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Topic:Superficial Digital Flexor Tendon
The Superficial Digital Flexor Tendon (SDFT) in horses is a critical component of the equine musculoskeletal system, primarily responsible for supporting the limb during locomotion. It is located on the back of the leg and extends from the muscle belly in the upper limb to its attachment on the pastern bone in the lower limb. The SDFT is prone to injury due to its high load-bearing function, particularly in performance horses. Injuries to this tendon can result from overuse, sudden trauma, or degenerative changes, leading to conditions such as tendinitis. This page compiles peer-reviewed research studies and scholarly articles that explore the anatomy, function, injury mechanisms, and rehabilitation strategies for the Superficial Digital Flexor Tendon in horses.
Ultrasonography as a method to determine tendon cross-sectional area. Ultrasonographic cross sectional area (CSA) measurements of equine superficial digital flexor (SDF) tendon were obtained to determine the feasibility of ultrasonography for CSA measurement of tendon in vivo and in vitro. Ultrasonographic measurements were compared with a more traditional CSA measurement method, ink-blot analysis. In addition, values for ultrasonographic SDF tendon mean echogenicity were obtained in vivo and in vitro. The left forelimb SDF tendons of 23 horses were evaluated ultrasonographically. Cross sectional images were acquired at 4-cm intervals distal to the base of the a...
Tendon, tendon sheath, and ligament injuries in the pastern. The palmar (plantar) aspect of the pastern is an anatomically complex area and an understanding of this is a prerequisite for accurate diagnosis of injuries in this area. The gross and normal ultrasonographic anatomy are described, and injuries of the superficial and deep digital flexor tendons and the digital flexor tendon sheath, the distal sesamoidean ligaments, and the palmar ligaments of the proximal interphalangeal joint are discussed.
Soft tissue injuries of the tarsus. Contrast radiography provides a clear survey of the size, shape, and location of extratendovaginal fluid-filled cavities, distended bursa, and tendon sheaths and demonstrates intersynovial communication. Ultrasonography effectively demonstrates Achilles tendon injury, slippage of the SDFT off the summit of the calcaneus, assorted ligamentous injuries, and cystic or solid extratendovaginal masses. It will also demonstrate distended bursae and tendon sheaths, but it is not as effective in demonstrating a synovial herniation, or a narrow synovial fistula. Contrast radiography may prove to be the ...
Transection of the accessory ligament of the superficial digital flexor tendon for treatment of tendinitis: long term results in 61 standardbred racehorses (1985-1992). Medical records and lifetime race results were obtained for 61 Standardbred racehorses treated consecutively from 1985 to 1992 with transection of the accessory ligament of the superficial digital flexor tendon (AL-SDF) for tendinitis of one or both forelimbs. A clinical diagnosis of tendinitis was confirmed in all cases by ultrasonographic examination. After surgery, 50 (82%) horses raced and 42 (69%) completed 5 or more starts. Eight horses (13%) failed to start and/or complete 5 or more races due to a recurrence of tendinitis. Six (10%) horses did not start and/or complete 5 or more starts ...
Transection of the accessory ligament of the superficial digital flexor muscle for the treatment of superficial digital flexor tendinitis in standardbreds: 40 cases (1988-1992). Medical records of 40 racing Standardbreds with superficial digital flexor tendinitis that underwent transection of the accessory ligament of the superficial digital flexor (SDF) muscle (superior check desmotomy) were reviewed. Surgery was performed bilaterally in 32 horses and unilaterally in 8. Concurrent palmar annular desmotomy was performed in 8 horses in which tendinitis involved the distal metacarpal region and confinement of the deep and SDF tendons by the annular ligament was suspected. Follow-up information was obtained for 32 horses, by telephone, and racing results were available f...
The cross-sectional areas of normal equine digital flexor tendons determined ultrasonographically. Fifty-two animals, comprising 22 Irish Draught crosses (Group A), 15 Thoroughbreds (Group B) and 15 ponies (Group C) were examined ultrasonographically using a 7.5 mHz linear array probe and stand-off pad. All animals were free of tendon disease as determined from clinical and ultrasonographical examination. The superficial (SDFT) and deep (DDFT) digital flexor tendons were scanned at 7 transverse (axial) levels between the carpus and metacarpophalangeal joint. Each transverse image was digitised using a commercially available frame grabber and the cross-sectional areas of each tendon at each ...
Three-dimensional sonographic imaging of the equine superficial digital flexor tendon. In a feasability study, a technique for constructing 3-dimensional sonographic images of the superficial digital flexor tendon (SDFT) was established in 6 clinically normal horses and applied to 7 horses with injured SDFT. Two-dimensional B-mode sonographic images were recorded on videotape as the sonographic transducer was manually moved along the palmar aspect of the metacarpal region. Selected videofields were digitized, and 3-dimensional images were constructed, using a computer work station and dedicated software program. The 3-dimensional images were of high quality and presented qualita...
Superior check ligament desmotomy for treatment of superficial digital flexor tendonitis in thoroughbred and standardbred horses. Bilateral superior check ligament desmotomy was performed on 31 Thoroughbred and 17 Standardbred horses as the sole method of treatment for superficial digital flexor tendonitis. Horses resumed racing between 6 and 19 months after surgery. Horses that were able to compete in 5 or more races without injury to the tendon again were considered to have had a successful return to racing. Twenty-five Thoroughbreds were suitable for later study and 13 of these (52%) raced on 5 or more occasions. Fifteen Standardbreds were suitable for later study and 10 of these (66%) raced on 5 or more occasions. Wi...
Treatment of superficial digital flexor tendinitis. This article reviews the research and clinical findings relevant to the treatment of acute tendinitis in the horse. The goals of treatment are to reduce inflammation, minimize scar tissue formation, and promote restoration of normal tendon function. A wide variety of treatments have and still are being used to treat tendinitis, which indicates that there is no uniformly successful way to return a horse to full athletic function after injury. Therapy depends on the severity of tendinitis and duration of injury and can be divided into treatment during the inflammatory, repair, and maturation pha...
Differential scanning calorimetric studies of superficial digital flexor tendon degeneration in the horse. Differential scanning calorimetry (DSC) of equine superficial digital flexor tendons revealed the presence of a small exothermic peak at 23 degrees C of unknown origin, and a large endothermic peak at 70 degrees C due to denaturation of cross-linked collagen fibres. In the central degenerated core of damaged tendons the denaturation temperature remained at 70 degrees C but the enthalpy decreased in relation to the extent of degeneration of the tendon. We suggest that this reduction in enthalpy is due to depolymerisation and denaturation of the collagen fibres. This contention is supported by t...
Exercise-induced hyperthermia as a possible mechanism for tendon degeneration. Mathematical modelling of tendon thermodynamics predicted that the temperature of the central core of the equine superficial digital flexor tendon would plateau at 11 degrees C above the tendon surface temperature during a sustained gallop. A mean temperature differential (between tendon core and surface) of 5.4 (S.E. +/- 1.0) degrees C was demonstrated in vivo in four horses. Peak intra-tendinous temperatures in the range 43-45 degrees C were recorded. Temperatures above 42.5 degrees C are known to result in fibroblast death in vitro [Hall (1988) Radiobiology for the Radiologist, 3rd Edn., pp...
Ultrasonographic evaluation and long-term follow-up of flexor tendonitis/desmitis in the metacarpal/metatarsal region in Dutch warmblood horses and standardbred racehorses. Over a 2 year-period, the ultrasonographic localization and distribution of flexor tendinous and ligamentous injuries, the long-term follow-up, and the outcome were studied in 101 Dutch Warmblood horses (DW) with a mean age of 8.7 years and in 71 Standardbred racehorses (ST) with a mean age of 5.2 years. The ratio between forelimb and hind limb flexor tendonitis/desmitis in the DW-group was 4:1 and in the ST-group group 4:3. In the DW-group, tendonitis/desmitis of the suspensory ligament (32%), the superficial digital flexor tendon (29%), the distal carpal check ligament (17%) of the forelimb ...
Scintigraphic and ultrasonographic diagnosis of soft tissue injury in a thoroughbred horse. A 2.5-year-old female Thoroughbred horse was referred to the veterinary teaching hospital for right front limb lameness of 1 year duration. Physical examination and diagnostic nerve blocks failed to localize the origin of the lameness. Scintigraphy with 99mTc-MDP suggested increased radionuclide uptake in the palmar metacarpal soft tissues of the right front limb. Ultrasonographic examination revealed hypoechoic lesions in the superficial digital flexor tendon and the suspensory ligament, suggesting tendinitis and desmitis. Combined imaging modalities improved detection and characterization of...
Sonographic brightness of the flexor tendons and ligaments in the metacarpal region of horses. Sonographic observations were made of the image mean gray scale (MGS) of the flexor tendons and ligaments in the left and right metacarpal regions of each of 10 clinically normal horses. In images made in the dorsal and sagittal planes, the MGS was measured at multiple sites in the superficial digital flexor tendon (SDFT), deep digital flexor tendon (DDFT), accessory ligament (AL), and suspensory ligament (SL), and at single sites in the medial and lateral limbs of the SL, and the palmar ligament. Relative sonographic brightness of each tendon and ligament was calculated by dividing the value ...
Ultrasonographically detected changes in equine superficial digital flexor tendons during the first months of race training. The forelimb superficial digital flexor (SDF) tendons of 6 Thoroughbreds were examined clinically and ultrasonographically during the first 4 months of race training. Sonograms were interpreted clinically and by use of computer-aided analysis. Tendon tissue from all horses was examined histologically at the end of the study. Computer-aided analysis of sonograms of the SDF tendons revealed trends toward an increase in mean cross-sectional area and a decrease in mean echogenicity over time with training. An inverse relation was found between increase in cross-sectional area and decrease in mean ...
Factors affecting the clinical outcome of injuries to the superficial digital flexor tendon in National Hunt and point-to-point racehorses. Ultrasonographic examination was used to define the severity of injuries to the superficial digital flexor tendon in 73 National Hunt or point-to-point racehorses and the factors influencing the outcome of the cases were examined. Thirty-four of the horses (46 per cent) returned to work with an average time out of training of 13.5 months. The rate of recurrence of the injury was 35 per cent. The severity of the lesions was related to the outcome; all the mildly affected horses returned to work, with 63 per cent of them racing and an average time out of training of 10.2 months; 50 per cent of t...
Ultrasonographic observations of the flexor tendons and ligaments of the metacarpal region of horses. Observations were made in dorsal and sagittal planes of the ultrasonographic mean gray scale of the flexor tendons and ligaments of the metacarpal regions of 5 Thoroughbred geldings, during weight bearing and nonweight bearing. In images made when the horses were nonweight bearing, the mean gray scale of the superficial and deep digital flexor tendons and accessory ligament was significantly reduced, but that of the interosseous medius muscle (suspensory ligament) was not. When relaxed, collagen fiber bundles in the tendons and ligaments acted as diffuse, rather than specular, reflectors of ul...
In vivo tendon forces in the forelimb of ponies at the walk, validated by ground reaction force measurements. The load distribution over tendinous structures in the equine forelimb was studied by computing forces from in vivo signals of implanted liquid-metal strain gauges in 5 ponies. For validation, these tendon forces were converted to joint moments, which were summed and compared to the calculated joint moments caused by the ground reaction force. Mean peak forces per kilogram body weight (n = 5) amounted to 5.2 N/kg for the superficial digital flexor tendon, 3.8 N/kg for the deep digital flexor tendon, 7.3 N/kg for the distal accessory (check) ligament and 8.4 N/kg for the third interosseous musc...
Ultrasonographic and histopathological findings in equine superficial digital flexor tendon injury. The ultrasonographic and histopathological findings in 12 normal and 28 injured superficial digital flexor tendons, with lesions ranging in duration from 2 days to 15 months, were compared. A consistent relationship between the ultrasonographic and histological findings was demonstrated. The echogenicity of lesions, the distinctness of their delineation from the surrounding tissue, and the presence and arrangement of the linear echoes were useful features by which to assess the ultrasonograms. Acute lesions were anechoic, a complex mixture of anechoic and hypoechoic areas, or diffusely hypoech...
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 circumfere...
Functional significance of the morphology and micromechanics of collagen fibres in relation to partial rupture of the superficial digital flexor tendon in racehorses. The high incidence of partial rupture of the superficial digital flexor tendor in the equine athlete represents a major cause for concern in the racing industry. Frequently, the lesion is localised to the central core of the tendon. This study tested the hypothesis that the site specific structural failure results from differences in the collagen fibre morphology and associated micromechanics between central and peripheral regions of the tendon. Bundles of collagen fibres were dissected from central and peripheral sites in the mid-metacarpal region of the tendon. Crimp morphology was quantifie...
Bilateral subluxation of the pastern joint in the forelimbs of a foal. A three-month-old foal was presented with subluxation of the proximal interphalangeal joint in both forelimbs. The condition, which was considered to represent an unusual manifestation of breakdown of the suspensory apparatus, appeared to have developed as a consequence of extreme overexertion, 10 days previously. This had resulted in rupture of the palmar supporting structures of the joint; namely, the superficial distal sesamoidean ligament, the insertion of the superficial digital flexor tendon and the palmar joint capsule. Severe laxity of the flexor tendons had been present in the neonata...
Microwave thermography: a non-invasive technique for investigation of injury of the superficial digital flexor tendon in the horse. Microwave thermographs were recorded from 77 normal horses. In 51% the lowest temperature was recorded in the mid-metacarpal region, and in 41% it was in the distal metacarpal region. The mean temperature of the normal limbs ranged from 25.04 to 37.4 degrees C. Maximum temperature differences between symmetrical points in both forelimbs ranged from 0 to 5.33 degrees C and differences in mean limb temperatures between both forelimbs ranged from 0 to 2.91 degrees C. In 48 horses with acute (less than 4 weeks' duration) injury of the superficial digital flexor tendon (SDFT) (36 unilateral, 12 bil...
The effect of regional nerve blocks on the lameness caused by collagenase induced tendonitis in the midmetacarpal region of the horse: a study using gait analysis, and ultrasonography to determine tendon healing. The influence of regional nerve blocks on lameness resulting from tendon injury was studied in six horses. Tendonitis was induced in the midmetacarpal region of the Superficial Digital Flexor Tendon (SDF), Deep Digital Flexor Tendon (DDF) and the Suspensory Ligament (SL) through collagenase injections. The results were evaluated through sequential clinical examinations, ultrasonographic imaging and kinetic gait analysis (force plate) during a period of 144 days post injury and subsequently compared with gross and microscopic findings. The lameness corresponding to the SDF and DDF tendon lesion...
Four forearm flexor muscles of the horse, Equus caballus: anatomy and histochemistry. Two of the forearm flexors of the horse, the superficial and deep digital flexor muscles, are critical to support the digital and fetlock joints, exhibit differing insertions, and are passively supported by the proximal and distal check ligaments, respectively. These two muscles differ in histochemical composition and architecture. The differences are correlated with the different stress levels transmitted through their tendons, and the different frequencies of clinical breakdown that have been reported. Both muscles contain type I and type IIa fibers. A few type IIb fibers occurred in the dee...
Healing of transected equine superficial digital flexor tendons with and without tenorrhaphy. Healing of transected superficial digital flexor tendons was evaluated mechanically and histologically in eight horses. Tendons sutured with polyglyconate had higher loads at failure than nonsutured tendons at weeks 5 and 9. The tendon stress at failure (force per unit area) was higher in the sutured tendons at week 5 but not at week 9, reflecting the increased size of the scar at week 9. Histologically, scars after tenorrhaphy were consistently more mature than nonsutured tenotomy scars. The mean maturity score for sutured tendons was higher than for nonsutured tendons at weeks 5 and 9. Overa...
Preliminary studies on the vascular anatomy of the equine superficial digital flexor tendon. The vascular and microvascular anatomy of normal equine superficial digital flexor tendons was studied by dissection of vinyl-perfused specimens and by microangiography on high detail film. The presence of an extensive intratendinous vascular latticework was confirmed, and a 'nutrient artery' described closely associated with the accessory ligament of the superficial digital flexor tendon (proximal check ligament). Circumferential stripping of the paratenon from the tendon to eliminate afferent vessels was performed bilaterally in three horses and unilaterally in a fourth, followed by a treadm...
Desmitis of the accessory ligament of the deep digital flexor tendon: 27 cases (1986-1990). Desmitis of the accessory ligament of the deep digital flexor tendon (ALDDFT) was diagnosed in 27 horses between September 1986 and December 1990. The first observed clinical sign in four horses was localised swelling in the proximal metacarpus. Twenty horses became lame suddenly during a work period and most developed swelling within 24 h of exercise. The injury was confirmed by ultrasonographic examination. Ten of 13 horses with uncomplicated desmitis of the ALDDFT resumed full work, within three to nine months of the onset of clinical signs, without recurrence of clinical signs in the perio...
