Changes

|q1=What abnormal features of the right forelimb can be recognised in the image?

|q1=What abnormal features of the right forelimb can be recognised in the image?

|a1=There is marked distension of the digital sheath on the palmar aspect of the fetlock. The distal end of the swelling has a notched appearance. The horse has a slightly broken back hoof–pastern axis and low heels.

|a1=There is marked distension of the digital sheath on the palmar aspect of the fetlock. The distal end of the swelling has a notched appearance. The horse has a slightly broken back hoof–pastern axis and low heels.

|l1=Palpable Points of the Horse - Anatomy & Physiology#Metacarpophalangeal Joint

|l1=Palpable Points - Horse Anatomy#Metacarpophalangeal Joint

|q2=From the history and clinical signs, what causes of lameness would you consider?

|q2=From the history and clinical signs, what causes of lameness would you consider?

|a2=

|a2=

*Previous penetrating wounds into the sheath, may be contributing factors. <br><br>

*Previous penetrating wounds into the sheath, may be contributing factors. <br><br>

But in view of the poor foot conformation, a foot problem should also be considered as the cause of the lameness, since these digital sheath swellings are not always painful.

But in view of the poor foot conformation, a foot problem should also be considered as the cause of the lameness, since these digital sheath swellings are not always painful.

|l2=

|l2=Annular Ligament Syndrome

|q3=What further tests would you perform to confirm your diagnosis?

|q3=What further tests would you perform to confirm your diagnosis?

|a3= Intrasynovial analgesia of the digital sheath will not always abolish the lameness, presumably because of adhesions or the mechanical influence of the constricted annular ligament.  

|a3= Intrasynovial analgesia of the digital sheath will not always abolish the lameness, presumably because of adhesions or the mechanical influence of the constricted annular ligament.  

*Ultrasonography is important for evaluation of the annular ligament and the flexor tendons, and may indicate the presence of adhesions.  

*Ultrasonography is important for evaluation of the annular ligament and the flexor tendons, and may indicate the presence of adhesions.  

*Regional analgesia of the foot should be performed to ensure that foot pain is not involved.

*Regional analgesia of the foot should be performed to ensure that foot pain is not involved.

|l3=Specific Nerve Blocks

|l3=Lameness - Horse

|q4= How would you treat this case?

|q4= How would you treat this case?

|a4= Acute cases should be treated with rest, possibly combined with both topical and systemic anti-inflammatory drug therapy. If this fails, an annular ligament desmotomy is indicated.

|a4= Acute cases should be treated with rest, possibly combined with both topical and systemic anti-inflammatory drug therapy. If this fails, an annular ligament desmotomy is indicated.

|l4=NSAIDs

|l4=Annular Ligament Syndrome

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