2012.09.04.

1

Diseases of tendons, tendon Diseases of tendons, tendon

sheath and bursaesheath and bursae

Dr. Tóth Péter

Szent István University, Faculty of Veterinary SciencesLarge Animal Clinic - Üllő

Tendon anatomyTendon anatomy

•Primery secondary and tertiery tendon bundles•Components: collagen

Associated structuresAssociated structures

•Endotendon: fine connective tissue between the strands in a tendon •Peritendon (peritenon): the connective tissue structures attached to and surrounding a tendon •Paratendon (paratenon): loose connective tissue filling the interstices of the fascial compartment in which a tendon is situated and which allows it to move freely; is not organized into discrete tendon sheaths. •Mesotendon: the connective tissue sheath attaching a tendon to its synovial sheath•Tendon sheath (epitendineum): white fibrous sheath surrounding a tendon

Mechanical properitiesMechanical properities

•Low extensibility

•Due to stress- elastic and visioelastic phase –

and rupture

•Approximately 3% of extension,

•dissappearance of the wave form and helicles

•3-5% of extension: partial rupture

•more than 5-6% of extension: total rupture

Tendon injuriesTendon injuries

•Tendon wounds•Cause, symptoms, treatment, prognosis

•Tendon rupture•Fibrillar damage, partial or total rupture

TendinitisTendinitis

•Acute•Chronic (aseptic)•Septic

2012.09.04.

2

TendinitisTendinitis

•Pathogenesis•stress•Degenerative changes•Heat•Hypoxia

Tendinitis Tendinitis --healinghealing

•Extrinsic way (peritendon, mesotendon, paratendon)•Intrinsic way (fibroblasts)

NO REGENERATION! - BUT REPARATION!Instead of collagen I. collagen III. fibres

Acute tendinitis clinical Acute tendinitis clinical

examinationexamination

•Visual examination at rest•Palpation•Visual examination at exercise•Ultrasonography•Other diagnostic possibilities

•X-ray•Scintigraphy•CT•MRI

Acute tendinitis Acute tendinitis ––

conservative treatmentconservative treatment

•Systemic (NSAID, Corticosteroids?)

•Local •cold, icepacs, topical DMSO•Pressure bandage, light cast•Subacute

•Peritendinous hyaluronic acid (Hylartil inj)•Intratendinous PSGAG (Adequan i.a.inj.)

•Shock wave therapy (in more chronic form!)•Stem cells

Tendinitis surgical treatmentTendinitis surgical treatment

•Desmotomy of the prox. accessory lig.•Tendon splitting

BLISTERS??? - FIRING???

Advices for high level competitive showjumpersAdvices for high level competitive showjumpers (Lieve (Lieve

Vandekeybus DVM Belgium)Vandekeybus DVM Belgium)

�� Keep the number of jumps below 50/ trainingKeep the number of jumps below 50/ training

�� Keep number of jumps below 12 before courseKeep number of jumps below 12 before course

�� Above 12y do not have a 6 weeks or more offAbove 12y do not have a 6 weeks or more off

�� Keep horses in regular exercise above 12y if competing on Keep horses in regular exercise above 12y if competing on high level high level

�� weekly 1 jumping trainingweekly 1 jumping training

�� Exercise every day, no long resting period! (>6weeks)Exercise every day, no long resting period! (>6weeks)

�� CK and ASTAT levels below 300U/CK and ASTAT levels below 300U/

2012.09.04.

3

2012.09.04.

4

Tendon sheath disordersTendon sheath disorders

�� NonNon--infectious Tenosynovitis of the DFTSinfectious Tenosynovitis of the DFTS

�� Accumulative low grade trauma (normal exercise)Accumulative low grade trauma (normal exercise)

�� Acute trauma (e.g. overreach)Acute trauma (e.g. overreach)

�� Abnormal force (hyperextension)Abnormal force (hyperextension)

�� Clinical signsClinical signs

�� Treatment: rest, bandage immobilisation, cold therapyTreatment: rest, bandage immobilisation, cold therapy

systemic AID therapy: short acting corticosteroid (e.g. systemic AID therapy: short acting corticosteroid (e.g. dexamethasone phosphat 0,06 mg/kg iv.) +NSAID therapy dexamethasone phosphat 0,06 mg/kg iv.) +NSAID therapy

(flunixin or phenylbutazone)(flunixin or phenylbutazone)

In 7In 7--14 days intrathecal 14 days intrathecal hyaluronic acidhyaluronic acid and and corticosteroidcorticosteroid (?)inj.(?)inj.

2012.09.04.

5

Septic inflammation of the DFTSSeptic inflammation of the DFTS

�� Infectious TenosynovitisInfectious Tenosynovitis

�� Penetrating woundPenetrating wound

�� Intrathecal injection (iatrogenic)Intrathecal injection (iatrogenic)

�� DiagnosisDiagnosis: severe lameness(!), heat, effusion: severe lameness(!), heat, effusion

�� TreatmentTreatment: AB therapy, synovial debridement, drainage : AB therapy, synovial debridement, drainage

�� Failure to return to intended useFailure to return to intended use:because of adhesion and fibrosis:because of adhesion and fibrosis

�� 77--14 days after injury: hyaluronic acid, repeted in 14 days14 days after injury: hyaluronic acid, repeted in 14 days

Diseases of bursaeDiseases of bursae

�� Aquired or congenital bursaeAquired or congenital bursae

�� Subcutan: (calcaneal, carpal, olecranon etc.)Subcutan: (calcaneal, carpal, olecranon etc.)

�� Subtendonous: navicular, bicipital, cunean, gastrocnemius Subtendonous: navicular, bicipital, cunean, gastrocnemius

�� Subligamentous: lig nuchaeSubligamentous: lig nuchae

�� Submuscular: Submuscular:

�� Types:Types:

�� Acute aseptic bursitisAcute aseptic bursitis

�� Chronic aseptic Chronic aseptic

�� Septic Septic

2012.09.04.

6

2012.09.04.

7

2012.09.04.

8

2012.09.04.

9