Ultrasonographic Anatomy of

the Equine Distal Limb

Lisa J. Zekas, DVM, DABVP –Eq, DACVR

and Chess Adams, DVM, DACVR
 Objectives
Brief introduction to ultrasound and the imaging
procedure.

+ Be able to identify a transverse and a longitudinal

image.

+ Be able to apply the anatomy of the distal

equine extremity to ultrasound images and
identify structures.
 Brief Introduction to Ultrasound
• Transducer produces sound waves and also receives
reflected sound waves.
• Sound waves travel in a plane through tissue.
• Sound waves are transmitted, absorbed or reflected by
tissues.
• Computer forms image – in shades of gray.

From: Zagzebski, JA; Essentials of Ultrasound

Physics, Mosby, © 1996
 Abdomen
Musculoskeletal Reproduction Liver - cholelithiasis
Palmar distal extremity Uterine cysts

Echocardiography Thorax
Infected umbilicus Pericardial effusion Pleuropneumonia
 Patient Preparation

Clip the area

Clean area
Coupling medium
alcohol
commercial gel
 Imaging technique
Systematic organized approach – must be
familiar with normal
Scan from proximal to distal
Evaluate structures individually
Transducer perpendicular to structure
Limb should be weight bearing
 Imaging Techniques
Label images - patient info, directions and
location
Two methods for location
1. Zones
2. Reference points
- cm distal to standard point
accessory carpal bone
point of hock
point of ergot
i.e. 5 cm DACB
 Ultrasonographic evaluation of structures
Size
• cross sectional area (cm2)
• dorsal-palmar thickness
• medial-lateral width
• proximal-distal length

From: Reef VB. Equine Diagnostic Ultrasound. WB Saunders, Philadelphia, PA. ” 1998
 Ultrasonographic evaluation of structures
Echogenicity - Appearance using shades of gray
-within structure itself
-compared to other structures
-compared to normal

anechoic
hypoechoic
hyperechoic
isoechoic
Ultrasonographic evaluation of structures

Parallel fiber pattern (tendons and ligaments)

Transverse images
Palmar (skin surface)

Medial Lateral

Dorsal
Longitudinal image
Palmar (skin surface)

Proximal Distal

Dorsal
 Imaging Techniques
As in radiography – it is best when pathology can
be seen in both planes
-(artifactual “lesions” can be created)

Longitudinal Transverse
Ultrasonographic Anatomy

From: Rantanen NW, McKinnon AO. Equine Diagnostic

Ultrasonography Williams and Wilkins Philadelphia, ”1998
Proximal metacarpal
region

Transverse

Longitudinal
Ultrasonographic Anatomy

From: Rantanen NW, McKinnon AO. Equine Diagnostic

Ultrasonography Williams and Wilkins Philadelphia, ”1998
 SDFT
DDFT
Medial
ALDDFT (or ICL)

TIOM (or SL)

Palmar surface of MCIII

SDFT
DDFT

Proximal
ALDDFT (or ICL)

TIOM (or SL)

Palmar surface of MCIII
Dorsal
Relation of SDFT to DDFT in proximal region

Hindlimb
Forelimb
Ultrasonographic Anatomy

From: Rantanen NW, McKinnon AO. Equine Diagnostic

Ultrasonography Williams and Wilkins Philadelphia, ”1998
Mid 1/3 of
metacarpal area

Transverse

Longitudinal
 SDFT
DDFT
ALDDFT (or ICL)

TIOM (or SL)

Palmar margin of MCIII is indistinct

SDFT
DDFT
*
ALDDFT (or ICL) – note how it thins DISTAL
and angles to join with the DDFT distally*.

TIOM (or SL)

Palmar surface of MCIII
Dorsal
 SDFT
DDFT
ALDDFT

SL splitting into branches

SDFT
DDFT
ALDDFT joining into DDFT

SL splitting into branches - so no

longer on midline
Ultrasonographic Anatomy

From: Rantanen NW, McKinnon AO. Equine Diagnostic

Ultrasonography Williams and Wilkins Philadelphia, ”1998
Transverse Longitudinal
Transverse Longitudinal
 SDFT

DDFT

Branch of Suspensory Ligament

MCIII

SDFT
DDFT
Suspensory Branches: imaged obliquely from medial and lateral sides

Transverse

Longitudinal
Longitudinal at insertion on
prox. sesamoid bone
 Lateral suspensory branch

Longitudinal view of
lateral suspensory branch

Abaxial border of
lat prox sesamoid bone

Lateral suspensory branch

Ultrasonographic Anatomy

From: Rantanen NW, McKinnon AO. Equine Diagnostic

Ultrasonography Williams and Wilkins Philadelphia, ”1998
Transverse Longitudinal
 SDFT
DDFT

Intersesamoidean ligament
Margin of sesamoid bone

SDFT
DDFT

Margin of sesamoid bone

Ultrasonographic Anatomy

From: Rantanen NW, McKinnon AO. Equine Diagnostic

Ultrasonography Williams and Wilkins Philadelphia, ”1998
Palmar Annular Ligament
Usually difficult to
identify unless
thickened
Superfical Digital Flexor Tendinitis
Deep Digital Flexor Tendonitis
 Suspensory ligament body
desmitis
Normal (for comparison) Affected limb
Suspensory branch desmitis
 Distal extremity Imaging

• Always image in two planes

transverse and longitudinal
• Image from palmar / plantar aspect
• Try to keep orientation consistent – label
images
 Summary: Objectives
+ Be able to identify a transverse and a longitudinal
image.

+ Be able to apply the anatomy of the distal

equine extremity to ultrasound images and
identify structures.

+ Questions?
Ultrasonographic Anatomy

From: Rantanen NW, McKinnon AO. Equine Diagnostic

Ultrasonography Williams and Wilkins Philadelphia, ”1998
 Midpastern

LATERAL
Transverse: slightly off to
lateral margin

Longitudinal
PROXIMAL

DORSAL
 DDFT
Lateral branch of
SDFT
Straight or superficial
sesamoidean ligament

Palmar aspect P1 Oblique or middle sesamoidean

ligament – (lateral aspect)

Effusion in tendon sheath

DDFT

PROXIMAL Straight or superficial

sesamoidean ligament

Palmar aspect of P1