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Equine veterinary journal2023; doi: 10.1111/evj.14000

Equine non-septic tenosynovitis: A systematic literature review of site-specific pathological lesions, outcomes and surgical complications.

Abstract: Non-septic tenosynovitis is a clinically relevant and often performance limiting musculoskeletal injury in the horse. Objective: To review the published literature to determine which tendon sheaths are commonly affected by non-septic tenosynovitis and to describe the most frequently reported pathological lesions, outcomes, and surgical complications in equine non-septic tenosynovitis. Methods: Systematic review. Methods: Literature searches were conducted in July 2021 from the online search engines PubMed, Scopus, Web of Science Core, VetMed Resource and ProQuest Theses & Dissertations. The inclusion criteria followed a participants, interventions, comparisons, outcome and study design (PICOS) approach. For inclusion, studies had to include live equids with non-septic tenosynovitis of any tendon sheath. Studies were excluded if they only described non-equine species, if they included data only on non-tendon sheath structures, or if they included data exclusively on cases of septic or contaminated tendon sheaths. Determination of non-sepsis relied on the diagnosis of the original authors; however, if non-sepsis was not explicitly specified, then cases that had a history of contamination of the sheath, a wound near the sheath or a positive bacterial culture were excluded from analysis. Data analysed included the distribution of structures affected by non-septic tenosynovitis, the most common pathological lesions identified within each sheath, and the most frequently reported surgical complications of non-septic tenosynovitis. The quality of each study was assessed using a methodological quality analysis. Results: A total of 85 studies describing non-septic tenosynovitis in the horse were included. Across all 85 studies, there were a total of 2449 tendon sheaths in 2101 horses reported to be affected by non-septic tenosynovitis. The digital flexor sheath was the most reported structure to be diagnosed with non-septic tenosynovitis: 41/85 (48%) studies examined the digital flexor sheath exclusively, followed by the carpal flexor sheath, tarsal flexor sheath, carpal extensor sheaths, tarsal extensor sheaths, and one case of biceps brachii non-septic tenosynovitis. For most tendon sheaths, the most common pathological lesion was an intrathecal tear of a soft tissue structure, including tears of the deep digital flexor tendon and tears of the manica flexoria. Bilateral disease was most common in the carpal flexor sheath, where distal radial physeal exostoses were the most common pathological lesions. Less common causes of non-septic tenosynovitis included neoplasia, fracture of a bone adjacent to a tendon sheath, and mineralisation of an intrathecal tendon. The likelihood of return to previous level of athletic function following non-septic tenosynovitis of most structures was approximately 50%, and the most common complication was persistent effusion following tenoscopy. While iatrogenic infection following surgery was uncommon, it was most likely following tenoscopy of the digital flexor sheath. Conclusions: Non-septic tenosynovitis is commonly reported in equine athletes, with intra-thecal tears of the deep digital flexor tendon, superficial digital flexor tendon and manica flexoria frequently reported. Directions for future research include more thorough assessment of and reporting of complications following non-septic tenosynovitis and correlation of characteristics of intrathecal pathological lesions with clinical outcomes.
© 2023 EVJ Ltd.
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Publication Date: 2023-09-21 PubMed ID: 37735927DOI: 10.1111/evj.14000Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This research paper conducts a systematic literature review to understand the impact and outcomes of non-septic tenosynovitis, a sort of musculoskeletal injury in horses. It specifically focuses on the commonly affected tendon sheaths, pathological lesions, surgical complications and offers suggestions for future research.

Research Methodology

  • The authors performed a systematic review of existing literature using several online databases including PubMed, Scopus, Web of Science Core, VetMed Resource and ProQuest Theses & Dissertations in July 2021.
  • The studies included in the review were chosen based on a participants, interventions, comparisons, outcome and study design (PICOS) approach. Only those studies that dealt with live equids with non-septic tenosynovitis of any tendon sheath were considered.
  • The researchers excluded studies that only described non-equine species or those that discussed only non-tendon sheath structures, or those that focused solely on cases of septic or contaminated tendon sheaths.
  • In terms of data analysis, the authors looked into the structures affected by non-septic tenosynovitis, the common pathological lesions identified within each sheath, and the recurrent surgical complications of non-septic tenosynovitis.
  • The quality of each study was evaluated using a methodological quality analysis.

Research Findings

  • A total of 85 studies that mentioned non-septic tenosynovitis in horses were included in the systematic review. Overall, these studies reported 2449 tendon sheaths in 2101 horses affected by non-septic tenosynovitis.
  • The digital flexor sheath was identified as the most frequently diagnosed structure with non-septic tenosynovitis. Other commonly affected structures included the carpal flexor sheath, tarsal flexor sheath, carpal extensor sheaths, and tarsal extensor sheaths.
  • The intrathecal tear of a soft tissue structure, including tears of the deep digital flexor tendon and tears of the manica flexoria, was the most prevalent pathological lesion detected within each tendon sheath.
  • Further, the likelihood of horses returning to their previous athleticism after suffering from non-septic tenosynovitis was around 50%, and the most frequent complication was persistent effusion following tenoscopy.

Conclusion and Future Directions

  • The paper concludes that non-septic tenosynovitis is common in equine athletes, with intrathecal tears of the deep digital flexor tendon, superficial digital flexor tendon and manica flexoria being the often-reported types.
  • The study suggests that future research can better focus on a thorough assessment of complications following non-septic tenosynovitis and investigate the correlation of characteristics of intrathecal pathological lesions with clinical outcomes.

Cite This Article

APA
Caspers MK, Gier CJ, Reesink HL. (2023). Equine non-septic tenosynovitis: A systematic literature review of site-specific pathological lesions, outcomes and surgical complications. Equine Vet J. https://doi.org/10.1111/evj.14000

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Caspers, McKenna K
  • Department of Clinical Sciences, Cornell University, Ithaca, New York, USA.
Gier, Collin J
  • Department of Clinical Sciences, Cornell University, Ithaca, New York, USA.
Reesink, Heidi L
  • Department of Clinical Sciences, Cornell University, Ithaca, New York, USA.
  • Equine and Nemo Farm Animal Hospital, Cornell University, Ithaca, New York, USA.

Grant Funding

  • Harry M. Zweig Memorial Fund for Equine Research

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Citations

This article has been cited 1 times.
  1. Scharf A, Acutt E, Bills K, Werpy N. Magnetic resonance imaging for diagnosing and managing deep digital flexor tendinopathy in equine athletes: Insights, advances and future directions. Equine Vet J 2025 Sep;57(5):1183-1203.
    doi: 10.1111/evj.14508pubmed: 40314097google scholar: lookup
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