Abstract
SummaryBackgroundInsertional deep digital flexor tendon (DDFT) lesions with concurrent injury to the flexor surface of the distal phalanx are uncommon and there is limited information regarding prognosis.ObjectivesTo provide descriptive data on horses with insertional DDFT injuries and determine whether there is any association between magnetic resonance imaging (MRI) findings, and outcome.Study designRetrospective case series.MethodsHorses with lameness localised to the foot that underwent low field standing MRI between January 2015 and April 2019 were included. Injury of the DDFT, presence of short tau inversion recovery (STIR) hyperintensity at the flexor surface of the distal phalanx and concurrent lesions were recorded. Follow‐up information was obtained by telephone questionnaire.ResultsThirty‐two horses fulfilled the inclusion criteria. Thirty‐one limbs had DDFT insertional lesions on MRI with three limbs showing hyperintense STIR signal of the flexor surface of the distal phalanx without a tendon lesion. Seventeen DDFT lesions were graded as mild and 14 as severe. Thirteen limbs showed hyperintense STIR signal within the tendon and 15 limbs showed hyperintense STIR signal within the flexor surface of the distal phalanx at the insertion of the DDFT and/or the distal sesamoidean impar ligament (DSIL). Eight horses returned to previous athletic function, 8 returned to a lower level of athletic activity, 4 were retired, 9 were subjected to euthanasia and 3 were lost to follow‐up. No significant association was found between DDFT lesion severity, hyperintense STIR signal within the DDFT, hyperintense STIR signal at the flexor surface of the distal phalanx and outcome post‐injury.Main limitationsSmall sample size and reliance on clients to provide accurate follow‐up information.ConclusionsInsertional DDF tendinopathy carries a guarded prognosis for return to previous athletic function. The presence of hyperintense STIR signal at the flexor surface of the distal phalanx did not appear to influence the prognosis.
Highlights
Deep digital flexor tendon (DDFT) injuries are a common cause of foot lameness in the horse (Dyson et al 2005; Mair and Kinns 2005)
Cases were included that underwent low-field magnetic resonance imaging (MRI) (0.27T) of a fore or hind foot following a positive response to diagnostic analgesia of the palmar/plantar nerves at the level just proximal to the ungular cartilages or at the base of the proximal sesamoid bones, and that showed MRI evidence of insertional deep digital flexor tendinopathy and/or hyperintense short tau inversion recovery (STIR) or T2* signal within the spongiosa bone and/or the compacta bone of the flexor surface of the distal phalanx at the insertion of the DDFT or the distal sesamoidean impar ligament (DSIL) as the most likely cause for the lameness
Insertional deep digital flexor tendinopathy and/or hyperintense STIR signal of the flexor surface of the distal phalanx at the insertion of the DDFT and/or the DSIL was seen in 34 limbs
Summary
Deep digital flexor tendon (DDFT) injuries are a common cause of foot lameness in the horse (Dyson et al 2005; Mair and Kinns 2005). Insertional lesions are located in the most distal 20mm of the DDFT and include small core lesions or sagittal plane splits; concurrent osseous remodelling of the distal phalanx can occasionally be present. These lesions can be found in isolation or in association with pathology in other portions of the DDFT (Blunden et al 2009; Schramme 2011). One study looking at MR images of 46 horses with lameness
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