DTL 2

Question 1

What are some injuries associated with the DDFT?

Answer 1

Intrathecal injury, tendon sheath, navicular bursa (Adhesions, linear tears and core lesions)

Question 2

What is one way to relieve pressure and help DDFT to heal?

Answer 2

-Perform a palmar annular ligament transection
-Check ligament Desotomy (More pressure on SDFT)

Question 3

What does regeneration mean?

Answer 3

Perfect healing (back to normal quality, no scar, efficient healing)

Question 4

What are some choices of regenerative medicine?

Answer 4

-Bone Marrow Mesenchymal Stromal Stem Cells (Large tendon or ligament tear)
-Adipose Stromal Vascular Fraction Cells
-Platelet Rich Plasma (Small lesion)
-Urinary Bladder Matrix

Question 5

What are the routes by which regenerative medicine can be administered?

Answer 5

Intralesional injection, Intrathecal Injection, IV perfusion or IA, Surgery

Question 6

If you have a small tear in the tendon which therapy should you use?

Answer 6

Conservative with PRP

Question 7

If you have an enthesopathy or calcification of the tendon or ligament which therapy should you use?

Answer 7

Shockwave and PRP

Question 8

If you have a Linear tear or core lesion of the ligament of tendon, what therapy should you use?

Answer 8

BM MSCs and PRP (Arterial infusion of forelimb)

Question 9

If a core lesion or rupture is present in older horses, what disease should you test for?

Answer 9

PPID

Question 10

If you have a rupture or laceration of the tendon or ligament, what should you treat with?

Answer 10

PRP, BM MSC, ASC, Coaptation support shoe

Question 11

How do you optimize tendon regeneration?

Answer 11

BM stem cells plus PRP
- make tendon matrix, growth factors, scaffolding to provide template for attachment and Maintenace of tendon cells

Question 12

What are some keys when injecting your regenerative therapy?

Answer 12

-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

Question 13

What are some considerations post injection?

Answer 13

-Avoid exercise in 1st week
-Avoid Shockwave
-Slow return to exercise with US monitor
-remodel extracellular matrix is critical
-Rehab critical

Question 14

What is the treatment decision made off of?

Answer 14

Which tendon, synovial or extra synovial, severity, location in tendon, cost, time

Question 15

What is the most common tendon injury in dressage horses?

Answer 15

Suspensory ligament (proximal)
-poorer prognosis in hind limb than forelimb

Question 16

What innervates the suspensory ligament?

Answer 16

Tibial nerve, lateral and plantar nerve branch proximal to calcaneus, deep branch lateral plantar nerve

Question 17

What kind of injuries can happen to the suspensory ligament?

Answer 17

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

Question 18

What risk factors lead to suspensory ligament injury?

Answer 18

Conformation - straight hock and dropped fetlock, dressage, geldings

Question 19

How do you diagnose a suspensory injury?

Answer 19

Lameness exam, diagnostic anesthesia, ultrasound, rad, nuclear scintigraphy, MRI

Question 20

What does the lameness exam show with suspensory injury?

Answer 20

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

Question 21

What does SLD look like on diagnostic anesthesia?

Answer 21

High six-point block - medial and lateral palanar and plantat metatarsal nerve
-Not helpful with TMT and tarsal sheath

Question 22

What do you see on ultrasound with a Suspensory ligament injury?

Answer 22

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

Question 23

Which 2 methods are best at diagnosis Suspensory ligament issues?

Answer 23

MRI and histology

Question 24

Are radiographs helpful with suspensory ligament issues? What about nuclear scintigraphy?

Answer 24

Not for acute cases, chronic = sclerosis and variation

NS - not helpful

Question 25

What are some treatment options for Suspensory Desmits?

Answer 25

Non-Surgical: conservative, shockwave, regenerative (PRP and BM MSC)

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

Question 26

What does non-surgical treatment of Suspensory ligament injury look like?

Answer 26

Prolonged rest, shockwave, BM, PEP, Stem cell, A cell

Question 27

What do you see if you have suspensory branch desmitis?

Answer 27

Straight hock, mottled fiber in suspensory
Treat: PRP, BM MSC, Fetlock support shoe (Salvage)

Question 28

Does forelimb or hindlimb suspensory desmitis have a better prognosis?

Answer 28

Forelimb - conservative can be successful, rest, rehabilitation, shockwave, laser, PRP and stem cell, chronic non-healing benefit from splitting

Question 29

Who is affected by degenerative suspensory ligament disease?

Answer 29

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

Question 30

What happens if a 15-20+ old horse has suspensory ligament disrruption?

Answer 30

Tear and dropped fetlock appearance, limit athletics, euthanasia may be needed, regenerative or fetlock arthrodesis

Question 31

If you have dropped fetlocks come in what should you immediately be worried about?

Answer 31

Suspensory ligament disruption