Disorders of Ligaments and Tendons 1 Flashcards
What is a tendon?
Cord of strong flexible tissue that connects muscles to bones
What is a ligament?
Strong cord that connects bone to bone
Why don’t tendons regenerate?
Low cellularity, small population progenitor cells, low vascularity, dense matrix, compressive trauma from retinaculum, degenerative process with apoptosis, degermation of matrix overcomes remodeling capabilities
When you have a tendon injury, how do you improve the outcome?
Decrease duration of inflammatory phase, decrease MMP, increase early blood flow, reduce strain/tension (cast or shoe), decrease compression, rehabilitation, molecular and cellular (regenerative medicine)
What are some extensor tendons?
Extensor carpi ulnaris, common digital extensor tendon, long digital extensor, lateral digital extensor
What kind of injuries can happen to tnedons?
Lacerations, ruptures, tendinitis/tendinopathies, tenocynovitis
What is the prognosis for injury to the extensor tendons?
Good to excellent! - can heal with rest and without intervention, all tendon therapies can be used for these injuries
-lacerations: clean, debride, bandage, rest, controlled exercise
-Rupture in foal: splint, flexural deformities contribute
-Tenosynovitis can occur - medical
How does a horse rupture it peroneus tertius?
Limb is stuck and horse pulls against it (hind limb)
-look like flexed stifle with straight hick
-Medical and conservative treatment good
What is more common superficial or deep digital flexor tendinitis?
Superficial
-Smaller crossectional area, more external (greater angle and risk of trauma), less vascular
Who does SDFT tendinitis usually occur in?
-Common in old PPID horses
-Common in racehorses
What is the pathogenesis of tendon injury?
-High strain and hyperthermia lead to matrix and cell damage
-Vascular injury
-Loss of mechanical properties (strain on uninjured portion of tendon and re-injry)
-Lameness - more strain and injury on contralateral tendon
Why do core lesions occur in the tendon?
Hyperthermia and less crimp to the internal aspect of the tendon
What are some risk factors for tendon injuries?
Age and exercise (SDFT)
Exercise in TB horses > 3ry
Cumulative high speed and distance training and racing
How do you diagnose a tendon injury?
Physical exam, lameness (pain, heat, swelling), palpation, lameness exam, ultrasound, MRI, thermography, PET
How can you use ultrasound to help ID tendon injury?
Transverse and longitudinal, measure, cross-sectional area, proximal to distal, echogenicity score (1-4), both limbs, serial exam in rehab
What do you do if you have an acute tendon injury?
Stall confinement, control inflammation (NSAID, Cold, Compression and Cooling) and bandage
What does sub-acute care look like?
-At 2 weeks (look bigger before this)
-Controlled exercise
-Serial ultrasound
-Medical therapy
-Surgical treatment
What are some medical treatments for tendon injuries?
Extracorporeal Shockwave Therapy
-low frequency, minimal tissue absorption and no heat generated
-Increase blood flow
-Induce analgesia, demyelination nerves
-Improved outcome SLD
Low Level laser therapy
Therapeutic ultrasound
How does extracorporeal shockwave therapy work?
Acoustic waved generated outside the body, focus on site, high pressure and velocity
What effects does shockwave have (ESWT)?
Mechanical and biological
-bone microfracture and hematoma - osteoblastic activity and healing
-Analgesia - hyper-stimulation and myelin sheath disruption
-Neovascularization
When should you use shockwave?
Not after cell therapy
-Mild lesion
-Chronic lesion
-tendon/bone and ligament and bone interfaces - insertion of tendon, collateral ligament, forelimb suspensory, mild hind limb suspensory
When should you use therapeutic laser?
Adjunctive, 6 weeks after cell therapy, careful choosing unit, higher wavelength and power is better for penetration
-Careful of hematomas
-Issues on pigmented skin
What is critical during rehabilitation with these tendon injury patients?
Time and controlled exercise
What should be occurring during rehabilitation?
Controlled exercise, sedation, slow progression with imaging
-Hand walk 2-8 weeks
-Tack walking 9-12 weeks (lameness exam)
-Tack walk with increase in trotting 13-16 weeks
-supervised turn out in small paddock
-if healed and sound gradual increase to full work starting in 6 months
What are some surgical treatments for tendon injury?
-Tendon splitting (increase blood flow)
-Transection of accessory ligament SDFT (proximal or superior check ligament desmotomy - more elastic lenght)
-Palmar/plantar annular ligament transection (more room SDFT and DDFT to move
-Tendoscopy and bursoscopy
What is tendon splitting used for?
Chronic cases and acute now (made chronic acute)
-Longitudinal stab incision into core lesion
-Decompress compartment syndrome
-Increase blood to anechoic core
-Collagenase model - more resolution core lesion quicker revascularization - increase collagen
What is tenosynovitis?
Injury to tendons in tendon sheath
-linear tear
-adhesion
-masses
-palmar annular ligament desmitis
-Septic tenosynovitis
What is tenoscopy?
Mass removal, debride, treat septic sheath, flexor sheath
