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Equine tendon and ligament disease - Coggle Diagram
Equine tendon and ligament disease
clinical evaluation
stance and gait
metacarpophalangeal joint extension
decreased
reduced weight bearing (pain)
fibroses (stiff) tendon
increased
severe SDFT/SL injuries
elevating toe
DDFT rupture
superficial digital flexor tendinopathy
palmar metacarpal swelling
initial lameness
pain on palpation
core lesion on USS
Proximal suspensory ligament desmitis
History
lameness variable in degree and acute or insidious onset
straight hock, overextending MTP joint
clinical signs
often lamer with limb on outside of a circle
proximal MC/MT swelling (variable)
pain on palpation
medial palmar vein distension
diagnostic analgesia or diagnostic imaging (USS, Radiography,gamma scintography, MRI)
suspensory body and branch desmitis
variable lameness
USS
Branches need imaging from medial and lateral aspects
Focal or generalised lesions
Enlargement
Periligamentar fibrosis very common
Bilateral involvement common
radiography
concurrent bony abnormalities
desmitis of the accessory ligament of the deep digital flexor tendon (inferior check ligament)
swelling in proximal metacarpal region
dorsal to SDFT
lameness variable (often absent)
USS often generalised enlargement
Deep digital flexor tendinopathy
almost always within digital sheath or navicular bursa
mid-substance disruption
marginal tears
tenosynovitis
dysfunction important consequences for associated soft tissue and bone
digital sheath
idiopathic distension
penetrating injuries - sepsis
non-septic inflammation
primary
most secondary
intra-thecal tendon and ligament injury
annular ligament syndrome
lameness is mild to moderate and minimally responsive to rest
occasionally irregular gliding of tendons
distended digital sheath
notch at level of PAL
digital sheath analgesia
usually positive but may not be 100%
USS >2mm thickness
Tendonitis treatment
acute inflammatory phase (0-2 weeks)
clinical signs
lameness
pain on palpation
heat
swelling
pathology
haemorrhage
inflammation
neutrophils, macrophages, monocytes, increased blood flow, oedema, proteolytic enzymes
minimise inflammation
physical therapy
application of cold (ice)
compression
MCP joint support
rest
medication
short acting steroids (only within 24-48h) systemically or peritendinously
beware of laminitis
NSAIDs
analgesia
surgery
percutaneous tendon splitting (knife, needles) possible to combine with intratendinous medication
subacute (reparative phase 1w-6m)
clinical signs
reduction or absence of lameness
resolution of signs of inflammation
tendon still palpably enlarged and soft
signs of re-injury if exercised too early
pathology
angiogenesis
fibroplasia (++ fibroblasts, collagen III, small collagen fibrils formed)
rational treatment
promote fibroplasia
optimise organisation of scar
mobilisation
early
progressive
introduce trotting after 3 months (SDFT)
regular ultrasonographic monitoring every 2-3m
exercise level based on CSAs (<10% increase)
Attempt to induce regeneration rather than repair
Scaffolds
ACell (lyophilised pig bladder submucosa)
Growth factors
Platelet rich plasma (PRP)
Cell therapy
Mesenchymal stem cells
From bone marrow – requires culture
From fat – ‘minimally manipulated’
Alloegnic (soon to be marketed by Boehringer Ingelheim)
chronic remodelling phase (3-18m)
clinical signs
tendon size decreases
tendon less pliable
reduced fetlock extension
(contractures)
pathology
collagen transformation from III to I
cross linking
thicker collagen fibrils
promote remodelling and prevent re-injury
controlled ascending exercise (lower exercise level)
USS monitoring
Surgery
desmotomy of accessory ligament of superficial digital flexor tendon (superior check ligament)
Developmental disease of tendon
flexural limb deformities
aetiology
congenital
uterine malpositioning
CDET rupture
acquired
part of developmental orthopaedic disease
pain (OCD, physics etc)
treatment
conservative: exercise, shoeing, splints
surgical release
carpal flexural deformity
congenital
exercise, physiotherapy, tube casts, (surgery)
distal interphalangeal joint flexural deformity
classification
Acquired – ~6 months of age
Type 1
Dorsal hoof wall less than vertical
treatment
Exercise and physiotherapy
Toe extension shoe
Surgery
Desmotomy of the ALDDFT
(DDFT tenotomy)
Type 2
Dorsal hoof wall past vertical
treatment
Usually surgery necessary
Desmotomy of ALDDFT
(DDFT tenotomy)
Pain-related?
NSAIDs
In adults
Forelimbs – chronic lameness
Hind-limbs – usually desmitis of ALDDFT
metacarpophalangeal joint flexural deformity
also can occur secondary to chronic SDFT tendinopathy in adults
treatment
exercise/physiotherapy
toe extension and raised heel shoe
splint/braces
beware of creating sores
surgery
desmotomy of ALDDFT/ALSDFT
SDFT tenotomy
tendon laxity
congenital or acquired secondary to casting
treatment
spontaneous recovery, heel trimming, heel extension shoe, controlled exercise
