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Background Digital flexor tendon sheath (DFTS) pathology is an important cause of lameness in horses. The outcome after surgical treatment is variable and depends on the exact diagnosis. Objectives To (1) describe the prevalence of lesions associated with lameness caused by nonseptic DFTS tenosynovitis in a large population of German sports and pleasure horses; (2) determine the sensitivity and specificity of diagnostic imaging techniques for identifying lesions within the DFTS with tenoscopic diagnosis being the gold standard; (3) explore associations between tenoscopically diagnosed lesions and signalment, purpose, and limb affected; and (4) describe the outcome following DFTS tenoscopy with nonseptic DFTS tenosynovitis in this population. Study design Retrospective case series. Methods Medical records of horses admitted for tenoscopic surgery of nonseptic DFTS tenosynovitis between 2011 and 2020 were reviewed. Follow‐up information was obtained via telephone contact. Sensitivity and specificity of ultrasonography and contrast tenography were determined using tenoscopic diagnosis as gold standard and univariable analysis was used to explore associations between signalment, case history, and tenoscopic diagnosis. Results Medical records from 131 horses were retrieved, of which 8 horses had bilateral disease and 6 horses were presented for tenoscopy on two separate occasions (3 for tenoscopy in the same limb, 3 in a different limb), thus, making a total of 145 limbs. Lesions were most commonly diagnosed in the deep (DDFT; n = 55 limbs) and superficial (SDFT; n = 55 limbs) digital flexor tendons. Manica flexoria (MF) lesions were detected in 44 limbs and palmar/plantar annular ligament (PAL) constriction in 99 limbs. In 36 limbs, only one structure within the DFTS was injured, whereas in 109 limbs a combination of lesions was noted, the most common being the combination of a SDFT lesion with PAL constriction. All affected limbs were examined with diagnostic ultrasonography; contrast tenography was performed in 86 limbs. For diagnosis of MF and DDFT tears, tenography was more sensitive (89% [confidence interval, CI: 65.4%–95.2%]; 72% [CI: 46.4%–89.3%], respectively) than specific (64% [CI: 52.5%–77.6%]; 53% [CI: 42.2%–73.3%], respectively) whereas ultrasonography was more specific (92% [CI: 84.5%–96.3%]; 92% [CI: 83.6%–96.0%]) with lower sensitivity (64% [CI: 47.7%–77.2%]; 54% [CI: 39.5%–67.9%]). For SDFT lesions, ultrasonography was highly specific (94% [CI: 86.9%–97.9%]) with lower sensitivity (66% [CI: 51.3%–77.4%]). Follow‐up information following first surgery was obtained for 118 horses (132 limbs): 18 (15.3%) of 118 horses remained chronically lame, 40 (33.8%) performed at a reduced level and 60 (50.8%) performed at the same or higher level following rehabilitation after tenoscopy. Horses with DDFT lesions had the poorest outcomes with only 36.6% returning to the same or higher level of exercise. Main limitations Retrospective analysis of clinical records and subjective outcome assessment based on owner follow‐up with potential recall bias. Findings on diagnostic imaging are impacted by many factors including equipment quality and operator expertise and experience. Conclusion Diagnostic imaging techniques were complimentary and contrast tenography was sensitive and ultrasonography was specific for the diagnosis of MF and DDFT lesions. Following tenoscopic surgery for nonseptic tenosynovitis of the DFTS, approximately half the cases were able to return to preinjury level of exercise.

Objective: To describe the MRI findings for 13 horses with deep digital flexor tendon (DDFT) injury at the proximal phalanx where the tendon goes from ovoid to bilobed in frontlimbs with tendon sheath distension. In addition, the prognosis of this lesion was assessed.Design: Retrospective case series.Animals: Thirteen client-owned horses.Procedures: Medical records were reviewed, and data were collected regarding signalment, history, MRI findings, and outcomes of horses. Findings of MRI were recorded and whether the case was confirmed with tenoscopy.Results: A diagnosis of DDFT injury at the junction between ovoid and bilobed portions at the level of the proximal phalanx was established in 13/20 (65%) horses that underwent MRI examination of the frontlimb digital flexor tendon sheath. Return to previous level of work was poor in this subset of horses with only three of 13 (23%) horses returning to previous level of work and one horse still in rehabilitation.Conclusions and Clinical Relevance: Standing low-field MRI represents a potentially useful diagnostic tool to evaluate digital flexor tendon sheath distension especially when evaluating the DDFT at the proximal phalanx where the tendon progresses from ovoid to bilobed. Prognosis of lesions of the DDFT at the proximal phalanx appears less favorable than previously reported causes of tendon sheath distension.

Dissertação de Mestrado Integrado em Medicina Veterinária The digital flexor tendon sheath (DFTS) enfolds the digital flexor tendons and their associated structures, protecting and facilitating its movements. Tenoscopic examination of the DFTS has become a routine procedure in equine surgical practice since it is a minimal invasive technique that allows the exploration of the sheath structures with direct observation of lesions and therefore, confirmation of a diagnosis and, in some cases, early treatment. In this work, medical records of horses that underwent tenoscopic examination of the DFTS in 2016 at four different equine hospitals in the United Kingdom had their medical records reviewed. Eighty-six cases (93 DFTSs) were included in this study. There were 31% Thoroughbreds, 28% Warmbloods, 20% Coldbloods, 12% Ponies and 9% unknown. Ninety-eight percent of horses were lame at the time of clinical examination, effusion was present in 94% of the DFTSs and the hindlimbs were more frequently intervened (61%). Palmar/plantar annular ligament (PAL) constriction (43%) was the most common pathology, followed by sheath penetration (27%), and tears of the flexor tendons (24%) and manica flexoria (MF) (19%). Other diagnosis included tendonitis, infectious tenosynovitis, fibrosis, diseases of sesamoidean ligaments and ganglion cysts. Results show that PAL constriction, flexor tendon and MF tears were diagnosed more frequently in the hindlimbs (72.5%, 64% and 90%, respectively), while traumatic injuries affected more forelimbs (60%). Coldbloods and Ponies were predisposed to MF tears and PAL constriction, Warmbloods to PAL constriction and flexor tendon tears, and Thoroughbreds to traumatic injuries. Young horses (10 years) were commonly diagnosed with MF tears and PAL constriction. Tenoscopy was of extreme importance as a diagnostic method, considering that MF tears were only identified by other diagnostic methods in 61% of cases, flexor tendon tears in 67% and PAL constriction in 53%. In conclusion, tenoscopy was proven to be a simple and useful diagnose and treatment method of DFTS pathology, even though the long term follow-up of the analysed horses was not studied. RESUMO - TENOSCOPIA DA BAÍNHA DIGITAL DOS TENDÕES: ANÁLISE RETROSPETIVA DE 86 CAVALOS (2016) - A bainha digital dos tendões (BDT) envolve os tendões flexores digitais e as estruturas associadas aos mesmos, protegendo-os e facilitando os seus movimentos. A examinação tenoscópica da BDT tornou-se um procedimento de rotina em cirurgia de equinos, visto ser uma técnica cirúrgica minimamente invasiva que permite a observação direta de lesões, confirmação de diagnósticos e, em alguns casos, tratamento precoce. Neste trabalho foram revistos os registos médicos dos cavalos que foram submetidos a tenoscopia da BDT em 2016 em quatro hospitais de equinos no Reino Unido. Oitenta e seis casos (93 BDTs) foram incluídos no presente estudo sendo que 31% eram de raça puro-sangue inglês, 28% de sangue quente, 20% de sangue frio, 12% póneis e 9% de raça desconhecida. Noventa e oito porcento dos cavalos exibiram claudicação e 94% dos membros tinham distensão da BDT. Os membros posteriores foram os mais intervencionados (61%). Constrição pelo ligamento anular palmar/plantar (LAP) (46%) foi a doença mais comum, seguida de lesão percutânea da bainha (27%), e lesões marginais dos tendões flexores (24%) e roturas da manica flexoria (MF) (19%). Outros diagnósticos incluíram tendinite, tenosinovite infeciosa, fibrose, doenças de ligamentos sesamoideus e quistos. Os resultados indicam que a constrição pelo LAP, lesões marginais dos tendões flexores e roturas da MF são mais frequentes nos membros posteriores (72.5%, 64% e 90%, respetivamente), enquanto lesões percutâneas afectam mais os membros anteriores (60%). Cavalos de sangue frio e póneis foram mais propensos a roturas da MF e constrição pelo LAP, cavalos de sangue quente a constrição pelo LAP e lesões marginais dos tendões flexores, e puro-sangue inglês a lesões traumáticas da BDT. Cavalos jovens (10 anos) foram mais afetados por roturas da MF e constrição pelo LAP. A tenoscopia é de extrema importância como método de diagnóstico, considerando que roturas da MF apenas foram identificadas por outros métodos em 61% dos casos, lesões marginais dos tendões flexores em 67% e constrição pelo PAL em 53%. Em conclusão, foi provado que a tenoscopia é uma técnica simples e útil de diagnóstico e tratamento de doenças da BDT, embora o acompanhamento da recuperação do cavalo a longo prazo não tenha sido estudado. N/A