liphook - Boehringer Ingelheim

Russell Parker BVsc. MSc. DipECVS MRCVS Liphook Equine Hospital LIPHOOK
EQUINE HOSPITAL Most medicaFons are performed with the horse weight bearing }  LiKing a forelimb is safe and can be useful }  Distal limb anatomy is similar } 
LIPHOOK
EQUINE HOSPITAL Complex anatomy }  5 joint spaces } 
◦  Tarsocrural ◦  Proximal intertarsal ◦  Talocalcaneal ◦  Distal intertarsal ◦  Tarsometatarsal LIPHOOK
EQUINE HOSPITAL } 
The needle is inserted 1cm dorsal or palmar to the saphenous vein, 2-­‐3cm distal to the palpable medial malleolus of the Fbia. The joint is superficial. LIPHOOK
EQUINE HOSPITAL LIPHOOK
EQUINE HOSPITAL Needle: 20G 1.5” }  The needle is inserted in the palpable notch created by the caudal margin of the Fbia and the cranial margin of the calcaneus to a depth of 1 inch. } 
LIPHOOK
EQUINE HOSPITAL Needle: 20G 1.5” }  The needle is inserted 1-­‐1.5 cm proximal to the palpable proximal margin of the 4th metatarsal bone in a dorsomedial direcFon, angled slightly distally } 
LIPHOOK
EQUINE HOSPITAL LIPHOOK
EQUINE HOSPITAL } 
Needle: ◦  23-­‐25G 5/8” medial approach } 
Insert the needle at the distal edge of the cunean tendon at the juncFon between the central tarsal bone, the third tarsal bone and the fused 1st/2nd tarsal bones. LIPHOOK
EQUINE HOSPITAL } 
Needle: 20G 1.5” } 
The needle is inserted immediately lateral to the long digital extensor tendon, 8mm proximal to the level of the proximal extent of MTIV in a plantaromedial direcFon (Just et al. 2007) LIPHOOK
EQUINE HOSPITAL } 
Variable depending on method of assessment 25% in latex studies (Bell et al. 1993) }  38% aKer arthrography (Kraus-­‐Hansen et al 1992) }  Up to 100% diffusion of mepivicaine (Gough et al 2002), 64% at >300mg/ml }  100% diffusion of MPA to DIT aKer TMT medicaFon (Serena et al 2005) } 
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But clinical experience suggests otherwise LIPHOOK
EQUINE HOSPITAL Large complex joint }  3 compartments with variable communicaFon } 
◦  Femoropatellar joint ◦  Medial femoroFbial joint ◦  Lateral femoroFbial joint LIPHOOK
EQUINE HOSPITAL Femoropatellar joint
60-70%
90%
20%
90%
Lateral
femorotibial joint
Medial
femorotibial joint
0%
90%
Vacek et al 1992
Gough et al 2002
Needle: 2” 19G }  The needle is inserted between the middle and medial patellar ligaments, 3-­‐4 cm proximal to the Fbial crest. The needle is parallel with the ground } 
LIPHOOK
EQUINE HOSPITAL Needle: 1.5” 2OG }  The needle is inserted caudal to the lateral patellar ligament or lateral edge of the patellar, 5-­‐7cm proximal to the Fbial crest unFl bone is contacted }  My preferred approach } 
◦  Beier fluid retrieval ◦  Less movement LIPHOOK
EQUINE HOSPITAL Needle: 1.5” 20G }  The needle is inserted 2 cm proximal to the Fbial crest between the medial patellar ligament and the medial collateral ligament to a depth of 1-­‐3cm } 
LIPHOOK
EQUINE HOSPITAL Needle: 1.5” 20G }  The needle is inserted between the lateral patellar ligament the long digital extensor tendon or between the LDE and the lateral collateral ligament, 1-­‐2 cm proximal to the Fbial crest } 
LIPHOOK
EQUINE HOSPITAL } 
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Bell BT, Baker GJ, Foreman JH, Abboi LC. (1993)
In vivo invesFgaFon of communica6on between the distal intertarsal and tarsometatarsal joints in horses and ponies. Vet Surg. 22(4):289-­‐92 Gough MR1, Munroe GA, Mayhew G (2002) Diffusion of mepivacaine between adjacent synovial structures in the horse. Part 2: tarsus and s6fle. Equine Vet J. 34(1):85-­‐90. Just EM, Patan B, Licka TF. (2007)
Dorsolateral approach for arthrocentesis of the centrodistal joint in horses. Am J Vet Res. 68(9):946-­‐52 Kraus-­‐Hansen AE, Jann HW, Kerr DV, Fackelman GE. (1992)
Arthrographic analysis of communica6on between the tarsometatarsal and distal intertarsal joints of the horse. Vet Surg. 21(2):139-­‐44. Serena A1, Schumacher J, Schramme MC, Degraves F, Bell E, Ravis W (2005) Concentra6on of methylprednisolone in the centrodistal joint aLer administra6on of methylprednisolone acetate in the tarsometatarsal joint. Equine Vet J. 2005 Mar;37(2):172-­‐4. Vacek JR, Ford TS, Honnas CM.(1992)
CommunicaFon between the femoropatellar and medial and lateral femoroFbial joints in horses. Am J Vet Res. 53(8):1431-­‐4 LIPHOOK
EQUINE HOSPITAL