EQUINE VETERINARY EDUCATION Equine vet. Educ. (2022) 34 (2) 73 doi: 10.1111/eve.13427_1
Case Report
Tenectomy of the superficial digital flexor tendon as a treatment of suspected septic tendinitis and tenosynovitis of the digital flexor tendon sheath followed by rehabilitation with an orthotic device
A. Lenoir* , M. Schramme, E. Segard-Weisse, M. Zimmerman and O. M. Lepage Centre for Equine Health, Ecole Nationale V
et France
*Corresponding author email:
augustin.lenoir@vetagro-sup.fr Keywords: horse; septic; superficial digital flexor tendon; tenectomy; orthotic; external support boot
Summary
A 15-year-old Sports horse gelding was referred for nonweightbearing lameness of the left hindlimb of one week’s duration. Ultrasonographic and radiographic evaluations revealed severe subcutaneous swelling over the entire limb and a moderately distended digital flexor tendon sheath (DFTS) filled with a moderate amount of hypoechoic fluid interspersed with synovial thickening and fibrin-like material. The appearance of the superficial (SDFT) and deep (DDFT) digital flexor tendons was within normal limits. Septic cellulitis was diagnosed and managed medically. After 14 days, septic tenosynovitis of the DFTS, with septic tendinitis of the SDFT and DDFT became evident. Surgical resection of the intrathecal portion of the septic SDFT was performed via an open incisional approach to the DFTS. Post-operatively, a half-limb cast was placed on the operated limb for 10 weeks. This was followed by a 6-week rehabilitation period with the help of an articulated orthotic support boot. The horse recovered, regained long-term pasture soundness and is used for light pleasure riding. Ultrasonography performed 5 months after surgical removal of the SDFT demonstrated the presence of a flat, banana-shaped layer of fibrous tissue with heterogenous echogenicity, variable fibre orientation
a)
and irregular margins, in the location of the resected SDFT (Fig 1). This case demonstrates that tenectomy of the SDFT followed by the use of an orthotic boot support during the rehabilitation period may be a viable salvage procedure for refractory septic tendinitis in the DFTS and can have a positive outcome.
erinaire de Lyon, VetAgro Sup, University of Lyon, Marcy-l’Etoile,
73
Key points
• Septic tendinitis is relatively common and may have life-threatening consequences.
• Tenectomy of the SDFT appears to be a viable option to treat chronic and severe septic tendinitis in the DFTS when infection cannot be controlled with medical treatment or tenoscopic lavage.
• The bilateral use of a custom-made equine support boot during the rehabilitation period prevented excessive loading of the injured tendon, the other components of the stay apparatus and the stay apparatus and the foot of the contralateral limb.
b)
*
*
Fig 1: Transverse (a; lateral is to the left) and longitudinal (b; proximal is to the left) ultrasonographic images obtained at the level of the fetlock canal, 5 months after surgery. The heterogeneous connective tissue bridge replacing the SDFT is visible (white arrow). Adhesions (black arrows) are present between the SDFT and the DDFT (white asterisk).
© 2020 EVJ Ltd
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