Tenosynovitis

Tenosynovitis



Basic Information image



Definition


The digital flexor tendon sheath (DFTS) is the synovial compartment located on the palmar/plantar aspect of the distal extremities surrounding the superficial and deep digital flexor tendons as they pass over the metacarpophalangeal and metatarsophalangeal and proximal interphalangeal joints. The sheath begins approximately at the junction of the middle and distal third of the metacarpus or metatarsus and continues to near the navicular bursa distally.



Synonym(s)


Vagina synovialis tendinis, theca tendinis, tendon sheath tendinitis



Epidemiology



Risk Factors




• Synovitis with trauma: Athletic activity, overreaching injury, rundown injuries


• Sepsis with trauma: Intrathecal injection, puncture wounds and lacerations, surgery, extension of superficial infection



Associated Conditions and Disorders




• Desmitis: Most commonly the proximal annular ligament, but involvement of the digital annular ligaments has been described


• Tendinitis: Deep and superficial digital flexor tendinitis within the sheath as well as injuries to the manica flexoria



Clinical Presentation



Disease Forms/Subtypes


Noninfectious synovitis of the DFTS can be categorized in three stages:



• Stage 1 (effusive): Mild to moderate soft and fluctuant effusion in one or more limbs with no associated lameness and no pain on palpation or significant response to fetlock flexion. This stage generally improves with work.


• Stage 2 (proliferative): Mild to moderate firm distension of the sheath with mild to moderate lameness and a positive response to fetlock flexion and palpation.


• Stage 3 (proliferative with adhesions and synovial masses): Firm and painful on palpation with severe lameness (may be reluctant to place heel down) and significant loss of comfortable range of motion (ROM) in the fetlock.


• Annular ligament syndrome: Often associated with DFTS synovitis. The palmar/plantar annular ligament (PAL) counteracts the forces placed on the proximal sesamoid bones during fetlock extension. This syndrome may be a primary injury or secondary response to chronic inflammation of the DFTS. Fibrosis of the PAL is a contributing factor in lameness associated with the DFTS.


• Infectious synovitis: Generally associated with wounds entering the DFTS but may be iatrogenic with intrathecal injection or surgery. Infection of the axial border of the proximal sesamoid bones may enter the tendon sheath, fetlock joint, or both, depending on the location and integrity of the intrasesamoidean ligament.



History, Chief Complaint


Swelling of the DFTS with or without lameness. This may be an acute or progressive onset.



Physical Exam Findings


Enlargement of the DFTS sheath, lameness



Etiology and Pathophysiology


Traumatic capsulitis or synovitis to the DFTS lining. This may include tearing of the vincula, synovial herniation, or damage to the tendons or manica flexoria and PAL.



Diagnosis image



Differential Diagnosis




• Cellulitis: Swelling and edema around the fetlock as a result of infection not associated with the tendon sheath.


• Fetlock joint synovitis: The swelling is generally confined to the dorsal aspect of the fetlock and the palmar/plantar outpouchings that are dorsal to the suspensory branches.


• Extension of bony injury or infection into the tendon sheath such as osteitis of the axial margin of the proximal sesamoid bones.


• DFTS synovitis: Noninfectious or infectious.

< div class='tao-gold-member'>

Related posts:

  1. Aggressive Stallion Behavior
  2. Aflatoxin Toxicosis
  3. Biliary Atresia
  4. Black Widow Spider Toxicosis

Stay updated, free articles. Join our Telegram channel
Tags:
Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Tenosynovitis

Full access? Get Clinical Tree
Get Clinical Tree app for offline access