Causes of Lameness: Tendons and Ligaments Flashcards
What are the classifications of tendon injuries?
internal = strains
external = wounds, trauma
What are the types of tendon injuries?
tendonitis
tenosynovitis (inside the tendon sheath)
What is the most common tendon injury?
internal strain of SDFT in MC regions
AKA “bowed” tendon
What are the causes of a mechanical injury of flexor tendon?
- Toed-in or toed-out conformation –> excessive medial or lateral strain on tendons
- Long toe and low heel –> delayed breakover and longer stride –> tendon strain
- Muscle fatigue –> rely more on tendons/ligaments –> tendon instability
- Uneven surfaces and mud with sudden turns –> uneven stress within tendon
- Improper bandaging –> stricture or stresses within tendon
- Unbalanced trimming and shoeing –> uneven impact –> force distributed unevenly within tendon
What are the phases of tendonitis?
- Tendon degeneration
i. Subclinical - Acute inflammatory phase
i. Onset of clinical signs, lasts 1-2 weeks - Reparative phase
i. Overlaps with inflammatory phase, peaks at 3 weeks, angiogenesis and fibroblast migration - Remodeling phase
i. Lasts several months, repair tissue stronger, but less elastic and prone to re-injury
What are the signs of tendonitis?
variable lameness
painful on palpation
swelling
heat
What are the diagnosis of tendonitis?
ultrasound, initial and follow-up
What is the treatment of tendonitis?
acute inflammation:
* cold therapy, NSAIDs, rest
repair/remodeling:
* shockwave
* intralesional regenerative therapies (platelet rich plasma (PRP), stem cells)
* no corticosteroids (they slow healing)
* pin firing and blistering
* transection of the proximal check ligament (SDFT)
* rehabilitation and controlled exercise
Describe SDF Tendonitis
AKA bowed tendon
forelimb > hindlimb
mid-proximal bows > low bows
What are the causes of SDF Tendonitis?
fetlock hyperextension
repetitive trauma
age
What does digital extensor tendonitis include?
common, long, or lateral digital extensor tendon
What is the cause of digital extensor tendonitis?
local trauma such as a kick
What are the signs of digital extensor tendonitis?
variable lameness, swelling, heat
What is the diagnosis of digital extensor tendonitis?
clinical signs, diagnosis
What is the treatment of digital extensor tendonitis?
rest, NSAIDs, DMSO, poultice, bandaging, cold/warm therapy
Describe SDFT injuries in the distal limb
forelimb > hindlimb
often outside digital flexor tendon sheath
Describe DDFT injuries in distal limb
hindlimb > forelimb
often inside digital flexor tendon sheath
results in sheath effusion and chronic tenosynovitis
What are the signs of tenosynovitis?
distention of tendon sheath, pain, heat
What is the diagnosis of tenosynovitis?
ultrasound
What is the treatment of tenosynovitis at fetlock?
transection of the annular ligament for SDF or DDF tenosynovitis at fetlock
What is thoroughpin?
non-septic tenosynovitis of DDF tendon sheath at level of hock
What are the signs of thoroughpin?
fluid filled swelling on plantar aspect of hock, non-painful, no lameness
What is the diagnosis of thoroughpin?
clinical signs, ultrasound
What is the treatment of thoroughpin?
drainage of fluid (will fill back up), DMSO sweat
What is septic tenosynovitis?
like septic osteoarthritis
What does septic tenosynovitis result in?
damage to tendon
adhesive formation
possible erosion of tendon sheath and progression of infection
What is tendon laceration?
loss of tendon function
concern about damage to adjacent structures
What is the prognosis for a tendon laceration?
prognosis:
flexor tendon worse than extensor tendon
guarded if both SDFT and DDFT involved
What is the cause of suspensory desmitis?
straight hocks
hyperextension of carpus/tarsus and fetlock
deep, soft footing
excessive rotational movement of limbs
secondary to fractured splint
What are the signs of suspensory desmitis?
swelling and pain on palpation (subjective)
mild to moderate lameness
positive Churchill sign
What is the technique for the Churchill sign?
finger pressure applied on posterior head of medial splint bone
What is a positive response for the Churchill sign?
upward and outward movement of leg
What is the diagnosis of suspensory desmitis?
ultrasound, radiographs, MRI
What is the treatment of suspensory desmitis?
NSAIDs and rest
cold/warm therapy
surpass
shockwave
intralesional injection (stem cells, PRP)
What is the signalment of proximal suspensory desmitis?
sport horses - eventers, jumpers, Western performance
hind limbs > forelimbs
Case: Reggie
What is the signalment for body and branch lesions in SL?
SBs and jumping horses
Case: Teddy
What is the cause of a suspensory ligament rupture?
extreme overextension of fetlock
occurs acutely; can accompany proximal sesamoid fracture
What are the signs of a suspensory ligament rupture?
dropped fetlock, lameness
What is the diagnosis of a suspensory ligament rupture?
rads to assess bones, U/S ligament
What is the treatment of a suspensory ligament rupture?
immobilize limb to prevent further damage:
cast, splint, or fetlock arthrodesis
euthanasia
What is the prognosis of a suspensory ligament rupture?
guarded prognosis:
most likely never return to performance work
What is the signalment of inferior check desmitis?
SB trotters and pacers
often overlooked, U/S has aided diagnosis
What is the cause of inferior check desmitis?
long toe/low heel –> slow breakover
unbalanced foot
What are the signs of inferior check desmitis?
lameness, pain on palpation
What is the diagnosis of inferior check desmitis?
local anesthetic, U/S, rads to rule out bony lesions
What is the treatment for check desmitis?
cold/warm therapy, bandaging
surpass, NSAIDs, shockwave
What is tarsal plantar desmitis?
AKA curb
inflammation of long plantar ligament
What are the causes of tarsal plantar desmitis?
conformation: sickle-hocked and cow-hocked
trauma
What are the signs of tarsal plantar desmitis?
plantar swelling distal to point of hock
pain, heat, swelling, lameness
What are the diagnosis of tarsal plantar desmitis?
clinical signs
local anesthetic
What are the treatments for tarsal plantar desmitis?
cold/warm therapy, rest
NSAIDs
topical DMSO, surpass
shockwave
pin firing, blistering, injected with counterirritants
Where are annular ligament constrictions?
palmar or plantar
What is the acute cause of an annular ligament constriction?
Annular ligament get damaged (ex. Wire cut) or tendon within it gets strained –> inflammation –> constriction of tendon(s)
What is the chronic cause of an annular ligament constriction?
Thickening of annular ligament –> constriction of tendon(s)
What are the signs of an annular ligament constriction?
Non-specific lameness which worsens with work, history of trauma to fetlock, distention of proximal digital flexor tendon sheath with “notch” created by annular ligament
What is the diagnosis of an annular ligament constriction?
Clinical signs, ultrasound (want to assess adhesion formation and tendon damage), radiographs to rule out sesamoid fracture
What is the treatment of an annular ligament constriction?
Surgical resection of the annular ligament with bandage application and return to exercise to prevent adhesions
What is an upward fixation of the patella?
Patella fixed over medial trochlear ridge
What is the cause of upward fixation of patella?
Poor conformation: steep angle between femur and tibia
What are the signs of upward fixation of patella?
hindlimb locked in extension
stifle and hock cannot flex
toe drags on ground when moving
tense patellar ligaments on palpation
What is the diagnosis of upward fixation of patella?
clinical signs
How do you treat upward fixation of patella?
mild case: hill work and NSAIDs, injection of counterirritants
more severe case: medial patellar desmotomy
What is the cause of a rupture of peroneus tertius?
overextension of hock joint
rupture usually occurs near origin
What are the signs of a rupture of peroneus tertius?
flexion of stifle with extension of hock
can bear weight
What is the diagnosis of a rupture of peroneus tertius?
clinical signs, rads to assess bone
What is the treatment of a rupture of peroneus tertius?
stall rest for 8-12+ weeks, euthanasia
