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EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2017
Case Report
Septic tendonitis of the deep digital flexor tendon in a Thoroughbred horse referred for weight loss and intermittent fever
I. Santinelli*, F. Beccati, F. Passamonti and M. Pepe Dipartimento di Medicina Veterinaria, Centro di Studi del Cavallo Sportivo, University of Perugia, Perugia, Italy. *Corresponding author email:
santinelliisabella@hotmail.it
Keywords: horse; septic tendonitis; septic tenosynovitis; fever Summary
This case report describes the history, clinical and diagnostic findings, treatment and outcome of a 3-year-old Thoroughbred gelding. The horse was examined for chronic weight loss, intermittent fever of 4 months’ duration and acute lameness of 2 weeks’ duration, and was finally diagnosed with septic tendonitis of the deep digital flexor tendon and digital flexor tendon sheath caused by Streptococcus equi ssp. zooepidemicus. Investigation of the lower respiratory tract also allowed isolation of S. equi ssp. zooepidemicus. Although surgical treatment was recommended, because of the severity of the lesion and the guarded prognosis for a return to full athletic function, the owner declined surgery. The horse was therefore treated aggressively with antimicrobials using systemic, local and regional approaches, and with anti- inflammatory drugs. At 20 months after discharge, the horse
was able to race, and he is now in full work with 20 races finished successfully.
Introduction Deep digital flexor tendonitis in horses is generally related to excessive strain on the tendon, which can induce inflammation or structural damage (Goodrich 2011). Injuries occur most commonly in the fetlock or pastern regions, within the digital flexor tendon sheath (DFTS) or within the hoof capsule. Injuries in the metacarpal or metatarsal regions and in the carpus or tarsus are less common (Dyson 2010). Septic tendonitis is extremely rare, in contrast with septic tenosynovitis, which is frequently described in the literature (Honnas et al. 1991; Schneider et al. 1992; Wereszka et al. 2007; Caron 2011). To the authors’ knowledge, only one report describes a
case of synovial sepsis and suspected tendon infection secondary to peritonitis (Archer et al. 2004) and few cases of primary septic tendonitis were reported by Kidd et al. (2002). The current case report describes the clinical and
diagnostic investigation and the long-term follow-up of a horse referred for chronic weight loss and intermittent fever. The horse was diagnosed with septic tendonitis of the deep digital flexor tendon (DDFT) and secondary tenosynovitis of the DFTS caused by Streptococcus equi ssp. zooepidemicus (S. zooepidemicus).
Case history
A 3-year-old Thoroughbred gelding was presented for intermittent fever (up to 40°C), chronic weight loss of 4 months’ duration and left hindlimb swelling associated with acute
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Fig 1: Diffusely swollen area of the left hindlimb at the level of the fetlock: note the distension of the digital flexor tendon sheath with scratches on the plantar aspect of the region. Many rings are visible on the dorsal part of the hoof wall (arrows).
lameness of 2 weeks’ duration. The horse had been treated with cefquinome, gentamicin, phenylbutazone and imidocarb diproprionate by the referring veterinary surgeon for intermittent periods because of suspected bronchopneumonia. The treatment had resulted in intermittent periods of remission of the fever.
Clinical findings
Upon presentation, the horse was bright and alert with a poor body condition (BCS 2/5) (Wright et al. 1998), heart and respiratory rates of 40 beats/min and 12 breaths/min respectively, and rectal temperature of 37.8°C. The horse showed mild kyphosis and severe atrophy of the muscles of the neck, the back and the left side of the croup; he had a tendency to maintain the left hindlimb protracted to avoid weightbearing. The distal part of the left hindlimb showed diffuse swelling with severe distension of the DFTS and some excoriations on the plantar aspect at the level of the pastern and fetlock; there were many rings in the proximal part of the hoof beginning at the level of the coronary band (Fig 1). The diffusely swollen area of the left hindlimb, primarily at the level of the fetlock, was hot and painful on palpation. The horse showed severe lameness of the left hindlimb at walk in a straight line (American Association of Equine Practitioners grade 4/5) with marked reduction of the caudal phase of the stride.
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