Dynamic flexion/extension and non‐weight bearing ultrasonography is helpful for identifying manica flexoria tears in horses

Abstract

Lesions of the manica flexoria are a tenoscopic finding in horses with digital flexor tendon sheath tenosynovitis. This retrospective case series study describes the ultrasonographic findings in seven horses admitted for digital flexor tendon sheath swelling associated with lameness and tenoscopic confirmation of a manica flexoria tear. Six horses had a partial manica flexoria tear, one a complete rupture. The ultrasonographic examination included a static examination on the weight and non-weight bearing limb and a dynamic limb assessment during flexion and extension. The main ultrasonographic finding at the static weight bearing examination in horses with a partial tear was an asymmetrical appearance of the manica flexoria at the level of the junction with the lateral border of the superficial digital flexor tendon, or an incomplete visualization of the manica flexoria in case of complete rupture. The split edges of the completed ruptured manica flexoria were seen floating in the synovial fluid at the examination in flexion. In six of seven cases, the superficial digital flexor tendon slid abnormally relative to the deep digital flexor tendon, during flexion/extension movements, with medial displacement of the superficial digital flexor tendon, appearance of an anechoic gap between the flexor tendons or reduced superficial digital flexor tendon sliding. Because ultrasonographic diagnosis of the manica flexoria tear is considered challenging, detection of these ultrasonographic features is helpful to increase the likelihood of identifying manica flexoria tears prior to tenoscopy. Authors recommend static ultrasonographic examination of the manica flexoria using a flexed limb position and dynamic ultrasonographic examination using flexion and extension positioning for horses with suspected digital sheath injury.

Tenoscopic resection of the manica flexoria in 21 horses using a two‐portal unilateral technique

“…A promising technique to detect MF tears preoperatively, however, the study does only include cases that had a tenoscopically confirmed diagnosis and was not available for the majority of our cases (Garcia da Fonseca et al . ). It remains unknown in how many cases the presumptive diagnosis of a MF rupture was not confirmed by surgery.…”

“…), although Garcia da Fonseca et al . () recommend static ultrasonographic examination of the MF using a flexed limb position and dynamic ultrasonographic examination using flexion and extension positioning. A promising technique to detect MF tears preoperatively, however, the study does only include cases that had a tenoscopically confirmed diagnosis and was not available for the majority of our cases (Garcia da Fonseca et al .…”

Highlights of recent clinically relevant papers

“…Lesions of the manica flexoria are a tenoscopic finding in horses with digital flexor tendon sheath tenosynovitis. This retrospective case series study by Rita Martins Garcia da Fonseca and colleagues in Portugal, Belgium and Italy described the ultrasonographic findings in seven horses admitted for digital flexor tendon sheath swelling associated with lameness and tenoscopic confirmation of a manica flexoria tear .…”

Detection of lesions of the DDFT and the proximal Manica flexoria of the SDFT – Comparison of ultrasonographic and tenoscopic findings in equine aseptic tenosynovitis of the common digital flexor tendon sheath

“…Allerdings wurden hier nur Untersuchungen an der stehenden, belasteten Gliedmaße durchgeführt. Die ultrasonographische Untersuchung der MF an der gebeugten und gestreckten unbelasteten Gliedmaße wurde in einer kleinen Fallserie (n = 7) bereits beschrieben (Garcia da Fonseca et al 2019). Zur präziseren Untersuchung der TBS wird empfohlen, den Ultraschallkopf nach lateral und medial zu verschieben, um Fehldiagnosen vorzubeugen, die z.…”

“…Die vorliegenden Untersuchungen ergaben, dass die Rupturen der MF zu 85 % medial und lediglich zu 15 % lateral vor-lagen. In der Literatur wird die Ruptur der MF mit 40 bis 52 % medial und mit 17 % bis 100 % lateral beschrieben(Wright und McMahon 1999, Arensburg et al 2011, Findley et al 2012, Diekstall et al 2019, Garcia da Fonseca et al 2019. In einer großangelegten Fallserie vonFindley et al (2012) traten 43 % (28/65) der MF-Rupturen medial und 17 % (11/65) lateral auf.…”