Equine tendon and ligament disease Flashcards Preview

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Flashcards in Equine tendon and ligament disease Deck (50):
1

Name 2 types of tendon injury

- percutaneous: laceration/ penetration
- subcutaneous - strain, displacement

2

Causes of over-strain injury

- sudden over-extension (DDFT?)
- preceding tendon degeneration with superimposed sudden over-extension (SDFT, SL)

3

Dx - tendon injry

- Hx (usually preceding intense period of exercise, signs can be delayed)
- CE - lameness (can be temporary, can persist for some tendon/ligament injuries)
- Stance/ gait - MCPJ extension (decreased with reduced weight bearing / pain and fibrosed/ stiff tendon. increased with severe SDFT/SL injuries. Elevating toe - DDFT rupture

4

What is a pathognomic sign for DDFT rupture?

toe elevation

5

How should you palpate the limb? 2

- weight bearing
- limb lifted

6

Which areas are difficult to palpate? 2

- proximal SL in HL
- pastern

7

What to assess on palpation? 3

- pain
- tendon suppleness
- oedema

8

What is the role of ultrasound?

- DIAGNOSIS
- SEVERITY ASSESSMENT: 7 d after injury, prognosis

9

What ultrasound equipment is used to examine the leg?

7.5 MHz (high frequency) + linear transducer

10

Describe SDFT tendinopathy

- palmar metacarpal swelling
- initial lameness (variable)
- pain on palpation
- 'core' lesion on ultrasound

11

Hx - suspensory ligament desmitis/ proximal suspensory desmitis

- HX: lameness variable in degree, acute or insidious
- CS: conformation (HL) is straight hock adn overextending MTP joint

12

CS - proximal suspensory disease

- Lameness (often lamer with limb on outside of circle, proximal MC/MT swelling is variable and with medial palmar vein distension, pain on palpation vs normal)
- diagnostic analgesia
- diagnostic imaging (US, xray, gamma-scintigraphy, MRI)

13

Suspensory body and branch desmitis:
- CS
- Ultrasound
- Radiograph

- CS: variable lameness
- ULTRASOUND: branches need imaging from medial and lateral aspects, focal or generalised lesions, enlargement, periligamentar fibrosis very common, bilateral involvement common
- RADIOGRAPH: concurrent bony abnormalities

14

Define ALDDFT

Accessory Ligament of the DDFT (= 'accessory check ligament')

15

CS - desmitis of the ALDDT ('inferior check ligament')

- swelling in proximal MC region, mostly lateral
- dorsal to SDFT
- lameness variable (often absent)

16

Ultrasound - desmitis of the ALDDT ('inferior check ligament')

- generalised enlargement

17

What happens in DDFT tendinopathy?

- usually within digital sheath or navicular bursa (never in MC region?)
- mid-substance disruption vs. border tears
- e.g. intra-thecal tendon tears

18

What is the manica flexoria?

part of the SDFT that wraps around the DDFT at the fetlock joint. Function is to maintain tendon alignment within DFTS.

19

Examples of intra-thecal tendon tears

- DDFT (usually lateral border for tear, TL)
- Manica flexoria (usually HL)

20

Ultrasound diagnosis: intra-thecal tendon tears

- difficult
- lateral or medial echogenic material
- MF instability in longitudinal view

21

Causes - tenosynovitis

DIGITAL SHEATH:
- idiopathic distension
- non-septic inflammation (primary, most secondary)
- penetrating injuries (sepsis)

22

What is tenosynovitis important?

because the dysfunction results in important consequences for soft tissues and bone

23

Define ALS

Annular Ligament Syndrome

24

CS - ALS

- Lameness (mild-moderate, minimally responsive to rest, occasionally irregular gliding of tendons)
- distended digital sheath
- 'notch' at level of PAL

25

Diagnosis - ALS

- Digital sheath analgesia (usually positive but may not be 100%, may have a mechanical component to lameness)
- Ultrasonography (+tenoscopy, look for if >2mm thickness)

26

General principles -tx of tendonitis

- many tx advocated in past (many have no effect, some are deleterious)
- very few EBVM choices
- base tx on tendon pathology and phases of tendon healing

27

What are the 3 phases of tendon healing?

- acute/ inflammatory
- subacute/ fibroplasia
- chronic/ remodelling (never back to normal)
- 12-18 months for tendon repair
- 3-6 months for ligament repair

28

Acute inflammatory phase of tendonitis (0-2 wks):
- CS
- Pathology
- Rational tx

- CS: lameness, pain on palpation, heat, swelling
- PATHOLOGY: haemorrhage and inflammation (neutrophils, macrophages and monocytes, increased BF, oedema, proteolytic enzymes)
- TX: minimise inflammation

29

Describe tx of acute inflammatory phase of tendonitis

- PHYSICAL THERAPY: apply cold/ ice, compression, MCP joint support (rest)
- MEDICATION: short-acting steroids (only within 24-48 hours, systemic or peritendinously, beware of laminitis and masking problem), NSAIDs (analgesia)
- SURGERY: percutaneous tendon splitting (knife, needles, may combine with intra-tendinous meds)

30

Subacute/ reparative phase of tendonitis (1 wk - 6 mo):
- CS
- Pathology
- Rational tx

- CS: reduction or absence of lameness, resolution of signs of inflammation, tendon still palpably enlarged and soft, signs of re-injury if exercised too early
- PATHOLGOY: angiogenesis, fibroplasia (many fibroblasts, collagen 3, small collagen fibrils formed)
- RATIONAL TX: promote fibroplasia, optimise scar organisation, regular US monitoring (every 2-3 months, exercise level based on CSA), mobilisation (early, progressive - introduce trotting 3 months after SFDT injury), biologicals

31

What biological tx may be given for tendonitis? 3

- scaffolds (ACell = lyophilised pig bladder submucosa
- growth factors (platelet rich plasma = PRP)
- cell therapy (mesenchymal SCs)

32

Outline method of mesenchymal SCs for tendonitis

- recovery of heparinised bone marrow from 2 separate sternebrae
- located with diagnostic ultrasound
- recovery of nucleated adherent SC population
- one passage
- resuspension in citrated supernatant of BM
- implantation under USG
- post-implantation 48 wk rehab programme

33

Chronic phase of tendonitis (3-18 months):
- CS
- Pathology
- Rational Tx

- CS: tendon size decreases, tendon less pliable, reduced fetlock extension, (contractures)
- PATHOLOGY: collagen transformation from 3 to 1, cross-linking, thicker collagen fibrils
- RATIONAL TX: promote remodelling, prevent re-injury

34

Outline tx for chronic phase of tendonitis

- controlled ascending exercise (lower exercise level)
- US monitoring
- Surgery: desmotomy of the accessory ligament of the SDFT ('superior check ligament'), higher incidence of suspensory desmitis, carpal sheath approach)

35

When is extracorporeal shock wave therapy indicated?

- Proximal Suspensory Desmitis (PSD): both TL and HL

36

When is fasciotomy and neurectomy therapy indicated?

For HL PSD which have failed to improve after the first 2 tx of extracorporeal shock wave therapy

37

What is extracorporeal shock wave therapy?

high energy pressure waves to pulverise the proximal suspensory region

38

How might you tx intra-thecal tendon/ligament lesions?

- medication?
- intrasynovial location gives poor healing
- tenoscopy/ arthroscopy

39

How might you tx HL manica flexoria tears?

good prognosis with removal (70-80%)

40

How might you tx TL DDFT tears?

debridement but poor prognosis (20-40%)

41

List some developmental diseases of tendon

- flexural limb deformities
- carpal flexural deformities
- DIPJ flexural deformity
- MCPJ flexural deformity
- tendon laxity

42

Describe flexural limb deformities:
- what
- aetiology
- tx

- tendon developmental disease
- AETIOLOGY: congenital (possibly uterine malpositioning or CDET rupture) or acquired (part of 'developmental orthopaedic disease', pain (OCD, physitis etc)
- TX: conservative (start with this, exercise, shoeing, splints), then surgical release if unsuccesful

43

Describe carpal flexural deformity
- what
- aetiology
- tx

- tendon developmental disease
- congenital
- TX: exercise and physio (most cases respond to this), then tube casts, (sx)

44

Describe DIPJ flexural deformity:
- what
- aetiology
- types
- tx
- adults

- tendon developmental disease
- acquired (6 months old)
- TYPE 1: dorsal hoof wall less than vertical
- TYPE 2: dorsal hoof wall past vertical
- Pain-related? --> NSAIDs
- ADULTS: TL --> chronic lameness, HL = usually desmitis of the ALDDFT

45

Another name fro DIPJ flexural deformity

'ballerina foals'

46

Tx - type 1 DIPJ flexural deformity

- exercise and physio
- toe extension shoe
- sx (desmotomy of ALDDFT, (DDFT tenotomy))

47

Tx - type 2 DIPJ flexural deformity

- usually sx necessary
- desmotomy of ALDDFT
- (DDFT tenotomy)

48

Describe MCPJ flexural deformity

- also can occur secondary to chronic SDFT tendinopathy in adults

49

Tx - MCPJ flexural deformity

- exercise/ physio
- toe extension and raised heel shoe
- splints/ braces (beware of sores!)
- sx (desmotomy of ALDDFT, desmotomy of ALSDFT, SDFT tenotomy)

50

Describe tendon laxity:

- congenital
- acquired (secondary to casting)
- Tx: spontaneous recovery, heel trimming, heel extension shoe, controlled exercise)