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1.
Proximal digital annular ligament (PDAL) desmitis occurs in horses for which PDAL desmotomy is the only reported treatment. The presented work aims to develop a technique for safely performing PDAL desmotomy in horses. Twenty hind limbs and 13 forelimbs, harvested from horses dead or euthanized for reasons unrelated to any structure in the pastern region, were used. All horses were free of disease at the level of their PDAL. Proximal digital annular ligament desmotomy was performed using a minimally invasive approach to the digital flexor tendon sheath between the palmar (plantar) annular ligament and the PDAL, using a medial or a lateral access. Limbs were immediately dissected after the procedure to assess the completeness of the PDAL desmotomy and any possible damage to surrounding structures. The PDAL was successfully transected in all limbs except one. Damage to the surrounding tissue included transection of the palmar digital nerve (n = 1), longitudinal tear of the superficial digital flexor tendon (n = 3), and transection of the ligament of the ergot (n = 21). A medial approach was found to be safer than a lateral approach. In conclusion, PDAL desmotomy can be performed in a safe, repeatable, and technically easy way. This is, to our knowledge, the first report of a standardized technique for performing a PDAL desmotomy in the horse.  相似文献   

2.
Endoscopy of the Digital Flexor Tendon Sheath in Horses   总被引：1，自引：0，他引：1  
An arthroscopic procedure for examination of the digital flexor tendons and tendon sheath was developed in 16 equine limbs and 12 horses. Distension of the tendon sheath and insertion of the arthroscope was accomplished through a cul-de-sac on the palmar or plantar surface of the tendon sheath 1 to 2 cm palmar or plantar to the digital neurovascular structures and between the annular ligament and proximal digital annular ligament. A single arthroscope entry point allowed examination of all regions of the tendon sheath cavity and most surfaces of the digital flexor tendons within the sheath. Distal to the fetlock, surgical procedures could be performed through additional entry portals on the lateral, medial, or palmar surfaces of the tendon sheath. The palmar digital vessels and nerves were avoided by palmar placement of the instrument incisions and insertion of a needle before incising the skin. The fetlock canal and proximal regions of the tendon sheath were examined by redirecting the arthroscope. Flexion of the fetlock aided passage of the arthroscope into the proximal tendon sheath regions. Evaluation of the palmar surface of the superficial digital flexor tendon was limited by the midline attachment of the tendon sheath, otherwise the surfaces of the tendons and tendon sheath could be examined with 25 degrees and 70 degrees arthroscopes. The tendon sheath was more tightly invested to the tendons in the proximal regions, limiting the arthroscope movements and second instrument access.  相似文献   

3.
Septic tenosynovitis in horses: 25 cases (1983-1989).   总被引：1，自引：0，他引：1  
The medical records of 25 horses with septic tenosynovitis treated over 7 years (1983 to 1989) were reviewed to determine clinical features of the disease and response to treatment. The median age of horses with septic tenosynovitis was 5 years (range, 1 month to 21 years). Fourteen fore limbs and 11 hind limbs were affected. Sepsis was located in the sheath of the digital flexor tendons of 22 horses. Sepsis was located in the sheath of the extensor carpi radialis tendon (1 horse), sheath of the long digital extensor tendon (1 horse), or sheath of the common digital extensor tendon (1 horse) in the remaining horses. Nine horses received only medical treatment, using a combination of broad-spectrum parenterally administered antimicrobial drugs (8 of 9 horses), nonsteroidal anti-inflammatory drugs (8 of 9 horses), or irrigation of the wound (4 of 9 horses). Fourteen horses were treated surgically with either transection of the palmar/plantar annular ligament of the metacarpo/metatarsophalangeal joint (5 of 14 horses), lavage of the sheath after insertion of drains into the sheath (7 of 14 horses), or both (2 of 14 horses). All horses treated surgically were concurrently treated parenterally with broad-spectrum antimicrobial drugs and nonsteroidal anti-inflammatory drugs. Two horses with septic tenosynovitis were not treated and were euthanatized at the owners' request. Five horses were euthanatized before discharge from the hospital. Two horses (both treated medically) were lost to follow-up. Follow-up information was obtained for 18 horses, 6 to 55 months after discharge from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

4.
Endoscopically Assisted Annular Ligament Release in Horses   总被引：1，自引：0，他引：1  
An endoscopically assisted technique for internally dividing the palmar or plantar annular ligament was developed in six cadaver limb specimens and two anesthetized horses. Under arthroscopic view, a slotted cannula was inserted into the digital sheath through a stab wound proximal to the annular ligament and advanced through the fetlock canal superficial to the flexor tendons with the slot oriented toward the fibers of the annular ligament. Division of the annular ligament by 90-degree tipped open and guarded blades was observed and verified by direct arthroscopic view. At necropsy, complete division of the annular ligament without iatrogenic damage to the neurovascular structures was confirmed by dissection. Annular ligament division was performed in seven horses with complex tenosynovitis conditions. Tenoscopic examination and removal of tendon and digital sheath adhesions, masses, and bands was followed by endoscopically assisted annular ligament transection. At follow-up, five horses were sound athletes without recurrent digital sheath problems, one horse had residual lameness, and one horse was still convalescing.  相似文献   

5.
Magnetic resonance (MR) imaging abnormalities in horses with lameness localized to the proximal metacarpal or metatarsal region have not been described. To accomplish that, the medical records of 45 horses evaluated with MR imaging that had lameness localized to either the proximal metacarpal or metatarsal region were reviewed. Abnormalities observed in the proximal suspensory ligament or the accessory ligament of the deep digital flexor tendon included abnormal high signal, enlargement, or alteration in shape. Twenty-three horses had proximal suspensory ligament desmitis (13 hindlimb, 10 forelimb). Sixteen horses had desmitis of the accessory ligament of the deep digital flexor tendon. One horse had desmitis of the proximal suspensory ligament and the accessory ligament of the deep digital flexor tendon on the same limb and one horse had desmitis of the proximal suspensory ligament on one forelimb and desmitis of the accessory ligament of the deep digital flexor tendon on the other forelimb. Four horses did not have abnormalities in the proximal suspensory ligament or accessory ligament of the deep digital flexor tendon. Eighty percent of horses with forelimb proximal suspensory ligament desmitis and 69% of horses with hindlimb proximal suspensory ligament desmitis returned to their intended use. Sixty-three percent of horses with desmitis of the accessory ligament of the deep digital flexor tendon were able to return to their intended use. MR imaging is a valuable diagnostic modality that allows diagnosis of injury in horses with lameness localized to the proximal metacarpal and metatarsal regions. The ability to accurately diagnose the source of lameness is important in selecting treatment that will maximize the chance to return to performance.  相似文献   

6.
The following report documents an unusual anatomical finding in two cases of aseptic tenosynovitis of the digital flexor tendon sheath. Disruption of the vinculum attachment between the palmar/plantar border of the superficial digital flexor tendon and the adjacent palmar/plantar annular ligament was identified in combination with other tendon pathology within the digital flexor tendon sheath. This tenoscopic finding has not been described previously in the literature.  相似文献   

7.
Desmitis of the fetlock annular ligament was diagnosed in 30 horses during a period of eight years. Most of the horses had been lame for a prolonged period and had chronically distended digital flexor tendon sheaths. Air tendograms demonstrated thickened palmar or plantar annular ligaments. In 25 horses the ligament was cut longitudinally; of these, 16 horses returned to full work without any difficulty and one became sound after a second operation. Follow up time varied from three months to seven-and-a-half years. None of the five untreated horses returned to work.  相似文献   

8.
Lameness originating from the metacarpo(tarso)phalangeal (MP) joint has a significant effect on the use and athletic competitiveness of a horse. The identification of the cause of lameness originating from the MP joint can be challenging, given the limitations of radiography, ultrasonography, and nuclear scintigraphy. Our purpose was to describe the injury types and incidence in magnetic resonance imaging (MRI) studies from 40 horses with lameness attributable to the MP joint region where it was not possible to reach a clinically plausible diagnosis using other imaging modalities. Horses were examined in a 1.5 T magnet (Siemens Medical Solutions) under general anesthesia. The frequency of occurrence of MR lesions was subchondral bone injury (19), straight or oblique distal sesamoidean desmitis (13), articular cartilage injury and osteoarthritis (eight), suspensory branch desmitis (seven), osteochondral fragmentation (seven), proximal sesamoid bone injury (seven), intersesamoidean desmitis (four), deep digital flexor tendonitis (four), collateral desmitis (three), superficial digital flexor tendonitis (two), enostosis‐like lesions of the proximal phalanx or MCIII (two), desmitis of the palmar annular ligament (one), desmitis of the proximal digital annular ligament (one), and dystrophic calcification of the lateral digital extensor tendon (one). Twenty‐five horses had multiple MR abnormalities. MRI provided information that was complementary to radiography, ultrasonography, and nuclear scintigraphy and that allowed for a comprehensive evaluation of all structures in the MP joint region and a diagnosis in all 40 horses.  相似文献   

9.
OBJECTIVE: To determine clinical and ultrasonographic abnormalities in horses with primary desmitis of the palmar or plantar annular ligament (PAL) and the response to treatment. DESIGN: Retrospective study. ANIMALS: 25 horses. PROCEDURE: Data collected from medical records included signalment, horse use, affected limb, severity and duration of lameness, results of diagnostic tests performed, ultrasonographic findings, treatment, and outcome. RESULTS: All horses had a prominent swelling in the region of the affected PAL, and signs of pain were evident during palpation of the swelling. In all horses, the affected PAL was thicker than normal as determined ultrasonographically. Twenty horses had hypoechoic regions in the PAL. Four horses, including 1 horse with 3 affected limbs, were treated by means of PAL desmoplasty, 9 were treated by means of PAL desmotomy, and 12 were treated with rest. Follow-up information was available for 21 horses. All 4 horses that underwent PAL desmoplasty, 4 of 7 horses that underwent PAL desmotomy, and 7 of 10 horses treated with rest alone became sound. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that primary desmitis of the PAL may be a cause of lameness in horses. Although significant differences in outcome between horses treated with rest alone versus PAL desmoplasty versus PAL desmotomy were not identified, because it is less invasive, PAL desmoplasty should be considered for treatment of horses with PAL desmitis that do not respond to conservative treatment and do not have any evidence of constriction of the digital flexor tendons.  相似文献   

10.
Two hundred and thirty‐two horses with lameness localized to the metacarpo(tarso)phalangeal (MCP/MTP) region without a radiographic diagnosis were evaluated. All horses had high‐field magnetic resonance (MR) imaging of the MCP/MTP region performed for the lame limb and the contralateral limb for comparison. There were 46 horses that had bilateral abnormalities in the forelimbs; 27 of these horses were not lame in the contralateral limb at the time of examination. Bilateral hind limb abnormalities were observed in 37 horses; 22 horses were not lame in the contralateral limb. Soft tissue abnormalities alone were observed in 218 limbs (162 horses). Subchondral bone and articular cartilage abnormalities alone were observed in 43 limbs (34 horses). A combination of soft tissue, subchondral bone, and cartilage abnormalities were observed in 64 limbs (36 horses). The distribution of primary abnormalities was as follows; oblique distal sesamoidean ligament desmitis (73 limbs in 56 horses), straight distal sesamoidean ligament desmitis (44 limbs in 38 horses), chronic subchondral bone injuries (15 limbs in 12 horses), suspensory ligament branch desmitis (14 limbs in 12 horses), collateral ligament desmitis (12 limbs in 12 horses), tendonitis of the superficial and deep digital flexor tendons (10 limbs in 10 horses), osteochondral defects greater than 1 cm (nine limbs in six horses), osteochondral defects less than 1 cm (eight limbs in seven horses), bone marrow lesions (six limbs in five horses), intersesamoidean ligament desmitis (five limbs in four horses). MR imaging is useful in diagnosing bone and soft tissue injuries when radiographs and ultrasound fail to yield a diagnosis.  相似文献   

11.
The accessory ligament of the hindlimb suspensory ligament arises from the plantar aspect of the calcaneus and fourth tarsal bones and blends with the suspensory ligament in the proximal aspect of the metatarsus. The accessory ligament of the suspensory ligament of both hindlimbs of 12 mature horses, with no history of hindlimb lameness, was assessed ultrasonographically. The ligament comprised linear parallel echoes which were consistently shorter than those of the lateral digital flexor tendon; the dorsal and plantar borders were parallel. Lameness associated with injury of the accessory ligament of the suspensory ligament was identified in 6 of 8 lame hindlimbs of 5 horses, unilaterally in 4 horses and bilaterally in one horse. In all horses there was concurrent proximal suspensory desmopathy. There was localised oedematous swelling on the distal medial aspect of the chestnut extending distally in 2 horses. Lameness was best identified when the horses were ridden. Perineural analgesia of the deep branch of the lateral plantar nerve abolished lameness in 3 horses but perineural analgesia of the tibial nerve was required to abolish lameness in the hindlimb with injury of the accessory ligament of the suspensory ligament in 2 horses. Injury of the accessory ligament of the suspensory ligament was characterised by marked decrease in echogenicity of the ligament and loss of parallel alignment of the linear echoes, which were shorter than normal in longitudinal images.  相似文献   

12.
Five cases of acquired flexural deformity of the metacarpophalangeal joint (MCPJ) in older horses and ponies were studied. The mean age of affected horses was 14-8 years. Four deformities developed following desmitis of the accessory ligament of the deep digital flexor tendon (ALDDFT) and superficial digital flexor tendon (SDFT) and one following tendonitis of the SDFT alone. All cases were markedly lame and demonstrated variable degrees of flexural deformity. Ultrasonographic examination was performed on all cases which revealed extensive adhesion formation between the ALDDFT and SDFT and reduced cross-sectional area of the deep digital flexor tendon in each case. A variety of treatments were unsuccessfully employed to treat this condition. The prognosis for acquired flexural deformity of the MCPJ in old horses following tendonous damage in the palmar metacarpus is likely to be poor.  相似文献   

13.
Pre‐surgical investigation of digital flexor tendon sheath pathology remains challenging with current standard imaging techniques. The aim of this prospective, anatomical, pilot study was to describe the anatomy of the equine hind limb digital flexor tendon sheath using a combination of computed tomography (CT) and computed tomographic contrast tenography in clinically normal cadaver limbs. Ten pairs of hind limbs with no external abnormalities were examined from the level of the tarsometatarsal joint distally. Limbs initially underwent non‐contrast CT examination using 120 kVp, 300 mAs, and 1.5 mm slice thickness. Sixty millilitres of ioversol iodinated contrast media and saline (final concentration 100 mg/ml) were injected using a basilar sesamoidean approach. The computed tomographic contrast tenography examination was then repeated, before dissection of the specimens to compare gross and imaging findings. The combined CT and computed tomographic contrast tenography examinations provided excellent anatomical detail of intra‐thecal structures. The borders of the superficial and deep digital flexor tendons, and the manica flexoria were consistently identifiable in all limbs. Detailed anatomy including that of the mesotenons, two of which are previously undescribed, and the plantar annular ligament were also consistently identifiable. Dissection of all 10 pairs of limbs revealed there to be no pathology, in accordance with the imaging findings. In conclusion, the combination of CT and computed tomographic contrast tenography may be useful adjunctive diagnostic techniques to define digital flexor tendon sheath pathology prior to surgical exploration in horses.  相似文献   

14.
Three isolated equine limbs were imaged with a low-field magnetic resonance system with a vertical magnetic field. Each limb was scanned in multiple positions with mild variation of the angle between the magnetic field and the long axis of the limb. When the long axis of the limb was not perpendicular to the magnetic field, a linear hyperintense signal was present at the palmar aspect of one of the deep digital flexor tendon lobes, at the level of the navicular bone and collateral sesamoidean ligaments, in proton density and T1-weighted pulse sequences. With increased angulation of the limb, the palmar hyperintense signal extended farther distally and proximally and additional signal hyperintensity was present at the dorsal aspect of the distal part of the other lobe of the deep digital flexor tendon. Increased signal intensity was also present in the collateral ligament of the distal interphalangeal joint on the same side as the palmar hyperintense signal in the tendon. The changes in the deep digital flexor tendon are due to the specific orientation of fibers at the palmar and dorsal aspect of the tendon, which is responsible for focal manifestation of the magic angle effect. Careful positioning of the limb perpendicular to the magnetic field can prevent this phenomenon. The association of palmar increased signal intensity in the deep digital flexor tendon with increased signal in the collateral ligament of the distal interphalangeal joint on the same side should be recognized as manifestations of the magic angle effect.  相似文献   

15.
The diagnosis of restriction of free movement of the flexor tendons through the fetlock canal usually rests on the characteristic clinical appearance of this condition, or airtendography. In a series of seven normal Warmblood horses and 16 diseased horses of various breeds, the efficacy of ultrasonography in the diagnosis of this condition was determined. In normal limbs, the annular ligament is a very thin structure usually not visible on sonograms. In diseased limbs, ultrasonography outlined flexor tendon injury, distension and thickening of the digital sheath, peritendovaginal tissue proliferation and thickening of the annular ligament. Four different types of constriction syndrome were noticed. The first type (nine cases), was characterised by thickening of the annular ligament and distension of the digital sheath; the second type (three cases) was dominated by distension of the digital sheath; the third type (three cases) was characterised by superficial digital flexor tendon injury and thickening of the annular ligament and in the fourth type (one case), the constriction resulted from distension of the digital sheath and extensive peritendovaginal tissue proliferation.  相似文献   

16.
Objective: To describe partial removal of the intrathecal component of the deep digital flexor tendon (DDFT) in horses with chronic septic DDF tendonitis and tenosynovitis unresponsive to conventional therapy, and to report long‐term outcome. Study Design: Case series. Animals: Horses (n=4). Methods: Four horses with chronic septic DDF tendonitis and tenosynovitis were treated by surgical tenectomy of the intrathecal component of the DDFT, followed by stabilization in casts and subsequent corrective shoeing. All horses were previously managed unsuccessfully with combinations of conventional therapy consisting of systemic antibiotics, through and through tendon sheath lavage/open drainage, regional limb perfusions, tenoscopy with debridement and transection of the palmar/plantar annular ligament, and intrathecal antibiotics. Results: Time from initial injury/diagnosis to tenectomy ranged from 10 to 210 days. Mean hospitalization time after surgery was 82 days. Long‐term follow‐up (>1.5 years; mean, 3.8 years) was available. All 4 horses were able to walk comfortably at pasture and were used as broodmares. Conclusions: Intrathecal tenectomy is a viable surgical procedure for treatment of chronic septic tenosynovitis of the digital sheath that is complicated by septic tendonitis of the DDFT.  相似文献   

17.
The purpose of this study was to describe ultrasonographic changes of the equine palmar metacarpal area attributed to the infiltration of local anesthetic solution and to determine whether these changes were noted immediately or at 24 h. The palmar metacarpal region of one forelimb in each of six horses was examined ultrasonographically with a 10-MHz linear array transducer and a 7.5-MHz curvilinear transducer. Transverse and longitudinal images were recorded at 5-cm intervals distal to the accessory carpal bone. High and low palmar and palmar metacarpal nerve blocks were performed with a 2% mepivacaine hydrochloride solution. Ultrasonographic examinations similar to the initial examination then were performed immediately, 1 h and 24 h postinjection. Cross-sectional area and mean pixel value were determined for the superficial and deep digital flexor tendons, the accessory ligament of the deep digital flexor tendon, the suspensory ligament, and the suspensory branches at each level and time period. Subjective ultrasonographic changes also were noted. No significant difference was noted in the cross-sectional area or mean pixel value of any structure at any level or time period compared to baseline. Subjective changes in the tendons and ligaments were not noted. There was mild hypoechoic swelling of the surrounding soft tissues and gas in the region of the injections. Gas could interfere with the evaluation of the origin of the suspensory ligament and the proximal portion of the accessory ligament of the deep digital flexor tendon within the first hour but was not detectable ultrasonographically at 24 h. Based on these findings, if gas interferes with an ultrasonographic examination performed temporally close to perineural anesthesia, a repeat examination at 24 h is recommended.  相似文献   

18.
This case report describes the intralesional application of autologous conditioned plasma (ACP) in seven horses as treatment of severe tendinitis of the superficial digital flexor tendon, deep digital flexor tendon, or desmitis of the inferior check ligament. Follow-up data of the horses revealed a positive outcome in 10 to 13 months post injury. All horses treated with ACP were either performing in their previous work-load or were back in full training. Further studies with long-term follow-up will have to be performed to support these clinical intermediate-term observations.  相似文献   

19.
The aim of the study was to characterize radiopharmaceutical uptake patterns in horses with clinical and ultrasonographic evidence of proximal suspensory desmitis. It was hypothesized that radiopharmaceutical uptake in the proximal palmar (plantar) aspect of the third metacarpal (metatarsal) bone would be greater in lame limbs of horses with proximal suspensory desmitis than in sound limbs and that there would be a positive correlation between the severity of ultrasonographic abnormalities and the degree of radiopharmaceutical uptake. Nuclear scintigraphic evaluation of the proximal metacarpal or metatarsal regions of 126 horses with ultrasonographic evidence of proximal suspensory desmitis was performed. In all horses lameness was substantially improved by perineural analgesia of the palmar metacarpal (subcarpal) or plantar metatarsal (subtarsal) nerves. Scintigraphic images were assessed subjectively, by profile analysis and using region of interest analysis. Associations between the degree of ultrasonographic abnormality and radiopharmaceutical uptake ratios and the presence of radiographic abnormalities and radiopharmaceutical uptake ratios were analyzed. Subjectively, the majority of horses had normal radiopharmaceutical uptake. Profile analysis provided little additional information. However with region of interest analysis there was greater radiopharmaceutical uptake ratios in plantar images in the proximal metatarsal regions of lame limbs compared with nonlame limbs. There was no association between radiological abnormalities and radiopharmaceutical uptake ratios. In forelimbs there was no association between ultrasonographic lesion grade and radiopharmaceutical uptake ratios, however in hindlimbs there was a significant relationship between ultrasonographic grade and radiopharmaceutical uptake ratios.  相似文献   

20.
Injuries of the plantar soft tissues of the tarsus and proximal metatarsus can be a source of lameness in horses, however published information is lacking on high field MRI characteristics of these tissues. Objectives of the current anatomic study were to (1) describe high‐field MRI features of the plantar tarsal and proximal metatarsal soft tissues; and (2) compare MRI findings with gross and histological appearances of selected structures for a sample of cadaver limbs from non‐lame horses. Single hindlimbs for 42 horses, and right and left hindlimbs for eight horses were scanned using high‐field MRI. The MRI findings were described for the 50 single limbs; and the MRI, gross postmortem and histological findings were compared for the eight pairs of hindlimbs. The superficial digital flexor tendon had uniform low signal intensity, surrounded by the flexor retinaculum of intermediate to high signal intensity on all sequences. The lateral digital flexor tendon had slightly higher signal intensity, enclosed on the plantaromedial aspects by the low signal intensity metatarsocalcaneal ligament. The accessory ligament of the deep digital flexor tendon varied in size and signal intensity. The proximal and distal plantar ligaments, accessory ligament of the suspensory ligament, and calcaneoquartal ligament had low signal intensity. The long plantar ligament comprised a number of related parts, separated by lines of high signal intensity corresponding with fibrous septae seen in gross anatomical specimens. The plantar aspect of the ligament had uniform low signal intensity in all sequences, but the dorsal half was more heterogeneous with multifocal spots or lines of higher signal intensity.  相似文献   

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