LA Ortho - Ten/lig Disorders

Question 1

Sparse fibroblasts

Answer 1

Histopath appearance of soft tissue
Contain nuclei
Proteoglycans - important for lubrication & diameter
Collagen - type I, crosslinked= very strong

Question 2

Phases in response to injury

Answer 2

Inflammatory phase
Repair phase
Remodeling phase
Result

Question 3

Events that occur in each phase of injury response

Answer 3

Inflammatory - vascular & cellular response
Repair - fibroblasts migrate into clot from intrinsic (things n within tendon) & extrinsic (surrounding cells) repair
Remodeling -
End result - decreased tensile strength & elasticity - prone to re-injury due to decreased elasticity

Question 4

Paratenon

Question 5

Epitenon

Question 6

Endotenon

Question 7

examples of extrinsic vs intrinsic healing

Answer 7

Extrinsic - para & epi tenon
Intrinsic - endotenon

Question 8

Diagnosing tendon / lig problems - physical exam

Answer 8

Complete physical appearance - symmetry, smooth profile
Palpation - NWB to separate tendons, can palp WB
Lameness - in movement to assess injury

Question 9

Diagnostic imaging for injury

Answer 9

Ultrasound
MRI - especially in foot/hoof
Thermography

Question 10

Directions to evaluate

Answer 10

Proximal to distal

Question 11

Stand-off

Answer 11

Clear addition to ultrasound probe
Adds distance to create dimension to see deep or superficial structures

Question 12

Ultrasound examinations

Answer 12

Use transverse and longitudinal views
Transverse can tell you how big around a lesion is
Longitudinal can show how far it extends into the limb & quality of collagen fibers

Question 13

Zoning locations of lesions

Answer 13

There are zones but using a ruler and giving exact location is more ideal for comparison

Question 14

Lesion classification

Answer 14

Mild, moderate, severe
Usually based on % of lesion space

Question 15

Tendon lacerations

Answer 15

Common injuries
Very slow to heal due to lack of presence of cells & requirement for WB on all 4 limbs
Extensor vs flexor
Use of horse
Associated structure injuries

Question 16

Treatment for tendon lacerations

Answer 16

Medically - conservatively
Surgically - goal is to minimize gap in tendon, constriction of blood supply (prevent adhesion)
External coaptation - cast, extended shoe or splint

Question 17

Extensor tendon lacerations

Answer 17

Long & lateral digital extensors are separate then fuse distally - very important for location of laceration = % or ability of some digital extensor function
Heal fairly well, less force applied

Question 18

Effect of SFGT lacerations

Answer 18

Fetlock dropped

Question 19

Effects of SDFT & DDFT lacerated

Answer 19

Fetlock dropped
Toe off ground

Question 20

Effects of DDFT lacerated

Answer 20

toe off ground - DDFT inserts on P3

Question 21

Effects of SDFT, DDFT, suspensory ligament lacerated

Answer 21

Fetlock on the ground
Toe off ground
Extremely difficult to treat

Question 22

Surgical treatment for lacerations

Answer 22

Wound lavage & debridement
Special suture tendons - minimize gap formations in tendons

Question 23

Prognosis for extensor tendons

Answer 23

Good >75% sound

Question 24

Prognosis for flexor injuries

Answer 24

Guarded
84% survival
42-82% sound

Question 25

Tendinitis /desmitis

Answer 25

Repetitive mechanical loading Cell/matrix damage Cell matrix response - adequate = adaption Inadequate = sub clinical injury - continued loading/injury - clinical injury/rupture

Question 26

Controlled inflammation

Answer 26

Keeping inflammation controlled in key for better prognosis Anti-inflammatories Supportive bandage Cold therapy Controlled exercise

Question 27

Main problem w tenon injury

Answer 27

No matter the therapy /prevention it will not speed up the healing process. The timeline for that it set Additional protocols can make the healing better or stronger but won’t drop the time line

Question 28

Surgical therapies for tendinitis

Answer 28

ALSDFT desmotomy - removing accessory lig of SDFT (proximal check ligament) Percutaneous tendon splitting- Creating small fan holes could increase extrinsic healing Most therapies involve SDFT

Question 29

Digital tendon sheath

Answer 29

Palmar/plantar annular lig constriction Not very elastic tissue

Question 30

Palmar/plantar annular lig constriction

Answer 30

Not elastic/flexible, pressure can lead to compartment syndrome = synovial effusion Treat medically

Question 31

Surgical treatment for Palmar/plantar annular lig constriction

Answer 31

Desmoplasty - like tendon splitting Desmotomy - transect to relieve compression Will heal back, goal is to relieve pressure/immediate strain

Question 32

Tenosynovitis

Answer 32

Idiopathic Acute - trauma or tendon injury Complex(chronic) Tenosynovial masses, digital sheath fibrosis, adhesions, PAL constrictions

Question 33

Clinical signs for tenosynovitis

Answer 33

Palp thickness/masses Fluctuate fluid swelling Chronic lameness

Question 34

Diagnosis for tenosynovitis

Answer 34

Thickened synovial sheath - PAL Tendon lesions Synovial masses Adhesions

Question 35

Medical therapy for tenosynovitis

Answer 35

Cold therapy Controlled exercise NSAIDS Intrathecal hyaluronic acid

Question 36

Surgical therapy for tenosynovitis

Answer 36

Arthroscopy PAL desmotomy