Case Study 
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RF - Accessory check ligament - proximalHistory: 
Nine year old Arabian mare that presented to Animal Imaging for an MRI of the right front carpal region.  The horse has been intermittently lame for two months.  Swelling has been noted above and below the carpus on the lateral aspect in the past.  The swelling seems to respond to poultices, ice, etc., but without bandaging, the swelling may reappear.  On a recent lameness exam, no improvement was noted after blocking up through the origin of the suspensory.  An ulnar nerve block alleviated the lameness 85 percent.  Ultrasound revealed a distended carpal canal with possible hemorrhage.  Radiographs of the carpus were within normal limits.  Soundness was achieved by blocking the flexor sheath.
RF - Accessory check ligament - DistalMRI Findings:  Multiple sequences show the presence of a rupture and abnormality to the accessory ligament of the superficial digital flexor, otherwise known as the superior check ligament.  This has an abnormal hyperintensity, lack of integrity, and marked fluid accumulation in assocation.  The ligament is damaged from its origin near the medial aspect of the distal radius all the way to the insertion and blending with the superficial digital flexor tendon.  A large amount of fluid present within the tendon sheath exists from proximal to the carpus to the distal extent of the sheath.   
LF - Normal accessory check ligament 
Impressions and Recommendations:
The primary pathology is the tearing of the accessory check ligament of the superficial digital flexor tendon from its union with the superficial digital flexor distal all the way up to its insertion on the caudal medial aspect of the radius.  Since this ligament is often transected in managing superifical digital flexor injuries, the pain is likely due to the marked effusion in the sheath.  Consider tenoscopic lavage or debridement of that region and extended controlled athletic rest.
Animal Imaging 
Animal Imaging is a veterinary referral diagnostic center in Irving offering MRI, Scintigraphy, Radiology, Fluoroscopy and Ultrasound for companion animals and equine patients. 

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Jake Hersman, DVM            Robert Cole, DVM, DACVR           Rita Echandi, DVM, DACVR
Managing Partner                 Imaging Director                              (972) 869-2180
(972) 869-2180                     (972) 869-2180                             
Susan Willenbrock
Office Manager
(972) 869-2180