DTL 2 Flashcards
What are some injuries associated with the DDFT?
Intrathecal injury, tendon sheath, navicular bursa (Adhesions, linear tears and core lesions)
What is one way to relieve pressure and help DDFT to heal?
-Perform a palmar annular ligament transection
-Check ligament Desotomy (More pressure on SDFT)
What does regeneration mean?
Perfect healing (back to normal quality, no scar, efficient healing)
What are some choices of regenerative medicine?
-Bone Marrow Mesenchymal Stromal Stem Cells (Large tendon or ligament tear)
-Adipose Stromal Vascular Fraction Cells
-Platelet Rich Plasma (Small lesion)
-Urinary Bladder Matrix
What are the routes by which regenerative medicine can be administered?
Intralesional injection, Intrathecal Injection, IV perfusion or IA, Surgery
If you have a small tear in the tendon which therapy should you use?
Conservative with PRP
If you have an enthesopathy or calcification of the tendon or ligament which therapy should you use?
Shockwave and PRP
If you have a Linear tear or core lesion of the ligament of tendon, what therapy should you use?
BM MSCs and PRP (Arterial infusion of forelimb)
If a core lesion or rupture is present in older horses, what disease should you test for?
PPID
If you have a rupture or laceration of the tendon or ligament, what should you treat with?
PRP, BM MSC, ASC, Coaptation support shoe
How do you optimize tendon regeneration?
BM stem cells plus PRP
- make tendon matrix, growth factors, scaffolding to provide template for attachment and Maintenace of tendon cells
What are some keys when injecting your regenerative therapy?
-More is not better
-Acute core lesion - longitudinal incision fills as injected
-Chronic granulation, longitudinal, multiple fenestrations to make area or cell, horizonal minimal needle splitting
What are some considerations post injection?
-Avoid exercise in 1st week
-Avoid Shockwave
-Slow return to exercise with US monitor
-remodel extracellular matrix is critical
-Rehab critical
What is the treatment decision made off of?
Which tendon, synovial or extra synovial, severity, location in tendon, cost, time
What is the most common tendon injury in dressage horses?
Suspensory ligament (proximal)
-poorer prognosis in hind limb than forelimb
What innervates the suspensory ligament?
Tibial nerve, lateral and plantar nerve branch proximal to calcaneus, deep branch lateral plantar nerve
What kind of injuries can happen to the suspensory ligament?
Proximal suspensory desmitis in hind limb, core lesion in body suspensory, suspensory branch lesion, avulsion are origin or branch, branch with calcification, rupture origin or branch, degenerative syspensory ligament desmitis
What risk factors lead to suspensory ligament injury?
Conformation - straight hock and dropped fetlock, dressage, geldings
How do you diagnose a suspensory injury?
Lameness exam, diagnostic anesthesia, ultrasound, rad, nuclear scintigraphy, MRI
What does the lameness exam show with suspensory injury?
Acute or insidious, mild or severe poor performance, positive eon flexion of full mib and upper limb, soft surface or circle, rarely heat, sensitivity or enlargement
What does SLD look like on diagnostic anesthesia?
High six-point block - medial and lateral palanar and plantat metatarsal nerve
-Not helpful with TMT and tarsal sheath
What do you see on ultrasound with a Suspensory ligament injury?
Increased cross sectional area, poor demarcation of margin, decreased echogenicity (focal or diffuse), focal anechoic lesion, focal mineralization
-Careful about operator variability, cross section variable
Which 2 methods are best at diagnosis Suspensory ligament issues?
MRI and histology
Are radiographs helpful with suspensory ligament issues? What about nuclear scintigraphy?
Not for acute cases, chronic = sclerosis and variation
NS - not helpful
What are some treatment options for Suspensory Desmits?
Non-Surgical: conservative, shockwave, regenerative (PRP and BM MSC)
Surgical: Desmoplasty and fasciotomy, deep branch of lateral plantar nerve neurectomy, neurectomy and fasciotomy, fasciotomy
What does non-surgical treatment of Suspensory ligament injury look like?
Prolonged rest, shockwave, BM, PEP, Stem cell, A cell
What do you see if you have suspensory branch desmitis?
Straight hock, mottled fiber in suspensory
Treat: PRP, BM MSC, Fetlock support shoe (Salvage)
Does forelimb or hindlimb suspensory desmitis have a better prognosis?
Forelimb - conservative can be successful, rest, rehabilitation, shockwave, laser, PRP and stem cell, chronic non-healing benefit from splitting
Who is affected by degenerative suspensory ligament disease?
Peruvian paso - bilateral hind limb, fetlock drop, heal with granulation tissue that is non-elastic
-stall rest, support, shoe,
-Prognosis grave for athletics and poor for comfort
What happens if a 15-20+ old horse has suspensory ligament disrruption?
Tear and dropped fetlock appearance, limit athletics, euthanasia may be needed, regenerative or fetlock arthrodesis
If you have dropped fetlocks come in what should you immediately be worried about?
Suspensory ligament disruption
