Needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses

Abstract

ObjectiveTo develop a technique for standing diagnostic needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses.Study designExperimental study.AnimalsSix cadaveric forelimbs (phase 1) and six healthy horses (phase 2).MethodsIn phase 1, six cadaveric forelimbs were used to assess needle arthroscopic evaluation of both joints. Six healthy horses were subsequently enrolled in phase 2 to validate the procedure in live animals. The joint was maintained in flexion with a custom‐made splint and base.ResultsIn phase 1, needle arthroscopy allowed thorough evaluation of the dorsal and palmar recesses of both joints with traditional arthroscopic portals. In phase 2, joint evaluation was also thorough but only dorsal approaches were performed. All horses underwent radiocarpal joint arthroscopy, whereas the middle carpal joint was evaluated in only three of six horses because of limb movement. The technique was quickly performed and well tolerated by all horses. Complications included moderate movement, mild iatrogenic cartilage damage, and mild hemarthrosis.ConclusionStanding needle arthroscopy allowed thorough evaluation of the dorsal aspect of both joints, although only three of six middle carpal joints were assessed because of movement limitations.Clinical significanceThe proposed technique offers an alternative diagnostic tool for radiographically silent intra‐articular lesions of the carpus while initially avoiding the cost and risks associated with general anesthesia. Arthroscopy of a single joint is recommended to minimize risks associated with movement during the procedure.

Diagnostic needle arthroscopy of the scapulohumeral joint in standing sedated horses

“…In addition, the arthroscopic portal was left unsutured but protected under a bandage for 24 to 48 hours, which is usually sufficient for incisional healing. This approach has been shown to be safe in other studies in which needle arthroscopy was used in a research or clinical setting 6,10‐12,17 . Finally, the system used in phase 1 to determine the amount of humeral head visible excluded the most medial and lateral aspects of the joint (Figure 1).…”

“…Needle arthroscopy is commonly used in horses and in man for diagnostic purposes and can be especially useful when diagnostics such as imaging may be limited. 6,[10][11][12][13] In equine medicine, the diagnosis of scapulohumeral pathologies primarily relies on radiography, which presents several limitations in the area despite its obvious utility. First, obtaining high-quality radiographs can be technically difficult due to the large muscle mass in the area and the superimposition of the osseous structures; however, radiographic quality has improved since the introduction of digital radiography.…”

“…This approach has been shown to be safe in other studies in which needle arthroscopy was used in a research or clinical setting. 6,[10][11][12]17 Finally, the system used in phase 1 to determine the amount of humeral head visible excluded the most medial and lateral aspects of the joint (Figure 1). This system does not accurately represent the amount of humeral head arthroscopically visible, but we decided to use it to provide the reader with the percentage of humeral head visible during needle arthroscopy, where pathology more commonly occurs.…”

“…Needle arthroscopy is commonly used in horses and in man for diagnostic purposes and can be especially useful when diagnostics such as imaging may be limited 6,10‐13 . In equine medicine, the diagnosis of scapulohumeral pathologies primarily relies on radiography, which presents several limitations in the area despite its obvious utility.…”

Highlights of recent clinically relevant papers

“…In this study Dimitri Kadic and colleague s in Canada described a technique for diagnostic needle arthroscopy of the radiocarpal and middle carpal joints in standing sedated horses.…”