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1.
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.  相似文献   

2.
Reasons for performing study: The sensitivity of ultrasonography for the diagnosis of manica flexoria (MF) tears within the digital flexor tendon sheath (DFTS) is lower than for diagnosis of marginal tears of the deep digital flexor tendon (DDFT). Additional diagnostic tools would assist in appropriate decision making for either conservative or surgical management. Objectives: To evaluate the improvement in lameness of horses with MF or DDFT tears following intrathecal analgesia and to assess the sensitivity and specificity of contrast radiography for the diagnosis of these tears. Methods: The case records of horses presented to a referral clinic over a 7‐year period that underwent intrathecal diagnostic analgesia, or intrathecal analgesia and contrast radiography, of the DFTS with subsequent tenoscopy were examined. Results: Fifty‐three limbs had intrathecal diagnostic analgesia performed and 23 contrast tenograms were assessed in horses undergoing DFTS tenoscopy. Horses with DDFT tears were significantly more likely to respond positively to intrathecal diagnostic analgesia than those with MF tears (P = 0.02). Using contrast radiography, tears of the MF were predicted with an overall sensitivity of 96% and specificity of 80%; marginal tears of the DDFT were predicted with an overall sensitivity of 57% and specificity of 84%. Conclusions: The results of intrathecal analgesia of the DFTS in combination with contrast radiography have a high sensitivity for predicting MF tears. The sensitivity of contrast radiography for predicting tears of the DDFT is lower but the specificity remains high. Potential relevance: Contrast radiography performed at the same time as intrathecal analgesia provides useful information regarding the presence of MF tears and DDFT tears, which can assist in the decision of whether to manage the lameness conservatively or with tenoscopic evaluation.  相似文献   

3.
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   

4.
Objective: To develop a tenoscopic approach for desmotomy of the accessory ligament of the deep digital flexor tendon (AL‐DDFT) in horses. Study Design: Experimental. Animals: Cadaveric forelimbs (n=10) and 4 forelimbs from 2 horses anesthetized for terminal teaching procedures, and 12 forelimbs of 6 experimental horses. Methods: Saline distention of the carpal flexor sheath facilitated insertion of an arthroscope into the distal medial aspect of the sheath between the AL‐DDFT and deep digital flexor tendon (DDFT). Location of an instrument portal on the lateral aspect of the metacarpus was identified with a needle. The lateral aspect of the AL‐DDFT was transected and the arthroscope and instrument were switched to transect the remaining fibers on the medial aspect. Cadaveric specimens were dissected for evaluation. Experimental horses were monitored for 30 days postoperatively. Results: Minor complications including incomplete division of the AL‐DDFT and shallow incision into the suspensory ligament were observed in some cadaver specimens. The AL‐DDFT was completely transected in all experimental horses with no suspensory ligament damage. Mean±SD surgical time (incision to skin closure) was 28.3±11.8 minutes. On ultrasonographic examination, transection of the AL‐DDFT was complete in all experimental horses. Minor DDFT fiber disruption was noted in 1 limb during ultrasound examination at day 30. Conclusions: A tenoscopic approach through the carpal flexor sheath provided adequate access for desmotomy of the AL‐DDFT.  相似文献   

5.
Objectives: To evaluate digital flexor tendon sheath (DFTS) synovial fluid cartilage oligomeric matrix protein (COMP) concentrations as a molecular marker for intrathecal pathology. Study Design: Case control study. Animals: Horses (n=46) with DFTS tenosynovitis; 23 fresh cadaver horses. Methods: DFTS synovial fluid samples were collected from clinical cases with noninfected DFTS tenosynovitis and from control DFTS. Clinical and surgical findings were recorded, and dissection of control limbs was performed to confirm the DFTS to be grossly normal. Synovial fluid COMP was quantified using a homologous competitive inhibition ELISA. Results: Abnormalities were identified tenoscopically: intrathecal tendon/ligament tearing was identified in 37 cases and 9 had other lesions. In control horses, synovial fluid COMP was higher in younger horses. Clinical cases with intrathecal tendon/ligament tearing had higher synovial fluid COMP than either clinical cases with other lesions, or controls. In horses ≥5 years old, the sensitivity and specificity of the assay was high for diagnosing intrathecal tendon/ligament tearing. Conclusions: COMP concentrations in DFTS synovial fluid were significantly greater than those in normal horses with noninfected tenosynovitis caused by intrathecal tendon/ligament tearing, but not by other lesions.  相似文献   

6.
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   

7.
Foot pain is the most common cause of lameness in horses. In sport horses, podotrochlear syndrome (‘navicular syndrome’) is reported to be the most frequent condition affecting the front foot. Ultrasonography has the potential to detect damage to the soft tissues as well as the bone surfaces; in some clinics it has become the technique of choice for the identification and documentation of many podotrochlear injuries. The purpose of this paper is to review the main pathological conditions of the proximal part of the podotrochlear apparatus (PTA) that can be diagnosed ultrasonographically, focusing on the deep digital flexor tendon (DDFT), podotrochlear bursa (PTB) and distal digital annular ligament (DDAL). Potentially significant ultrasonographic findings of the DDFT include thickening of one or both lobes, longitudinal tears, focal or diffuse changes in echogenicity, irregularities of the dorsal border and adhesions between the DDFT and the proximal sesamoidean ligament and/or distal sesamoid bone. Deep digital flexor tendon injuries are often associated with concurrent lesions of the PTB (acute to chronic bursitis) and of the DDAL (desmopathy). Both feet should be routinely examined as lesions of the PTA are often bilateral. We currently consider that ultrasonography should be routinely employed as the primary diagnostic procedure to complement radiography of the equine foot.  相似文献   

8.
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   

9.
Lesions of the manica flexoria are a tenoscopic finding in horses with digital flexor tendon sheath tenosynovitis. This retrospective case series study describes the ultrasonographic findings in seven horses admitted for digital flexor tendon sheath swelling associated with lameness and tenoscopic confirmation of a manica flexoria tear. Six horses had a partial manica flexoria tear, one a complete rupture. The ultrasonographic examination included a static examination on the weight and non‐weight bearing limb and a dynamic limb assessment during flexion and extension. The main ultrasonographic finding at the static weight bearing examination in horses with a partial tear was an asymmetrical appearance of the manica flexoria at the level of the junction with the lateral border of the superficial digital flexor tendon, or an incomplete visualization of the manica flexoria in case of complete rupture. The split edges of the completed ruptured manica flexoria were seen floating in the synovial fluid at the examination in flexion. In six of seven cases, the superficial digital flexor tendon slid abnormally relative to the deep digital flexor tendon, during flexion/extension movements, with medial displacement of the superficial digital flexor tendon, appearance of an anechoic gap between the flexor tendons or reduced superficial digital flexor tendon sliding. Because ultrasonographic diagnosis of the manica flexoria tear is considered challenging, detection of these ultrasonographic features is helpful to increase the likelihood of identifying manica flexoria tears prior to tenoscopy. Authors recommend static ultrasonographic examination of the manica flexoria using a flexed limb position and dynamic ultrasonographic examination using flexion and extension positioning for horses with suspected digital sheath injury.  相似文献   

10.
REASONS FOR PERFORMING STUDY: Lacerations to the digital flexor tendon sheath (DFTS) are a common injury in the horse, but little information is available in the literature regarding prognostic indicators. OBJECTIVE: To ascertain whether laceration of the DFTS carried a better prognosis if treated by tenoscopic lavage, debridement and repair within 36 h of the original injury. METHODS: A retrospective analysis of 39 horses treated surgically for lacerations to the DFTS was performed over a 3 year period. The injury-to-surgery interval was recorded as <36 or >36 h. The structures damaged by the injury were also recorded, as well as age, sex, use and outcome. RESULTS: Sixteen horses had laceration and contamination of the DFTS alone, of which 15 (94%) returned to their original or intended use. Sixteen horses had lacerations involving the superficial digital flexor tendon, of which 12 (75%) made a full recovery. Six horses had lacerations to both superficial and deep digital flexor tendons, 5 were subjected to euthanasia intraoperatively and one is paddock sound. Treatment within 36 h of initial laceration carried a significantly better prognosis for return to intended athletic use (25 of 28 horses allowed to recover from anaesthesia) than treatment after 36 h (2 of 5 P = 0.03; Fisher's Exact Test). CONCLUSIONS: If sepsis is treated early using tenoscopic visualisation, lavage and repositol antibiotics, the limiting factor in return to athletic function is tendon damage. POTENTIAL RELEVANCE: This study supports anecdotal evidence that early treatment of synovial sepsis improves the prognosis for return to intended use. It also provides information on prognostic indicators including extent of damage to collateral structures.  相似文献   

11.
OBJECTIVE: To determine the outcome of horses with "complex" digital tenosynovitis treated by tenoscopic proximal annular ligament desmotomy and resection of synovial masses or adhesions, or both, within the digital sheath. STUDY DESIGN: Retrospective evaluation. ANIMALS OR SAMPLE POPULATION: Twenty-five horses with a clinical and ultrasonographic diagnosis of palmar or plantar proximal annular ligament constriction and ultrasonographic evidence of synovial masses or adhesions within the digital tendon sheath. METHODS: Each horse had tenoscopic surgery for annular ligament desmotomy combined with adhesiolysis and/or synovial mass resection. Mean follow-up time was 3.4 years. Spearman's rank correlation was used to assess the relationship between functional outcome or cosmetic results and preoperative variables including duration of clinical signs, digital sheath synovial fluid total protein concentration and nucleated cell count, thickness of the palmar or plantar proximal annular ligament (PAL), severity of adhesions, severity of synovial masses, degree of synovial distention, or limb affected. RESULTS: A total of 18 (72%) horses returned to athletic soundness, 4 were improved but not sound, and 3 were not improved. Cosmetic outcome was normal in 10 horses, improved but not normal in 12, and not improved in 3 horses. Cosmetic and functional outcome were significantly adversely affected by the duration of clinical signs and the severity of synovial masses. CONCLUSIONS: With appropriate tenoscopic surgical attention, horses with complex tenosynovitis syndrome characterized by synovial masses, adhesions, or both adhesions and masses, and PAL constriction, have a good prognosis for return to athletic soundness. CLINICAL RELEVANCE: Horses with PAL constriction and additional digital tendon sheath pathology such as adhesions and synovial masses have a 72% chance of returning to sound athletic performance, however 60% of horses retain some degree of cosmetic blemish in the affected limb. There is an inverse relationship between the duration of clinical signs and outcome, and therefore, prompt surgical attention is advised.  相似文献   

12.
The aim of this study was to describe the tenovaginoscopic approach to the bovine common digital flexor tendon sheath (CDFTS). A comparative anatomical, ultrasonographic and endoscopic study was undertaken using 26 healthy cadaver feet from adult dairy cows. Tenovaginoscopy was performed using a rigid, 30° arthroscope (length 18 cm; outer diameter 4mm) enabling a direct view of the synovial cavity and the following structures: digital flexor tendons, digital annular ligaments, lateral and medial pouches, three mesotendons, the vinculum of the superficial digital flexor tendon, and a slot-shaped opening in the manicaflexoria of the hind feet. Additionally, four clinical cases of septic tenosynovitis treated with lavage under tenovaginoscopic control were examined. Tenovaginoscopy represents a feasible, minimally invasive method for the diagnosis and treatment of septic tenosynovitis of the CDFTS, which allows the degree of alterations of the normal structures to be evaluated.  相似文献   

13.
This study was designed to develop a reliable technique for endoscopic examination of the tarsal sheath of the lateral digital flexor tendon of horses. The anatomy of the tendon sheath and associated structures was studied in detail in cadavers before determining portals for the insertion of an arthroscope into the sheath. Approaches into the sheath through the proximal pouch and through the flexor retinaculum, at the level of the sustentaculum tali, were performed and compared in cadavers. The proximal pouch portal permitted visualisation only of the proximal half of the sheath, while the approach through the retinaculum allowed examination of the entire sheath. The normal endoscopic appearance of the tarsal sheath was studied. The endoscopic approach was subsequently used to examine and treat 5 horses with tarsal sheath tenosynovitis, including 2 cases of chronic, traumatic tenosynovitis and 3 of subacute septic tenosynovitis. Four of these horses had fragmentation of the sustentaculum tali. The technique allowed adequate examination of the sheath and debridement of adhesions and lesions within the lumen of the sheath. Fragments dorsal to the medioplantar edge of the sustentaculum tali could not be visualised endoscopically and had to be removed after widening of the wound. All 5 horses survived. Follow-up enquiries (8-31 months) revealed that the horses were all reported to be sound. Four were performing at their previous level of activity, 1 was used for hacking. The 2 cases presented with chronic tenosynovitis had residual sheath distension with no associated loss of function. A prospective study, including longer term follow-up investigation, is currently being performed.  相似文献   

14.
OBJECTIVE: To determine history, physical and diagnostic examination findings, medical treatment, and outcome of horses with open injuries to the digital flexor tendon sheath treated with the assistance of tenoscopy. DESIGN: Betrospective study. ANIMALS: 20 horses. PROCEDURE: Medical records of 20 horses with open injuries to the digital flexor tendon sheath were reviewed. Signalment, history, physical and diagnostic examination results, bacteriologic culture and susceptibility testing results, surgical and medical treatments, and follow-up examination results were determined. Outcome was determined by use of telephone interview or physical examination. RESULTS: All horses were treated with tenoscopic-assisted lavage and debridement. Eighteen horses survived, and 2 were euthanatized during treatment. All horses were either grade-4 or grade-5 lame before treatment. Ten horses returned to previous use. Four horses were considered mildly lame and in athletic use. Three horses were considered mechanically lame and are in use with reduced expectations. One horse was lost to follow-up after being sold. One horse was euthanatized for financial reasons and 1 because of complications from regional sepsis. CONCLUSIONS AND CLINICAL RELEVANCE: Tenoscopy appears to be a useful modality in the treatment of open injury to the digital flexor tendon sheath in horses. Direct viewing, guided debridement, and targeted large-volume lavage are advantages obtained with intrathecal arthroscopy. Tenoscopy, when combined with antimicrobial and anti-inflammatory treatment, appears to offer a good chance of survival for affected horses.  相似文献   

15.
Objective: To report outcome after the surgical treatment of lacerations of the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), suspensory ligament (SL), and/or distal sesamoidean ligaments (DSL) in horses. Study Design: Case series. Animals: Horses (n=106) with lacerations of the SDFT, DDFT, SL, and/or DSL. Methods: Medical records (1988–2002) were reviewed for signalment, limb and tendon/ligament involvement (location and extent of injury, tendon sheath involvement), method of repair, and outcome. Results: The median age of horses was 7 years and the follow‐up time ranged from 1 to 10 years. Fifty‐five percent of horses returned to their previous level of performance, 27% to a lower level, and 18% were euthanatized. Multivariate statistical analysis demonstrated that the number of structures transected had the most significant influence on outcome. No significant association was detected between outcome and tendon sheath involvement, tendon suturing, casting, or limb affected. Fetlock hyperextension was the most significant complication. Conclusions: A high survival rate can be expected after SDFT, DDFT, SL, and/or DSL lacerations in horses, but only 55% of affected horses returned to their previous activity level. The number of structures affected was the major factor determining whether horses returned to an equal level of performance.  相似文献   

16.
REASON FOR PERFORMING STUDY: Constriction of the digital flexor tendon sheath (DFTS) and its contents by the palmar/plantar annular ligament (PAL) is well recognised. However, primary injury of the PAL has not been well documented. OBJECTIVES: To describe the clinical features of PAL injury, determine its prevalence with or without subcutaneous fibrosis and/or concurrent injury within the DFTS, and assess response to treatment. METHODS: Horses were selected for inclusion based upon clinical features consistent with PAL injury and the presence of a thickened PAL (> or =2 mm) verified ultrasonographically. A retrospective analysis of case records from 3 clinics was performed. Details of breed, age and use, and results of clinical and ultrasonographic assessments and response to treatment were recorded. Horses were treated conservatively or surgically by desmotomy of the PAL, with or without tenoscopic evaluation of the DFTS. A telephone questionnaire was performed to assess response to treatment. RESULTS: Seventy-one horses were included in the study and middle aged or older general purpose riding horses predominated. PAL desmopathy occurred more frequently in hind- than in forelimbs. The method of treatment, thickness of the PAL or presence of subcutaneous fibrosis did not significantly affect prognosis; however, <50% of horses were able to return to athletic function. There was a trend for horses with PAL desmopathy alone to have the best outcome. Bilateral thickening of the PAL or concurrent fore- and hindlimb injuries had a negative effect on prognosis, as did the simultaneous presence of subcutaneous fibrosis and lesions within the DFTS. CONCLUSIONS AND CLINICAL RELEVANCE: PAL injury is characterised by a convex contour of the palmar/plantar aspect of the fetlock, associated with thickening of the ligament with or without subcutaneous fibrosis. Bilateral PAL thickening is common in older horses, ponies and cobs; however, bilateral PAL enlargement is often present with only unilateral lameness. Treatment methods used in this study did not appear to influence outcome significantly.  相似文献   

17.
Reasons for performing the study: Detailed magnetic resonance imaging (MRI) and histological appearances of the accessory ligament of the deep digital flexor tendon (AL‐DDFT) have not been documented previously in detail. Objectives: To: 1) describe anatomical connections between the AL‐DDFT and adjacent structures; 2) describe high‐field and low‐field MRI and histological appearances of the AL‐DDFT in the forelimb of horses with no carpal or proximal metacarpal pain; and 3) assess the relationship between age, breed, gender, height, weight and MRI findings. Methods: Ten forelimbs were dissected to determine anatomical relationships among the AL‐DDFT and adjacent structures. High‐ and low‐field MR images of the AL‐DDFT and related structures from 29 cadaver limbs of nonlame horses were analysed subjectively and objectively. The relationship between age, breed, gender, height, weight and MRI findings was assessed using a Chi‐squared test. Twelve ALs‐DDFT were examined histologically. Histological and MRI findings were compared subjectively. Results: Fibrous bundles were seen between the AL‐DDFT and the lateral aspect of the superficial digital flexor tendon (n = 9) and the DDFT (n = 2). The AL‐DDFT had low to intermediate signal intensity in most limbs in most high‐field and low‐field MRI sequences. In 69% of limbs, oblique bands of higher signal intensity than the rest of the ligament were identified in high‐field images of the AL‐DDFT. The cross‐sectional area of the AL‐DDFT in the proximal 7 cm of the metacarpal region ranged from 68.1–299 mm2. There was no significant relationship between age, gender, weight or height and either the cross‐sectional area of the AL‐DDFT or the presence of oblique higher signal intensity bands. Histological examination revealed that the AL‐DDFT had thick collagen bundles arranged in large crimps and sometimes crossing in oblique directions. The cellularity was greater than in the deep digital flexor tendon in all limbs. Conclusion and potential relevance: The large variability in the MRI appearance and size of the AL‐DDFT in nonlame horses should be borne in mind when interpreting MR images of lame horses.  相似文献   

18.

Background

Longitudinal tears in the lateral aspect of the deep digital flexor tendon are the most common causes of pain localised to the equine digital flexor tendon sheath. However conventional ultrasonographic techniques provide limited information about acute lesions. Ultrasonographic contrast agents are newly developed materials that have contributed to advancement in human diagnostic imaging. They are currently approved for intravenous use in human and animal models. In this study we described intrathecal use in the horse. This study was undertaken to evaluate the reliability of standard and angle contrast-enhanced ultrasonography to detect and characterize surgically-induced longitudinal lesions in the deep digital flexor tendons.In this pilot study surgically-induced lesions were created in the lateral aspect of the deep digital flexor tendon within the digital flexor tendon sheath in 10 isolated equine limbs to generate a replicable model for naturally occurring lesions. Another 10 specimens were sham operated. All the limbs were examined ultrasonographically before and shortly after the intrasynovial injection of an ultrasound contrast agent containing stabilised microbubbles. The images were blindly evaluated to detect the ability to identify surgically-created lesions. The deep digital flexor tendons were dissected and a series of slices were obtained. The depth of longitudinal defects identified with contrast-enhanced ultrasound scans was compared to the real extent of the lesions measured in the corresponding gross tendon sections.

Results

Contrast-enhanced ultrasonography with both angle and standard approach provided a significant higher proportion of correct diagnoses compared to standard and angle contrast ultrasonography (p < 0.01). Contrast-enhanced ultrasonography reliably estimated the depth of surgically-induced longitudinal lesions in the deep digital flexor tendons.

Conclusion

Contrast-enhanced ultrasound of the digital flexor tendon sheath could be an effective tool to detect intrasynovial longitudinal tears of the deep digital flexor tendon, although an in vivo study is required to confirm these results for naturally occurring lesions.  相似文献   

19.
OBJECTIVE: To determine the effect of intrathecal amikacin administration and repeated tenovaginocentesis on the total nucleated cell count (TNCC), total protein (TP) concentration and cytologic characteristics of synovial fluid of the equine digital flexor tendon sheath (DFTS). STUDY DESIGN: Randomized, cross-over experimental design. ANIMALS: Adult horses (n=8). METHODS: Synovial fluid was aseptically collected from the DFTS and either 1 mL amikacin sulfate (250 mg/mL) or lactated Ringer's solution (LRS) was injected into the DFTS. Serial synovial fluid samples were obtained at 0, 12, 24, 48, and 72 hours. The opposite treatment was administered to the contralateral DFTS after a washout period of 2 weeks. RESULTS: Treatment increased TP concentration, TNCC, percentage of neutrophils, and neutrophil counts from baseline levels. There was no difference between treatment of the DFTS with amikacin or LRS. Values peaked at 12-24 hours after the initial centesis and then declined toward baseline levels. CONCLUSIONS: Injection and repeat centesis of the normal DFTS with 250 mg amikacin or an equivalent volume of LRS resulted in mild increases in synovial fluid analytes from baseline. Synovial inflammation in this study was not accompanied by lameness at the walk and measured analytes returned toward baseline levels within 12-24 hours of first injection. CLINICAL RELEVANCE: The effect of tenovaginocentesis and intrathecal administration of amikacin or LRS on DFTS synovial fluid values are modest in most horses; however, some horses can develop marked increases in synovial fluid values that may be interpreted as sepsis.  相似文献   

20.
REASON FOR PERFORMING STUDY: Specific analgesic techniques are required in diagnosis of lameness to isolate the exact origin of pain to the many structures of the foot that may be involved. OBJECTIVE: To determine if analgesia of the digital flexor tendon sheath (DFTS) results in anaesthesia of other portions of the foot, such as the sole, distal interphalangeal joint (DIPJ), or navicular bursa (NB). METHODS: Lameness caused by pain in the dorsal margin or heel region of the sole of the foot was induced in 18 horses by: using set-screws to create solar pressure (Trial 1: n = 5); or administering endotoxin intrasynovially into the DIPJ (Trial 2: n = 6) and NB (Trial 3: n = 7). The gait of each horse was evaluated by examining videotape recorded before and after creation of lameness and after administration of mepivacaine hydrochloride into the DFTS. RESULTS: Median lameness scores in Trial 1 at 10 min post injection of the DFTS were not significantly different from those before administration of local anaesthetic solution into the DFTS (P> or =0.05), but median lameness scores were reduced significantly at 20 min (P< or =0.05). In Trials 2 and 3, median lameness scores were not significantly different at observations made at 10 and 20 min post injection of the DFTS. CONCLUSIONS: Analgesia of the DFTS has little effect on lameness caused by pain originating in the sole, DIPJ or NB. POTENTIAL RELEVANCE: Improvement of lameness in horses after intrasynovial analgesia of the DFTS is probably caused by attenuation of pain within the structures contained in the DFTS.  相似文献   

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