Page 387 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

362 CHAPTER 1

VetBooks.ir 1.718 superficial tendon tears may provide temporary or
long-term relief, although recurrence is common.
DDFT tears will be described separately. Tenoscopy
is particularly useful to debride or resect a torn man-
ica flexoria and to remove space-occupying mass-
like lesions.
Physiotherapy is useful to decrease fibrosis,
resolve inflammation and distension and encourage
healing with improved limb mobility.
Chronic or recurrent tenosynovitis is difficult to
treat. Conservative management and physiother-
apy, including passive motion and swimming, and
therapeutic ultrasound may improve some cases.
Intrathecal hyaluronate is not indicated in chronic
cases. Corticosteroids may be helpful in some cases,
but disappointing in others. IRAP may provide
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Fig. 1.718 Tenoscopic image of the DDFT as it some relief.
emerges from beneath the manica flexoria of the Tenoscopic surgery is indicated in most chronic
SDFT. Note the tearing of the lateral edge of the cases. It is useful to debride adhesions and superfi-
DDFT. (Photo courtesy Graham Munroe) cial lesions and to perform a partial synovectomy
where hypertrophic synovitis causes mechanical
Management impairment to tendon movement within the sheath.
Idiopathic distension is usually not treated, but some Annular ligament desmotomy can be performed
cases, especially if treated early, may respond to rest under tenoscopic guidance and may also be helpful
and pressure bandages. Intrathecal corticosteroid in some cases, although it should first be confirmed
injections may provide temporary resolution of the that the ligament is involved in tendon constriction
distension, but in most cases the swelling recurs or motion impairment, as complications are com-
within a few weeks or months. Aspiration of the monplace. It should also be born in mind that adhe-
fluid is contraindicated as it only provides temporary sion formation and recurrence of the tenosynovitis
resolution and might cause bleeding and inflamma- is common following annular ligament desmotomy.
tion in the sheath.
Acute tenosynovitis is best treated by rest with Prognosis
controlled exercise, systemic NSAIDs, cold hos- The prognosis is good for cold distension, although
ing and/or application of ice. Pressure bandages the blemish often persists. Acute cases without
should be applied between treatments for 2–4 weeks. lesions to the tendons or scutums carry a fair prog-
Intrathecal sodium hyaluronate and/or short-acting nosis, but aggressive anti-inflammatory treatment is
corticosteroid injections may be helpful in non- warranted. Tenoscopic treatment has been associ-
responsive cases. Recently, interleukin-1 receptor ated with an overall success rate of 68% in digital
antagonist protein (IRAP ) has been used as an anti- sheath tenosynovitis, although this depends greatly
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inflammatory treatment in synovial cavities with on the lesions present.
promising results, although there is a lack of objec- Tendinous lesions often persist because of fibro-
tive studies to confirm its efficacy in tenosynovitis. cartilaginous metaplasia and necrosis. Recurrent
If superficial lesions are present on the tendons lameness is usual, and the prognosis is therefore
or scutums, tenoscopy should be recommended as considered guarded, especially for lesions of the
a first-stage treatment. Tenoscopy is also indicated DDFT (see later) and in the forelimb. Early teno-
if medical management fails to resolve the inflam- scopic debridement of superficial lesions can carry a
mation after several weeks. Surgical debridement of good prognosis.