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LA sx Q's shuffled > Tendonitis And Tendon Laceration > Flashcards

Tendonitis And Tendon Laceration Flashcards

1
Q

Where does the SDF tendon insert?

A

Divides at P1 and inserts primarily on P2

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2
Q

Where does the DDF tendon insert?

A

P3

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3
Q

Where does the suspensory ligament originate and insert ?

A

Originates from proximal MC/MT III

Insert on seasamoid bones
Extensor branch of seasmoid ligament joints common digital extensor tendon

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4
Q

What is the purpose of the endotendon?

A

Provides intrinsic blood supply

Has nerves, growth factors, and provides elasticity

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5
Q

What is the epitenon ?

A

Contiguous with endotendon, surrounds tendon

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6
Q

What is the paratenon?

A

Surrounds tendons NOT in a sheath

Reduces frictional forces, supplies blood vessels, repair elements

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7
Q

What do you call the stain able to be exerted on a tendon that it goes from crip pattern to straight?

A

Toe region

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8
Q

The toe region (crimp to straight) allows the tendon to extend by ___%

A

1-3

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9
Q

How much is a tendon stretched during a walk?

A

3-8%

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10
Q

How much is a tendon extended at a trot ?

A

7-10%

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11
Q

How much is a tendon extended at a gallop?

A

12-16%

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12
Q

How much can a tendon extend before rupture?

A

12-20%

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13
Q

Scar tissue formation starts out with type ____ collagen and remodels over time to induce more type ___ collagen

A

3; 1

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14
Q

T/F: tendons enclosed in a tendon sheath have better healing than those not enclosed

A

False

Tendons in a tendon sheath have less efficient healing

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15
Q

What is tendonitis?

A

Inflammation of a tendon

Most commonly from overused, but can be from infection/injury

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16
Q

What are the 2 mechanisms of overstrain?

A

Sudden overload

Repetitive microtrauma (most common) —> molecular degeneration with progressively weakens tendon

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17
Q

Percutaneous trauma can clean to serious damage to the palmar aspect of the pastern/metacarpus. Extensor tendon lacerations rarely have long term consequences through, why?

A

Extensor tendons are non necessary for weight bearing in the horse

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18
Q

Why tendons are most prone to tendonitis/desmitis?

A

SDFT and SL

Take the most load during heel strike (landing)

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19
Q

Where do tears in the synovial cavities most commonly occur?

A

DDFT of forelimb

Manica flexoria of hindlimb

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20
Q

What are predisposing factors for tendonitis?

A

Anything increasing stress on the tendon/ligament

Poor ground
Inadequate training —>muscle fatigue

Poor confirmation —> long sloping pastern
Poor hoof care —> long toes or underrun heels

Improper bandaging//boots

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21
Q

What can you often find on PE of a horse with tendonitis?

A

Bowing of the palmar contour of the limb

Inflammation (heat, pain, swelling, lameness)

Severe lameness initially but once inflammatory phase has passed (1-2weeks) lameness resolves rapidly

Altered angles of limbs

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22
Q

What is the BEST tool for diagnosis of tendonitis?

A

Ultrasound

See hypogenic areas in the tendons if there is damage

23
Q

When is the best time to do an ultrasound for tendonitis?

A

One week after injury
—> allows injury to fully declare itself
—> time for inflammatory process to decrease and better visualization

24
Q

What type of US probe do you use to visualize tendonitis?

A

Linear 7.5-12MHz transducer

Evaluate transverse and longitudinal planes and both limbs

25
Q

When doing US of the palmar aspect of the cannon bone, what structures are you visualizing from superficial to deep?

A

SDF, DDF check ligament, suspensory ligament

26
Q

What tendons are you visualizing from superfiical to deep when doing US at the level of the fetlock?

A

SDF, DDF, seasmoid ligament

27
Q

How does acute injury of a tendon appear on US?

A 
Enlargement 
Hypoechgenicity 
Reduced striation 
Shape 
Margin or position changes
28
Q

How does a chronic tendon injury appear on ultrasound?

A

Variable enlargement and echogenicity

Irregular situated pattern — > fibrosis

29
Q

What method of imaging can be used for a suspected tendon injury that cannot be found on ultrasound?

A

MRI

30
Q

What is the treatment for tendonitis?

A

All treatment regimens include rest and a controlled exercise program

Cooling, support and rest

31
Q

What is the goal of treatment for tendonitis?

A

Restoration of the tensile strength of the tendon without peritendinous granulation tissue and adhesions

  • reduce inflammation
  • seed healing/return to work
  • increase tensile strength
  • decrease risk of re-injury
32
Q

How long should you apply cold therapy for tendonitis

A

20mins

Cold hydrotherapy is better than ice packs

33
Q

Why do we use compression and coaptation for tendonitis treatment?

A

Reduce inflammation/edema

Severe injury may require splint/cast

34
Q

What types of intralesional injections can be done for tendonitis treatment?

A

Platelet rich plasma (PRP)
Stem cell therapy
Bone marrow

35
Q

What are the benefits to platelet rich plasma for intralesional treatment of tendonitis?

A

Contains growth factors

Can provide scaffold for mesenchymal stem cell growth

36
Q

Where are bone marrow stem cells taken from and what is the turn around time for the lab? How does this compare to adipose derived stem cells?

A

Tubercoxae or sternum with Jamshidi

3weeks for bone marrrow
48hrs for adipose (to lab), but can be don in 90mins if done in house

37
Q

Why is bone marrow stem cell therapy better than adipose stem cell therapy?

A

Bone marrow can better differentiate into musculoskeletal tissue and provides growth factors

38
Q

How does shock wave therapy improve healing from tendonitis?

A

Increase vascularization and growth factors in the area

Decreases pain

May reduce recovery time

39
Q

What is the annular liagment?

A

Where superficial wraps around the deep to switch positions at the level of the pastern

40
Q

Where does the superior check ligament attach?

A

From the SDF to the radius

41
Q

What surgical procedure can you do to releive strain the on the SDF?

A

Superior check desmotomy

Strain is relive on the SDF but it is transferred over to suspensory ligament

42
Q

A horse comes into your clinic, it has been lame for the past 2 weeks but has mildly improved with stall rest.
Over the RH pastern joint you see significant swelling above and below the joint with a narrowed constriction in the middle.

What is causing this and how would you treat?

A

Most likely effusion in the DDF tendon sheath, the constriction is caused by the annular ligament

You can confirm this with US —> should see hypogenic DDF and thickened annular ligament

Treat with an annular ligament desmotomy -> relieve pressure on DDFT

43
Q

What is the most important comportment of treatment for tendonitis?

A

Rehab!
Strict rest initially, passive ROM
Hand walking followed by walking under saddle
Trot under saddle with prolonged walking for warm up and cool down

Canter with prolonged warm up and cool down

Slow return to exercise over months
Guided by several rechecks on US to check fiber alignment

44
Q

Common causes of tendon laceration?

A

Trauma
Overload
Infection

45
Q

What are the most commonly lacerated tendons in forelimb of the horse?

A

Common digital extensor
Lateral digital extensor

Usually between fetlock and carpus

  • occurs from running into /jumping over objects
46
Q

What are the most commonly lacerated tendons in the hindlimb?

A

Long digital extensor
Lateral digital extensor
Severance below hock

Flexor tendons
Usually between carpus/ hock and fetlock
(Kicking objects)

47
Q

How can tendon lacerations be dignaosed ?

A

PE
— external lacerations

Radiology
—can see infection (gas producing bacteria)

US

Tenoscopy

Lameness

48
Q

Horse has a slight drop in their fetlock, but the toe is not raised from the ground.

What tendon is lacerated?

A

SFT

49
Q

Horse has a drop in the fetlock and the toe is lifted of the ground.

What tendons are lacerated?

A

SDF and DDF

50
Q

Horse has compete drop of the fetlock where is is touching the ground.

What tendons are lacerated?

A

SDF
DDF
Suspensory ligament

51
Q

Horse has an injury just caudal to the hock. How would you test for tendon laceration ?

A

You would hold the stifle in extension. Try to flex the hock..

Normal horse.. the hock and stifle flex and extend in unison due to reciprocal apparatus

Tendon laceration = hock can be flexed without flexion of the stifle

Calcaneus tendon AKA Achilles’ tendon

52
Q

What tendon opposes the forces of the DDF and causes the toe to be elevated from the ground when DDF tendon is lacerated?

A

Common digital extensor

53
Q

What are treatment options for tendon lacerations?

A

Corrective shoeing
— if you use a toe block in a cow, that toe must be healthy or it will fail because it is bearing all the weight

Bandage

Casts

Surgery

54
Q

What are the surgery options for tendon lacerations

A

Suturing tendons back together —> locking loop

These often fail in the flexor tendons of large animals —> sutures pull through

Extensor tendons have good prognosis —> not weight bearing

LA sx Q's shuffled (9 decks)

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