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Equine Final Year > Soft Tissue Injuries > Flashcards

Soft Tissue Injuries Flashcards

1
Q

What is the important of soft tissue injuries in veterinary practice?

A
  • All animals
    • Lameness
    • Pain
    • Loss of function
    • Welfare
  • Performance animals
    • Decreased performance/inhibition of performance
  • Production animals
    • Decreased production/inhibition of production
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2
Q

What are the most 2 common types of soft tissue injuries?

A

Percutaneous

Overstrain

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3
Q

What are percutaneous soft tissue injuries?

A
  • Full thickness laceration
  • Partial thickness laceration

Some sort of wound, percutaneous injury, that then directly affects soft tissues. Certain soft tissues which are less concerned about than others. Don’t worry about extensor tendon, horse will manage fine - horse will adapt and learn to flick leg forward. If equivalent injury on plantar or palmar part of limb - palmar much more difficult to heal and are much more important to the long term prognosis

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4
Q

What are overstrain soft tissue injuries?

A
  • Acute onset overload (overwhelming tensile strength)
  • Molecular degeneration preceeding strain

Overstrain - overloading, causes structure to break down. Most common injury in performance animals - chronic fatigue and eventually, normal strength of structure is exceeded and fibres start to break down. Usually look acute, but if often chronic as there is small amounts of microdamage that accumulate and cause the injury to happen.

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5
Q

What are some common locations of soft tissue injuries in horses and dogs?

A

Common locations of soft tissue injuries

  • Tendons
    • Horses:
      • SDFT (esp. race horses)
      • DDFT
  • Ligaments
    • Horses:
    • Suspensory ligament
      • Proximal suspensory desmitis (esp. Dressage horses)
      • Suspensory branch desmitis
  • Dogs:
    • Achilles
    • Biceps brachii
    • Cruciate ligament disease
    • Collateral ligaments
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6
Q

How can you use the history to diagnose tendon and ligament injuries?

A
  • Duration of problem
  • Onset of problem
  • Exacerbation of problem
  • Presenting signs
  • Response to treatment
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7
Q

How can you use clinical evaluation to diagnose tendon and ligament injuries?

A

Clinical evaluation

  • Evaluate stance/ posture
  • Palpate limbs with animal standing
    • Swelling
    • Heat
    • Pain on palpation
  • Lift limb and palpate when soft tissues relaxed
  • Lift contralateral limb
  • Check range of motion
  • No weight bearing palpation as well as weight bearing
  • Always look at contralateral limb - animals are good at balancing weight in subtle ways, so may look normal until you increase the load on it by holding one leg up
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8
Q

What is the likely problem here?

A

Forelimb normal, hindlimbs there is marked hyperextension of both metatarsal phalangeal joints - worse on right HL. No wounds. Use anatomy we can suspect severe extensive breakdown of suspensory apparatus

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9
Q

If you just have a sunken fetlock, what is likely tobe dysfunctioning? (equine)

A

Just a small sink of fetlock - just a SDFT dysfunction

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10
Q

If you have a sunken fetlock AND toe off the ground, what is likely to be dysfunctioning? (equine)

A

SDFT and DDFT dysfunction if fetlock sunk AND toe off the ground

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11
Q

If you have a collapsed fetlock AND toe off the ground - what is likely to be dysfunctioned? (equine)

A

If COLLAPSED fetlock AND toe off the ground, SDFT, DDFT and suspensory ligament dysfunction

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12
Q

If you have knuckling, what soft tissue structure is likely to be dysfunctioning? (equine)

A

Extensor dysfunction

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13
Q

What is the emergency treatment for soft tissue injuries?

A
  • Aim: Stabilise limb and restore biomechanical function
  • Local wound care
  • Antibiotics and Anti-inflammatories
  • Stabilise limb
    • Flexor tendon dysfunction
      • Bandage limb and apply palmar or dorsal splint or use commercial splint (ie Kimsey)
    • Extensor tendon dysfunction
      • Bandage and dorsal splint
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14
Q

When treating a soft tissue injury, how should you stabilise it?

A

Try to get limb into single bony collar, want the force to go through the bones and not through the soft tissues. Transfer forces through bone so as not to disrupt STs any further

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15
Q

What are the principles of ultrasonography when looking for soft tissue injuries?

A
  • Know anatomy!!!
  • Use contralateral limb/ side
    • Use identical conditions ie weight bearing evenly
  • Prepare area of interest
    • Clip area to increase contact
    • Use plenty of ultrasound gel
  • Use transverse and longitudinal images
  • Maximise you chance of recognising a lesion
    • Image at approximately 7 days after injury
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16
Q

When using ultrasound to look for a soft tissue injuries, when should you US?

A

To maximise chance of recognising a lesion, image at approxiamtely 7 days after injury

Some ST injuries are not immediately apparent, sometimes takes a few days and the fibres get broken up more by MMPS and macrophages to eat away broken bits, for it to become apparent

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17
Q

What are some strengths and weaknesses of ultrasonography when looking for soft tissue injuries?

A

Strengths

  • Good for soft tissues
  • Good for bony surface
  • Easy and quick to perform
  • Portable unit
  • GA not necessary
  • Oedema of soft tissue injury provides excellent contrast

Weaknesses

  • Expensive equipment
  • Experience in interpretation necessary
  • 2D images obtained
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18
Q

When looking at soft tissue injuries on ultrasonography, what are you looking for changes in?

A

Changes in

  • Echogenicity
  • Cross-sectional area
  • Fibre alignment
  • Margins of the structure
  • Shape of the structure
  • Location of the structure
19
Q

What changes will you see externally with superficial digital flexor tendonitis?

A
  • Swelling
    • Generalised> Palmar metacarpus
  • Heat
  • Pain to palpation
  • +/-Lameness •+/-Vascular engorgement
  • With leg up
    • Thickened SDFT
    • Soft swelling of SDFT
    • Pain on gentle ‘pinching’
20
Q

What would you find on ultrasound with superficial digital flexor tendonitis?

A
  • Core lesions most common
  • Transverse
    • Loss of normal echogenicity
      • Acute lesions: anechoic
      • Subacute lesions: hypoechoic
      • Chronic lesions: hyperechoic areas –Increased CSA
  • Longitudinal
    • Loss of normal parallel fibre alignment
21
Q

What would you see on ultrasonography with chronic lesions of soft tissues?

A

Lesions with mexed echogenicity

Changes in fibre alignment

22
Q

How can you use ultrasound for prognosticating?

A
  • Fibre alignment
    • Indicates ‘quality’ of scar
  • Prognosis
    • Pattern at original injury
    • Pattern at return to full work
23
Q

How should you use ultrasonography during rehabilitation?

A
  • Major contributor to successful return to function
    • Re-scan every 2-3 months
    • Re-scan prior to a change in exercise level
    • If >10% increase in CSA then reduce exercise level
24
Q

What is the consequence of tendon injury?

A
  • Tendons do NOT regenerate
    • Fibrose
  • Healed tendons
    • Stiffer than normal tendon
      • Predisposes to re-injury
      • Less efficient energy store
        • Poorer performance
  • Aim of treatment should be regeneration
25
Q

How do tendons regenerate?

A

tendons DO NOT regenerate

They fibrose

26
Q

How do healed tendons compare to non-injured tendons?

A

Healed are stiffer than normal and a less efficient energy store, which causes poorer performance

27
Q

What are the principles of treatment for soft tissue injuries?

A
  • SHOULD be based on soft tissue pathology and phases of healing
    • Many treatments advocated previously
    • Few evidence based treatments
  • Divide into the phases of healing
    • Acute
    • Subacute
    • Chronic
28
Q

How should you treat the acute phase of soft tissue injury?

A

Acute phase: anti - inflammatory

  • Physical therapy
    • Cold
    • Compression +/- coaptation
    • Rest
  • Medical therapy
    • NSAIDs
    • steroids??
29
Q

What is the treatment for the subacute phase of soft tissue injury?

A

Subacute phase: fibroplasia

  • Mobilisation
    • Early
    • Progressive
  • Regular ultrasonographic monitoring
    • CSA
    • Fibre pattern
30
Q

What is the treatment of the chronic phase of soft tissue injuries?

A

Chronic phase: remodelling

  • Controlled ascending exercise
  • Ultrasonographic monitoring
31
Q

How can you try and prevent tendonitis?

A

How do we try and prevent tendinitis….?

  • Maximise the quality of the tendon prior to skeletal maturity
    • Exercise immature horses stimulates tendon formation and adaptation
  • Reduce degeneration after skeletal maturity
    • Avoid ‘tendon training in skeletally mature horses
  • Reduce risk factors for tendonitis
    • Decrease speed, fatigue, jumping, weight
    • Improve ground surface, shoeing
  • (Detect tendinitis early)
    • Ultrasound?
32
Q

What is the proximal suspensory ligament desmitis?

How is it diagnosed?

A
  • Rare to palpate any swelling
  • Rare to palpate any heat
  • Often can elicit pain on deep palpation
  • Diagnosed on diagnostic analgesia and imaging findings (ultrasound +/-MRI)
  • Most horses present with lameness issues
    • Can be unilateral or bilateral
33
Q

What is suspensory branch desmitis?

How is it diagnosed?

A
  • Palpable pain
  • Peri-ligamentous heat
  • Peri-ligamentous and ligamentous swelling
  • Lameness (variable)
  • Diagnosed on history, physical examination findings, diagnostic imaging- **ultrasonography** and (MRI)
  • Chronic desmitis
    • Peri-ligamentous fibrosis very common
34
Q

What is an additional treatment strategy for a ligamentous injury?

A
  • Extracorporeal shockwave therapy
    • Useful for enthesious problems?
      • Analgesia
35
Q

What is the prognosis for ligamentous injuries?

A
  • Proximal suspensory desmitis
    • Forelimb-good
    • Hindlimb
      • Acute desmitis-reasonable
      • Chronic desmitis-poor
        • Improved with ECSWT (40-50%)
        • Improved with surgical intervention (fasciotomy and neurectomy) (up to 90% reported)
  • Branch desmitis
    • Reasonable but recurrence quite common
    • Chronic desmitis worse prognosis
36
Q

What would you see with desmitis of the Accessory Ligament of DDFT?

A
  • Swelling in the proximal Metacarpal region
  • Pain on palpation
  • Heat
  • Vessel engorgement
  • Lameness variable
  • Rare in hindlimb
    • Acute onset lameness
    • Fetlock flexural deformity
  • Focal or diffuse lesions
    • Increased CSA
    • Loss of normal fibre pattern
    • Loss of normal contour
37
Q

What is tenosynovitis?

A

Tenosynovitis is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon, typically leading to joint pain, swelling, and stiffness. Tenosynovitis can be either infectious or noninfectious

38
Q

Where are common places to get secondary tenosynovitis of the digital flexor tendon sheath?

A
  • Common secondary tenosynovitis
    • Superficial digital flexor tendon
    • Deep digital flexor tendon
    • Manica flexoria
    • Palmar annular ligament
39
Q

What are some additional treatments for tenosynovitis of DFTS?

A
  • Intra synovial anti-inflammatories
    • Steroids
    • Hyaluronic acid
  • Tenoscopy
40
Q

What is tenoscopy?

A

Tenoscopy is a technique similar to arthroscopy, in which tiny incisions in the skin allow for careful visualization and cleaning of tendon injuries

  • Diagnostic value
  • Therapeutic value
    • Damaged soft tissues
      • Mechanical irritation
      • Release of inflammatory mediators
      • Poor healing within synovial structure
41
Q
A
42
Q

What are some treatment options for DDFT lesions within the foot?

A
  • Rest
  • Farriery
  • Intrabursal/Intraarticular medications
  • Bursoscopy
43
Q

How can you diagnose lesions of the DDFT further distally into the foot?

A
  • Increasingly recognised as a cause of lameness
  • Impossible to use ultrasound through the keratinised hoof wall
    • MRI - No other successful diagnostic imaging techniques APART from MRI

Equine Final Year (102 decks)

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