Tendonitis

Question 1

Where does the SDF divide and insert?

Answer 1

Divides @ P1 and inserts on P2

Question 2

Where does the DDF insert?

Answer 2

P3

Question 3

Where does the suspensory ligament originate and insert?

Answer 3

O: MC/MT3
I: sesamoid bones

Question 4

The extensor branch of the SL joins which extensor tendon?

Answer 4

Common digital extensor

Question 5

Contains intrinsic blood supply, nerves, growth factors, and provides elasticity

Answer 5

Endotenon

Question 6

Continguous w/endotenon, surrounds the tendon

Answer 6

Epitenon

Question 7

Surrounds tendons not in a sheath

Answer 7

Paratenon

Question 8

Reduces frictional forces, supplies blood vessels, and repairs elements

Answer 8

Paratenon

Question 9

Graph of how tendons respond to stress

Answer 9

Stress-strain curve

Question 10

How far can a tendon extend before rupture?

Answer 10

12-20%

Question 11

How far can a tendon extend at a walk?

Answer 11

3-8%

Question 12

How far can a tendon extend at a trot?

Answer 12

7-10%

Question 13

How far can a tendon extend at a gallop?

Answer 13

12-16%

Question 14

These structures have limited intrinsic repair

Answer 14

Tendons

Question 15

What is the main type of collagen found in scars?

Answer 15

Type 3

Question 16

Tendons in this location are less effective at healing

Answer 16

Tendon sheath

Question 17

Less elasticity of a tendon increases what?

Answer 17

Risk of re-injury

Question 18

What are 2 mechanisms of over straining?

Answer 18

Sudden overload or strain induced

Question 19

Which mechanism of overstaining is most common?

Answer 19

Repetitive microtrauma (strain induced)

Question 20

How does repetitive microtrauma cause overstraining?

Answer 20

Molecular inflammation progressively weakens the tendon

Question 21

Caused by over-reaching, wire snag, or kicking usually while the tendon is under load

Answer 21

Percutaneous trauma

Question 22

When is percutaneous trauma most serious?

Answer 22

Trauma to palmar aspect of pastern/MC

Question 23

Why is flexor tendon damage more severe than extensor tendon damage?

Answer 23

Extensor tendons are not weight bearing

Question 24

What tendons are most prone to injury?

Answer 24

SDFT and SL

Question 25

When do most tendonitis causes occur?

Answer 25

During heel strike or push-off

Question 26

Which tendon is most affected by load on push-off?

Answer 26

DDFT

Question 27

What is the most common location for tears in synovial cavities?

Answer 27

DDFT (forelimb) and manica flexoria (hindlimb)

Question 28

What are management factors that predispose to tendonitis/desmitis?

Answer 28

Increased stress, poor/deep ground, inadequate training, poor hoof care

Question 29

What are anatomical factors that predispose to tendonitis/desmitis?

Answer 29

Long sloping pasterns

Question 30

What will you notice on PE that will indicate tendonitis?

Answer 30

Bowing of palmar contour of the limb

Question 31

How long is the inflammatory phase of tendonitis?

Answer 31

1-2 weeks

Question 32

How is lameness affected during the course of a tendonitis episode?

Answer 32

Lame until inflammatory phase passes, then resolves rapidly

Question 33

What is the best modality for diagnosing tendonitis?

Answer 33

Ultrasound

Question 34

When is the best time to US a suspected tendonitis?

Answer 34

1 week after injury

Question 35

What probe do you use to dx tendonitis?

Answer 35

7.5-12mHz linear transducer

Question 36

What will you see in a damaged tendon on US?

Answer 36

Loss of normal striated fiber pattern

Question 37

How do you measure the location of the tendonitis lesion so you can track it over time?

Answer 37

Measure distance between transducer and accessory carpal bone

Question 38

Where does the DDFT become bi-lobed?

Answer 38

level of the fetlock

Question 39

What should you always offer to clients when there is pathology of the foot?

Answer 39

MRI

Question 40

How do you treat tendonitis?

Answer 40

Rest, controlled exercise, cooling, and support

Question 41

What are the goals of tendonitis treatment?

Answer 41

Reduced inflammation, best env for wound to heal, increase tensile strength, decrease risk of re-injury

Question 42

Why should you use cold hydrotherapy for 20min rather than ice?

Answer 42

Ice causes reflex vasodilation and can bring inflammation back to the site

Question 43

Reduces inflammation/edema

Answer 43

Compression and coaptation

Question 44

What NSAIDs do you use for tendonitis treatment?

Answer 44

Phenylbutazone

Question 45

What are non-surgical tendonitis treatments?

Answer 45

Intra-lesional injections, shock wave therapy, therapeutic US

Question 46

Provides scaffoling and growth factors to support repair of the tendon

Answer 46

PRP (platelet rich plasma)

Question 47

What do you inject into a tendon for intra-lesional therapy?

Answer 47

PEP, stem cells, bone marrow

Question 48

Mesenchymal stem cells, progenitor cells, and growth factors that help tissue heal w/less fibrosis

Answer 48

Stem cell therapy

Question 49

What is the most ideal non-surgical treatment available for tendonitis at this time?

Answer 49

Autologous stem cells

Question 50

Cultured from bone marrow from tuber coxae or sternum

Answer 50

Autologous stem cells

Question 51

How do you aspirate bone marrow for an autologous stem cell treatment?

Answer 51

Jamshidi

Question 52

Cells derived from adipose tissue from either side of the tail head

Answer 52

Stem cells

Question 53

Is adipose stem cells or bone marrow stem cells more effective for tendonitis treatment?

Answer 53

Bone marrow stem cells

Question 54

Increases vascularization and growth factors in the area and decreases pain

Answer 54

Shock wave therapy

Question 55

What is the goal of shock wave therapy?

Answer 55

More "organized" scar at the end of healing

Question 56

What are surgical treatment options for tendonitis?

Answer 56

Suturing tendon, superior check desmotomy, annular ligament desmotomy

Question 57

When can you perform a tendon suture?

Answer 57

In cases of percutaneous injury

Question 58

Provides support to flexor tendons and the body of the fetlock and does not have the ability to stretch

Answer 58

Annular ligament

Question 59

What is the most important component to surgical treatment of tendonitis?

Answer 59

Rehabilitation

Question 60

What is the difference in prognosis when using controlled exercise rehabilitation vs. no rehab?

Answer 60

71% with vs 25% without

Question 61

Scar tissue has less ______ and less _____ than normal tendon

Answer 61

Less elasticity and less strength