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Distal limbs – carpus/tarsus and distally

image of Distal limbs – carpus/tarsus and distally
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Abstract

The following are some of the indications for radiography of the distal extremities: lameness that can be related to a distal extremity; pain on manipulation or palpation of a joint or region; unexplained or unresolved swelling; signs of joint laxity; postural abnormalities, such as hyperextension of a joint or angular limb deformity (valgus or varus malformation); and suspected immune-mediated joint disease. This chapter explains radiography and normal anatomy, alternative imaging techniques and abnormal imaging findings.

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Figures

Image of 16.2
16.2 (a) DPa view of a normal carpus of a mature dog. (b) DPa view of a normal carpus of a 2-month-old dog. (c) DPa view of a normal carpus of a mature cat. Acc = accessory carpal bone; C1 = first carpal bone; C2 = second carpal bone; C3 = third carpal bone; C4 = fourth carpal bone; DP = distal phalanx of first digit; Mc (1–5) = individual metacarpal bones; PP = proximal phalanx of first digit; R = radius; Rc = radial carpal bone; Rc (1–3) = three separate ossification centres that fuse to form the radial carpal bone; Re = radial epiphysis; Rm = radial metaphysis; S = sesamoid bone in the abductor pollicis longus muscle; St = styloid process of the ulna; U = ulna; Uc = ulnar carpal bone; Um = ulnar metaphysis.
Image of 16.3
16.3 PID view of a normal pes of a mature cat. 1–8 = individual plantar metatarsophalangeal sesamoid bones; A = tarsometatarsal joint; B = metatarsophalangeal joint; C = proximal interphalangeal joint; D = distal interphalangeal joint; Mt2 = second metatarsal bone; Mt3 = third metatarsal bone; Mt4 = fourth metatarsal bone; Mt5 = fifth metatarsal bone; P1 = first phalanx; P2 = second phalanx; P3 = third phalanx.
Image of 16.4
16.4 (a) PID view of a normal tarsus of an immature dog. (b) PID view of a normal tarsus of a 2-month-old dog. (c) PID view of a normal tarsus of an immature cat. C = calcaneus; CaQ = calcaneoquartile joint; CeD = centrodistal joint; F = fibula; FT = fibular tarsal bone; LM = lateral malleolus; MM = medial malleolus; T = tibia; T1 = first tarsal bone; T2 = second tarsal bone; T3 = third tarsal bone; T4 = fourth tarsal bone; Tc = central tarsal bone; TCa = talocalcaneal joint; TCe = talocentral joint; TCr = tarsocrural joint; TMt = tarsometatarsal joint; TT = tibial tarsal bone.
Image of 16.5
16.5 ML view of a normal carpus of a mature cat. Acc = accessory carpal bone; Distal c = distal row of carpal bones; DP = distal phalanx of first digit; Mc1 = first metacarpal bone; Mcs = metacarpal bones; PP = proximal phalanx of first digit; R = radius; Rc = radial carpal bone; Re = radial epiphysis; St = styloid process of the ulna; U = ulna; Uc = ulnar carpal bone.
Image of 16.6
16.6 ML view of a normal tarsus of an immature dog. C = calcaneus; CaQ = calcaneoquartile joint; CeD = centrodistal joint; F = fibula; FT = fibular tarsal bone; MT1 = first metatarsal bone; MTs = metatarsal bones; T = tibia; Tc = central tarsal bone; TCe = talocentral joint; TCr = tarsocrural joint; TMt = tarsometatarsal joint; TT = tibial tarsal bone.
Image of 16.7
16.7 ML view of a normal manus of a mature cat. DP = distal phalanx; ds = dorsal metacarpophalangeal sesamoids; Mc1 = first metacarpal bone; Mcs = metacarpal bones; P1 = first phalanx; P2 = second phalanx; P3 = third phalanx; PP = proximal phalanx; ps = palmar metacarpophalangeal sesamoids.
Image of 16.8
16.8 PIL-DMO view of a canine tarsus. In this image the plantaromedial and dorsolateral aspects of the hock joint are visualized.
Image of 16.9
16.9 DL-PaMO view of a normal carpus of a mature dog. In this image the dorsomedial and palmarolateral aspects of the carpus are visualized.
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16.10 PIM-DLO view of a canine tarsus. In this image the plantarolateral and dorsomedial aspects of the hock joint are visualized.
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16.11 DM-PaLO view of a normal carpus of a mature dog. In this image the dorsolateral and palmaromedial aspects of the carpus are visualized.
Image of 16.12
16.12 ML flexed view of a canine hock. Adhesive tape is used to hold the tarsocrural joint in a fully flexed position. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 16.13
16.13 ML extended view of a canine tarsus. Adhesive tape is used to stabilize the hock in the extended position. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 16.14
16.14 DPa views of a canine carpus. (a) Neutral view. There appears to be rotation of the distal row of carpal bones and opening of the medial aspect of the intercarpal articulation. (b) Stress applied to the medial aspect of the joint depicting intercarpal rotation and laxity.
Image of 16.15
16.15 Set-up for the application of stress tarsal views. The tarsus is stabilized by adhesive tape. (a) Maximum stress is applied to the medial (M) aspect of the tarsus. (b) Maximum stress is applied to the lateral (L) aspect of the tarsus. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 16.16
16.16 ML radiograph of the digits. The second and fifth digits have been taped in the splayed position to enable all phalanges to be seen individually.
Image of 16.17
16.17 A juvenile dog with a transverse mid-diaphyseal fracture of P2. (a) ML view of a splayed toe radiograph. Arrow denotes the fracture. (b) PID view. Note that the phalangeal fracture is not visible in this view. (Courtesy of Mountains Animal Hospital)
Image of 16.18
16.18 DPI flexed skyline view of the tarsocrural articulation. (a) Positioning. The hocks of the dog are elevated on a box or block of sponge. Another sponge is inserted between the hocks to separate them and the stifles are taped together to ensure a symmetrical dorsoplantar view. The pedes are angled approximately 15 degrees from the primary X-ray beam, which is centred on the tarsocrural joint. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (b) Radiograph of this view.
Image of 16.19
16.19 Carpal radiographs of two different dogs. The arrow points to the sesamoid bone in the tendon of the abductor pollicis longus muscle. (a) DPa view. (b) DM-PaLO view.
Image of 16.20
16.20 Tarsal radiographs in a dog depicting the two sesamoid bones on the plantar surface of the tarsometatarsal articulation. (a) PID view. The black arrows point to the intra-articular tarsometatarsal bone, which is medially located. The white arrows point to the lateral plantar tarsometatarsal bone. (b) ML view. One of the plantar tarsometatarsal sesamoids is defined by the arrowheads.
Image of 16.21
16.21 Dorsal and palmar/plantar metacarpo/tarsophalangeal sesamoids in the dog. (a) ML view. The white arrow points to the single dorsal sesamoid bone located in the extensor tendons. The white arrowheads point to the palmar (plantar) sesamoids. (b) DPa/PID view. The palmar/plantar sesamoid bones are numbered from medial to lateral. (c) Close-up image of (b) demonstrating the margins of the paired palmar (plantar) sesamoid bones (arrowheads) and the single dorsally located sesamoid (arrowed).
Image of 16.22
16.22 PID view of the pes of a cat with supernumerary digits. There were six digits on each foot. (Courtesy of Forest Animal Hospital)
Image of 16.23
16.23 PID view of a kitten with congenital absence of the medial pair of digits and their adjacent tarsal bones. (Courtesy of the Enfield Veterinary Hospital)
Image of 16.24
16.24 PID view of the tarsus of a Bernese Mountain Dog. The arrows show the additional bones that are fused to the central tarsal bones. The arrowheads point to a paired dewclaw and a fused pair of first metatarsal bones. (Courtesy of C Bailey)
Image of 16.25
16.25 ML view of the thoracic limbs of a dog with brachycarpometacarpalia. Note that the bones of the right thoracic limb ® are smaller and shorter than those of the left thoracic limb (L).
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16.26 DPa view. Mach bands are seen where two metacarpal bones are superimposed (arrowed).
Image of 16.27
16.27 A 4-month-old Irish Wolfhound with a comminuted fracture of the calcaneus. (a) ML and (b) PlD radiographic views showing a small fracture at the base of the calcaneus (arrowhead) and subtle lucencies within the complicated opacity of articulation of the calcaneus and the talus. (c) Parasagittal and (d) dorsal plane bone window CT images of the tarsus. The tibia (T), fibula (F), calcaneus (C) and fourth tarsal bone (T4) are identified. Note the number of irregular lucent fracture lines separating the comminuted fragments in the dorsal and medial aspect of the base of the calcaneus. There is also an incidental conical lucent focus of a small retained endochondral cartilage core extending proximally from the distal physis of the tibia (arrowed). (Courtesy of DA Lidbetter)
Image of 16.28
16.28 Parasagittal T2W MR image of the normal carpus of a Coon Hound. The accessorioquartile ligament (small arrowhead) is evident, extending from the accessory carpal bone (Ca) dorsodistally to the palmar margin of the fourth carpal bone (C4). The accessoriometacarpal (arrowed) and palmar carpometacarpal (large arrowhead) ligaments are also evident, extending distally to the palmar metacarpal bones (M4). (Courtesy of KA Johnson)
Image of 16.29
16.29 A 4-year-old dog with chronic pelvic limb lameness due to a foreign body (thorn). (a) ML view of pes showing soft tissue swelling on the dorsum of the distal metatarsus (arrowhead). (b) Parasagittal and (c) transverse STIR MR images demonstrate a linear hypointense focus (arrowed) (the foreign body) surrounded by hyperintense inflammatory tissue and fluid on the plantar aspect of the distal metatarsus. (Courtesy of PR Gavin and The University Veterinary Centre, Sydney)
Image of 16.30
16.30 Soft tissue phase scintigram of the extremities of a dog using technetium-99. Relative hypovascularity is present in the right extremity, which was involved in a degloving injury.
Image of 16.31
16.31 A middle-aged Cattle Dog cross-breed with hyperextension of both carpi and tarsi.
Image of 16.32
16.32 ML tarsal view of a dog. There is thickened soft tissue proximal to and around the calcaneus (arrowed). Within the thickened soft tissue foci of calcification are evident; these changes represent a chronic tendinopathy of the tendons of insertion of the Achilles tendon. (Courtesy of Petersham Veterinary Hospital)
Image of 16.33
16.33 DPI view of a cat tarsus. A fine line of soft tissue calcification (arrowed) is the result of avulsion of the origin of the medial collateral ligament from the medial malleolus. (Courtesy of Sylvania Veterinary Hospital)
Image of 16.34
16.34 DPa view of digits of a dog. An enthesophyte on the axial surface of a metacarpal bone (arrowed) signifies a chronic injury to the medial metacarpophalangeal collateral ligament of the manus. (Courtesy of Coreen Avenue Veterinary Clinic)
Image of 16.35
16.35 Feline carpus with ligamentous injuries. (a) DPa view looks normal. (b) DPa view illustrating medial instability induced by stress radiography. (c) ML view with palmar instability induced by stress radiography. (Courtesy of the Kippax Veterinary Hospital)
Image of 16.36
16.36 Comminuted fracture of the central and fourth tarsal bones of a racing Greyhound. (a) ML view. (b) PID view.
Image of 16.37
16.37 PID view of the tarsus of a racing Greyhound. There is mineralization within soft tissues on the medial aspect of the joint, representing avulsion of the medial collateral ligament of the joint.
Image of 16.38
16.38 DPa views of the left metacarpal region of a racing Greyhound, trained and raced running in an anticlockwise direction. (a) Note the increased osseous opacity in the diaphysis of the fifth metacarpal bone (Mc5; arrowheads), which represents a region of stress osteitis in the left thoracic limb. (b) A comminuted fracture of Mc5. (Courtesy of Gladesville Veterinary Hospital)
Image of 16.39
16.39 Ultrasonogram of the Achilles tendon (between + and x) imaged in sagittal and transverse planes. The left tendon (L) appears normal in both planes. Fibres within the tendon appear as hyperechoic linear echoes in the sagittal plane and stippled echogenic foci in the transverse plane. The right tendon ® is thickened and its margins are less well defined. There are fewer linear echoes in the sagittal plane and stippled foci are less echoic in the transverse plane, indicative of damaged (torn) fibres. CALC = calcaneus.
Image of 16.40
16.40 Carpal flexural deformity in a cross-bred puppy. (a) Side view. (b) Front view.
Image of 16.41
16.41 PID view of a dog with OCD of the medial ridge of the talus. Note the osteochondral fragmentation of the medial trochlear ridge of the talus (arrowed).
Image of 16.42
16.42 Osteochondral fracture of the lateral ridge of the tibial tarsal bone (arrowed). (a) PI15°M-DLO view. (b) Flexed ML view. (Courtesy of The Animal Referral Hospital)
Image of 16.43
16.43 An expansile bone lesion (osteochondroma) arising from the mid-diaphysis of Mc5 in a dog. The lesion has a well defined margin and trabeculated texture. (a) ML view. (b) DPa view. (Courtesy of The Valley Veterinary Hospital)
Image of 16.44
16.44 Scottish Fold cats with osteochondral dysplasia. (a) DPa view of the distal limb. Ankylosing periarticular changes are present involving the bones of, and adjacent to, the carpus. The distal joints also appear swollen. (b) ML view of the tarsus with ankyloses of the intertarsal and tarsometatarsal joints.
Image of 16.45
16.45 Metaphyseal osteopathy in a dog with metaphyseal bone necrosis (white arrows) adjacent to the normal physes (black arrows). (a) ML view of distal and radius and ulna. (b) DPa view of distal metacarpal bones.
Image of 16.46
16.46 German Shepherd Dog littermates. The dog on the left has normally formed and straight legs. The dog on the right has chondrodystrophoid malformation of both thoracic limbs.
Image of 16.47
16.47 Craniocaudal/DPa view of a thoracic limb of a chondrodystrophoid dog with short ulna syndrome. Valgus displacement of the carpus and manus is evident as a result of angulation of the distal radius and loss of lateral stability, which is usually provided by the styloid process of the ulna.
Image of 16.48
16.48 (a) DPa view. Fragmentation of the palmar metacarpophalangeal sesamoids numbers 2 and 7 (arrowed) is evident on this radiograph of a manus. (b) A scintigraphic study of the same dog shows increased activity in the distal end of the third metacarpal bone, without demonstrable increase in isotope uptake in the fragmented sesamoid bones. Interpretation: healing callus or osteitis. (Courtesy of Gladesville Veterinary Hospital)
Image of 16.49
16.49 DPa view of the carpus of a small dog. Cyst-like lucencies (arrowed) and subchondral erosion (arrowhead) indicate an erosive arthropathy. (Courtesy of the Department of Veterinary Clinical Science, University of Bristol)
Image of 16.50
16.50 DPa view of an erosive polyarthropathy due to rheumatoid arthritis in a dog showing advanced destruction of the metacarpophalangeal joints and, to a lesser extent, the interphalangeal joints. (Courtesy of Hornsby Veterinary Hospital)
Image of 16.51
16.51 Feline progressive polyarthropathy. In this cat, soft tissue swelling surrounds the carpus. Periosteal proliferation is noted on the distal radius, the accessory carpal bone and the proximal ends of the metacarpal bones. (a) DPa view. (b) DL-PaMO view. (Courtesy of The University Veterinary Centre, Sydney)
Image of 16.52
16.52 Chronic progressive polyarthropathy in the tarsus of a cat. Soft tissue swelling is present around the tarsus and periosteal new bone formation is noted on the distal tibia, calcaneus and distal rows of tarsal bones as well as the proximal ends of the metatarsal bones. (a) PID view. (b) ML view. (Courtesy of The University Veterinary Centre, Sydney)
Image of 16.53
16.53 DPa view of osteopenia in a dog with nutritional secondary hyperparathyroidism. In the metaphyseal zones new bone formation continues, resulting in relative increased bone opacity, but elsewhere, under-mineralization and reduction in cortical thickness is evident due to active bone resorption. (Courtesy of The University Veterinary Centre, Sydney)
Image of 16.54
16.54 DPa view of the expansion of physeal cartilage (arrowed and arrowheads) and malformation of the zones of calcification. Provisional ossification of the metaphyses is evident in the distal radius and ulna and in the distal metacarpal physeal regions in this dog with rickets.
Image of 16.55
16.55 D15°M-PaLO view of a dog with bacterial septic arthritis, which has eroded the distal margin of the radial carpal bone (arrowed). (Courtesy of Vineyard Veterinary Hospital)
Image of 16.56
16.56 DPa view of a focal region of increased bone opacity and expansion by periosteal proliferation in the distal metacarpus and in P1 of the digit of a dog. This was caused by bacterial osteomyelitis. (Courtesy of Vineyard Veterinary Hospital)
Image of 16.57
16.57 PID view of osteodestruction of P1 and P2 of the digit of a dog. There is soft tissure mineralization around these bones caused by fungal osteomyelitis. (Courtesy of Baulkham Hills Veterinary Hospital)
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16.58 DPa view of an unstructured mixed pattern of lucency and opacity in an expanded metacarpal bone caused by a pyogranulomatous osteomyelitis. (Courtesy of Sylvania Veterinary Hospital)
Image of 16.59
16.59 (a) ML splayed toe view and (b) DPa view of soft tissue swelling surrounding P2 and P3 of the fourth digit of a dog with subungual squamous cell carcinoma. P3 is osteolucent and, unusually, has not lost the nail, as commonly occurs in such cases. (Courtesy of Winmalee Veterinary Hospital)
Image of 16.60
16.60 DPa view of digital soft tissue swelling and destruction of P3 of the second digit in a dog with subungual neoplasia. New bone proliferation is present on P2 of the second digit. (Courtesy of Bradbury Veterinary Clinic)
Image of 16.61
16.61 Lung–digit syndrome in a cat. (a) D15°M-PaLO view of a distal thoracic limb. Soft tissue swelling surrounds P2 and P3 of the third digit, representing a metastatic neoplasm. (b) Lateral thoracic radiograph. A well defined soft tissue mass is present in the left caudal lung of this cat. It was a primary bronchogenic carcinoma.
Image of 16.62
16.62 Lucent foci of bone destruction present in the distal radius, ulna, and in the ulnar and radial carpal bones of a dog with synovial sarcoma. (a) DPa view. (b) Pa15°M-DLO view. (Courtesy of Allpets Veterinary Hospital)
Image of 16.63
16.63 PID view of a focal region of increased opacity of cancellous bone (arrowed) at the distal end of a metacarpal bone in a young dog with panosteitis. (Courtesy of The University Veterinary Centre, Sydney)
Image of 16.64
16.64 DPa view of new bone in a palisade configuration seen on the metacarpal bones of a dog with hypertrophic osteopathy.
Image of 16.65
16.65 Soft tissue mineralization on the plantar surface of the tarsus of a dog with calcinosis circumscripta. (a) ML view. (b) PID view. (Courtesy of The University Veterinary Centre, Sydney)
Image of 16.66
16.66 ML view showing the presence of disuse osteopenia distal to the healing tibial fracture in a dog.

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