Virginia Equine Imaging
A. Kent Allen, D.V.M. and Associates

Patient

• 16 yo, Thoroughbred, Gelding used as an eventing horse.

History

• Patient presented for an acute onset of severe LF lameness on 7/20/23. Evaluation revealed moderate to severe sensitivity over the medial heel and medial quarter of the LF foot.
• Abscess was drained from medial sole area.
• The horse was sent home with instructions of soaking the foot and applying poultice bandages to help draw out the abscess.

Diagnosis

Radiography

There was a moderate periosteal reaction at the dorsal aspect of the second phalanx. This finding was new when comparing with X-rays taken 2 months before.

Diagnosis

Ultrasound

There was moderate enlargement of the proximal aspect of the medial collateral ligament of the distal interphalangeal joint.

Diagnosis

• The horse was referred to a surgical center for further diagnosis and treatment of the severe lameness. During hospitalization, a LF coffin joint tap was performed and the results were within normal limits. Advanced diagnostic imaging (CT) revealed an enthesopathy of the collateral ligament.
• Because of the collateral ligament involvement it was decided to perform a MRI through VEI.

Diagnosis

Magnetic Resonance Imaging

1. Medial collateral distal interphalangeal (DIP) ligament disruption in the distal half.
2. Bone edema at the distal insertion of the medial collateral ligament, as well as throughout the quarter.
3. Severe distension of the coffin joint.
4. Moderate distension of the navicular bursa.
5. Sclerosis of the coffin bone at the lateral and medial distal collateral fossa.

Treatment plan:

1. LF medial collateral ligament shoe with double clips.
2. LF coffin joint injection with PRP.
3. US guided injection of the LF medial collateral ligament with PRP.
4. EQ Pro Therapy on the LF medial collateral ligament 2-3 times per week.
5. 4 weeks of stall rest.

EQ Pro Therapy:

• The horse received 2-3 Low-Frequency Therapeutic Ultrasound sessions per week for 3 months.
• A total of 23 treatment sessions were applied using the following protocol:

The Gray Transducer was used first for 5 minutes at 65% power output and then the Blue Transducer was used for 10 minutes at 65% power output on the LF medial collateral ligament of the coffin joint inside of the hoof wall.

Progress

• A lameness evaluation was performed 30 days after the diagnosis and the horse was sound at a walk.
• It was recommended to start with 5 minute hand-walks and 20 minutes of turnout in a small pen once daily.
• He was started on Trazodone to try to keep him quiet during the rehabilitation period.

Progress

• Injections of the LF coffin joint and LF medial collateral ligament were performed 2 months after the diagnosis.
• During the lameness exam performed a month later, the horse presented a 1/5 LF lameness on the straight away trot.
• It was recommended to increase the turnout time to 30-45 minutes once a day.

Radiograph guided injection of the medial collateral ligament.

Outcome:

• On lameness evaluation, 4 months after the diagnosis, the horse was sound on the straight away trot and lunging in both directions.

Outcome:

• The horse was gradually returned to work with the objective of using him as a trail horse.
• During his most recent lameness examination (9/20/24), the horse was sound at a trot and the owner reports that he has been performing as expected.

Conclusion

• In our clinical experience, the use of Low-Frequency Ultrasound Therapy has demonstrated significant benefits in treating horses with collateral ligament injuries.
• Horses treated with Low-Frequency Ultrasound Therapy have shown improved outcomes compared to those treated with orthobiologics alone.
• The combination of Low-Frequency Ultrasound and Orthobiologic Therapy in our clinic, has been associated with:
  .
  – Shorter recovery periods.
  – Enhanced healing of the collateral ligament.

Conclusion

• Based on our cases, we believe that the use of Low-Frequency Ultrasound Therapy offers a valuable addition to traditional treatments, providing an effective and non-invasive option for managing collateral ligament injuries in horses.