 48% accuracy, superior to dorsal (32%) and palmaroproximal (36%) approaches
- •Palmaroproximal approach resulted in inadvertent digital flexor tendon sheath injection in 64% of attempts
- •Dorsolateral approach required fewer needle manipulations compared to other techniques
- •Five inexperienced veterinary students demonstrated variable success rates across all three injection methods