Tendonitits

Question 1

The proximal check ligament supports which tendon and attaches where?

Answer 1

SDF and attaches to the back of the radius

Question 2

The distal check ligament supports which tendon and attaches where?

Answer 2

DDF and attaches to back of cannon bone

Question 3

Where does the SDF divide?

Answer 3

P1 and inserts primarily on P2

Question 4

Where does the suspensory ligament originate from and where does it attach?

Answer 4

Proximal MC/MT III

Attaches on proximal sesamoid bones

Question 5

What are tendons primarily made of?

Answer 5

Water and collagen type I fibers

Question 6

Endotendon

Answer 6

Endotendon: intrinsic blood supply, nerves, growth factors (surrounds fasicles and wraps entire tendon)

Question 7

Epitendon

Answer 7

Epitendon: contiguous with endotendon, surrounds tendon & endotendon ( tendons not within a sheath and outside of synovial cavity have these-allows tendon to slide within sheath by decrease friction w/ movement)

Question 8

Paratendon

Answer 8

Surrounds tendons- NOT IN A SHEATH

Outside synovial cavity

Question 9

What allows for the stretch of tendons?

Answer 9

Crimp pattern- when crimp becomes extended and lost, then becomes stretched out

Question 10

Which crimp is lost first?

Answer 10

Center lost before periphery

Question 11

How far can a tendon extend before rupturing?

Answer 11

12-20% (elastic region)

Question 12

What percentage do tendons extend at a walk, trot and gallop?

Answer 12

Walk: 3-8%
Trot: 7-10%
Gallop: 12-16%

Question 13

T/F: Tendons have a high healing property and can typically heal on their own

Answer 13

FALSE- limited intrinsic repair and requires help from us a lot of the time

Question 14

Formation of type III collagen results in what?

Answer 14

Less elastic tendon & increase plastic regions increasing the risk of re-injury

Question 15

What is the definition of tendonitis?

Answer 15

Inflammation of a tendon- most commonly from overuse but can be from infection or traumatic injury

Question 16

Where is the most common area for tendonitis?

Answer 16

SDF

Question 17

What percentage of TB return to race post SDF tendonitis?

Answer 17

20-60%

Question 18

What are the two mechanisms of overstrain?

Answer 18

Sudden overload (acute injury)
Strain induced= most common; due to repetitive microtrauma: phase of molecular degeneration which progressively weakens the tendon

Question 19

What are the two types of tendon injury classifications?

Answer 19

Overstrain

Percutaneous trauma

Question 20

When is percutaneous trauma most serious?

Answer 20

When trauma to the palmar aspect of pastern/metacarpus

Question 21

Why do extensor tendon lacerations rarely have long term consequences?

Answer 21

Flexor tendons are weight bearing so they can lacerate about 1/2 of tendons and still be able to walk
Extensor tendons are non-weight bearing structures that are used to bring a foot forwards (may notice knuckling)

Question 22

Which tendons are most prone to injury?

Answer 22

SDFT and SL

have the most load during heel strike

Question 23

Which tendon most commonly has tears within synovial cavities on fore/hind limbs?

Answer 23

DDFT (forelimb)
Manica flexoria (hind limb)

Question 24

Why are core lesions of the SDFT common?

Answer 24

Lesion in center of tendon, relatively well-circumscribed and oval in shape because of crimp
SDFT loses crimp first so this is first at risk for injury

Question 25

What is it called if there is tendonitis whithin the tendon sheath?

Answer 25

Tenosynovitis

Question 26

Where does tenosynovitis occur?

Answer 26

Annular ligament constriction

Question 27

What are predisposing factors for tendonitis?

Answer 27

Anything that increases stress on tendon/ligament - poor/deep ground surface - inadequate training --> muscle fatigue - poor conformation (long sloping pasterns) - poor hoof care (long toes, underrun heels) - improper bandaging/boots

Question 28

What would be noticed in a patient on distal PE if they had tendonitis?

Answer 28

Bowing of palmar contour of the limb (Bowed tendon)

Question 29

Upon palpation of a site with tendonitis what will you feel?

Answer 29

Swelling, painful response

Question 30

What are the cardinal CS of inflammation?

Answer 30

Heat Pain Swelling Lameness

Question 31

What is the best tool that is used for diagnosing tendonitis?

Answer 31

Ultrasound

Question 32

When is the best time to ultrasound a tendon and why?

Answer 32

One week after injury because it will be getting bigger from all the inflammatory mediators associated with the tear will be coming in and cleaning it up so you will need to wait a bit till the body clears that area so you can see what is going on

Question 33

What US probe is used on tendons?

Answer 33

7.5-12 MHz linear transducer

Question 34

What planes should a limb with suspected tendonitis be evaluated?

Answer 34

Transverse and longitudinal planes

Question 35

Where should you measure for US evaluation of tendons to see if tendonitis is present?

Answer 35

Distance between transducer and accessory carpal bone

Question 36

When does the DDFT become bilobed?

Answer 36

At the pastern

Question 37

What is the pathology of acute tendonitis?

Answer 37

Enlargement, hypoechogenicity, reduced striated pattern (hemorrhage) Changes in shape, margin or position

Question 38

What is the pathology of chronic tendonitis?

Answer 38

Variable enlargement and hetero/hyperechogenicity, irregular striated patterns (fibrosis)

Question 39

Where would you most commonly use a bone scan for tendonitis diagnosis?

Answer 39

Suspecting tendonitis where DDFT inserts and ends at P3 (can't view on US because blocked by hoof capsule)

Question 40

What do all treatment regimens of tendonitis include?

Answer 40

Rest and a controlled exercise program

Question 41

What are 3 integral parts of management of tendonitis?

Answer 41

Cooling Support/Compression Rest

Question 42

What is the goal of tendonitis treatment?

Answer 42

Restoration of tensile strength of the tendon w/out peritendinous granulation tissue and adhesions

Question 43

What are some non-sx treatments of tendonitis?

Answer 43

Cold therapy (20 minutes) Compression and coaptation (reduces inflammation/edema) NSAIDs (Phenylbutazone)

Question 44

What are the three types of intra-lesional injections used for tendonitis tx?

Answer 44

Platelet rich plasma Stem cell therapy Bone marrow

Question 45

What types of stem cells can be used for tendonitis tx?

Answer 45

Mesenchymal stem cells Bone marrow derived stem cells Adipose derived stem cells Allogenic

Question 46

What type of tendonitis treatment can increase vascularization and growth factors in the area?

Answer 46

Electric shock wave therapy | - decreases pain

Question 47

What tendons must be surgically repaired if damaged?

Answer 47

Superior check desmotomy | Annular ligament desmotomy

Question 48

What is the most important component of treatment of tendonitis?

Answer 48

Rehabilitation