DISTAL INTERPHALANGEAL JOINT CAPSULE ENTHESOPATHY IS ASSOCIATED WITH ARTICULAR CARTILAGE LOSS

DISTAL INTERPHALANGEAL JOINT CAPSULE ENTHESOPATHY IS ASSOCIATED WITH ARTICULAR CARTILAGE LOSS | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Equine Veterinary Journal This is a preprint and has not been peer reviewed. Data may be preliminary. 14 March 2025 V1 Latest version Share on DISTAL INTERPHALANGEAL JOINT CAPSULE ENTHESOPATHY IS ASSOCIATED WITH ARTICULAR CARTILAGE LOSS Authors : Monika A. Samol , Myra Barrett 0000-0001-5060-6009 [email protected] , and David Frisbie Authors Info & Affiliations https://doi.org/10.22541/au.174196820.02131301/v1 348 views 226 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Significant distal interphalangeal joint (DIPJ) pathology can occur with few radiographic findings but can be accompanied by joint capsule enthesopathy on the middle phalanx. Objectives: To explore the associations and correlations between DIPJ capsule enthesopathy identified radiographically and DIPJ articular cartilage abnormalities and other concurrent soft tissue or osseous pathology within the foot found on MRI. Study Design: Retrospective and descriptive case series. Methods: Cases identified with DIPJ capsule enthesopathy were retrospectively reviewed. Abnormalities were graded using a 4-point scale. Descriptive statistics and Spearman’s rank correlations were used to analyze the relationship between the presence and grade of DIPJ capsule enthesopathy, lameness, and DIPJ intra- and extra-articular abnormalities. Results: Twenty-one MRI scans and radiographs with DIPJ capsule enthesopathy were analyzed. DIPJ articular cartilage lesions were identified in 20/21 limbs (95%). There was no significant correlation between the degree of DIPJ capsule enthesopathy and severity of articular cartilage lesions. DIPJ proliferative synovitis and osteophytes were present in majority of limbs (91% and 95%), respectively. DIPJ collateral ligaments were abnormal in 52% of the limbs. DIPJ capsule enthesopathy grade was moderately positively correlated with DIPJ collateral ligaments’ findings severity (p=0.01). Main Limitations: Retrospective character, no histopathology, studied cases limited to one referral center. Conclusions: The presence of DIPJ capsule enthesopathy on radiographs is a reliable finding to rule in DIPJ damage and support further case management, particularly in cases where advanced imaging is unavailable or desired. Title: DISTAL INTERPHALANGEAL JOINT CAPSULE ENTHESOPATHY IS ASSOCIATED WITH ARTICULAR CARTILAGE LOSS Keywords : distal interphalangeal joint, cartilage loss, high-field MRI, joint capsule enthesopathy Background: Significant distal interphalangeal joint (DIPJ) pathology can occur with few radiographic findings but can be accompanied by joint capsule enthesopathy on the middle phalanx. Objectives: To explore the associations and correlations between DIPJ capsule enthesopathy identified radiographically and DIPJ articular cartilage abnormalities and other concurrent soft tissue or osseous pathology within the foot found on MRI. Study Design: Retrospective and descriptive case series. Methods: Cases identified with DIPJ capsule enthesopathy were retrospectively reviewed. Abnormalities were graded using a 4-point scale. Descriptive statistics and Spearman’s rank correlations were used to analyze the relationship between the presence and grade of DIPJ capsule enthesopathy, lameness, and DIPJ intra- and extra-articular abnormalities. Results: Twenty-one MRI scans and radiographs with DIPJ capsule enthesopathy were analyzed. DIPJ articular cartilage lesions were identified in 20/21 limbs (95%). There was no significant correlation between the degree of DIPJ capsule enthesopathy and severity of articular cartilage lesions. DIPJ proliferative synovitis and osteophytes were present in majority of limbs (91% and 95%), respectively. DIPJ collateral ligaments were abnormal in 52% of the limbs. DIPJ capsule enthesopathy grade was moderately positively correlated with DIPJ collateral ligaments’ findings severity (p=0.01). Main Limitations: Retrospective character, no histopathology, studied cases limited to one referral center. Conclusions: The presence of DIPJ capsule enthesopathy on radiographs is a reliable finding to rule in DIPJ damage and support further case management, particularly in cases where advanced imaging is unavailable or desired. INTRODUCTION The distal interphalangeal joint (DIPJ) is one of multiple structures in the foot that is a common source of lameness in the horse. Due to the limited specificity of diagnostic analgesia, it can be difficult to determine what is the primary source of foot related lameness, and radiography of the distal limb is often the first line imaging modality used to help diagnose the most likely cause. Although most readily available and inexpensive, radiographs provide limited information. While recognizing the limitations, the goal of the radiographic study is to best determine which radiographic findings are most likely to correlate with significant lameness related pathology. Radiographic findings associated with DIPJ pathology include osteophytes, joint capsule enthesopathy and narrowing of the joint space. However, there can be significant pathology within the joint with few radiographic findings and substantial cartilage damage can be present with a radiographically normal DIPJ space [1] . Another specific challenge to radiographically assessing DIPJ damage is that cartilage pathology it can occur without subchondral and/or trabecular bone involvement or periarticular osteophyte formation [1,2] . Horses with articular cartilage damage of the DIPJ often have synovitis accompanied by joint capsule thickening and enthesopathy. Joint capsule enthesopathy results in osseous production along the dorsal diaphyseal cortex of middle phalanx (P2), which can be identified radiographically. Damage or loss of DIPJ articular cartilage, as well as other associated joint damage, has significant implications to the long-term athletic career of performance horses [1]. Therefore, it is important for both prognostic and therapeutic purposes to identify articular cartilage damage of DIPJ. While this can readily be performed with high field MRI, contrast arthrogram CT and, depending on the stage of disease, low field MRI, it is beneficial to have relatively reliable radiographic findings to indicate DIPJ damage, especially when advanced imaging is not an option. The objectives of this study were to explore the associations and correlations of DIPJ capsule enthesopathy identified radiographically and on high-field MRI with lameness, DIPJ articular cartilage abnormalities and other associated soft tissue or osseous pathology within the hoof capsule, including DIPJ effusion, proliferative synovitis, periarticular osteophytes, and collateral ligament injury. We hypothesized that the presence of DIPJ capsule enthesopathy will be strongly associated and correlated with articular cartilage loss of the DIPJ. MATERIALS AND METHODS The study is a retrospective, descriptive case series from a single equine referral center. A medical record search was conducted for distal limb MRI exams from 1 January 2013 to January 31 2024 with diagnosis of DIPJ capsule enthesopathy. The inclusion criteria was radiographically evident DIPJ capsule enthesopathy based on single LM radiograph obtained within 1 month post or prior MRI exam. Diagnostic images (MRI and radiographs) were reviewed by an equine diagnostic imaging resident (blinded for peer review) prior to inclusion to the study. The resident was not blinded to the clinical history of each case and had access to the original imaging reports, which had been reviewed and approved by experienced board-certified equine radiologists at the time of image acquisition. No discrepancies were identified in described findings between the original reports and resident review. DIPJ capsule enthesopathy is characterized by irregular osseous production at the site of joint capsule insertion i.e., along the dorsal cortex of P2. The radiographic and MRI-based DIPJ capsule enthesopathy severity scale (grade 1-mild, grade 2-mild to moderate, grade 3-moderate, grade 4-marked, Fig. 1) was applied based on the radiologist report. Any additional abnormalities of other structures within the hoof capsule were recorded and graded (0-normal, 1-mild, 2-mild to moderate, 3-moderate, 4-marked) based on the MRI examination and radiologists’ assessment. These included DIPJ articular cartilage lesions, DIPJ synovial proliferation and effusion, DIPJ periarticular margins, and DIPJ collateral ligaments. Patient signalment, discipline and clinical examination findings were recorded when available. These included breed, age, sex, results of diagnostic analgesia, AAEP 5-point lameness score, and lameness duration at the time of MRI. Clinically significant improvement for diagnostic analgesia was considered >60%. MRI studies performed from 1January 2013 to 31 January 2019 were conducted using a 1 Tesla (T) magnet (ONI OrthOne – GE Healthcare, Chicago, IL, USA). Standard sequences included dorsal plane T1 fast spin echo (FSE) and short-tau inversion recovery (STIR), transverse T2 FSE, proton density (PD) and STIR, and sagittal three-dimensional T1 gradient echo (GRE) and STIR sequences. Studies after 29 January 2019 were conducted with 3T magnet (Siemens Megnetom Skyra- ONI Incorporated, Wilmington, MA, USA). The standard imaging protocol included transverse PD and STIR, three-dimensional dual-echo steady state (DESS) and sagittal intermediate weighted Dixon sequences. All MRI studies were performed under general anesthesia in lateral recumbency. Descriptive statistics were used to analyze the relationship between the presence and grade of DIPJ capsule enthesopathy and horse signalment, limb distribution, lameness grade and duration, DIPJ articular cartilage abnormalities, proliferative synovitis, effusion, and collateral ligament injury. Spearman’s rank correlation was used to test correlations between the radiographic and MRI-based DIPJ capsule enthesopathy grades and severity of DIPJ pathologies listed above. A P value ≤ 0.05 was considered statistically significant for all tests [SAS 9.4]. (SAS Institute Inc.). For Spearman’s correlation test, the following correlation coefficient (r) with corresponding levels of agreements were used: 0.00 – none, 0.00 – 0.20- slight, 0.21-0.40 – fair, 0.41-0.60 – moderate, 0.61 – 0.80 – substantial, 0.81 -1.00 – almost perfect. RESULTS Study population included total of 18 horses. The majority were Warmbloods (8) and Quarter Horses (7). The remainder consisted of 1 Thoroughbred and 2 Friesian horses. Age ranged from 2 to 11 years old with average of 9.8 years (median 11 years). There were 14 geldings, 4 mares, and no intact males. Of the 11 horses with recorded use, 5 were used for Western performance, 3 for show jumping, and 3 for dressage. For 7 horses information was not recorded. A total of 21 limbs (10 left fore, 9 right fore, 2 left hind; including 3 horses with bilateral forelimb studies) with confirmed distal interphalangeal joint capsule enthesopathy on MRI and LM radiographs were included in the analysis. Lameness grade was recorded for 18 limbs and ranged from 1-4 on the 5-point AAEP lameness scale, with a median of 2 and average of 2.6. Moderate positive correlation was found between the degree of MRI DIPJ capsule enthesopathy and lameness severity (r= 0.45). Reported lameness duration ranged from 3 days to 36 months based on available data from 15 cases (median 3 months, average 8 months). For 2 horses detailed information regarding lameness duration was not available, however it was noted that lameness was chronic. Results of lameness workup were available for 12 limbs. Lameness was alleviated with palmar/plantar digital nerve block in 7 horses (7/12, 58%), abaxial sesamoid nerve block in 3 horses (3/12, 25%), basisesamoid nerve block in 1 horse (1/12, 8%), and 1 horse to pastern semi-ring block (1/12, 8%). Same horse that blocked to semi-ring block also blocked to intra-articular analgesia of DIPJ. Distal interphalangeal joint (Table 1) Average DIPJ capsule enthesopathy radiographic severity grade was 2.5 (median 2.5) and ranged from 1 to 3 in 17 limbs (grade 1- 5/21, 24%; grade 2- 6/21, 29%, grade 3- 6/21, 29%) and 4 limbs were graded as 4 (4/21, 19%). For the MRI-based DIPJ capsule enthesopathy, average severity grades were slightly higher (average 2.7, median 3) with majority of cases graded as 3 (9/21, 43%), followed by grade 1 (5/21, 24%), grade 4 (5/21, 24%), and grade 2 (2/21, 10%). DIPJ articular cartilage lesions were identified in 20/21 limbs (95%). One horse without identified DIPJ articular cartilage loss had significant DIPJ collateral ligament (CL) abnormalities graded as moderate and marked. Average DIPJ cartilage lesion score was 3.2 (median 3), with most of cases assessed as moderate and marked (grade 3- 9/20, 45%, grade 4- 6/20, 30%, grade 2- 4/20, 20%, grade 1- 1/20, 5%). Cartilage abnormalities were most commonly described as multiple partial thickness defects and thinning (7/20) followed by cases of diffuse thinning and alteration of signal intensity (5/20) and multiple partial and full thickness defects and alteration in signal intensity (4/20). In 2 cases (2/20) full thickness defects with cartilage thinning and subchondral bone loss were described. In the remaining 2 cases, 1 horse had fragmentation of the lateral P2 condyle and 1 had multiple full-thickness cartilage defects in the medial DIPJ described. The correlation between the severity of articular cartilage lesions and DIPJ capsule enthesopathy was fair for radiographs (r= 0.33) and absent for MRI (r= -0.05). In the majority of limbs (19/21, 91%) distal interphalangeal joint proliferative synovitis was present and graded as moderate (grade 3-13/19, 68%; grade 4-3/19, 16%; grade 1- 3/19, 16%, grade 2-0/19, 0%) with an average severity grade of 2.9 (median 3). Only fair correlation was found between the severity of proliferative synovitis and DIPJ capsule enthesopathy based on radiographs and MRI (r= 0.38 and 0.31, respectively). DIPJ effusion was identified in 13/21 limbs (62%) with average grade of 2.5 (median 3) (grade 1- 4/14, 29%; grade 2- 0/22, 0%; grade 3- 8/14, 57%, grade 4- 1/14, 7%). There was a moderate negative correlation between the MRI-based grade of DIPJ capsule enthesopathy and effusion that was statistically significant (r=-0.44, p=0.04). DIPJ CLs were considered abnormal in 52% of the limbs included (11/21). In 3 limbs the medial CL was injured, in 4 the lateral CL, and in 4 both CLs were considered abnormal. In cases where both CLs had abnormalities and grades differed between CLs, the higher grade was used for statistics. The average grade assigned for CLs was 2.4 (median 3). There were slightly more cases graded as moderate (grade 3- 3/11, 36%) followed by mild cases (grade 1- 3/11, 27%), mild to moderate and marked changes (grade 2 and 4 – 2/11, 18% each). The correlation between the severity of DIPJ CL abnormalities and DIPJ capsule enthesopathy was only fair for radiographs (r=0.33), however for MRI-based assessment the correlation was moderate (r=0.33) and statistically significant (p=0.01). Periarticular osteophytes were present in most of cases (20/21, 95%) and most of which were graded as moderate (grade 3-13/20, 65%) followed by grades 1 and 2 (4/20, 20%, and 3/20, 15%, respectively). Only slight correlation was observed between the osteophyte grade and DIPJ capsule enthesopathy for radiographs and MRI (r= 0.03, r=0.16, respectively). Please refer to table 2 for complete summary of results for tested correlations. DISCUSSION Consistent with our hypothesis, DIPJ capsule enthesopathy was strongly associated with the DIPJ articular cartilage abnormalities. However, the correlation between the severity of DIPJ capsule enthesopathy and degree of articular cartilage loss was weak for both MRI and radiographic assessment. Nevertheless, the presence of DIPJ capsule enthesopathy on radiographs is a reliable finding to rule in DIPJ damage and support further case management, particularly in cases where advanced imaging is not feasible. If MRI is pursued in these cases, high-field MRI is preferred due to its superiority in detecting articular cartilage abnormalities [3–5] . Damage or loss of DIPJ articular cartilage and associated joint pathology can be a significant source of pain and lameness in competitive athletic horses as well as horses used for pleasure. [1] . Untreated articular cartilage lesions can shed debris into the joint space, which can perpetuate the proinflammatory cascade of the synovium [6] . This observation is consistent with our results. Namely, 86% of horses with articular cartilage lesions had evidence of DIPJ proliferative synovitis (Fig.3). Additionally, we observed that with the increasing severity of DIPJ capsule enthesopathy, joint effusion volume was decreasing, which is also consistent with proliferative synovitis and progression of degenerative joint disease. Articular cartilage lesions are generally considered as degenerative, however this can manifest differently at different rates based on various aspects of the etiology [3] . Repetitive physical overload or single concussion/trauma can disrupt the integrity of joint structures and result in inflammatory responses. Such disturbances of joint homeostasis negatively affect chondrocyte vitality and function eventually leading to articular cartilage damage [7,8]. This is reflected by a wide range of reported lameness duration (from 3 days to 36 months) that was poorly correlated with the degree of DIPJ capsule enthesopathy and other extra- and intra-articular abnormalities assessed here. However, interestingly there was a moderate positive correlation between the MRI-based severity of DIPJ capsule enthesopathy and lameness grade. The CLs of the DIPJ support the joint in sagittal, dorsal, and transverse planes [9,10]. The prevalence of DIPJ CL desmopathy is estimated 15-30% in horses that undergo MRI due to chronic foot lameness [11,12], however in study by Beasley et al. after inclusion of CL desmopathy cases that were considered primary cause of lameness, the incidence was only 6.6% [9]. In our study population, a high incidence of CL abnormalities was observed (52%) that ranged in severity from mild to marked (2 cases). Furthermore, the severity of CL findings was moderately positively correlated with MRI-grade for DIPJ capsule enthesopathy and statistically significant (p=0.01). It is unclear the exact relationship of CL injures and DIPJ articular cartilage damage. It is possible that joint instability due to cartilage loss leads to gradual CL degeneration or abnormalities in CLs resulting in joint instability promotes cartilage loss. We suspect the latter scenario may be more likely for cases with severe changes in CLs that may have been a result of single overload/trauma whereas mild abnormalities may either represent early degenerative changes like fiber disruption or chondroid metaplasia due to DIPJ micro-instability related to repetitive overload and cartilage loss. High-field MRI is superior in providing detail regarding the extent and severity of DIPJ subchondral bone and articular cartilage defects [13,14] . High (≥1 Tesla) and low field MRI units (≤0.3 T) are used for equine imaging. Low field MRI systems have low cost, high availability and an ability for standing scans but present greater magnetic field inhomogeneity, longer scan times, lower signal to noise ratio with smaller field of view comparing to high field units [15]. Low field units often provide good diagnostic information about osseous and soft tissue pathology in the foot; however, they have limited diagnostic utility in articular cartilage damage assessment [2,5,13,14] , In other joints, such as the fetlock, articular cartilage damage detection is often extrapolated from adjacent subchondral changes [15]. Such approach may result in false negative findings in the DIPJ as articular cartilage loss frequently occurs without concurrent changes in subchondral bone. For example, in our case series only 1 horse had identified subchondral bone abnormalities along with the cartilage defects. High field MRI and CT arthrography is superior for detecting subtle abnormalities, particularly affecting the articular cartilage [3,4,16] . The use of intra-articular contrast injection for MR arthrography (gadolinium or saline) may help with increasing the visualization of articular cartilage surface, however in van Zadelhoff et al. study, it did not improve the detection of cartilage damage in low-field MR system (0.27T) [14] . T1-weighted gradient echo (GRE) MRI sequences provide good contrast between cartilage and subchondral bone whereas T2W fast-spine echo (FSE) or dual-echo steady state (DESS) sequences have high contrast between the cartilage (low signal) and joint fluid (high signal) creating an arthrogram-like effect that can improve detection of superficial cartilage lesions in high-field MRI systems [4,17] (Fig. 2). Limitations of this study include its retrospective character, no histopathologic evaluation in any of the cases, and caseload limited to one referral center. In conclusion, our data support that the presence of DIPJ capsule enthesopathy on radiographs is highly associated with articular cartilage loss. This finding can support clinical evaluation of DIPJ pathology as the likely cause of lameness and help plan further diagnostic workup, treatment and further imaging. Knowing this finding can be a helpful adjunct in the interpretation of low-field MRI in relation to pathology of the DIPJ. Detailed characterization of articular cartilage damage can aid in medical management and prognostication, particularly in cases in which surgical debridement is considered since some lesions are arthroscopically inaccessible. REFERENCES 1. Frisbie, D.D., Werpy, N.M., Kawcak, C.E. and Barrett, M.F. (2016) Distal Limb. In: Joint Disease in the Horse , Elsevier. pp 281–301. https://linkinghub.elsevier.com/retrieve/pii/B9781455759699000206. Accessed February 18, 2024.2. Gutierrez‐Nibeyro, S.D., Werpy, N.M., Gold, S.J., Olguin, S. and Schaeffer, D.J. 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(2005) Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001‐December 2003) and response to treatment. Equine Vet. J. 37 , 113–121.12. Dyson, S.J., Murray, R., Schramme, M. and Branch, M. (2004) Collateral desmitis of the distal interphalangeal joint in 18 horses (2001–2002). Equine Vet. J. 36 , 160–166.13. Crema, M.D., Roemer, F.W., Marra, M.D., Burstein, D., Gold, G.E., Eckstein, F., Baum, T., Mosher, T.J., Carrino, J.A. and Guermazi, A. (2011) Articular Cartilage in the Knee: Current MR Imaging Techniques and Applications in Clinical Practice and Research . RadioGraphics 31 , 37–61.14. Van Zadelhoff, C., Schwarz, T., Smith, S., Engerand, A. and Taylor, S. (2020) Identification of Naturally Occurring Cartilage Damage in the Equine Distal Interphalangeal Joint Using Low-Field Magnetic Resonance Imaging and Magnetic Resonance Arthrography. Front. Vet. Sci. 6 , 508.15. Nelson, B.B., Kawcak, C.E., Barrett, M.F., McIlwraith, C.W., Grinstaff, M.W. and Goodrich, L.R. (2018) Recent advances in articular cartilage evaluation using computed tomography and magnetic resonance imaging. Equine Vet. J. 50 , 564–579.16. Hontoir, F., Nisolle, J.-F., Meurisse, H., Simon, V., Tallier, M., Vanderstricht, R., Antoine, N., Piret, J., Clegg, P. and Vandeweerd, J.-M. (2014) A comparison of 3-T magnetic resonance imaging and computed tomography arthrography to identify structural cartilage defects of the fetlock joint in the horse. Vet. J. 199 , 115–122.17. Kijowski, R. (2010) Clinical Cartilage Imaging of the Knee and Hip Joints. Am. J. Roentgenol. 195 , 618–628. Fig. 1 Radiographic DIPJ capsule enthesopathy grades (A-D). A. Grade 1 (mild); B. Grade 2 (mild to moderate); C- Grade 3 (moderate); D- Grade 4 (marked). Fig. 2 A. Lateromedial radiograph of the right fore foot and pastern regions. White arrows point to mild to moderate, focal, osseous production at the dorsoproximal cortex of P2 in the region of DIPJ capsule insertion. B. Corresponding sagittal T2 DESS MRI image depicting osseous proliferation on P2 cortex (white arrows) as seen on radiograph (A.). C. Sagittal intermediate weighted Dixon (water only) image. There is a high signal focus within the cartilage of the P2 medial condyle at its palmar aspect (dashed arrow) representing DIPJ articular cartilage defect. Note mild effusion in the dorsal recess of DIPJ and joint capsule insertion site on dorsoproximal diaphyseal cortex of P2. Fig. 3 Sagittal (A.) and transverse (B.) T2 DESS MRI images of the left fore foot and pastern. Note marked osseous proliferation at the mid-dorsal cortex of P2 (white arrows; DIPJ capsule enthesopathy) and large amount of intermediate signal proliferative tissue within the dorsal recess of DIPJ (*). This horse had multiple partial thickness defects and thinning of the DIPJ articular cartilage that were graded as marked. Table 1. Summary of limb (n=21) and grade distributions for specific soft tissue and osseous abnormalities in the DIPJ including radiographic joint capsule enthesopathy (CE DX), MR based joint capsule enthesopathy (CE MR), articular cartilage defects (AC defects), proliferative synovitis (prolif. Syn.), joint effusion, collateral ligaments (CLs), and osteophytes. 1 5 (24%) 5 (24%) 1 (5%) 3 (16%) 4 (31%) 3 (27%) 4 (20%) 2 6 (29%) 2 (9%) 4 (20%) 0 (0%) 0 (0%) 2 (18%) 3 (15%) 3 6 (29%) 9 (43%) 9 (45%) 13 (68%) 8 (62%) 4 (36%) 13 (65%) 4 4 (19%) 5 (24%) 6 (30%) 3 (16%) 1 (8%) 2 (18%) 0 (0%) Average 2.5 2.7 3.2 2.9 2.5 2.4 2.5 Table 2. Summary of Spearman’s correlation coefficients results and corresponding p-values characterizing the relationship between DIPJ capsule enthesopathy grade (radiographic and MRI-based) and severity of studied DIPJ abnormalities and lameness (severity and duration). DIPJ CE DX DIPJ CE MRI DIPJ AC lesions 0.33 (0.14) -0.05 (0.82) DIPJ proliferative synovitis 0.38 (0.09) 0.31 (0.16) DIPJ effusion -0.22 (0.34) -0.44 (0.04) DIPJ osteophytes 0.03 (0.90) 0.16 (0.49) DIPJ CL injury 0.38 (0.09) 0.53 (0.01) Lameness severity 0.23 (0.35) 0.45 (0.06) Lameness duration [mo] -0.16 (0.53) -0.34 (0.19) Information & Authors Information Version history V1 Version 1 14 March 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Equine Veterinary Journal Authors Affiliations Monika A. Samol Colorado State University College of Veterinary Medicine and Biomedical Sciences View all articles by this author Myra Barrett 0000-0001-5060-6009 [email protected] Colorado State University College of Veterinary Medicine and Biomedical Sciences View all articles by this author David Frisbie Colorado State University College of Veterinary Medicine and Biomedical Sciences View all articles by this author Metrics & Citations Metrics Article Usage 348 views 226 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Monika A. Samol, Myra Barrett, David Frisbie. DISTAL INTERPHALANGEAL JOINT CAPSULE ENTHESOPATHY IS ASSOCIATED WITH ARTICULAR CARTILAGE LOSS. Authorea . 14 March 2025. DOI: https://doi.org/10.22541/au.174196820.02131301/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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