Transthecal Arthroscopy of the Palmar Distal Interphalangeal Joint in the Horse: A Cadaver Study.
Authors: Rubio-Martínez Luis M, Bracamonte Jose L, Tompkins Samantha, Villarino Nicolás F
Journal: Veterinary surgery : VS
Summary
# Transthecal Arthroscopy of the Palmar Distal Interphalangeal Joint Arthroscopic examination of the distal interphalangeal joint (DIPJ) in horses traditionally relies on a conventional blind approach, which limits visualisation of critical palmar structures including the navicular bone and the palmar synovial pouches—areas frequently affected by degenerative disease. Rubio-Martínez and colleagues tested an alternative transthecal technique on 26 cadaver forelimb pairs, wherein one limb underwent conventional arthroscopy whilst the other was explored via a sharply dissected pathway through the distal reflection of the digital flexor tendon sheath, allowing direct access to the palmar pouch. The transthecal approach significantly outperformed the conventional method, achieving substantially greater visualisation of the navicular bone, palmar condylar surfaces of the second phalanx, and palmar DIPJ pouches (all P < 0.001), with comparable rates of iatrogenic soft tissue damage between techniques. For practitioners managing chronic, nonseptic DIPJ pathology—particularly navicular disease or osteochondral lesions affecting palmar structures—this transthecal approach warrants consideration as it provides the superior visual field necessary for accurate diagnosis and targeted treatment. However, the creation of a communication pathway between the DIPJ and digital flexor tendon sheath presents a significant infection risk, making this technique inappropriate for suspected septic arthritis until further clinical validation establishes appropriate infection-control protocols.
Read the full abstract on PubMed
Practical Takeaways
- •The transthecal arthroscopic approach may improve diagnostic accuracy for non-infected DIPJ conditions by providing superior visualization of the navicular bone and palmar joint structures compared to conventional blind arthroscopy
- •Do not use the transthecal approach if synovial sepsis is suspected, as it creates communication between the DIPJ and digital flexor tendon sheath, risking spread of infection
- •This technique is a valid alternative for investigating chronic, non-septic DIPJ problems where improved visualization could guide treatment decisions
Key Findings
- •Transthecal approach provided significantly greater visualization of navicular bone compared to conventional approach (P < 0.001)
- •Transthecal approach visualized palmar aspect of 2nd phalanx condyles and palmar synovial pouches with significantly better visualization than conventional approach (P < 0.001)
- •No significant differences in iatrogenic damage to relevant structures between transthecal and conventional approaches
- •Transthecal approach creates communication with digital flexor tendon sheath, potentially contraindicated in septic conditions