Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Equine BCM > Disorders of Ligaments and Tendons > Flashcards

Disorders of Ligaments and Tendons Flashcards

1
Q

What are some of the reasons that tendons do not regenerate?

A
  1. Low cellularity
  2. Small population of progenitor cells
  3. Low vascularity (no blood supply inside fibrils similar to cartilage)
  4. Dense matrix
  5. Compressive trauma from retinaculum
  6. Degenerative process with apoptosis
  7. Degeneration of matrix overcomes remodeling capabilities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the annular ligament?

A

A type of retinaculum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do tendons get injured?

A

If overstretched the cells themselves can be injured, but also tendon cells that have tension cut off can undergo apoptosis and also produce enzymes that further breakdown collagen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can you improve the outcome in tendon cases?

A
  1. Decrease duration of inflammatory phase
  2. Decrease elaboration of MMPs (matrix metalloproteinases)
  3. Increase early blood flow
  4. Reduce strain/tension on the tendon
  5. Reduce excessive compression of the tendon
  6. Rehabilitation over time (minimize work initially, gradually increase with time)
  7. Molecular and cellular approaches (regenerative medicine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 4 extensor tendons in horses and what are the main injuries they are predisposed to?

A
  1. Extensor carpi ulnaris
  2. Common digital extensor
  3. Long digital extensor
  4. Lateral digital extensor

susceptible to lacerations, ruptures, tendinitis/tendinopathies, tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the prognosis for extensor tendon injury?

A

Good regardless of type of injury
-can heal with rest without intervention in many cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What age of horse is the most predisposed to extensor tendon rupture?

A

Foals-often associated with flexural deformities but not always

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the signs associated with peroneus tertius rupture

A

Flexed stifle with a straight hock -failure of the stay apparatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Do you need to treat peroneus tertius ruptures?

A

No, but may need to place splint if horse is struggling to put foot down properly
-heal with conservative management and rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which is more common- superficial or deep flexor tendonitis? What makes it more prone to injury?

A

Superficial
-goes through greater angle than DDFT at fetlock, more prone to trauma as superficial, smaller cross-sectional area, less vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common reason that racehorses are retired?

A

SDF tendinitis
- has significant economic and welfare impact
-prone to reinjury (better once retired)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the pathogenesis of SDFT injuries?

A

-High strain during running and galloping as well as hyperthermia leads to matrix and cell damage
-vascular injury
-loss of mechanical properties leads to higher strain on the uninjured portions of the tendon leads to reinjury
-lameness leads to higher strain and injury of the contralateral tendon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Where do SDFT lesions tend to accumulate?

A

In the center of the tendon due to hyperthermia (core lesion)
-increased tension of collagen fibrils central to the tendon (less crimp=less elasticity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name some of the risk factors for developing a SDFT lesion?

A

-exercised thoroughbreds >/= 3 years
-cumulative high speed distance in training and racing
-deep footing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you diagnose tendon injuries?

A

Physical exam
-lameness exam-palpate well to assess for pain, heat or swelling
-diagnostic imaging- ultrasound (requires major change), MRI, thermography, PET imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe some of the characteristics of using ultrasound to diagnose tendon injuries

A

Need both transverse and longitudinal views
-measure in cm DACB or DPOH
-can get percentage of cross-sectional area
-measure proximal to distal extent of the lesion
-score echogenicity
-ultrasound both limbs
-should do serial exams during rehab to see if the treatment is working–> can start to increase exercise with improvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should you do in the acute phase for SDF lesions?

A

Stall confinement, control inflammation (NSAIDS, cold therapy, compression with cooling), bandaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When can you start some hand walking in SDF lesion cases?

A

After 2 weeks (subacute phase)
-serial ultrasound exam to determine if you can start controlled exercise, medical therapy or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does shockwave therapy promote?

A

Analgesia (not really what we want), demyelination of nerve fibers
-results in microscopic tendon splitting which may increase blood flow
-releases an acoustic wave of high pressure and velocity resulting in mechanical and biological responses (bone microfracture and hematoma, neovascularization)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What injuries is shockwave the best for?

A

Suspensory ligament injury, collateral ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When should shockwave be used?

A

Never after cell therapy (wait at least 6 weeks)
-mild lesions
-pre-treating chronic lesions prior to other therapy
-best for tendon/bone and ligament/bone interfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What component of tendon rehab is the most important for cellular and fiber realignment?

A

Controlled exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe a good physical rehab plan for tendon injuries

A

Slow progression with recheck injury
-hand walking during week 2-8
-tack walking during week 9-12 with repeat lameness exam
-tack walking with gradual increase in trotting from week 13-16
-then supervised turnout
-if healed and sound can gradually increase to full work at 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How long does tendon take to remodel?

A

Up to 18 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What surgical treatment options are there for tendon injuries?

A
  1. Tendon splitting- increases blood flow and turns chronic non-healing injuries into acute injuries
  2. Transection of accessory ligament of SDFT (proximal check) to increase the elastic length of the muscle/tendon unit
  3. Palmar/plantar annular ligament transection for low bows and tenosynovitis-allows for more room for SDFT/DDFT to move, heal and function
  4. Tenoscopy and bursoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When should you use tendon splitting?

A

In chronic cases- decompression to reduce chance of compartment syndrome and increase blood supply to anechoic core

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe tenosynovitis.

A

Injury to tendons in tendon sheath
- linear tear, adhesions, or masses (from frayed end of tendon)

Can also have palmar annular ligament desmitis or septic tenosynovitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Name the indications for tenoscopy

A

Mass removal, debridement of longitudinal tears of tendons and adhesions, treatment of septic sheath, flexor sheath (PAL transresection or manica flexoria tear resection)

29
Q

What are the main differences in physiology of the DDF compared to SDF

A

Much more vascular in metacarpal/tarsal region
-has compression as well as tension at the fetlock and navicular bone

30
Q

What type of injuries is the DDF susceptible to?

A

Intrathecal, tendon sheath or navicular bursa injuries (adhesions, linear tears, core lesions)

31
Q

T/F: core lesions are more common in the DDF than SDF

A

False- they are less common

32
Q

What is the treatment when there is constriction of the tendons through the fetlock region- DDF tendon sheath

A

Cut annular ligament- can allow tendons to heal more readily

33
Q

What is the goal of regenerative medicine?

A

To have perfect healing -healing of injured tissue back to original quality with no scar formation and normal function

34
Q

Describe bone marrow mesenchymal stromal stem cells

A

Cells from horse being treated (autologous) mixed with PRP
-often preferred for tendon and ligament injuries
-antifibrotic

35
Q

Describe the adipose stromal vascular fraction method for regen medicine

A

Takes fat biopsy-send to California and they send back a sample high in stem cells
-quicker turnaround, more expensive

36
Q

Describe PRP for regen medicine

A

Blood is collected from horse being treated, it is then centrifuged to concentrate platelets
-increases angiogenesis and attraction of fibroblasts
-can induce fibrosis
-good for small lesions and tendon-bone interfaces

37
Q

Describe Acell (urinary bladder matrix)

A

A xenogenenic injectable powder
- causes flare-not recommended

38
Q

What are the options for delivery of regenerative therapies?

A

Intralesional injection- US or MRI guided tendon injection
-intrathecal injection
-IV perfusion or IA (better for getting into lesion)
-surgery (concurrent with intratendinous injection in surgery)

39
Q

If you have a marginal lesion on a tendon, what should you do for treatment?

A

Conservative management
-PRP injection if client wants something

40
Q

What is the treatment for enthesopathy (tendon attached to bone)?

A

Shockwave therapy followed by PRP
- OR bone marrow stem cells and PRP

41
Q

If tendon has become calcified, what treatment should you pursue?

A

Shockwave therapy (more intense than normal-used a lot in human medicine but not extremely efficacious in animals) followed by PRP
-bone marrow stem cells CONTRAINDICATED

42
Q

What is the treatment that should be pursued with linear tears in tendons?

A

Surgery followed by bone marrow derived stem cells and PRP (arterial infusion)

43
Q

What is the treatment for a core lesion in the tendon?

A

Test for PPID (cushings) in older horses as there is an association between the two
-can also use bone marrow cells and PRP

44
Q

What is the treatment you should choose with tendon rupture or laceration?

A

Anything really after surgery
-depends on severity of lesion
-can use coaptation/support shoes

45
Q

What is the most common site of injury in dressage horses?

A

Suspensory ligament
-proximal most common site
-poorer prognosis for hindlimb vs forelimb

46
Q

Where do racehorses tend to have suspensory problems?

A

Core lesions
-treat the same as other tendon problems

47
Q

What are the differences in the hindlimb that make the suspensory ligament more prone to injury?

A

Huge MT4 (bone wraps around suspensory)
-also there’s a thick band of fascia between MT 2 and 4 (when suspensory gets inflamed there is nowhere for fluid to go=compression of ligament and nerve)

48
Q

Name some of the different injuries that can occur at the suspensory ligament

A

Proximal suspensory desmitis in the hindlimb
-core lesions within the body of the suspensory
-suspensory branch lesions
-avulsions at origin or branch insertions
-branch lesions with calcification (poor prognosis)
-ruptures of origin or branches
-degenerative suspensory ligament desmitis (aka equine systemic proteoglycan accumulation)

49
Q

In what horses are degenerative suspensory ligament desmitis most common in?

A

-known genetic factor makes it more common in paso fin horses
-also present in quarter horses and warmbloods

50
Q

Describe the pathogenesis of degenerative suspensory ligament desmitis?

A

Remodeling process goes awry as horses age- instead of placing collagen the cells produce large amounts of proteoglycan
-causes loss of strength and failure

51
Q

What are the risk factors for proximal suspensory desmitis in the hind?

A

Conformation- straight hocks or dropped fetlocks
-dressage, geldings

52
Q

How do the majority of these suspensory desmitis cases present?

A

Insidious onset
-often progressive performance issues
-positive to full limb and upper limb flexion, worse on soft surface and circling
-rarely can see heat, sensitivity or enlargement
-eliminated by high 6 block

53
Q

What is the single nerve that innervates the suspensory ligament in the hindlimb?

A

The deep branch of the lateral plantar nerve
-block introduces air-do US before or wait a few days

54
Q

What does blocking the deep branch of the lateral plantar nerve also block?

A

The lateral plantar nerve
- why you need to do the low 6 point block prior

55
Q

What is one of the main limitations to a block localizing to the deep branch of the lateral plantar nerve?

A

-Blocks the back of the cannon bone
-might have bone pain and not suspensory pain

56
Q

Why is US so difficult for suspensory injuries

A

huge blood vessels get in the way, lateral splint bone blocks the probe, hair grows in direction of probe

57
Q

What can you actually see on US of suspensory?

A

Increased cross sectional area, poor demarcation of margins, decreased echogenicity (local or diffuse), focal anechoic lesion or demineralization
-lots of disagreements about interpretation of these images

58
Q

T/F: MRI of suspensory has great correlation with histopathology of suspensory

A

True
-but horse has to be anesthetized

59
Q

What can increase sensitivity of us for suspensory injuries?

A

Lifting up the leg to allow for angle contrast

60
Q

What radiographic changes might you see in suspensory cases?

A

No changes in acute cases, can see sclerosis/lysis at proximal plantolateral MT 3 in chronic cases (but these can also see in normal cases)

61
Q

What are some treatment options for suspensory ligament desmitis?

A

Conservate (shockwave-treats bone and ligament, regen therapies)
- if theres a hole, fill it

Surgical: desmoplasty and fasciotomy, neurectomy of deep branch of lateral plantar nerve, *neurectomy and fasciotomy, fasciotomy

62
Q

What is the main contraindication for neurectomy of deep branch of the lateral plantar nerve?

A

Horses with straight leg conformation

63
Q

Which treatment option has the worst prognosis for suspensory injuries?

A

Prolonged rest (only 12.5% return to work)

64
Q

What are the common physical exam findings in cases of suspensory BRANCH desmitis?

A

One side enlarged on ultrasound
-straight hock conformation
-mottled fiber pattern

65
Q

What is a helpful treatment to add on to shockwave and injections in cases of suspensory desmitis with sinkage of the fetlock joint?

A

Fetlock support shoes
-push the fetlocks up
-use in cases of suspensory rupture, bad branch lesions and degenerative desmitis

66
Q

T/F: forelimb suspensory desmitis cases do well with conservative therapy alone

A

True
-but chronic non healing injuries may benefit from splitting

67
Q

What are the goals of desmoplasty and fasciotomy?

A

To decompress acute lesions and promote new blood supply in chronic lesions
-use for proximal core lesions only
-need to have a very controlled postoperative exercise program
-creates a new injury in ligament-healing and rehab takes longer than other techniques
-use in cases where there is a core lesion on US

68
Q

Why can the deep branch neurectomy be an effective treatment?

A

Cutting the nerve will cause the muscle to shrink and relieve the compression
-muscle replaced by collagen

69
Q

What is the main advantage of neurectomy plus fasciotomy?

A

Quicker return to work- can be as early as 60 days

Equine BCM (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions