Noninfected tenosynovitis of the digital flexor tendon sheath: a retrospective analysis of 76 cases

Abstract

Summary Reasons for performing study: Until recently, the pathogenesis of noninfected tenosynovitis of the digital flexor tendon sheath (DFTS) has been considered obscure. With the advent of tenoscopy some inciting causes have been described, but to date few cases with a precise diagnosis have been reported. Hypothesis: Tenoscopic surgery enables accurate diagnosis and facilitates treatment of noninfected tenosynovitis of the DFTS. Methods: The case records of all horses with noninfected tenosynovitis of the DFTS admitted to a referral clinic over a 7‐year period were evaluated retrospectively. Follow‐up information was obtained by telephone questionnaire. Results: A total of 76 horses were referred; all were evaluated tenoscopically and 11 of these subsequently were explored by open surgical techniques. The most common diagnoses were marginal tears of the deep digital flexor tendon (DDFT) (n = 44) and tears of the manica flexoria (MF) (n = 23). Greater than 6 months' follow‐up information was available for 61 animals, of which 68% were sound and 54% returned to preoperative levels of performance. Sheath distension was eliminated in 33% and improved in 69% of horses. Marginal tears of the DDFT, marked preoperative distension and open surgical repair of deep digital flexor lesions were associated with reduced levels of post operative performance: Marginal tears were associated with post operative lameness and long tears with a reduced performance level compared with short tears. Marginal tears of the deep digital flexor tendon, marked preoperative distension and increasing duration of clinical signs also were associated with lack of improvement in distension following surgery. Conclusion: Tenosynovitis of the DFTS may result from tears in the deep or superficial digital flexor tendons, manica flexoria or other structures with synovial communication. To date, these can be identified confidently only by tenoscopy, which also permits appropriate lesion management. Potential relevance: The diagnostic information obtained from and therapeutic options offered by tenoscopy justify its early use in cases of noninfected tenosynovitis of the DFTS.

Rupture of the Vinculum in Association with Tendon Injury within the Digital Flexor Tendon Sheath in Two Horses

“…AT-DFTS in horses is well described in the literature [8][9][10][11][12]. AT-DFTS is a commonly encountered condition characterized by a palpable effusion of the DFTS proximal and distal to the PAL.…”

Exposure of a tendon extracellular matrix to synovial fluid triggers endogenous and engrafted cell death: A mechanism for failed healing of intrathecal tendon injuries

“…Surgical debridement in isolation does not generate acceptable success rates [12] with 60-62% of horses diagnosed with DDFT tears unable to return to their previous level of work and the prognosis worsening to 82% for larger tears [13].…”

Palmar annular ligament desmotomy in horses with the Arthrex-Centerline™ : An <i>ex-vivo</i> study

“…The desmopathy of the palmar annular ligament (PAL) has been described in several different conditions in the horse (Gerring and Webbon, 1984;Dik et al, 1995;van den Berg et al, 1995;Wilderjans et al, 2003). The PAL syndrome is characterized by constriction and thickening of the flexor sheath with a relatively normal appearance of the PAL.…”

“…An increase in the volume of the digital flexor tendon sheath (DFTS) may be due to a lesion within the superficial flexor tendon, the manica flexoria or tenosynovitis of the synovial sheath of the flexor tendons (Dik et al, 1995;van den Berg et al, 1995;Smith and Wright, 2006). The classic presentation of the disease is characterized by lameness associated with the fetlock bowed at the level of PAL (Gerring and Webbon, 1984;Smith and Wright, 2006) and the proximal edge of the DFTS. Injury to the PAL has been described in the literature as plantar/palmar annular desmitis (PADs) and is due to a thickening of the annular ligament (McGhee et al, 2005).…”

“…The PAL desmotomy has been described with several techniques, such as surgical treatment for PAL syndrome. Open surgery, minimally blinded surgery and endoscopic surgery have been employed (Nixon, 1990;Nixon et al, 1993;Fortier et al, 1999;Hawkins and Moulton, 2002;Smith and Wright, 2006). The use of endoscopic techniques are minimally invasive and allow access to the PAL, creating intraoperative visualization of the intrathechal structures.…”