Interactive Case Tutorial

 Review the history and signalment for the client  Evaluate the radiographs provided  Explore the interactive images and compare the answers given with your own interpretations. When you’ve clicked on the image, click the same spot again to make the label disappear.  Answer the questions regarding a diagnosis and recommendations  Review the radiologist’s findings

 Signalment: 8 year old Hanoverian gelding  History: evaluation of intermittent forelimb lameness first noted 1 year prior; grade 2-3/5 on left thoracic limb; 70% improvement with palmar digital nerve block  Study: distal left thoracic limb views

L FRONT L Normal distal phalanx Gas from nerve block Elongation of navicular Side bone New bone on navicular

L L Enlarged and abnormally shaped synovial invaginations Fragment at distal margin Slight irregularity of solar margin with enlarged vascular channel likely from stress remodeling New bone on navicular Medullary sclerosis with poor corticomedullary differentiation

 Provide a diagnosis based on your findings. Submit Moderate to severe left front navicular degeneration with avulsion fragments at the origin of the impar ligament Feedback Continue

 Provide your recommendation for this client. Submit Corrective shoeing Feedback Continue

 Corticomedullary differentiation of the navicular bone is decreased due to medullary sclerosis  Several synovial invaginations of the navicular bone are enlarged and abnormally shaped  At the medial and distal margin of the navicular bone are separate bone fragments with associated defects in the distal margin

 The patient also had less severe right front navicular degeneration  The front feet were trimmed and shod with six degree wedge EDSS shoes  Stall rest for 6-8 weeks after which controlled hand walking 5 minutes twice daily can be begun