Lecture 15: Tenosynovitis and Desmitis Flashcards
(77 cards)
1
Q
Muscles attach to periosteum via
A
Tendons
2
Q
What are tendons made of
A
Ropes of collagen fibers
3
Q
What is the tendon composed of
A
Tenocytes/fibroblasts (sparse)
4
Q
What are tenocytes/ fibroblasts responsible for
A
synthesis and turnover of ECM
5
Q
Metabolism of tenocytes and fibroblasts are regulated by ___
A
Biomechanical and mechanical stimuli
6
Q
What is the ECM of tendons made of
A
- Water- 65%
- Collagen- type I- 30%
- Elastin
- Glycoproteins
7
Q
Tendon Collagen fibers are oriented ___to long axis of bone which it’s important for ___
A
Parallel, elasticity and energy storage (makes horses run fast)
8
Q
Tendons allow for __motion
A
Gliding
9
Q
What is the vascular supply of the tendon
A
- Muscle/bone at origin/insertion
- Paratenon and endotenon in tendon proper
10
Q
Compared to tendons ligaments have less ___, ___ and ___
A
Collagen, elastic and organization
11
Q
___generates movement and __resist movement
A
Tendons, ligaments
12
Q
What are some internal causes of tendonitis
A
- Bio mechanical overload (strain)
- Hyperthermia
- Vascular
13
Q
What are some external causes of tendon injuries
A
Blunt trauma, wounds
14
Q
Are flexors or extensors more commonly affected with tendonitis
A
Flexors
15
Q
Is the SFDT or DDFT more commonly affected with tendonitis
A
SFDT
16
Q
Why is resolution of tendonitis problematic
A
- Slow to heal- poor blood supply
- Inferior in strength and elasticity
- High incidence of recurrence
17
Q
Which tendon has the smallest cross sectional area and is most external so experiences the greatest strain and trauma
A
SDFT
18
Q
SDFT is less vascular in the ___region which is where most lesions occur
A
Mid-metacarpal region
19
Q
Identify 1-4
A
- SDFT
- Inferior check
- DDFT
- Lateral suspenory ligament
20
Q
Which venogram is DDFT and which is SDFT
A
left: DDFT- more vascularized
Right: SDFT
21
Q
What bio mechanical forces contribute to overload in tendonitis
A
- Altered hoof conformation- under run heels and long toe
- Work on very hard or very soft surfaces
- Muscular fatigue at end of race- tendons take on load
22
Q
What hoof conformation contributes to tendonitis
A
Underrun heels an long toe
23
Q
what is wrong with this hoof confirmation and what does it predispose them to
A
Underrun heels and long toe
Tendonitis
24
Q
What occurs in the subclinical phase of tendonitis
A
Degradation of ECM, weakened tendon
25
What occurs in clinical phase of tendonitis (1-2 weeks)
Acute inflammation- lame, warm, swollen
26
What occurs during reparative phase of tendonitis (3 weeks)
1. Tenocytes migration
2. Fibroplasia
3. Angiogenesis
27
What occurs in remodeling phase of tendonitis
1. Type III collagen replaced with type I
2. Formation of cross links
3. Re-orientation of fibers with max tension- parallel to axis of limb
28
What is the result of repaired tendonitis
Scar tissue with reduced strength and increased stiffness/less elasticity
29
__% of SDFT injuries reoccur
60%
30
Reinjury of tendons occurs at ___interface
Scar/normal tendon interface
31
What are the clinical signs of tendonitis
1. Lameness
2. SDFT bow
3. Lesion within tendon sheath- tendon effusion
4. Pain on palpation
32
What is wrong here
Tendonitis, SDFT bowing
33
What modality do you use to evaluate tendon injuries
Ultrasound
34
What data is obtained during ultrasound of tendon injuries
1. Lesion echongenicity grade (1-4)
2. % loss of linear fiber pattern
35
Lesions usually look worse on ultrasound __weeks post injury
2 weeks
36
What is wrong
SDFT injury- black spot is hematoma
37
What is grade 1 lesion echogenicity
Tendon enlargement with lesions appearing only slightly hypoechoic (bright). Minimal fiber pattern disruption and minimal infiltration of inflammatory fluid
38
What is grade 2 echogenicity lesion
Approximately half echoic and half anechoic. Fiber pattern disruption and local inflammation
39
What is grade 3 echogenicity lesion
Mostly anechoic and represent significant fiber tearing
40
What is grade 4 echogenicity lesion
Totally anechoic, rupture. Lesions appear homogenous black areas within a structure and indicate almost total fiber tearing with hematoma formation
41
How do you evaluate rehabilitation protocol and gradual return to work from tendonitis
Serial ultrasounds every 6 weeks
42
What is treatment for acute/clinical phase of tendonitis/desmitis
1. Stall confinement
2. Control inflammation: NSAIDS, ice boots, cold hosing, game ready
3. Bandaging
43
___is critical for treatment of tendon injury in repair phase and beyond
Controlled exercise
44
What does this progression show (left to right)
Realignment of tenocytes
45
How long does it take for tendon and ligament injuries to heal
6-7 months
46
What are some treatment options for repair phase and beyond for tendon/ligament injuries
Intra-lesional injections (PRP, stem cells, IGF-1, hyaluronic acid(
47
What are some surgical options for tendon and ligament injuries
1. Tendon splitting
2. Proximal check ligament desmotomy
3. Palmar/plantar annular ligament desmotomy
48
What is tendon splitting
Insert scalpel into core of lesion and fan it longitudinally through entire lesion- open and drain hematoma and fluid and also increase blood supply
49
Where is the proximal check ligament
Comes off back of radius, right above the knee
50
What is a proximal check ligament desmotomy
Cut it and it will increase elastic length of muscle tendon-unit and decrease tension
51
What is a palmar/plantar annular ligament desmotomy performed for
Low bows of SDFT and DDFT
52
What is the purpose of palmar/plantar annular ligament desmotomy
Allows more room for tendon to move, heal and function
53
What are some primary causes of palmar/plantar annular ligament constriction
Trauma to PAL, desmitis of PAL
54
What are some secondary causes of palmar/plantar annular ligament constriction
1. Repetitive or severe trauma to sheath
2. Infectious tenosynovitis
3. SDF/DDF tendonitis
55
What is the most frequent MRI diagnosis of the foot
Distal tendonopathy of DDFT
56
Where is the lesion located and what is it associated with for distal tendonopathy of DDFT
Lesions at level of navicular bone
Associated with navicular syndrome
57
What is treatment for distal tendonopathy of DDFT
Intra-lesional medication, navicular bursoscopy
58
What is prognosis for distal tendonopathy of DDFT
Fair to poor
59
____tendon lacerations heal well
Extensor
60
What tendon is lacerated when you see hyperextension of fetlock
SDFT
61
What ligament is lacerated when you see hyperextension of fetlock
Suspensory ligament
62
What ligament is lacerated when you see toe up
DDFT
63
What ligament is lacerated when you see fetlock on the floor
SDFT, DDFT, and SL
64
Which tendon lacerations have fair to poor cosmetic and functional outcomes
Flexor tendons
65
What are the three subdivisions of suspensory ligament
1. Origin
2. Body
3. Medial and lateral branches
66
What is the function of the suspensory ligament
Prevent fetlock hyperextension
67
What structures can be affected near the suspensory ligament
1. Splint bones
2. Proximal sesamoid bones
68
Warmbloods get suspensory ligament desmitis where and what limbs
Origin/proximal suspensory in the hind limbs
69
What do you do to evaluate traumatic suspensory desmitis
Nerve blocks, ultrasound, nuclear scintigraphy
70
Where do thoroughbreds and standards breeds typically get traumatic suspensory ligament desmitis and what limbs
Body and branches/insertion in front limbs
71
What do you do to evaluate a traumatic suspensory ligament desmitis in body and branches
Nerve blocks and ultrasound
72
How can you tx traumatic suspensory ligament desmitis
1. Intra-lesional meds
2. Shock wave
73
What treatment can you do for hindlimb proximal suspensory traumatic desmitis
Fasciotomy and neurology of deep branch of lateral plantar nerve
74
The deep branch of lateral plantar nerve provides ___ to suspensory ligament
Sensory (no motor)
75
What breeds are genetically predisposed to degenerative suspensory ligament desmitis
1. Peruvian paso
2. Arabians
3. Saddlebreds
76
What is the treatment and prognosis for degenerative suspensory ligament desmitis
No treatment, very painful, poor prognosis
77
An Arabian presents with chronic dropping fetlocks what is it most likely
Degenerative suspensory ligament desmitis
