Where is the Volar Pouch

D. E. Larsen, DVM  

Dr. Adams was a massive man, both in his physique and in his professional reputation. He was not tall, less than six feet, but very muscular. His rugged facial features made him appear to have a scowl on his face in the best of times. In those moments, when he was mad at a horse or a student, some would say he was fearsome.

There was a story while we were in school about Dr. Adams attending a meeting of equine veterinarians. The first presenter was doing a ground-up portrait of the perfect equine veterinarian to lighten the audience. 

He started with the feet, then the legs, on up to the chest and arms. The picture was that of a cartoon gorilla. In actuality, it portrayed Dr. Adams pretty close. Dr. Adams was in the front row and was becoming red in the face because it seemed everyone except the presenter recognized the similarity to Adams. I have no idea if the story was true, but it was told a lot in those years.

However, he was a great teacher. When I was assigned to him for my senior rotation in large animal surgery, I was thrilled. That thrill did not last long.

On the first Monday morning of my two-week rotation, the Junior student and I waited in front of the large animal surgery room. Finally, Dr. Adams arrives at 8:00 AM sharp.

“Good morning, Guys,” Dr. Adams says. “You two are lucky. We have a busy couple of weeks coming up. I want to get off to a running start here.”

He throws up an x-ray of the lower leg of a horse on the viewer.

“Where is the Volar Pouch, Larsen?” Dr. Adams asked. 

“Um,” I stammer.

“Jon, same question?” Dr. Adams says to the junior student.

“I guess I don’t know,” Jon replies.

“Okay, let’s get started on the day,” Adams says. “But, you two have an anatomy test in my office at 1:00 PM on Wednesday. If you fail that test, you fail the rotation.”

And if the rumors of Adams’ power were correct, we will play hell graduating if we fail the rotation. This was not only intimidating, but it was also damn scary.

When the casework was done for the day, Jon and I were in a rush to get home. I had managed to get through the first 3 years of Vet School with little studying outside of the classroom and clinic. Now, I had a couple of nights to review the anatomy of the horse in exquisite detail. 

Dr. Adams was the author of Lameness in Horses and enjoyed the reputation as the leading authority on the horse’s legs. That gave us a clue. Make sure you know every detail of the anatomy of the horse’s legs.

For the next two nights, I reviewed my anatomy notes from my freshman year. I committed the equine section of Sisson’s book, The Anatomy of Domestic Animals, to memory. My memory is pretty much photographic. I can save pictures in my mind, but not text. On occasion, I can save captions to the photos for a brief time.

Finally, Wednesday came. We had surgery scheduled for the morning. Dr. Adams was a skilled surgeon. In this jumper, there was a chip fracture of a carpal bone. A significant amount of the time involved getting the horse under anesthesia and positioned on the surgery table. The surgery was brief in Dr. Adams’  hands. The chip was removed, and Dr. Adams left the closure to his intern and senior student, me.

“Don’t forget the test in my office at 1:00,” Adams said as he pulled off his surgery gloves.

“We’re looking forward to it,” I replied with an unseen smile, but I am sure it reflected in my eyes.

Adams smiled and departed the surgery room. 

When the horse was recovered, and back in the stall, Jon and I had a full hour and a half for a final review.

“I am going to take Sisson and go grab a coffee and a sandwich over at the MU,” I said.

“That might be good,” Jon said. “I will join you, but I think I have had my quota of coffee for the week.”

There was no real conversation at the table. We ate a quick sandwich, and both did a final review of Sisson. My pages turned much quicker than Jon’s. When the time came, we got up and walked back to the hospital. 

Dr. Adams’ office was on the second floor of the hospital. When we turned the corner to his office, we ran into a crowd of classmates. Word of our test had spread through the classes, and everyone wanted to watch. It must be like a crowd viewing a hanging. We worked our way through the crowd and took our seats in the office.

These professors all tried to present themselves as intimidating as possible. I found it almost laughable. In my last year in the Army, it was common for me to make presentations at general staff meetings, for generals with 2 or 3 stars on their collars. They were much more formidable than any professor. So in this situation, I was pretty relaxed. Jon was not so much.

Dr. Adams wasted no time. He started firing questions, some oral, some with x-rays on the viewer, and some with pictures from slides projected on to the wall. Like all tests, they are easy if you are prepared. I think the fact that both of us didn’t miss a question was getting to Dr. Adams. 

“You haven’t asked about the volar pouch,” Jon said.

“I figured that would be the question you studied first,” Dr. Adams said. “But since you mention it, why don’t you tell where it is located and what it is, and why it is important on that x-ray I had Monday morning.”

“The volar pouch is an extension of the joint capsule and is located between the cannon bone and the suspensory ligament, just above the sesamoids of the fetlock. If it is distended, it indicates inflammation in the joint.”

“That’s a good answer, Jon,” Dr. Adams said. “You should not overlook that on an x-ray.”

“If you did an adequate clinical exam, you should know it is distended before the x-ray is ever taken,” I said.

“That’s a good point, but in this business here, I am often looking at x-rays of horses that I didn’t examine,” Dr. Adams said.

Finally, he puts a picture on the wall. This was a picture of the two planter nerves on the lower front legs of a horse. There is a nerve that communicates between these two nerves. It crosses the leg at an angle. . You could tell which leg you were looking at by the directing that this nerve was running between the two primary nerves. This was a picture right out of Sisson.

“Larsen, what leg is this?” Dr. Adams asked.

“The left leg,” I said. “The left front leg,” I added.

“How do you know that?” Dr. Adams asked.

“That is the picture out of Sisson,” I said. And then, looking at a blank wall, I used my finger to trace the words in the caption of that picture as I read the caption.

The hallway audience erupted in laughter.

Adams shook his head and smiled. “That’s all I have, I can’t top that.”

That could have been the only time I ever saw the man smile. There was never a mention of the test in the remaining time days of the rotation. We learned a lot, and even though I was not fond of horses, I learned everything I could from the man.

Photo by Laila Klinsmann from Pexels

Published by d.e.larsen.dvm

Country vet for over 40 years in Sweet Home Oregon. I graduated from Colorado State University in 1975. I practiced in Enumclaw Washington for a year and a half before moving to Sweet Home to start a practice.

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