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Locomotor > Equine tendon and ligament disease > Flashcards

Equine tendon and ligament disease Flashcards

1
Q

Name 2 types of tendon injury

A
  • percutaneous: laceration/ penetration

- subcutaneous - strain, displacement

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2
Q

Causes of over-strain injury

A
  • sudden over-extension (DDFT?)

- preceding tendon degeneration with superimposed sudden over-extension (SDFT, SL)

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3
Q

Dx - tendon injry

A
  • Hx (usually preceding intense period of exercise, signs can be delayed)
  • CE - lameness (can be temporary, can persist for some tendon/ligament injuries)
  • Stance/ gait - MCPJ extension (decreased with reduced weight bearing / pain and fibrosed/ stiff tendon. increased with severe SDFT/SL injuries. Elevating toe - DDFT rupture
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4
Q

What is a pathognomic sign for DDFT rupture?

A

toe elevation

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5
Q

How should you palpate the limb? 2

A
  • weight bearing

- limb lifted

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6
Q

Which areas are difficult to palpate? 2

A
  • proximal SL in HL

- pastern

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7
Q

What to assess on palpation? 3

A
  • pain
  • tendon suppleness
  • oedema
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8
Q

What is the role of ultrasound?

A
  • DIAGNOSIS

- SEVERITY ASSESSMENT: 7 d after injury, prognosis

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9
Q

What ultrasound equipment is used to examine the leg?

A

7.5 MHz (high frequency) + linear transducer

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10
Q

Describe SDFT tendinopathy

A
  • palmar metacarpal swelling
  • initial lameness (variable)
  • pain on palpation
  • ‘core’ lesion on ultrasound
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11
Q

Hx - suspensory ligament desmitis/ proximal suspensory desmitis

A
  • HX: lameness variable in degree, acute or insidious

- CS: conformation (HL) is straight hock adn overextending MTP joint

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12
Q

CS - proximal suspensory disease

A
  • Lameness (often lamer with limb on outside of circle, proximal MC/MT swelling is variable and with medial palmar vein distension, pain on palpation vs normal)
  • diagnostic analgesia
  • diagnostic imaging (US, xray, gamma-scintigraphy, MRI)
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13
Q

Suspensory body and branch desmitis:

  • CS
  • Ultrasound
  • Radiograph
A
  • CS: variable lameness
  • ULTRASOUND: branches need imaging from medial and lateral aspects, focal or generalised lesions, enlargement, periligamentar fibrosis very common, bilateral involvement common
  • RADIOGRAPH: concurrent bony abnormalities
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14
Q

Define ALDDFT

A

Accessory Ligament of the DDFT (= ‘accessory check ligament’)

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15
Q

CS - desmitis of the ALDDT (‘inferior check ligament’)

A
  • swelling in proximal MC region, mostly lateral
  • dorsal to SDFT
  • lameness variable (often absent)
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16
Q

Ultrasound - desmitis of the ALDDT (‘inferior check ligament’)

A
  • generalised enlargement
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17
Q

What happens in DDFT tendinopathy?

A
  • usually within digital sheath or navicular bursa (never in MC region?)
  • mid-substance disruption vs. border tears
  • e.g. intra-thecal tendon tears
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18
Q

What is the manica flexoria?

A

part of the SDFT that wraps around the DDFT at the fetlock joint. Function is to maintain tendon alignment within DFTS.

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19
Q

Examples of intra-thecal tendon tears

A
  • DDFT (usually lateral border for tear, TL)

- Manica flexoria (usually HL)

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20
Q

Ultrasound diagnosis: intra-thecal tendon tears

A
  • difficult
  • lateral or medial echogenic material
  • MF instability in longitudinal view
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21
Q

Causes - tenosynovitis

A

DIGITAL SHEATH:

  • idiopathic distension
  • non-septic inflammation (primary, most secondary)
  • penetrating injuries (sepsis)
22
Q

What is tenosynovitis important?

A

because the dysfunction results in important consequences for soft tissues and bone

23
Q

Define ALS

A

Annular Ligament Syndrome

24
Q

CS - ALS

A
  • Lameness (mild-moderate, minimally responsive to rest, occasionally irregular gliding of tendons)
  • distended digital sheath
  • ‘notch’ at level of PAL
25
Q

Diagnosis - ALS

A
  • Digital sheath analgesia (usually positive but may not be 100%, may have a mechanical component to lameness)
  • Ultrasonography (+tenoscopy, look for if >2mm thickness)
26
Q

General principles -tx of tendonitis

A
  • many tx advocated in past (many have no effect, some are deleterious)
  • very few EBVM choices
  • base tx on tendon pathology and phases of tendon healing
27
Q

What are the 3 phases of tendon healing?

A
  • acute/ inflammatory
  • subacute/ fibroplasia
  • chronic/ remodelling (never back to normal)
  • 12-18 months for tendon repair
  • 3-6 months for ligament repair
28
Q

Acute inflammatory phase of tendonitis (0-2 wks):

  • CS
  • Pathology
  • Rational tx
A
  • CS: lameness, pain on palpation, heat, swelling
  • PATHOLOGY: haemorrhage and inflammation (neutrophils, macrophages and monocytes, increased BF, oedema, proteolytic enzymes)
  • TX: minimise inflammation
29
Q

Describe tx of acute inflammatory phase of tendonitis

A
  • PHYSICAL THERAPY: apply cold/ ice, compression, MCP joint support (rest)
  • MEDICATION: short-acting steroids (only within 24-48 hours, systemic or peritendinously, beware of laminitis and masking problem), NSAIDs (analgesia)
  • SURGERY: percutaneous tendon splitting (knife, needles, may combine with intra-tendinous meds)
30
Q

Subacute/ reparative phase of tendonitis (1 wk - 6 mo):

  • CS
  • Pathology
  • Rational tx
A
  • CS: reduction or absence of lameness, resolution of signs of inflammation, tendon still palpably enlarged and soft, signs of re-injury if exercised too early
  • PATHOLGOY: angiogenesis, fibroplasia (many fibroblasts, collagen 3, small collagen fibrils formed)
  • RATIONAL TX: promote fibroplasia, optimise scar organisation, regular US monitoring (every 2-3 months, exercise level based on CSA), mobilisation (early, progressive - introduce trotting 3 months after SFDT injury), biologicals
31
Q

What biological tx may be given for tendonitis? 3

A
  • scaffolds (ACell = lyophilised pig bladder submucosa
  • growth factors (platelet rich plasma = PRP)
  • cell therapy (mesenchymal SCs)
32
Q

Outline method of mesenchymal SCs for tendonitis

A
  • recovery of heparinised bone marrow from 2 separate sternebrae
  • located with diagnostic ultrasound
  • recovery of nucleated adherent SC population
  • one passage
  • resuspension in citrated supernatant of BM
  • implantation under USG
  • post-implantation 48 wk rehab programme
33
Q

Chronic phase of tendonitis (3-18 months):

  • CS
  • Pathology
  • Rational Tx
A
  • CS: tendon size decreases, tendon less pliable, reduced fetlock extension, (contractures)
  • PATHOLOGY: collagen transformation from 3 to 1, cross-linking, thicker collagen fibrils
  • RATIONAL TX: promote remodelling, prevent re-injury
34
Q

Outline tx for chronic phase of tendonitis

A
  • controlled ascending exercise (lower exercise level)
  • US monitoring
  • Surgery: desmotomy of the accessory ligament of the SDFT (‘superior check ligament’), higher incidence of suspensory desmitis, carpal sheath approach)
35
Q

When is extracorporeal shock wave therapy indicated?

A
  • Proximal Suspensory Desmitis (PSD): both TL and HL
36
Q

When is fasciotomy and neurectomy therapy indicated?

A

For HL PSD which have failed to improve after the first 2 tx of extracorporeal shock wave therapy

37
Q

What is extracorporeal shock wave therapy?

A

high energy pressure waves to pulverise the proximal suspensory region

38
Q

How might you tx intra-thecal tendon/ligament lesions?

A
  • medication?
  • intrasynovial location gives poor healing
  • tenoscopy/ arthroscopy
39
Q

How might you tx HL manica flexoria tears?

A

good prognosis with removal (70-80%)

40
Q

How might you tx TL DDFT tears?

A

debridement but poor prognosis (20-40%)

41
Q

List some developmental diseases of tendon

A
  • flexural limb deformities
  • carpal flexural deformities
  • DIPJ flexural deformity
  • MCPJ flexural deformity
  • tendon laxity
42
Q

Describe flexural limb deformities:

  • what
  • aetiology
  • tx
A
  • tendon developmental disease
  • AETIOLOGY: congenital (possibly uterine malpositioning or CDET rupture) or acquired (part of ‘developmental orthopaedic disease’, pain (OCD, physitis etc)
  • TX: conservative (start with this, exercise, shoeing, splints), then surgical release if unsuccesful
43
Q

Describe carpal flexural deformity

  • what
  • aetiology
  • tx
A
  • tendon developmental disease
  • congenital
  • TX: exercise and physio (most cases respond to this), then tube casts, (sx)
44
Q

Describe DIPJ flexural deformity:

  • what
  • aetiology
  • types
  • tx
  • adults
A
  • tendon developmental disease
  • acquired (6 months old)
  • TYPE 1: dorsal hoof wall less than vertical
  • TYPE 2: dorsal hoof wall past vertical
  • Pain-related? –> NSAIDs
  • ADULTS: TL –> chronic lameness, HL = usually desmitis of the ALDDFT
45
Q

Another name fro DIPJ flexural deformity

A

‘ballerina foals’

46
Q

Tx - type 1 DIPJ flexural deformity

A
  • exercise and physio
  • toe extension shoe
  • sx (desmotomy of ALDDFT, (DDFT tenotomy))
47
Q

Tx - type 2 DIPJ flexural deformity

A
  • usually sx necessary
  • desmotomy of ALDDFT
  • (DDFT tenotomy)
48
Q

Describe MCPJ flexural deformity

A
  • also can occur secondary to chronic SDFT tendinopathy in adults
49
Q

Tx - MCPJ flexural deformity

A
  • exercise/ physio
  • toe extension and raised heel shoe
  • splints/ braces (beware of sores!)
  • sx (desmotomy of ALDDFT, desmotomy of ALSDFT, SDFT tenotomy)
50
Q

Describe tendon laxity:

A
  • congenital
  • acquired (secondary to casting)
  • Tx: spontaneous recovery, heel trimming, heel extension shoe, controlled exercise)

Locomotor (31 decks)

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