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  Discussion on Research Summary: A simplified technique for blocking the proximal suspensory in a hind limb
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DrO

Posted on Friday, Jan 18, 2008 - 8:34 am:

Spending a lot time around the hind limb with a needle and repeated injections can be bad for your health. A easier technique has been evaluated and believed to be effective for blocking the proximal suspensory in the hind limb. For more on diagnosis of proximal suspensory desmitis of the rear limb see the article.
DrO

Vet Surg. 2007 Dec;36(8):760-4.
In vitro evaluation of a single injection technique for diagnostic analgesia of the proximal suspensory ligament of the equine pelvic limb.

Hughes TK, Eliashar E, Smith RK.

Equine Referral Hospital, Royal Veterinary College, Herts, UK.

OBJECTIVE: To examine the anatomic relationship of the deep branch of the lateral plantar nerve (DBLPN) with structures of the proximal metatarsal region, and to define the anatomic location of a solution injected using a single injection technique for diagnostic analgesia of the proximal suspensory ligament (PSL). STUDY DESIGN: Descriptive study. ANIMALS: Cadaveric equine pelvic limbs (n=29). METHODS: The proximal metatarsal region of both pelvic limbs (n=5 horses, 10 limbs) was dissected and measurements were made of anatomic structures relative to the head of the 4th metatarsal bone (HMT4). A single injection technique was used to inject dye 15 mm distal to the HMT4, axial to the MT4 at a depth of 25 mm in each limb from 10 equine cadavers (19 limbs). Hind limbs were dissected and the position of the dye was recorded. RESULTS: DBLPN branched from the lateral plantar nerve (LPN) at a mean distance of 30 mm proximal to the HMT4 and entered the PSL at a mean distance of 17 mm distal to the HMT4. A 2nd DBLPN was observed in 1 of 10 dissected limbs. Blue dye surrounded the DBLPN in 18 limbs (95%). CONCLUSIONS: A single injection technique was likely to have resulted in desensitization of the DBLPN in 18 of 19 limbs (95%). CLINICAL RELEVANCE: This technique provides a reliable method using a single needle puncture for perineural analgesia of the DBLPN for diagnosis of proximal suspensory desmitis of the pelvic limb with a minimal risk of inadvertently desensitizing structures within the tarsal sheath and the tarsometatarsal joint.
New Member:
suzannem

Posted on Sunday, Jan 20, 2008 - 10:30 am:

Dr.O, would you mind taking a look at the horse shown in the photos (click on link below) and giving me your opinion, if the different pastern angles between the two hind legs suggest a sesamoid ligament issue...or simply bad hoof care. I would greatly appreciate any advice you might have. If this needs to be evaluated, should I have a vet, farrier, or both look at this. I just got the horse (fostering) and would like to know if this is something to be concerned about. or not.



Thank you!
Suzanne
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