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  Discussion on Collateral ligament desmitis
Author Message
Member:
jessblue

Posted on Wednesday, Jul 17, 2013 - 1:12 pm:

Hi Dr O. You may remember my previous posts about my horse with suspected low grade laminitis. I also posted hoof pics. I have now had my horse MRI scanned to both front feet after he remained very low grade lame on both fronts lunged on hard surface and sore on turning on concrete. I would greatly appreciate your help in interpreting the scan report as I didnt fully understand what my vet summarised and the prognosis for return to work in such horses.

The report summary says:
Desmitis of the lateral collateral ligament of the DIP joint and fragmentation of P£ at its insertion LF
Asymmetric ossification of the cartilages of the foot and densification of the lateral cartilage LF
Fragmentation of the distal border of the navicular bone LF
Mild desmitis of the DSIL LF and RF
Desmitis of the medial collateral ligament of the DIP joint and fragmentation of P3 at its insertion

My vet said that some of this was general wear and tear to be expected of a 9 year old horse who has evented but that the main issue was collateral ligament desmitis which was reasonably mild. He said that I need to get him shod in heartbar shoes and rest. We commenced cartrophen injections today, but I wanted to avoid cortisone in case of laminitis.

Could you please give me your understanding of this report and if you have any experience of the prognosis for horses with this condition. My vet was relieved there was no problem in the DDFT. Can horses with this return to athletic function with correct treatment?

Also I was hoping to take my horse barefoot as he has some serious foot issues which had not been helped by farriery. Underrun heels for one. My vet said he must be shod and I am unsure as feel he needs to establish a better heel conformation before being shod again. Any thoughts on barefoot vs heartbars for this condition?

Many thanks
Moderator:
DrO

Posted on Friday, Jul 19, 2013 - 2:48 pm:

Hello Jessica,
Not being able to evaluate the severity of the lesions present I really cannot prognose the condition so I must take the veterinarian's word that the lesions seen are examples of mild collateral ligament desmitis and with proper rest should come sound. The description of "fragmentation" of the distal insertion onto P3 sounds a little more than mild desmitis.

I don't see the logic of using heart bar shoes for collateral desmitis of the DIP. However bare foot may not fix a severely underrun heel either. For my recommendations see HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Hoof » Correcting Long Toe Low Heel Foot Conformation.
DrO
Member:
jessblue

Posted on Saturday, Jul 20, 2013 - 8:04 am:

Thank you Dr O. I agree, I am concerned about the "fragmentation" at insertion. I have not really been able to find anything online directly explaining this. My take on it is it is where there is some splitting of the fibres or bone and/or ligament at the point at which it attaches to the bone. Would this be right? Have you come across this term before in MRI reports? I have heard the term enthesiopathy (?) and wondered if this is the same thing? I believe this is some kind of inflammation at point of insertion. I can ask my vet further when he comes out next to give the cartrophen injections he advised.

My horse did stay sound when wearing heartbars, but this may have been coincidental, but my vet now says heartbars are the treatment choice for cld of the dip. I just feel without addressing his hoof issues we are merely putting a very temporary sticking plaster over the problem. Essentially the horse has underrun heels, I feel because his heels have contracted so much, possibly shoeing could be behind this and my instinct was to go for a barefoot rehab initially then followed by remedial farriery in the future when we had developed a stronger hoof capsule. There is a lot of interest in a barefoot rehab approach to caudal hoof problems in the UK and it seems to have a lot of sense behind it. I understand that diet, stimulation and trimming are very important to achieve success however.

The report did not specify lesions or tears of the ligaments. It described an increased signal strength and enlargement of the ligaments. I think my vets understanding of this is that this is a milder case as there were no tears or lesions. At least that is how he explained it to me.He also mentioned that some of the findings would be consistent with normal wear and tear on a jumping horse of his age and werent necessarily of concern. I noticed there was mention of fragmentation of the distal border of the navicular bone, however my vet said that he doesnt have "navicular disease" I assume he is using radiograph images to make this conclusion along with MRI results? It is all very confusing and I am sadly a person who wants to know as much as possible so I am able to make the best decisions for myself and my horse.

I was sent to an equine hospital for the MRI that has one of the best interpreters of MRIs in out part of the country as I was told that not just anyone is capeable of interpreting them accurately, I can see why as this is such a complex issue.
I have included the part of the report which fully describes the findings with regard to the collateral ligaments in case this throws any light on it for you.
"There is enlargement of the proximal portion of the lateral collateral ligament and increased signal throughout this ligament. There are smaller region of increased signal within the medial collateral ligament also"
RF (This is the complete report for this foot)
"In this foot the cartilages are more symmetric in degree of ossification. There is fragmentation of P3 at the insertion of the collateral ligament and this ligament appears enlarged.

The summary I posted in my initial post.

I am actually surprised there is not more detail. I assume if lesions of tears were seen they would have been described.

I will be reading the correction of hoof conformation article.
Moderator:
DrO

Posted on Saturday, Jul 20, 2013 - 1:32 pm:

"Fragmentation" could apply to either the soft (ligament) or the bony (P3) tissue or both. Your post indicates that the bone is fragmented (avulsed?) at the insertion of the ligament. This would not be the same as enthesopathy but might cause enthesophytes (abnormal bony projections at the attachment of a tendon or ligament) to form.
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