Tendonitis Flashcards
Where does the SDF divide and insert?
Divides @ P1 and inserts on P2
Where does the DDF insert?
P3
Where does the suspensory ligament originate and insert?
O: MC/MT3
I: sesamoid bones
The extensor branch of the SL joins which extensor tendon?
Common digital extensor
Contains intrinsic blood supply, nerves, growth factors, and provides elasticity
Endotenon
Continguous w/endotenon, surrounds the tendon
Epitenon
Surrounds tendons not in a sheath
Paratenon
Reduces frictional forces, supplies blood vessels, and repairs elements
Paratenon
Graph of how tendons respond to stress
Stress-strain curve
How far can a tendon extend before rupture?
12-20%
How far can a tendon extend at a walk?
3-8%
How far can a tendon extend at a trot?
7-10%
How far can a tendon extend at a gallop?
12-16%
These structures have limited intrinsic repair
Tendons
What is the main type of collagen found in scars?
Type 3
Tendons in this location are less effective at healing
Tendon sheath
Less elasticity of a tendon increases what?
Risk of re-injury
What are 2 mechanisms of over straining?
Sudden overload or strain induced
Which mechanism of overstaining is most common?
Repetitive microtrauma (strain induced)
How does repetitive microtrauma cause overstraining?
Molecular inflammation progressively weakens the tendon
Caused by over-reaching, wire snag, or kicking usually while the tendon is under load
Percutaneous trauma
When is percutaneous trauma most serious?
Trauma to palmar aspect of pastern/MC
Why is flexor tendon damage more severe than extensor tendon damage?
Extensor tendons are not weight bearing
What tendons are most prone to injury?
SDFT and SL
When do most tendonitis causes occur?
During heel strike or push-off
Which tendon is most affected by load on push-off?
DDFT
What is the most common location for tears in synovial cavities?
DDFT (forelimb) and manica flexoria (hindlimb)
What are management factors that predispose to tendonitis/desmitis?
Increased stress, poor/deep ground, inadequate training, poor hoof care
What are anatomical factors that predispose to tendonitis/desmitis?
Long sloping pasterns
What will you notice on PE that will indicate tendonitis?
Bowing of palmar contour of the limb
How long is the inflammatory phase of tendonitis?
1-2 weeks
How is lameness affected during the course of a tendonitis episode?
Lame until inflammatory phase passes, then resolves rapidly
What is the best modality for diagnosing tendonitis?
Ultrasound
When is the best time to US a suspected tendonitis?
1 week after injury
What probe do you use to dx tendonitis?
7.5-12mHz linear transducer
What will you see in a damaged tendon on US?
Loss of normal striated fiber pattern
How do you measure the location of the tendonitis lesion so you can track it over time?
Measure distance between transducer and accessory carpal bone
Where does the DDFT become bi-lobed?
level of the fetlock
What should you always offer to clients when there is pathology of the foot?
MRI
How do you treat tendonitis?
Rest, controlled exercise, cooling, and support
What are the goals of tendonitis treatment?
Reduced inflammation, best env for wound to heal, increase tensile strength, decrease risk of re-injury
Why should you use cold hydrotherapy for 20min rather than ice?
Ice causes reflex vasodilation and can bring inflammation back to the site
Reduces inflammation/edema
Compression and coaptation
What NSAIDs do you use for tendonitis treatment?
Phenylbutazone
What are non-surgical tendonitis treatments?
Intra-lesional injections, shock wave therapy, therapeutic US
Provides scaffoling and growth factors to support repair of the tendon
PRP (platelet rich plasma)
What do you inject into a tendon for intra-lesional therapy?
PEP, stem cells, bone marrow
Mesenchymal stem cells, progenitor cells, and growth factors that help tissue heal w/less fibrosis
Stem cell therapy
What is the most ideal non-surgical treatment available for tendonitis at this time?
Autologous stem cells
Cultured from bone marrow from tuber coxae or sternum
Autologous stem cells
How do you aspirate bone marrow for an autologous stem cell treatment?
Jamshidi
Cells derived from adipose tissue from either side of the tail head
Stem cells
Is adipose stem cells or bone marrow stem cells more effective for tendonitis treatment?
Bone marrow stem cells
Increases vascularization and growth factors in the area and decreases pain
Shock wave therapy
What is the goal of shock wave therapy?
More “organized” scar at the end of healing
What are surgical treatment options for tendonitis?
Suturing tendon, superior check desmotomy, annular ligament desmotomy
When can you perform a tendon suture?
In cases of percutaneous injury
Provides support to flexor tendons and the body of the fetlock and does not have the ability to stretch
Annular ligament
What is the most important component to surgical treatment of tendonitis?
Rehabilitation
What is the difference in prognosis when using controlled exercise rehabilitation vs. no rehab?
71% with vs 25% without
Scar tissue has less ______ and less _____ than normal tendon
Less elasticity and less strength
