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Equine Medicine and Surgery > Lecture 15: Tenosynovitis and Desmitis > Flashcards

Lecture 15: Tenosynovitis and Desmitis Flashcards

1
Q

Muscles attach to periosteum via

A

Tendons

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2
Q

What are tendons made of

A

Ropes of collagen fibers

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3
Q

What is the tendon composed of

A

Tenocytes/fibroblasts (sparse)

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4
Q

What are tenocytes/ fibroblasts responsible for

A

synthesis and turnover of ECM

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5
Q

Metabolism of tenocytes and fibroblasts are regulated by ___

A

Biomechanical and mechanical stimuli

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6
Q

What is the ECM of tendons made of

A
  1. Water- 65%
  2. Collagen- type I- 30%
  3. Elastin
  4. Glycoproteins
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7
Q

Tendon Collagen fibers are oriented ___to long axis of bone which it’s important for ___

A

Parallel, elasticity and energy storage (makes horses run fast)

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8
Q

Tendons allow for __motion

A

Gliding

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9
Q

What is the vascular supply of the tendon

A
  1. Muscle/bone at origin/insertion
  2. Paratenon and endotenon in tendon proper
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10
Q

Compared to tendons ligaments have less ___, ___ and ___

A

Collagen, elastic and organization

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11
Q

___generates movement and __resist movement

A

Tendons, ligaments

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12
Q

What are some internal causes of tendonitis

A
  1. Bio mechanical overload (strain)
  2. Hyperthermia
  3. Vascular
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13
Q

What are some external causes of tendon injuries

A

Blunt trauma, wounds

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14
Q

Are flexors or extensors more commonly affected with tendonitis

A

Flexors

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15
Q

Is the SFDT or DDFT more commonly affected with tendonitis

A

SFDT

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16
Q

Why is resolution of tendonitis problematic

A
  1. Slow to heal- poor blood supply
  2. Inferior in strength and elasticity
  3. High incidence of recurrence
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17
Q

Which tendon has the smallest cross sectional area and is most external so experiences the greatest strain and trauma

A

SDFT

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18
Q

SDFT is less vascular in the ___region which is where most lesions occur

A

Mid-metacarpal region

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19
Q

Identify 1-4

A
  1. SDFT
  2. Inferior check
  3. DDFT
  4. Lateral suspenory ligament
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20
Q

Which venogram is DDFT and which is SDFT

A

left: DDFT- more vascularized
Right: SDFT

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21
Q

What bio mechanical forces contribute to overload in tendonitis

A
  1. Altered hoof conformation- under run heels and long toe
  2. Work on very hard or very soft surfaces
  3. Muscular fatigue at end of race- tendons take on load
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22
Q

What hoof conformation contributes to tendonitis

A

Underrun heels an long toe

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23
Q

what is wrong with this hoof confirmation and what does it predispose them to

A

Underrun heels and long toe
Tendonitis

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24
Q

What occurs in the subclinical phase of tendonitis

A

Degradation of ECM, weakened tendon

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25
Q

What occurs in clinical phase of tendonitis (1-2 weeks)

A

Acute inflammation- lame, warm, swollen

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26
Q

What occurs during reparative phase of tendonitis (3 weeks)

A
  1. Tenocytes migration
  2. Fibroplasia
  3. Angiogenesis
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27
Q

What occurs in remodeling phase of tendonitis

A
  1. Type III collagen replaced with type I
  2. Formation of cross links
  3. Re-orientation of fibers with max tension- parallel to axis of limb
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28
Q

What is the result of repaired tendonitis

A

Scar tissue with reduced strength and increased stiffness/less elasticity

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29
Q

__% of SDFT injuries reoccur

A

60%

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30
Q

Reinjury of tendons occurs at ___interface

A

Scar/normal tendon interface

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31
Q

What are the clinical signs of tendonitis

A
  1. Lameness
  2. SDFT bow
  3. Lesion within tendon sheath- tendon effusion
  4. Pain on palpation
32
Q

What is wrong here

A

Tendonitis, SDFT bowing

33
Q

What modality do you use to evaluate tendon injuries

A

Ultrasound

34
Q

What data is obtained during ultrasound of tendon injuries

A
  1. Lesion echongenicity grade (1-4)
  2. % loss of linear fiber pattern
35
Q

Lesions usually look worse on ultrasound __weeks post injury

A

2 weeks

36
Q

What is wrong

A

SDFT injury- black spot is hematoma

37
Q

What is grade 1 lesion echogenicity

A

Tendon enlargement with lesions appearing only slightly hypoechoic (bright). Minimal fiber pattern disruption and minimal infiltration of inflammatory fluid

38
Q

What is grade 2 echogenicity lesion

A

Approximately half echoic and half anechoic. Fiber pattern disruption and local inflammation

39
Q

What is grade 3 echogenicity lesion

A

Mostly anechoic and represent significant fiber tearing

40
Q

What is grade 4 echogenicity lesion

A

Totally anechoic, rupture. Lesions appear homogenous black areas within a structure and indicate almost total fiber tearing with hematoma formation

41
Q

How do you evaluate rehabilitation protocol and gradual return to work from tendonitis

A

Serial ultrasounds every 6 weeks

42
Q

What is treatment for acute/clinical phase of tendonitis/desmitis

A
  1. Stall confinement
  2. Control inflammation: NSAIDS, ice boots, cold hosing, game ready
  3. Bandaging
43
Q

___is critical for treatment of tendon injury in repair phase and beyond

A

Controlled exercise

44
Q

What does this progression show (left to right)

A

Realignment of tenocytes

45
Q

How long does it take for tendon and ligament injuries to heal

A

6-7 months

46
Q

What are some treatment options for repair phase and beyond for tendon/ligament injuries

A

Intra-lesional injections (PRP, stem cells, IGF-1, hyaluronic acid(

47
Q

What are some surgical options for tendon and ligament injuries

A
  1. Tendon splitting
  2. Proximal check ligament desmotomy
  3. Palmar/plantar annular ligament desmotomy
48
Q

What is tendon splitting

A

Insert scalpel into core of lesion and fan it longitudinally through entire lesion- open and drain hematoma and fluid and also increase blood supply

49
Q

Where is the proximal check ligament

A

Comes off back of radius, right above the knee

50
Q

What is a proximal check ligament desmotomy

A

Cut it and it will increase elastic length of muscle tendon-unit and decrease tension

51
Q

What is a palmar/plantar annular ligament desmotomy performed for

A

Low bows of SDFT and DDFT

52
Q

What is the purpose of palmar/plantar annular ligament desmotomy

A

Allows more room for tendon to move, heal and function

53
Q

What are some primary causes of palmar/plantar annular ligament constriction

A

Trauma to PAL, desmitis of PAL

54
Q

What are some secondary causes of palmar/plantar annular ligament constriction

A
  1. Repetitive or severe trauma to sheath
  2. Infectious tenosynovitis
  3. SDF/DDF tendonitis
55
Q

What is the most frequent MRI diagnosis of the foot

A

Distal tendonopathy of DDFT

56
Q

Where is the lesion located and what is it associated with for distal tendonopathy of DDFT

A

Lesions at level of navicular bone
Associated with navicular syndrome

57
Q

What is treatment for distal tendonopathy of DDFT

A

Intra-lesional medication, navicular bursoscopy

58
Q

What is prognosis for distal tendonopathy of DDFT

A

Fair to poor

59
Q

____tendon lacerations heal well

A

Extensor

60
Q

What tendon is lacerated when you see hyperextension of fetlock

A

SDFT

61
Q

What ligament is lacerated when you see hyperextension of fetlock

A

Suspensory ligament

62
Q

What ligament is lacerated when you see toe up

A

DDFT

63
Q

What ligament is lacerated when you see fetlock on the floor

A

SDFT, DDFT, and SL

64
Q

Which tendon lacerations have fair to poor cosmetic and functional outcomes

A

Flexor tendons

65
Q

What are the three subdivisions of suspensory ligament

A
  1. Origin
  2. Body
  3. Medial and lateral branches
66
Q

What is the function of the suspensory ligament

A

Prevent fetlock hyperextension

67
Q

What structures can be affected near the suspensory ligament

A
  1. Splint bones
  2. Proximal sesamoid bones
68
Q

Warmbloods get suspensory ligament desmitis where and what limbs

A

Origin/proximal suspensory in the hind limbs

69
Q

What do you do to evaluate traumatic suspensory desmitis

A

Nerve blocks, ultrasound, nuclear scintigraphy

70
Q

Where do thoroughbreds and standards breeds typically get traumatic suspensory ligament desmitis and what limbs

A

Body and branches/insertion in front limbs

71
Q

What do you do to evaluate a traumatic suspensory ligament desmitis in body and branches

A

Nerve blocks and ultrasound

72
Q

How can you tx traumatic suspensory ligament desmitis

A
  1. Intra-lesional meds
  2. Shock wave
73
Q

What treatment can you do for hindlimb proximal suspensory traumatic desmitis

A

Fasciotomy and neurology of deep branch of lateral plantar nerve

74
Q

The deep branch of lateral plantar nerve provides ___ to suspensory ligament

A

Sensory (no motor)

75
Q

What breeds are genetically predisposed to degenerative suspensory ligament desmitis

A
  1. Peruvian paso
  2. Arabians
  3. Saddlebreds
76
Q

What is the treatment and prognosis for degenerative suspensory ligament desmitis

A

No treatment, very painful, poor prognosis

77
Q

An Arabian presents with chronic dropping fetlocks what is it most likely

A

Degenerative suspensory ligament desmitis

Equine Medicine and Surgery (27 decks)

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