Page 573 - Adams and Stashak's Lameness in Horses, 7th Edition

Lameness of the Distal Limb 539

marginal tears, especially those with extruded fibers or 3. Barr A, Deny HR, Waterman AE, et al. Proximal phalangeal frac-
tures in the horse. Vet Comp Orthop Trauma 1988;2:86–90.
adhesions, and tears in the manica flexoria. 14,64,77,78 If the 4. Brokken MT, Schneider RK, Tucker RL. Surgical approach for
VetBooks.ir sent, tenoscopy is strongly recommended, especially if 5. Bukowiecki CF, van Ee RT, Schneiter HL. Internal fixation of
lameness is confirmed to the DFTS and effusion is pre-
removal of nonarticular base sesamoid fragments of the proximal
sesamoid bones in horses. Vet Surg 2008;37:619–624.
This is espe-
the ultrasound findings are equivocal.
14,77
cially true if the DFTS has been treated by intrathecal comminuted transverse scapular fracture in a foal. J Am Vet Med
Assoc 1989;195:781–783.
administration of anti‐inflammatory drugs with lack of 6. Caron JP, Fretz PB, Bailey JV, et al. Proximal interphalangeal
resolution or rapid recurrence of lameness. arthrodesis in the horse. a retrospective study and a modified
screw technique. Vet Surg 1990;19:196–202.
7. Cohen JM, Schneider RK, Zubrod CJ, et al. Desmitis of the distal
Treatment digital annular ligament in seven horses: MRI diagnosis and surgi-
cal treatment. Vet Surg 2008;37:336–344.
Treatment depends on the location, type, and severity 8. Colahan PT, Wheat JD, Meagher DM. Treatment of middle phalangeal
of the lesion. Branch lesions of the SDFT are usually fractures in the horse. J Am Vet Med Assoc 1981;178:1182–1185.
treated with a controlled rehabilitation program similar 9. Contino EK, Werpy NM, Morton A, et al. Metacarpophalangeal
to any bowed tendon injury; however, 6–12 months is joint lesions identified on MRI in horses with lameness that
typically needed. If the SDFT lesion is within the DFTS resolves with palmar digital and intra‐articular analgesia. Vet
Comp Ortho Trauma 2013;40:11–12.
or if DFTS effusion is present, surgical exploration via 10. Crabill MR, Watkins JP, Schneider RK, Auer JA. Double‐plate fixa-
tenoscopy is often helpful to further diagnose the spe- tion of comminuted fractures of the second phalanx in horses: 10
cific problem and debride the damaged tendon. 77,78 cases (1985–1993). J Am Vet Med Assoc 1995;207:1458–1461.
Lesions of the DDFT at the level of the pastern or fet- 11. Dechant JE, MacDonald DG, Crawford WH. Repair of complete
dorsal fracture of the proximal phalanx in two horses. Vet Surg
lock canal are often within the DFTS, and tenoscopy is 1998;27:445–449.
often beneficial because these lesions are often difficult 12. Doran RE, White NA, Allen D. Use of a bone plate for treatment
to diagnose and treat. 2,64,77,78 An annular ligament des- of middle phalangeal fractures in horses: seven cases (1979–1984).
J Am Vet Med Assoc 1987;191:575–578.
motomy may be performed at the time of surgery if con- 13. Dyson S. Ultrasonographic examination of the pastern region.
sidered appropriate. 2,77 When there is distension of the Equine Vet Educ 1992;4:254–258.
DFTS and ultrasound does not reveal tendon injury, 14. Edinger J, Mobius G, Ferguson J. Comparison of tenoscopic and
medication of the DFTS with corticosteroids, HA, or ultrasonographic methods of examination of the digital flexor tendon
sheath in horses. Vet Comp Orthop Traumatol 2005;18:209–214.
interlukin‐1 receptor antagonist protein (IRAP) can be 15. El‐Guindy MH, Ali MA, Samy MT. Chronic osteoarthrosis in the
performed. If there is lack of lameness resolution or equine proximal interphalangeal joint. Proc Am Assoc Equine
recurrence of lameness, additional diagnostics such as Pract 1986;32:6–15.
tenoscopy should be pursued. Intralesional injection of 16. Ellis DR, Greenwood RE. Six cases of degenerative joint disease of
regenerative products such as PRP or stem cells directly the proximal interphalangeal joint of young thoroughbreds.
Equine Vet J 1985;17:66–68.
into the damaged tendon can also be performed. See 17. Ellis DR, Simpson DJ, Greenwood RES. Observations and man-
Chapter 8 for more details on these treatments. agement of fractures of the proximal phalanx in young thorough-
breds. Equine Vet J 1987;19:43–49.
18. Fiske‐Jackson AR, Barker WHJ, et al. The use of intrathecal analgesia
Prognosis and contrast radiography as preoperative diagnostic methods for
digital flexor tendon sheath pathology. Equine Vet J 2013;45:36–40.
In general, soft tissue injures of the SDFT and DDFT in 19. Fjordbakk CT, Strand E, Milde AK, et al. Osteochondral frag-
the pastern region can be difficult to diagnose and tend to ments involving the dorsomedial aspect of the proximal inter-
have a worse prognosis than SDFT and DDFT injuries in phalangeal joint in young horses: 6 cases (1997–2006). J Am Vet
Med Assoc 2007;230:1498–1501.
the metacarpal or metatarsal region. Horses with SDFT 20. Fuerst A, Derungs S, von Rechenberg B, et al. Use of a parathyroid
branch injuries in the pastern region are thought to have a hormone peptide (PTH(1‐34))‐enriched fibrin hydrogel for the
poorer prognosis to return to racing than SDFT injuries in treatment of a subchondral cystic lesion in the proximal inter-
the metacarpal region, with more frequent recurrence of phalangeal joint of a warmblood filly. J Vet Med A Physiol Pathol
injury. Following tenoscopic debridement, surface lesions Clin Med 2007;54:107–112.
of the DDFT within the DFTS result in only 38%–42% of 21. Genetzky RM, Schneider EJ, Butler HC, et al. Comparison of two
surgical procedures for arthrodesis of the proximal interphalan-
horses returning to previous level of performance. 2,64 geal joint in horses. J Am Vet Med Assoc 1981;179:464–468.
Without tenoscopic debridement of surface DDFT lesions, 22. Grewal JS, McClure SR, Booth LC, et al. Assessment of the ultra-
especially when there are extruded fibers, the prognosis sonographic characteristics of the podotrochlear apparatus in
appears to be poor. In one study, 10 of 17 horses with clinically normal horses and horses with navicular syndrome.
J Am Vet Med Assoc 2004;225:1881–1888.
longitudinal tears of the DDFT returned to their previous 23. Groom LJ, Gaughan EM, Lillich JD, et al. Arthrodesis of the prox-
77
level of work. In another study of 76 horses with chronic imal interphalangeal joint affected with septic arthritis in 8 horses.
DFTS tenosynovitis, sheath distension was eliminated in Can Vet J 2000;41:117–123.
33% and improved in 69% of the horses. In the same 24. Hago BED, Vaughan LC. Use of contrast radiography in the inves-
64
tigation of tenosynovitis and bursitis in horses. Equine Vet J
study, 68% of the horses were sound, and 54% returned 1986;18:375–382.
to their preoperative level of performance. 64 25. Hago BED, Vaughan LC. Radiographic anatomy of tendon
sheaths and bursae in the horse. Equine Vet J 1986;18:102–106.
26. Harrison LJ, May SA. Bilateral subluxation of the pastern joint in
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