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Flashcards in Equine Tendon and Ligament Dz Deck (41):
1

What are the most common sites of tendon injury?

- SDFT
- Suspensory
- Accessory ligament of the DDFT
- DDFT
(in that order)

2

Types of tendon injury?

> percutaneous
- laceration/penetration
> subcutaneous (most common)
- not associated with direct external trauma
- strain, displacement

3

Cause of over-strain injuries?

> sudden overextension
- ?DDF
> preceding tendon degeneration + sudden oveextension
- SDFT, SL
(working close to limit of strain)

4

How does the tendon sheath affect the physiology of tendon?

- outside sheath, paratenon surrounds the tendon
- in sheath, healing slower and poorer
- adhesions can form here

5

What is a bowed tendon?

- SDFT injury
- usually extrathecally ( outside tendon sheath)

6

Hx of tendon injury?

- intense excercise
- signs can be delaed

7

clinical exam findings with tendon/lig injuries?

> lameness
- can be temporary
- or can persisnt chronically (DDFT/SL)
> MCP joint overextension
- decrreased with reduced weight bearing (so weigh up lameness with overextension)
- fibrosed (stiff) tendon
> elevating toe
- PATHOGNOMONIC with DDFT (sole flexor of distal interphalangeal joint)
> palpation
- limb lifted (apply pressure ID pain) and weight bearing (location)
- may be bilaterally affected just one worse than the other
- prox SL in HL and pastern difficult to palpate
- assess pain, oedema, suppleness of tendons

8

When can ultrasound be used for assessing severity of tendon injuries?

- ~7d
- and give prognosis

9

Type of equipment used for ultrasounding tendons?

- high frequency 7.5MHz and linear transducer

10

Clinical exam findings with SDFT tendinopathy/tenditis?

> palmar metacarpal swelling
- initial lameness (variable)
- pain on palpation
- core lesion with surrounding healthy tissue

11

Hx and PE findings of PROXIMAL suspensory ligament desmitis?

> conformation (straight hock and hyperextension of the felock)
- pdf or result?
> Hx: lameness variable, acute or insiduous onset
- worse on outside circle, soft
> PE: medial palmar veain distension
- pain on palp
- diagnostic anaglesia
- imaging (US, radiograph, scintigraphy, MRI

12

What is the strangulation technique?

pushing SDFt and DDFt to palapte underlying SL in proximal canon

13

Where is the lameness worse on lameness workkup with proximal suspensory disease?

- OUTSIDE circle
- soft surface

14

Ultrasound/radiographic findings with suspensory body and branch desmitis?

(ligamentous origin)
- image from medial and lateral (both branches)
- focal/gneeralised lesions poss
- enlargement
- periligamentar fibrosis very common
- bilateral involvement common
> radiographpy
- concurrent bony abnormlaities

15

PE finding with desmitis of the accessory ligament of DDFT (Inferior check)

- swelling prox metacarpal region
- dorsal SDFT
- lamess often ABSENT
- ultrasound : generalised enlargement

16

Which is the rarest tendinopathy?

DDFT
- commonly within digital sheath or navicular bursa (never really in metacarpal region)
> mid-substance disruption v border tears
- usually lateral

17

Which intra-thecal tendon tears are most common in fore and hindlimbs?

> DDFT
- lateral border
- forelimbs
> manica flexoria
- usually HL
> ultrasound diffficult
- lateral or medial echogenic material
- MF instability in longitudinal view
- distended flexor tendon sheath

18

What are windgalls?

Bilat symmetrical, tenosynovitis -> idiopathic distnesion of the digital sheath
No need for tx if non painful and bilateral (common ponies)

19

How does tenosynovitis affect lexor tendon region?

- important consequences for associated soft tissues and bone

20

Causes of digital sheath tenosynovitis?

- idiopathic (widngalls)
- non-septic (1* or mostly 2* )
- penetrating injuries -> sepsis

21

What is ALS? PE?

> annular ligament syndrome
- milkd-mod lameness
- minimally responsive to rest
- occasionally irregular gliding of tendons
- distended digital sheath with notch at level of PAL

22

Further dxx findigns with ALS?

> digital sheath analgesia
- usually + but may not be 100%
- ?mechanical element to lameness?
> Ultrasound
- >2mm thickness

23

What are the 3 phases of tendonitis?

> acute
inflammaotry
> subacute
fibroplasia
> chronic
- remodelling
(over ~1yr, SL quicker, tendons slower)

24

Historical tx for tendonitis?

- many tx advocated n the past
- many no effect, some deleterious
- little evidence base

25

What clinical signs and pathology is associated with the inflammatory phase? (first 2 weeks)

> PE
- lamenss (dt inflam)
- pain on palp
- heat and swelling
> Path
- hameorrhage
- inflam (neutrophils, macrophages, monocytes, ^ blood flow, oedema, proteolytic enzymes)

26

Rational tx of inflammmaory phase of tendopathy?

= minimise inflammation
> physical therapy
- cold
- compression
- MCP joint support
- rest
> Meds
- short acting steroids (only within 24-48hrs, systemic or PERItendinosly, risk laminitis or apparnet resolution and over working!)
- NSAIDs (analgesia too)
> surgery
- percutaneous tendon splitting
- poss combined with intrateninour medication
- minimal evidence

27

Clinical signs and pathology associated with subacute reparative phase (1 week-6months)

> clinical signs
- reduction/abscence of lameness
- resolution of inflame
- tendon still palpably enlarged and soft
- signs of re-injury if exercised too early
> path
- angiogenesis
- fibroplasia (++ fibroblasts, collagen III, small collagen fibrils formed)

28

Tx in subacute phase (1week-6 months)

> mobilisation
- early
- prgressive (introduce trotting after 3 months for SDFT)
> regular ultrasound monitoring
- every 2-3months
- excercise based on cross sect area of tendonds (

29

3 main regenerative medicines for tendiopathy? Aims of regenerative medicine?

= aims are to induce regeneration cf. repair (-> scar)
> scaffolds
- ACell (lyophilised pig bladder submucosa)
> growth factors
- PRP (platelet rich plasma)
> cell therapy
- mesenchymal stem cells

30

Outline mesenchymal stem cell protocol?

- locate bone marrow in sternum, heparinise
- recover nucleated adherent stem cell population (one passage??)
- resuspension in citrated supernatant of BM
- implantation under ultrasound guidance (standing)
- 48 week rehab programme
> shown to be effective in racers and sports horses

31

Clinical signs and pathology associated wih chronic remodelling phase (3-18 months)

> clinical signs
- tendon size decreases
- tendon less pliable
- reduced fetlock extension
- contracture
> path
- collagen transformation from III-I
- cross-linking
- thicker collagen fibrils

32

Rational Tx in chronic phase?

= promote remodelling and prevent re-injury
> controlled ascending excercise (lower excercise level)
- with ultrasound monitoring
> surgery
- desmotomy of the accessory ligament of the SDFT ("superior check ligament")
-> ^ incidence of suspensory dismitis?
- carpal sheath approach (tenoscopic)

33

What is the fetlock joint?

Metacarpophalangeal

34

What specific txx are indicated for proximal suspensory ligament desmitis ?

> extracorporeal shock wave therapy
- forelimb PSD 50% @ 6 months for chronic cases, 90% for conservative management of acute cases
- hindlimb PSD 40% @ 6 months for chronic, 10% for acute/0% chronic cases with conservative management only
> fasciotomy and neurectomy
- for hindlimb PSD failed to improve after first 2 tx

35

Specific txx for intrathecal tendon/ligament lesions?

- medication? tenoscopy/arthroscopy?
- intrasynovial location = poor healing
> H/L manica flexoria tears
- good prog with removal (80%)
> F/L DDFT tears
- debridement but poor prog (20-40%)

36

Give egs. of developmental tendon diseases

= FLexural limb deformities
- congenital (uterine malpositiioning/CDET extensor rupture) or acquired (DOD, pain -> v loading)
> carpal flexural deformity
- congenital
> DIP flex deform
- aquired ~6mo
- type 1 =hoof can still sit flat on floor (can be loaded normally)
- type 2 =hoof past the vertical (breaker point)
- pain related? NSAIDs
- in adults: chronic lameness (FLs) or ALDDFT desmitis (HLs) can look the same
> MCP flex deform
- can occur 2* to chronic SDFT tendinopathy in adults too

37

Tx carpal limb deformity

- tx: exercise, physio, tube casts, surgery? if sx needed, prog too poor

38

Tx DIP deformity

> type 1
- exercise, physio
- toe extension shoe
- surgery: ALDDFT desmotomy /DDFT tenotomy
> type 2
- usually surgery
- ALDDFT desmotomy/DDFT tenotomy

39

Which structure is responsible for flexing the DIP?

DDFT§

40

Tx MCP flex deform?

- ALDDFT/ALSDFT desmotomy
- SDFT tenotomy last resort

41

Causes of tendon laxity? Tx?

- congenital
- acquired 2* to casting
> Tx: corrective farreiry/shoeing/ casts?? Not sure