Tendonitits Flashcards
The proximal check ligament supports which tendon and attaches where?
SDF and attaches to the back of the radius
The distal check ligament supports which tendon and attaches where?
DDF and attaches to back of cannon bone
Where does the SDF divide?
P1 and inserts primarily on P2
Where does the suspensory ligament originate from and where does it attach?
Proximal MC/MT III
Attaches on proximal sesamoid bones
What are tendons primarily made of?
Water and collagen type I fibers
Endotendon
Endotendon: intrinsic blood supply, nerves, growth factors (surrounds fasicles and wraps entire tendon)
Epitendon
Epitendon: contiguous with endotendon, surrounds tendon & endotendon ( tendons not within a sheath and outside of synovial cavity have these-allows tendon to slide within sheath by decrease friction w/ movement)
Paratendon
Surrounds tendons- NOT IN A SHEATH
Outside synovial cavity
What allows for the stretch of tendons?
Crimp pattern- when crimp becomes extended and lost, then becomes stretched out
Which crimp is lost first?
Center lost before periphery
How far can a tendon extend before rupturing?
12-20% (elastic region)
What percentage do tendons extend at a walk, trot and gallop?
Walk: 3-8%
Trot: 7-10%
Gallop: 12-16%
T/F: Tendons have a high healing property and can typically heal on their own
FALSE- limited intrinsic repair and requires help from us a lot of the time
Formation of type III collagen results in what?
Less elastic tendon & increase plastic regions increasing the risk of re-injury
What is the definition of tendonitis?
Inflammation of a tendon- most commonly from overuse but can be from infection or traumatic injury
Where is the most common area for tendonitis?
SDF
What percentage of TB return to race post SDF tendonitis?
20-60%
What are the two mechanisms of overstrain?
Sudden overload (acute injury) Strain induced= most common; due to repetitive microtrauma: phase of molecular degeneration which progressively weakens the tendon
What are the two types of tendon injury classifications?
Overstrain
Percutaneous trauma
When is percutaneous trauma most serious?
When trauma to the palmar aspect of pastern/metacarpus
Why do extensor tendon lacerations rarely have long term consequences?
Flexor tendons are weight bearing so they can lacerate about 1/2 of tendons and still be able to walk
Extensor tendons are non-weight bearing structures that are used to bring a foot forwards (may notice knuckling)
Which tendons are most prone to injury?
SDFT and SL
have the most load during heel strike
Which tendon most commonly has tears within synovial cavities on fore/hind limbs?
DDFT (forelimb) Manica flexoria (hind limb)
Why are core lesions of the SDFT common?
Lesion in center of tendon, relatively well-circumscribed and oval in shape because of crimp
SDFT loses crimp first so this is first at risk for injury
What is it called if there is tendonitis whithin the tendon sheath?
Tenosynovitis
Where does tenosynovitis occur?
Annular ligament constriction
What are predisposing factors for tendonitis?
Anything that increases stress on tendon/ligament
- poor/deep ground surface
- inadequate training –> muscle fatigue
- poor conformation (long sloping pasterns)
- poor hoof care (long toes, underrun heels)
- improper bandaging/boots
What would be noticed in a patient on distal PE if they had tendonitis?
Bowing of palmar contour of the limb (Bowed tendon)
Upon palpation of a site with tendonitis what will you feel?
Swelling, painful response
What are the cardinal CS of inflammation?
Heat
Pain
Swelling
Lameness
What is the best tool that is used for diagnosing tendonitis?
Ultrasound
When is the best time to ultrasound a tendon and why?
One week after injury because it will be getting bigger from all the inflammatory mediators associated with the tear will be coming in and cleaning it up so you will need to wait a bit till the body clears that area so you can see what is going on
What US probe is used on tendons?
7.5-12 MHz linear transducer
What planes should a limb with suspected tendonitis be evaluated?
Transverse and longitudinal planes
Where should you measure for US evaluation of tendons to see if tendonitis is present?
Distance between transducer and accessory carpal bone
When does the DDFT become bilobed?
At the pastern
What is the pathology of acute tendonitis?
Enlargement, hypoechogenicity, reduced striated pattern (hemorrhage)
Changes in shape, margin or position
What is the pathology of chronic tendonitis?
Variable enlargement and hetero/hyperechogenicity, irregular striated patterns (fibrosis)
Where would you most commonly use a bone scan for tendonitis diagnosis?
Suspecting tendonitis where DDFT inserts and ends at P3 (can’t view on US because blocked by hoof capsule)
What do all treatment regimens of tendonitis include?
Rest and a controlled exercise program
What are 3 integral parts of management of tendonitis?
Cooling
Support/Compression
Rest
What is the goal of tendonitis treatment?
Restoration of tensile strength of the tendon w/out peritendinous granulation tissue and adhesions
What are some non-sx treatments of tendonitis?
Cold therapy (20 minutes)
Compression and coaptation (reduces inflammation/edema)
NSAIDs (Phenylbutazone)
What are the three types of intra-lesional injections used for tendonitis tx?
Platelet rich plasma
Stem cell therapy
Bone marrow
What types of stem cells can be used for tendonitis tx?
Mesenchymal stem cells
Bone marrow derived stem cells
Adipose derived stem cells
Allogenic
What type of tendonitis treatment can increase vascularization and growth factors in the area?
Electric shock wave therapy
- decreases pain
What tendons must be surgically repaired if damaged?
Superior check desmotomy
Annular ligament desmotomy
What is the most important component of treatment of tendonitis?
Rehabilitation
