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MRI Case of the Month

History

 
  • 3 year old Quarter Horse Mare used for reining
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  • Examination revealed a grade 2/5 right front lameness
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  • Lameness improved 90% with a low four point block

Ultrasound Examination

 




  • The suspensory ligament is moderately enlarged. The medial lobe is more affected than the lateral lobe (arrow on left).
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  • There is fiber disruption in the dorsal aspect of the medial lobe of the suspensory ligament (arrow on right).
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  • There is bone loss on the palmar margin of the third metatarsal bone at the attachment of the suspensory ligament (arrowhead on right).

MRI Examination

 








  • The suspensory ligament is enlarged. There is sclerosis and bone resorption at the attachment of the ligament on the third metacarpal bone (arrowheads). There is edema in the third metacarpal bone at the attachment of the suspensory ligament (red arrow).
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  • There is fiber disruption with adjacent degenerative injury in the dorsal aspect of the medial lobe of the suspensory ligament (yellow arrows).

Diagnosis

 
Moderate chronic injury to the suspensory ligament in the right forelimb with ligament and bone involvement. The ligament is enlarged with areas of fiber disruption and degenerative injury. The third metacarpal bone has focal resorption and trabecular bone sclerosis as well as edema, which could only be identified on the MR images.
 

Treatment

 
  • Platelet rich plasma (PRP) was placed around the suspensory ligament with ultrasound guidance.
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  • Shockwave was performed once a week for 3 treatments (focused unit, E6 probe, 800 shocks) was performed at the suspensory ligament attachment on the proximal metacarpal bone.
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  • Regional limb perfusion with Tiludronate was performed.
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