Page 381 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

356 CHAPTER 1

VetBooks.ir be hosed for 15–20 minutes with cold water 2–4 treat with associated tissue fibrosis and extension
Septic tenosynovitis may be more challenging to
times daily (or ice-packs applied). The duration of
rest varies with the severity of the lesion, but healing
gical treatment with debridement and, occasionally,
is usually fairly rapid and most horses can return to into surrounding tissues and joints. Aggressive sur-
work within 2–12 weeks. Wounds should be treated complete resection of the tendon and sheath may be
as appropriate and the limbs kept bandaged. Casts or life saving and even, in some cases, allow return to
splints may be applied over a dressing to limit move- work, although some degree of mechanical impair-
ment of the wound edges and tendon stumps or if ment is to be expected in many cases.
there is severe impairment of motion.
In the case of complete rupture, complete box RUPTURED EXTENSOR
rest is necessary. The limb should be supported TENDON IN FOALS
with splints placed over the dorsal and/or palmar or
plantar aspect of the limb from elbow or mid-crus (See p. 41.)
to the foot and over a padded bandage. An alumi-
num or resin splint system that encloses the foot or RUPTURE OF THE EXTENSOR CARPI
is attached to the toe of the shoe prevents the digit RADIALIS TENDON IN ADULT HORSES
and carpus or hock from flexing and will thus pro-
vide best results. The splint is left on the limb for Definition/overview
3–4 weeks, after which a thick bandage is applied to Spontaneous partial to complete rupture of the ECR
the limb for a further 2–6 weeks depending on the tendon is a rare condition affecting adult horses,
clinical appearance of the wound. Passive manipu- particularly those used for show jumping.
lation and physiotherapy may be useful to aid in
regaining full joint motion. Aetiology/pathophysiology
Aseptic tendon sheath injuries are treated with The cause is unknown, but may involve repeated
box rest, daily in-hand exercise, cold hosing or trauma to the dorsal carpus, repeat strain injuries
application of ice packs and systemic and topical or a single, sudden trauma on a tense tendon during
anti- inflammatory drugs. Intrathecal injection of carpal flexion.
hyaluronic acid may be useful in acute or subacute
cases. Short-acting steroidal drugs may be used in Clinical presentation
cases that fail to respond to conservative treatment The tear or rupture occurs in the carpal region,
alone. within the carpal sheath of the ECR tendon. Partial
Chronic, adhesive tenosynovitis may be a thera- tears cause mild to moderate lameness with tenosy-
peutic challenge. Complete surgical stripping of novitis and sheath distension. Complete rupture is
the sheath synovium is generally successful in these characterised by sudden-onset lameness with marked
cases. Tendon resection has been performed for sal- sheath distension over the cranial aspect of the distal
vage in severe, unresponsive cases, but may not yield antebrachium and dorsal carpus. Typically, there is
a full return to function. an exaggerated, stringhalt-like flexion of the carpus
during the stride, supposedly from lack of counter
Prognosis resistance to the flexor muscle action.
The prognosis is good to fair for most extensor ten-
don injuries. Tenosynovitis often leads to persistent Diagnosis
distension of the affected sheath despite treatment. Ultrasonography will show tenosynovitis and char-
This is often of no consequence to the normal use acterise the partial or complete tendon rupture
of horses, although some mechanical impairment (Fig. 1.707).
of joint movement can affect performance. Severed
extensor tendons tend to heal through fibrosis and Management
scar tissue formation, but most horses appear to Conservative treatment with support bandaging and
adapt and regain full function with time. splints or a tube cast from elbow to fetlock may be