Equine Tendon and Ligament Disease Flashcards
What are the two different types of tendon injury?
Percutaneous or Subcutaneous
How do percutaneous tendon injuries occur?
Laceration or penetration
How do subcutaneous tendon injuries occur?
Strain or displacement caused by sudden over-extension (DDFT) or preceding tendon degeneration with superimposed sudden over-extension (SDFT/SL)
What is the common history behind tendon injuries?
Preceding intense period of exercise but signs can be delayed
Is severity of signs linked to severity of injury?
No
How can you evaluate stance and gait for tendon injury?
Metacarpophalangeal joint extension is decreased with reduced weight bearing due to pain and fibrosed tendons
Metacarpophalangeal joint extension is increased with severe SDFT/SL injuries
Toe elevation = DDFT rupture
When should the limb be palpated?
Both weight-bearing and when the leg is lifted
How is ultrasound used to aid diagnosis?
Compare the affected and normal limb
Assess severity about 7 days post injury to give prognosis
Use a 7.5 MHz and a linear transducer +/- stand off pad
What signs are seen with superficial digital flexor tendinopathy?
Palmar metacarpal swelling, variable initial lameness, pain on palpation, core lesion seen on ultrasound
What are the signs seen with suspensory ligament desmitis?
Variable degree of lameness, acute/insidious onset, straight hock and overextending MTP joint, lamer with the limb on outside of circle, proximal MC/MT swelling variable with medial palmar vein distension, pain on palpation
How do you diagnose suspensory ligament desmitis?
Diagnostic analgesia and ultrasonography
What are the signs of suspensory body and branch desmitis?
Variable lameness
On ultrasound focal or generalised lesions, enlargement, periligamentar fibrosis and commonly bilateral involvement
Concurrent bony abnormalities on radiographs
What are the signs associated with inferior check ligament desmitis?
Swelling in proximal metacarpal region dorsal to SDFT
Lameness often variable and can be absent
Generalised enlargement on ultrasound
What clinical signs are seen with DDFT tendinopathy?
Usually within sheath or navicular bursa almost never in metacarpal region
Mid-substance disruption vs border tears
Which tendons are injured in front and back legs if intra-thecal tendon tears?
DDFT usually lateral border in forelimbs
Manica flexoria usually in hindlimb
How are intra-thecal tendon tears diagnosed?
Ultrasound diagnosis is difficult due to lateral/medial echogenic material
Manica flexoria instability in longlitudinal view
What is the manica flexoria?
Loop of SDFT that wraps around DDFT and its sites of attachment can tear
What can cause tenosynovitis and what consequences can dysfunction have?
Idiopathic distension, primary/secondary non-septic or septic inflammation
Soft tissue and bone consequences
What are the signs of annular ligament syndrome?
Mild-moderate lameness minimally responsive to rest occasionally with irregular gliding of tendons
Distended digital sheath with a notch at PAL level
Digital sheath analgesia usually positive but may not be 100% (mechanical component)
Ultrasonography = >2mm in thickness
What are the general principles for treating tendon injuries?
Very few evidence based treatment choices
Rational treatment based on tendon pathology and phases of tendon healing
In the acute phase, how should a tendon be treated?
Physical therapy - cold, compression and MCP joint support
Short acting steroids only within 24-48 hours or NSAIDs
Surgery involving percutaneous tendon splitting using a knife/needles
In the sub-acute phase, how should a tendon be treated?
Mobilisation early and progressively
Regular ultrasonographic monitoring every 2-3 months
Exercise levels based on CSA’s to maintain <10% increase
Induce regeneration rather than repair (ACell, growth factors, stem cell therapy)
What treatment should be used for chronic tendon injuries?
Controlled ascending exercise, ultrasonographic monitoring,
Surgery - desmotomy of accessory ligament of SDFT
What specific treatment can be used for proximal suspensory desmitis? Effectiveness data?
Extracorporeal shock wave therapy
Forelimb = 53% at 6 months in chronic, 86-90% for conservative acute phase treatment
Hindlimb = 41% at 6 months in chronic, 13% for acute
What can fasciotomy and neurectomy be used to treat?
Hindlimb PSD which have failed to improve after first two treatments
What treatment do intra-thecal tendon/ligament lesions often require and why?
Tenoscopy/arthroscopy and joint medication as intrasynovial location often gives poor healing
What is the aetiology of flexural limb deformities?
Congenitial due to uterine malpositioning or CDET rupture
Acquired as part of developmental orthopedic disease
What is the treatment of flexural limb deformities?
Conservative through exercise, shoeing and splits or surgical release
What is carpal flexural deformity aetiology and treatment?
Congenital and treated with exercise, physiotherapy, tube casts and surgery
When is distal interphalangeal joint flexural deformity acquired?
Around 6 months
What is type 1 distal interphalangeal joint flexural deformity? How is it treated?
Dorsal hoof wall less than vertical
Exercise and physiotherapy, toe extension shoe and surgery through desmotomy of ALDDFT
What is type 2 distal interphalangeal joint flexural deformity? How is it treated?
Dorsal hoof wall past vertical
Surgery of desmotomy of ALDDFT or DDFT tenotomy
What treatment is used for metacarpophalangeal joint flexural deformity?
Exercise/physiotherapy, toe extension and raised heel shoe, splints/braces, surgery of desmotomy of ALDDFT/ALSDFT or SDFT tenotomy
What is the tendon toxity?
Spontaneous recovery, heel trimming, heel extension shoe and controlled exercise
