Equine tendon and ligament disease

Question 1

2 types of tendon injury

Answer 1

‘Percutaneous’ - laceration/penetration

‘Subcutaneous’ - strain, displacement

Question 2

Cause of over-strain injury - tendon

Answer 2

Sudden over-extension

Preceding tendon degeneration with superimposed sudden over-extension

Question 3

tendon - History

Answer 3

Usually a preceding intense period of exercise

Signs can be delayed

Question 4

tendon - Clinical examination

Answer 4

Lameness
Can be temporary
Lameness can be persistent for some tendon/ligament injuries

Question 5

Metacarpophalangeal joint extension changes

Answer 5

Decr - Reduced weight-bearing + Fibrosed (stiff) tendon

Increased with severe - SDFT/SL injuries

Question 6

Elevating toe

Answer 6

DDFT rupture

Question 7

Some areas difficult to palpate

Answer 7

Proximal SL in H/L

Pastern

Question 8

what to assess on palpation

Answer 8

Pain on palpation
Suppleness of tendons
Oedema

Question 9

Superficial digital flexor tendinopathy

Answer 9

Initial lameness (variable)
Pain on palpation
‘Core’ lesion on ultrasound

Question 10

Proximal suspensory desmitis - history

Answer 10

Lameness variable in degree

Acute or insidious onset

Question 11

Proximal suspensory desmitis - clinical signs - conformation

Answer 11

Straight hock

overextending MTP joint

Question 12

Proximal suspensory desmitis - clinical signs - lameness

Answer 12

Often lamer with the limb on the outside of a circle
Proximal MC/MT swelling - Variable, Medial palmar vein distension
Pain on palpation

Question 13

Proximal suspensory desmitis - diagnosis

Answer 13

Diagnostic analgesia

imaging - Ultrasonography, Radiography, (Gamma scintigraphy, MRI)

Question 14

Suspensory body and branch desmitis - ultrasonography

Answer 14

Branches need imaging from medial and lateral aspects 
Focal or generalised lesions 
Enlargement 
Periligamentar fibrosis very common 
Bilateral involvement common

Question 15

Suspensory body and branch desmitis - radiography

Answer 15

Concurrent bony abnormalities

Question 16

Desmitis of the accessory ligament of the deep digital flexor tendon (‘inferior check ligament’) - presentation

Answer 16

Swelling in the proximal metacarpal region

Dorsal to SDFT

Question 17

DDFT Tendinopathy

Answer 17

Usually within digital sheath or navicular bursa

Question 18

Intra-thecal tendon tears - location - DDFT

Answer 18

Usually lateral border

Forelimbs

Question 19

Intra-thecal tendon tears - location - Manica flexoria

Answer 19

Usually hindlimb

Question 20

Annular ligament syndrome (ALS)

Answer 20

Lameness - mild-moderate, minimally responsive to rest, occasionally irregular gliding of tendons
Distended digital sheath
notch at PAL level

Question 21

General principles of treatment for tendonitis

Answer 21

V.few evidence-based choices

based on tendon pathology + phases of tendon healing

Question 22

acute phase infl - clinical signs

Answer 22

Lameness
Pain on palpation
Heat
Swelling

Question 23

acute phase infl - Pathology

Answer 23

Haemorrhage

Inflammation

Question 24

acute phase infl - physical therapy

Answer 24

Application of cold (ice)
Compression
MCP joint support

Question 25

acute phase infl - rational treatment

Answer 25

minimise infl

Question 26

acute phase infl - medication

Answer 26

short-acting steroids - systemically/peritendinously | NSAIDs

Question 27

acute phase infl - surgery

Answer 27

Percutaneous tendon splitting | Possible to combine with intra-tendinous medication

Question 28

subacute reparative phase - Clinical signs

Answer 28

Reduction or absence of lameness Resolution of signs of infl Tendon still palpably enlarged and soft Signs of re-injury if exercised too early

Question 29

subacute reparative phase - Pathology

Answer 29

Angiogenesis | Fibroplasia - ++ fibroblasts

Question 30

subacute reparative phase - rational treatment

Answer 30

promote fibroplasia | optimise organisation of scar

Question 31

subacute reparative phase - ongoing treatment

Answer 31

mobilisation | ultrasounds every 2-3 months