26.5.2: Treatment and rehab of soft tissue pathology Flashcards
Aims of first aid for soft tissue injuries and how this is achieved
Aims of first aid: prevent injury becoming worse, reduce pain
This looks like:
* Reducing inflammation
* Providing stability
* Reducing tendon loading
First aid treatment of soft tissue injuries in the inflammatory phase
- NSAIDs: IV dose immediately, then oral course for 2-3 weeks after/ as long as there is inflammation (i.e. heat, pain, swelling)
- Steroids: single dose dexamethasone IV on first day after injury -> aim to stop inflammatory cascade
- External support: bandage to provide compression and reduce oedematous swelling, pain relief
- Cold therapy: through cold hosing or ice bandages
- Confinement to stable or yard
Mainstay = time and rest
When can you try intralesional therapies for soft tissue injuries and what options are there?
At end of inflammatory phase (2-3 weeks after injury).
Only if hole/space present, not if tendon just swollen.
Injected under ultrasound guidance. Aim to improve speed and quality of healing but not a substitute for rest and controlled exercise.
Options:
* Stem cell therapy
* Platelet rich plasma
* Bone marrow aspirate concentrate
SDFT with large core lesion (hypoechoic area)
Can inject intralesion therapy into this area.
Collateral ligament of coffin joint with large core lesion
Describe the use of stem cells for intralesional therapy
- 2 stage procedure: collection from bone marrow or fat, then reimplantation
- Stem cells differentiate into tenocytes and promote healing
✅ Good effect
😔 Expensive
Describe the use of platelet rich plasma for intralesional therapy
- Autologenous graft of platelets suspended in plasma
- Collect from blood by filtraton or centrifugation
✅ Stimulate angiogenesis (new blood vessel growth -> bring nutrients, growth factors, oxygen) and proliferation and differentiation of tissues (stimulates healing)
Describe the use of BMAC for intralesional therapies
Bone marrow aspirate concentrate
* Autologenous graft of fluids and cells from within bone marrow
* Collected from sternum or tuber coxae using large gauge needle (Jamshidi needle)
* Contains mesenchymal stem cells, platelets, growth factors -> centrifuged to concentrate cells
* Injected into lesion under ultrasound guidance
✅ Single stage procedure
❌ Fewer stem cells, platelets compared to stem cell therapy or PRP
How would you surgically treat palmar/ plantar annular ligament desmitis?
- Palmar / plantar annular ligament desmotomy
- Cutting this reduces pressure and allows tendons underneath to move freely
How would you surgically treat SDFT tendonitis?
- Superior check ligament desmotomy
- Release the weight bearing the SDFT has to undergo by transecting the check ligament and thus reducing pressure
How would you surgically treat manica flexoria tear?
Remove the manica flexoria
How woud you surgucally treat injury to the DDFT?
Surgically debride
e.g. remove any exposed fibres (arthroscopy)
Aims of rehabilitation for horses with soft tissue injuries
- Hasten return to function
- Improve function of structure involved
- Reduce pain and inflammation
- Reduce re-injury rates
- Improve QOL
- Improve range of motion or flexibility
- Improve proprioception and balance
- Adopt a whole animal approach
How could a controlled exercise programme be used in a horse with a soft tissue injury? When should you start this?
Tailor to the individual case and reassess progress via lameness, palpation and ultrasound. Start at the end of the inflammatory phase (2-4 weeks after injury).
Which of the following horses can be turned out sooner following soft tissue injury?
a) calm horse with individual paddock
b) anxious horse living in herd paddock
a) calm horse with access to individual paddock
