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Barnes HKS, Sinovich M, Baldwin CM, Gillen A, Stack JD. Ex vivo pilot study evaluating needle tenoscopy of the digital flexor tendon sheath and its suitability to assist palmar annular ligament transection. EQUINE VET EDUC 2023. [DOI: 10.1111/eve.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Harriet K. S. Barnes
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
| | | | - Christopher M. Baldwin
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
| | - Alexandra Gillen
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
| | - John David Stack
- Department of Equine Clinical Studies, The Philip Leverhulme Equine Hospital University of Liverpool Neston UK
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Espinosa P, Nieto JE, Snyder JR, Galuppo LD, Katzman SA. A novel ultrasonographic assisted technique for desmotomy of the palmar/plantar annular ligament in horses. Vet Surg 2017; 46:611-620. [DOI: 10.1111/vsu.12630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Pablo Espinosa
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California; Davis California
| | - Jorge E. Nieto
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California; Davis California
| | - Jack R. Snyder
- Circle Oak Equine, Sports Medicine and Rehabilitation; Petaluma California
| | - Larry D. Galuppo
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California; Davis California
| | - Scott A. Katzman
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine, University of California; Davis California
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Pilati N, Pepe M, Gialletti R, Moriconi F, Beccati F. Septic Tenosynovitis Caused by Porcupine Quills: Clinical and Diagnostic Findings, Treatment, and Long-Term Outcome in Seven Horses. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rubio-Martínez LM, Elmas CR, Black B, Monteith G. Clinical use of antimicrobial regional limb perfusion in horses: 174 cases (1999-2009). J Am Vet Med Assoc 2013; 241:1650-8. [PMID: 23216042 DOI: 10.2460/javma.241.12.1650] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the clinical use of regional limb perfusion with antimicrobials (A-RLP), complications, and outcome in a large series of patients. DESIGN Retrospective case series. ANIMALS 174 horses. PROCEDURES Medical records of horses treated with A-RLP between 1999 and 2009 were reviewed. Signalment, primary complaint, horse use, etiology, duration of clinical signs, previous treatment, structures involved, concurrent conditions, A-RLP characteristics, additional treatments, complications, and outcome were recorded. At long-term follow-up, 2 outcomes were investigated: survival rate and return to previous use at the same or higher level. Univariate and multivariate logistic regression analyses were conducted. RESULTS Group 1 (96 horses) included septic synovitis. Group 2 (50 horses) included extrasynovial lacerations (23 horses) and fresh, minimally contaminated intrasynovial lacerations without evidence of established synovial infection (27 horses). Group 3 (28 horses) included miscellaneous other conditions. Only minor complications were reported in 12.26% of horses that received IV (n = 155) and 33% of horses that received intraosseous (27) A-RLP. Horses with septic synovitis had a lower survival rate (53.43%) than did horses with lacerations (91.89%). Within group 2, no significant differences in short- or long-term outcomes were found between horses with extrasynovial and fresh, minimally contaminated intrasynovial lacerations. For the horses returning to previous use, 80% of horses with septic synovitis and 72.72% of horses with lacerations were performing at the same or higher level at the time of follow-up. CONCLUSIONS AND CLINICAL RELEVANCE The results of the present study indicated that A-RLP is a safe technique with minimal adverse effects. The IV route presented fewer complications than intraosseous injection. Horses with infection of synovial structures had a lower survival rate than did those with acute, minimally contaminated intrasynovial lacerations. The latter had a similar prognosis for horses with extrasynovial lacerations treated with A-RLP.
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Affiliation(s)
- Luis M Rubio-Martínez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Canada.
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Mc Nally TP, Slone DE, Hughes FE, Lynch TM. Tenosynoviotomy for sepsis of the digital flexor tendon sheath in 9 horses. Vet Surg 2012; 42:114-8. [PMID: 23164091 DOI: 10.1111/j.1532-950x.2012.01033.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe a tenosynoviotomy technique for treatment of sepsis of the digital flexor tendon sheath (DFTS) in horses and report long-term outcome. STUDY DESIGN Case series. ANIMALS Horses (n = 9). METHODS Horses were positioned in lateral recumbency with the affected limb uppermost. A linear incision was made just lateral to the mesotenon beginning 5 cm proximal to the apices of the proximal sesamoid bones, extending 2 cm distal to the bifurcation of the superficial digital flexor tendon (SDFT). The incision was continued through the skin, subcutaneous tissue, palmar/plantar annular ligament, and DFTS. Tenotomy of the distal lateral branch of the SDFT was also performed. The site was thoroughly debrided, lavaged, and packed with gauze and allowed to heal by second intention. Follow-up was obtained via owner telephone interview. RESULTS Mean surgery time was 32 minutes (range, 10-64 minutes). Systemic antibiotics were administered postoperatively (range, 11-46 days; mean, 23 days). Mean hospitalization was 11 days (range, 0-49 days). Follow-up was available for 7 (70%) horses. One year postoperatively, 5 (71%) horses were serviceable for their intended use, and 2 (29%) had been euthanatized. Of 5 survivors, 3 returned to ridden exercise, 1 was retired as a broodmare, and 1 was a broodmare. All owners were satisfied with the cosmetic appearance of the surgery site. CONCLUSION Open drainage via tenosynoviotomy, performed as a salvage procedure, represents a feasible treatment for DFTS sepsis.
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McCoy AM, Goodrich LR. Use of a radiofrequency probe for tenoscopic-guided annular ligament desmotomy. Equine Vet J 2011; 44:412-5. [PMID: 21848530 DOI: 10.1111/j.2042-3306.2011.00454.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Annular ligament desmotomy is commonly performed in horses with chronic tenosynovitis. Previously reported tenoscopic techniques have limitations related to haemorrhage and awkward instrumentation. Radiofrequency (RF) energy affords precision and excellent haemostasis and may be a good alternative to sharp transection of the annular ligament in horses. OBJECTIVE To describe a technique for using a RF probe for tenoscopic-guided annular ligament desmotomy and to report the clinical outcome of horses in which it was performed. METHODS Cadaver specimens (n = 14) and live horses undergoing unrelated terminal procedures (n = 2) were used to optimise the tenoscopic-guided RF annular ligament desmotomy technique. Records were examined for all horses undergoing annular ligament desmotomy with an RF probe from 2003 to 2008 for which follow-up of >1 year post operatively was available. RESULTS The annular ligament was successfully transected in the cadaver and live horse model limbs using 2 different commercially available RF probes. Complete transection was achieved with practice and confirmed on gross dissection. Histopathology did not reveal any collateral damage to surrounding tissue. Follow-up of >1 year was available for 6 of 7 clinical cases. Four of 6 horses returned to work. Owners were satisfied with the outcome in all cases. CONCLUSIONS Desmotomy using a RF probe allows precise tissue transection under tenoscopic guidance without damage to surrounding structures or haemorrhage. With experience, it is an easily performed technique. In clinical patients, an acceptable outcome may be expected. POTENTIAL RELEVANCE Tenoscopic-guided RF annular ligament desmotomy offers advantages, including reliable haemostasis and precise tissue transection, over previously reported techniques and is a viable surgical alternative for treating horses with annular ligament desmitis and other complex pathology within the tendon sheath.
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Affiliation(s)
- A M McCoy
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
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Marsh CA, Watkins JP, Schneider RK. Intrathecal Deep Digital Flexor Tenectomy for Treatment of Septic Tendonitis/Tenosynovitis in Four Horses. Vet Surg 2011; 40:284-90. [DOI: 10.1111/j.1532-950x.2011.00795.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Smith LJ, Mellor DJ, Marr CM, Mair TS. What is the likelihood that a horse treated for septic digital tenosynovitis will return to its previous level of athletic function? Equine Vet J 2010; 38:337-41. [PMID: 16866201 DOI: 10.2746/042516406777749155] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- L J Smith
- Institute of Comparative Medicine, Faculty of Veterinary Medicine, University of Glasgow, UK
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Fraser BSL, Bladon BM. Tenoscopic surgery for treatment of lacerations of the digital flexor tendon sheath. Equine Vet J 2010; 36:528-31. [PMID: 15460078 DOI: 10.2746/0425164044877396] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Lacerations to the digital flexor tendon sheath (DFTS) are a common injury in the horse, but little information is available in the literature regarding prognostic indicators. OBJECTIVE To ascertain whether laceration of the DFTS carried a better prognosis if treated by tenoscopic lavage, debridement and repair within 36 h of the original injury. METHODS A retrospective analysis of 39 horses treated surgically for lacerations to the DFTS was performed over a 3 year period. The injury-to-surgery interval was recorded as <36 or >36 h. The structures damaged by the injury were also recorded, as well as age, sex, use and outcome. RESULTS Sixteen horses had laceration and contamination of the DFTS alone, of which 15 (94%) returned to their original or intended use. Sixteen horses had lacerations involving the superficial digital flexor tendon, of which 12 (75%) made a full recovery. Six horses had lacerations to both superficial and deep digital flexor tendons, 5 were subjected to euthanasia intraoperatively and one is paddock sound. Treatment within 36 h of initial laceration carried a significantly better prognosis for return to intended athletic use (25 of 28 horses allowed to recover from anaesthesia) than treatment after 36 h (2 of 5 P = 0.03; Fisher's Exact Test). CONCLUSIONS If sepsis is treated early using tenoscopic visualisation, lavage and repositol antibiotics, the limiting factor in return to athletic function is tendon damage. POTENTIAL RELEVANCE This study supports anecdotal evidence that early treatment of synovial sepsis improves the prognosis for return to intended use. It also provides information on prognostic indicators including extent of damage to collateral structures.
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Affiliation(s)
- B S L Fraser
- Donnington Grove Veterinary Surgery, Oxford Road, Newbury, Berkshire RG14 2JB, UK
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Wereszka MM, White NA, Furr MO. Factors associated with outcome following treatment of horses with septic tenosynovitis: 51 cases (1986-2003). J Am Vet Med Assoc 2007; 230:1195-200. [PMID: 17501662 DOI: 10.2460/javma.230.8.1195] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify factors associated with outcome (ie, survival and return to function) following treatment of horses with septic tenosynovitis. DESIGN Retrospective case series. ANIMALS 51 horses with septic tenosynovitis. PROCEDURES Information was obtained from medical records and through follow-up conversations with owners. Factors analyzed for an association with outcome included affected limb, etiology, duration of clinical signs prior to examination, presence of complications, primary treatment, secondary treatments, number of surgical procedures, and hospitalization time. RESULTS Concurrent complications were identified in 41 (80%) horses. The primary treatment consisted of through-and-through lavage in 26 (51%) horses, tenoscopy in 20 (39%), and tenosynoviotomy combined with lavage in 5 (10%). Forty (78%) horses were discharged, and 37 (73%) survived at least 1 year after surgery; 21 of the 37 (57%) returned to their previous or a higher level of performance. Percentages of horses that survived 1 year after discharge and percentages that returned to their intended use did not vary significantly among treatments. Horses with tendon rupture or sepsis of an adjacent joint were significantly less likely to survive. Horses with tendon injury or pannus were significantly less likely to return to their intended use. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that various factors were associated with outcome in horses with septic tenosynovitis. However, surgical technique was not found to be associated with survival rate or rate of return to intended use.
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Affiliation(s)
- Marta M Wereszka
- Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech, Leesburg, VA 20177, USA
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Meagher DT, Latimer FG, Sutter WW, Saville WJA. Evaluation of a balloon constant rate infusion system for treatment of septic arthritis, septic tenosynovitis, and contaminated synovial wounds: 23 cases (2002–2005). J Am Vet Med Assoc 2006; 228:1930-4. [PMID: 16784388 DOI: 10.2460/javma.228.12.1930] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE-To determine clinical findings and outcome in horses treated by means of a balloon constant rate infusion system. DESIGN-Retrospective case series. ANIMALS-23 horses. PROCEDURES-Medical records of horses examined at The Ohio State University veterinary teaching hospital from 2002 to 2005 that had septic arthritis, septic tenosynovitis, or penetration of a synovial structure and in which treatment involved a balloon constant rate infusion system were searched. Information pertaining to signalment, history, physical examination findings, clinicopathologic data, treatment, and duration of hospitalization was recorded. RESULTS-Mean+/- SD duration of hospitalization was 11.5+/-5.26 days. No correlation between duration of clinical signs and duration of hospitalization or duration of infusion pump use was detected, but correlations between WBC count and duration of hospitalization and WBC and duration of infusion-pump use were observed. All horses survived to discharge. Follow-up information was obtained on 17 horses, 16 of which were alive at the time of follow-up. Twelve of 13 horses for which followup information was available for at least 5 months were alive 5 months or longer after discharge. Thirteen of the 16 horses alive at follow-up were reported by owners as not lame, whereas the remaining 3 were mildly lame or intermittently moderately lame or had developed angular limb deformity in the contralateral limb. CONCLUSIONS AND CLINICAL RELEVANCE-Balloon constant rate infusion systems may be used effectively in treatment of septic arthritis, septic tenosynovitis, and contaminated synovial wounds. Clinical response and long-term outcome appeared to be comparable to results obtained with other techniques.
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Affiliation(s)
- Daniel T Meagher
- Department of Veterinary Clinical Science, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
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Lopes MA, Sullins KE, Walker BL. Tenoscopy in 33 horses with septic and nonseptic digital tenosynovitis (1997–2001). J Equine Vet Sci 2006. [DOI: 10.1016/j.jevs.2005.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jann H, Pasquini C. Wounds of the distal limb complicated by involvement of deep structures. Vet Clin North Am Equine Pract 2005; 21:145-65, viii. [PMID: 15691605 DOI: 10.1016/j.cveq.2004.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors describe the clinically relevant structures of the distal limb and the current diagnostic and treatment modalities. Specific problems include tendon laceration, septic tenosynovitis, and sep-tic arthritis of the distal joints. A detailed description of tendon repair, tendon sheath lavage, and postoperative convalescent methodology is provided. This article makes available to the reader information necessary to appropriately diagnose and treat wounds of the distal equine limb involving deep structures. Information on the overall prognosis is also provided.
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Affiliation(s)
- Henry Jann
- Oklahoma State University, College of Veterinary Medicine, 002 Boren Veterinary Teaching Hospital, Stillwater, Oklahoma 74078, USA.
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Abstract
Antimicrobial medication should be considered an adjunct to the general care of wounds rather than a substitute for lavage, drainage, or other physical care intended to promote healing. Judicious use is based on results of diagnostic procedures and the professional judgment of the attending veterinarian. Organisms that contaminate or infect wounds of horses are similar to those that can affect human patients, such that personal hygiene and protection are important when caring for these equine patients, because attendants can easily be exposed to them. Although those organisms are considered to be ubiquitous, the inoculum that may be present on or in an infected wound may be substantially greater than that encountered during other daily activities of the veterinarian. Proper disposal of the bandage materials and personal protective clothing is important. Bacterial resistance is one of many "survival tactics" of bacteria and has been an important clinical consideration for physicians and veterinarians since antimicrobial drugs were discovered. Controversies and insufficient understanding of bacterial resistance abound, however. The entirety of the subject is beyond the scope of this article, but it is important to the veterinary profession and for the formulation of wound management in horses. We and our animal patients live in a world populated by microbial organisms of various types. Resistance among bacteria is likely to continue to be a clinical consideration in the future as it has been during the past 60 to 70 years. As veterinarians, we must recognize the zoonotic nature of resistance and implement biosecurity procedures to protect ourselves, other people in contact with those pathogens, and our patients. We must also recognize the merits of judicious targeted use of antimicrobial drugs and apply appropriate principles during the course of professional care for the well-being of our animal patients.
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