Diagnostic imaging for soft tissue injuries

Question 1

Restraint of the horse

Answer 1

• Sedation (detomidine and butorphanol
  usually)
• A handler to hold the horse / lift contralateral leg

Question 2

Prep of the skin

Answer 2

• Clippers
• Surgical spirit
• Ultrasound transmission gel

Question 3

Which scanner probe?

Answer 3

• A high frequency linear probe
• A “stand off” to attach to the probe

Question 4

Benefits of using a stand off

Answer 4

• Improve contact area and image size
• Enhance detail visible in superficial layers

Question 5

Are acute soft tissue injuries hypoechoic or hyperechoic?

Answer 5

• Hypoechoic (darker than the normal section of tendon

Question 6

Are chronic soft tissue injuries hypoechoic or hyperechoic?

Answer 6

• Hyperechoic, as type 3 collagen is often more dense than type 1

Question 7

Best angle/side to scan the AL-DDFT

Answer 7

• Published evidence that scanning from the lateral aspect is the best thing for accessory ligaments as we don’t necessarily see the whole ligament if we scan from the palmar aspect

Question 8

Another name for the accessory ligament of the DDFT?

Answer 8

• inferior check ligament

Question 9

Where to find the straight sesamoidean ligament

Answer 9

• only found distal to the metacarpophalangeal joint as it only exists in the pastern region
• the oblique sesamoidean ligament is also only distal to the metacarpophalangeal joint

Question 10

Where does injury of the suspensory ligament usually swell first?

Answer 10

• in the space of the plantar recess
  – it can’t swell outwards so instead it fills ^ first

Question 11

Sensitivity of US for tears of the Manica Flexoria

Answer 11

• poor

Question 12

How to diagnose tears of the Manica Flexoria

Answer 12

• contrast radiography
• inject into tendon sheath
• walk a few steps
• take lateromedial radiograph

At the same time you can also inject some LA (at the same site), which can give reassurance that this is the entirety of the horses problem

Question 13

Key points

Answer 13

• Consider scanning before blocking in cases where
  severe soft tissue injury is suspected
• Finding pathology in two planes is necessary for
  lesion characterization and prognostication
• Comparing with the contralateral limb is extremely
  helpful
• The weight-bearing vs non weightbearing
  appearance of soft tissues is significant
• Don’t underestimate the benefits of radiography in
  some soft tissue diseases
• Contrast enhanced techniques can add further
  value to radiography