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Noninfected tenosynovitis of the digital flexor tendon sheath: a retrospective analysis of 76 cases.
Abstract: Until recently, the pathogenesis of noninfected tenosynovitis of the digital flexor tendon sheath (DFTS) has been considered obscure. With the advent of tenoscopy some inciting causes have been described, but to date few cases with a precise diagnosis have been reported. Objective: Tenoscopic surgery enables accurate diagnosis and facilitates treatment of noninfected tenosynovitis of the DFTS. Methods: The case records of all horses with noninfected tenosynovitis of the DFTS admitted to a referral clinic over a 7-year period were evaluated retrospectively. Follow-up information was obtained by telephone questionnaire. Results: A total of 76 horses were referred; all were evaluated tenoscopically and 11 of these subsequently were explored by open surgical techniques. The most common diagnoses were marginal tears of the deep digital flexor tendon (DDFT) (n = 44) and tears of the manica flexoria (MF) (n = 23). Greater than 6 months' follow-up information was available for 61 animals, of which 68% were sound and 54% returned to preoperative levels of performance. Sheath distension was eliminated in 33% and improved in 69% of horses. Marginal tears of the DDFT, marked preoperative distension and open surgical repair of deep digital flexor lesions were associated with reduced levels of post operative performance: Marginal tears were associated with post operative lameness and long tears with a reduced performance level compared with short tears. Marginal tears of the deep digital flexor tendon, marked preoperative distension and increasing duration of clinical signs also were associated with lack of improvement in distension following surgery. Conclusions: Tenosynovitis of the DFTS may result from tears in the deep or superficial digital flexor tendons, manica flexoria or other structures with synovial communication. To date, these can be identified confidently only by tenoscopy, which also permits appropriate lesion management. Conclusions: The diagnostic information obtained from and therapeutic options offered by tenoscopy justify its early use in cases of noninfected tenosynovitis of the DFTS.
Publication Date: 2006-03-16 PubMed ID: 16536382DOI: 10.2746/042516406776563350Google Scholar: Lookup The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
Summary
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This research has analysed past case records of horses suffering from noninfected tenosynovitis of the digital flexor tendon sheath. Using the method of tenoscopy, the researchers have identified potential causes and effective treatments. The study reveals that marginal tears and tears in the manica flexoria were the most common diagnosable causes. Majority of the patients treated returned to their previous performance levels with sheath distension either eliminated or improved in most cases.
Methodology
- The researcher used a retrospective approach, examining case records of all horses admitted to a referral clinic over seven years, presenting with noninfected tenosynovitis of the digital flexor tendon sheath (DFTS).
- 76 horses in total were evaluated using tenoscopy, a method that allows a detailed view of the tendon sheath and nearby structures, assisting in accurate diagnosis and treatment of conditions.
- Further to tenoscopic examination, 11 of the cases also underwent open surgical exploration.
Results
- Tenoscopy revealed that the most common diseases were marginal tears of the deep digital flexor tendon (44 out of 76 horses) and tears in the manica flexoria (23 out of 76 horses).
- Post-treatment, it was found that for 68% of the horses, their health soundness returned and 54% were able to return to their preoperative levels of performance. Sheath distension, a symptom associated with the condition, was either eliminated (in 33% of the horses) or improved (in 69% of the horses).
- However, horses with certain conditions like marginal tears of the deep digital flexor tendon, marked pre-surgery distension, and longer duration of clinical signs demonstrated lesser improvement post-surgery. For instance, horses with marginal tears were more prone to postoperative lameness and long tears had an impact on performance level compared to short tears.
Conclusions
- According to the researchers, tears in the deep or superficial digital flexor tendons, manica flexoria, or other structures with synovial communication could result in noninfected tenosynovitis of the DFTS.
- They concluded that currently, these issues can only be identified confidently using tenoscopy, which in turn, facilitates appropriate management and treatment of such lesions.
- Based on the positive results from the research, they advocated for early use of tenoscopy as a diagnostic tool in cases of noninfected tenosynovitis of the DFTS.
Cite This Article
APA
Smith MR, Wright IM.
(2006).
Noninfected tenosynovitis of the digital flexor tendon sheath: a retrospective analysis of 76 cases.
Equine Vet J, 38(2), 134-141.
https://doi.org/10.2746/042516406776563350 Publication
Researcher Affiliations
- Reynolds House Referrals, Greenwood Ellis & Partners, 166 High Street, Newmarket, Suffolk CB8 9WS, UK.
MeSH Terms
- Animals
- Female
- Follow-Up Studies
- Horse Diseases / diagnosis
- Horse Diseases / diagnostic imaging
- Horse Diseases / surgery
- Horses / injuries
- Lameness, Animal
- Ligaments, Articular / diagnostic imaging
- Ligaments, Articular / surgery
- Male
- Radiography
- Retrospective Studies
- Tendon Injuries / diagnosis
- Tendon Injuries / diagnostic imaging
- Tendon Injuries / surgery
- Tendon Injuries / veterinary
- Tenosynovitis / veterinary
- Treatment Outcome
- Ultrasonography
Citations
This article has been cited 13 times.- 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.
- Smith R, Önnerfjord P, Holmgren K, di Grado S, Dudhia J. Development of a Cartilage Oligomeric Matrix Protein Neo-Epitope Assay for the Detection of Intra-Thecal Tendon Disease. Int J Mol Sci 2020 Mar 20;21(6).
- Ribitsch I, Gueltekin S, Keith MF, Minichmair K, Peham C, Jenner F, Egerbacher M. Age-related changes of tendon fibril micro-morphology and gene expression. J Anat 2020 Apr;236(4):688-700.
- Khan MR, Dudhia J, David FH, De Godoy R, Mehra V, Hughes G, Dakin SG, Carr AJ, Goodship AE, Smith RKW. Bone marrow mesenchymal stem cells do not enhance intra-synovial tendon healing despite engraftment and homing to niches within the synovium. Stem Cell Res Ther 2018 Jun 19;9(1):169.
- Lacitignola L, De Luca P, Imperante A, Tommasa SD, Crovace A. Palmar annular ligament desmotomy in horses with the Arthrex-Centerline™ : An ex-vivo study. Open Vet J 2018;8(1):53-56.
- Lacitignola L, De Luca P, Guarracino A, Crovace A. Computed Tomographic Tenography of Normal Equine Digital Flexor Tendon Sheath: An Ex Vivo Study. Vet Med Int 2015;2015:903169.
- Bertuglia A, Mollo G, Bullone M, Riccio B. Identification of surgically-induced longitudinal lesions of the equine deep digital flexor tendon in the digital flexor tendon sheath using contrast-enhanced ultrasonography: an ex-vivo pilot study. Acta Vet Scand 2014 Nov 25;56(1):78.
- Jerosch J, Aldawoudy A. Tendoscopic management of peroneal tendon disorders. Knee Surg Sports Traumatol Arthrosc 2007 Jun;15(6):806-10.
- 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).
- 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.
- 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.
- 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.
- 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).
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