Summary Background Manica flexoria (MF) tears are a well‐recognised cause of lameness in horses presenting with effusion of the digital flexor tendon sheath (DFTS). Ultrasonography (US) is a commonly used first line imaging modality during examination of horses presented with DFTS effusion. However, its reported sensitivity for detection of MF tears is low. Objectives To describe a novel US technique to predict the location of the MF tear. Study design Prospective descriptive observational study. Methods Twenty‐two horses (23 limbs) diagnosed with MF tears were included in the study. A standardised US protocol including examination with the limb weight bearing and non‐weight bearing was used. Furthermore, with the limb held in flexed position digital pressure was simultaneously applied to the medial and lateral proximal DFTS outpouchings in axial direction. The aim was to create turbulence of the synovial fluid within the DFTS and improve visualisation of the torn MF. The US examination was performed by one experienced operator and one junior clinician. All horses underwent tenoscopic examination. Results In all cases MF tear was diagnosed during tenoscopic examination of the DFTS. The location of the MF tear was correctly predicted in 91.3% (21/23) of the limbs. The main features used to predict location of the MF tear included floatation of the torn fibres of the MF within the synovial fluid, increased distance between DDFT and SDFT on the side at which the MF was torn and recoiling of the MF on the side contralateral to the tear. Main limitations Relatively small number of cases included. Conclusions The novel US technique was useful to identify the location of MF tear and facilitate identification of the previously described ultrasonographic features consistent with tears of the MF. The agreement between operators was perfect as from the data analysis.

Summary This case report describes the diagnosis and arthroscopic removal of a ruptured epidermoid cyst in a distal interphalangeal (DIP) joint of a horse. The cyst was the cause of chronic moderate lameness and following removal the horse returned to athletic performance. However, 12 months postoperatively the horse was retired due to the recurrence of lameness. Epidermoid cysts have been diagnosed elsewhere in the equine digit but have not been reported intra‐articularly to the best of our knowledge.

SummaryBackgroundUltrasonography (US) is commonly used as a first‐line imaging modality in horses with lameness localised to the digital flexor tendon sheath (DFTS). The reported sensitivity of US for the detection of manica flexoria (MF) tears is low.ObjectivesTo report sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of US for diagnosing MF tears.Study designProspective observational study.MethodsSixty‐seven horses (70 limbs) with lameness localised to the DFTS were enrolled. All the horses underwent a standardised US examination of the DFTS including weightbearing (WB), nonweightbearing (NWB) and dynamic NWB US examination. The presence or absence of a MF tear was recorded. All the horses underwent tenoscopic examination as part of the treatment plan. The US diagnosis was recorded and compared with tenoscopic findings. Sensitivity, Sp, PPV and NPV were calculated.ResultsCobs and ponies were over‐represented (46/67 horses). Ultrasonographic examination correctly predicted the presence of a MF tear in 34/37 (92%) limbs (true positive). In 31/33 (94%) limbs, the MF was considered normal during US examination and this was confirmed during surgery (true negative). In two of 33 (6%) cases, US led to a false‐positive diagnosis. In three of 37 (8%) cases, US failed to identify the presence of a MF tear (false negative (FN)). In all three cases, the MF was only partially torn. The calculated sensitivity of ultrasonography for the detection of MF tears was 92%, specificity 94%, PPV 94% and NPV 91%. There was no significant difference in the ability of operators to identify MF tears.Main limitationsTwo different operators (both DECVS) performed the ultrasonographic examination. The operator performing the US examination was not blinded to the results of the lameness examination. The tenoscopic examination was performed by the same surgeon who had performed the lameness and ultrasonographic examination.ConclusionsUltrasonographic examination of the DFTS is an accurate diagnostic modality to rule in or out the presence of a MF tear. Partial MF tears that do not affect its distal border and/or its attachment onto the SDFT can be challenging to diagnose during US examination.