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Locomotor > Equine Tendon and Ligament Disease > Flashcards

Equine Tendon and Ligament Disease Flashcards

1
Q

What are the types of tendon injury?

A

‘Percutaneous’ - laceration or penetration

‘Subcutaneous’ - Strain or displacement

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2
Q

What are the causes of overstrain injury in equids?

A

Sudden overextension - DDFT

Preceding tendon degeneration with superimposed sudden overextension - SDFT, SL

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3
Q

What is a typical history of a horse with a tendon injury?

A

There is usually a preceding intense period of exercise, although signs can be delayed.

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4
Q

What is the area most prone to injury in the equine limb?

A

Weight bearing tendons on the palmar aspect

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5
Q

Describe the stance and gait in a clinical evaluation for diagnosis in equine tendon injury…

A 
MCPJ extension 
decreased with:
- reduced weight-bearing (pain)
- fibrosed (stiff) tendons
increased with severe SDFT/SL injuries

Elevated toe
- DDFT rupture (bears weight and the toe lifts, pathognomic)

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6
Q

What do you need to look at during palpation in the lame horse?

A

Observation - site of metacarpal swelling

Palpate - weight bearing (it is not possible to elicit pain in the standing horse as you can’t squeeze the tendons), limb lifted

Some area difficult to palpate - proximal SL in hindlimb

Assess BOTH LIMBS

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7
Q

What is the role of diagnostic ultrasonography in the lame horse?

A

Diagnosis - affected limb and normal limb

Assessment of severity - around 7 days after injury in order to assess the prognosis

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8
Q

What equipment do you need to perform diagnostic ultrasonography on equine tendons and ligaments?

A

7.5+ MHz linear transducer

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9
Q

Describe superficial digital flexor tendinopathy…

A

Palmar metacarpal swelling
Initial lameness variable
Pain on palpation
‘Core’ lesion on ultrasound

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10
Q

What is the typical history of a horse with suspensory ligament desmitis or proximal suspensory desmitis?

A

Lameness variable in degree

Acute or insidious onset

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11
Q

What are the clinical signs of suspensory ligament desmitis or proximal suspensory desmitis?

A

Confirmation (hindlimb)
Straight hock, overextending MTP joint (unknown which comes first)

Lameness
Often lamer with the limb on the outside of a circle
Proximal MC/MT swelling, this can be very transitory, so there may be none or very little when you arrive or palpate. Swelling is variable and there can be medial palmar vein distension (although this can occur with any soft tissue injury at this location).

Pain on palpation

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12
Q

Describe the ultrasonography of suspensory body and branch desmitis…

A

Branches need imaging from medial and lateral aspects

Focal or generalised lesions

Enlargement

Peripligamentar fibrosis is very common

Bilateral involvement is common

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13
Q

Describe the radiography of suspensory body and branch desmitis…

A

Often concurrent bony abnormalities; attachment sites on bones that may occur in response.

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14
Q

What is another name for the DDFT?

A

Inferior check ligament

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15
Q

Describe the signs of desmitis of the DDFT..

A

Swelling in the proximal metacarpal region

Dorsal to the SDFT

Lameness is variable, but often absent

Ultrasonography shows a general enlargement

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16
Q

Describe ultrasonography of intra-thecal tendon tears…

A

Ultrasonographic diagnosis is difficult

Lateral or medial echogenic “material”

Oblique views

MF instability in longitudinal view

Contrast tenography

17
Q

Describe the lameness of annular ligament syndrome…

A

Mild to moderate
Minimally responsive to rest
Occasionally irregular gliding of tendons

18
Q

What is the importance of the synovium?

A

Important for frictionless movement of tendon over the joints.

19
Q

What can cause dysfunction of the digital sheath?

A

“Idiopathic” distension
Penetrating injuries - sepsis
Non-septic inflammation (primary and most secondary)

20
Q

What are the three phases of tendon healing?

A
  1. Acute (inflammatory) phase
  2. Subacute (fibroplasia) phase
  3. Chronic (remodelling) phase
21
Q

What are the clinical signs of the acute inflammatory phase of tendon healing…

A 
0-2 weeks
Lameness
Pain on palpation
Heat
Swelling
22
Q

Describe the pathology in the acute inflammatory phase of tendon healing…

A

Haemorrage

Inflammation

  • Neutrophils
  • Macrophages and monocytes
  • Increased blood flow
  • Oedema
  • Proteolytic enzymes
23
Q

What is the rational treatment for the acute phase of tendon healing?

A

Minimise inflammation

24
Q

How can inflammation be minimised in the acute phase of tendon healing?

A

Physical therapy
Application of cold (ice)
Compression
MCP joint support (rest!)

Medication
\+ Short acting steroids
-- only with 24/48 hours
systemically or peritendinously
-- beware of laminitis
\+ NSAIDs
-- analgesia

Surgery
- Percutaneous tendon splitting
knife
- Needles (possible to combine with intra-tendinous medication)

25
Q

What are the clinical signs of the subacute, reparative phase of tendon healing?

A

1 wk - 6 mons

Reduction or absence of lameness

Resolution of signs of inflammation

Tendon still palpably enlarged and soft

Signs of reinjury if exercised too early

26
Q

What is the pathology of the subacute, reparative phase of tendon healing?

A

Angiogenesis

Fibroplastia

27
Q

What is the treatment rationale for subacute, reparative phase of tendon healing?

A

Promote fibroplasia

Optimise organisation of scar

28
Q

What is the pathology of the chronic remodelling phase of tendon healing?

A

3 - 18 months

Collagen transformation from type III to I

Crosslinking

Thicker collagen fibres

29
Q

What can extracorporeal shockwave therapy be used for?

A

Proximal suspensory desmitis

30
Q

What are the possibly aetiologies of flexural limb deformities?

A

Congenital

  • Uterine malpositioning
  • Common digital extensor tendon rupture

Acquired

  • Part of developmental orthopaedic disease
  • Pain (OCD etc)
31
Q

How can you treat carpal flexural deformity?

A

Exercise and physiotherapy
Tube cast
Surgery

32
Q

How can you treat flexural limb deformities?

A

Exercise
Shoeing
Splints
Surgical release

33
Q

Describe the two types of distal interphalangeal joint flexural deformities…

A

Type 1
Dorsal hoof wall is less than vertical

Type 2
Dorsal hoof wall is past vertical

34
Q

How would you treat type 1 DIP joint flexural deformity?

A

Exercise and physiotherapy
Toe extension shoe
Surgery (desmotomy of the ALDDFT, DDFT tenotomy)

35
Q

How would you treat type 2 DIP joint flexural deformity?

A

Usually needs surgery
Desmotomy of ALDDFT
DDFT tenotomy

36
Q

What are the types of tendon laxity?

A

Congenital

Acquired (secondary to casting)

37
Q

How can you treat metacarpophalangeal joint flexural deformity?

A

Exercise or physiotherapy
Tow extension and raised heel shoe
Splint or braces
Surgery

Locomotor (16 decks)

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