Treatment is rest with hand-walking, NSAIDs, DMSO and cold hydrotherapy. In severe or unresolved cases, the surgical of the carpal annular ligament or of the long plantar ligament is the best option. Massage can be used to decrease swelling of the carpal or tarsal tunnel and to remove adhesions or areas of fibrosis that may restrict or compress the carpal or tarsal canal.
Prognosis is good for athletic return with appropriate treatment.
Annular Ligament Constriction The annular ligament wraps around the fetlock joint to hold the flexor tendons, suspensory ligaments and proximal sesamoids in place. It helps to support the fetlock joint as well.
The etiologies of annular ligament restriction include desmitis of the annular ligament itself (primary) or tendonitis/tenosynovitis of the flexor tendons at the level of the PSBs (secondary).
As ligaments are inelastic, any situation that results in inflammation or swelling within the annular ligament or in the structures that the annular ligament surrounds, will cause thickening and of those structures as the ligament can’t expand. If restriction is moderate to severe, it will not allow the flexor tendons to glide over the PSBs and may even restrict blood blow to the structures leading to more inflammation and compression necrosis.
Predisposition includes hyperextension of the fetlock during strenuous activity and this predisposes for tendon and ligament injuries in the area.
Clinical signs include distinctive swelling on the palmar/plantar fetlock. Tendon sheath effusion creates a pouch that is seen at the top of the ligament and possibly below the ligament as well, creating a ‘ ’ like appearance where the ligament lies. Pain on palpation will vary with pressure and mild to moderate lameness is seen depending on the extent of the desmitis & constriction.
Diagnosis is through case history, signs & symptoms, palpation and ultrasound.
Treatment will vary according to which structures are affected. If only annular desmitis is present, treatment is conservative with rest, hand-walking, NSAIDs and support bandaging. In more severe cases or when lameness is not resolved, desmotomy can be performed. This involves cutting the annular ligament to relieve the constriction.
Prognosis for return to athletic performance is very good provided no tendon damage occurred.
Subluxation of the Sacroiliac Joint Subluxation of the sacroiliac joint is described as a sprain of the resulting in abnormal articulation between the sacrum and wing of ilium.
sacroiliac ligaments
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