Bovis ISSN 2398-2993

Tenosynovitis

Contributor(s): Sophie Mahendran , Paul Wood

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Introduction

  • Tenosynovitis involves inflammation of the synovial membrane of the tendon sheaths, most commonly the digital flexor tendon sheath (CDFTS) +/- fibrous layer.
  • Most healthy cattle do not have any communication between the two CDFTS, but one may develop in the presence of pathological processes.
  • Septic tenosynovitis does not commonly occur on both tendon sheaths concurrently.
  • Cause: two forms of tenosynovitis have been recognized in cattle:
  1. Aseptic - traumatic, secondary synovitis, idiopathic
  2. Septic - direct extension, iatrogenic, hematogenous.
  • Signs: localized swelling of the palmar/plantar aspect of the fetlock region between the suspensory ligament and flexor tendons and plantar/palmar pastern (digital flexor sheath) +/- lameness, local heat, pain, wound, discharge.
  • Diagnosis: ultrasonography, synovial fluid analysis, radiography, perineural and intrathecal local anesthesia, tenosynovioscopy.
  • Treatment: rest, anti-inflammatories; drainage, lavage and antibiotics; intrathecal corticosteroids and hyaluronate; tenosynovioscopy.
  • Prognosis: poor.

Pathogenesis

Etiology

  • The common digital flexor tendon sheath (CDFTS) structure is different from other synovial joints. The synovial lining cells of the tendon sheath are fibroblastic in appearance and are composed of a single synovial cell type.
  • The tendon sheath contains abundant blood vessels but few nerve fibers. Synovial fluid produced by the tendon sheath has a lower concentration of hyaluronic acid and a lower mucinous precipitate quality, but the cellular and protein concentration in tendon sheath fluid and joint fluid are similar.
  • The digital flexor tendon sheath originates 6 to 8 cm proximal to the fetlock and extends distally to a point immediately distal to the coronary band.
  • The tendon sheath is confined on its palmar/plantar surface by the palmar/plantar annular ligament of the fetlock, the palmar/plantar digital annular ligament (distal to the accessory digits or dewclaw), and the distal interdigital ligaments (proximal to the heel bulbs).
  • Inflammation of the digital tendon sheath should be suspected when focal swelling of the palmar/plantar aspect of the pastern is observed concurrent with focal swelling extending proximally from the level of the dewclaws.

Predisposing factors

General

  • Neonates - failure of passive transfer Colostrum: overview predisposes to primary septicemic conditions, along with poor hygiene and inadequate feeding levels.
  • Adults - poor transition cow management, twinning and dystocia Dystocia can predispose to development of metritis and toxic mastitis which can lead to septicemic seeding of bacteria to the tendon sheath.

Pathophysiology

Aseptic tenosynovitis

Traumatic synovitis of sheath lining
  • Leads to contusions and/or tearing of the synovial membrane with intrathecal hemorrhage and acute inflammation.
  • The latter leads to hyperemia, edema and thickening of the synovium.
  • Trauma may be from kicks, falls and knocks, or from low grade repetitive trauma.
  • Abnormal forces outside of normal range, i.e. hyperextension, can lead to damage either as one-off severe forces or repetitive lower level forces over time. This can occur as a breeding injury, or due to restraint with a rope.
Idiopathic
  • Calves may be born with the condition.
  • Adult cattle, especially older animals, can have an insidious in onset; chronic low-grade trauma or wear and tear.

Septic tenosynovitis

Direct extension
  • From deep digital sepsis or puncture wounds/lacerations to the palmar/plantar aspect of the distal limb, especially above and below the fetlock → introduction of bacteria and/or foreign bodies → sepsis.
Iatrogenic
  • Injection of irritant chemicals.
Hematogenous spread
  • From primary septicemic foci such as navel ill, ETEC enteritis or pneumonia.
  • Extension from septic foci within intersesamoidean ligament resulting from septic osteitis of the sesamoid bones.
  • Ascending deep digital sepsis (this form is rare).

Timecourse

  • Acute onset after periods of excessive activity or penetrating injury.
  • Chronic cases may fluctuate over months with periods of improvement and then recurrence of lameness.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Mulon P Y, Desrochers A & Francoz D (2016) Surgical management of septic arthritis. Veterinary clinics of North America: food animal practice 2 (3), 777-795 PubMed.
  • Desrochers A & Francoz D (2014) Clinical Management of Septic Arthritis in Cattle. Veterinary clinics of North America: food animal practice 30 (1), 177-203 PubMed.
  • Steiner A, Anderson D E & Desrochers A (2014) Diseases of the tendons and tendon sheaths. Veterinary clinics of North America: food animal practice 30 (1), 157-175 PubMed.
  • Findley J A (2012) Injuries to the digital flexor tendon sheath in the horse. UK Vet 17, 10-13.
  • Bertagnoli A, Räber M, Morandi N, Mortellaro C M & Steiner A (2012) Tenovaginoscopic approach to the common digital flexor tendon sheath of adult cattle: Technique, normal findings and preliminary results in four clinical cases. The veterinary journal 191 (1), 121-127 PubMed.
  • Kofler J (2009) Ultrasonography as a diagnostic aid in bovine musculoskeletal disorders. Veterinary clinics of North America: food animal practice 25 (3), 687-731 PubMed.
  • Anderson D E, Desrochers A & St. Jean G (2008) Management of tendon disorders in cattle. Veterinary clinics of North America: food animal practice 24 (3), 551-566 PubMed.
  • Lugo J & Gaughan E M (2006) Septic arthritis, tenosynovitis, and infections of hoof structures. Veterinary clinics of North America: equine practice 22 (2), 363-388 PubMed.
  • Anderson D E & Jean G (1996) Diagnosis and management of tendon disorders in cattle. Veterinary clinics of North America: food animal practice 12 (1), 85-116 PubMed.
  • Schneider R K et al (1992) A retrospective study of 192 horses affected with septic arthritis-tenosynovitis. Equine vet 24, 436-442 PubMed.

Other sources of information

  • McIlwraith C W (2002) Tenosynovitis. In: Adams lameness in horses. 5th edn. Lippincott, Williams & Wilkins, Baltimore. pp 630-634.
  • Smith R K W & Webbon P M (1999) Digital sheath tenosynovitis. In: Equine medicine and surgery. 5th edn. Eds: Colahan P T, Merritt A M, Moore J N & Mayhew I G. Mosby, St Louis. pp 1575-1577.


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