Diagnosis and outcome following tenoscopic surgery of the digital flexor tendon sheath in German sports and pleasure horses

Abstract

Background: Digital flexor tendon sheath (DFTS) pathology is an important cause of lameness in horses. The outcome after surgical treatment is variable and depends on the exact diagnosis.Objectives: To (1) describe the prevalence of lesions associated with lameness caused by nonseptic DFTS tenosynovitis in a large population of German sports and pleasure horses; (2) determine the sensitivity and specificity of diagnostic imaging techniques for identifying lesions within the DFTS with tenoscopic diagnosis being the gold standard; (3) explore associations between tenoscopically diagnosed lesions and signalment, purpose, and limb affected; and (4) describe the outcome following DFTS tenoscopy with nonseptic DFTS tenosynovitis in this population.Study design: Retrospective case series.Methods: Medical records of horses admitted for tenoscopic surgery of nonseptic DFTS tenosynovitis between 2011 and 2020 were reviewed. Follow-up information was obtained via telephone contact. Sensitivity and specificity of ultrasonography and contrast tenography were determined using tenoscopic diagnosis as gold standard and univariable analysis was used to explore associations between signalment, case history, and tenoscopic diagnosis.Results: Medical records from 131 horses were retrieved, of which 8 horses had bilateral disease and 6 horses were presented for tenoscopy on two separate occasions (3 for tenoscopy in the same limb, 3 in a different limb), thus, making a total of 145 limbs. Lesions were most commonly diagnosed in the deep (DDFT; n = 55 limbs) and superficial (SDFT; n = 55 limbs) digital flexor tendons. Manica flexoria (MF) lesions were detected in 44 limbs and palmar/plantar annular ligament (PAL) constriction in 99 limbs. In 36 limbs, only one structure within the DFTS was injured, whereas in 109 limbs a combination of lesions was noted, the most common being the combination of a SDFT lesion with PAL constriction. All affected limbs were

Static, dynamic and non‐weightbearing ultrasound evaluation of the digital flexor tendon sheath improves sensitivity and specificity of manica flexoria tears diagnosis in cobs and ponies

“…A wider contact surface (probe/skin) allows for better visualisation of the tendons and ligaments borders as well as MF contours (Seignour et al, 2012). reported (Cender et al, 2023;Smith & Wright, 2006).…”

“…Digital flexor tendon sheath (DFTS) pathology is a common cause of lameness in horses. The most commonly diagnosed lesions within the DFTS are tears of the deep digital flexor tendon (DDFT) affecting its lateral borders (38%–58% of horses undergoing tenoscopy), superficial digital flexor tendon (SDFT) fibrillation/hyperaemia (14%–38% of horses undergoing tenoscopy) and tears of the manica flexoria (MF) (30% of horses undergoing tenoscopy) (Arensburg et al, 2011; Cender et al, 2023; Findley et al, 2012; McIlwraith et al, 2015; Smith & Wright, 2006; Wright & McMahon, 1999).…”

“…Fibrillation and focal tears of the MF can be treated by local trimming and debridement of the torn fibres. Total resection of the MF under tenoscopic guidance is recommended if one margin of the MF is completely ruptured from its attachment to the SDFT (Cender et al, 2023; Smith & Wright, 2006). The prognosis for return to previous level of activity after such procedure is good with 79% of horses returning to pre‐injury use (Findley et al, 2012).…”

“…Ultrasonography (US) is the first‐line imaging modality in horses presented with a DFTS effusion (Schramme & Smith, 2011). The use of US to diagnose MF tears has been reported to have a low sensitivity (38%–64%) (Cender et al, 2023; Smith & Wright, 2006). In recent years, the advantages of nonweightbearing (NWB) and dynamic flexion/extension ultrasonographic examination have been reported (Garcia da Fonseca et al, 2018; Seignour et al, 2012).…”

Highlights of recent clinically relevant papers

“…The aims of this study were to (1) describe the prevalence of lesions associated with lameness caused by nonseptic DFTS tenosynovitis in a large population of German sports and pleasure horses; (2) determine the sensitivity and specificity of diagnostic imaging techniques for identifying lesions within the DFTS; (3) explore associations between tenoscopically diagnosed lesions and signalment, purpose and limb affected; and (4) describe the outcome following DFTS tenoscopy with nonseptic DFTS tenosynovitis in this population.…”