Case Notes: This month’s case was an 8-year-old warmblood jumper gelding that was referred in for a Nuclear Scan of the front end. Horse’s history indicated an initial grade 2 right front lameness of 6 weeks duration; worse on left circle. Lameness blocked repeatedly to ASNB. Horse did not improve with PDNB, proximal suspensory block, or IA fetlock or coffin joint blocks.
Diagnostics: The radiologist found the following areas to have Increased Radiopharmaceutical Uptake (IRU):
- Right front fetlock, mild and diffuse, most prominent medially.
- Right and left navicular bones and solar aspects of distal phalanges, mild and diffuse.
- Right third metacarpal bone, focal and mild, proximal aspectRight distal phalanx, mild to moderate and diffuse.
Below are the images to support these findings:
Diagnostics (continued): The radiologist suggested MR imaging of the front feet and fetlock based on this study and the blocking pattern. The Radiologist found the following from the MR study:
- There was mild to moderate synovitis in the distal interphalangeal joint characterized by increased fluid and synovial proliferation (fig. 3).
- There was mild fluid in the navicular bone and in the trabecular bone of the distal phalanx at the impar ligament and deep digital flexor tendon insertions as well as in the extensor process indicating edema and/or contusion (fig. 2 & 3).
- There was mild bursitis in the navicular bursa characterized by increased fluid and synovial proliferation (fig. 3).
- There was mild focal bone resorption in the distal phalanx lateral of midline at the impar ligament attachment (fig. 2).
- There was dorsal margin fraying and fibrillation in the deep digital flexor tendon distal to the navicular bone. This finding is located midline and medial of midline (fig. 3).
- There was focal abnormality affecting the bone of the medial palmar process of the proximal phalanx at the level of the fetlock joint. The abnormality was most consistent with fluid affecting the subchondral and trabecular bone. Bone loss or decreased bone density could also be considered, this area should be monitored (fig. 1).
- There was mild arthrosis in the metacarpophalangeal joint characterized by periarticular osteophyte formation (fig. 3).
- In the distal aspect of the third metacarpal bone there was moderate sclerosis of the medial condyle and mild sclerosis of the lateral condyle (fig. 2).
Below are the images of the left fore, signaling these findings: