La gaine carpienne chez le cheval : comment améliorer les techniques diagnostiques de base actuelles?
Objective: (1) To assess the effect of carpal sheath anaesthesia on skin sensitivity of the distal forelimb and to determine potential locations for desensitisation of palmar nerves. (2) To investigate the use of a needle arthroscope for diagnostic tenoscopy of the carpal sheath in standing horses. Study design: Experimental ex vivo and in vivo studies. Animals: Cadaveric limbs (n=20+6) and live horses (n=8+6). Methods: (1) Mechanical nociception of the distal forelimb was measured with a dynamometer on 8 horses between t0 and t180mn after intrathecal anesthesia (mepivacaine). Twenty cadaveric limbs were prepared and dissected transversally or longitudinally. (2) Needle and regular arthroscopes were compared during carpal sheath tenoscopy of 6 cadaveric limbs. Then, standing carpal sheath tenoscopy was performed in 6 sedated healthy horses with the needle arthroscope.  Results: (1) Six out of 8 horses were completely desensitized on both heel bulbs. Cadaveric specimens revealed close proximity between the sheath and palmar nerves at 2 possible diffusion sites identified. (2) Needle arthroscopy allowed thorough visualization of the proximal region of the carpal sheath in cadaveric limbs and standing horses (6/6). However, remaining flexor tendons tension limited visualization of the superficial digital flexor tendon in 4/6 of horses. Conclusion: (1) Carpal sheath anaesthesia should be interpreted within 15min post-injection and perineural or articular blocks distal to the carpus should be delayed for more than 3 hours post-carpal sheath anesthesia. (2) Standing carpal sheath tenoscopy allows a safe and thorough evaluation of the proximal region of the sheath, offering an alternative diagnostic technique.
Horse Carpal sheath Anaesthesia Tenoscopy