The biblical saying, "two are better than one because they have a good return for their work," succinctly describes recommendations Natalie Zdimal, DVM, recently made regarding diagnostic imaging for suspensory-ligament-related injuries. Horses with such injuries generally have discomfort in the back the back of the fore- and hind-limbs near the knee and hock joints.

"Injuries in those areas are a common source of lameness in equine athletes," said Zdimal, currently a practitioner at Bayhill Equine Sports Medicine & General Practice, in Redwood City, Calif., during the 2012 American Association of Equine Practitioners’ Convention, held Dec 1-5 in Anaheim, Calif.

She added that with these particular horses, "injury to the (suspensory) ligament has been the primary focus historically, but we now know that … the ligament, the bone-ligament interface, and the bone surface can all sustain injury and cause lameness."

Veterinarians can use several diagnostic tools to determine the cause of such lameness, but they haven’t yet proven one method superior. This is likely because proximal suspensory apparatus injury or pathology (damage) is complex. Nuclear scintigraphy (bone scans) and magnetic resonance imaging (MRI) are two options for diagnosing lameness and, particularly, injuries that occur in the proximal suspensory apparatus area.

Immediately before performing a bone scan, veterinarians inject a horse with a radioactive compound (usually Technecium-99m) that accumulates at the site of injury. During the bone scan, practitioners look for "hot spots," or areas of increased uptake of t