Exam 1 - Equine Soft Tissue Injuries

Question 1

where is type II collagen found?

Answer 1

joints

Question 2

where is type III collagen found?

Answer 2

scar tissue

Question 3

what is the composition of the SDFT like in regards to anatomical make-up?

Answer 3

longitudinal homogenous collagenous fibers

Question 4

what are the weight-supporting structures found in the limbs of horses?

Answer 4

superficial flexor tendon, deep flexor tendon, & suspensory ligament

in the pastern - remember the distal sesamoidean ligaments

Question 5

when assessing a tendon laceration on the palmar/plantar aspect of horse limbs, what are you evaluating during wound assessment?

Answer 5

weight supporting structures

neurovascular supply

synovial cavities

Question 6

on the dorsal aspect of horse limbs, what tendons extend down the full length of the leg? which does not?

Answer 6

forelimb - common digital extensor, lateral digital extensor only goes to P1

pelvic limb - long digital extensor

Question 7

at the cannon region in the forelimb/hind limb (metacarpal/metatarsal), if there is a flexor surface wound, what weight supporting structures are you concerned about?

Answer 7

sdf, ddf, & branches of the suspensory ligament

Question 8

what imaging modality is indicated for investigating soft tissue structures within the hoof capsule?

Answer 8

MRI

Question 9

at the digit region in the forelimb/hind limb (fetlock down), if there is a flexor surface wound, what weight supporting structures are you concerned about?

Answer 9

some of the sdf, ddf, distal sesamoidean ligaments, & the digital sheath

Question 10

what structures do you think are injured? why?

Answer 10

sdf & suspensory ligament branches - dropped fetlock

Question 11

what structures do you think are injured? why?

Answer 11

both the sdf/suspensory ligament & the ddf

toe is up & fetlock is dropped

Question 12

what would you expect to see if only the deep digital flexor tendon was involved in an injury?

Answer 12

toes would be pointed up off of the ground

Question 13

what benefits does ulstrasonography provide for tendon lacerations?

Answer 13

you can assess structural compromise to see what structures are affected, the fiber integrity, the percentage of cross-sectional damage, & also used as a way to assess healing in follow up exams

Question 14

what diagnostic should you do prior to stitching up a tendon laceration?

Answer 14

radiographs - look for bony involvement & foreign bodies

Question 15

what is the initial management of flexor surface wounds?

Answer 15

initial first aid for wound care (abx) & provide weight-bearing function if there is flexor instability

Question 16

what is this? why would you use it?

Answer 16

dorsal splint cast - flexor instability

do a low bulk bandage with a dorsal splint & cast material for dorsal cortical alignment to remove work from the soft tissue structures

Question 17

T/F: this is the most desirable coaptation for a horse with tendon lacerations resulting in flexor instability

Answer 17

true - kimsey leg saver splint

Question 18

what are the disadvantages of tenorraphy?

Answer 18

horse has to undergo anesthesia & it is costly

Question 19

what are the purposes of doing a tenorraphy for flexor surface wounds?

Answer 19

restore functional length of affected tendons, minimize the gap, reduce fibrosis

Question 20

T/F: tenorraphy on flexor surface wounds is a weight-supporting surgery

Answer 20

false - not even close

Question 21

what should be done in conjunction with a tenorraphy?

Answer 21

flexor support - need 12 weeks of protection with a gradual reduction - use u/s to help evaluate

start with a cast to hold the fetlock in slight flexion -> move to bandage cast -> move to splint bandage

dorsal support

Question 22

what is the prognosis of flexor surface wounds?

Answer 22

guarded to fair - 45-60% return to function

Question 23

T/F: prognosis of flexor surface wounds is dependent upon the structures involved in the injury

Answer 23

false - not dependent

Question 24

what structures are involved in extensor surface wounds in horses?

Answer 24

long/common/lateral digital extensor, dorsal metacarpus/metatarsus, digital extensor tendon sheath, & synovial structures

Question 25

what clinical signs would you expect to see in a horse with extensor surface wounds?

Answer 25

knuckling forward, dorsal weight bearing, & normal with solar placement

Question 26

what should you do for a horse with extensor surface wounds?

Answer 26

work up similarly to flexor surface - may use u/s & rads debride the wound, skin & sub-q reconstruction (may use delayed closure or second intention healing) splint them in extension (build up behind pastern region), ensure weight bearing, & keep them in stall rest for 4-6 weeks

Question 27

what can go wrong with a caudal splint in a horse with a surface extensor injury?

Answer 27

could cause a contracture - make sure they are full weight bearing to help prevent this

Question 28

what is the prognosis for horses with extensor surface wounds?

Answer 28

good to excellent - 70-80% return to function extensors bear less load & have a minimal effect on gait, so better prognosis than flexor tendon lacerations

Question 29

what are some complications associated with extensor surface wounds in horses?

Answer 29

can develop exuberant granulation tissue, cortical sequestrums, digital contracture, or secondary stringhalt

Question 30

what locations do we commonly see strain-induced injuries in horses?

Answer 30

tendonitis in the SDFT/DDFT suspensory desmitis in the origin/body/branches of suspensory apparatus distal sesamoidean desmitis in the straight & oblique sesamoidean ligaments

Question 31

what are the 2 different pathogenesis we see with strain induced injuries in horses?

Answer 31

acute overload/cumulative injuries from acute damage/inflammation where we see a repair response molecular degeneration with no inflammatory or reparative response

Question 32

what horses do we commonly see strain-induced injuries from the pathogenesis of molecular degeneration?

Answer 32

racing horses in their SDFT - looks like bowed tendons, SDF tendonitis in the mid-metacarpal region - associated with speed

Question 33

what is the lesion seen with strain injuries of the SDFT in the mid-metacarpal region of race horses?

Answer 33

weakened core lesion

Question 34

what is the typical presentation of a horse with SDF tendonitis in the mid-metacarpal region from a strain-induced injury?

Answer 34

inflammation/bowed tendon, pain, heat, & SWELLING lameness correlates with amount of inflammation loss of function/fetlock support (SDFT/suspensory ligament) - can look acute even if cumulative problem

Question 35

how do you diagnose SDF tendonitis proximal to the hoof capsule? what about in the hoof capsule?

Answer 35

ultrasound MRI for hoof capsule

Question 36

how do you treat a strain-induced injury in a horse with SDF tendonitis?

Answer 36

rest/ice/compression - physical therapy systemic nsaids regenerative therapy surgical therapy rehabilitation - stall confinement, progressive exercise plan with gradual loading of healing tissues to optimize function

Question 37

what is the historical re-injury rate of horses with strain-induced injuries?

Answer 37

80%

Question 38

what horses typically get sesamoiditis in their proximal sesamoid bones?

Answer 38

racing horses

Question 39

what is indicated for small fragment fractures of the proximal sesamoid bones?

Answer 39

surgical removal

Question 40

what is indicated for major fractures of the proximal sesamoid bones?

Answer 40

surgical fixation

Question 41

where is type I collagen found in the body?

Answer 41

the tendons