Lipoma of the long digital extensor tendon sheath in a horse

This paper describes the occurrence of a lipoma associated with the long digital extensor tendon sheath at the level of the tarsus in a 5‐month‐old female Thoroughbred. Radiographic and ultrasonographic images were interpreted as being an atypically located lipoma. Its position and character have some similarities to lipoma arborescens, which is reported to occur in and around human joints and tendon sheaths. Surgical removal is considered to be the treatment of choice.     

A case of carpal intersynovial fistula in a horse.

A tentative diagnosis of a fistula between the tendon sheaths of the right extensor carpi radialis and the intercarpal joint was confirmed by positive contrast radiography following injection of sodium diatrizoate into the joint. Surgical removal of a tag of synovial membrane and repair of the fistula was carried out. Post surgical treatment included mild exercise to prevent adhesions within the sheath. A month following discharge, contrast radiography revealed no communication between joint and tendon sheath. At this time mild distension of the sheath was relieved by aspiration and it did not recur when the horse returned to work following a further month of rest.     

Traumatic communication of the extensor carpi radialis tendon sheath and antebrachiocarpal joint in two horses

Two horses were examined due to lacerations at the level of the craniodistal antebrachii. Further evaluation of the lacerations revealed communication with the extensor carpi radialis tendon sheath and potentially the antebrachiocarpal joint. Positive contrast arthrography performed via the palmarolateral pouch of the antebrachiocarpal joint was used to diagnose communication with the extensor carpi radialis tendon sheath. Both the joints and tendon sheaths were treated aggressively with surgical debridement and lavage, followed by post operative medical management and rehabilitation. Both horses made a full recovery and are performing in their intended level of use with acceptable cosmetic results. Traumatic communication with the carpal joints should be considered when evaluating lacerations involving the forelimb extensor tendon sheaths.     

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.     

Para-articular osteochondroma with intersynovial fistula between the common digital extensor sheath and carpometacarpal joint

A 7-year-old Holsteiner gelding was presented with a left common digital extensor sheath effusion of one-year's duration. Radiographic examination revealed two extra-articular mineralised bodies adjacent to the dorsolateral carpometacarpal joint. Ultrasonography confirmed an intrathecal location of one mineralised body in the common digital extensor sheath, palmar fraying of the common digital extensor tendon and tenosynovitis. Ultrasound could not confirm whether the second mineralised body was intrathecal or located external to the common digital extensor sheath. Common digital extensor tenoscopy facilitated removal of both mineralised bodies and revealed a fistula communicating with the carpometacarpal joint. The mineralised bodies, initially thought to be synovial osteochondromas, were histologically identified as para-articular osteochondromas. There are no previously published reports of para-articular chondroma/osteochondroma in the horse. Despite surgical removal of the para-articular osteochondromas, concern for future extensor sheath distension remained given the communication between the carpometacarpal joint and common digital extensor sheath.     

Tenoscopic removal of a protruding osteophyte as a treatment for chronic common digital extensor tendinopathy and associated tenosynovitis

This report describes an adult Quarter Horse gelding that was presented for evaluation of chronic tenosynovitis of the right common digital extensor tendon sheath. Radiographic and tenoscopic evaluation confirmed the presence of a periarticular osteophyte from the third metacarpal bone protruding into the common digital extensor tendon sheath. Tenoscopic surgical resection of the osteophyte and debridement of the affected tendon resolved the tenosynovitis and associated right forelimb lameness. Osteophytes in this location can be a source of focal traumatic tendonitis of the common digital extensor tendon which can lead to a chronic tenosynovitis of the common digital extensor tendon sheath. Tenoscopic debridement and lavage is a viable treatment option for chronic nonseptic common digital extensor tendinopathy and associated tenosynovitis.     

Radiographic anatomy of tendon sheaths and bursae in the horse

Contrast radiography was used to determine the position, shape, relationship and capacity of a number of tendon sheaths and bursae which have clinical significance in the horse. It was possible to establish the normal range of radiographic anatomy for these structures. Some variation in the extent and form of tendon sheaths were found between individual horses and between foals and adults.     

First cases of animal diseases published since 2000. 4. Horses

In this fourth article of a series of papers listing first case reports of animal diseases published since 2000, the following six cases of horse diseases are discussed: Disseminated metastatic intramedullary melanoma. Lipoma of the extensor tendon sheaths. Meningoencephalomyelitis in a neonatal foal due to Salmonella agona infection. Neuronal ceroid lipofuscinosis. Placentitis due to Rhodococcus equi infection. Right atrial diverticulum in a foal. After a short introduction, the bibliographical data, the abstract of the author(s), and some additional information derived from the article are given. The article will be regularly updated adding overlooked as well as new first reports.     

ULTRASONOGRAPHY OF THE DORSAL AND LATERAL ASPECTS OF THE EQUINE CARPUS: TECHNIQUE AND NORMAL APPEARANCE

The normal ultrasonographic appearance of the dorsal and lateral soft tissue structures and anatomic landmarks of the equine carpus useful in clinical imaging are described.
Both limbs of 5 cadavers and 5 clinically sound adult horses were imaged using a 7.5 MHz sector transducer. At the dorsal aspect of the carpus and distal radius, the extensor carpi radialis- and the common digital extensor tendon and their tendon sheaths were easily identified. These two tendons are the most prominent structures in this region. Smaller and more difficult to identify are the tendon and tendon sheath of the extensor carpi obliquus-, the lateral digital extensor- and the ulnaris lateralis muscle. The ultrasonographic appearance and course through the carpal region of the tendons and tendon sheaths mentioned are described. Other soft tissue structures examined include the lateral collateral ligament, the carpal joint capsule and the distal articular cartilage of the radius. Ultrasonographic findings correlated well with gross anatomy in the cadavers limbs.     

Mesenteric strangulation by pedunculated lipomas without involvement of associated intestine in four horses

An unusual form of strangulation of mesentery only by pedunculated lipoma was identified as the cause of moderate to severe colic in four horses. The small intestinal mesentery was involved in three horses and the small colon mesentery in the fourth horse, but the associated intestine was not strangulated, haemorrhagic, nor obviously obstructed in any horse. In all horses, a patch of haemorrhagic mesentery of variable size was evident around the origin of a mesenteric lipoma and a major mesenteric vessel. One horse was subjected to euthanasia at the owner's request and the remaining three had surgery from which they made a complete recovery after the removal of the lipoma. Intestinal resection was not performed in any of the three horses undergoing surgery. An isolated mesenteric strangulation by lipoma is an uncommon cause of colic in older horses that have the typical presentation of a strangulating lipoma. The removal of the involved lipoma without mesenteric or intestinal resection can be associated with complete recovery.     

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.     

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.     

Subchondral bone cysts with fractures of the extensor processes in a horse.

Probable cause of fracture in a Paint gelding was a congenital bone defect involving the extensor process area of the right and left forelimb distal phalanges. Radiographically and histologically, subchondral bone cysts at the fracture lines were suspected. These cysts were thought to have developed in association with abnormal ossification centers at the extensor process areas of the third phalanx. Partial avulsion of weak extensor processes would then occur from natural forces exerted on these weakened bony prominences via the common digital extensor tendon. Support for osteochondrosis as a cause of this bone cyst formation was seen in histologic examination of fragments removed. Within the bony trabeculae, a dysplastic focus of cartilage with mineralized plaques and osseous tissues was observed. Findings supported a diagnosis of osteochondrosis, to the extent that the disease is presently understood in horses. Surgical correction by fragment removal was performed to circumvent progression of degenerative joint disease, which was evident as partial cartilage erosion of the distal dorsal articular surface of the second phalanx and fracture fragments. Recovery from surgery was rapid, and several months after surgery, the horse was sound for pleasure riding.     

Orbital Surgery in Two Horses

The case histories of 2 horses that required surgery within the orbit are described. In 1 horse, severely comminuted fractures of the left facial area and orbit were repaired in 2 stages, the first consisting of elevation and wiring of the depressed fractures. In the second stage, an autogenous tendon graft from the lateral digital extensor tendon of the left front leg was used to reconstruct the orbital floor and elevate the globe in the orbit. In the second horse, a retrobulbar tumor causing exophthalmos and prolapse of the nictitans was removed by creating a bone flap of the zygomatic process of the frontal bone for exposure.     

Septic tenosynovitis in horses: 25 cases (1983-1989).

The medical records of 25 horses with septic tenosynovitis treated over 7 years (1983 to 1989) were reviewed to determine clinical features of the disease and response to treatment. The median age of horses with septic tenosynovitis was 5 years (range, 1 month to 21 years). Fourteen fore limbs and 11 hind limbs were affected. Sepsis was located in the sheath of the digital flexor tendons of 22 horses. Sepsis was located in the sheath of the extensor carpi radialis tendon (1 horse), sheath of the long digital extensor tendon (1 horse), or sheath of the common digital extensor tendon (1 horse) in the remaining horses. Nine horses received only medical treatment, using a combination of broad-spectrum parenterally administered antimicrobial drugs (8 of 9 horses), nonsteroidal anti-inflammatory drugs (8 of 9 horses), or irrigation of the wound (4 of 9 horses). Fourteen horses were treated surgically with either transection of the palmar/plantar annular ligament of the metacarpo/metatarsophalangeal joint (5 of 14 horses), lavage of the sheath after insertion of drains into the sheath (7 of 14 horses), or both (2 of 14 horses). All horses treated surgically were concurrently treated parenterally with broad-spectrum antimicrobial drugs and nonsteroidal anti-inflammatory drugs. Two horses with septic tenosynovitis were not treated and were euthanatized at the owners' request. Five horses were euthanatized before discharge from the hospital. Two horses (both treated medically) were lost to follow-up. Follow-up information was obtained for 18 horses, 6 to 55 months after discharge from the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)     

New surgical approach to the plantar fetlock joint through the digital flexor tendon sheath wall and suspensory ligament apparatus in cases of concurrent septic synovitis in two cattle

A new surgical approach to the infected fetlock joint is described in two cattle suffering from septic tenosynovitis of the lateral digital flexor tendon sheaths of the right lateral hind-digits with concurrent septic serofibrinous arthritis of the adjoining fetlock joints, caused by penetrating wounds. In both patients, the infected sheaths were opened and the superficial and deep digital flexor tendons were removed. Intraoperatively, a small entry through the fetlock joint capsule was detected, directly distal to the lateral proximal sesamoid bone. The tract was surgically enlarged and a second approach into the plantar fetlock joint pouch was created proximally by making a 3 cm long and 0.5 cm wide incision between the two lateral suspensory ligament branches. This allowed easy access to the plantar joint pouch, removal of fibrin clots and an effective joint lavage using 5L of sterile saline solution. The incisions of the fetlock joint capsules remained unsutured and were drained using soft polyurethane foam to preclude premature closure. The tendon sheath wounds remained unsutured. In both patients, the digital flexor tendon sheath and the fetlock joint were lavaged daily for the following three days. The infection was eliminated in both cattle and both fully recovered without residual lameness.     

A review of tendon injury: Why is the equine superficial digital flexor tendon most at risk?

Tendon injury is one of the most common causes of wastage in the performance horse; the majority of tendon injuries occur to the superficial digital flexor tendon (SDFT) whereas few occur to the common digital extensor tendon. This review outlines the epidemiology and aetiology of equine tendon injury, reviews the different functions of the tendons in the equine forelimb and suggests possible reasons for the high rate of failure of the SDFT. An understanding of the mechanisms leading to matrix degeneration and subsequent tendon gross failure is the key to developing appropriate treatment and preventative measures.     

Treatment of an invasive equine mast cell tumour in the extensor carpi radialis by extensive tenomyectomy and local corticosteroid injections

Equine mast cell tumours (MCT) have been reported to occur in the skin, respiratory tract, oral cavity, synovial structures and eye. These tumours are typically locally invasive and nonaggressive. In this case, a MCT was located in the extensor carpi radialis (ECR) and was highly infiltrative. Excision of the ECR and local corticosteroid injection was curative and resulted in a good functional outcome. A 12-year-old Thoroughbred gelding presented for lameness, swelling and pruritus associated with the right antebrachium. Sonographic changes were suggestive of severe tenosynovitis and purulent material in the ECR. Surgical exploration revealed maceration at the ECR musculotendinous junction. The extensor sheath contained a large quantity of caseous material and serosanguinous fluid. The ECR tendon and 75% of the muscle was excised. Cytology and histopathology were consistent with a MCT that infiltrated the surgical margins. Post-operatively the horse was treated with multiple local corticosteroid injections along the incision. Right forelimb movement was initially limited, however, there was steady improvement over 3 months with increasing exercise. At 18 months post-operatively, no lameness was detectable in the walk, trot or canter and no recurrence of MCT was apparent. The horse appeared to compensate for loss of the ECR by using the biceps during the swing phase. Partial excision and local corticosteroid treatment can be curative for cases of invasive MCT. Extensive excision of the ECR is a viable treatment option for neoplasia or other conditions affecting the ECR in the horse.     

A giant nonstrangulating mesenteric lipoma as a cause of recurrent colic in a horse

Colic is a major cause of veterinary attendance in general practice and although most colic episodes remain isolated, recurrence may occur and definitive diagnosis can be difficult to obtain. This report describes an unusual presentation of a lipoma in a middle‐aged horse presented for recurrent colic. A massive lipoma causing a nonstrangulating space occupying obstruction of the small intestine was found during an exploratory celiotomy and was considered to be the most likely cause of the recurrent episodes of abdominal discomfort.     

Surgical resection of an osteoma of two thoracic spinous processes in a horse

This report describes the successful surgical removal of an osteoma of the thoracic dorsal spinous processes of a horse that presented with back pain. Osteomas of the spine are frequently reported in the literature in people, but have not been previously described in the horse.