Disorders of Ligaments and Tendons 1

Question 1

What is a tendon?

Answer 1

Cord of strong flexible tissue that connects muscles to bones

Question 2

What is a ligament?

Answer 2

Strong cord that connects bone to bone

Question 3

Why don’t tendons regenerate?

Answer 3

Low cellularity, small population progenitor cells, low vascularity, dense matrix, compressive trauma from retinaculum, degenerative process with apoptosis, degermation of matrix overcomes remodeling capabilities

Question 4

When you have a tendon injury, how do you improve the outcome?

Answer 4

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)

Question 5

What are some extensor tendons?

Answer 5

Extensor carpi ulnaris, common digital extensor tendon, long digital extensor, lateral digital extensor

Question 6

What kind of injuries can happen to tnedons?

Answer 6

Lacerations, ruptures, tendinitis/tendinopathies, tenocynovitis

Question 7

What is the prognosis for injury to the extensor tendons?

Answer 7

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

Question 8

How does a horse rupture it peroneus tertius?

Answer 8

Limb is stuck and horse pulls against it (hind limb)
-look like flexed stifle with straight hick
-Medical and conservative treatment good

Question 9

What is more common superficial or deep digital flexor tendinitis?

Answer 9

Superficial
-Smaller crossectional area, more external (greater angle and risk of trauma), less vascular

Question 10

Who does SDFT tendinitis usually occur in?

Answer 10

-Common in old PPID horses
-Common in racehorses

Question 11

What is the pathogenesis of tendon injury?

Answer 11

-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

Question 12

Why do core lesions occur in the tendon?

Answer 12

Hyperthermia and less crimp to the internal aspect of the tendon

Question 13

What are some risk factors for tendon injuries?

Answer 13

Age and exercise (SDFT)
Exercise in TB horses > 3ry
Cumulative high speed and distance training and racing

Question 14

How do you diagnose a tendon injury?

Answer 14

Physical exam, lameness (pain, heat, swelling), palpation, lameness exam, ultrasound, MRI, thermography, PET

Question 15

How can you use ultrasound to help ID tendon injury?

Answer 15

Transverse and longitudinal, measure, cross-sectional area, proximal to distal, echogenicity score (1-4), both limbs, serial exam in rehab

Question 16

What do you do if you have an acute tendon injury?

Answer 16

Stall confinement, control inflammation (NSAID, Cold, Compression and Cooling) and bandage

Question 17

What does sub-acute care look like?

Answer 17

-At 2 weeks (look bigger before this)
-Controlled exercise
-Serial ultrasound
-Medical therapy
-Surgical treatment

Question 18

What are some medical treatments for tendon injuries?

Answer 18

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

Question 19

How does extracorporeal shockwave therapy work?

Answer 19

Acoustic waved generated outside the body, focus on site, high pressure and velocity

Question 20

What effects does shockwave have (ESWT)?

Answer 20

Mechanical and biological
-bone microfracture and hematoma - osteoblastic activity and healing
-Analgesia - hyper-stimulation and myelin sheath disruption
-Neovascularization

Question 21

When should you use shockwave?

Answer 21

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

Question 22

When should you use therapeutic laser?

Answer 22

Adjunctive, 6 weeks after cell therapy, careful choosing unit, higher wavelength and power is better for penetration
-Careful of hematomas
-Issues on pigmented skin

Question 23

What is critical during rehabilitation with these tendon injury patients?

Answer 23

Time and controlled exercise

Question 24

What should be occurring during rehabilitation?

Answer 24

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

Question 25

What are some surgical treatments for tendon injury?

Answer 25

-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

Question 26

What is tendon splitting used for?

Answer 26

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

Question 27

What is tenosynovitis?

Answer 27

Injury to tendons in tendon sheath
-linear tear
-adhesion
-masses
-palmar annular ligament desmitis
-Septic tenosynovitis

Question 28

What is tenoscopy?

Answer 28

Mass removal, debride, treat septic sheath, flexor sheath