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Home / Equine Research Bank / Equine Vet J / Improved diagnostic criteria for digital flexor tendon sheat...
Equine veterinary journal2019; 52(2); 205-212; doi: 10.1111/evj.13166

Improved diagnostic criteria for digital flexor tendon sheath pathology using contrast tenography.

Abstract: Pathology of the digital flexor tendon sheath is a significant cause of lameness in the horse. Imaging is important to identify lesions and inform on prognosis prior to tenoscopic surgery. Objective: To use a large population to evaluate 1) the sensitivity and specificity of digital flexor tendon sheath (DFTS) contrast radiographs in diagnosing manica flexoria (MF) tears, deep digital flexor tendon (DDFT) tears and constriction of the palmar/plantar annular ligament (PAL) using novel criteria; 2) predisposition to pathology in signalment and limb affected. Methods: Multicentre retrospective cohort study. Methods: The medical records of 206 horses with lameness localised to the DFTS, contrast radiographs and subsequent tenoscopic surgery were reviewed. Breed and limb predispositions were evaluated for pathology of the DDFT, MF and PAL constriction. Contrast radiographs of the DFTS were reviewed by four masked operators and for each pathology the sensitivity, specificity and interobserver variability were calculated. Results: Contrast tenography was a sensitive test for MF tears (92% confidence interval [CI] 88.4-94.4%; specificity 56%, CI 51.1-61.1%) and specific for diagnosing DDFT tears (73%, CI 68.6-76.8%; sensitivity 54%, CI 47.8-60.2%) but had a lower sensitivity (71%, CI 65.1-75.9% ) and specificity (45%, CI 39.1-52.0%) for PAL constriction. It had good to substantial interobserver agreement for MF and DDFT tears (Krippendorff's alpha 0.68 and 0.46 respectively). Ponies (57%) and cobs (58%) were significantly more likely to be affected with MF tears (other breeds 20-39%, P = 0.003) and Thoroughbreds (50%), warmbloods (45%) and draught breeds (48%) were more likely to have DDFT tears (other breeds 22-34%, P = 0.01). MF tears and PAL constriction were overrepresented in the hindlimbs compared to DDFT tears in forelimbs. Conclusions: No standardisation of contrast radiographs was possible. The subjectivity of diagnosis of PAL constriction may also have led to bias. Radiographs were read as JPEGS reducing ability to manipulate images. Conclusions: Contrast radiography of the DFTS is accurate in the pre-operative diagnosis of DFTS pathologies. Different pathologies are overrepresented in certain breeds and limbs.
© 2019 EVJ Ltd.
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Publication Date: 2019-09-23 PubMed ID: 31429480DOI: 10.1111/evj.13166Google Scholar: Lookup
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Summary

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The research article focuses on improving the diagnostic criteria for digital flexor tendon sheath pathology in horses using contrast tenography. It emphasizes on imaging’s role in identifying lesions and informing prognosis prior to surgery.

Research Methodology

  • The study is a multicentre retrospective cohort type, where researchers studied the records of 206 horses that showed lameness localized to the digital flexor tendon sheath.
  • These horses had undergone contrast radiographs and subsequent tenoscopic surgery.
  • The study aimed to determine: a) the sensitivity and specificity of these contrast radiographs in diagnosing three possibilities – manica flexoria (MF) tears, deep digital flexor tendon (DDFT) tears and constriction of the palmar/plantar annular ligament (PAL); b) the potential predisposition of certain horse breeds and limbs to such pathology.
  • The contrast radiographs were assessed by four examiners who were unaware of the patients’ identities. The researchers also tested for interobserver variability, a measure of agreement or consensus among different observers.

Key Findings

  • Contrast tenography appeared to be a reliable way to detect MF tears, with high sensitivity but relatively low specificity.
  • It has been found specific for diagnosing DDFT tears, but has a lower sensitivity.
  • The method performed relatively poorly when diagnosing PAL constriction both in terms of sensitivity and specificity.
  • The research showed substantial agreement among different examiners for MF and DDFT tears.
  • It was found that ponies and cobs were more likely to be affected with MF tears while Thoroughbreds, Warmbloods, and draught breeds were more prone to DDFT tears.
  • MF tears and PAL constrictions were more commonly found in hindlimbs as compared to DDFT tears which were more likely in forelimbs.

Study Limitations

  • The study was unable to standardize contrast radiographs due to varying conditions of the imaging.
  • The diagnosis of PAL constriction was somewhat subjective, which may have introduced some bias into the results.
  • The images were viewed as JPEGs, which limited the ability to manipulate the images for detailed examination.

Conclusion

  • The use of contrast tenography for the pre-operative diagnosis of DFTS pathologies in horses appears to be accurate.
  • The study also reveals that different horse breeds and particular limbs are more prone to specific types of DFTS pathologies.

Cite This Article

APA
Kent AV, Chesworth MJ, Wells G, Gerdes C, Bladon BM, Smith RKW, Fiske-Jackson AR. (2019). Improved diagnostic criteria for digital flexor tendon sheath pathology using contrast tenography. Equine Vet J, 52(2), 205-212. https://doi.org/10.1111/evj.13166

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 52
Issue: 2
Pages: 205-212

Researcher Affiliations

Kent, A V
  • Peterson and Smith Equine Hospital, Ocala, Florida, USA.
Chesworth, M J
  • Royal Veterinary College Equine Referral Hospital, London, UK.
Wells, G
  • Royal Veterinary College Equine Referral Hospital, London, UK.
Gerdes, C
  • Rossdales Diagnostic Centre, Newmarket, Suffolk, UK.
Bladon, B M
  • Donnington Grove Veterinary Group, Newbury, Berkshire, UK.
Smith, R K W
  • Royal Veterinary College Equine Referral Hospital, London, UK.
Fiske-Jackson, A R
  • Royal Veterinary College Equine Referral Hospital, London, UK.

MeSH Terms

  • Animals
  • Forelimb
  • Hindlimb
  • Horse Diseases
  • Horses
  • Lameness, Animal
  • Retrospective Studies
  • Tendons

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This article includes 19 references
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Citations

This article has been cited 6 times.
  1. van Veggel ECS, Selberg KT, van der Velde-Hoogelander B, Vanderperren K, Cokelaere SM, Bergman HJ. Deep Digital Flexor Tendon Injury at the Level of the Proximal Phalanx in Frontlimbs With Tendon Sheath Distension Characterized by Standing Low-Field Magnetic Resonance Imaging in Horses: 13 Cases (2015-2021). Front Vet Sci 2021;8:734729.
    doi: 10.3389/fvets.2021.734729pubmed: 34869716google scholar: lookup
  2. Aßmann AD, Sànchez-Andrade JS, Argüelles D, Bischofberger AS. Does Low-Field MRI Tenography Improve the Detection of Naturally Occurring Manica Flexoria Tears in Horses?. Animals (Basel) 2025 Jul 31;15(15).
    doi: 10.3390/ani15152250pubmed: 40805040google scholar: lookup
  3. Miles S, McCauley C, Carossino M, Del Piero F, Liu CC, Gaschen L. Normal MRI features of the manica flexoria in horses and evaluation of the anatomic variability between forelimbs and hindlimbs. PLoS One 2025;20(7):e0327880.
    doi: 10.1371/journal.pone.0327880pubmed: 40690480google scholar: lookup
  4. 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
  5. Breen LJ, Stack JD, Gillen AM, Baldwin CM. Needle tenoscopy of the digital flexor tendon sheath in a standing equine cadaver model using a novel approach and guided palmar/plantar annular ligament desmotomy. Vet Surg 2025 Apr;54(3):524-533.
    doi: 10.1111/vsu.14213pubmed: 39911071google scholar: lookup
  6. Aßmann A, Ohlerth S, Hartmann S, Torgerson P, Bischofberger A. Does Direct MRI Tenography Improve the Diagnostic Performance of Low-Field MRI to Identify Artificially Created Soft-Tissue Lesions within the Equine Cadaveric Digital Flexor Tendon Sheath?. Animals (Basel) 2023 Dec 7;13(24).
    doi: 10.3390/ani13243772pubmed: 38136809google scholar: lookup
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