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  Discussion on Intrasynovial Tendon Laceration (Long Digital Extensor)
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New Member:
taz17

Posted on Saturday, May 15, 2010 - 4:34 pm:

Hi!
I posted this on the rehabilitation area, but just posting in here, too, just to see if someone can help.

My horse had an injury on her long digital extensor tendon. I looked up here, and the prognosis for that sort of injury is supposed to be good. But it seems that with intrasynovial tendon lacerations, it seems to be different? The vets who operated on my horse think that this is a rarely documented injury, and so the prognosis is uncertain, but I am hoping that someone on here may have had experience with this before. Below is her surgery report. I would gladly appreciate if someone could tell me in plain English what it means, and also whether they agree with the prognosis itself (uncertain).
Many thanks,
Taz


The horse was admitted to the surgery in July 2009. The horse had lameness that had been localised to the stifle by nerve blocks. The horse had responded to a period of rest but had gone lame again on return to exercise. The horse underwent arthroscopy of both stifles, which revealed a tear in the origin of the long digital extensor tendon.

I’ve advised that the horse should have box rest for three weeks followed by three weeks walking in hand exercise. Six weeks after surgery the horse should be turned into a restricted area such as a menage or barn for a further six weeks. Three months after surgery the horse should be reassessed with a view to turn out into a paddock for a further three months. The prognosis is uncertain, as this is a rarely documented injury. Intrasynovial tendon lacerations are always slow to heal.

The details of the surgery are below.

On admission radiographs of both stifles revealed some faint new bone on the cranial aspect of the medial intercondylar eminence of the tibia, visible on flexed lateral radiographs. The following day the horse was given a general anaesthetic and positioned in dorsal recumbency. The left medial femoro-tibial joint was examined arthroscopically from a lateral approach. This revealed no abnormalities of the cranial ligament of the medial meniscus or medial aspect or of the cranial cruciate ligament. There was mild surface irregularity of the cartilage on the medial femoral condyle. The arthroscope was repositioned to enter the medial femoro-tibial joint from the medial instrument portal and was then bluntly advanced through the septum into the lateral femoro-tibial joint. This revealed no abnormalities of the cartilage of the lateral femoral condyle, lateral meniscus or cranial ligament of the lateral meniscus. Examination of the long digital extensor tendon revealed a relatively deep split in the proximal aspect of the tendon. Palpation confirmed the split was remarkably deep but was associated with minimal prolapsed tendon fibres. The arthroscope was repositioned a third time back into the lateral portal to examine the lateral femoro-tibial joint, which revealed minimal abnormalities to the lateral aspect of the cranial cruciate ligament. Finally both arthroscope and instrument were advanced into the lateral femoro-tibial joint from a medial approach through the joint septum to allow limited debridement of the tear in the long digital extensor tendon.

The right medial femoro-tibial joint was examined from a lateral approach, which revealed no abnormalities. The cartilage surface of the medial femoral condyle was marginally irregular similar to the left hind. The lateral
femoro-tibial joint was examined from a medial approach, which again revealed no abnormalities. In this case the long digital extensor tendon was pristine.
New Member:
taz17

Posted on Saturday, May 15, 2010 - 4:41 pm:

P.S.: My horse is now 5 years old.
Moderator:
DrO

Posted on Sunday, May 16, 2010 - 12:22 pm:

Welcome Taz,
The article you refer to above discusses the distal extensor tendons that lie on the front of the lower leg. You describe injury to the proximal aspect which is a bit of a rarity. This is a short little tendon before giving rise to the muscle belly and it originates off the extensor fossa of the distal lateral femur along with the tendinous peroneus tertius. How long ago did the injury happen and how long did you rest the horse the first time?

Being a bit uncertain as to the nature of the injury I too am unsure what the prognosis is. If the tendon has a longitudinal tear with minimal fiber disruption (I cannot find a description of such an injury) and if this is the sole cause of lameness I would think the prognosis fair to good with adequate rest and rehab. Has the integrity of the distal digital extensor and peronius tertius also been assessed? This is a far more common injury that would occur under similar circumstances as to damage to the long digital extensor. For more on this see, Diseases of Horses » Lameness » Diseases of the Upper Rear Limb » Ruptured Peroneus Tertius.
DrO
PS I deleted your other discussion, to help us stay organized please just make each posting once. Thanks.
New Member:
taz17

Posted on Sunday, May 16, 2010 - 7:19 pm:

Thanks for your answer DrO.

The injury occurred in August 2008 - however, it took a while for it to be diagnosed. The first vet saw nothing really wrong (despite horse lifting leg up to her tummy when I saw her lunged and being lame) after doing X-rays and just said 10 days rest, put shoes on and continue to work.

Second vet (it's a large vet practice) then decided that the horse needed to be examined on their premises. They did a lameness investigation and could not replicate the lameness as the horse was a bit excitable. They said we should continue working. The vets started believing it was bone spavin. This led to cortisone injections in the hocks.

This went on until around May 2009. We have moved by then and had a different vet who looked at the X-rays and said there was only mild bone growth, and he didn't think that was the cause for the lameness. He did nerve blocks and this located the cause as being in the stifle. Then the keyhole surgery with the above vet report was made. That's all I really know - I don't know what else they checked up on other than what the vet report says.

We actually gave my horse more rest than the vet report stipulated. She had time off until the end of March really... So all in all, since the surgery, she had about 8 months of rest.
Moderator:
DrO

Posted on Wednesday, May 19, 2010 - 7:52 am:

How is the horse's soundness now?
DrO
Member:
taz17

Posted on Wednesday, May 19, 2010 - 8:49 am:

Please see my reply below... double posting.
Member:
taz17

Posted on Wednesday, May 19, 2010 - 8:50 am:

Well, the injury occured August 2008 but she only had the keyhole surgery nearly a year later in July 2009. She was mostly off just being a horse (stabled at night, paddock during the day... that's after the boxrest, etc.) until the end of March 2010. In April, we thought we should start slow. She has been ridden in walk and neither the yard owner, nor my riding instructor saw her lameness.

We have moved to another yard since due to relocation. At that yard, they have started to trot her, though she has been extremely bolshy and rides like a rodeo horse. They get free vet visits once a week, so the yard owner asked the vet to clarify the vet report for her "in plain English". This happens to be the same vet practice who told us to continue exercising her - and also the one she was referred to for the keyhole surgery. Apparently, the vet's reaction to the report was "Oh, dear!". He then asked to see my horse ridden and they rode her, and apparently, he could see that she was still lame, and he thought she may need to be put onto a paddock for another year with no guarantee it would heal. This is for an injury that originally occurred in August 2008.

When you see my horse running around in the turnout arena, you would not guess she was lame... huge impressionable trot, she bucks and rears, and is as the yard owner says an "extremely powerful horse". My horse hates being made to work though and the vet seems to blame it on her injury (when really, she just never liked working - ever).

I really don't know what to do... the yard owner believes all my mare may be good for is to be a broodmare, and I am very upset about this all. I just get this feeling that no vet in the area seems to know what to do and it's all just a waiting game.
Moderator:
DrO

Posted on Saturday, May 22, 2010 - 9:36 am:

Taz, if you feel the veterinarians have hit a diagnostic, prognostic wall I would recommend you collect together all the veterinary reports and images and mail them to a orthopedic surgeon at one of the veterinary hospitals, they may be able to clarify the situation.
DrO
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