Causes of Lameness: Tendons and Ligaments

Question 1

What are the classifications of tendon injuries?

Answer 1

internal = strains

external = wounds, trauma

Question 2

What are the types of tendon injuries?

Answer 2

tendonitis

tenosynovitis (inside the tendon sheath)

Question 3

What is the most common tendon injury?

Answer 3

internal strain of SDFT in MC regions

AKA “bowed” tendon

Question 4

What are the causes of a mechanical injury of flexor tendon?

Answer 4

• Toed-in or toed-out conformation –> excessive medial or lateral strain on tendons
• Long toe and low heel –> delayed breakover and longer stride –> tendon strain
• Muscle fatigue –> rely more on tendons/ligaments –> tendon instability
• Uneven surfaces and mud with sudden turns –> uneven stress within tendon
• Improper bandaging –> stricture or stresses within tendon
• Unbalanced trimming and shoeing –> uneven impact –> force distributed unevenly within tendon

Question 5

What are the phases of tendonitis?

Answer 5

1. Tendon degeneration
   i. Subclinical
2. Acute inflammatory phase
   i. Onset of clinical signs, lasts 1-2 weeks
3. Reparative phase
   i. Overlaps with inflammatory phase, peaks at 3 weeks, angiogenesis and fibroblast migration
4. Remodeling phase
   i. Lasts several months, repair tissue stronger, but less elastic and prone to re-injury

Question 6

What are the signs of tendonitis?

Answer 6

variable lameness

painful on palpation

swelling

heat

Question 7

What are the diagnosis of tendonitis?

Answer 7

ultrasound, initial and follow-up

Question 8

What is the treatment of tendonitis?

Answer 8

acute inflammation:
* cold therapy, NSAIDs, rest

repair/remodeling:
* shockwave
* intralesional regenerative therapies (platelet rich plasma (PRP), stem cells)
* no corticosteroids (they slow healing)
* pin firing and blistering
* transection of the proximal check ligament (SDFT)
* rehabilitation and controlled exercise

Question 9

Describe SDF Tendonitis

Answer 9

AKA bowed tendon

forelimb > hindlimb

mid-proximal bows > low bows

Question 10

What are the causes of SDF Tendonitis?

Answer 10

fetlock hyperextension

repetitive trauma

age

Question 11

What does digital extensor tendonitis include?

Answer 11

common, long, or lateral digital extensor tendon

Question 12

What is the cause of digital extensor tendonitis?

Answer 12

local trauma such as a kick

Question 13

What are the signs of digital extensor tendonitis?

Answer 13

variable lameness, swelling, heat

Question 14

What is the diagnosis of digital extensor tendonitis?

Answer 14

clinical signs, diagnosis

Question 15

What is the treatment of digital extensor tendonitis?

Answer 15

rest, NSAIDs, DMSO, poultice, bandaging, cold/warm therapy

Question 16

Describe SDFT injuries in the distal limb

Answer 16

forelimb > hindlimb

often outside digital flexor tendon sheath

Question 17

Describe DDFT injuries in distal limb

Answer 17

hindlimb > forelimb

often inside digital flexor tendon sheath

results in sheath effusion and chronic tenosynovitis

Question 18

What are the signs of tenosynovitis?

Answer 18

distention of tendon sheath, pain, heat

Question 19

What is the diagnosis of tenosynovitis?

Answer 19

ultrasound

Question 20

What is the treatment of tenosynovitis at fetlock?

Answer 20

transection of the annular ligament for SDF or DDF tenosynovitis at fetlock

Question 21

What is thoroughpin?

Answer 21

non-septic tenosynovitis of DDF tendon sheath at level of hock

Question 22

What are the signs of thoroughpin?

Answer 22

fluid filled swelling on plantar aspect of hock, non-painful, no lameness

Question 23

What is the diagnosis of thoroughpin?

Answer 23

clinical signs, ultrasound

Question 24

What is the treatment of thoroughpin?

Answer 24

drainage of fluid (will fill back up), DMSO sweat

Question 25

What is septic tenosynovitis?

Answer 25

like septic osteoarthritis

Question 26

What does septic tenosynovitis result in?

Answer 26

damage to tendon adhesive formation possible erosion of tendon sheath and progression of infection

Question 27

What is tendon laceration?

Answer 27

loss of tendon function concern about damage to adjacent structures

Question 28

What is the prognosis for a tendon laceration?

Answer 28

prognosis: flexor tendon worse than extensor tendon guarded if both SDFT and DDFT involved

Question 29

What is the cause of suspensory desmitis?

Answer 29

straight hocks hyperextension of carpus/tarsus and fetlock deep, soft footing excessive rotational movement of limbs secondary to fractured splint

Question 30

What are the signs of suspensory desmitis?

Answer 30

swelling and pain on palpation (subjective) mild to moderate lameness positive Churchill sign

Question 31

What is the technique for the Churchill sign?

Answer 31

finger pressure applied on posterior head of medial splint bone

Question 32

What is a positive response for the Churchill sign?

Answer 32

upward and outward movement of leg

Question 33

What is the diagnosis of suspensory desmitis?

Answer 33

ultrasound, radiographs, MRI

Question 34

What is the treatment of suspensory desmitis?

Answer 34

NSAIDs and rest cold/warm therapy surpass shockwave intralesional injection (stem cells, PRP)

Question 35

What is the signalment of proximal suspensory desmitis?

Answer 35

sport horses - eventers, jumpers, Western performance hind limbs > forelimbs Case: Reggie

Question 36

What is the signalment for body and branch lesions in SL?

Answer 36

SBs and jumping horses Case: Teddy

Question 37

What is the cause of a suspensory ligament rupture?

Answer 37

extreme overextension of fetlock occurs acutely; can accompany proximal sesamoid fracture

Question 38

What are the signs of a suspensory ligament rupture?

Answer 38

dropped fetlock, lameness

Question 39

What is the diagnosis of a suspensory ligament rupture?

Answer 39

rads to assess bones, U/S ligament

Question 40

What is the treatment of a suspensory ligament rupture?

Answer 40

immobilize limb to prevent further damage: cast, splint, or fetlock arthrodesis euthanasia

Question 41

What is the prognosis of a suspensory ligament rupture?

Answer 41

guarded prognosis: most likely never return to performance work

Question 42

What is the signalment of inferior check desmitis?

Answer 42

SB trotters and pacers often overlooked, U/S has aided diagnosis

Question 43

What is the cause of inferior check desmitis?

Answer 43

long toe/low heel --> slow breakover unbalanced foot

Question 44

What are the signs of inferior check desmitis?

Answer 44

lameness, pain on palpation

Question 45

What is the diagnosis of inferior check desmitis?

Answer 45

local anesthetic, U/S, rads to rule out bony lesions

Question 46

What is the treatment for check desmitis?

Answer 46

cold/warm therapy, bandaging surpass, NSAIDs, shockwave

Question 47

What is tarsal plantar desmitis?

Answer 47

AKA curb inflammation of long plantar ligament

Question 48

What are the causes of tarsal plantar desmitis?

Answer 48

conformation: sickle-hocked and cow-hocked trauma

Question 49

What are the signs of tarsal plantar desmitis?

Answer 49

plantar swelling distal to point of hock pain, heat, swelling, lameness

Question 50

What are the diagnosis of tarsal plantar desmitis?

Answer 50

clinical signs local anesthetic

Question 51

What are the treatments for tarsal plantar desmitis?

Answer 51

cold/warm therapy, rest NSAIDs topical DMSO, surpass shockwave pin firing, blistering, injected with counterirritants

Question 52

Where are annular ligament constrictions?

Answer 52

palmar or plantar

Question 53

What is the acute cause of an annular ligament constriction?

Answer 53

Annular ligament get damaged (ex. Wire cut) or tendon within it gets strained --> inflammation --> constriction of tendon(s)

Question 54

What is the chronic cause of an annular ligament constriction?

Answer 54

Thickening of annular ligament --> constriction of tendon(s)

Question 55

What are the signs of an annular ligament constriction?

Answer 55

Non-specific lameness which worsens with work, history of trauma to fetlock, distention of proximal digital flexor tendon sheath with "notch" created by annular ligament

Question 56

What is the diagnosis of an annular ligament constriction?

Answer 56

Clinical signs, ultrasound (want to assess adhesion formation and tendon damage), radiographs to rule out sesamoid fracture

Question 57

What is the treatment of an annular ligament constriction?

Answer 57

Surgical resection of the annular ligament with bandage application and return to exercise to prevent adhesions

Question 58

What is an upward fixation of the patella?

Answer 58

Patella fixed over medial trochlear ridge

Question 59

What is the cause of upward fixation of patella?

Answer 59

Poor conformation: steep angle between femur and tibia

Question 60

What are the signs of upward fixation of patella?

Answer 60

hindlimb locked in extension stifle and hock cannot flex toe drags on ground when moving tense patellar ligaments on palpation

Question 61

What is the diagnosis of upward fixation of patella?

Answer 61

clinical signs

Question 62

How do you treat upward fixation of patella?

Answer 62

mild case: hill work and NSAIDs, injection of counterirritants more severe case: medial patellar desmotomy

Question 63

What is the cause of a rupture of peroneus tertius?

Answer 63

overextension of hock joint rupture usually occurs near origin

Question 64

What are the signs of a rupture of peroneus tertius?

Answer 64

flexion of stifle with extension of hock can bear weight

Question 65

What is the diagnosis of a rupture of peroneus tertius?

Answer 65

clinical signs, rads to assess bone

Question 66

What is the treatment of a rupture of peroneus tertius?

Answer 66

stall rest for 8-12+ weeks, euthanasia