Equine Tendon and Ligament Dz Flashcards
What are the most common sites of tendon injury?
- SDFT
- Suspensory
- Accessory ligament of the DDFT
- DDFT
(in that order)
Types of tendon injury?
> percutaneous - laceration/penetration > subcutaneous (most common) - not associated with direct external trauma - strain, displacement
Cause of over-strain injuries?
> sudden overextension - ?DDF > preceding tendon degeneration + sudden oveextension - SDFT, SL (working close to limit of strain)
How does the tendon sheath affect the physiology of tendon?
- outside sheath, paratenon surrounds the tendon
- in sheath, healing slower and poorer
- adhesions can form here
What is a bowed tendon?
- SDFT injury
- usually extrathecally ( outside tendon sheath)
Hx of tendon injury?
- intense excercise
- signs can be delaed
clinical exam findings with tendon/lig injuries?
> lameness
- can be temporary
- or can persisnt chronically (DDFT/SL)
MCP joint overextension
- decrreased with reduced weight bearing (so weigh up lameness with overextension)
- fibrosed (stiff) tendon
elevating toe
- PATHOGNOMONIC with DDFT (sole flexor of distal interphalangeal joint)
palpation
- limb lifted (apply pressure ID pain) and weight bearing (location)
- may be bilaterally affected just one worse than the other
- prox SL in HL and pastern difficult to palpate
- assess pain, oedema, suppleness of tendons
When can ultrasound be used for assessing severity of tendon injuries?
- ~7d
- and give prognosis
Type of equipment used for ultrasounding tendons?
- high frequency 7.5MHz and linear transducer
Clinical exam findings with SDFT tendinopathy/tenditis?
> palmar metacarpal swelling
- initial lameness (variable)
- pain on palpation
- core lesion with surrounding healthy tissue
Hx and PE findings of PROXIMAL suspensory ligament desmitis?
> conformation (straight hock and hyperextension of the felock)
- pdf or result?
Hx: lameness variable, acute or insiduous onset
- worse on outside circle, soft
PE: medial palmar veain distension
- pain on palp
- diagnostic anaglesia
- imaging (US, radiograph, scintigraphy, MRI
What is the strangulation technique?
pushing SDFt and DDFt to palapte underlying SL in proximal canon
Where is the lameness worse on lameness workkup with proximal suspensory disease?
- OUTSIDE circle
- soft surface
Ultrasound/radiographic findings with suspensory body and branch desmitis?
(ligamentous origin) - image from medial and lateral (both branches) - focal/gneeralised lesions poss - enlargement - periligamentar fibrosis very common - bilateral involvement common > radiographpy - concurrent bony abnormlaities
PE finding with desmitis of the accessory ligament of DDFT (Inferior check)
- swelling prox metacarpal region
- dorsal SDFT
- lamess often ABSENT
- ultrasound : generalised enlargement
Which is the rarest tendinopathy?
DDFT
- commonly within digital sheath or navicular bursa (never really in metacarpal region)
> mid-substance disruption v border tears
- usually lateral
Which intra-thecal tendon tears are most common in fore and hindlimbs?
> DDFT - lateral border - forelimbs > manica flexoria - usually HL > ultrasound diffficult - lateral or medial echogenic material - MF instability in longitudinal view - distended flexor tendon sheath
What are windgalls?
Bilat symmetrical, tenosynovitis -> idiopathic distnesion of the digital sheath
No need for tx if non painful and bilateral (common ponies)
How does tenosynovitis affect lexor tendon region?
- important consequences for associated soft tissues and bone
Causes of digital sheath tenosynovitis?
- idiopathic (widngalls)
- non-septic (1* or mostly 2* )
- penetrating injuries -> sepsis
What is ALS? PE?
> annular ligament syndrome
- milkd-mod lameness
- minimally responsive to rest
- occasionally irregular gliding of tendons
- distended digital sheath with notch at level of PAL
Further dxx findigns with ALS?
> digital sheath analgesia - usually + but may not be 100% - ?mechanical element to lameness? > Ultrasound - >2mm thickness
What are the 3 phases of tendonitis?
> acute inflammaotry > subacute fibroplasia > chronic - remodelling (over ~1yr, SL quicker, tendons slower)
Historical tx for tendonitis?
- many tx advocated n the past
- many no effect, some deleterious
- little evidence base
What clinical signs and pathology is associated with the inflammatory phase? (first 2 weeks)
> PE - lamenss (dt inflam) - pain on palp - heat and swelling > Path - hameorrhage - inflam (neutrophils, macrophages, monocytes, ^ blood flow, oedema, proteolytic enzymes)
Rational tx of inflammmaory phase of tendopathy?
= minimise inflammation > physical therapy - cold - compression - MCP joint support - rest > Meds - short acting steroids (only within 24-48hrs, systemic or PERItendinosly, risk laminitis or apparnet resolution and over working!) - NSAIDs (analgesia too) > surgery - percutaneous tendon splitting - poss combined with intrateninour medication - minimal evidence
Clinical signs and pathology associated with subacute reparative phase (1 week-6months)
> clinical signs
- reduction/abscence of lameness
- resolution of inflame
- tendon still palpably enlarged and soft
- signs of re-injury if exercised too early
path
- angiogenesis
- fibroplasia (++ fibroblasts, collagen III, small collagen fibrils formed)
Tx in subacute phase (1week-6 months)
> mobilisation
- early
- prgressive (introduce trotting after 3 months for SDFT)
regular ultrasound monitoring
- every 2-3months
- excercise based on cross sect area of tendonds (
3 main regenerative medicines for tendiopathy? Aims of regenerative medicine?
= aims are to induce regeneration cf. repair (-> scar)
> scaffolds
- ACell (lyophilised pig bladder submucosa)
> growth factors
- PRP (platelet rich plasma)
> cell therapy
- mesenchymal stem cells
Outline mesenchymal stem cell protocol?
- locate bone marrow in sternum, heparinise
- recover nucleated adherent stem cell population (one passage??)
- resuspension in citrated supernatant of BM
- implantation under ultrasound guidance (standing)
- 48 week rehab programme
> shown to be effective in racers and sports horses
Clinical signs and pathology associated wih chronic remodelling phase (3-18 months)
> clinical signs - tendon size decreases - tendon less pliable - reduced fetlock extension - contracture > path - collagen transformation from III-I - cross-linking - thicker collagen fibrils
Rational Tx in chronic phase?
= promote remodelling and prevent re-injury
> controlled ascending excercise (lower excercise level)
- with ultrasound monitoring
> surgery
- desmotomy of the accessory ligament of the SDFT (“superior check ligament”)
-> ^ incidence of suspensory dismitis?
- carpal sheath approach (tenoscopic)
What is the fetlock joint?
Metacarpophalangeal
What specific txx are indicated for proximal suspensory ligament desmitis ?
> extracorporeal shock wave therapy
- forelimb PSD 50% @ 6 months for chronic cases, 90% for conservative management of acute cases
- hindlimb PSD 40% @ 6 months for chronic, 10% for acute/0% chronic cases with conservative management only
fasciotomy and neurectomy
- for hindlimb PSD failed to improve after first 2 tx
Specific txx for intrathecal tendon/ligament lesions?
- medication? tenoscopy/arthroscopy?
- intrasynovial location = poor healing
> H/L manica flexoria tears - good prog with removal (80%)
> F/L DDFT tears - debridement but poor prog (20-40%)
Give egs. of developmental tendon diseases
= FLexural limb deformities
- congenital (uterine malpositiioning/CDET extensor rupture) or acquired (DOD, pain -> v loading)
> carpal flexural deformity
- congenital
> DIP flex deform
- aquired ~6mo
- type 1 =hoof can still sit flat on floor (can be loaded normally)
- type 2 =hoof past the vertical (breaker point)
- pain related? NSAIDs
- in adults: chronic lameness (FLs) or ALDDFT desmitis (HLs) can look the same
> MCP flex deform
- can occur 2* to chronic SDFT tendinopathy in adults too
Tx carpal limb deformity
- tx: exercise, physio, tube casts, surgery? if sx needed, prog too poor
Tx DIP deformity
> type 1 - exercise, physio - toe extension shoe - surgery: ALDDFT desmotomy /DDFT tenotomy > type 2 - usually surgery - ALDDFT desmotomy/DDFT tenotomy
Which structure is responsible for flexing the DIP?
DDFT§
Tx MCP flex deform?
- ALDDFT/ALSDFT desmotomy
- SDFT tenotomy last resort
Causes of tendon laxity? Tx?
- congenital
- acquired 2* to casting
> Tx: corrective farreiry/shoeing/ casts?? Not sure
