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Equine > Eq2- mid1- diseases of tendons, ligaments, sheath and bursae > Flashcards

Eq2- mid1- diseases of tendons, ligaments, sheath and bursae Flashcards

1
Q

What is a Energy storing tendon?

A

Tendons: connects muscle to bone, its purpose is to move a joint

Energy storing tendon:

  • support the hyperextended metacarpophalangeal joint during weight bearing
  • release energy when the limb is protracted
  • horse bounces up and down on springs
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2
Q

Mechanical properties

  • Stress-strain curve
A

1: toe - elimination of crimp
2: linear phase
3: yield point - beyond its irreversible damage
4: rupture

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3
Q

Incidences of tendon injuries:

A
  1. Traumatic: any type of horse
  2. Strain induced
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4
Q

Strain-induced types of tendon injuries:

A
  • Racing thoroughbreds: SDFT in forelimb
  • Elite show jumpers: forelimb SDFT and DDFT injuries
  • Elite eventers: forelimb SDFT injuries
  • Dressage horses: hindlimb suspensory lig. injuries
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5
Q

Complete rupture, loss of function in Deep digital flexor tendon

A
  • toe flips out
  • if ruptured in the metacarpal/metatarsal region and outside the DFTS: it can heal satisfactory if immobilised
  • if ruptured near insertion or within the DFTS: very poor to hopeless prognosis
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6
Q

Complete rupture, loss of function in Superficial digital flexor tendon

A
  • reasonable prognosis if immobilised: cast or Robert-Jones bandage
  • often transected together with DDFT
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7
Q

Complete rupture, loss of function in Suspensory ligament

A
  • fetlock drops
  • grave (bad) prognosis
  • degenerative/traumatic/catastrophic
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8
Q

Repair of tendon and ligament injuries

A
  • no regeneration!
    1. Intratendinous haemorrhage
    2. inflammatory reaction
  • designed to remove damaged tendon tissue
  • but excessive and causes further damage
  1. reparative phase
  • starts within a few days
  • angiogenesis
  • scar tissue formation
  • higher ratio of collagen type III/I
  1. remodelling phase
    * gradual, incomplete replacement of type III to type I
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9
Q

Superficial digital flexor tendon - site of injury and diagnosis

A
  • Most common site: mid-metacarpal region.
  • common injury in racehorses and jumpers
  • Within the DFTS and the carpal sheath: less common
  • In the pastern region: often traumatic
  • overreach

Diagnosis:

  • beware if UL too quickly
  • true extent of the injury may not be apparent
  • repeat UL a week later

Treatment: Acute, subacute and chronic phase

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10
Q

Superficial digital flexor tendon - principles of treatment of Acute phase

A
  1. Acute phase:
    - aim to minimise inflammation and limit the action of proteolytic enzymes
    - physical therapy
    - rest, cold, immobilisation
    - systemic short-acting corticosteroids in first 24-48 hr
    - never intralesional steroids
    - ccalcification!
    - NSAIDs
    - some controversy
    - (surgical treatment - tendon splitting, desmotmy ofAL-SDFT)
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11
Q

Superficial digital flexor tendon - principles of treatment of Subacute phase

A
  1. Subacute (fibroplastic) phase:
    - progressive mobilisation
    - ultrasonographic monitoring
    - regenerative therapies:
  • Mesenchymal stem cell therapy: stem cells differetiante into tenocytes, regenerate matrix
  • PRP (protein rich plasma): autologous blood, centrifugation, gravity filtration.
  • Soup of growth factors - stimulate cell proliferation and matrix synthesis
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12
Q

Superficial digital flexor tendon - principles of treatment of Chronic phase

A
  1. Chronic (remodelling) phase:
    - controlled exercise
    - regular UL monitoring
    - To prevent re-injury
    - takes time, at least 6-12 month before returing to full work
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13
Q

Deep digital flexor tendon - site of injury and diagnosis

A

Site of injury:

  • Metacarpal region: majority of injuries within the DFTS
  • Pastern region: down to insertion. Most distal part can only be imaged with MRI or CT
  • generally poor prognosis
  • Lesions in the fetlock region - typical to high level show jumpers
  • Limited healing ability of tendons within synovial environment
  • adhesion formation
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14
Q

MRI indications:

A
  • If lameness cant be explained by finding of conventional diagnostic imaging
  • most commonly imaged regions is the foot
  • possible up to carpus and hock (stifle)
  • Time consuming: 2feet –> at least 1.5-2 hr
  • only a small area can be examined: multiple sequences, hundreds of images
  • interpretation requires specialist knowledge
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15
Q

Suspensory ligament

A

Proximal aspect:

  • central muscle and adipose tissue
  • forelimb; medial and lateral lobes

Branches Proximal suspensory desmitis/desmopathy

  • different disease process and prognosis in the forelimb and in the hindlimb
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16
Q

Forelimb proximal suspensory desmitis - clinical findings

A

Pain on palpation:

  • but many horses show some response when pressure is applied to SL
  • pain when pressure is applied to the bone

Difficult to palpate the most proximal aspect

Typically lamer with the limb on the outside of the circle

17
Q

Forelimb proximal suspensory desmitis - Acute form

A
  • reasonable prognosis
  • can return to exercise in 3-4 months
  • controlled exercise
  • +/- intralesional therapy
18
Q

Forelimb proximal suspensory desmitis - Chronic form

A
  • more difficult to manage
  • guarded prognosis
19
Q

Hindlimb proximal suspensory desmopathy - clinical findings

A
  • usually no localising signs
  • typically lamer with the limb on the outside of the circle
  • but often bilateral
  • can present as a poor performance case with poor hindlimb impulsion
  • usually degenerative process
  • common in dressage horses but can be seen in any dicipline
  • straight hock
  • predisposes
20
Q

Hindlimb proximal suspensory desmopathy - treatment

A
  • conservative management: poor success rate
  • most successful treatment: surgery –> plantar neurectomy and fasciotomy –> 80% success rate if no other contributing problems
21
Q

Branches of the Suspensory ligament - clinical findings

A
  • any discipline
  • +/- distension of McP(MtP joint - thickened SL branch (periligament thickening?)
  • pain
  • response to flexion
22
Q

Branches of the Suspensory ligament - treatment

A
  • management
  • depends on type of injury, age, use
  • conservative treatment: U/S findings often persist for a long time
  • Shock wave, regenerative laser?
  • Surgery: Arthroscopy for axial lesions
23
Q

Accessory ligament of the deep digital flexor tendon - clinical findings

A
  • much more common in the FL than the HL
  • usually painfull on palpation

Acute cases: rest, cooling, intralesional treatment, regenerative laser, shockwave

Chronic, non-responsive cases: desmotomy

24
Q

Accessory ligament of the deep digital flexor tendon - treatment

A

Acute cases:

  • rest, cooling, intralesional treatment, regenerative laser, shockwave

Chronic, non-responsive cases: - desmotomy

25
Q

Collateral ligament injuries

A
  • can be true sprai injuries
  • rupture results in luxation/subluxation of joint
26
Q

Digital flexor tendon sheath (DFTS) - clinical findings

A
  1. Distension:
    - bilateral?
    - symmetrical? (size, shape, heat, firmness)
    - response to flexion
    - if sudden onset and/or associated with pain, heat, resistance to flexion
    - investigate further
  2. often cosmetic problem
  3. If associated lameness: greater improvement to low 4-point nerve block than to intrathecal analgesia
27
Q

Digital flexor tendon sheath (DFTS) - Primary tenosynovitis can be due to

A
  • accumulative low-grade trauma
  • direct trauma
  • abnormal force (hyperextension)
  • infectious
28
Q

Digital flexor tendon sheath (DFTS) - Secondary tenosynovitis can be due to:

A
  • DDF tendonitis
  • Damage to the manica flexoria
  • damage to the synovial layers
  • tearing of the vincula
  • PAL injury
29
Q

Distension of the DFTS can be due to?

A

Palmar annular ligament syndrome

  • distension of DFTS + thickening of PAL
30
Q

Palmar annular ligament syndrome:

A

Leads to distension of the DFTS seen with:

  • desmopathy of PAL: external trauma or overextension of fetlock
  • chronic inflammation
  • adhesion, fibrosis
  • perpetuating condition: inflammation, pressure, stenosis, further inflammation
31
Q

Thickening of the palmar annular ligament:

A
  • primary injury to the PAL
  • thickening
  • compression of DFTS
  • with or without subcuaneous fibrosis
32
Q

Tendon sheaths not necessarily related to trauma:

A
  • carpal sheath (SDFT lesion, osteochondroma)
  • Tarsal sheath (DDF, sustentaculum tali lesion)
33
Q

Tenon sheaths often related to trauma:

A

tendon sheaths of the extensor tendons

34
Q

Bursae injury can be?

A
  • Congenital
  • Acquired (at the site of trauma)
  • Hygroma, Calcaneal bursa, Navicular bursa
35
Q

What is Hygroma

A

Bursae injury

  • acquired bursae
  • can be result of trauma
  • non-painfull
  • no communication with other structures
  • usually no lameness
  • cosmetic problem
36
Q

Calcaneal bursa

A
  • subcutaneous
  • capped hock
  • intertendinous
  • subtendinous
  • aseptic bursitis often a cosmetic problem
37
Q

Navicular bursa

A
  • podotrochlear apparatus
  • diagnosis with MRI
38
Q
A

Equine (8 decks)

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