Alternative surgical treatment for synovial ganglion cyst of the digital tendon sheath in one horse

Abstract

Summary A 6‐year‐old Highland pony gelding was presented with severe left fore (LF) limb lameness of acute onset. The lameness occurred concomitantly with mild digital flexor tendon sheath (DFTS) effusion and focal painful swelling on the lateral aspect of the LF fetlock region. Clinical examination and diagnostic analgesia localised the lameness to the fetlock region and on ultrasound, a cyst‐like structure filled with anaechoic fluid was detected just proximal to the lateral sesamoid bone, at the proximo‐lateral aspect of the DFTS and adjacent to the lateral neurovascular bundle. Communication between the cyst‐like structure and the DFTS was suspected ultrasonographically and then confirmed with contrast tenography. Tenoscopic examination of the LF DFTS was performed and the communication between the fluid‐filled structure and the synovial cavity was detected. The defect in the DFTS wall was enlarged tenoscopically and the lining of the cyst‐like structure was debrided. The horse recovered well post‐operatively and was back in work with no evident lameness 8 months after surgery. This alternative minimally invasive surgical treatment had an excellent outcome and has the advantage of reducing the risk associated with en bloc resection.

Acquired peri‐articular ganglion cyst in the lateral femorotibial joint in an 18‐year‐old Percheron cross mare

“…This case report describes an acute lameness caused by the development of acquired peri‐articular ganglion cyst attached to the left lateral femorotibial joint as a result of trauma. A synovial ganglion cyst of the digital synovial sheath has been reported, and surgical debridement of the cyst in the digital sheath resulted in resolution of the lameness (Lipreri and Kelly 2020). According to the authors' knowledge, this is the first reported case that describes a peri‐articular ganglion cyst originating from the stifle joint.…”

“…However, a ganglion is described as a small cyst that does not contain synovial lining and that connects to a joint or tendon sheath through a one‐way tract (Pool 1990). Recently, Minshall and Wright (2012) proposed the term synoviocoele to describe a cavity of synovial origin resulting from disruption of both fibrous and synovial layers of a congenital synovial structure (Lipreri and Kelly 2020).…”

“…One case report described successful, conservative management of a similar clinically significant fluid‐filled mass associated with the digital flexor tendon sheath in a pony (Smith 2009). The mass was injected with corticosteroids and atropine, and the limb was bandaged for 48 h. In humans, conservative management of dorsal wrist ganglion is associated with increased recurrence rate and reduced success rate compared to surgical excision (Kahn and Hayat 2011; Lipreri and Kelly 2020).…”

Ultrasound‐guided tenoscopic decompression of digital sheath synoviocoeles in 10 horses

“…A minimally invasive approach for treatment of popliteal cysts in human knee joints, 12 and the subsequent description of successful treatment of tarsal sheath synoviocoeles using tenoscopic enlargement of the communication, 11 prompted the development of the same approach to treat DFTS synoviocoeles. Recently, a single successful treatment of tenoscopic enlargement of the synoviocoele defect into the DFTS has been reported but no case series has been published to date 14 …”

“…Recently, a single successful treatment of tenoscopic enlargement of the synoviocoele defect into the DFTS has been reported but no case series has been published to date. 14 The purpose of this study was therefore to report the clinical and diagnostic features of DFTS synoviocoeles in 10 horses treated by tenoscopic fenestration under intraoperative ultrasonographic guidance, and to report the long-term outcome of return to athleticism and lameness resolution.…”