Equis ISSN 2398-2977

Tenosynovioscopy

Synonym(s): Tenoscopy

Contributor(s): Patrick Colahan, Graham Munroe

Introduction

  • Tenosynovioscopy or tenoscopy is the endoscopic evaluation of tendon sheaths.
  • It complements ultrasonography by providing additional diagnostic information particularly on proliferative synovial lesions, adhesions and tendon tears    Ultrasonography: overview    Ultrasonography: flexor tendon  .
  • Surgical opportunities include:
  • The equipment that is used is exactly the same as for arthroscopy with regards to choice of arthroscope, irrigating fluids, fluid delivery systems and hand instruments.

Motorized synovial resectors are particularly useful in sheaths.

  • Any tendon sheath is theoretically available for tenosynovioscopy but at present it is regularly used in the first three, and rarely in the last:
    • Digital flexor tendon sheath.
    • Carpal sheath.
    • Tarsal sheath.
    • Extensor tendon sheaths of the carpus and tarsus.
  • Minimally invasive technique.

Advantages

  • Small skin incisions leading to:
    • Minimal trauma.
    • Low rate of dehiscence of wounds.
    • Low infection rates.
    • Less post-operative scarring.
    • Early return to motion in the limb.
  • Good visibility of the internal structures within the sheath.
  • Flexible placement of instrument portals and triangulation techniques give flexible access to abnormal structures.

Disadvantages

  • These are not specific to tenosynovioscopy and are similar to arthroscopy.
  • Development of specific anatomical knowledge both for the approach and intra-sheath is essential, allied to regular practice and honing of specific surgical skills.

Digital tendon sheath

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Carpal sheath

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Tarsal sheath

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Extensor tendon sheaths

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Further Reading

Publications

Refereed papers
  • Recent references fromPubMed andVetMedResource.
  • Minshall G J & Wright I M.(2013)Frontal plane fractures of the accessory carpal bone and implications for the carpal sheath of the digital flexor tendons. Equine Vet JOct 24PubMed.
  • Findley J A, De Oliveira F & Bladon B (2012)Tenoscopic surgical treatment of tears of the manica flexoria in 53 horses. Vet Surg41(8), 924-930PubMed.
  • Minshall G J & Wright I M (2012)Synoviocoeles associated with the tarsal sheath: description of the lesion and treatment in 15 horses. Equine Vet J44 (1), 71-75PubMed.
  • Minshall G J & Wright I M (2012)Tenosynovitis of the carpal sheath of the digital flexor tendons associated with tears of the radial head of the deep digital flexor: observations in 11 horses. Equine Vet J44(1), 76-80PubMed.
  • Wright I M & Minshall G J (2012)Clinical, radiological and ultrasonographic features, treatment and outcome in 22 horses with caudal distal radial osteochondromata. Equine Vet J 44(3), 319-324PubMed.
  • Arensburg L et al(2011)Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitudinal tears in the digital flexor tendons: a retrospective study of 135 tenoscopic procedures. Equine Vet J43(6), 660-668PubMed.
  • Byron C R et al(2010)Modified tenoscopic method for carpal flexor retinaculum release in a horse. Vet Surg39(2), 239-243PubMed.
  • Nixon A J, Schachter B L & Pool R R (2004)Exostoses of the caudal perimeter of the radial physis as a cause of carpal synovial sheath tenosynovitis and lameness in horses: 10 cases (1999-2003). JAVMA224(2), 264-270PubMed.
  • Textor J A, Nixon A J & Fortier L A (2003)Tenoscopic release of the equine carpal canal. Vet Surg32(3), 278-284PubMed.
  • Hand D R et al (2001)Osteomyelitis of the sustentaculum tali in horses: 10 cases (1992-1998). JAVMA219(3), 341-345PubMed.
  • Cauvin E R et al(1999)Endoscopic examination of the tarsal sheath of the lateral digital flexor tendon in horses. Equine Vet J31(3), 219-227PubMed.
  • Southwood L L et al(1999) Desmotomy of the accessory ligament of the superficial digital flexor tendon in the horse with use of a tenoscopic approach to the carpal sheath. Vet Surg28(2), 99-105PubMed.
  • Cauvin E R J, Munroe G A & Boyd J S (1997)Endoscopic examination of the carpal flexor tendon sheath in horses.  Equine Vet J29(6), 459-466PubMed.
  • Platt D & Wright I M (1997)Chronic tenosynovitis of the carpal extensor tendon sheaths in 15 horses. Equine Vet J29(1), 11-16PubMed.
  • Nixon A J (1990)Endoscopy of the digital flexor tendon sheath in horses. Vet Surg 19(4), 226-271PubMed.


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