Tendonitis Flashcards
What is the proximal/accessory ligament to the SDF?
Superior check ligament
What is the distal/accessory ligament of the DDF?
Inferior check ligament
From cranial to caudal, what structures do you encounter?
Third metacarpal bone > Suspensory ligament > DDF tendon > SDF tendon
What is the make-up of a tendon?
70% water, 30% dry matter
What 2 things make up the non-collagenous matrix of a tendon?
Tenocytes
Glycoproteins
What is important to remember about a relaxed tendon fascicle?
There is a crimp to allow for stretching.
What is the endotenon?
Blood supply, nerves and growth factors
What is the epitenon?
Contiguous with the endotenon, surrounds the tendon.
What is the paratenon?
Surrounds tendons NOT in a sheath
What is an example of a tendon that is not in a sheath?
Digital tendon flexor sheath
What is the purpose of the crimp pattern in tendons?
Allows for stretching
Where is the crimp in a tendon lost first?
Center
What is the “toe” region?
The point where a load is applied to the tendon and the crimp is lost.
How much can a tendon extend before it ruptures?
12-20%
How much does a tendon extend at the toe region?
1-3%
How much does a tendon extend at a walk?
3-8%
How much does a tendon extend at a trot?
7-10%
How much does a tendon extend at a gallop?
12-16%
How does a tendon heal?
Scar tissue (type III collagen) forms a less elastic tendon
**NOTE: risk of re-injury
What tendons are less efficient at healing?
Those in a tendon sheath.
What is tendonitis?
Inflammation of a tendon.
What are 3 causes of tendonitis?
Overuse
Infection
Traumatic injury
What is one of the most common sites of tendonitis?
SDF tendon
What are 2 mechanisms of an overstrain tendon injury?
Sudden overload
Strain induced
What is the most common mechanism of an overstrain tendon injury?
Strain induced
What is strain induced overstrain?
Repetitive microtrauma
What are 3 causes of percutaneous tendon trauma?
Over-reaching (kicking back of front foot with the toe of the back foot)
Wire
Kicking
NOTE: Usually while tendon is under load, except with wire cuts.
What type of tendon lacerations rarely have long term consequences?
Extensor tendon lacerations
How much of the tendon have be lacerated and still provide full function at a walk?
50%
What two tendons are most prone to injury?
SDF tendon
Suspensory ligament
NOTE: This is because they have the most load during a heel strike.
What are the most common front and hind limb tendon tears within synovial cavities?
DDFT (forelimb) Manica flexoria (hindlimb)
What is a predisposing factor to tendonitis?
Increased stress on the tendon
What are 3 common histories in a case with tendonitis?
Percutaneous injury
Acute athletic event
Poor performance
What are the 4 cardinal signs of inflammation?
Pain
Swelling
Heat
Lameness
What is the best tool for diagnosing tendonitis?
Ultrasound of course!
When is the best time to ultrasound an injury?
One week post-injury to give swelling and hematoma time to resolve. Also, a wound can take several days to declare itself.
Why should you always evaluate both limbs?
To find normal (or could be bilateral).
If looking at an ultrasound of a limb, what structure would you see from superficial to deep?
SDF
DDF
Check ligament
Suspensory ligament
What would you expect to see acutely in a tendonitis case (3 things)?
Enlargement
Hypoechogenicity
Reduced striated pattern
What two things would you expect to see in a chronic tendonitis case?
Variable enlargement and echogenicity
Fibrosis
What 2 things do all treatment plans include for a tendonitis case?
Rest
Controlled exercise program
What 3 things are integral parts of management of a tendonitis case?
Cooling
Support
Rest
What is the goal of treating tendonitis?
To restore tensile strength.
What type of tendonitis is a medical emergency?
Acute because we need to reduce the inflammation.
What are 4 goals of treating acute tendonitis?
Reduce inflammation
Speed healing
Increase tensile strength
Decrease risk of re-injury
What are 5 forms of non-surgical tendonitis treatment?
Cold therapy (20 minutes) Compression and coaptation NSAIDs Intralesional injections ESWT (shockwave therapy)
What are 3 different substances used in an intralesional injection?
Platelet rich plasma (PRP)
Stem cells
Bone marrow
What is the best type of intralesional injection?
Stem cells mixed with PRP.
NOTE: This is costly.
What are the 2 common surgical interventions for treating tendonitis?
Tendon splitting
Desmotomy
