See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/313276002

Clinical findings, treatment, and outcome in 11 dairy heifers with breakdown

injury due to interosseous medius muscle rupture: NUSS et al.

Article in Veterinary Surgery · February 2017

DOI: 10.1111/vsu.12610

CITATIONS READS

3 478

3 authors, including:

Karl Nuss Hans Geyer

University of Zurich University of Zurich
267 PUBLICATIONS 1,813 CITATIONS 220 PUBLICATIONS 1,123 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Histological and physical assessement of poor hoof horn wuality in Lipizzaner horses and a therapeutic trial with biotin and a Placebo View project

Imaging modalities, diagnostics View project

All content following this page was uploaded by Hans Geyer on 18 January 2018.

The user has requested enhancement of the downloaded file.

Received: 13 April 2016
| Accepted: 5 September 2016
DOI 10.1111/vsu.12610

ORIGINAL ARTICLE

Clinical findings, treatment, and outcome in 11 dairy heifers with

breakdown injury due to interosseous medius muscle rupture

Karl Nuss1 | Jasmin Boppart1 | Hans Geyer2

1
Department for Farm Animals, Abstract
University of Z€urich, Switzerland
2
Institute of Veterinary Anatomy, Objective: To describe the diagnosis, treatment, and prognosis of fetlock breakdown
Vetsuisse Faculty, University of due to interosseus medius muscle rupture in cattle.
Z€urich, Switzerland Study Design: Retrospective clinical study.
Correspondence Animals: Dairy heifers with unilateral or bilateral interosseus medius muscle rupture
Karl Nuss, Department for Farm (n 5 11).
Animals, Vetsuisse Faculty
University of Zurich,
Methods: Breakdown injury due to rupture of the interosseus medius muscle was
Winterthurerstrasse 260, 8057 documented clinically, radiographically, and ultrasonographically. Breakdown was
Zurich, Switzerland. bilateral in 4 heifers (3 in forelimbs, 1 in hind limbs) and unilateral in 7 (all hind
Email: [email protected] limbs). One heifer with severe bilateral hind limb breakdown was slaughtered and
the remaining 10 were treated by transfixation pin cast (1 heifer), box rest (n 5 2),
and/or a cast and splint (7).
Results: Hyperextension of the fetlock and hyperflexion of the proximal interphalan-
geal joints during weight bearing were characteristic for interosseus muscle breakdown.
Ultrasonographically, the origin and body of the interosseus muscle and the branches
to the sesamoid bones were primarily affected by the rupture. Conservative treatment
was successful (used for their intended purpose) in 8 of 9 heifers with a median life-
span of 32 months after discharge from the clinic (range 6-83).
Conclusion: Rupture of the interosseus medius muscle in young cattle may be more
common than previously suggested in the literature. Imaging with ultrasound allowed
more detailed localization of lesions of the musculo-tendinous structure. Interosseus
medius muscle rupture had a favorable prognosis when treated conservatively in
these heifers.

1 | INTRODUCTION suspensory apparatus of the loaded limb during the stance

phase is released when the limb is advanced.3
In cattle, diseases of the suspensory apparatus of the fetlock Even though each of the paired digits has a separate
generally have received little attention in the literature.1,2 The interosseus muscle, they are unanimously referred to in the
interosseus muscle (M. interosseus medius) in cattle can be singular.4-7 The interosseus medius muscle of the forelimbs
compared with the suspensory ligament in horses, but is named (Figure 1) and hind limbs has a similarly complex and multi-
differently because of its relatively large muscle content. It con- layered structure. Monographs describing the structure, com-
stitutes an anatomically complex structure (Figure 1) that func- position, and functions of the interosseus muscle in cattle
tions primarily as the suspensory apparatus of the fetlock and have been published.3,8 In the forelimb, it originates as a thin
digits, preventing overextension of the fetlock joint and over- tendinous plate at the deep palmar carpal ligament and at the
flexion of the proximal interphalangeal joints. During locomo- proximal palmar aspect of the metacarpal bones, and then
tion, the energy stored in the stretched components of the increases in thickness distally. In the hind limb, the origin is

Veterinary Surgery 2017; 46: 197-205 wileyonlinelibrary.com/journal/vsu V

C 2017 The American College of Veterinary Surgeons | 197
198 | NUSS ET AL.

FIGURE 1 Schematic 3D reconstruction of the interosseus medius muscle in cattle showing the different parts of this complex
and multilayered structure

analogous. It starts at the plantar region of the tarsus and at eral reports in the literature describing the different echoge-
the proximal plantar aspect of the metatarsal bones; however, nicity patterns during ultrasound examination resulting from
exact differentiation of the fibers at the origin of the structure tendinous tissue being interspersed with muscle tissue in cat-
is difficult. In the mid-metacarpus/tarsus, the interosseus tle10,11 and horses.12 The interosseus muscle contains a rela-
muscle splits into an axial part and 2 abaxial parts. The axial tively large amount of muscle tissue in young cattle but very
part forms 2 branches that insert at the 2 axial sesamoid little in older cattle.5,6
bones, and 2 axial (interdigital) extensor branches. The abax- In the last 100 years, only a few cases of interosseus
ial parts of the interosseus medius muscle form strong muscle lesions have been described in cattle in the accessible
branches to their respective abaxial sesamoid bones. They literature. One case was the result of trauma incurred during
then continue dorsally as flat branches and unite with the a fight with another animal, one was associated with heavy
interdigital extensor branches at the insertion of the proper work in a draft animal, and one occurred in a heifer on pas-
extensor tendons of the respective proximal interphalangeal ture.1,2,13 In contrast to cattle, damage to the interosseus
joint.6,7 In addition, a strong tendinous ligament connecting muscle—named suspensory ligament—is very common in
and supporting the superficial digital flexor tendon branches horses and has been researched extensively.12,14,15 Several
off the axial part of the interosseus muscle. This ligament is categories of suspensory ligament injury are recognized in
commonly referred to as the accessory ligament (Figure 1), horses, including avulsion of the origin of the ligament,
but is also known as the ligamentum intertendineum. The proximal suspensory desmitis, desmitis of the body or
accessory ligament and the superficial digital flexor tendon branches of the suspensory ligament, sesamoiditis, fracture of
unite at the level of the sesamoid bones to form a cuff the proximal sesamoid bones, and desmitis of the distal sesa-
around the deep flexor tendon referred to as the manica moidean ligaments.16,17 Injuries causing complete rupture of
flexoria. The accessory ligaments and the superficial digital the interosseus muscle/suspensory ligament are referred to as
flexor tendons insert together at the flexor tuberosity of the breakdown injuries.
middle phalanges.5-7,9 Because interosseous medius muscle lesions causing
The interosseus medius muscle of both cattle and horses lameness and breakdown injuries may be more common in
is primarily a tendinous structure but also contains relatively cattle than generally assumed, the purpose of this study was
large amounts of muscle, as well as fat, tissue. There are sev- to describe the clinical signs, diagnostic procedures,
NUSS ET AL.
| 199

treatment, and prognosis of interosseus medius muscle rup- to the dorsal aspect of the proximal interphalangeal joint and
ture in cattle. the sesamoid bones to prevent pressure sores. The entire
treatment schedule lasted a total of 6 months in the last 6
2 | MATERIALS AND METHODS cases. The purpose of the cast, which was changed every 3-4
weeks, was immobilization of the lower limb during the first
The medical records from 2004-2015 were searched for cat- 3 months of stall rest, after which time a splint was applied
tle with a diagnosis of breakdown injury due to rupture of for another 4 weeks. The remaining 2 months of treatment
the interosseus muscle. The search yielded 11 young cattle served to facilitate remodeling of the affected ligaments and
with acute unilateral or bilateral hyperextension of the fet- the cattle were maintained in a box stall with the recommen-
lock joint. Five of these cases were seen in a single year dation to limit exercise to hand walking. Long-term results
(2010), prompting this retrospective study. Three cases were in terms of productive life span, number of calves produced,
then followed prospectively. All cattle underwent clinical, recurrence, and reason for culling were obtained from the
orthopedic, radiographic, and ultrasonographic examinations, national livestock database or by telephone interview of the
but hematological and biochemical analyses were not done. owner (Table 1). Evaluation of data was descriptive.
Latero-medial and dorso-palmar/plantar radiographs were
taken in standing or recumbent cattle. Ultrasonography using 3 | RESULTS
a 5-10 MHz linear probe was carried out in recumbent cattle
affected bilaterally and in standing cattle when only 1 limb There were 10 Brown Swiss and one Holstein-Friesian dairy
was affected and standing was less painful. The entire inter- heifers with a mean age of 11 months (median, 10 months;
osseus muscle was examined in transverse and longitudinal range 8-15). The caseload of lame cattle in the clinic during
views. For examination of the 2 accessory ligaments and the the study period consisted of 66% Brown Swiss, 27%
branches to the 4 sesamoids, separate longitudinal views Holstein-Friesian, and 7% other breeds. Eight heifers were
were necessary. In the transverse view, only the axial sesa- from tie stall-operations with outdoor yards and pasturing,
moid branches could be imaged together with the accessory and 3 were from free stall-operations with an outdoor yard.
ligaments and the flexor tendons. For the abaxial branches, In all cases, acute lameness associated with abnormal limb
separate transverse views were necessary. The thin interdigi- position was noticed after a stay in the outdoor yard or after
tal and abaxial branches could not be differentiated clearly pasture turnout, often in April or early November (3 heifers
and consistently. each).
All treated heifers received ketoprofen (3 mg/kg IV once On clinical examination, the heifers favored the affected
daily for at least 3 consecutive days) and were either main- limb or assumed an abnormal posture when both limbs were
tained in an individual box stall with straw bedding appropri- affected (Figure 2A). The cattle were reluctant to stand and
ate for their size or stabled in a tie stall on soft rubber mats spent most of the time lying down except when eating. Some
covered with 10 cm of straw bedding. The treatment protocol preferred to eat lying down. At the walk, weight was borne
evolved over time as our ability to assess the severity and by the affected limb(s), albeit with hyperflexion of the fet-
extent of the suspensory apparatus damage by ultrasonogra- lock joint. Lameness scores were estimated at 3-4/5
phy improved. The first case, a calf with bilateral interosseus (0 5 sound; 5 5 non-weight bearing), but was difficult to
medius muscle rupture in the forelimbs, was treated with grade in bilaterally affected animals. In standing cattle, there
transfixation casts. Two other cattle seen early in the study, was considerable painful hyperextension of the fetlock joint,
one affected bilaterally, were treated conservatively by with the dewclaws nearly contacting the ground, and a
means of stall rest for 6 weeks (Table 1). Thereafter, the noticeable break in the digital axis at the proximal interpha-
treatment protocol underwent gradual standardization and a langeal joint (Figure 2B). Because of hyperextension of the
stepwise therapeutic management regime using fiberglass fetlock joint and flexion of the proximal interphalangeal joint
casts and splints was established. In the forelimbs, a fiber- during weight bearing, the first phalanx assumed a position
glass cast that included the foot and the carpus (full limb cast almost parallel to the ground and the middle phalanx was
up to the elbow joint) was initially applied, and in the hind almost vertical to the ground. This characteristic leg posture
limb, a half limb cast that extended to just below the tarsus of heifers with interosseus muscle rupture was consistently
was applied. The fetlock and proximal interphalangeal joints accompanied by a spindle-shaped swelling at the palmar/
were fixed in flexion thereby aligning the metacarpal/tarsal plantar aspect of the fetlock joint.
and foot axes and creating mild elevation of the heels. In the Systematic palpation of the lower leg elicited a pain
last 4 cases of the series, the heels were additionally padded response that was most pronounced at the palmar/plantar
with a wooden or silicone wedge that was incorporated into aspect of the fetlock region. Bilateral interosseus muscle rup-
the cast to provide better footing. Extra padding was applied ture occurred in the forelimbs in 3 heifers and in the hind
200 | NUSS ET AL.

TABLE 1 Chronological summary of findings of 11 heifers with interosseus muscle rupture

Age at Lifespan after

rupture discharge
# Breed (months) Limb(s) Treatment Outcome (months)
1 Brown Swiss 12 L/R front Transfixation pin cast Persistently infected N/A
with BVDV,
euthanasia

2 Brown Swiss 9 R hind Splint 4 weeks, box rest 6 Good 83

weeks

3 Brown Swiss 15 R hind Box rest 6 weeks Delayed healing, 8

persistent lameness

4 Brown Swiss 13 L/R front Box rest 6 weeks Good 53

5 Brown Swiss 9 Left hind Cast 6 weeks, splint 4 Good 68a

weeks, box rest 4 months

6 Brown Swiss 13 L/R front Cast 6 weeks, splint 4 Good 68a

weeks, box rest 4 months

7 Brown Swiss 10 Left hind Cast 6 weeks, splint 4 Good 30a

weeks, box rest 4 months

8 Holstein-Friesian 13 Left hind Cast 6 weeks, splint 4 Good 32

weeks, box rest 4 months

9 Brown Swiss 8 R/L hind None Slaughter N/A

10 Brown Swiss 8 R hind Cast 6 weeks, splint 4 Good 24

weeks, box rest 4 months

11 Brown Swiss 9 R hind Cast 6 weeks, splint 4 Good 6a

weeks, box rest 4 months
Abbreviations: R 5 right; L 5 left; BVDV 5 bovine virus diarrhea virus.
a
Alive at the time of report.
Good outcome 5 heifer kept for intended purpose, slaughter not related to breakdown injury.

limbs of one other. The remaining 7 heifers had unilateral A striking sign of interosseus medius muscle rupture on
interosseus muscle rupture in a hind limb. ultrasonograms of all heifers was the thickened and wavy
Radiographs showed soft tissue swelling at the fetlock appearance of the branches to the proximal sesamoid bones
(Figure 3), which was diffuse at the palmar/plantar aspect compared with a normal limb (Figures 4 and 5). These
and characterized by a typical bulge dorsally. The most branches usually were less echoic and the characteristic
noticeable radiographic finding was sinking of the proximal tendinous structure was indistinct compared with normal
sesamoid bones (and dewclaws). In the weight-bearing limb, branches. Ultrasonographically, anechoic areas indicating
the sesamoid bones were seen distal to the metacarpal/tarsal seroma or hematoma formation were seen from the origin of
condyles in alignment with the long axis of the bones instead the interosseus muscle at the metacarpal/metatarsal bones to
of palmar/plantar to the condyles of the metacarpal/metatar- just proximal to the sesamoid bones and mainly involved the
sal bones (Figure 3). In some cases, the extensor process of body of the interosseus muscle and the 4 branches to the ses-
the horizontally-positioned first phalanx bordered directly on amoid bones (Figure 5B), but were also visible around the
the epiphysis of the metacarpal/metatarsal bone, but avulsion accessory ligament and the superficial digital flexor tendon.
fractures were not seen. Because of flexion of the proximal Ten of the 11 cases were treated by various regimes (Fig-
interphalangeal joints, the condyles of the first phalanges ure 6) as described above. Nine were discharged from the
projected markedly beyond the joint surface of the middle clinic and 8 had a good long-term outcome regardless of the
phalanges. husbandry system. The mean post-treatment productive life
NUSS ET AL.
| 201

F I G U R E 2 A 13-month-old Brown Swiss heifer (#4; Table 1) with bilateral interosseus medius muscle rupture (breakdown
injury) in the forelimbs. A, Heifer resting on her carpal joints to avoid weight bearing. B, Painful stance in the right forelimb with
overextension of the fetlock joint and hyperflexion of the proximal interphalangeal joint and toe-touching in the similarly affected
left limb in the same heifer

span of the 9 heifers after discharge from the clinic was 41 The heifer was treated with transfixation casts, which
months (median, 32 months; range 6-83), and 6 of the cows resulted in weight bearing without lameness; however, rou-
produced offspring (mean, 2.5 calves; range 1-4). Four cattle tine testing of a skin biopsy sample for bovine virus diar-
were still alive at the time of this writing (mean post- rhea virus at admission was positive and the heifer was
treatment lifespan 48 months; range 6-68 months), and none euthanatized 3 days postoperatively. Another heifer (#3)
of the 8 cattle had recurrence of signs of breakdown injury was discharged from the clinic with strict instructions for
according to the owner. box stall confinement, but according to the owner this did
Treatment was unsuccessful in 2 cases. Heifer #1 had not solve the problem and the heifer was slaughtered 8
severe bilateral interosseus muscle rupture in the forelimbs. months later.

FIGURE 3 Latero-medial radiographic views of the right hind foot of 2 heifers with rupture of the interosseus muscle showing
soft tissue swelling and densities (dorsal bulge) at the fetlock. A, Non-weight bearing foot of an 8-month-old Brown Swiss heifer
(#10) with sinking of the sesamoid bones (arrow) and dewclaws and a broken digital axis at the proximal interphalangeal joint
(arrow heads) in both digits. B, Weight-bearing foot of an 8-month-old Brown Swiss heifer (#9) with breakdown injury due to rup-
ture of the interosseus muscle with extreme sinking of the sesamoid bones and dewclaws and horizontal position of the proximal
phalanges
202 | NUSS ET AL.

F I G U R E 4 Ultrasonograms of parts of the interosseus muscle at the level of the metatarsal growth plate and sesamoid bones,
viewed in the sagittal plane from the plantar aspect using a 5-10 MHz linear probe. Healthy heifer (A) and heifer with injured inter-
osseus muscle in the right hind limb (B). 1 5 superficial digital flexor tendon, 2 5 deep digital flexor tendon, 3 5 accessory liga-
ment of the interosseus to the superficial flexor tendon, 4 5 branch of the interosseus muscle to a sesamoid bone. P 5 physis,
C 5 condyle, S 5 sesamoid bone. A, Interosseus muscle rupture is recognized by the thickened, hypoechogenic, and wavy branch
(B, 4) to the sesamoid bone. The structure of the accessory ligament (B, 3) and superficial digital flexor (B, 1) tendon is also less
defined compared to the same structures in the normal heifer (A)

One heifer (#9) with severe bilateral interosseus muscle nation of the hind feet of this heifer showed edema and hem-
rupture in the hind limbs of 11 days duration was not treated orrhage in the subcutaneous and fascial tissues (Figures 5
and instead slaughtered after admission. Post-mortem exami- and 7). The digital flexor tendons were macroscopically

F I G U R E 5 Cross-sectional ultrasonograms using a 5-10 MHz linear probe, and postmortem specimens of the flexor tendons
and interosseus muscle of the metatarsal bones 10 cm proximal to the fetlock joint in young cattle. Healthy heifer (A) and (C), hei-
fers (#10 [B] and #9 [D]) with interosseus medius muscle rupture at the level of the branches to the sesamoid bones. 1 5 superficial
digital flexor tendon, 2 5 deep digital flexor tendon, 3 5 accessory ligament, 4 5 branch to the sesamoids (4A 5 axial branch,
4B 5 abaxial branch), 5 5 metatarsal bones. Thickening and marked hypoechogenicity are ultrasonographic signs of injured sesa-
moidean branches in (A) compared to (B). Hemorrhage is visible in the vicinity of the injured branches to the sesamoids in the post-
mortem specimen (D, arrow) but also within the branches at locations that correspond to muscle tissue (C, arrow) in the healthy
specimen
NUSS ET AL.
| 203

F I G U R E 6 A, Eight-month-old Brown Swiss heifer with interosseus muscle rupture in the right hind limb treated with a half
limb cast (including the foot) for support of the suspensory apparatus (#10, same heifer as Figure 2a). B, Radiograph of the left hind
foot after application of a fiberglass cast to support repair of the interosseus muscle in a 13-month-old Holstein-Friesian heifer (#8).
The metatarso- and inter-phalangeal joints are flexed to align the axes of the metatarsus and the digits. The position of the sesamoid
bones is almost normal to allow for tension release of the sesamoidean branches of the interosseus medius muscle

normal, but the interosseus muscle from its origin at the prox- its branches to the proximal sesamoid bones. Signs of hemor-
imal aspect of the metatarsal bones to close to its insertion at rhage at the abaxial branches and at the insertion site at the
the sesamoid bones had changes of varying degree (Figure proximal interphalangeal joints indicated that other structures,
7). The damage of the branches to the sesamoid bones was including the insertion of the proper extensor tendons and the
most severe, but there also were hemorrhages in the abaxial joint capsule, may have been damaged (Figure 7).
branches inserting at the proximal interphalangeal joints. The
accessory ligament and the interdigital branch of the interos- 4 | DISCUSSION
seus muscle were less severely affected. Thus the main gross
findings were rupture of the origin of the interosseus muscle This case series describes a relatively large number of young
at the proximal aspect of the metacarpal/metatarsal bones and cattle with breakdown injury in the fetlock joint due to

FIGURE 7 Postmortem specimen of a hind foot of a heifer with bilateral interosseus muscle rupture in the hind limbs (#9, same
heifer as in Figure 2B). Hemorrhagic lesions are seen in the interosseus medius muscle, extending from its origin (MIMO) at the
metatarsal bones down to the level of the proximal interphalangeal joint (PIJ), as well as in the branches (SB) to the sesamoid bones,
the origin of the accessory ligament (AL), and the abaxial extensor branch to the proper digital extensor tendons at the level of the
proximal interphalangeal joint (AbB). SDFT 5 superficial digital flexor tendon; DDFT 5 deep digital flexor tendon; MF 5 manica
flexoria (sleeve); F 5 plantar parts of the tendon sheath, fascia, and annular ligaments have been dissected and reflected distally to
show the DDFT* exiting (arrow) the manica flexoria
204 | NUSS ET AL.

rupture of the interosseus muscle that was confirmed ultraso- cations be ruled out in cattle with disorders of the suspensory
nographically in all cases. The principal ultrasonographic apparatus.
finding of interosseus muscle rupture was the wavy appear- Ultrasonographic findings were similar in all the heifers.
ance and decreased echogenicity of the normally hyperechoic Based on the results of several recent studies,10,11,19 we
tendinous branches to the sesamoid bones. In some cases, expect that ultrasonography will be used in future cases to
hypoechoic changes were also seen at the origin of the inter- assess the severity of interosseus muscle rupture and the pro-
osseus muscle at the proximal metacarpal/metatarsal bones. gress of healing more objectively, and that the development
Our case series included mostly Brown Swiss cattle but of targeted treatment protocols will be possible.
there also was one Holstein-Friesian heifer. A breed predis- In practice, the diagnosis of interosseous muscle rupture
position to interosseus muscle degeneration has been can be made based on the clinical signs alone. In contrast to
described in horses, but is less likely in Brown Swiss cattle, other studies,1,2 our cases with interosseous muscle rupture
which were overrepresented in the present study at 66% of in the forelimbs did not have carpal flexion. Therefore, the
the clinic caseload. Brown Swiss are dual-purpose cattle and involvement of other structures was not likely. In horses,
similar to beef breeds and Eringer cattle. Young cattle of some fetlock hyperextension may occur with complete rup-
these breeds likely have more access to pasture and thus a ture of the superficial digital flexor tendon, but it is less
higher chance of sustaining injuries because of overexertion. severe than that seen in suspensory rupture.17
In addition to the 11 cases presented here, we have seen The interosseus muscle ruptures described in our report are
bilateral hind limb interosseus muscle rupture in a young similar to complete rupture of the suspensory ligament (break-
Limousin bull and a unilateral forelimb rupture in an Eringer down injury) in horses. In horses, the prognosis for survival
cow injured in a fight. Furthermore, interosseus muscle rup- following complete breakdown of the suspensory apparatus is
ture has been described in an Angus bull and a Holstein guarded to poor in most cases, despite long-term application of
heifer.1,2 splint bandages or casts or surgical arthrodesis of the fetlock
Another interesting feature was the relatively young age joint.17 The prognosis in the only heifer with severe bilateral
of affected cattle, which points to a predisposition of young breakdown injury in the hind limbs was poor and euthanasia
cattle, possibly related to the relatively high muscle content rather than treatment was elected. Most of our cases were
of the interosseus muscle and the propensity of young ani- treated conservatively based on our empirical assessment. The
mals to run and jump. We assume that acute breakdown total treatment time was relatively long at 6 months, but was
injury due to interosseus muscle rupture, analogous to unfit acceptable to the owners because it consisted mainly of stall
horses,18 is the result of acute overloading of the suspensory rest with few bandage changes. Long-term box rest usually is
apparatus, which may occur during jumping or similar not a problem in young cattle and, compared with horses, the
activities. risk of recurrence is much smaller because cattle are not used
Muscle and fat tissue are seen among the tendinous tissue for athletic activities. Our treatment protocol was primarily
from the origin of the interosseus muscle to the division of empirical based on the time required for healing of a ruptured
the sesamoidean ligaments or even beyond (Figure 5C). The tendon/suspensory ligament1,20,21 and was associated with a
content of muscle tissue is at least 20% in young cattle and good long-term outcome in 8 of 9 cases. Serial ultrasound
<10% in mature cattle,8 which may predispose younger cat- monitoring for 2-3 months in mild cases and up to 9-12
tle to interosseous muscle rupture. Even though it can be months in severe cases has been recommended to assess pro-
assumed that blood vessels and nerves were affected by over- gress of healing in equids,17 but was not done in these heifers.
stretching of the interosseus muscle, similar to suspensory In summary, acute rupture of the interosseus muscle with
ligament breakdown injuries in horses,17 there were no signs breakdown in the fetlock joint is a relatively rare cause of
of progressive loss of blood supply that affected long-term lameness in cattle and according to our observations is most
healing in these heifers. likely to occur in young cattle. Interosseus muscle rupture
Radiography was not primarily carried out for diagnostic may be unilateral or bilateral in the forelimbs or hind limbs.
purposes, but rather for determining whether other injuries, A diagnosis of interosseus muscle rupture can be made based
such as fractures or fetlock joint luxation, were present. on the characteristic malposition of the affected foot and the
Bone fragments and fetlock joint ankylosis were seen in a pain response to palpation of the palmar/plantar fetlock
bull with interosseous muscle rupture.1 Features of suspen- region, but radiography and ultrasonography are recom-
sory ligament rupture in horses, including fracture of the ses- mended to rule out secondary lesions and to help better
amoid bones, or proximal suspensory desmitis associated define the damaged tissues. Treatment using fiberglass casts
with fractures of the metacarpal/tarsal bones at the origin of and splints was largely successful and the prognosis was
the interosseus muscle, were not seen in the heifers described good. In addition to acute cases described in this report, it is
in our report, but it is important that these and other compli- likely that chronic excessive weight bearing because of a
 NUSS ET AL.
| 205

painful disorder of the contralateral limb would lead to sus- [10] Tryon KA, Clark CR. Ultrasonographic examination of
pensory apparatus damage and dropped fetlock. the distal limb of cattle. Vet Clin North Am Food Anim
Pract. 1999:5:275-300.
ACKNOWLEDGMENT [11] Goncalves PV, Silva LA, Silva LH, et al. Ultrasonogra-
phy of the distal limbs in Nellore and Girolando calves 8
The authors thank Sarah Schuetz and Jeanne Peter Zocher
to 12 months of age. BMC Vet Res. 2014;10:102.
for creation of the schematic 3D image of the bovine inter-
[12] Bischofberger AS, Konar M, Ohlerth S, et al. Magnetic
osseus medius muscle in Figure 1.
resonance imaging, ultrasonography and histology of the
suspensory ligament origin: a comparative study of nor-
C O NFL IC T O F I NT E RE S T mal anatomy of warmblood horses. Equine Vet J. 2006;
The authors declare no conflicts of interest related to this 38:508-516.
report. [13] Wyssmann E. Rupture of the flexor of the first phalanx
(M. interosseus medius). In: Wyssmann E, ed. Limb
Diseases in Cattle. Zurich: Orell Fuessli; 1942:157-
R EF ERE NC ES 158.
[1] Nelson DR, Kneller SK, Martin DD. Treatment of rup- [14] Hill AE, Gardner IA, Carpenter TE, et al. Prevalence,
ture of suspensory ligament and superficial flexor tendon location and symmetry of noncatastrophic ligamentous
in a bull. Aust Vet J. 1997;75:244-246. suspensory apparatus lesions in California Thoroughbred
[2] Rosenberger G. Illustrated case report no. 2. Breakdown racehorses, and association of these lesions with cata-
in a heifer. Dtsch Tieraerztl Wochenschr. 1974;81:43. strophic injuries. Equine Vet J. 2016;48:27-32.
[3] Schl€ucker R. Biomechanical Examinations of the Interos- [15] Plevin S, McLellan J, O’Keeffe T. Association between
seus Medius Muscle in Cattle [Inaugural dissertation]. sesamoiditis, subclinical ultrasonographic suspensory lig-
Munich, Germany: Institute for Veterinary Anatomy, ament branch change and subsequent clinical injury in
Veterinary Faculty University of Munich; 2012. yearling Thoroughbreds. Equine Vet J. 2014;46: 451-
[4] Greenough P, MacCallum F, Weaver A. Anatomy. In: 457.
Greenough P, MacCallum F, Weaver A, eds. Lameness [16] Bramlage LR, Gabel AA, Hackett RP. Avulsion fractures
in Cattle. Edinburgh: Oliver and Boyd; 1972:97-124. of the origin of the suspensory ligament of the horse.
[5] Augsburger H, Frewein J, Seiferle E. Active locomotor J Am Vet Med Assoc. 1980;176:1004-1010.
apparatus, muscle system, Myologia. In: Nickel R, [17] Gibson KT, Steel CM. Tutorial article—conditions of the
Schummer A, Seiferle E, eds. Lehrbuch der Anatomie suspensory ligament causing lameness in horses. Equine
der Haustiere. 8th ed. Berlin: Parey; 2004:273-569. Vet Ed. 2002;14:39-50.
[6] Budras K, Habel RE. Bovine Anatomy. 2nd ed. Hann- [18] Bukowiecki CF, Bramlage LR, Gabel AA. In vitro
over: Schluetersche Verlagsanstalt; 2011:18. strength of the suspensory apparatus in training and rest-
[7] Dyce KM, Sack WO, Wensing CJG. The forelimb of the ing horses. Vet Surg. 1987;16:126-130.
ruminant. In: Dyce KM, Sack WO, Wensing CJG, eds. [19] Nogueira GM, Cattelan JW, Pereira WAB, et al. Ultraso-
Textbook of Veterinary Anatomy. 4th ed. St. Louis, MO: nographic characterization of flexor tendinous structure
Saunders Elsevier; 2010:728-741. muscle and ligaments of the distal limb of crossbred hei-
[8] M€uller-Calgan H. Form and Development of the Interos- fers. Arq Bras Med Vet Zootec. 2011;63:600-608.
seus Apparatus in Ruminants [Inaugural dissertation]. [20] Smith RK, McIlwraith CW. Consensus on equine tendon
Munich, Germany: Institute for Veterinary Anatomy, disease: building on the 2007 Havemeyer symposium.
Veterinary Faculty University of Giessen; 1954. Equine Vet J. 2012;44:2-6.
[9] Whay R. The Anatomy of The Bovine Foot—A Pictorial [21] Anderson DE, Desrochers A, St Jean G. Management of
Approach. Philadelphia, PA: University of Pennsylvania tendon disorders in cattle. Vet Clin North Am Food Anim
Press; 1954:1-56. Pract. 2008;24:551-566.

View publication stats