ISSN 2398-2977      

Tarsus: tarsal sheath tenosynovitis

pequis
Contributor(s):

Chris Whitton

Synonym(s): Thoroughpin


Introduction

  • Cause: chronic tenosynovitis of tarsal sheath dorsal to hock.
  • Signs: lameness, distension of tarsal sheath above hock   Deep digital flexor tendon: tendinitis - thoroughpin  , fluid   →   thickened synovium.
  • Diagnosis: tendon ultrasonography   Ultrasonography: flexor tendon  .
  • Radiography:
    • Take standard views   Hindlimb: radiography  particularly plantarolateral-dorsomedial oblique.
    • Also dorsoplantar flexed view for sustentaculum tali.
    • May see osseus changes to sustentaculum tali of calcaneus   Tarsus: tarsal sheath tenosynovitis - skyline radiograph  .
    • Soft tissue mineralization.
  • Treatment: fluid drainage, inject corticosteroids   Dexamethasone  - short-term treatment only; arthroscopic debridement   Joint: arthroscopy - overview  of proliferative synovium and breakdown of adhesions; anti-inflammatories.
  • Prognosis: often recurs.

Pathogenesis

Etiology

Idiopathic thoroughpin

  • Spontaneously in young and sports horses.
  • Trauma - direct major injury to the tendon sheath, occasionally with chip fractures or fragmentation of sustentaculum tali edge.
  • Traumatic thoroughpin and/or strain or sprain of the sheath wall itself or associated soft tissues.
  • Multiple minor injuries to the sheath.

Septic

  • Wounds over sustenaculum tali   →   breach of tarsal sheath which may   →    destruction of the lateral digital flexor tendon and fibrocatilages   →    osteitis of calcaneus.

Other causes

Pathophysiology

  • Primary tenosynovitis often due to trauma.
  • Penetrating wound   →   sepsis.
  • Osteitis or ostemylelitis of sustentaculum tali   Bone: osteitis - septic  .
  • Deep digital flexor tendinitis within sheath.

Classification

  • Idiopathic (swelling without signs of inflammation).
  • Traumatic.
  • Acute septic.
  • Chronic aseptic.
  • Septic.

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.
  • Archer D C, Clegg P D & Edwards G B (2004) Septic tenosynovitis of the tarsal sheath of an Arab gelding and suspected sepsis of the lateral digital flexor tendon subsequent to bacterial peritonitis. Vet Rec 155 (16), 485-489 PubMed.
  • ter Braake F (2002) Direct endoscopic approach improves prognosis of septic-synovitis in the horse. Tijdschr Diergeneeskd 127 (14-15), 444-449 PubMed.
  • Hand D R, Watkins J P, Honnas C M & Kemper D (2001) Osteomyelitis of the sustentaculum tali in horses: 10 cases (1992-1998). JAVMA 219 (3), 341-345 PubMed.
  • Cauvin E R, Tapprest J, Munroe G A, May S A & Schramme M C (1999) Endoscopic examination of the tarsal sheath of the lateral digital flexor tendon in horses. Equine Vet J 31 (3), 219-227 PubMed.
  • Hago B E & Vaughan L C (1986) Use of contrast radiography in the investigation of tenosynovitis and bursitis in horses. Equine Vet J 18 (5), 375-382 PubMed.

Other sources of information

  • Cauvin E R J (2004) Conditions Affecting the Tarsal Sheath. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 32-33.

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