Tendon & Ligament Disease Flashcards
What is the role of the Interfascicular Matrix/ Endotenon’s?
Allows fascicles to slide & allows tendons to elongate
Which tendonous areas are most commonly affected by injuries?
Palmar/plantar in the metacarpal/ metatarsal region
and in the pastern area
What are the two types of tendon injury?
Percutaneous- laceration/ penetration, trauma
Subcutaneous- over strain injury (most common!)
What is characteristic of the stance/ gait of a horse with a tendon injury?
Metacarpopharyngeal joint extension aka sinking of the fetlock
Also elevated toes (more characteristic of a DDFT rupture)
What ultrasonography calibaration combination is best for viewing tendons?
High frequency with a linear transducer
On the physical and diagnostic exam, what would we expect to see in a superficial digital flexor tendinopathy?
Palmar metacarpal swelling when palpated
Core lesion in the centre of the tendon on ultrasound
What are the two types of deep digital flexor tendinopathy that we see?
Mid substance disruption
Marginal tears
What can cause Tenosynovitis? (3)
[inflammation of the fluid-filled synovium within the tendon sheath]
Idiopathic distension
Penetrating injuries & sepsis
Non septic inflammation secondary to tendon injury or annular ligament syndrome
What is Annular ligament syndrome (ALS)?
thickening of the palmar or plantar annular ligament (PAL)
What are the signs of Annular Ligament syndrome? (3)
Lameness
Distended digital sheath
Notch/ swelling at the level of the plantar annular ligament
What can cause an intra-thecal tendon tear?
inflammation of the tendon sheath leading to the outside of the tendon to split
Which areas of the forelimb and the hindlimb are commonly associated with intra-thecal tendon tears?
Forelimb- DDFT
Hindlimb- Manica Flexoria (this is the loop of the SFT that wraps around the DDFT just above the fetlock)
How can we diagnose an intra thecal tendon tear?
NOT ultrasound
We use contrast tenography
What are the signs of Acute Tendonitis?
lameness, pain, heat and swelling due to haemorrhage and inflammation
How is Acute Tendonitis best treated? (4)
Application of cold to reduce swelling
Compression to reduce oedema
NSAIDs
Short acting steroids - avoid ideally (laminitis)
Can we treat Acute Tendonitis surgically?
Yes- perform a percutaneous tendon splitting to help accelerate the resolution of the lesion
When would we classify Tendonitis as being in the subacute/ reparative phase?
[specific time period]
1 week- 6 months
What are the clinical signs of Subacute Tendonitis?
Reduced lameness but tendon palpably enlarged and soft
What are the aims when considering the treatment of Subacute Tendonitis?
Promote fibroplasia
Optimise the organisation of the scar
How can we promote healing in Subacute Tendonitis?
Early, progressive exercise
Injection of growth factors such as platelet rich plasma
Cell therapy with mesenchymal stem cells
When would we classify Tendonitis as Chronic/ in the Remodelling phase?
3-18 months
[expect quicker healing time/ shorter remodelling phase for a ligament vs tendon]
What are the clinical signs of Chronic Tendonitis?
Decreased tendon size
Less pliable tendon
Reduced fetlock extension
What can we do to accelerate the Remodelling/ Chronic phase of Tendonitis?
Desmotomy of the accessory ligament- cutting the ligament provides more length to the DDFT allowing the heel to be flatter on the floor
What therapies can we use specifically for Proximal Suspensory Dermatitis?
Extracorpeal shock wave therapy
Fasciotomy and Neurectomy (cut nerve that comes from the proximal suspensory ligament)
What are the two types of Distal Interpharyngeal Joint Flexural Deformity?
Type 1- dorsal hoof wall is less than vertical
Type 2- dorsal hoof wall is past vertical (tippy toes)
How do we treat Distal Interpharyngeal Joint Flexural Deformity?
Type 1- physiotherapy, toe extension shoe, (can also do desmotomy but only if these methods don’t work)
Type 2- surgery!- Desmotomy of the Accessory ligament of the DDFT
How can a horse get Metacarpophalangeal joint flexural deformity?
Congenital due to disparity between the lengths of the limb and length of the tendons
Acquired due to chronic SDFT tendinopathy
What is the prognosis of a Metacarpopharyngeal joint flexural deformity?
Not great- can be challenging to treat
