CAL: Cases Tendon and Lig Injury

Question 1

How would a horse with perineus tertius rupture present and locomote?

Answer 1

• ability to flex the stifle while the hock is extended

- metatarsal protracted in a vertical orientation d/t lack of hock flexion

Question 2

Tx perineus tertius rupture? Prognosis?

Answer 2

• 3 months rest

- prog good, function usually repaired by fibrotic repair of ligament

Question 3

What is a slipped SDFT? Presentation?

Answer 3

• SDFT displaced from point of hock (calcaneous)
• acute presentation, displacement d/t trauma usually tearing of the medial retinaculum or occasionally split of the SDFT
• distress d/t altered mechanics of the hock (constant flexion/extension)
• can be intermittent of permentnat

Question 4

Tx and prognosis of a slipped SDFT?

Answer 4

• conservative (if permenant, tendon will eventually function in new position)
• surgical repair with mesh (poor success rate)
• intermittent displacement moe of a problem
  > prog fair for permenant but will drop a level of ability
  > guarded for intermittent without surgery

Question 5

What is a common site for DDFT injuries and what does this cause? Best dxx to confirm?

Answer 5

• just proximal to the navicular bursa -> navicular syndrome
• MRI or navicular bursoscopy best imaging modalities

Question 6

Tx DDFT injury? Prog?

Answer 6

> conservative
- rest up to 12 mo
- correct foot balance to minimise load on DDF T
- NSAIDs
surgical
- navicular bursoscopy
- debride torn fibres
- not all DDFt injuries in the foot are amenable to bursoscopy
prog conservative 25% return to work surgical 50% retun to previous level of work

Question 7

If you are presented with a horse with lacerations to the palmar mid-metacarpus, very lame, with toe off the ground in stance, what structures are involved?

Answer 7

• complete transection of the SDFT and DDFT

- look at diagram on CAL

Question 8

What must be remembered when looking at lacerations?

Answer 8

Laceration of tendon most likely a differnet place to the skin

Question 9

What dxx useful for assessing lacerations to the distal limbs? Exception?

Answer 9

• ultrasound

- unless massive skin deficit

Question 10

What associated structures other than tendon/ligament can be involved with laceration/penetration wounds?

Answer 10

• tendon sheaths

- may get infected and need tx = septic joints

Question 11

Management of a horse with complete transection of the SDFT and DDFt

Answer 11

> support MCP joint eg. Kimzey splint
conservative
- wound mangmenet
- cast
- special show
surgery (recommended for completel transection)
- debride ST and tendon ends
- repair of tendon if cast removal for partial laceration : 6 weeks
cast removal for complete transection : 10-12 weeks with change @ 6-8weeks
- protect tendon loading after cast removal by either palmar splint SDFT) and/or fish tail shoe (DDFT)

Question 12

What does a flexural deformity of the DIP joint look like? Causes? Confirm you dx?

Answer 12

• fully weight bearing but holds the foot on tip toes
• causes:
• ALDDFT desmitis
• adhesions of DDFt and other structures
  > Dxx
• palpation (proximal metatarsal region)
• ultrasound (similar signs to forelimb)

Question 13

What are the 2 types of ALDDFT desmitis in the hindlimb? Tx? Prog?

Answer 13

• lameness with swelling of the ALDDFT
• DIP joint flexural deformity
  > tx
• conservative for lameness caused by desmitis
• resection for persistnet lameness and flexural deformity
• post-op physio (prevent recurrence)
• often recurs (guarded prognosis)