Tendonitis

Question 1

What is the proximal/accessory ligament to the SDF?

Answer 1

Superior check ligament

Question 2

What is the distal/accessory ligament of the DDF?

Answer 2

Inferior check ligament

Question 3

From cranial to caudal, what structures do you encounter?

Answer 3

Third metacarpal bone > Suspensory ligament > DDF tendon > SDF tendon

Question 4

What is the make-up of a tendon?

Answer 4

70% water, 30% dry matter

Question 5

What 2 things make up the non-collagenous matrix of a tendon?

Answer 5

Tenocytes

Glycoproteins

Question 6

What is important to remember about a relaxed tendon fascicle?

Answer 6

There is a crimp to allow for stretching.

Question 7

What is the endotenon?

Answer 7

Blood supply, nerves and growth factors

Question 8

What is the epitenon?

Answer 8

Contiguous with the endotenon, surrounds the tendon.

Question 9

What is the paratenon?

Answer 9

Surrounds tendons NOT in a sheath

Question 10

What is an example of a tendon that is not in a sheath?

Answer 10

Digital tendon flexor sheath

Question 11

What is the purpose of the crimp pattern in tendons?

Answer 11

Allows for stretching

Question 12

Where is the crimp in a tendon lost first?

Answer 12

Center

Question 13

What is the “toe” region?

Answer 13

The point where a load is applied to the tendon and the crimp is lost.

Question 14

How much can a tendon extend before it ruptures?

Answer 14

12-20%

Question 15

How much does a tendon extend at the toe region?

Answer 15

1-3%

Question 16

How much does a tendon extend at a walk?

Answer 16

3-8%

Question 17

How much does a tendon extend at a trot?

Answer 17

7-10%

Question 18

How much does a tendon extend at a gallop?

Answer 18

12-16%

Question 19

How does a tendon heal?

Answer 19

Scar tissue (type III collagen) forms a less elastic tendon

**NOTE: risk of re-injury

Question 20

What tendons are less efficient at healing?

Answer 20

Those in a tendon sheath.

Question 21

What is tendonitis?

Answer 21

Inflammation of a tendon.

Question 22

What are 3 causes of tendonitis?

Answer 22

Overuse
Infection
Traumatic injury

Question 23

What is one of the most common sites of tendonitis?

Answer 23

SDF tendon

Question 24

What are 2 mechanisms of an overstrain tendon injury?

Answer 24

Sudden overload

Strain induced

Question 25

What is the most common mechanism of an overstrain tendon injury?

Answer 25

Strain induced

Question 26

What is strain induced overstrain?

Answer 26

Repetitive microtrauma

Question 27

What are 3 causes of percutaneous tendon trauma?

Answer 27

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.

Question 28

What type of tendon lacerations rarely have long term consequences?

Answer 28

Extensor tendon lacerations

Question 29

How much of the tendon have be lacerated and still provide full function at a walk?

Answer 29

50%

Question 30

What two tendons are most prone to injury?

Answer 30

SDF tendon Suspensory ligament NOTE: This is because they have the most load during a heel strike.

Question 31

What are the most common front and hind limb tendon tears within synovial cavities?

Answer 31

``` DDFT (forelimb) Manica flexoria (hindlimb) ```

Question 32

What is a predisposing factor to tendonitis?

Answer 32

Increased stress on the tendon

Question 33

What are 3 common histories in a case with tendonitis?

Answer 33

Percutaneous injury Acute athletic event Poor performance

Question 34

What are the 4 cardinal signs of inflammation?

Answer 34

Pain Swelling Heat Lameness

Question 35

What is the best tool for diagnosing tendonitis?

Answer 35

Ultrasound of course!

Question 36

When is the best time to ultrasound an injury?

Answer 36

One week post-injury to give swelling and hematoma time to resolve. Also, a wound can take several days to declare itself.

Question 37

Why should you always evaluate both limbs?

Answer 37

To find normal (or could be bilateral).

Question 38

If looking at an ultrasound of a limb, what structure would you see from superficial to deep?

Answer 38

SDF DDF Check ligament Suspensory ligament

Question 39

What would you expect to see acutely in a tendonitis case (3 things)?

Answer 39

Enlargement Hypoechogenicity Reduced striated pattern

Question 40

What two things would you expect to see in a chronic tendonitis case?

Answer 40

Variable enlargement and echogenicity | Fibrosis

Question 41

What 2 things do all treatment plans include for a tendonitis case?

Answer 41

Rest | Controlled exercise program

Question 42

What 3 things are integral parts of management of a tendonitis case?

Answer 42

Cooling Support Rest

Question 43

What is the goal of treating tendonitis?

Answer 43

To restore tensile strength.

Question 44

What type of tendonitis is a medical emergency?

Answer 44

Acute because we need to reduce the inflammation.

Question 45

What are 4 goals of treating acute tendonitis?

Answer 45

Reduce inflammation Speed healing Increase tensile strength Decrease risk of re-injury

Question 46

What are 5 forms of non-surgical tendonitis treatment?

Answer 46

``` Cold therapy (20 minutes) Compression and coaptation NSAIDs Intralesional injections ESWT (shockwave therapy) ```

Question 47

What are 3 different substances used in an intralesional injection?

Answer 47

Platelet rich plasma (PRP) Stem cells Bone marrow

Question 48

What is the best type of intralesional injection?

Answer 48

Stem cells mixed with PRP. NOTE: This is costly.

Question 49

What are the 2 common surgical interventions for treating tendonitis?

Answer 49

Tendon splitting | Desmotomy