Septic Arthritis of the Distal Interphalangeal Joint in 12 Horses

The medical records of 12 horses with septic arthritis of a distal interphalangeal joint were reviewed to determine clinical features and response to treatment. Sepsis was caused by trauma or an injection that resulted in an open or contaminated distal interphalangeal joint. All horses were severely lame. Treatment included broad-spectrum parenterally administered antimicrobial drugs (ten horses), percutaneous through-and-through joint lavage (eight horses), indwelling drains (three horses), immobilization of the limb in a cast (three horses), intraarticular injection of sodium hyaluronate (one horse), intraarticular injection of antimicrobial drugs (five horses), curettage of the distal phalanx (one horse), and cancellous bone grafting to promote fusion (one horse). Five horses were euthanatized. Ankylosis of the affected joint developed in five horses, four of which are pasture sound. Two horses treated medically are sound although one underwent subsequent palmar digital neurectomy for treatment of navicular syndrome.     

Treatment of septic common digital extensor tenosynovitis by complete resection in seven horses

OBJECTIVE: To describe and evaluate a technique for radical resection of the entire intrathecal component of the common digital extensor tendon (CDET) in horses. STUDY DESIGN: Prospective clinical study. ANIMALS OR SAMPLE POPULATION: Seven client-owned horses. METHODS: Seven horses with wounds that resulted in septic tenosynovitis of the CDET sheath were treated by complete surgical resection of the affected tendon and ablation of the tendon sheath; 5 had previous surgery that was unsuccessful. Time from initial injury to complete resection was 1-22 weeks. In 6 horses, the wound was closed primarily using a closed suction (4 horses), penrose (1), or passive open drainage system (1). In 1 horse, the surgical wound healed by second intention. All horses had postoperative bandaging, antibiotic administration, and physiotherapy. RESULTS: Surgical wounds healed primarily in 6 horses and by second intention in 1 horse. Follow-up (mean, 26.4 months; range, 18-38 months) was available for 6 horses; all returned to their athletic performance level without lameness or gait abnormality. CONCLUSIONS: Complete resection of the CDET was an effective surgical technique for management of chronic septic tenosynovitis. CLINICAL RELEVANCE: Horses with infection of the CDET and its sheath may be returned to long-term soundness without gait abnormality after radical resection.     

Resection of the common digital extensor tendon in a gelding

A four-year-old gelding was lame owing to a chronic septic common digital extensor tendon and sheath. The horse had been treated by open surgical lavage but the sepsis had recurred after three months. Physical, ultrasonographic, cytological and histological examinations confirmed chronic septic tenosynovitis and tendonitis. The entire intrathecal component of the common digital extensor tendon was resected under general anaesthesia and the synovial lining of the sheath was ablated. Postoperatively the horse regained good limb function and became sound.     

Closed Suction Drainage in the Treatment of Infectious Arthritis of the Equine Tarsocrural Joint

Infectious arthritis of the tarsocrural joint was treated in 13 horses with closed suction drainage through a flat, fenestrated, latex (Jackson-Pratt) drain, broad-spectrum antimicrobial agents, nonsteroidal anti-inflammatory drugs, and bandage immobilization. In 11 horses, arthroscopic lavage and debridement were also performed. Ingress drains were placed for lavage in six horses. Ten horses returned to their previous level of competition or were sound. One horse raced but had lameness of the affected tarsocrural joint and dropped in racing class; one horse was euthanatized because of laminitis in the supporting limb; and one horse was lame, but useful as a breeding animal. Closed suction drainage appeared to be a useful treatment in horses with infectious arthritis. Although arthroscopy was not necessary, it facilitated fibrin removal, lavage, and partial synovectomy. Because of the development of Pseudomonas superinfection in one horse, the use of simultaneous ingress catheters was not recommended.     

Tenoscopic-assisted treatment of open digital flexor tendon sheath injuries in horses: 20 cases (1992-2001)

OBJECTIVE: To determine history, physical and diagnostic examination findings, medical treatment, and outcome of horses with open injuries to the digital flexor tendon sheath treated with the assistance of tenoscopy. DESIGN: Betrospective study. ANIMALS: 20 horses. PROCEDURE: Medical records of 20 horses with open injuries to the digital flexor tendon sheath were reviewed. Signalment, history, physical and diagnostic examination results, bacteriologic culture and susceptibility testing results, surgical and medical treatments, and follow-up examination results were determined. Outcome was determined by use of telephone interview or physical examination. RESULTS: All horses were treated with tenoscopic-assisted lavage and debridement. Eighteen horses survived, and 2 were euthanatized during treatment. All horses were either grade-4 or grade-5 lame before treatment. Ten horses returned to previous use. Four horses were considered mildly lame and in athletic use. Three horses were considered mechanically lame and are in use with reduced expectations. One horse was lost to follow-up after being sold. One horse was euthanatized for financial reasons and 1 because of complications from regional sepsis. CONCLUSIONS AND CLINICAL RELEVANCE: Tenoscopy appears to be a useful modality in the treatment of open injury to the digital flexor tendon sheath in horses. Direct viewing, guided debridement, and targeted large-volume lavage are advantages obtained with intrathecal arthroscopy. Tenoscopy, when combined with antimicrobial and anti-inflammatory treatment, appears to offer a good chance of survival for affected horses.     

Osteomyelitis of the sustentaculum tali in horses: 10 cases (1992-1998)

OBJECTIVE: To determine outcome of horses with osteomyelitis of the sustentaculum tali (ST), with or without associated tarsal sheath tenosynovitis, following surgical debridement and lavage. DESIGN: Retrospective study. ANIMALS: 10 horses in which a diagnosis of osteomyelitis of the ST had been made on the basis of history, physical examination findings, and results of radiography. PROCEDURE: Information on results of diagnostic testing, surgical findings, postoperative treatment, and short-term outcome was obtained from the medical records. Long-term follow-up information was obtained through reevaluation of horses at the teaching hospital and telephone conversations with referring veterinarians, owners, and trainers. RESULTS: Treatment consisted of surgical debridement, intra- and postoperative lavage, and long-term antimicrobial and anti-inflammatory treatment. Eight horses had evidence of involvement of the tarsal sheath. One horse was euthanatized after surgery because of a lack of response to treatment; the other 9 were discharged from the hospital. Severity of lameness had improved, but all still had grade-1 or -2 lameness at the time of discharge. One horse was euthanatized after discharge because of contralateral hind limb laminitis, and another horse was lost to follow-up. Of the remaining 7 horses, 6 returned to their previous use, and 1 was sound but retired for breeding for unrelated reasons. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that horses with osteomyelitis of the ST, with or without concomitant tarsal sheath tenosynovitis, can have an excellent to good outcome and may return to their previous use after surgical debridement of affected tissues and lavage of the tarsal sheath.     

Effect of sodium hyaluronate in collagenase-induced superficial digital flexor tendinitis in horses.

Superficial digital flexor tendinitis was induced in each forelimb of 8 horses by injecting 4,000 U of collagenase into the midmetacarpal region of the tendon. In each horse, each tendon was treated 24 and 96 hours after the collagenase injection with SC injections of sodium hyaluronate (treated limbs) or an equal volume of 0.9% NaCl solution (control limbs). Exercise was restricted for the first 3 weeks of the study, and a controlled exercise program was instituted for the remainder of the study. Horses were evaluated clinically for lameness, tendon swelling, and midmetacarpal limb circumference. Ultrasonographic examinations were performed regularly (11 examinations/horse) throughout the study, and all horses were euthanatized 12 weeks after collagenase injections. Tendons from 4 horses were harvested for biomechanical testing, and samples were obtained from tendons from the remaining 4 horses for biochemical analysis of collagen. Samples were obtained from all tendons for microscopic evaluation. Significant differences between treated and control tendons were not noticed in any of the variables examined in live horses, although trends toward less lameness in treated limbs and toward better healing on ultrasonographic examination in control limbs were recorded. Significant differences were not noticed in biomechanical or biochemical evaluations, and the only significant (P < 0.05) microscopic finding was more severe inflammation in tendons from treated limbs. This study did not reveal significant benefits of treatment with sodium hyaluronate outside a synovial sheath on tendon repair in collagenase-induced tendinitis.     

Traumatic Septic Tenosynovitis of the Tarsal Sheath with Fragmentation of the Sustentaculum Tali: Surgical Treatment and Outcome in 3 Horses

This case report describes surgical treatment of 3 cases of septic chronic tenosynovitis of the tarsal sheath with fragmentation of the sustentaculum tali in 3 horses. Diagnosis was based on clinical signs, radiographic and ultrasonographic findings, synovial fluid cytology, and bacteriology. In each case, treatment consisted of tenovaginoscopy of the tarsal sheath performed with the horse under general anesthesia and regional intravenous perfusion of antibiotics. Follow-up data obtained between 12 and 46 months after surgery reported a good outcome, with a good cosmetic appearance in all cases described. Two horses returned to their intended use at 44 and 46 months, and 1 horse reportedly showed a remarkable functional improvement after 12 months. Despite the poor prognosis associated with the chronicity of the lesions, the presence of adhesions and the degree of involvement of the lateral digital flexor tendon, tenovaginoscopy of the tarsal sheath and regional antimicrobial therapy were successful therapeutic options for treating septic tenosynovitis of the tarsal sheath with fragmentation of the sustentaculum tali.     

自拟化瘀膏外敷配合红外线灯照射治疗马骡指(跖)部腱鞘炎的疗效观察

观察自拟化瘀膏外敷、红外线灯照射以及两者配合应用治疗马骡指（跖）部腱鞘炎的疗效,加以对比得出较好的治疗方案,以提高马骡指（跖）部腱鞘炎治愈率。自2003年8月至2010年12月在深圳赛马会、深圳世界之窗和吉林省农安县等地治疗指（跖）部腱鞘炎的马骡40余匹。随机分为四组,分别采用自拟化瘀膏外敷、红外线灯照射以及两者配合应用,并设对照组。化瘀膏外敷组治愈率66．67％、红外线灯照射组治愈率72．73％、自拟化瘀膏外敷配合红外线灯照射组治愈率87．53％。采用自拟化瘀膏外敷配合红外线灯照射治疗马骡指（跖）部腱鞘炎获得良好疗效,为临床治疗该病提供了切实可行的治疗方法。     

Treatment and outcome of chronic tenosynovitis in three horses

Three horses were presented for treatment of chronic infections of the digital flexor tendon sheath. Clinical signs included severe lameness, and heat, pain and swelling of the digital flexor tendon sheath. The horses were treated with surgical lavage of the tendon sheath, systemic and local antibiotics, and analgesics. In each case, resolution of the lameness occurred over weeks to months. Only one horse returned to athletic activity, while the other two became comfortable at pasture. Response to treatment in cases of chronic tenosynovitis may not be as rapid or complete as that reported for acute tendon sheath infections.     

Treatment and outcome of chronic septic tenosynovitis in three horses

Three horses were presented for treatment of chronic infections of the digital flexor tendon sheath. Clinical signs included severe lameness, and heat, pain and swelling of the digital flexor tendon sheath. The horses were treated with surgical lavage of the tendon sheath, systemic and local antibiotics, and analgesics. In each case, resolution of the lameness occurred over weeks to months. Only one horse returned to athletic activity, while the other two became comfortable at pasture. Response to treatment in cases of chronic tenosynovitis may not be as rapid or complete as that reported for acute tendon sheath infections.     

Intrathecal deep digital flexor tenectomy for treatment of septic tendonitis/tenosynovitis in four horses

Objective: To describe partial removal of the intrathecal component of the deep digital flexor tendon (DDFT) in horses with chronic septic DDF tendonitis and tenosynovitis unresponsive to conventional therapy, and to report long‐term outcome. Study Design: Case series. Animals: Horses (n=4). Methods: Four horses with chronic septic DDF tendonitis and tenosynovitis were treated by surgical tenectomy of the intrathecal component of the DDFT, followed by stabilization in casts and subsequent corrective shoeing. All horses were previously managed unsuccessfully with combinations of conventional therapy consisting of systemic antibiotics, through and through tendon sheath lavage/open drainage, regional limb perfusions, tenoscopy with debridement and transection of the palmar/plantar annular ligament, and intrathecal antibiotics. Results: Time from initial injury/diagnosis to tenectomy ranged from 10 to 210 days. Mean hospitalization time after surgery was 82 days. Long‐term follow‐up (>1.5 years; mean, 3.8 years) was available. All 4 horses were able to walk comfortably at pasture and were used as broodmares. Conclusions: Intrathecal tenectomy is a viable surgical procedure for treatment of chronic septic tenosynovitis of the digital sheath that is complicated by septic tendonitis of the DDFT.     

A Modified Cloward''s Technique for Arthrodesis of the Normal Metacarpophalangeal Joint in the Horse

A modified Cloward's technique was performed for arthrodesis of one metacarpophalangeal (MCP) joint in eight horses. Dorsal arthrotomies were performed medial and lateral to the common digital extensor tendon and two 16 mm holes were drilled through the joint. A perforated cylindrical stainless steel basket filled with cancellous bone was impacted into each hole. The limbs were supported in casts for 8 weeks. The joints were examined and radiographed at 4 weeks, 8 weeks, 6 months, and 10 months. One horse was euthanatized at week 14 to assess the progress of the arthrodesis. In the other seven horses, there was clinical fusion at month 6. Dynamographic evaluations were performed 11 months after surgery at the walk and trot. The maximum vertical forces exerted during weight bearing by treated and control limbs were compared. No difference was detected at the walk; however, a significant difference was present at the trot (p less than 0.05). It was calculated that at the trot the horses placed 90% as much force on the treated limb as on the control limb. Eleven months after surgery, the baskets contained compact and cancellous bone. Ingrowth of bone occurred through all openings, completely filling the baskets and fusing the joints.     

Comparison of surgical and nonsurgical treatment of humeral fractures in horses: 22 cases (1980-1989).

Medical records of 22 horses with humeral fractures were reviewed. The horses were from 2 to 144 months old (mean, 25.8 +/- 37.3 months). Ten horses were treated with stall confinement, 3 were treated surgically, and 9 were euthanatized at the time of diagnosis. Seven of 10 horses treated nonsurgically (stall confinement) were able to be ridden 5 to 12 months after the diagnosis was made (mean, 7.5 +/- 2.6 months). One horse treated nonsurgically was euthanatized 6 months after diagnosis because of laminitis in the contralateral limb. Two horses treated nonsurgically were lost to follow-up evaluation. Two of the 3 horses treated surgically had fractures repaired with Rush pins. The fractured humerus of the third horse was repaired with lag screws. Of the 3 surgically treated horses, 1 was pasture sound 10 months after surgery, but developed varus deviation in the contralateral carpus 6 weeks after repair; 1 horse was euthanatized 2 weeks after surgery because of failure of the implant; and the other horse was sound for riding 10 months after surgery. On the basis of these findings, young horses with humeral fractures that are treated nonsurgically can become sound for riding.     

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 15-year-old Sports horse gelding was referred for nonweightbearing lameness of the left hindlimb. Septic cellulitis was diagnosed and managed medically. After 14 days, septic tenosynovitis of the digital flexor tendon sheath (DFTS), with septic tendinitis of the superficial (SDFT) and deep (DDFT) digital flexor tendons, became evident. Surgical resection of the intrathecal portion of the septic SDFT was performed. Post-operatively, a half-limb cast was placed on the operated limb for 10 weeks followed by an articulated orthotic support boot during a rehabilitation period of 6 weeks. The horse recovered and regained long-term pasture soundness. Ultrasonography demonstrated the presence of bridging connective tissue in the location of the resected SDFT.     

Injection of corticosteroids, hyaluronate, and amikacin into the navicular bursa in horses with signs of navicular area pain unresponsive to other treatments: 25 cases (1999-2002)

OBJECTIVE: To determine history, clinical and radiographic abnormalities, and outcome in horses with signs of navicular area pain unresponsive to corrective shoeing and systemic nonsteroidal anti-inflammatory drug administration that were treated with an injection of corticosteroids, sodium hyaluronate, and amikacin into the navicular bursa. DESIGN: Retrospective study. ANIMALS: 25 horses. PROCEDURE: Data collected from the medical records included signalment, history, horse use, severity and duration of lameness, shoeing regimen, results of diagnostic anesthesia, radiographic abnormalities, and outcome. RESULTS: 17 horses had bilateral forelimb lameness, 7 had unilateral forelimb lameness, and 1 had unilateral hind limb lameness. Mean duration of lameness was 9.2 months. All horses had been treated with corrective shoeing and nonsteroidal anti-inflammatory drugs for at least 6 months; 18 had previously been treated by injection of corticosteroids and sodium hyaluronate into the distal interphalangeal joint. Fourteen horses had mismatched front feet, and 21 horses had signs of pain in response to application of pressure over the central aspect of the frog. Palmar digital nerve anesthesia resulted in substantial improvement in or resolution of the lameness in all horses. Twenty horses (80%) were sound and returned to intended activities 2 weeks after navicular bursa treatment; mean duration of soundness was 4.6 months. Two horses that received numerous navicular bursa injections had a rupture of the deep digital flexor tendon at the level of the pastern region. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that navicular bursa treatment may provide temporary improvement in horses with signs of chronic navicular area pain that fail to respond to other treatments.     

Factors affecting outcome of extensor tendon lacerations in the distal limb of horses. A retrospective study of 156 cases (1994-2003)

Distal limb lacerations are common injuries in horses, with a better prognosis reported for extensor tendons lacerations compared to flexor tendons lacerations. The objective of the present study was to determine the influence of type and location of injury, modalities of treatment and post surgical complications on the outcome of extensor tendon lacerations. The medical records of 156 horses surgically treated for extensor tendon lacerations over a 10-year period were analysed retrospectively. Information was obtained for 124 horses with a minimum of 18 months follow-up. Statistical analysis was performed on 129 horses (five horses were euthanatized during hospitalization) in order to determine factors affecting outcome. Seventy-four percent of the horses returned to soundness, 17% had moderate gait impairment and 9% remained lame. Approximately 60% of the sports horses returned to an equal or higher level of performance, and 17.5% returned to a lower level. In the multivariate statistical analysis, the only significant factor that favourably influenced outcome was complete suture of the wound. A significant association could not be detected between outcome and absence of a functional extensor tendon, The most important post-surgical complication was extensive scarring of the wound. The present results report outcome of extensor tendon lacerations in a large number of horses and outline the importance of primary wound healing in order to avoid major scarring with potential functional consequences.     

Effects of sodium hyaluronate on tendon healing and adhesion formation in horses

Sodium hyaluronate reduces adhesions after tendon repair in rodents and dogs, and has been used in limited clinical trials in people. To evaluate its effect on tendon healing and adhesion formation in horses and to compare these effects with those of a compound of similar visco-elastic properties, a study was performed in horses, using a model of collagenase injection in the flexor tendons within the digital sheath. Eight clinically normal horses were randomly allotted to 2 groups. Adhesion formation between the deep digital flexor tendon and the tendon sheath at the pastern region was induced in the forelimbs of all horses. Using tenoscopic control, a 20-gauge needle was inserted into the deep digital flexor tendon of horses under general anesthesia and 0.2 ml of collagenase (2.5 mg/ml) was injected. The procedure was repeated proximally at 2 other sites, spaced 1.5 cm apart. A biopsy forceps was introduced, and a 5-mm tendon defect was created at each injection site. Group-A horses had 120 mg of sodium hyaluronate (NaHA) gel injected into the tendon sheath of one limb. Group-B horses had methylcellulose gel injected at the same sites. The contralateral limbs of horses in both groups served as surgical, but noninjected, controls. Horses were euthanatized after 8 weeks of stall rest. Ultrasonographic evaluation revealed improved tendon healing after NaHa injection, but no difference in peritendinous adhesion formation. Tendon sheath fluid volume and hyaluronic acid (HA) content were greater in NaHA-treated limbs. Gross pathologic examination revealed considerably fewer and smaller adhesions when limbs were treated with NaHA. However, significant difference in pull-out strengths was not evident between NaHA-treated and control limbs. Histologically, the deep digital flexor tendon from the NaHA-treated limbs had reduced inflammatory cell infiltration, improved tendon structure, and less intratendinous hemorrhage. Treatment with methylcullulose had no significant effect on tendon healing, adhesion size, quantity, or strength or on the volume and composition of the tendon sheath fluid. Sodium hyaluronate, administered intrathecally, appears to have a pharmaceutically beneficial action in this collagenase-induced tendinitis and adhesion model in horses.     

What is the likelihood that a horse treated for septic digital tenosynovitis will return to its previous level of athletic function?

REASONS FOR PERFORMING STUDY: Septic digital tenosynovitis is a serious problem in the horse, with a poor prognosis being reported for recovery. HYPOTHESIS: The occurrence of septic digital tenosynovitis would significantly reduce the likelihood of a horse returning to its previous level of athletic function. METHODS: Medical records of 90 horses treated for septic digital tenosynovitis were reviewed. Data retrieved included age, sex, location of inciting cause of sepsis, time from onset of clinical signs to presentation for treatment, and whether the horse survived to be discharged. Long-term outcome was determined through telephone questionnaires. Univariate analyses of categorical variables were conducted for each outcome. RESULTS: Overall, 87.8% of horses (79/90) survived to be discharged from the hospital. Only one factor examined was shown to have a significant effect on outcome. A delay of 1-7 days between onset of clinical signs and presentation for treatment reduced significantly the likelihood of the horse surviving to be discharged from the hospital. Of the horses discharged from the hospital, long-term follow-up was available for 72 horses, with 54.2% (39/72) returning to their previous level of athletic function. CONCLUSIONS: Only approximately 50% of horses treated for septic digital tenosynovitis returned to their previous level of athletic function following resolution of synovial sepsis. POTENTIAL RELEVANCE: Accurate figures allowing a realistic assessment of the athletic future of a horse following treatment for septic digital tenosynovitis are of value to both the owner and treating veterinarian.     

Septic tenosynovitis of the tarsal sheath of an Arab gelding and suspected sepsis of the lateral digital flexor tendon subsequent to bacterial peritonitis

A 21-year-old Arab gelding with clinical signs of acute peritonitis had a perforating ulcer on the mesenteric border of the jejunum which resulted in localised contamination of the abdomen with ingesta. The affected segment of jejunum was resected and the abdomen was lavaged extensively. Postoperatively, the gelding was treated with broad-spectrum antibiotics, non-steroidal anti-inflammatory drugs and intravenous fluids, but after four days it became acutely non-weight bearing on its right hindlimb, and a tendonitis of the lateral digital flexor tendon within the tarsal sheath was identified ultrasonographically. The septic tendonitis was treated with broad-spectrum antibiotics but progressed proximodistally within the tendon until it involved both the tarsal sheath and the associated tarsocrural joint, necessitating the euthanasia of the gelding.