Introduction: Metacarpal exostosis-suspensory adhesions and impingement are commonly implicated
in lameness. Visualization and surgical management has been described in textbooks
but there is little reporting of clinical cases. This study aims to highlight agreement
between surgical and ultrasonographic findings.
Case Descriptions and Results: A 14-year-old mare with a right MCIV exostosis. There was a mild-to-moderate right
forelimb lameness. Radiographs demonstrated an active exostosis in the middle third
of MCIV. Ultrasonography highlighted suspensory impingement. Surgery was performed.
Impingement and adhesions were identified. MCIV was amputated proximally, and the
suspensory freed. The horse received standardized postoperative care and made excellent
postoperative progress.
An 8-year-old gelding with a left MCII exostosis associated with the midportion of
the suspensory ligament. There was a mild-to-moderate forelimb lameness, localized
to the feet and partially the exostosis. Ultrasonography demonstrated an exostosis-suspensory
adhesion, with a focal tear of the ligament. At surgery, there were adhesions between
the suspensory midbody and the exostosis. The adhesions were transected and MCII amputated
proximally. Postoperative management was as above. The horse returned to work, but
lameness recurred 14 months postoperatively.
An 11-year-old gelding with a left MCIV exostosis. There was no significant lameness.
Radiographs demonstrated proliferative exostosis at the proximal-mid MCIV. Ultrasonography
demonstrated suspensory impingement. Surgery demonstrated exostosis-suspensory and
lateral palmar metacarpal nerve adhesions. These were transected and MCIV amputated.
Rehabilitation postoperatively was as above. The horse made a full return to work.
Discussion/Conclusion: These cases demonstrate a strong correlation between ultrasonographic and the surgical
findings. The follow-up is encouraging, with a relatively fast return to work.
