Desmotomy of the Accessory Ligament of the Superficial Digital Flexor Tendon in the Horse with Use of a Tenoscopic Approach to the Carpal Sheath

Abstract

Desmotomy of the accessory ligament of the superficial digital flexor tendon by using a tenoscopic approach to the carpal sheath is an alternative technique to the medial incisional approach.

Tenoscopy

“…Tenosynovitis of the carpal sheath can result from osteochondroma of the caudal distal radius (Held et al, 1988;Lee et al, 1979;Nixon, 2002a;Southwood et al, 1997;Squire et al, 1992;Stahre & Tufvesson, 1967;; exostosis of the caudal margin of the bony remnant of the distal radial physis (Nixon et al, 2004); tearing of the accessory ligament of the SDF (Nixon et al, 2004); fractures of the accessory carpal bone Nixon et al, 2004); superficial digital flexor tendonitis ; incomplete rupture of the DDFT (Dik, 1990); and tearing of the radial head of the DDF . Tenoscopy also offers a minimally invasive approach to desmotomy of the accessory ligaments of the SDF (Southwood et al, 1999) and DDF (Caldwell et al, 2011) and for treatment of carpal tunnel syndrome (Textor et al, 2003).…”

“…The authors routinely use variations of the standard proximolateral approach to the carpal sheath as described by Southwood et al (1998). This technique allows evaluation of the entire proximal portion of the carpal sheath, including the carpal canal, but provides limited access to the metacarpal region of the sheath.…”

Evaluation of a Tenoscopic Approach for Desmotomy of the Accessory Ligament of the Deep Digital Flexor Tendon in Horses

“…An 18 g, 3.8 cm needle was inserted into the carpal flexor sheath at a site between the ulnaris lateralis and lateral digital extensor muscles $1-2 cm proximal to the distal radial physis. 17 The carpal flexor sheath was distended with 120 mL sterile saline (0.9% NaCl) solution or until the distal aspect of the sheath could be identified as a soft, fluid-filled enlargement on the medial aspect of the palmar metacarpus. The location for insertion of the arthroscopic cannula was determined by selecting a site over the AL-DDFT where fluid distention of the carpal flexor sheath could be identified.…”

“…13,[15][16][17][18] To our knowledge, a tenoscopic approach for desmotomy of the AL-DDFT has not been reported. Our purpose was to describe a surgical technique for desmotomy of the AL-DDFT using a tenoscopic approach through the distal aspect of the carpal flexor sheath.…”

Proximal Check Ligament Desmotomy

“…7,10 Tenoscopically assisted superior check ligament desmotomy has also been described and may offer the advantages of decreased incisional complications and operative time. 11,12 Flexural limb deformities of the metacarpophalangeal joint will sometimes respond to inferior check ligament desmotomy alone or in combination with proximal check ligament desmotomy. 2,13 Fetlock flexural deformities have also been treated with superficial digital flexor tenotomy.…”