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Equine final practical exam - Surgery > 5. Examination of the tendons and tendon sheaths > Flashcards

5. Examination of the tendons and tendon sheaths Flashcards

1
Q

What is a tendon?

A

A fibrous connective tissue that connects muscle to bone

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2
Q

Function of tendon:

A

Moves the joint

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3
Q

What is a tendon sheath?

A

Structure that surrounds the tendon, helps and protects tendons from abrasive damage as they move

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4
Q

Name the tendon sheaths:

A
  1. DFTS = Digital Flexor Tendon Sheath
  2. Carpal sheath
  3. Tarsal sheath
  4. Tendon sheath of extensor tendons (dorsal surface)
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5
Q
A
  1. Radius
  2. Carpus
  3. 5th metacarpal
  4. 3rd metacarpal
  5. 1st phalanx
  6. 2nd phalanx
  7. 3rd phalanx
  8. Distal sesamoid
  9. Proximal sesamoid
  10. Extensor branch of suspensory ligament
  11. Deep digital flexor tendon
  12. Stright sesamoid ligament
  13. Oblique sesamoid ligament
  14. Suspensory ligament
  15. Superficial digital flexor tendon
  16. Check ligament of deep digital flexor tendon
  17. Check ligament of superficial digital flexor tendon
  18. Digital cushion
  19. Frog
  20. Sole
  21. Hoof wall
  22. Heel
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6
Q

Most important clinical structures of tendons and tendon sheaht:

A
  1. SDFT = Superficial Digital Flexor Tendon
  2. DDFT = Deep Digital Flexor Tendon
  3. Suspensory ligament
  4. DFTS = Digital Flexor Tendon Sheath
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7
Q

Which strucutre is damaged?

A

Peroneus tertius rupture. A concurrent flexion and extension of hock and stifle

Part of reciprocal appartatus of the hindlimb.

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8
Q

Pathognomonic clinical signs of peroneus tertius rupture:

A

􀁸 horse are able to extend the hock while the stifle
is flexed
􀁸 horses are able to bear weight on the limb
􀁸 characteristic dimple on the caudodistal aspect
of the soft tissue of the crus
􀁸 at trot: overextension of the hock, lameness, delayed protraction of the affected limb

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9
Q

SDFT - Origin and insertion

A

Origin: Epicondylus medialis humeri

Insertion: Proximopalmar on phalanx media

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10
Q

Injuries of SDTF:

A

Common in forelimb - Mid-metacarpal region in racehorses and events due to traumatic overreach

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11
Q

Name a strucutre/band of the SDFT, which wraps the DDFT:

A

Manica flexoria

Found just proximal of the fetlock region

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12
Q

Which structure is damaged?

A

DDFT rupture

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13
Q

DDFT - Origin and insertion

A

Origin:

Insertion: Facies flexoria of distal phalanx

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14
Q

Injuries of DDFT:

A
  1. In pastern region
  2. In fetlock region: Typical in high level show eventers
  3. Complete rupture: Toe flips up

-> Generally poor prognosis

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15
Q

What is the suspensory ligament?

A

A structure which stabilize the normal hyperextension of the fetlock joint and provide excessive hyperextension.

The ligament run down on palmar/plantar aspect of the cannon bone, btw the splint bones

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16
Q

Suspensory ligament - origin and insertion:

A

Origin: Just below carpus/tarsus
Insertion: With two branches, one of each dorsal site of pastern bone

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17
Q

predilection sites of Injuries of suspensory ligament:

A

proximal origin and at the distal branches

18
Q

Typical injuries of the suspensory ligament:

A
  1. complete rupture: fetlock drops, severe hyperextension, poor prognosis
  2. in forelimb: prox. susp. desmitis
  3. in hindlimb: prox. susp. desmopathy: often bilateral in dressage horses (more motion in hind limb), predisposing factor: straight hock
  4. injury of the distal branches: distension of MCP / MTP joint, thickening, response to flexion
19
Q

Which structure is damaged?

A

Complete rupture of the suspensory ligament

20
Q

Which structure is damaged?

A

Complete rupture of the suspensory ligament

21
Q

DFTS - Origin and insertion

A

Origin: Distal 1/3 of MC/MT
Insertion: just proximally to the navicular bursa

22
Q

Which structures is sorrounded by DFTS?

A

SDFT and DDFT

23
Q

Disorders of DFTS?

A
  1. non-septic tenosynovitis: common in sports medicine practice
  2. septic tenosynovitis: in case of wounds, penetrating injuries
  3. manica flexoria tears
  4. distension
    ->bilateral: often cosmetic problem
    ->unilateral with clearly delineated swelling: more likely to implicated in lameness
24
Q

What can be seen?

A

Palmar annular ligament syndrome.

Distension of tendon sheath and swelling

25
Q

What is the palmar annular ligament syndrome?

A

Distension of DFTS and thickening of palmar annular ligament

26
Q

What can palmar annular ligament syndrome cause?

A

Desmopathy of PAL, which again causes external trauma and overextension of the fetlock

27
Q

Consequences of palmar annular ligament syndrome?

A

Chronic inflammation, causing adhesions and fibrosis

28
Q

If the palmar annular ligament syndrome keeps getting worse?

A

We call it “perpetuating condition”.

We see inflammation, pressure, stenosis - which will induce further inflammation

29
Q

Examination of a horse with tendon or tendon sheath problems:

A
  1. history
  2. clinical examination
    -> Observation: visible signs, distension of tendon sheaths (bilateral vs. unilateral)
    -> palpation: heat, swelling, pain
    -> response to flexion
  3. gait assessment -> grade of lameness
  4. diagnostic analgesia -> localize the lameness
  5. ultrasonography
  6. Tendonography
  7. standing MRI
30
Q

Diagnostic analgesia of DDFT:

A

Distal 4-point block: Affects them distal of fetlock joint

High palmar block: Distal limb including fetlock

Subcarpal block: Whole MC region

31
Q

Diagnostic analgesia of SDFT:

A

Distal 4-point block: Affects them distal of fetlock joint

High palmar block: Distal limb including fetlock

Subcarpal block: Whole MC region

32
Q

Diagnostic analgesia of suspensory ligament:

A

Lateral palmar analgesia

Suspensory ligament origin infiltration

33
Q

Diagnostic analgesia of DFTS:

A

Greater improvement to low 4-point block, than to intrathecal analgesia

34
Q

What is intratechal anaesthesia?

A

Lateral or medial approach, 10-15 ml with botj injections

Proximal palmar approach +
Distal palmar approach

35
Q

What can be check on US?

A

fibre pattern of SDFT, DDFT
Thickening of PAL
Integrity of the manica flexoria
Can permit detection of tears of the Manica flexoria

36
Q

What is tendonography?

A

Radiography of the tendons with usage of contrast material

37
Q

What technique would you use to perform tendonography?

A

o patient preparation, aseptic preparation of the skin
o inject 5 - 7 ml meglumine diatrozoate
o than LM view

38
Q

Diagnostic criteria of tendonography:

A

o Manica flexoria: outlines as two parallel lines
o tears in DDFT: contrast material in the tendon

39
Q

what can we evaluate with standing MRI?

A

Evaluation of bony and soft tissue strucutres

40
Q

Indication of standing MRI?

A

If lameness cannot be explained by findings of conventional diagnostic imaging

41
Q

What is MRI?

A

Thin slices of 3D

42
Q

How long time for doing an MRI?

A

Its VERY time consuming, can be 3-4 hrs for only two feet, and only a small area can be examined.

Equine final practical exam - Surgery (12 decks)

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