ISSN 2398-2977      

DIP joint: disease - overview

pequis

Synonym(s): Distal interphalangeal joint disease, Coffin joint disease


Introduction

Pathogenesis

Etiology

Trauma

  • Usually implicated.
  • Damage to articular cartilage, joint capsule and/or subchondral bone.
  • Overextension or asymmetrical loading of the joint either acutely or chronically can   →   synovitis and cartilage damage with subsequent osteoarthritis of the DIP joint   PIP joint: osteoarthritis  .
  • Fractures: fracture of the extensor process of the distal phalanx caused by excessive tension on common digital extensor tendon or from overextension of the distal interphalangeal joint; oblique or sagittal fractures of distal phalanx with an articular component   Distal phalanx: fractures  ; body of the distal phalanx extending into the DIP joint (rare); articular chip fractures of the medial or lateral condyle of the middle phalanx   Middle phalanx: fracture  .
  • Subluxation: secondary to partial rupture of the DDFT (traumatic or iatrogenic).
  • Osseus fragmentation of extensor process of distal phalanx may be asymptomatic.
  • Degenerative joint disease, often following an underlying conformational abnormality   DIP joint: flexural deformity  , or a fracture within the DIP joint    Musculoskeletal: osteoarthritis (joint disease)  .
  • Collateral ligament damage/desmitis +/- avulsion fractures - uncommon.
  • Damaged distal sesamoidean impar ligament   Straight sesamoidean ligament: desmitis  .

Congenital and perinatal conditions

  • Separate centers of ossification on extensor process of distal phalanx.
  • Flexural deformity may be congenital or acquired   DIP joint: flexural deformity  .

Infectious

  • Penetrating wounds of the sole or distal pastern, heel bulb lacerations or spread of infection from navicular bursa   →   septic arthritis   Joint: septic arthritis - adult  .
  • Occasionally hematogenous spread of infection in foals   →   septic arthritis   Joint: septic arthritis - foal  .

Multifactoral

Miscellaneous

  • Osseous cyst-like lesions involving proximal P1 close to the DIP joint, and at the insertion of the collateral ligament(s) on P1   Bone: osseous cyst-like lesions  .
  • New bone formation on the dorsal aspect of the middle phalanx - unknown etiology.

Predisposing factors

General

Pathophysiology

  • The distal interphalangeal joint (DIP) is the articulation between the middle phalanx, distal phalanx and the navicular bone.
  • The collateral sesamoidean ligament (CSL), the distal sesamoidean impar ligament (DSIL) and branches of the palmar digital nerves run in close proximity to the palmar aspect of the joint.
  • The joint can move in 3 planes: flexion and extension (principal normal movement); lateral and medial; rotation and sliding.
  • Joint stability is provided by various ligaments including collaterals, deep digital flexor tendon (DDFT), distal digital annular ligament (DDAL), CSL and DSIL.
  • See also: Joint: synovial pathobiology   Joint: synovial pathobiology  .

Timecourse

  • Flexural deformities often noticeable at birth or otherwise between 4 weeks and 4 months.
  • Acute onset for fractures, sepsis.
  • Chronic and insidious onset for low-grade osteoarthritis, bone cysts, DJD.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Dakin S G, Dyson S J, Murray R C & Tranquille C (2009) Osseous abnormalitites associated with collateral desmopathy of the distal interphalangeal joint: Part 1. Equine Vet J 41 (8), 786-793 PubMed.
  • Dakin S G, Dyson S J, Murray R C & Newton R (2009) Osseous abnormalitites associated with collateral desmopathy of the distal interphalangeal joint: Part 2 - Treatment and outcome. Equine Vet J 41 (8), 794-799 PubMed.
  • Dyson S J et al (2004) Collateral desmitis of the distal interphalangeal joint in 18 horses (2001-2002). Equine Vet J 36 (2), 160-166 PubMed.
  • Dyson S J (1998) The puzzle of distal interphalangeal joint pain. Equine Vet Educ 10 (3), 119-125 VetMedResource.

Other sources of information

  • Dyson S J (2003) The Distal Phalanx and Distal Interphalangeal Joint. In: Diagnosis & Management of Lameness in the Horse. Eds: Ross M W & Dyson S J. Saunders, USA.

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