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Locomotor > Equine Tendon and Ligament Disease > Flashcards

Equine Tendon and Ligament Disease Flashcards

1
Q

What are the two different types of tendon injury?

A

Percutaneous or Subcutaneous

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2
Q

How do percutaneous tendon injuries occur?

A

Laceration or penetration

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3
Q

How do subcutaneous tendon injuries occur?

A

Strain or displacement caused by sudden over-extension (DDFT) or preceding tendon degeneration with superimposed sudden over-extension (SDFT/SL)

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4
Q

What is the common history behind tendon injuries?

A

Preceding intense period of exercise but signs can be delayed

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5
Q

Is severity of signs linked to severity of injury?

A

No

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6
Q

How can you evaluate stance and gait for tendon injury?

A

Metacarpophalangeal joint extension is decreased with reduced weight bearing due to pain and fibrosed tendons
Metacarpophalangeal joint extension is increased with severe SDFT/SL injuries
Toe elevation = DDFT rupture

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7
Q

When should the limb be palpated?

A

Both weight-bearing and when the leg is lifted

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8
Q

How is ultrasound used to aid diagnosis?

A

Compare the affected and normal limb
Assess severity about 7 days post injury to give prognosis
Use a 7.5 MHz and a linear transducer +/- stand off pad

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9
Q

What signs are seen with superficial digital flexor tendinopathy?

A

Palmar metacarpal swelling, variable initial lameness, pain on palpation, core lesion seen on ultrasound

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10
Q

What are the signs seen with suspensory ligament desmitis?

A

Variable degree of lameness, acute/insidious onset, straight hock and overextending MTP joint, lamer with the limb on outside of circle, proximal MC/MT swelling variable with medial palmar vein distension, pain on palpation

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11
Q

How do you diagnose suspensory ligament desmitis?

A

Diagnostic analgesia and ultrasonography

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12
Q

What are the signs of suspensory body and branch desmitis?

A

Variable lameness
On ultrasound focal or generalised lesions, enlargement, periligamentar fibrosis and commonly bilateral involvement
Concurrent bony abnormalities on radiographs

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13
Q

What are the signs associated with inferior check ligament desmitis?

A

Swelling in proximal metacarpal region dorsal to SDFT
Lameness often variable and can be absent
Generalised enlargement on ultrasound

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14
Q

What clinical signs are seen with DDFT tendinopathy?

A

Usually within sheath or navicular bursa almost never in metacarpal region
Mid-substance disruption vs border tears

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15
Q

Which tendons are injured in front and back legs if intra-thecal tendon tears?

A

DDFT usually lateral border in forelimbs

Manica flexoria usually in hindlimb

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16
Q

How are intra-thecal tendon tears diagnosed?

A

Ultrasound diagnosis is difficult due to lateral/medial echogenic material
Manica flexoria instability in longlitudinal view

17
Q

What is the manica flexoria?

A

Loop of SDFT that wraps around DDFT and its sites of attachment can tear

18
Q

What can cause tenosynovitis and what consequences can dysfunction have?

A

Idiopathic distension, primary/secondary non-septic or septic inflammation
Soft tissue and bone consequences

19
Q

What are the signs of annular ligament syndrome?

A

Mild-moderate lameness minimally responsive to rest occasionally with irregular gliding of tendons
Distended digital sheath with a notch at PAL level
Digital sheath analgesia usually positive but may not be 100% (mechanical component)
Ultrasonography = >2mm in thickness

20
Q

What are the general principles for treating tendon injuries?

A

Very few evidence based treatment choices

Rational treatment based on tendon pathology and phases of tendon healing

21
Q

In the acute phase, how should a tendon be treated?

A

Physical therapy - cold, compression and MCP joint support
Short acting steroids only within 24-48 hours or NSAIDs
Surgery involving percutaneous tendon splitting using a knife/needles

22
Q

In the sub-acute phase, how should a tendon be treated?

A

Mobilisation early and progressively
Regular ultrasonographic monitoring every 2-3 months
Exercise levels based on CSA’s to maintain <10% increase
Induce regeneration rather than repair (ACell, growth factors, stem cell therapy)

23
Q

What treatment should be used for chronic tendon injuries?

A

Controlled ascending exercise, ultrasonographic monitoring,

Surgery - desmotomy of accessory ligament of SDFT

24
Q

What specific treatment can be used for proximal suspensory desmitis? Effectiveness data?

A

Extracorporeal shock wave therapy
Forelimb = 53% at 6 months in chronic, 86-90% for conservative acute phase treatment
Hindlimb = 41% at 6 months in chronic, 13% for acute

25
Q

What can fasciotomy and neurectomy be used to treat?

A

Hindlimb PSD which have failed to improve after first two treatments

26
Q

What treatment do intra-thecal tendon/ligament lesions often require and why?

A

Tenoscopy/arthroscopy and joint medication as intrasynovial location often gives poor healing

27
Q

What is the aetiology of flexural limb deformities?

A

Congenitial due to uterine malpositioning or CDET rupture

Acquired as part of developmental orthopedic disease

28
Q

What is the treatment of flexural limb deformities?

A

Conservative through exercise, shoeing and splits or surgical release

29
Q

What is carpal flexural deformity aetiology and treatment?

A

Congenital and treated with exercise, physiotherapy, tube casts and surgery

30
Q

When is distal interphalangeal joint flexural deformity acquired?

A

Around 6 months

31
Q

What is type 1 distal interphalangeal joint flexural deformity? How is it treated?

A

Dorsal hoof wall less than vertical

Exercise and physiotherapy, toe extension shoe and surgery through desmotomy of ALDDFT

32
Q

What is type 2 distal interphalangeal joint flexural deformity? How is it treated?

A

Dorsal hoof wall past vertical

Surgery of desmotomy of ALDDFT or DDFT tenotomy

33
Q

What treatment is used for metacarpophalangeal joint flexural deformity?

A

Exercise/physiotherapy, toe extension and raised heel shoe, splints/braces, surgery of desmotomy of ALDDFT/ALSDFT or SDFT tenotomy

34
Q

What is the tendon toxity?

A

Spontaneous recovery, heel trimming, heel extension shoe and controlled exercise

Locomotor (17 decks)

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