Page 357 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

332 CHAPTER 1

VetBooks.ir Avulsion in the author’s experience is always partial (Figs. 1.652, 1.653). This is often symmetrically
bilateral and involves marked thickening of the dis-
and should be differentiated from PSB fractures.
Fractures of the distal one-third of the splint bones
present with diffuse areas with heterogeneous echo-
are clearly identified as an interruption of the bone tal most portion of the SL branches. The latter may
interface and fibrous tissue adhesions may be identi- genicity and loss of striation on longitudinal scans.
fied with the SL. The PSB interface is very irregular (entheseopathy)
A specific condition encountered in Standard- and hypoechogenic areas are often present in the
breds is distal entheseopathy of the SL branches SL immediately proximal to the insertion. This is
likely to represent chronic entheseopathy. This
1.649 may be unassociated with lameness but can lead to
severe branch injury or to more insidious exercise
intolerance.

Management
Conservative and medical management are con-
ducted as for SDF tendonitis. Horses can resume
work relatively quickly (3–4 months) with adequate
controlled exercise protocols. Unfortunately, recur-
rence is extremely common. Ultrasonographically,
these injuries rarely heal properly and tend to evolve
as chronic, active lesions. Tendon splitting (longitu-
dinal tenotomy) may be useful in the subacute stage
or in the presence of chronic entheseopathy.
Biological treatments are commonly used but core
Fig. 1.649 Ectopic mineralisation is visible within lesions being unusual, injections may be difficult.
the ligament parenchyma (yellow arrows) in this There are no published studies to objectively assess
longitudinal sonogram of the medial branch of the SL. their efficacy. In one study, PRP used for chronic
Red arrows = periligamentous fluid. entheseopathy failed to alter the prognosis in young

1.650 1.651

Figs. 1.650, 1.651 Transverse (1.650) and longitudinal (1.651) (centred on the lesion as indicated by the dotted
line) sonograms of a medial SL branch avulsion. The SL ligament is very heterogeneous and irregularly thickened
with diffuse hypoechogenic tissue in the deep (axial) part of the ligament. Small, hyperechogenic interfaces
casting shadow artefacts represent avulsion fragments (yellow arrows). Red arrows = periligamentous fluid.