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Musculoskeletal > LA MS 8: Eq Tendon, Ligament And Muscle Dz > Flashcards

LA MS 8: Eq Tendon, Ligament And Muscle Dz Flashcards

1
Q

Tendonitis

A

Common, debilitating Injury
Fxn of tendon and ligaments
Resolution problematic
–tendon slow to heal
–healed tendon lacks elasticity, strength
–high incidence of recurrence - heal with a fibrous scar that less elastic (weakest pt at jxn of scar and normal tissue)

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2
Q

Microscopic anatomy

A

Spare tenocytes, fibroblasts

ECM

  • water
  • collagen - type 1
  • elastin
  • glycoproteins
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3
Q

Structural Hierarchy

A

Tropocollagen –> microfibril –> subfibril –> fibril –> fascicle
Blood supply comes from around the tendon
High order - tendon rarely able to reconstruct self

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4
Q

Why the SDF?

A

Smaller cross sectional area
Most external –> greatest strain, most prone to trauma
Less vascular in the mid-MC –> less likely to heal (whereas DDFT highly vascular until goes over the fetlock canal

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5
Q

Pathogenesis of Tendon Injury

A 
2 broad classes 
1. External 
2. Internal 
Intrasynovial vs extrasynovial 
SDFT > DDFT 
FL > HL 
IMPORTANT - LIFE-THREATENING INJURY IF LACERATION INSIDE THE TENDON SHEATH
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6
Q

Pathogenesis of tendon injury: external

A

Laceration

Blunt trauma

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7
Q

Pathogenesis of tendon injury: internal

A

Biomechanical overload (strain)
Hyperthermia
Vascular

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8
Q

Phases of Tendonitis

A
  1. Pre-clinical
  2. Clinical - 1-2wks –> IFM
  3. Repair - peaks 21d after onset of CS
    - -tenocyte migration, angiogenesis
  4. Remodeling - up to 18mo
    * if you can intervene during the IFM, much better prognosis to return to athletic performance
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9
Q

Biomechanical forces

A

Altered hoof conformation –under run heels, long toe
Hard or very soft ground
Muscular fatigue near end of performance

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10
Q

PE

A

Lame
Visual “bow”
Palp: heat, pain, swelling

Should be able to dx SDF or DDF tear by palp and visual exam
To dx suspensory tear, need regional ax and US (black spots on US are fluid-filled but also have a lot of cells - those cells need to be told what to do)

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11
Q

US Exam

A

Cross section, linear exam
Ecogenic score
BOTH LIMBS
Serial exams - is tx working? Can exercise be increased?
Be sure to examine with both WB and non-WB

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12
Q

Rehab protocols

A

Time and controlled exercise critical - cells need to know what to do

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13
Q

Acute Phase Care

A

Stall rest
Control IFX - NSAIDS, cold (water, ice)
Bandage - compression and pain relief
PRP?

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14
Q

Sub-Acute Care

A 
Controlled exercise 
Serial US exams 
Med therapy 
Sx tx 
Surpass - topical NSAID
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15
Q

Surgical Therapies

A
  1. Transaction of the accessory lig of the SDF
    - -aka prox check lig desmotomy
    - -increases elastic length of m/t unit (lig less elastic than m)
    - -accessory ligament attaches to distal radius
  2. Palmar/plantar annular ligament transaction for low bows
    - -allows more room for SDF/DDF to move, heal and function
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16
Q

PAL Constriction

A 
Primary 
--Trauma to PAL
--Desmitis of PAL 
Secondary 
--Trauma to digital sheath - repetitive or severe 
--IFX tenosynovitis 
--Tendonitis of SDF/DDF
17
Q

Tendon Lacerations - extensor tendons

A

Heal well

Fair-good functional and cosmetic outcome

18
Q

Tendon lacerations - flexor tendons

A

Extrasynovial:
–fair functional/cosmetic outcome
Intrasynovial:
–fair to poor functional/cosmetic outcome
IFX = LIFE THREATENING
CRITICAL EMERGENCY - ATTEND TO IMMEDIATELY
–prog drops to guarded after 24hr

19
Q

Suspensory Ligament Desmitis

A

AKA intraosseus - 2-11% muscle
3 subdivisions: head, body, branches
Functions to prevent over-extension of fetlock

20
Q

Quartet of dz associated with suspensory lig desmitis?

A
  1. Suspensory ligament
  2. Avulsion at origin of the suspensory lig
  3. Splints - MCII/MCIV
  4. Sesamoid Bones
21
Q

CS/Dx of Suspensory Desmitis

A

Lameness +/- sensitive to palp
Perineural nerve blocks - high 4pt: palmar carpal, palmar MC
–subcarpal block supposedly more specific (blocks deep branch of the lateral palmar nerve)
US: weighted, unweighted
MRI
RADS : sesamoid, splint bones, prox MCIII, also look for avulsion off the back of the cannon bone
Bone scan (origin lesions)

22
Q

Suspensory desmitis tx

A

Rest - up to 3mo
Biologics
Shock wave - pain relief

23
Q

Muscle Dzs

A 
Pain, strain, tears 
Myopathy 
Polysaccharide storage dz 
Hyperkalemic periodic paralysis 
Stringhalt 
Fibrotic myopathy
24
Q

Muscle strains

A

Highly prone to reinjury

Can lose indicator day or two later - need owner to point out swelling that was there yesterday

25
Q

Fibrotic Myopathy

A

Fibrosis of semitendinosis
Uni&raquo_space; bilat
Cause = trauma

26
Q

Dx Fibrotic Myopathy

A

Characteristic gait

US, RADS

27
Q

Tx Fibrotic Myopathy

A

Semitendinosus tenotomy

Often confused with upward fixation of patella

28
Q

Stringhalt

A

Cause = neurogenic, Australian dandelions
Goose step
Non-painful
Tx = lateral digital extensor myotenectomy

Musculoskeletal (10 decks)

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