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the origin of the proximal suspensory ligament (PSL); and third, a confirmed diagnosis of injury to the palmaroproximal aspect of the metacarpus by a veterinary radiologist on low-field MRI. Horses that had a discernible forelimb lameness at the trot

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in Journal of the American Veterinary Medical Association

diffusion was evident during the first 10 minutes after injection but not thereafter. 13 Anecdotally and experimentally, gas artifacts in the region of the proximal suspensory ligament can be visualized during ultrasonographic examination following

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in Journal of the American Veterinary Medical Association

Abstract

Objective—To investigate tissue diffusion of anesthetic agent following administration of low palmar nerve blocks (LPBs) in horses.

Design—Randomized clinical trial.

Animals—12 adult horses.

Procedures—In 9 horses, mepivacaine hydrochloride–iohexol (50:50 dilution) injections were administered bilaterally (2 or 4 mL/site) to affect the medial and lateral palmar and palmar metacarpal nerves (4 sites). Lateral radiographic views of both metacarpal regions were obtained before and at 5, 15, 30, 60, 90, and 120 minutes after block administration; proximal and distal extents of contrast medium (and presumably anesthetic agent) diffusion from palmar and palmar metacarpal injection sites were measured and summed to determine total diffusion. Methylene blue solution was injected in forelimbs of 3 other horses that were subsequently euthanized to determine the potential route of anesthetic agent diffusion to the proximal suspensory ligament region.

Results—Mean extents of proximal and total contrast medium diffusion were 4.0 and 6.6 cm, respectively, for the palmar metacarpal nerves and 4.3 and 7.1 cm, respectively, for the palmar nerves. Subtle proximal diffusion secondary to lymphatic drainage was evident in 17 of the 18 limbs. Contrast medium was detected in the metacarpophalangeal joint or within the digital flexor tendon sheath in 8 and 7 limbs, respectively. In the cadaver limbs, methylene blue solution did not extend to the proximal suspensory ligament region.

Conclusions and Clinical Relevance—In horses, LPBs resulted in minimal proximal diffusion of anesthetic agent from the injection sites. Limbs should be aseptically prepared prior to LPB administration because inadvertent intrasynovial injection may occur.

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in Journal of the American Veterinary Medical Association

Abstract

Case Description—A 2-year-old male Suri alpaca was referred for evaluation of severe right forelimb lameness of 2 weeks' duration following a traumatic episode.

Clinical Findings—Examination of the distal aspect of the metacarpus revealed 4 wounds exuding purulent material. On weight bearing, the metacarpophalangeal joint was severely hyperextended with the palmar surface touching the ground. Ultrasonography of the palmar surface of the metacarpus revealed desmitis of the proximal suspensory ligament, a large core lesion of the deep digital flexor tendon at mid-metacarpus, and complete loss of fiber pattern within the deep digital flexor tendon and lateral aspect of the superficial digital flexor tendon distally.

Treatment and Outcome—The alpaca was treated systemically with antimicrobials and anti-inflammatory drugs and underwent repeated antimicrobial intraosseous regional limb perfusion. A bandage and splint were applied to stabilize the affected forelimb in an anatomically correct position, and the alpaca underwent prolonged stall confinement. At the time of hospital discharge 5 days after initial evaluation, clinical evidence of infection at the wound sites was absent. Three months following treatment, the alpaca was moving freely in a small paddock and had moderate hyperextension of the metacarpophalangeal joint.

Clinical Relevance—Treatment of septic flexor tendonitis and suspensory desmitis with antimicrobial intraosseous regional limb perfusion in combination with systemic treatment with antimicrobials and orthopedic support resulted in an excellent outcome in this alpaca. Antimicrobial intraosseous regional limb perfusion is simple to perform and has the potential to be beneficial in the treatment of infections in the distal portion of a limb in camelids.

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in Journal of the American Veterinary Medical Association

exuding purulent material. The metacarpophalan-geal joint was severely hyperextended during weight bearing, and ultrasonography revealed desmitis of the proximal suspensory ligament, a large core lesion of the deep digital flexor tendon, and complete loss

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in Journal of the American Veterinary Medical Association

both forelimbs and hind limbs. Approaches for diagnostic local analgesia of the hind limb proximal suspensory ligament include high plantar 4-point nerve block, direct infiltration into the origin of the suspensory ligament, and 2 techniques to

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in Journal of the American Veterinary Medical Association

. 10. Boening KJ Löffeld S Weitlamp K , et al. Radial extracorporal shock wave therapy for chronic insertion desmopathy of the proximal suspensory ligament , in Proceedings . 46th Annu Meet Am Assoc Equine Pract 2000 ; 203 – 207 . 11

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in Journal of the American Veterinary Medical Association

enthesopathy among others. 2 For the proximal metatarsal region, the enthesis of the proximal suspensory ligament (PSL) into the plantar aspect of the third metatarsal bone and the suspensory ligament itself are very frequently identified as source of pain and

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in Journal of the American Veterinary Medical Association

perineural analgesia, and results of ultrasonographic examination. Injuries to the proximal suspensory ligaments of the forelimbs and hind limbs were treated with extracorporeal shock wave therapy every 7 days for 3 weeks in conjunction with intraligamentous

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in Journal of the American Veterinary Medical Association

; 148 ( 10 ): 561 – 568 . doi: 10.1024/0036-7281.148.10.561 14. Boening K , Loeffeld S , Weitkamp K , Matuschek S . Radial extracorporeal shock wave therapy for chronic insertion desmopathy of the proximal suspensory ligament . In: The

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in American Journal of Veterinary Research