Equine soft tissue injuries of the distal limb

Question 1

What is strain

Answer 1

the amount a tendon elongates for amount of stress put into it

Curve not linear

Question 2

Sections of stress strain graph

Answer 2

1 = straightening of tendon crimp, don’t get much deformation
2 = elasticc deformation; tendon absorbs lots of strain before deforming and returns elastic energy
3 = non-elastic deformation; potential for microdamage here
4 = failre/rupture

Question 3

What safety factor do most equine soft tissues have

Answer 3

only 1.2

Question 4

What is COMP

Answer 4

Cartilage oligometric matrix peptide
Involves in organising collagen into efficient systems; high early in life esp in middle of SDFT where it needs to be more elastic

Question 5

What age is COMP high i.e window to make a difference with tendon education

Answer 5

<3 years

Question 6

Difference in collagen in DDFT between mid metacarpal region and fetlock

Answer 6

In mid metacarpal region, more elastic with lots of type 1 collagen

In fetlock region, it is changing direction and needs to be resistant to compreeion; more type II colagen

Question 7

What is chondroid metaplasia

Answer 7

Where there is more type II collagen in a tendon so it is more ike cartilage
See this where tendons change direction
Also after injury

Question 8

What has suspensory ligament evolved from

Answer 8

interosseus muscle; so it has some muscle fibres and fat

Question 9

Where do most SDFT injuries happen

Answer 9

Mid metacarpal region; mostly forelimb

Question 10

Where do most DDFT injuries happen

Answer 10

Where it changes direction i.e around fetlock within tendon sheath or around navicular bone wihtin hoof

Question 11

Where do suspensory ligament injuries tend to happen

Answer 11

At prox origin + insertion onto prox sesamoid bones

Question 12

Where do check ligament injuries happen and how do they present

Answer 12

IN prox third of forelimb metacarpus on lateral side
Get a pathognomic lateral swelling

Question 13

What are common soft tissues around stifle that get injured

Answer 13

Cruciate ligament
Medial meniscus

Question 14

When does most tendon education happe

Answer 14

in the foal so want foal to be active

Question 15

Why should we refrain from training horses at competition standard too often

Answer 15

Because this puts them in stage 3 of stress/strain graph i.e above threshold for microdamage of tendons

Question 16

What are the advantages/disadvantages of overreach boots and when should we use them

Answer 16

can stop overreach injuries
But contributes to physiologcal heating effect in tendons so can cause denaturaiton

Only use in horses that tend to overreach

Question 17

What happens in the remodelling phase o tendon injury

Answer 17

Tendon size decreases
Transformation back to springy type I collage from type III

Question 18

Why do scar tissue lesions in tendons tend to extend proximally and distally over same cross sectinoal area

Answer 18

Because this section is non-compliant so during tendon stretch there is pulling on the parallel fibres above and below the lesion

Question 19

What structures are within the digital flexor tendon sheath

Answer 19

DDFT
SDFT
MAnica flexoria
Palmar/plantar annular ligament

Question 20

what is the manica flexoria

Answer 20

Part of SDFT which forms a tunnel for DDFT to travel through

Question 21

What is the annular ligament and what happens when it gets injured

Answer 21

= ligament that holds DDFT/SDFT in canal
Very uncompliant tissue

When it is injured and heals, it shortens causing constriction of the tendon sheath, this leads to effusions around flexor tendons and even more compression and inflammaiton
= compartment-like syndrome

Question 22

How do treat palmar annular ligamnet syndrome

Answer 22

Cut the palmar annular ligament

Question 23

Characteristics of ultrasound as a diagnostic device for soft tissue injuries

Answer 23

High specificity
Low sensitivity

Question 24

Why is it. agood idea to do tenoscopy and removal of torn manica flexoria parts

Answer 24

Because they drive tneon injury

Question 25

What do we see with a peroneus tertius tear

Answer 25

Reciprocal apparatus breaks down Can extend the tarsus without extending stifle

Question 26

What is peroneus tertius the antagonist of

Answer 26

SDFT

Question 27

What horses is locking stifle seen most in

Answer 27

Miniature horses

Question 28

How to treat locking stifle in mild vs severe cases

Answer 28

mild = rehab severe = medial patellar ligament desmotomy

Question 29

Which meniscus is more commonly injured and which aspect

Answer 29

Medial meniscus as cranial aspect

Question 30

How to diagnose meniscal injuries

Answer 30

arthroscope U/S can be used for severe ones

Question 31

What kind of lameness is cruciate ligament injury associated with

Answer 31

Acute, severe lameness rather than degeneration

Question 32

What can we do to treat refractory cases of soft tissue injury in tarsal region

Answer 32

Neurectomy of deep branch of lateral plantar nerve + plantar fasciotomy to allow ligament to swell out

Question 33

What is a contraindication for neurectomy of lteral plantar nerve for lameness in tarsal region

Answer 33

marked ligament degeneration because the neurectomy can accelerate degeneration

Question 34

What sort of injuries would be candidates for biological therapies

Answer 34

Need something to inject into e,g tendon core lesion injuries within synovial structures

Question 35

Are bone marrow or adipose derived stem cells better

Answer 35

Bone marrow e.g from sternabrae

Question 36

How good is platelet rich plasma in soft tissue injury

Answer 36

Seems to heal quicker but just as likely to re-injur so less populat now

Question 37

What is the only consistently proven practctice to improve soft tissue injuries

Answer 37

Controlled exercise programH

Question 38

How to do a controlled exercise program

Answer 38

Start early with walking in hand Increase work gradually over 6-12 weeks Don't turn out free until up to canter level work in school

Question 39

What type of laser has the best effect in soft tissue injury

Answer 39

Class 4

Question 40

Difference between water treadmill and swimming

Answer 40

Water treadmill provides stress for bones and soft tissue to make them heal Adds resistance vs swimming good for aerobic fitness

Question 41

What sedatino choice would be good for scanning a horse

Answer 41

detomidine; gives 45 mins sedation + butorphanol

Question 42

What frequency probe do we use for tendon scanning

Answer 42

High freq linear probe This gives good tissue detail (traded off against low depth but this isn't needed)

Question 43

What is a lameness with thickening on lateral aspect of prox third of metacarpu s likely to be

Answer 43

Check ligament injury e.g split injury

Question 44

Large swelling on back of tarsus/carpus localises to where

Answer 44

Digital flexor tendon sheath

Question 45

Swelling over lateral aspect of distal metacarpu s might be injury to what structure

Answer 45

suspensory ligament (this is where it inserts on prox sesamoids)

Question 46

Why is the fibre pattern in a torn tendon so poor

Answer 46

Because it is not under tension See similar finding when a non-weight bearing tendon is scanned

Question 47

How should shockwave threapy be delivered for best results; weight bearing or not

Answer 47

Non-weight bearing