Journal of Veterinary Advances
Metacarpophalangeal Joint Angle Measurement in Equine
Forelimbs
Alrtib A. M., Oheida A. H., Abushhiwa M. H. and Davies H. M. S.
J Vet Adv 2015, 5(2): 831-840
DOI: 10.5455/jva.20150211074852
Online version is available on: www.grjournals.com
ISSN: 2251-7685
ALRTIB ET AL.
Original Article
Metacarpophalangeal Joint Angle Measurement in
Equine Forelimbs
1
1
Alrtib A. M., 1Oheida A. H., 2Abushhiwa M. H. and 3Davies H. M. S.
Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli 13662, Libya.
2
Department of Surgery, Faculty of Veterinary Medicine, University of Tripoli, Tripoli 13662, Libya.
3
Department of Veterinary Science, Faculty of Veterinary Science, University of Melbourne, Victoria 3010, Australia.
Abstract
The objective of the present study was to identify a consistent method for measuring the equine
metacarpophalangeal joint (MCPJ) angle in a standing horse; and investigate effects of lifting the contralateral
limb, changing head position and treadmill exercise on that angle. A circle circumference was best fit onto
lateromedial radiographs of the dorsal region of the lateral condyle of three MCPJs with radio-opaque markers
fixed on the bony prominences. The circle center was assumed to approximate the center of MCPJ motion and
the bony eminence at this point was used to position the goniometer in subsequent tests. MCPJ dorsal angles of
ten vertically-fixed cadaver forelimbs were measured with a goniometer five times by rater A, and once by rater
B. MCPJ angles of fourteen horses were measured before and after lifting the contralateral limb. Five (standing)
and eight (limb lifted) horses were measured six and five times in random order respectively. Skin marked
MCPJ of five horses were filmed in five different head positions (forward, right, left, raised, and lowered).
Duplicate MCPJ angles of 6 control and 6 exercised horses were measured before and after treadmill exercise.
The goniometer repeatability coefficient was 4.7° (95%CI 3.9° to 6.0°) and was similar in horses standing
squarely and with the contralateral limb lifted. There was no significant difference in MCPJ measurements
between raters. MCPJ dorsal angles were significantly less with the contralateral limb lifted. There was no
significant effect of head position. The right MCPJ dorsal angle decreased with exercise. In conclusion, the
goniometer can be used to measure MCPJ angles in live horses, either standing squarely or with the
contralateral limb lifted. Recent exercise, but probably not head position may affect the angle.
Keywords: Horse, metacarpophalangeal, angle, forelimb.
Corresponding author: Department of Anatomy, Histology and Embryology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli 13662, Libya.
Received on: 03 Feb 2015
Revised on: 13 Feb 2015
Accepted on: 11 Feb 2015
Online Published on: 27 Feb 2015
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J. Vet. Adv., 2015, 5(2): 831-840
METACARPOPHALANGEAL JOINT ANGLE MEASUREMENT IN …
Introduction
In general, the MCPJ is considered to be one of
the most important joints in the equine body (Heat
et al., 1985). The MCPJ is formed by the
articulations between the third metacarpal bone
(Mc3) and the proximal phalanx (P1) in addition to
the medial and lateral proximal sesamoid bones
palmarly. Based on the number of axes of the joint
and its nature of movement, the MCPJ is a uniaxial
synovial joint with an angular movement (flexion
and extension) (Sisson, 1975; Pasquini et al., 2007).
In racehorses, the MCPJ is the most susceptible
joint to overloading (Pool, 1996). Its articular
cartilage covers a relatively small area in relation to
its large range of motion (Hartog et al., 2009). This
would make the MCPJ highly prone to trauma and
to the development of osteoarthritis (Pool, 1996).
The measurement of various joint angles in
humans and estimates of their range of motion are
often used to differentiate between normal and
pathological joints as well as in the assessment and
treatment of musculoskeletal disorders (Dejnabadi
et al., 2005; Menadue et al., 2006; Mundermann et
al., 2006; Shimamura et al., 2006). In dogs,
methods of measuring the joint angles have been
developed and are recommended to be included in
the diagnostic protocol for lameness assessment in
forelimbs (Jaegger et al., 2002; Cook et al., 2005).
In the equine, the MCPJ angle shows variation
amongst horses. According to Holmstrom et al.,
(1990)
who
studied
the
conformational
characteristics in 356 Warmblood horses, MCPJ
dorsal angle was between 136° and 168°. Weller et
al., (2006) reported that the range of MCPJ angle in
108 National Hunt racehorses was between 135°
and 165°. Although the influence of breed on MCPJ
angulation seems to be questionable, other factors
have been assumed to affect the wide range of the
joint angle. These factors include changes in the toe
angle (Rooney, 1984; Bushe et al., 1988) and the
unequal distribution of the horse’s weight on the
limbs (Denoix et al., 1996). Therefore, in order to
identify a consistent and accurate measurement of
the MCPJ angle, the methods of measurement of the
joint angle should be thoroughly studied and the
832
possible causes of changes in the joint angle should
be taken into consideration.
A number of techniques have been developed
for non-invasive measurement of MCPJ angle exvivo and in-vivo. The majority of these techniques
attempted to consider the forces acting on the
structures of the distal forelimb during exercise
(Vilar et al., 1995; Hartog et al., 2009) or to study
the movement and coordination of the joints within
the forelimb using kinematic systems (Back et al.,
1994).
Vilar et al., (1995) studied the changes in
equine MCPJ surface contact while estimating
MCPJ angles in walk, trot and gallop. The joints
were subjected to different loads and the angles
were measured using a simple protractor from the
surface anatomy. The mean palmar MCPJ angles
were 218, 226 and 240 degrees during walking,
trotting and galloping respectively. In another study,
Hartog et al., (2009), measured MCPJ angle by
placing markers on specific parts of the limb and
the joint angle was calculated from measurements
of digital photographs. However, in both of these
studies neither the anatomical features of the
landmarks nor validation of the tools used to
measure the angle were described sufficiently.
MCPJ angle of post-mortem limbs mounted in
a loading apparatus were measured by Wilson et al.,
(1999) whilst comparing two methods of sesamoid
bone fixation. The center of rotation of the MCPJ
was estimated and selected linear parameters were
used to measure MCPJ angle. These authors used
the center of the condyle from the lateral aspect to
estimate the center of motion. This estimation might
be inaccurate because the condyle of Mc3 has two
different curvatures for articulation with two
different bones (first phalanx and the sesamoids)
and consequently each condyle has two centers of
rotation.
There are several reports in the literature
concerning the range of MCPJ motion during
movement. Corley and Goodship (1994), for
example, studied the total range of motion of the
carpus and MCPJ using a kinematic system. Van
Oldruitenborgh-Oosterbaan
et
al.,
(1995)
investigated the influence of additional loading on
the range of MCPJ motion in exercised horses.
Despite the results in the previous two studies,
J. Vet. Adv., 2015, 5(2): 831-840
ALRTIB ET AL.
using skin markers in their measurements might
cause considerable errors. According to Fuller, et
al., (1997) and Nielsen, et al., (2003) significant
errors can be generated due to skin marker
movement relative to the bony landmarks. They
measured the joint angle during movement where
changes may be transient and affected by many
factors including gait, balance, working surface, and
rider position.
In the literature there are no studies
investigating the changes that might occur in MCPJ
angle of standing horses due to changes in head and
neck position or exercise. Although measuring
MCPJ angle in standing horses might be useful in
clinical diagnostic protocols for detecting lameness
in equine forelimbs and/or for choosing a good
performance horse, there are no studies concerning
the joint angle and factors which could affect its
measurement in standing horses in vivo.
Although the MCPJ angle has been measured
and studied previously, description and validation
of landmarks used to measure the angle are still
unclear. Therefore, the present study aimed to
develop a consistent method to measure the MCPJ
angle as well as investigating the effect of a number
of factors on the angle measurements.
Materials and Methods
Animals
Ex-Vivo
Ten distal forelimbs were obtained from five
horses to investigate the consistency of goniometer
measurement, and another five forelimbs were used
to estimate the center of motion of the MCPJ. All
the specimens were collected from horses that died
or were euthanised for non-orthopedic reasons and
appeared to have no pathology or malformation in
the MCPJ region. Each limb was transected at the
distal fourth of the radius.
In-Vivo
Fourteen mixed breed horses were used to
study the effect of lifting the contralateral limbs on
MCPJ angles. Thirteen mixed breed horses were
used to assess the consistency of MCPJ angle
measurements when the horses were standing
squarely and when the contralateral limb was lifted.
Five horses were used to study the effect of the head
position on MCPJ angles. Twelve horses (6
exercised and 6 control) were used to study the
immediate effect of exercise on MCPJ angle.
The experimental protocol was approved by the
Animal Ethics Committee at the University of
Melbourne.
Methods
Estimating the Center of MCPJ Motion
A radio-opaque marker (approximately 1mm2)
was fixed on a bony prominence on the lateral
epicondyle of the distal Mc3. Latero-medial
radiographs were taken of three MCPJs. To
determine the center of motion, a circle was drawn
on the radiograph using the Photoshop software
program where the circumference of the circle was
best fit onto the most dorsal region of the condyle
where Mc3 articulates with P1 (Figure 1).
Identifying the lateral region of the condyle from
the medial region was based on a previous study by
the first author (Alrtib, 2013). Then the center of
this circle was taken as the approximate center of
MCPJ motion.
Fig. 1: Lateral aspect of the distal end of an equine third metacarpal bone (left) and a lateromedial view of the
metacarpophalangeal joint (right) showing the method of estimating the center of motion of the joint. On the bone, a marker was fixed
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J. Vet. Adv., 2015, 5(2): 831-840
METACARPOPHALANGEAL JOINT ANGLE MEASUREMENT IN …
on the bony eminence where the lateral collateral ligament originates on the lateral epicondyle of the distal Mc3. The radiograph
shows the circle which was drawn onto the most dorsal region of the condyle. The center of the circle was approximately taken as the
center of MCPJ motion.
Two distal limbs were photographed to confirm
the position of the center of motion in relation to
external features of the bones. The photographs
were taken perpendicular to the lateral aspect of the
distal extremities at the same level as the eminence.
Each eminence was marked before photographing.
Then the center of motion was identified using the
above mentioned radiographic method.
Measuring MCPJ Angle
MCPJ angle was measured using a Prestige
Medical 8-inch protractor goniometer to an
accuracy of 0.1 of a degree. The center of rotation
of the goniometer was positioned on the lateral
aspect of the approximate center of motion of the
MCPJ. The moveable scale arms were then aligned
parallel to the dorsal aspect of the third metacarpal
bone and the pastern axis. The angle was then taken
dorsally between the longitudinal axes of Mc3 and
P1 as shown in Figure 2.
Fig. 2: Lateral aspect of a distal limb showing the dorsal metacarpophalangeal angle. The center of the angle is located at
the approximate center of motion of the joint. The angle is taken between the longitudinal axes of Mc3 and P1 which were
estimated by eye when using the goniometer.
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J. Vet. Adv., 2015, 5(2): 831-840
ALRTIB ET AL.
Consistency of the Goniometer in Measuring
MCPJ Angle
Ten cadaver forelimbs were positioned
vertically on rectangular Perspex plates and fixed
randomly with different MCPJ angles. A series of
five measurements of MCPJ angle were taken by
the first author (rater A) for each limb. To avoid
bias, the order of measurements was randomized
using a random numbers table (White et al., 1979).
Another set of measurements was taken for MCPJ
angles of the same forelimbs by another person
(rater B).
Effect of Lifting the Contralateral Forelimb on
MCPJ Angle
MCPJ angles of twenty-eight joints from
fourteen horses were measured two times. The first
measurements were taken when the animal was
standing squarely on a concrete floor. The second
measurements were taken with the contralateral
limb lifted and the carpus of the flexed limb held at
the same level as the carpus of the measured limb.
Consistency of Measuring MCPJ Angle either
in a Standing Position or with the Contralateral
Forelimb Lifted
Measurements of MCPJ angle were taken from
ten joints of five horses with the horse standing
squarely. Each joint angle was measured six times.
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J. Vet. Adv., 2015, 5(2): 831-840
A series of measurements of sixteen MCPJs of eight
horses were repeated five times with the
contralateral limb lifted. All these measurements
were taken by the author in random order with an
hour interval between each two consecutive
measurements for the same limb.
Effect of the Horse’s Head Position on MCPJ
Angle
Ten MCPJ angles of five horses were measured
using
Hoof-Metron
measurement
software
(EponaTech Metron, Metron-Hoof, Version 6.06,
EponaTech LLC, USA) according to the following
procedure. Three skin markers were fixed on each
limb. One marker was fixed on the center of motion
of the joint and the other two on the proximal third
of Mc3 and the distal third of P1. The markers were
placed on imaginary lines which could be drawn
from the center of motion and directed up and down
parallel to the dorsal surface of Mc3 and P1
respectively.
A video camera was used at a consistent
distance and orientation to record the changes of the
joint angle during alterations in the head position.
The changes in MCPJ angle were studied in five
different head positions; forward, right, left, raised,
and lowered (Figure 3A).
METACARPOPHALANGEAL JOINT ANGLE MEASUREMENT IN …
Fig. 3: Effect of the head positions on the MCPJ angle. A) Photographs show the five different head positions. B)
Graphs demonstrate the changes in the value of the right and the left MCPJ angles in five horses at the five different
positions (1: Forward; 2: Right; 3: Left; 4: Raised; and 5: Lowered).
Effect of Exercise on MCPJ Angle
Twelve horses that had not been in work for at
least 3 months but were accustomed to the treadmill
were used; six were controls and the other six were
exercised. The exercised group was exercised on the
treadmill for one minute walking, two minutes
trotting at 10 km/h, and another two minutes
trotting at 20 km/h. Duplicate measurements of
MCPJ angles of the control and the exercised horses
were taken using the goniometer before the exercise
started, and again within 2 minutes after exercise
finished. The duplicate measurements were taken
with the horse repositioned between each pair of left
and right MCPJ measurements. The mean of each
duplicate measurement was calculated.
836
Statistical Analysis
A paired t-test was used to assess if there was
any systematic difference between rater A and rater
B and also to assess if there was any statistical
difference when the contralateral limb was lifted. In
the former study, the first reading of rater A for
each limb was used for this calculation. Limits of
agreement were calculated and plotted using
MedCalc v11.3.2 software to compare the two
raters (Bland and Altman, 1999). The repeatability
coefficient (Bland and Altman, 1999) of the MCPJ
that was measured by rater A was calculated with
WinPepi v10.5 software (Abramson, 2004). The
repeatability coefficient can be interpreted as there
being a 95% expectation that two measurements
taken by the same rater from the same limb will
J. Vet. Adv., 2015, 5(2): 831-840
ALRTIB ET AL.
differ by less than the value of the repeatability
coefficient. It indicates the consistency of the rater
in obtaining the same values from the same subject.
A repeated measures ANOVA was conducted
to test the effect of head position on MCPJ angle.
Stata v11.1 software was used for the analysis. A
two-tailed P-value < 0.05 was considered to be
statistically significant. A two-sample t-test was
used to compare the change in MCPJ angle from
pre to post-test between the exercised horses and the
control horses. A two-tailed P-value < 0.05 was
considered to be statistically significant.
Results
The center of motion of the dorsal part of the
metacarpal condyle of the MCPJ was approximately
located on or around the eminence of the lateral
epicondyle of the distal Mc3.
The repeatability coefficient of the goniometer
was 4.7; 95%CI 3.9 to 6.0 degrees. The mean MCPJ
angle for rater A was 161.4 (SD 3.6) and for rater B
was 162.9 (SD 2.9) degrees. Rater B had a mean of
1.5 degrees (SD 2.1, 95%CI -0.02 to 3.02) greater
than rater A, but this was not statistically significant
(P=0.052). The 95% limits of agreement were from
-2.7; 95%CI -5.3 to 0.0 to 5.7; 95%CI 3.0 to 8.3
degrees.
In both limbs, MCPJ dorsal angles were
significantly smaller after lifting the contralateral
limbs (P<0.001). The means before and after the
contralateral limb was lifted were 150.1° (SD 5.2)
and 141.2° (SD 6.7) in the right limb, and 154.9°
(SD 7.4) and 145.6° (SD 8.1) in the left limb
respectively. The ranges of MCPJ angle when the
horse was standing squarely were 140° to 160° in
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J. Vet. Adv., 2015, 5(2): 831-840
the right limb, and 139° to 167° in the left limb. The
ranges of MCPJ angle with the contralateral limb
lifted were 130° to 155° in the right limb, and 130°
to 161° in the left limb.
The repeatability coefficients of MCPJ angle
measurements were similar, both when the horses
were standing squarely and when the contralateral
forelimb was lifted. In the standing position, the
repeatability coefficients were 5.5; 95%CI 4.3 to 7.5
and 4.8; 95%CI 3.8 to 6.6 for the right and left
limbs respectively. When the contralateral limb was
lifted, the repeatability coefficients were 5.2;
95%CI 4.2 to 6.9, and 4.8; 95%CI 3.9 to 6.4 for the
right and left limbs respectively.
Changing the head position showed no
significant effect on the right MCPJ angle (P=0.84)
nor on the left MCPJ angle (P=0.99) (Figure 3B).
Individual comparisons between head positions
were not carried out because there was no overall
effect of head position.
MCPJ angles of the exercised horses decreased
by 3.4 (SD 2.8) degrees in the right limbs (five out
of six horses) and increased by 2.0 (SD 4.0) degrees
in the left limbs (four out of six) as shown in Figure
4. In the control horses however, the angle
increased in the right and decreased in the left limb
by 0.25 (SD 1.1) degrees. This net decrease of 3.6
degrees (95%CI 0.2 to 7.0) in the right forelimb in
the exercised horses was statistically significant (P
= 0.038). Whereas in the left limb, the net increase
with exercise of 2.25 degrees (95%CI -1.5 to 6.0)
was not statistically significant (P = 0.21). The
mean difference between both MCPJs of 5.4 (SD
2.9)
degrees
was
statistically significant
(P=0.0065).
METACARPOPHALANGEAL JOINT ANGLE MEASUREMENT IN …
Fig. 4: Graphs to show the effect of exercise on the right and left MCPJ joint angles in control and exercised horses.
MCPJ dorsal angle in the right limbs decreased significantly with a mean of 3.6 degrees (95%CI 0.2 to 7.0). However, the
changes of the angle in the left limbs were not significant. The horizontal lines indicate the means.
Discussion
The position of the center of motion of the
MCPJ was estimated in a previous study (Hartog et
al., 2009). However, that estimation did not
illustrate clearly how the centre of motion was
identified. Although the metacarpophalangeal joint
consists of four bones, only the third metacarpal and
the proximal phalanx bones participate in the dorsal
joint angle as measured in the present study. Based
on the results, it was clear that the center of motion
of the dorsal part of the metacarpal condyle was
approximately located on or around the eminence of
the epicondyle of the distal Mc3. Hence, for the
purposes of this study, the region of the joint that
was used to find the position of the center of motion
of the equine MCPJ was the dorsal portion of the
distal condyle of Mc3. This bony eminence, where
the lateral collateral ligament of the MCPJ
originates, could be found consistently in live
horses.
The repeatability coefficient of the goniometer
in measuring MCPJ angle was 4.7 degrees with a
mean of 161.4 (SD 3.6) degrees for rater A and
162.9 (SD 2.9) degrees for rater B. According to
Bruton et al., (2000) an error of ±5 degrees in
goniometry measures might be clinically
838
acceptable. This means that the error expressed by
the repeatability coefficient in the current study
could be considered acceptable and the goniometer
is a reliable tool to measure the equine MCPJ angle.
Placing the goniometer on a particular landmark on
skin to measure the MCPJ angle was practically
difficult in live horses especially with the
requirement to obtain accurate measurements. Thus,
raising the contralateral forelimb could offer a more
controllable environment to measure the angle
precisely. However, in this study, in addition to the
requirement for another assistant to raise the
contralateral limb, this lifting produced a significant
decrease in MCPJ angle measurements. Lifting the
contralateral limb might cause some difficulty to the
horses in balancing and distribution of their weight
on just three limbs especially when continued for
periods of longer than two to three minutes.
Therefore, as the MCPJ angle could be affected by
lifting the contralateral limb and required more
assistance, it would be reasonable to measure the
angle during the standing posture.
Displacement of skin markers from underlying
bony landmarks was estimated by Weeren et al.,
(1988). These authors found that there was a
displacement of approximately 2mm at the level of
the MCPJ during movement; walking, trotting and
J. Vet. Adv., 2015, 5(2): 831-840
ALRTIB ET AL.
galloping. The current study disregarded such
displacement error which would take place between
the bone landmarks and the goniometer because all
measurements of the MCPJ angle were taken during
the standing posture of the horses. In addition, in
every single measurement the operator positioned
the centre of the goniometer directly over the bone
landmarks. Such a positioning of the goniometer
directly on the landmarks was intended to reduce
any subjectivity in identification of the landmarks
and consequently increase the accuracy of the angle
measurements.
The head and neck region represents
approximately 10% of the total body mass of the
horse (Sprigings and Leach, 1986). A study
evaluating three different types of reins, mentioned
that head and neck position mainly affected
forelimb kinetics (Biau et al., 2002). This would
occur because of the head and neck influence on the
weight balance between limbs which subsequently
changes MCPJ angle measurements. The current
study found that head movement had no significant
effect on MCPJ angle. However, it can be seen from
figure 3B that the statistical results would be
affected by some variables between the horses.
Despite the insignificant results, maintaining a
standard head and neck position might help to
minimise unexpected errors.
Damage to the tendons and ligaments has been
correlated to the repetitive stress and strain placed
on these structures during training (Lin et al., 2004;
Kumar, 2001) and unusual stresses such as
overextension or exaggerated pressure in a direction
not normally undertaken (Smith and Goodship,
2008). Hence, many reports concerned the effect of
exercise on horses’ kinematics and tissues during
movement. A number of the studies monitored the
change in the range of motion in some joints
including the MCPJ during movement (Corley and
Goodship, 1994; Van Oldruitenborgh-Oosterbaan et
al., 1995). In the current study, a significant change
was reported in the right MCPJ angle of the
exercised horses but not in the left MCPJ angle.
This result might indicate greater support and
longer contact duration of the right leading limb
compared with the contralateral limb (Deuel and
Lawrence, 1987) and there is some evidence that
horses may tend to control their right forelimb more
839
J. Vet. Adv., 2015, 5(2): 831-840
consistently than their left (Deuel and Lawrence,
1987; Davies and Watson, 2005). Despite the
significant effect being in the right or the left
leading limb, it is known that the overextension of
MCPJ results in high tensile loads being imposed on
the flexor tendons and suspensory ligament (Smith
and Goodship, 2008). Therefore, it seems
reasonable to assume that there is a relationship
between changes in MCPJ angle and exercise.
Further studies are obviously needed to investigate
this assumption in normal horses and horses with
clinical problems.
In conclusion, the current study has described
an easy, accessible and reliable method to measure
MCPJ angle in the field. Some factors such as
recent exercise and lifting the contralateral limb
should be considered before measuring the angle.
Further studies are needed to identify relationships
between MCPJ angle in sound horses and
pathological cases as well as possible relationships
to training regimes.
Acknowledgments
The authors would like to thank the Libyan
government for financial support, Sara Malone and
Laurel Hui-Leigh Chew for their assistance in
measurements, and would also like to thank Dr.
Simon Bailey for providing the opportunity to use
his horses for measurements and Garry Anderson
for advice on statistical analysis.
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