Anatomy and Ultrasound-Guided Injection of the Deep Branch of the Lateral Palmar Nerve in the Horse: A Cadaveric Study.

Ultrasound-guided DBLPaN injection shows promise as a more PSL-specific diagnostic analgesic technique in horses.

Proximal suspensory ligament (PSL) injuries are a frequent source of equine forelimb lameness, yet pain localization in the proximal metacarpal and carpal region remains diagnostically challenging because existing analgesic techniques lack PSL specificity. This cadaveric study investigated the innervation of the PSL with emphasis on the deep branch of the lateral palmar nerve (DBLPaN) and aimed to develop a reproducible, landmark-based, ultrasound-guided injection technique targeting this nerve. Eighteen cadaveric forelimbs underwent dissection to characterize DBLPaN anatomy, including the number of accessory branches and key distances from the distal margin of the accessory carpal bone (ACB). Considerable anatomical variability was noted, with two to six accessory branches per DBLPaN identified. The mean distance from the distal ACB margin to DBLPaN origin was 2.5 cm, and to its insertion on the PSL was 5.1 cm. An ultrasound-guided injection technique was subsequently validated in 20 additional limbs, achieving full success in 65%, partial success in 25%, and failure in 10% of cases. The cumulative success rate of 90% (full and partial) suggests clinically meaningful utility. These findings offer new anatomical detail regarding PSL innervation and establish a foundation for developing more specific diagnostic nerve blocks in horses with suspected PSL pathology. Further in vivo investigation is warranted to confirm efficacy and refine the technique for routine clinical application.

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