Use of tenoscopy for management of septic tenosynovitis caused by a penetrating porcupine quill in the synovial sheath surrounding the digital flexor tendons of a horse.

This study details a veterinary case wherein a horse was successfully treated for a severe infection in its sheath surrounding the tendon, caused by a porcupine quill, using a minimally invasive procedure called tenoscopy.

Case Background

• The patient was a 6-year-old Quarter Horse gelding who presented a severe lameness in its left forelimb. This lameness came suddenly, 21 days after the horse had an encounter with a porcupine.
• After the encounter, the horse was treated by a referring veterinarian, who removed quills and treated the horse with antibiotics and hydrotherapy for two weeks. Despite these efforts, the horse showed signs of infection and discomfort, including a fever and a swollen digital synovial sheath, the protective sheath surrounding the tendons in the horse’s leg.
• A physical examination caused the horse pain, leading to the suspicion of septic tenosynovitis, a severe, bacterial infection, caused by a remaining porcupine quill.

Treatment Process and Findings

• The horse underwent exploratory tenoscopy, a procedure wherein a small camera is inserted into the area to be inspected, in this case the horse’s tendon sheath. This examination revealed large build-ups of fibrin, an insoluble protein involved in the clotting of blood, inside the synovial sheath, indicating an active infection. Moreover, a hidden 1.2-cm long porcupine quill was also located.
• A bacteriological culture of the fluid from the tendon sheath was analyzed, leading to the identification of Staphylococcus aureus bacteria, a common agent of infection in these cases.

Procedure and Results

• The treatment involved removing the located quill, debriding (removing dead or damaged tissue) the fibrin, and washing the sheath to dilute inflammatory mediators and bacteria.
• The horse showed a dramatic improvement after this minimally invasive procedure, validating the value of tenoscopy in diagnosing and treating similar conditions.
• The paper suggests that tenoscopy can significantly enhance a clinician’s ability to directly inspect, treat, and offer a prognosis for septic synovial sheath conditions in a minimally invasive way.