Tendons in horses are fibrous connective tissues that attach muscles to bones, facilitating movement and providing stability to the musculoskeletal system. They are composed primarily of collagen fibers, which confer strength and flexibility, allowing horses to perform various physical activities. Equine tendons are subject to significant mechanical stress during locomotion, making them susceptible to injury, particularly in performance horses. Common tendon injuries include strains, tears, and tendinitis, which can impact a horse's mobility and performance. This page compiles peer-reviewed research studies and scholarly articles that explore the structure, function, and pathology of tendons in horses, as well as advancements in diagnostic and therapeutic approaches for tendon injuries.
Riemersa DJ, Schamhardt HC.A clamp designed for holding tendons in force/elongation studies is described. No slippage occurred when tensile forces up to 13,800 N were applied to horses digital flexor tendons fixed in this clamp.
Adams SB, Fessler JF, Thacker HL.FIBROMAS arise from connective tissue and occur in all domestic animals (Smith, Jones and Hunt 1972; Stannard and Pulley 1978). They are most frequently noted in the dermis or subcutis, but may be present wherever connective tissue occurs. In the dermis and subcutis of the horse fibromas are grossly similar to sarcoids and may be difficult to differentiate (Baker and Leyland 1975). Fibromas have been described as tumours of the tendon sheath or tendon proper in man (Flynn 1975), but have not been described in this location in the horse.
Lochner FK, Milne DW, Mills EJ, Groom JJ.Strains gauges were applied to the superficial flexor tendon, deep flexor tendon, and suspensory ligament of sound adult horses. Maximum tendon strain occurred during full weight bearing while walking, when the forelimb was perpendicular to the group surface. There was decrease in tendon strain with increase in hoof angle for the deep digital flexor, but no change in tendon strain for the superficial digital flexor and suspensory ligament with changing hoof angle. At physiologic rates of strain, tendons were able to withstand large loads without yielding. Load strain curves developed in vitro ...
Valdez H, Clark RG, Hanselka DV.Flexible medical grade carbon fiber was surgically implanted in tenectomized or lacerated superficial and deep digital flexor tendons of 13 horses (7 clinical cases and 6 experimental), ranging in age from 15 months to 10 years and weighing 300 to 500 kg. The 6 experimental horses were euthanatized at 30-, 45-, 60-, and 90-day intervals for gross and histologic evaluation of the results. Three of the experimental horses served as their own controls. Of the 7 clinically affected horses, 3 were euthanatized because they developed laminitis or the wound failed to heal. The remaining 4 horses in t...
Williams IF, Heaton A, McCullagh KG.The histological appearance of cells and tissues in the reparative scar tissue which forms in the equine superficial flexor tendon following partial rupture was compared to that of normal tendon. The repair fibroblasts were found to be larger and more basophilic than the tenocytes of normal tendon, to have large vesicular nuclei and to resemble the 'myofibroblasts' described in scar tissue elsewhere. The cell to matrix ratio in scarred zones of tendon was found to be increased and the concentration of collagen in these areas was less than in normal tendon. However, the scar tissue collagen was...
Goodship AE, Brown PN, Yeats JJ, Jenkins DH, Silver IA.The results of an assessment of carbon fibre for biological use are given, with particular reference to the clinical use of the material in the treatment of equine tendon injury. Biocompatability of the fibres is assessed using fibroblast cell cultures and replacement of normal tendon with carbon fibre prostheses in experimental animals. The rationale and technique for using this material in clinical cases of tendon injury in the racehorse are described. Results are given from 62 implant operations in a limited series of 40 horses.
Littlewood HF.A technique for implanting carbon fibre into sprained flexor tendons in horses is described. Insertion of the fibres through paravertebral needles which passed through the affected region of the tendon was considered to be preferable to direct implantation into the surgically opened tendon. The results of the eight cases treated to date are dealt with briefly, together with a discussion as to how this form of treatment could be further evaluated.
Llewellyn HR.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...
Franks PW.A technique was developed using radioactive isotopes as a source of radiation for the treatment of injuries to the superficial and deep flexor tendons and the associated ligaments in the horse. The treatment area was sub-divided so that different dosages could be applied over the limb as necessary. A plaster of Paris impression was taken of the whole area to be treated. In the isotope laboratory a plaster negative was made and loaded with the dose of radioactive isotope. The loaded cast was then strapped to the horse's limb for the calculated time, usually about three days. A total of 42 horse...
Parry DA, Craig AS, Barnes GR.A study has been made of the ultrastructural organization of the collagen fibrils and elastic fibres in tendons and ligaments from horses of ages ranging from 2 months premature to 19 years. Diameter distributions of the collagen fibrils in the common digital extensor tendon, the superficial flexor tendon and the suspensory ligament are unimodal in the foetal tissue and at birth, and at these stages of development the three collagenous tissues are virtually indistinguishable. However, at maturity, the ligament and flexor tendon have bimodal distributions similar to that found for rat-tail tend...
Herrick WC, Kingsbury HB, Lou DY.This paper describes the result of an investigation of strains and strain rates which normally occur in the tendons of the equine foreleg and presents stress-strain curves and moduli for the tendons at these rates. It has previously been demonstrated that resistance to flexion of the joints of the distal part of the equine foreleg is provided by a passive system of tendons and ligaments. It is therefore possible, using a large displacement, high-rate testing machine, to duplicate in the laboratory the strain rates and forces which are normally produced in the tendons of the foreleg of the runn...
Webbon PM.The normal appearance of the superficial (SFT) and deep (DFT) digital flexor tendons was described and the difference between their histological structures was emphasised. Further differences were recognised between different sites from the same tendon and between tendons in the fore and hind limbs of the same animal. Both of the tendons underwent changes with age but although a number of alterations in the histological appearance were described, a particular change, involving a patchy loss of stainable nuclei, was found at the common site of SFT injuries. While this appearance has been seen i...
Wentink GH.The locomotor pattern of the hind limb of seven horses has been studied in intact animals and after transection of the following structures: the peroneus tertius tendon, the cranial tibial muscle, both cranial tibial muscle and peroneus tertius tendon, and the superficial digital flexor tendon. The investigation was carried out by high speed cinematography and electromyography. It is concluded that (1) the muscles and tendons over the cranial aspect of the tibia play an important role during the support phase; (2) the movements of the hind limb may be performed without the action of the crania...
Kingsbury HB, Quddus MA, Rooney JR, Geary JE.The distal portion of the forelimb of the horse is provided with a stay apparatus composed of tendons, ligaments, and fascia. This stay apparatus provides the major resistance to joint flexion during the support phase of the stride. The laboratory test system described was shown to be able to reproduce in vitro limb motions and hoof forces measured with a running horse. These results indicated the stay apparatus operates in a largely passive mode, active muscle contraction apparently serving to provide rigidity only early in the support phase of the stride. The testing system described was des...
Strömberg B, Tufvesson G.Four autologous tendon grafting techniques, bipedicle, pedicle and free grafts of the deep digital flexor tendon and free grafts from the lateral digital extensor tendon were described. The vascularization and remodelling of the transplant and the reactions in the donor, as well as the recipient tendon, were studied by means of microangiographic and histochemical methods. The results indicated that regardless of the technique used the grafts were revascularized and replaced by a highly orientated and organized tendon. The use of free grafts may therefore be worthwhile in treatment of severe te...
Mason TA.Seven cases of chronic tenosynovitis affecting the extensor carpi radialis or lateral digital extensor tendon and their sheaths are described. All cases were chronic and in 4 of the cases previous treatment by drainage and local corticosteroid injection had been ineffective. Surgical exploration of 6 cases demonstrated a distinct lesion and specific surgical treatment was carried out.
Rich T, Henderson LB, Becker DL, Cornell H, Patterson-Kane JC.Superficial digital flexor tendon (SDFT) injuries of horses usually follow cumulative matrix microdamage; it is not known why the reparative abilities of tendon fibroblasts are overwhelmed or subverted. Relevant in vitro studies of this process require fibroblasts not already responding to stresses caused by the cell culture protocols. We investigated indicators of replicative damage in SDFT fibroblast monolayers, effects of this on their reparative ability, and measures that can be taken to reduce it. Results: We found significant evidence of replicative stress, initially observing consistent...
Salinas P, Lira-Velásquez D, Bongiorno A, Sandoval C.The aim of this study was to quantify the distribution of aligned and non-aligned collagen in cross-sections of the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT) in different levels of the distal forelimb of equines diagnosed with NS (Navicular Syndrome). Sixty equine forelimbs were collected. Was compared two groups (NA, Not affected vs. NS-group) by t-Student. Diagnosis of NS was based on clinical and lameness examination, diagnostic analgesia and radiological findings. The proportion of aligned and non-aligned collagens at 2 levels for the SDFT and 3 levels ...
McCoy AM, Goodrich LR.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 unrel...
Whitlock D, Garcia TC, Vallance SA, Stover SM.The specific biomechanical circumstances that induce excessive superficial digital flexor tendon (SDFT) strain in horses are unknown. Objective: Carpal joint hyperextension during axial limb loading during the middle of stance disproportionately enhances SDFT strains compared to suspensory ligament (SL) strains. Methods: Superficial digital flexor tendon and SL strains were measured in 7 cadaver limbs during in vitro loading that maintained carpal extension or allowed carpal hyperextension by constraining, or allowing rotation of, the radius during loading conditions that simulated the middle ...
van Schie HT.The ultrasonic examination of tendons and ligaments of the distal limb of the horse improves the diagnostic possibilities of these frequently injured structures. The successful application is based upon a reliable knowledge of the normal sonographic anatomy and upon a standardized, flawless technic of the examination. Practice and experience allow the recognition of minor alterations which enables a more precise diagnosis, a more reliable prognosis, and in follow-up examinations also more specific information about the further use of the horse.
Riemersma DJ, van den Bogert AJ.A procedure is described by which the length of a tendon at the onset of loading is determined objectively. The procedure includes the fitting of third-order polynomial functions on the load-elongation data. The onset of loading is detected by an increasing fit of the polynomial by selective data reduction of the initial part of the load-elongation curve. The procedure results in an objective and reproducible definition of the zero strain level of a tendon.
Chans-Veres J, Albiñana-Cunningham J, Quintela JM, Pereira E, Tejero S.Surgery for severe equine cavo-varus is complex and must be individualized. The interindividual phenotypic variability demands a personalized planning of each foot to be operated. The study's primary goal was to evaluate the function and satisfaction of a series of patients with severe equinus cavo-varus deformity who underwent a triplanar tarsectomy and transposition of the posterior tibial tendon in a single stage surgery after a patient specific 3D biomodel planning. A series of 12 feet (5 patients bilaterally) operated with this technique was analyzed. The cohort comprised 2 females (28.5 ...
Koren L, Stahl S, Rovitsky A, Peled E.Amputation of fingers with tendon avulsion occurs through a traction injury, and most occur through a ring avulsion mechanism. Usually the flexor digitorum profundus is torn out with the amputated finger. Replantation usually is recommended only when the amputation is distal to the flexor digitorum superficialis insertion. Animal bites are relatively common, with a decreasing order of frequency of dogs, cats, and humans. Horse bites are relatively infrequent but are associated with crush injuries and tissue loss when they occur. This article describes a 23-year-old man with amputation of his m...
Shiroma JT, Engel HN, Wagner PC, Watrous BJ.In horses, dorsal subluxation of the proximal interphalangeal joint in the pelvic limb, which realigned when weight was applied to the limb, improved following surgery. Improvement was observed, if not immediately, at least within two weeks after treatment. The severity and duration of the condition appear to be important considerations in predicting the time necessary for resolution of the condition following surgery. Treatment consisted of surgical resection of a small segment of the medial head of the deep digital flexor tendon in the pelvic limb. The section removed was positioned distal t...
Lempe-Troillet A, Ludewig E, Brehm W, Budras KD, Winter K, Edinger J.The object of this study was to describe previously defined soft tissue structures by using spin and gradient sequences in a 0.5 Tesla magnetic resonance system in order to improve the characterisation of tendon and ligaments at the plantar region of the equine tarsus and metatarsus while considering possible age-related variations. Methods: Cadaveric hindlimbs from twenty-two Warmblood horses with an age range from one month to twenty-five years were examined in spin and gradient echoes. The proximal suspensory ligament from six limbs was dissected to assign the signal intensities histologica...
Wood AK, Sehgal CM, Reef VB.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...
Anoushepour A, Eftekhari S, Masoudifard M.Superficial digital flexor tendon (SDFT) plays an important role in the locomotion of the horses with flexion of the limbs. In the hind limb, it passes over the calcaneal bone and attaches to medial and lateral surfaces of calcaneous by two bands of connective tissue; while, the medial band is weaker than the lateral one. Occasionally, severe trauma, over-extension or fracture of the calcaneous may cause rupture of the supportive bands leading to tendon luxation. An 11-year-old Thoroughbred jumping gelding with symptoms of lameness in both legs, after examination by an internal specialist vete...
Johnson SA, Sikes KJ, Johnson JW, Van Zeeland E, Wist S, Santangelo KS, King MR, Frisbie DD.Low load exercise training with blood flow restriction (BFR) has become increasingly used by human physical therapists to prescribe controlled exercise following orthopaedic injury; its effects on the equine superficial digital flexor tendon (SDFT), however, are unknown. Objective: To investigate outcomes of pressure specific BFR walking exercise on uninjured equine SDFT biomechanics and histomorphology. Methods: Controlled in vivo experiment. Methods: Four forelimbs of four horses were exposed to 40 BFR-walk sessions (10-min interval walking) on a treadmill over a 56-day study period with the...
Wood AD, Parker RA, Marcatili M, Anderson J, Robinson N, Stack JD.To determine the outcome of tenoscopically guided palmar/plantar annular ligament (PAL) desmotomy to treat PAL constriction without concurrent intrathecal soft-tissue injury, notably of the digital flexor tendons and manica flexoria. Methods: Retrospective multicenter cohort study. Methods: Sixty-five horses. Methods: Horses from four UK equine hospitals, with digital flexor tendon sheath (DFTS) tenosynovitis, which underwent tenoscopically guided PAL desmotomy for treatment of PAL constriction between 2017 and 2022 were included. All horses had lameness isolated to the DFTS/PAL, and PAL const...
Tamura N, Yoshihara E, Seki K, Mae N, Kodaira K, Iimori M, Yamazaki Y, Mita H, Urayama S, Kuroda T, Ohta M, Kasashima Y.The potential value of hypervascularity detected with power Doppler ultrasonography (PDU) within equine superficial digital flexor tendon (SDFT) as a prognostic factor of SDFT injury is not clear. The purpose of this study was to test the hypothesis that hypervascularity within SDFT is one of the risk factors for subsequent severe SDFT injury and to evaluate the prognostic value. A prospective cohort study of 97 Thoroughbred racehorses without any clinical signs of SDFT injury was conducted. Six variables of age, body weight, sex, the cross-sectional area of SDFT, PDU signal within SDFT and ex...
Schumacher A, Gehlen H.This literature review analyzes the historical development of polo, its organizational structure, the course of the game, as well as the breeding, rearing, and training practices of polo horses. Frequently occurring ailments, such as musculoskeletal injuries, respiratory diseases, and internal illnesses, are highlighted. Lameness is a major problem, with injuries to the superficial digital flexor tendon being the most common cause. Other notable diseases include exercise-induced pulmonary hemorrhage (EIPH), myositis, rhabdomyolysis, and equine infectious anemia (EIA). To ensure the welfare of ...
Heidari N, Faragher RGA, Pattison G, Dudhia J, Smith RKW.Tendinopathy is a common age-related disease which causes significant morbidity for both human athletes and performance horses. In the latter, the superficial digital flexor tendon is an excellent model for human tendinopathies because it is a functional homologue of the human Achilles tendon and a primary site of injuries with strong similarities to the human disease. Corticosteroids have been previously used clinically to treat tendinopathic inflammation, but they upregulate the p53-p21 axis with concomitant reductions in cell proliferation and collagen synthesis in human tenocytes. This phe...
White JM, Hibner-Szaltys M, Duz M, Withers JM, Marcatili M.To determine the influence of breed (cob [CB] and non-cob [NC]), obturator type and surgical experience on the number of attempts, time taken and iatrogenic damage (ID) created when entering the digital flexor tendon sheath (DFTS) tenoscopically. Methods: Prospective experimental cadaveric study. Methods: A total of 104 cadaver limbs. Methods: An equal number of randomly selected CB and NC limbs were operated using a conical obturator (OB) or a switching stick (SS) by one boarded (BS) and one resident surgeon (RS). Skin measurements, number of attempts and time taken to enter the DFTS were rec...
Willette JA, Tsoi M, Frobish D, VanderBroek AR.The objectives of the study were to describe a standing percutaneous adhesion induction model in the digital flexor tendon sheath (DFTS) of horses and to evaluate the effect of intrathecal administration of the angiotensin-converting enzyme (ACE) inhibitor enalapril on tendon healing and adhesion formation. Methods: Randomized, blinded, controlled experimental study. Methods: Eight healthy horses. Methods: A collagenase-induced adhesion model was implemented in the deep digital flexor tendon (DDFT) of both forelimbs under standing ultrasonographic guidance. Daily intrathecal injections of 5 ...
Dörner CA, Vargas V, Castellón CH.The aim of this prospective case-control study was to describe and implement a reliable, accurate, and straightforward ultrasound-guided proximo-medial approach technique for injecting the carpal flexor tendon sheath in horses. The proximo-medial ultrasound-guided approach for intrathecal access to the carpal canal, as described in this study, was firstly developed on ten cadaveric limbs using an undiluted ionic iodinated contrast medium. Landmarks were identified, and the access point was established. Subsequently, the technique was validated in ten horses, and its efficacy was compared with ...
Yildirim İG, Karaarslan S, Erkan A.Musculoskeletal injuries (MSI) are a major concern in the horse racing industry, often leading to career-ending outcomes. Contributing factors include conformation, limb and joint defects, hoof structure, age, and hard track surfaces. Objective: This study aimed to evaluate the distribution of MSI in Thoroughbred and Arabian racehorses during racing and training, categorised by breed and track surface. Methods: Retrospective cohort study. Methods: The data from 2018 to 2023 were collected at the Turkish Jockey Club's Şirinyer Hippodrome (38°23'03.7″ N 27°09'01.0″ E), covering 553 MSI ca...
Breen LJ, Stack JD, Gillen AM, Baldwin CM.(1) To evaluate the feasibility of needle tenoscopy of the digital flexor tendon sheath (DFTS) using basisesamoid (BS) and proximolateral (PL) approaches in a standing equine cadaver model. (2) To report visualization of intrathecal DFTS anatomy via both approaches. (3) To determine the efficacy of needle scope-guided palmar/plantar annular ligament (PAL) desmotomy. (4) To report any iatrogenic damage associated with the procedure. Methods: Ex vivo experimental. Methods: Ten equine cadaver limbs. Methods: Limbs were placed in a Kimzey leg-saver splint and needle tenoscopy was performed using t...
Barton CK, Nelson BB, Winther TM, Maker TC, Goodrich LR.To develop and optimize a tenoscopic technique for resection of the manica flexoria utilizing a radiofrequency probe. Methods: Experimental study. Methods: Eighteen cadaver limbs and two experimental horses. Methods: Tenoscopic-guided resection of the manica flexoria using radiofrequency energy proceeded sequentially by transection of the medial, lateral and proximal borders. The technique was performed in ex vivo limbs and then in vivo to replicate clinical scenarios. Time to complete resection of the manica flexoria (mean ± SD) and complications was recorded. Limbs were dissected and sc...
Colla S, Johnson JW, McGilvray KC, Zanotto GM, Seabaugh KA.Therapeutic shoeing for horses is used to affect the palmar angle (PA) of the distal phalanx. These changes may influence the strain on the distal interphalangeal joint collateral ligaments (DIJCLs). This cadaveric study aimed to assess DIJCL strain under varying loads and PA adjustments. Using 26 cadaver forelimbs, eight optical markers were placed on one DIJCL for strain measurement under five different loads (1000-5000 newtons) at a neutral PA, followed by PA increases of 2°, 4°, and 6° and decreases of -2° and -4°. The results indicate that increases in PA corresponded to significantl...
McCarthy RD, Ordóñez HJ, Semevolos SA.To compare core temperatures of superficial and deep digital flexor tendons (SDFT, DDFT) during application of a compression cooling system versus ice boots and during subsequent lower limb bandaging. Methods: Experimental study. Methods: Paired forelimbs of six sedated horses. Methods: Thermocouples were placed in the core of SDFT and DDFT of both front limbs of each horse. A compression cooling system was applied to one front limb and an ice boot was applied to the other front limb for 60 min and then removed for 60 min. Standing bandages were then applied to both front limbs for 60 mi...
Woods TDC, Dixon J, Fraser BSL, Melvaine C.Exploratory tenoscopy is considered the gold standard technique to identify intrathecal pathology of the equine carpal flexor tendon sheath (CFTS). Preoperative diagnosis allows for more precise prognostication and surgical planning, potentially associated with improved surgical outcomes. This prospective, descriptive, anatomical study aimed to describe the anatomy of the equine CFTS using noncontrast and contrast CT in clinically normal cadaver limbs. Ten pairs of equine forelimbs free of gross external abnormalities were examined from mid-antebrachium to distal metacarpus. Specimens initiall...
Velásquez JM, Tamayo-Arango L, Santos-Silva T, Miglino MA.Horse joints are common sites of injury, orthopedic issues, and surgical and clinical interventions. For this reason, a thorough understanding of joint anatomy, including the boundaries of their recesses and their relationships with other structures of the locomotor apparatus, is essential. This study aimed to develop cast anatomical models of the synovial structures of the equine hand and foot, compare different casting materials and visualization methods, and identify the most suitable technique for enhancing the understanding of equine limb arthrology. Additionally, an anatomical descriptio...
Kerbert MP, Delling U, Verhaar N.To investigate the computed tomography (CT) and gross anatomy of the equine medial digital flexor tendon sheath (MDFTS), and the endoscopic anatomy and approach to the MDFTS. Methods: Ex vivo experimental study and one clinical case. Methods: Twelve clinically normal cadaveric hindlimbs. Methods: Dissection, native and contrast CT scans were conducted to evaluate the anatomy of the MDFTS. Based on these findings, the portal locations for the endoscopic approaches were determined. Six hindlimbs were used in the pilot phase and another six limbs were selected for the main study. Endoscopic image...
Albanese V, Straticò P, Fischer H, Petrizzi L.Injuries to the distal limb are common in horses. The clinical aspect of the lesions is variable based on the structures that are involved. Synovial structures as well as tendons and/or ligaments may be involved in such injuries, affecting treatment modalities and costs, and prognosis. This retrospective study compares wounds involving synovial structures to wounds without such involvement in terms of treatment duration and costs, and prognosis. Synovial wounds were much more expensive to treat and carried a lower prognosis. Involvement of tendons and/or ligaments in the wounds resulted in mor...
