Proximal injuries of the accessory ligament of the deep digital flexor tendon in forelimbs and hindlimbs: 12 horses (2006–2010)
Authors: Dyson S.
Journal: Equine Veterinary Education
Summary
# Editorial Summary: Proximal ALDDFT Injuries in Equine Forelimbs and Hindlimbs Until Dyson's 2012 review, proximal injuries of the accessory ligament of the deep digital flexor tendon (ALDDFT)—occurring in the carpal/proximal metacarpal region of the forelimb and tarsal/proximal metatarsal region of the hindlimb—lacked detailed ultrasonographic characterisation in the equine literature. By establishing baseline ultrasound appearances in sound horses and reviewing 12 clinical cases presenting between 2006 and 2010, this work demonstrated that proximal ALDDFT lesions present with markedly different clinical signatures depending on limb location: forelimbs showed no localising signs and required diagnostic analgesia to identify the pain source, whilst hindlimbs typically exhibited oedematous swelling in the proximoplantaromedial metatarsal region or generalised thickening at the proximal ALDDFT. Prognosis varied considerably, with only 1 of 3 forelimb cases and 4 of 6 hindlimb cases returning to full function, whilst 2 hindlimb cases suffered recurrent injury despite resuming work. For practitioners, this research underscores that proximal ALDDFT injuries warrant inclusion in differential diagnoses for both fore- and hindlimb lameness even when palpable abnormalities are absent, and highlights the diagnostic value of ultrasonography in regions that may otherwise appear clinically unremarkable.
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Practical Takeaways
- •Consider proximal ALDDFT injury as a differential diagnosis for forelimb or hindlimb lameness even when no obvious swelling or palpable abnormalities are present—use diagnostic analgesia and ultrasonography to confirm
- •Hindlimb ALDDFT injuries may be more obvious clinically (oedematous swelling in proximoplantaromedial metatarsal region) compared to forelimb injuries, which are more subtle
- •Prognosis is guarded; only 1 of 4 forelimbs returned to full function, and hindlimb cases have significant recurrence risk despite conservative management
Key Findings
- •Forelimb ALDDFT injuries (4 horses) presented without localising clinical signs and required diagnostic analgesia for diagnosis
- •Hindlimb ALDDFT injuries (8 horses) presented with oedematous swelling in the proximoplantaromedial metatarsal region (7/8) or generalised thickening (1/8)
- •Ultrasonography confirmed diagnosis in all 12 horses with proximal ALDDFT injuries
- •Return to work rates were 25% for forelimb injuries (1/4) and 67% for hindlimb injuries (4/6), with 2/6 hindlimb cases experiencing recurrent injury