Management of ligamentous navicular pain

no MRI available, ISELP exam!

An ISELP certified examination should be the ultimate goal for a lame horse! Better than a mobile MRI, the diagnostic tools of an ISELP certified vet. might bring light into the hidden source of lameness in the distal phalanx! DISTAL SESAMOIDEAN (impar) LIGAMENT (DSL) …. CASE – lame 3,5/5 RF

clinical examination: video on insta/pferdesportpraxis

This mare showed intermittent chronic lameness 2,5/5 since 3 years, that was managed with suboptimal corrective shoeing, physical therapy and NSAD in extreme episodes. Exacerbation to 3,5/5, extreme pain in the right turn. Pastern joint negativ, coffin joint (4ml) 75% positiv after 20 min, distal digit. n. (2ml) 100% pos. after 3 min. 10 mg triamcinolone i.a. coffin j.,  & 10 mg. in pastern joint … sound after 1 week.

radiology: more images on insta/pferdesportpraxis

Sclerosis navicular bone with lucency. Sclerosis enthesis DDFT, enthesiopathy DSL. Severe arthropathy pastern joint.

 

ultrasonography: image magnification on insta/pferdesportptaxis

Watch thickening & split of DSL with enthesiopathy. Enthesiopathy of DDFT. Enlargement DDAL.

discussion

Navicular disease with exacerbation by desmitis DSL, insertional enthesioptahy DDFT (see diagnostic injections). The management with steroid injection seems here more justified, because there are rather chronic findings, that might be detected in sound to slightly lame episodes, too. However recurrence must be expected. The non functioning pastern joint might provoke hyper flexion of the coffin joint and therefore overstressing the navicular apparatus by squeezing. I.A. pastern joint treatment might help.

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DR. MATTHIAS KELLER, ISELP cert. | PFERDESPORTPRAXIS