Equine Tendon and Ligament Dz Flashcards

(41 cards)

1
Q

What are the most common sites of tendon injury?

A
  • SDFT
  • Suspensory
  • Accessory ligament of the DDFT
  • DDFT
    (in that order)
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2
Q

Types of tendon injury?

A
> percutaneous
- laceration/penetration 
> subcutaneous (most common)
- not associated with direct external trauma
- strain, displacement
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3
Q

Cause of over-strain injuries?

A
> sudden overextension
- ?DDF
> preceding tendon degeneration + sudden oveextension 
- SDFT, SL 
(working close to limit of strain)
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4
Q

How does the tendon sheath affect the physiology of tendon?

A
  • outside sheath, paratenon surrounds the tendon
  • in sheath, healing slower and poorer
  • adhesions can form here
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5
Q

What is a bowed tendon?

A
  • SDFT injury

- usually extrathecally ( outside tendon sheath)

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6
Q

Hx of tendon injury?

A
  • intense excercise

- signs can be delaed

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7
Q

clinical exam findings with tendon/lig injuries?

A

> 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

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8
Q

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

A
  • ~7d

- and give prognosis

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9
Q

Type of equipment used for ultrasounding tendons?

A
  • high frequency 7.5MHz and linear transducer
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10
Q

Clinical exam findings with SDFT tendinopathy/tenditis?

A

> palmar metacarpal swelling

  • initial lameness (variable)
  • pain on palpation
  • core lesion with surrounding healthy tissue
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11
Q

Hx and PE findings of PROXIMAL suspensory ligament desmitis?

A

> 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

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12
Q

What is the strangulation technique?

A

pushing SDFt and DDFt to palapte underlying SL in proximal canon

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13
Q

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

A
  • OUTSIDE circle

- soft surface

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14
Q

Ultrasound/radiographic findings with suspensory body and branch desmitis?

A
(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
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15
Q

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

A
  • swelling prox metacarpal region
  • dorsal SDFT
  • lamess often ABSENT
  • ultrasound : generalised enlargement
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16
Q

Which is the rarest tendinopathy?

A

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

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17
Q

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

A
> 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
Q

What are windgalls?

A

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

19
Q

How does tenosynovitis affect lexor tendon region?

A
  • important consequences for associated soft tissues and bone
20
Q

Causes of digital sheath tenosynovitis?

A
  • idiopathic (widngalls)
  • non-septic (1* or mostly 2* )
  • penetrating injuries -> sepsis
21
Q

What is ALS? PE?

A

> 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
Q

Further dxx findigns with ALS?

A
> digital sheath analgesia
- usually + but may not be 100% 
- ?mechanical element to lameness? 
> Ultrasound 
- >2mm thickness
23
Q

What are the 3 phases of tendonitis?

A
> acute
  inflammaotry
> subacute 
fibroplasia
> chronic
- remodelling 
(over ~1yr, SL quicker, tendons slower)
24
Q

Historical tx for tendonitis?

A
  • 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