Tendonitis Flashcards
Toe region
area on a tendon stress graph where a tendon’s crimp pattern absorbs 1-3% of strain
when are SDFT and SL most prone to injury
landing phase
treatment options for tendonitis (9)
MUST include rest + controlled exercise/rehab (while monitoring with serial US)
- cold hydrotherapy > ice packs (do for 20 mins)
- compression and coaptation to decrease edema and inflammation (severe may need splint/cast)
- phenylbutazone
- intralesional injections under US guidance (PRP, stem cells)
- shock wave therapy (to increase vascularization and GF -> more organized scar tissue and decreased recovery times; great at decreasing pain)
- US laser therapy
- surgery
- suturing tendon post percutaneous injury
- annular ligament desmotomy if edema building up
- superior check desmotomy
where to harvest stem cells from horse BM
tuber coxae or sternum
stress on tendon at a walk
3-8%
tendon units from inside out
- collagen fibers
- fibril
- fascicule (surrounded by endotenon, which supplies blood, nerves, GFs, and elasticity)
- tendon (surround by epitenon)
paratenon surrounds tendons that are NOT in a sheath (decreases friction, supplies blood and repair elements)
what causes tears in synovial cavity and where are they most common?
cause unknown
most common in DDFT of forelimb and Flexor Manica of hindlimb
how can you measure tendonitis using US?
- Using US zones for metacarpal and pastern regions
- use measuring tape to measure distance between accessory carpal bone/calcaneous and transducer
when is the DDFT most prone to injury?
during push off phase
surgical options to treat tendonitis
- suturing tendon post percutaneous injury
- annular ligament desmotomy (if edema building up within tendon sheath)
- superior check desmotomy
gold standard diagnostic for tendonitis
US ***do it 1 week AFTET injury because takes time to declare itself due to inflammatory cytokines
use 7.5-12 MHz transducer
always take both linear and transverse views
ALWAYS do both limbs (often bilateral if overuse injury)
_____ and _____ are most prone to injury during landing phase
SDFT and SL
There are US zones for which regions when measuring tendonitis?
metacarpal and pastern regions
which is better for tendonitis: cold hydrotherapy or ice packs?
cold hydrotherapy (no longer than 20 mins)
predisposing factors to tendonitis (6)
- poor/deep ground
- inadequate training
- muscle fatigue
- poor conformation: long sloping pasterns
- poor hoof care (long toes; underrun heels)
- improper bandaging/boots
signs you might see with tendonitis (3)
- bowing of tendons
- < change in limb in severe cases
- severe lameness initially (but lameness will rapidly resolve once inflammatory phase has passed (1-2 weeks post injury)
_____ can restrict swelling if tendonitis occurs beneath it
annular ligament
tendons have a _____ pattern to impart elasticity
crimp/wave (decreases with age)
NSAID used for tendonitis
phenylbutazone
stress on tendon at a gallop
12-16%
intralesional injection options for tendonitis
- PRP: growth factors + scaffold for mesenchymal stem cells
- stem cells (decrease fibrosis and inflammation): autologous (bone marrow > adipose) vs. allogenic
Insertion of SDF
divides at P1 and then inserts on P2
US is the gold standard diagnostic tool for tendonitis. what must you always remember? (3)
- image 1 week AFTER injury (takes time to declare itself due to inflammatory cytokines)
- ALWAYS take both linear and transverse views
- ALWAYS do both limbs (often bilateral if overuse injury)
endotenon
surrounds tendon fascicules and supplies blood, nerves, GFs, and elasticity
signs of chronic tendonitis on US
- variable enlargement
- MIXED echogenicity
- fibrosis/irregular striations
paratenon
surrounds tendons that are NOT in a sheath (decreases friction, supplies blood and repair elements)
options of stem cells to treat tendonitis
autologous: bone marrow better but takes 3 weeks to get back; adipose only takes 90 mins-48 hours (sites for BM include sternum or tuber coxae)
allogenic
what do the extensor branches of the suspensory ligament join with?
common digital extensor; they branch away at the level of the fetlock/proximal sesamoids (where the suspensory ligament attaches)
stress on tendon at a trot
7-10%
epitenon
surrounds tendon and is contiguous with endotenon
tendon repair capabilities
limited
type 1 -> type 3 (aka it scars over)
tendons in a sheath heal WORSE
PE components when evaluating for tendonitis
- look for bowing of tendons
- look for signs of inflammation
- may present with severe lameness initially but will rapidly resolve once inflammatory phase has passed (1-2 weeks post injury)
- look for < change in limb in severe cases
- lameness exam (always palpate both when weight bearing and not) +/- nerve block
origin and insertion of suspensory ligament
origin: proximal MC/MTIII (reminder: this area is blocked by lateral palmar nerve block)
insertion: proximal sesamoids; has extensor branches that join with common digital extensor
what surrounds tendon fascicules
endotenon (supplies blood, nerves, GFs, and elasticity)
level of stress needed to rupture a tendon
12-20%
most important component of tendonitis treatment
rest + controlled exercise (with serial US)
what imaging tools can be used for tendonitis?
- US (G.S.)
- MRI
- nuclear scintigraphy (for when you can’t isolate lameness or find lesion)
goals of treatment for tendonitis (4)
- decrease inflammation
- decrease risk of reinjury
- speed up healing
- increase tensile strength
insertion of DDF
dives between SDF (which divides at P1) and inserts on P3
Appearance of acute tendonitis on US
- enlarged but not thickened
- hypoechogenicity
- reduced striations
- shape, margin, or position changes
what surrounds tendon
epitenon (and paratenon if NOT in a sheath)
which area of a tendon heals worst?
areas in a sheath
causes of tendonitis
- most commonly repetitive microtrauma (molecular inflammation progressively weakens tendon)
- percutaneous (palmar/plantar more severe)
- acute injury
- EDx of tears in synovial cavity unknown
______ join to form a tendon
collagen fibers
true or false: never treat tendonitis with blistering, counter irritation, or pin firing
true
shock wave therapy for treatment of tendonitis
increases vascularization + GFs -> more organized scar tissue + decreased recovery time
also GREAT at decreasing pain (beware risk of reinjury!!)
this is GREAT at decreasing pain from tendonitis (beware reinjury!!)
shock wave therapy
