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1.
A 5-year-old Arabian stallion with moderate effusion in the right carpal canal and intermittent lameness in this limb was diagnosed to have an osteochondroma projecting from the distal portion of the radius into the carpal canal. oral phenylbutazone treatment over the next 3 years allowed the stallion to continue its show career. Right forelimb lameness returned at that time, and ultrasonography revealed the osteochondroma impinging on the dorsal surface of the deep digital flexor tendon. The owner elected to have the osteochondroma surgically removed. The horse was anesthetized, and the carpal sheath was distended with balanced polyionic solution. A 4-mm arthroscope was inserted into the carpal sheath, and the osteochondroma projecting into the sheath was identified. The osteochondroma was removed by use of a Ferris-Smith bone rongeur, which was inserted into the carpal sheath through a stab incision over the osteochondroma. The effusion in the carpal sheath and the lameness resolved by 2 months, and the horse was returned to training 4 months after surgery.  相似文献   

2.
CASE DESCRIPTION-A 4-year-old Quarter Horse stallion was evaluated because of a 10-month history of moderate (grade 3/5) left forelimb lameness (detectable during trotting over a smooth, hard surface). CLINICAL FINDINGS-No abnormalities were detected in either forelimb via palpation or application of hoof testers; however, lameness was eliminated after administration of a palmar digital nerve block in the left forelimb. Whereas radiography and ultrasonography did not identify any left forelimb foot abnormalities, magnetic resonance (MR) imaging revealed a circumscribed soft tissue mass in the distal aspect of the digital flexor tendon sheath (DFTS) dorsal to the lateral aspect of the deep digital flexor tendon. Subsequently, the left forelimb DFTS was injected with local anesthetic, which resulted in 90% improvement of the horse's lameness. TREATMENT AND OUTCOME-The distal aspect of the left forelimb DFTS was evaluated tenoscopically. The mass was removed under tenoscopic guidance, after which the distal digital annular ligament was transected. The horse received phenylbutazone orally for 10 days, and the left forelimb DFTS was injected with hyaluronic acid and methylprednisolone acetate 7 days after the surgery. Following a rehabilitation program, the horse was returned to full training at 6 months after surgery and competed successfully during a 2-year follow-up period. CLINICAL RELEVANCE-Use of MR imaging should be considered in all lame horses for which a definitive diagnosis cannot be made via radiography, ultrasonography, or other imaging techniques, especially when the lameness has been localized to a specific anatomic region by use of diagnostic anesthesia.  相似文献   

3.
A 5-year-old Quarter Horse mare was presented to the Michigan State University Equine Surgery Service for evaluation of a right hind metatarsophalangeal joint injury. On presentation, the horse was a grade 4/5 lame. Radiographs and ultrasonography showed peritendinous ossification/mineralisation of soft tissue structures and digital flexor tenosynovitis with profound intracapsular mineralisation. A digital flexor tendon sheath tenoscopy was performed with a plantar annular ligament desmotomy and a manica flexoria ligament tenotomy. During surgery, a significant amount of tan granular material was found within the digital tendon sheath. Approximately 80% of this material was removed, and a sample was sent for histopathology. The horse was diagnosed with eosinophilic granulomatous tenosynovitis. Long-term follow-up revealed improvement with four treatments of intralesional triamcinolone given 2–4 weeks apart. The horse became serviceably sound (grade 1/5) and was beginning light work under the saddle approximately 5 months post-tenoscopy.  相似文献   

4.
OBJECTIVE: To determine the clinical, radiographic, ultrasonographic, and arthroscopic findings associated with tenosynovitis of the carpal synovial sheath induced by exostoses that originate from the caudal surface of the physeal scar of the distal radius and determine the results of surgical removal of those exostoses in horses. DESIGN: Retrospective study. ANIMALS: 10 horses. PROCEDURE: Medical records of horses with effusion in the carpal synovial sheath and lameness evaluated from 1999 to 2003 were examined. RESULTS: All horses had a history of intermittent mild to moderate effusion of the carpal synovial sheath and lameness of 1 forelimb. Results of regional perineural and intrathecal anesthesia of the carpal synovial sheath confirmed that the lameness originated in the carpal synovial sheath. Radiography revealed exostoses originating from the caudal cortex of the distal radius at the level of the closed physis. Arthroscopy was performed for confirmation and removal of exostoses that penetrated the carpal synovial sheath and impinged on the deep digital flexor tendon. All horses returned to previous athletic activity. One horse had a recurrence of clinical signs 12 months after surgery, which resolved with medical treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Tenosynovitis of the carpal synovial sheath and lameness were caused by impingement of exostoses of the caudal radius on the lining and contents of the carpal synovial sheath. Although the clinical signs and surgical treatment were similar to that caused by osteochondromas, these exostoses developed at the level of the closed physis of the distal radius and were not radiographically or histologically similar to osteochondromas.  相似文献   

5.
A 15-year-old Sports horse gelding was referred for nonweightbearing lameness of the left hindlimb. Septic cellulitis was diagnosed and managed medically. After 14 days, septic tenosynovitis of the digital flexor tendon sheath (DFTS), with septic tendinitis of the superficial (SDFT) and deep (DDFT) digital flexor tendons, became evident. Surgical resection of the intrathecal portion of the septic SDFT was performed. Post-operatively, a half-limb cast was placed on the operated limb for 10 weeks followed by an articulated orthotic support boot during a rehabilitation period of 6 weeks. The horse recovered and regained long-term pasture soundness. Ultrasonography demonstrated the presence of bridging connective tissue in the location of the resected SDFT.  相似文献   

6.
This report describes an adult Quarter Horse gelding that was presented for evaluation of chronic tenosynovitis of the right common digital extensor tendon sheath. Radiographic and tenoscopic evaluation confirmed the presence of a periarticular osteophyte from the third metacarpal bone protruding into the common digital extensor tendon sheath. Tenoscopic surgical resection of the osteophyte and debridement of the affected tendon resolved the tenosynovitis and associated right forelimb lameness. Osteophytes in this location can be a source of focal traumatic tendonitis of the common digital extensor tendon which can lead to a chronic tenosynovitis of the common digital extensor tendon sheath. Tenoscopic debridement and lavage is a viable treatment option for chronic nonseptic common digital extensor tendinopathy and associated tenosynovitis.  相似文献   

7.
A mare was evaluated for acute left forelimb lameness with effusion of the carpal flexor sheath. No osseous abnormalities were noted during radiographic examination. Significant disruption of the accessory ligament of the deep digital flexor tendon was seen during ultrasonographic examination. Carpal sheath effusion and lameness resolved after medical treatment.  相似文献   

8.
Objective —To describe the tenoscopic anatomy of the carpal sheath of the flexor tendons (carpal sheath) viewed from a lateral approach.
Study Design —Tenoscopic observation of structures within the carpal sheath subsequently confirmed by dissection.
Animals or Sample Population—12 equine cadaveric forelimbs.
Methods —The limbs were positioned lateral side up with the carpus slightly flexed. After distention of the carpal sheath, a portal for the arthroscope was made approximately 3 cm proximal to the distal radial physis and 2.5 cm caudal to the radius between the tendons of the ulnaris lateralis and lateral digital extensor muscles.
Results —A lateral tenoscopic approach was adequate to identify all structures within the carpal sheath. From proximal to distal, structures identified using this approach were the radial head of the deep digital flexor muscle, accessory ligament of the tendon of the superficial digital flexor muscle, distal radial physis, tendons of the superficial and deep digital flexor muscles, accessory carpal bone, antebrachiocarpal and middle carpal joints, and vincula of the tendon of the deep digital flexor muscle.
Conclusions —A lateral tenoscopic approach offered an easy, repeatable entry into the carpal sheath and allowed good observation of all structures within the sheath except for the medial borders of the tendons of the deep and superficial digital flexor muscles.
Clinical Relevance —Applications of a lateral tenoscopic approach to the carpal sheath include diagnostic procedures, lavage and synovial resection for septic tenosynovitis, desmotomy of the accessory ligament of the tendon of the superficial digital flexor muscle for flexural deformity or tendinitis, and removal of osteochondromas from the distal radial metaphysis.  相似文献   

9.
Osteochondroma of the distal portion of the radius was diagnosed in 3 horses with a history of lameness and distention of the common tendon sheath of the superficial and deep digital flexor tendons at the level of the carpal canal. In 2 horses, the exostosis was removed through an incision at the caudal border of the lateral digital extensor muscle above the carpal ligament.  相似文献   

10.
Chronic active tenosynovitis of the digital sheath can become increasingly complicated by intrathecal mass and adhesion development, annular ligament constriction, and secondary linear clefting or flattening of the tendons. Endoscopic techniques (tenoscopy) provide a minimally invasive mechanism for thorough digital sheath examination, resection of masses and adhesions, transection of the annular ligament, and debridement of frayed edges after secondary damage. Use of a torniquet, an arthroscope entry point distal to the annular ligament, and instrument portals over the proximal cul-de-sacs of the sheath provide access for tendon and tendon sheath repair. The surgery in advanced cases can be challenging but improvement in work capability and cosmetic appearances are frequently positive. Similarly, a complex form of carpal sheath tenosynovitis can develop from intrusions of bony exostoses and osteochondroma from the radius, tears of the flexor tendons, overextension of the carpus, or fracture of the accessory carpal bone. Tenoscopic examination and debridement within the carpal sheath can assist in rehabilitation. Additionally, the proximal check ligament can be easily transected using carpal sheath tenoscopic techniques. A lateral arthroscope entry proximal to the accessory carpal bone provides access to most clinically relevant regions within the carpal sheath. Instrument portals are made after spinal needle insertion to establish the most appropriate path to the lesion. Removal of bone protrusions and tenosynovial masses, debridement of flexor tendon damage, and release of the carpal retinaculum all offer better chances of improved work capability in a variety of carpal sheath diseases. The examination of the carpal sheath and its contents is more complete than that following open approaches, and a return to rehabilitation exercise programs can be quickly initiated after surgery.  相似文献   

11.
Three horses were presented for treatment of chronic infections of the digital flexor tendon sheath. Clinical signs included severe lameness, and heat, pain and swelling of the digital flexor tendon sheath. The horses were treated with surgical lavage of the tendon sheath, systemic and local antibiotics, and analgesics. In each case, resolution of the lameness occurred over weeks to months. Only one horse returned to athletic activity, while the other two became comfortable at pasture. Response to treatment in cases of chronic tenosynovitis may not be as rapid or complete as that reported for acute tendon sheath infections.  相似文献   

12.
Three horses were presented for treatment of chronic infections of the digital flexor tendon sheath. Clinical signs included severe lameness, and heat, pain and swelling of the digital flexor tendon sheath. The horses were treated with surgical lavage of the tendon sheath, systemic and local antibiotics, and analgesics. In each case, resolution of the lameness occurred over weeks to months. Only one horse returned to athletic activity, while the other two became comfortable at pasture. Response to treatment in cases of chronic tenosynovitis may not be as rapid or complete as that reported for acute tendon sheath infections.  相似文献   

13.
A horse with unilateral forefoot lameness had bilateral deep digital flexor tendon (DDFT) lesions on computed tomography (CT). Venous contrast enhanced CT revealed distal sesamoidean impar desmitis in the lame forelimb. Computed tomography is useful for diagnosis of soft tissue lesions within the hoof capsule and contrast enhancement improves lesion conspicuity.  相似文献   

14.
A Percheron mare was presented for acute, severe lameness and marked swelling of the right forelimb after being cast. The mare was initially diagnosed with cellulitis of the forelimb but as her condition improved and the affected limb was able to bear more weight it became apparent that the limb was hyperextended at the level of the carpus. Widening of the palmar aspect of the middle carpal joint was observed radiographically. During ultrasonographic examination, excessive fluid in the carpal sheath and perithecal swelling were noted and tearing of the palmar carpal ligament was suspected. A dynamic brace was fabricated to prevent hyperextension of the carpus. After discontinuation of systemic antibiotics, the mare became febrile and forelimb lameness worsened. Cytology of fluid from the middle carpal joint confirmed joint sepsis and the mare was anaesthetised for arthroscopic examination. A tear in the palmar carpal ligament, characterised by focal fibre disruption and fibrillation, was identified during arthroscopic and tenoscopic examination. Communication between the carpal flexor tendon sheath and middle carpal joint was identified during these procedures. Both the middle carpal joint and carpal flexor tendon sheath were lavaged with physiological saline solution. Post operatively, swelling and lameness slowly resolved. Four months after discharge, the mare was sufficiently sound to be maintained at pasture. Viewed from its lateral aspect, the limb no longer appeared to be hyperextended from the carpus.  相似文献   

15.
A 9‐year‐old Warmblood gelding underwent magnetic resonance (MR) imaging of the carpal and proximal metacarpal regions for evaluation of prolonged right forelimb lameness. Magnetic resonance findings were indicative of desmopathy of the right lateral carpometacarpal ligament and the interosseous ligament between the third and fourth metacarpal bones. Based on the MR findings and lack of response to conservative therapy, surgery using a drilling technique was performed to facilitate fusion of the right carpometacarpal joint. After surgery and a 6‐month rest and rehabilitation programme, the horse returned to soundness. This case report describes a unique combination of lateral carpal/proximal metacarpal soft tissue injuries that resulted in prolonged lameness and were treated with facilitated arthrodesis of the carpometacarpal joint. These soft tissue injuries should be considered as a differential diagnosis in horses with lameness localised to the proximal metacarpal/distal carpal region.  相似文献   

16.
A 2-year-old Thoroughbred colt was referred for evaluation of effusion within the tarsal sheath and associated lameness of the right hind limb. Conservative treatment consisting of needle aspiration and pressure bandaging had been unsuccessful. Radiography of the right tarsus revealed proliferative periosteal reaction along the distal caudal border of the sustentaculum tali and medial aspect of the calcaneus. The owners elected conservative treatment, using a local injection of corticosteroid and pressure bandaging the tarsus. Five months later, the severity of the effusion and lameness had increased. Radiography revealed increased reactive bone along the sustentaculum tali and mineralization of the plantar tarsal ligament and tarsal sheath. Surgical exploration revealed fibrous adhesions between the medial aspect of the calcaneus and the flexor tendon and associated soft tissue mineralization. The adhesions were broken down and the reactive bone along the calcaneus was removed. The mineralized soft tissue within the tarsal sheath was excised. Five months after surgery, the horse was sound at the trot, with only minimal tarsal sheath effusion. The response to treatment for tarsal sheath effusion and lameness caused by bony changes of the sustentaculum tali is often unsatisfactory. After responding poorly to conservative treatment, the horse in this report had a favorable outcome to the surgical intervention of this condition.  相似文献   

17.
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   

18.
A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness.  相似文献   

19.
Objective— To report the use of a proximolateral endoscopic portal with a distolateral instrument portal for carpal retinaculum release in a horse clinically affected with carpal canal syndrome. Study Design— Clinical report. Animals— A 4‐year‐old Thoroughbred female. Methods— Carpal canal syndrome secondary to traumatic suppurative tenosynovitis was treated by accessory carpal bone debridement and carpal retinaculum release using a tenoscopic approach to the carpal flexor synovial sheath through a proximolateral endoscope portal and a distolateral instrument portal. Results— Resolution of carpal sheath effusion and lameness occurred allowing racing 14 months later. Use of a distolateral instrument portal was not associated with complications or iatrogenic damage to neurovascular structures and reduced endoscope and instrument interference and offered easier access to the distal aspect of the carpal sheath. Conclusions— Carpal retinaculum release may be safely accomplished with a distolateral instrument portal when access to the distal aspect of the carpal sheath is needed. Clinical Relevance— The distolateral instrument portal described may be a useful alternative to a proximolateral portal when distal carpal sheath instrument access is necessary or advantageous.  相似文献   

20.
A 19.5-year-old male mongrel dog developed a progressive lameness and swelling around the right carpus. A tumor (6 x 3 x 3 cm) was found in the caudal of distal antebrachium of the right forelimb, including tendons of the superficial digital flexor muscle and deep digital flexor muscle. No joint destruction was observed. The tumor consisted of round and spindle cells arranged in a compact sheet. There were occasional slit-like spaces or lumina, and areas rich in collagen fibers giving an appearance of tendon tissues. Neoplastic cells gave a positive immunoreaction to vimentin, but negative reactions to antibodies against S-100 protein, cytokeratin and myoglobin. Based on these findings, this tumor was diagnosed as a synovial sarcoma generating from the tendon and tendon sheath, which is very uncommon in dogs.  相似文献   

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