MT I Flashcards
1
Q
Definition of a lame horse:
A
Structural or functional disorder in one or more limbs and related structures.
2
Q
Anatomical landmarks/location of lameness
A
- Hoof, navicular bone
- Tendons, ligaments
- Tendon sheat, bursae
3
Q
Explain the reciprocal apparatus
A
Stifle is always moving together with the hock. So if you flex the stifle the hock will be flexed as well, as the fetlock & the digits work together.
Peroneus Tertius/fibularis tertius on the front attached from the extensor fossa of femur and insert in 3rd tarsal bone
4
Q
What are the Phases of the strides
A
1. Supporting phase
- Landing
- Loading
- Stance
1. Breakover Phase
- Heel lift
- Toe pivot
1. Swinging phase
5
Q
Which phase of the stride is this?
A
Break over phase
* Extension: Fetlock
* Hyperextension: DIPJ (Distal interphalangeal joint)
6
Q
Which phase of the stride is this?
A
Stance phase
Hyperextension: Fetlock
Flexion: DIPJ
7
Q
Which phase of the stride is this?
A
Breake over phase
8
Q
Which phase of the stride is this?
A
**Stance phase
**
9
Q
Which phase of the stride is this?
A
Swinging phase
- Flexion (Caudal)
- Extension (Cranial)
10
Q
What is shown on the picture
A
Abnormal Joint Hyperextension
11
Q
What is shown on the picture
A
Constant DIPJ Hyperextesion
12
Q
Explain the different Interference forms at the trot
A
A. Front limb to front limb
B. Ipsilateral front to hind
C. Pacer (Diagonal limbs)
D. Ipsilateral hind to front
13
Q
Explain the different feet movement from a skyline view
A
Normal – padding – winging – plaiting
14
Q
What could be potential causes for Lameness
A
- Trauma
- Congenital (Ex. Navicular disease)
- Acquired
- Infection
- Metabolic disturbances
- Circulatory disorders (Aortoiliac Thrombosis)
- Nervous system
- Pain
- Mechanical
- Paralytic disorders
15
Q
Lameness due to infection
* If foal is lame (No injury) Nr 1 reason is?
* Treatment?
A
* Nr 1 reason is –> Joint Infection
* * Hematogen origin, swollen joint, fetlock – stifle. Effusion of infected site, think first of all joint.
* If infection do not give steroids but AB intraarticular.
16
Q
Lameness due to metabolic disorders
* Example
* What to do?
A
- Laminitis
- Endotoxemia
What to do with this:
* Make **abaxial perineural block **
* Check pulsation – if laminitis hard pulsation
17
Q
Lameness due to circulatory disorders
- Example
- Signs?
- How to Diagnose?
A
* Aortoiliac Thrombosis
- Beginning light lameness on left – sweat and colic symptoms.
- Worsening during training, shows great pain
- Saphenous vein (Dors.med. aspect of heart) Less arterial blood supply, less backflow so the veins are empty.
- **One leg is warm, while the other is cold **
Diagnose with Ultrasonography.
18
Q
Lameness due to the nervous system
* Example
*
A
- Sweeney:
-
Suprascapular Neuropathy. When horse walk to you, horse flexing shoulder against abaxial direction.
* Atrophy of supraspinatus and infraspinatus muscle (Colateral ligament) - Can have a hit from anything and damage to the peripheral nerve but able to regenerate itself.
19
Q
What are the different degree of lameness
A
**1 – 5 **or 1 – 10 (Europe) 0 - 5 (AAEP)
* Grade I: Very mild
* Grade II: Mild
* Grade III: Moderate
* Grade IV: Severe
* Grade V: Non – Weight bearing
20
Q
How to distinguish the Character of the lameness
A
- Unchanging (Warming up)
-
Changing =
* Improving during training/examination (must probably be Chronic Osteoarthritis)
* Intermittent (Few steps, very lame and walk again)
21
Q
How to classify the lamenes
A
Classification of lameness
* Supporting limb lameness
* Swinging limb lameness
* Compensatory lameness
* Untypical lameness
* Special lameness
22
Q
How to recognize supporting limb lameness
- Phase of the stide
- Head and neck movement
- Where to localize the pain
- What happens to the fetlock?
- What happens to the cranial phase of the stride in relation to supporting or swinging phase lameness?
A
Cranial phase is longer
* More pain during contraction
* Will quickly shift weight to the other side.
Head and neck movement:
* Head and neck **elevation on the affected side.*
The problem is usually lower
Worse in inside circle
IMPORTAINT:
Lameness in when viewing from front:
1. Head and neck elevated
2. Hyperextension in fetlock during stans
3. **Cranial phase of the stride **
* Longer when supporting lameness
* Shorter when swinging phase lameness
23
Q
How to recognize swinging limb lameness
A
- Cranial phase is shortened
- It is evident during motion
- Usually the problem is higher
- Worse in outside circle
24
Q
How to recognize compensatory lameness?
A
- Uneven distribution of weight on another limb
- Lame FL –> Other FL
- Navicular diesase –> Sole bruise
25
How to recognize Untypical lameness
- When more than one limb is effected
26
How to recognize special lameness
Example
Diagnosis
Picture
* Ex:** rupture of peroneus tertius**
* **Upward fixation of the patella**
*** DDFT rupture** --> Take **sonography**
*** Chronic navicularis syndrom **
Picture: Achilles tendon to loose --> Stifle is in full extension : **The whole reciprocal apparatus is destroyed.** Fibularis tertius and peroneus tertius ruptured. Yearling – Preform x – ray from stifle
## Footnote
****
27
**Patella fixation**
* Type of abnormality
* What to do surgically
* How to lock the patella
* How to improve without surgery
28
Fibrotic Myopathy
- **Last movement of swinging phase** --> Dropping the leg back again, due to **semimembranosus** and **semitendinosus** **myopathy**
- Can see a groove, do not forget to palpate.
29
Steps of the lameness examination
30
Anamnesis in lameness examination
- How long has the horse been lame?
- What is the cause of the lameness?
- How did it happen?
- Has been rested or exercised?
- Previous treatment, what was the result?
- When was the horse shod?
Can get aseptic inflammation around the chorion --> test the nails
Hoof abcess.
- Is he still in work?
- Does he warm out of the lameness?
31
What can be seen
**Osteoarthrithis in distal Interphalangeal joint.**
* Swelling around coronary bone = **ring bone**
32
What can be seen
**Ancleosis**: Joint fuse and become one structure.
33
What can be seen
Bone sparring on hock
34
LAMENESS
Visual examination
At a distance and close examination
Distance:
- Conformation
- Body condition
- Positure
- Atrophy, asymmetry
Close:
- Hoof
- Swelling, distension
35
LAMENESS
Visual examination
What are you able to preform in the practice
- Anamnesis
- Visual examination
- Palpation
- Provocation test
- Diagnostic anaesthesia
36
Visual examination
1. At a distance (All directions)
2. At rest
3. At exercise
4. What are you able to preform in the practice
37
Lameness
Supplementary diagnostic aids
- RTG
- Arthroscopy
- MRI
- UltraSound
- Synovia analysis
- CT
38
What is shown on the picture
Provocating tests
(flexion)
39
What is the purpose of diagnostic analgesia
- Find site of pain causing lameness
- Confirm suspected site of pain
40
Diagnostic analgesia
What is the reason of failure?
- Bad technique
- Variation of peripheral nerve anatomy
- Local anaesthetic diffuses proximally
- 70 – 80% positivity is a positive result
- Deep bony pain is difficult to anaesthetize
- You cannot block out all intraarticular pain.
- Mechanical lameness.
41
Diagnostic analgesia
What local anaesthetics should we use?
Less irritant:
* **Mepivacaine**,
* **Prilocaine**,
* **Bupivacaine**
More irritant:
* **Lidocaine**
42
Diagnostic analgesia
Effect of duration
**Fast** acting (2h DOA)
* **Mepivacaine**
* Prilocaine
**Slower** acting (4h DOA)
* **Bupivacaine**
43
Diagnostic analgesia and restrain
- Depends on horse
- Minimal restraint is less stressful
- Good handler is essential
- Position yourself safely
Physical:
o **Twitch**
**Sedation**
o Small doses
o **Xyalzine** (0.1 – 0.2 mg/BWT)
o **Detomidine** (0.005mg/Bwt) --> **Safer**, affect result in higher doses.
**Leg position** (On ground, held by clinician, held by assistant)
44
Diagnostic analgesia
Patient preparation
- Perineural analgesia
o **Clean procedure** (Clip if hairy)
o** Antiseptic scrub** until clean
(Povidone iodine, chlorhexidine)
o **Alcohol** with swab then **spray**.
45
Diagnostic analgesia
Patient preparation
- Intrasynovial analgesia
o Aseptic procedure
o Clip
o 5 minute antiseptic scrub
o Alcohol wash
o Sterile gloves
o Fresh bottle anaesthetic
46
Diagnostic analgesic procedure
1. Size needle
2. Quantity of analgesia
3. Time for evaluation
4. Intra synovial analgesia
5. Post block
1.** 18 – 25 gauge needles** (Use fine needles when possible) --> Length depends on size
2. Quantity of anaesthetic **depends on site**
3. Evaluate
**o 5–10minutes
o 20 – 30 minutes
o 60 minutes**
**4. Intrasynovial analgesia**
o Usually acts more **quickly**
o** Shorter duration**
** 5. Post block
**o Sterile wrap (5 . 10 min)
47
Diagnostic analgesia
– fore limb strategy
NO clinical suspicion as to site of pain
- Block from** distal to proximal**
- Use **regional** blocks
- Differentiate with intrasynovial blocks later if necessary.
48
Which Perineural analgesia blocks can be done on the – FORELIMB
- Deep digital nerve block (TPA 1)
- (Prox palm digital block (TPA2)
- Abax.sesamoid bloc (MPA)
- Four point block
- High palmar block
- (Subcarpal block)
- Lat. Palmar block
- Ulnar block
- N. Medianus et N.musculocutaneus block.
49
Perineural analgesia blocks – FORELIMB
**Deep digital nerve anaesthesia**
1. Size needle
2. Quantity
3. Anatomical landmark
4. Structure anaesthetised
- 23G 1.5 needle
- 1.5 ml anaesthetic
- At level of collateral cartilage
Structures anaesthetised:
o Palmar foot
o Toe
o DIP joint
o +/- distal DDFT lesions
o Part of P2 and joint
50
Perineural analgesia blocks – FORELIMB
**Positive low or prox palm digit analgesia**
Differentiate structures with:
* DIP
* Navicular bursa block
* PIP block
51
Perineural analgesia blocks – FORELIMB
**3. Abaxial Sesamoid Block**
1. Anatomical landmark
2. Size of needle
3. Quantity
4. Used in case of
5. Structures anaesthetised
Anatomical land mark 2.
Size of needle
Quantity
1. At level of **prox. Sesamoid bone:**
2. **22–23G ** ---> 1.5cm needle
3. **3ml** local anaesthetic
4. Use this block if **laminitis**. Nervovascular bundle surrounded by tubular facsia --> Do not have a stable type anaesthesi. Set the block parallel to the nerve not straight in it.
5. Structures anaesthetised
* As for PDB (**Proximal pastern**)
* Sometimes include --> **Fetlock joint** (MCP) & **Sesamoid** bone locally.
* Block** distal DDFT lesions**
At level of distal aspect of prox sesamoid bone
* **26G **--> 1.5 cm needle
* **1.5m**l of local anaesthetics.
52
Interarticular analgesia blocks – FORELIMB
**4. Distal interphalangeal joint analgesia**
Procedure
Size needle
Quantity
Anaesthetised structures
- **Aseptic procedure**
- **19 G** - 3cm needle
- **6ml anaesthetic**
- **DIP joint, dorsal sole (toe)**
-** 10 ml anaestetics --> Block heel as well**
53
Interarticular analgesia blocks – FORELIMB
**5. Navicular bursa analgesia**
Procedure
Size needle
Quantity
Anaesthetised structures
- **Aseptic procedure**
- **Radiographic control**
- **19 G** 7cm needle
- **3.5ml** anaesthetic
- 0.5ml iohexol contrast solution
- Structures anaesthetised
o **Navicular bursa**
o **Dorsal sole (toe)**
o **Navicular bone**
o **Navicular ligaments (Not heel)**
o **30 minutes: DIP joint**
54
Perineural analgesia – FORELIMB
**6. Proximal interphalangeal joint (PIPJ)**
Doral approach
- **21 G** 2.5cm needle
- **5ml** anaesthetic
Palmar approach
- **21 G** 2.5cm needle
- **5ml** anaesthetics
Structures anaesthetised
- **Pip joint**
55
Perineural analgesia – FORELIMB
**7. 4 point block (N. digit.palm.,nn. Metacarpales)**
- **23 G** 1.5 cm needle
- **1.5 – 3ml** anaesthetic
- **Palmar nerves (lat.med)**
- **Palmar metacarpal nerves**
56
Perineural analgesia – FORELIMB
**8. Positive 4 point block**
Differentiate structures with:
o MCP analgesia
o Digital sheath analgesia
57
Perineural analgesia – FORELIMB
**9. Metacarpophalangeal joint anesthesia**
Structures anaesthetised
- **MCP joint**
- Subchondral bone pain --> **slow** to respond
- 30min may anaesthetize;
- **Dist. Suspensory branches + sesamoids**
- Dorsal and palmar approaches
o **19–22G** 3-4cm needle
o **10ml** anaesthetic
58
Perineural analgesia – FORELIMB
**9. Metacarpophalangeal joint anesthesia**
**Dorsal approach**
o Easier
o Articular cartilage easily traumatised
59
Perineural analgesia – FORELIMB
**9. Metacarpophalangeal joint anesthesia**
**Palmar approach**
- Between suspensory ligament and MC3
- Sometimes difficult to be sure of centesis
60
Perineural analgesia – FORELIMB
**10. Digital flexor tendon sheath (DFTS) analgesia**
Structures anaesthetizes
- Digital sheath
- Local structures with time
- Annular ligament
- Often only a partial improvement
- Proximal and Palmar approach
61
Perineural analgesia – FORELIMB
**10. Digital flexor tendon sheath (DFTS) analgesia**
**Proximal approach**
- **20G** 2.5cm needle
- **10 – 15ml** anaesthetic
62
Perineural analgesia – FORELIMB
**10. Digital flexor tendon sheath (DFTS) analgesia**
**Distal Palmar approach**
- **20G** 2.5cm needle
- **10 – 15ml** anaesthetic
63
Perineural analgesia – FORELIMB
**11. High palmar block**
- **20G** 3cm needle
- **5ml in each side**
- **Palmar nerves**
64
Perineural analgesia – FORELIMB
**12. Subcarpal block**
- Supf + DDF tendon anesth.
- Structures anaesthetised
o Whole metacarpal region
o 65% chance of penetrating carpometacarpal (CMC) joint
o Dorsal branches must be anaesthetised
to block the skin dorsally
65
Perineural analgesia – FORELIMB
**13. Lateral palmar analgesia**
- **Spesific for suspensory ligament lesions**
- **22G** 1.5cm needle
- **5ml** anaesthetic
- less chance of blocking the CMC joint
66
Perineural analgesia – FORELIMB
**14. Suspensory ligament origin infiltration**
- **Spesific for suspensory ligament lesions**
- **19G** 5cm needle
- **10ml** anaesthetics
- From lateral
- Include palmar metacarpal nerves
67
Perineural analgesia – FORELIMB
**15. Postive subcarpal analgesia
**
- Perform middle carpal joint analgesia
- Can diffuse around palmar nerves
And block metacarpal structures
68
Perineural analgesia – FORELIMB
**16. Middle carpal and antebrachiocarpal analgesia**
- Dorsal pouches
- Medial or lateral
- **19G** 3cm needle
- **5ml** anaesthetic
- Check in **5 – 20 minutes**
- Remember: Subcarpal analgesia and middle carpal joint analgesia may block the same structures
- Clinical findings may help to differentiate
69
Perineural analgesia – FORELIMB
**17. N. Ulnaris analgesia**
- **18G** 4cm needle
- **10 – 15ml** anaesthetic
- **10cm prox from accessory carpal bone**
70
Perineural analgesia – FORELIMB
**18. N. Medianus analgesia**
- **5cm below elbow joint, medial side**
- Caudomedial surface of radius
- Just cranial from m.flex. carpi radialis
- **10ml** local anaesthetic
- Arteria and vein located caudally form it
- False positive response because of elbow joint
71
Perineural analgesia – FORELIMB
**N. Musculocutaneous anaesthesia**
- **Branch for skin**
- Seldom necessary
- **4x3ml**
o V. Cephalica cran.caud .
o V. Cephalica. Access.cran. caud
72
Perineural analgesia – FORELIMB
**20. Elbow anaesthesia**
- Cranial + caudal pouch
- **19G** 9cm needle
- **25ml** anaesthetic
- **NB radial nerve**
Cran approach: Signs of radial paresis
Method: Infront of collateral ligament 2/3 distance between humerus epicondyle and tub. Radii in cranial direction
Caud approach: Method: Infront of olecranon caud form epicondyle long needle, may need skin local anaesthesia
73
Perineural analgesia – FORELIMB
**21. Shoulder joint anaesthesia**
- **19G** 9cm needle
- **25ml** anaesthetic
- **Wait 30 minutes**
- Inbetween **tub majus pars cran et caud humeri**
- **Infront of infraspinatus insertion**
74
Perineural analgesia – FORELIMB
**22. Bicipital bursa anaesthesia**
- **19G** 9cm needle
- **20ml** local anaesthetic
- Puncture under **ultrasonographic control adviced**
- **4cm distal and 6-7 cm caudal from tub.majus pars cranialis humeri**
75
Diagnostic analgesia – HINDLIMB
Indication and Procedure
- **Fractious horses**
- Low doses of **detomidine and butorphanol** **don’t seem to affect lameness.**
- **Aspesis for intra – articular blocks**
- Bind **tail** out of the way
76
Diagnostic analgesia – HINDLIMB
**Strategy**
- No obvious site of lameness (Sequential block from distal)
- Conformation of clinical suspicions (Specific blocks)
77
Nerve blocks of the hindlimb
1. Plantar digital block
2. Pastern ring block
3. Low plantar six point
4. Subtarsal (Deep branch of lateral plantar nerve, LPN)
5. Intra – articular Tarsometatarsal and Centrodistal
6. Intra – articular Tarsocrural joint
7. Tarsal sheath
8. Tibial and Peroneal
9. Intra – articular Femoropatellar, medial and lateral Femorotibial
10. Intra – articular coxofemoral
11. Sacroilliac joint
78
Nerve blocks hindlimb
**1. Plantar digital block**
- Same as in forelimb
79
Nerve blocks hindlimb
**2. Pastern ring block**
- Include dorsal branches
- And dorsal metatarsal nerves
- Blocks pastern and foot
80
Nerve blocks hindlimb
**3. Low plantar six point**
* **Plantar digital nerve**
* **Plantar metatarsal nerve**
o Important for subchondral bone of distal MCIII
* **Dorsal metatarsal nerve**
o **Deep peroneal nerve, N. Saphenous + supf peroneus nerve**
* **Blocks all tissues distal to block**
* Positive (return later to block)
o **Fetlock**
o **Digital sheath.**
81
Nerve blocks hindlimb
**4. Subtarsal (high plantar)**
- Now less frequent used,
- Instead Deep branch of lateral plantar nerve (LPN)
- Plantar and plantar metatarsal
- **5m**l deep and supf **20G** 4cm needle
- **Blocks suspensory ligament**
- **Complete ring block to anaesthetise whole metatarsus**
82
Nerve blocks hindlimb
**5. Intra – articular Tarsometatarsal and Centrodistal**
- Usually communicate
- Do **TMT first plantolateral**
- **21G**,4cm needle
- **5–10ml**
- Usually **communicate**
- **Do TMT first from plantarolateral**
83
Nerve blocks hindlimb
**6. Intra – articular Tarsocrural joint**
- **19G** 4cm needle
- **10 – 15ml**
- Dorsomedial: Axial to saphenous vein
- Communicates w/ prox. Intertarsal joint.
84
Nerve blocks hindlimb
**7. Tarsal sheath**
- **19G**, 4cm needle
- **15 – 20ml**
o **Easier when distended**
o Plantar to TC joint capsule
85
Nerve blocks hindlimb
**8. Tibial and Peroneal**
* Superficial and deep peroneal
* - Hands breadth above point of hock
* - Between long and lat dig ext muscles
* o **15ml** 4cm deep
o **5ml** under skin
- TIBIAL
o **20ml** 1cm deep
o From medial side
TIBIAL and PERONEAL
o May have medial and plantar superficial sensation
o Should eliminate sensation in foot and suspensory ligament o Blocks all tarsal structures
o May not achieve 100% resolution of lameness
86
Nerve blocks hindlimb
**9. Intra – articular Femoropatellar, medial and lateral Femorotibial**
- **19G** 6cm needle for all blocks
- **20 – 35ml** anaesthetic
- Usually communicate --> Do **all three together**
- **50% improvement** is probably significant
- May not block bone cysts, patellar and collateral ligament injuries.
87
Nerve blocks hindlimb
**9. Intra – articular Femoropatellar, medial and lateral Femorotibial*
**- Femoropatellar joint**
o Either side of middle patellar ligament
o Difficult to retrive synovial fluid
88
Nerve blocks hindlimb
**9. Intra – articular Femoropatellar, medial and lateral Femorotibial*
**- Medial femorotibial**
o Pouch cranial to medial collateral ligament o Fluid should be retrived
89
Nerve blocks hindlimb
**9. Intra – articular Femoropatellar, medial and lateral Femorotibial**
**Lateral femorotibial joint**
o In extensor notch cranial or caudal to long digital extensor tendon
90
Nerve blocks hindlimb
**9. Intra – articular Femoropatellar, medial and lateral Femorotibial*
91
Nerve blocks hindlimb
**10. Intra – articular coxofemoral**
- **19G** 20 cm needle
- **30ml** anaestethic (Rarely preformed and difficult)
92
Nerve blocks hindlimb
**11. Sacroilliac joint**
- **Be aware!** Sciatic nerve ventral to the S/I joint
- Cranial gluteal nerve caudal margin ileal wing
- Medial approach preferred to avoid nerve
- Cranial to tuber sacrale
- Caudal to L6 dorsal spine
- From contralaterally
- Probably peri articular
- Usually block bilaterally
- **20 – 25cm** needle
- **30 ml** anaesthetic
- Can use **ultrasound guidance**
93
DISEASES OF TENDONS LIGAMENTS, TENDON SHEATH AND BURSAE
Tendons vs Ligaments
Tendon
o Connects muscle to bone
o Its purpose is to move a joint
Ligament
o Connects bone to bone
o Stabilizing role
94
TENDONS COMPOSITION
Energy storing - acts as a spring
o SDFT
Positional
o Digital extensor tendons
Somewhat different internal characteristics
95
Characteristics of an energy storing tendon
- Support the hyperextended metacropophalangeal joint during weight-bearing
- Release energy when the limb is protracted
- Horse bounces up and down on springs
96
Blood supply to the tendon
Blood supply:
o From muscle at **musculotendonous junction**
o From the **bone at insertion site**
o From paratenon (in tendon sheath)
o From mesotendon (in tendon sheath)
97
Mechanical properties of the Tendon
**Stress-strain curve**
o 1 - toe (elimination of crimp)
o 2 - linear phase
o 3 - yield point (beyond it irreversible damage)
o 4 - rupture
98
Mechanical properties of the Tendon
- Normal strain in diff gates
- Ultimate tensile strength, where does it rupture?
Normal strain
o Walk 2-4%
o Trot 4-6%
o Gallop 16,6% has been recorded in vivo
**SDFT** ultimate tensile strength (rupturing in **mid-metacarpal region**)
o 12kn or 12 tons!
99
Type of injury
Traumatic injury of DDFT
100
Tendons
Occurence of injury
Traumatic injury
- Traumatic: *any type of horse*
101
Tendons
Occurence of injury
**Strain-induced predilection sites**
- Racing thoroughbred
- Elite show jumpers
- Elite eventers
- Dressage horses
- Injuries within tendon sheats
o Racing thoroughbred:
- **SDFT in forelimb** (mid-MC region)
o Elite-show jumpers:
- **Forelimb SDFT and DDFT injuries**
o Elite eventers:
- **Forelimb SDFT injuries**
o Dressage horses:
- **Hindlimb suspensory ligament injuries**
Injuries within tendon sheaths:
- **very poor healing capacity, so poor prognosis!!**
102
Type of injury
SDFT injury
103
Tendons
Traumatic injuries
**DDFT**
Prognosis
Complete rupture, loss of function
- Deep digital flexor tendon (DDFT)
o **Toe flips up** (see photo above) - always the sign!
o If in the metacarpal/metatarsal region and **outside the DFTS** - can heal satisfactorily if **immobilized**
o If ruptured **near the insertion/within the DFTS** -very poor to **hopeless prognosis**
104
Tendons
Traumatic injuries
**SDFT**
Prognosis
**Superficial digital flexor tendon (SDFT)**
o **Reasonable prognosis if immobilized **
- **Cast** or **Robert-Jones bandage**
- Often transected together with DDFT
105
Type of injury
Suspensory ligament
106
Tendons
Traumatic injuries
**Suspensory ligament**
Prognosis
**Suspensory ligament, often in racehorses**
* **Prox. sesamoid bone drops**
* **Fetlock drops**
- **Graveprognosis**
- **Degenerative/traumatic/catastrophic**
107
Tendons
Traumatic injuries
**Other traumatic injuries**
- **Overreach injuries**
o Pastern
o (Metacarpalregion)
- **Other physical trauma**
- o From fence etc.
Boots/bandages won ́t prevent **tendinitis/tendinopathy** but can protect the limb from physical injuries
108
NON-TRAUMATIC TENDON AND LIGAMENT INJURIES
- **Tendinitis/tendinopathy**
- **Desmitis/desmopthy**
109
NON-TRAUMATIC TENDON AND LIGAMENT INJURIES
**Pathogenesis**
- **Overstain injuries** (sudden overload)
o Most ligament and some DDFT injuries
- **Degenerative process**
- Often bilateral
- Often asymptomatic initially
- Associated with age and exercise
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REPAIR OF TENDON AND LIGAMENT INJURIES
**NO REGENERATION!!**
- **Intratendinous haemorrhage** (immediately after injury!)
- **Inflammatory reaction**
o Designed to remove damaged tendon tissue
o But excessive and causes further damage (because of the cytokines are in such high amounts)
- **Reparative phase**
o Starts within a **few days**
o **Angiogenesis** in the tendons
o **Scar tissue formation** - higher ratio of collagen type III/I
- **Remodeling phase** (will never have the same tendon back)
o Gradual, incomplete replacement of **collagen type III to type I**
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Tendon and ligament injuries
PRINCIPLES OF DIAGNOSIS
1. **Clinical examination**
- Visible signs
- Palpation (focal heat, pain)
1. **Gait assessment**
2. **Diagnostic analgesia**
3. **Ultrasonographic** examination to look at the **soft tissue**
4. (**MRI**, if it is **not clear in ultrasound**, or if it is in the **hoof capsule**)
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Site of injury
SDFT
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Superficial digital flexor tendon
**Sites of injury**
Occurence in?
Most common site:
- **Mid-metacarpal region**
o Common injury in **racehorses and jumpers**
- **Within the DFTS and the carpal sheath** (proximally)
o Less common
- **In the pastern region**
o Often traumatic, overreach
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What should you be aware off in case of SDFT injuries?
**Beware of ultrasound too quickly**
o Might not see the extent of the injury
o The hemorrhage can mask or cover the injury
o The injury can an grow a lot in the first weeks
o True extent of the injury may not be apparent
o **Repeat ultrasound a week later**
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Which injurie?
Injurie of SDFT due to over reach, injurie in the pastern region
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PRINCIPLES OF TREATMENT
SDFT injurie
Acute
Subacute
Chronic
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PRINCIPLES OF TREATMENT
SDFT injurie
**ACUTE PHASE**
Aim
Therapy
Medication
Surgery?
- **Minimize inflammation** and **limit the action of proteolytic enzymes**
- **Physical therapy**: rest, cold (cooling machine, gel) , immobilization (put in boxrest)
- **Systemic short-acting corticosteroids** in first **24-48 hours**
- (**NEVER into a tendon**, can lead to mineralization in the tendon which is irreversible!!)
- **Never intralesional steroids**: calcification!
- **NSAID ́s**: some controversy
- **(Surgical treatment** - tendon splitting, desmotomy of AL-SDFT)
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PRINCIPLES OF TREATMENT
SDFT injurie
**Subacute (fibroplastic) phase**
Aim
Montoring
Therapy
- **Progressive mobilization** (important that they move, but not too much)
- **Ultrasonographic monitoring**
- **Regenerative therapies**
o **Mesenchymal stem cell therapy**
(Autologous blood, stem cells from sternum)
-->Stem cells differentiate into tenocytes, regenerate matrix o **PRP (protein rich plasma)**
--> **Autologous blood** (stem cells from sternum), centrifugation, gravity filtration
--> **Soup of growth factors** - stimulate cell proliferation and matrix synthesis
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PRINCIPLES OF TREATMENT
SDFT injurie
**Chronic (remodeling) phase**
- Not really much to do except **controlled exercise**
- Regular **ultrasonographic monitoring**
- To **prevent re-injury**
- **Takes time** - at least **6-12 months** before returning to full work (NO therapy can shorten this)
