Noninfected tenosynovitis of the digital flexor tendon sheath: a retrospective analysis of 76 cases.
Authors: Smith M R W, Wright I M
Journal: Equine veterinary journal
Summary
# Editorial Summary: Noninfected Tenosynovitis of the Digital Flexor Tendon Sheath Smith and Wright's retrospective analysis of 76 horses referred for noninfected digital flexor tendon sheath (DFTS) tenosynovitis over seven years demonstrates that tenoscopy is essential for identifying the underlying pathology driving clinical signs that would otherwise remain undiagnosed. Marginal tears of the deep digital flexor tendon (DDFT) accounted for 58% of cases (n=44), with manica flexoria tears representing 30% (n=23); all horses underwent tenosynoscopic evaluation and eleven required open exploration. Among the 61 animals with follow-up data beyond six months, 68% achieved clinical soundness and 54% returned to preoperative performance levels, though outcomes were significantly compromised by marginal DDFT tears, marked preoperative sheath distension, and the need for open surgical repair. Sheath distension—the most visible clinical sign—resolved entirely in only 33% of cases and showed improvement in 69%, suggesting that normalisation of effusion does not always correlate with functional recovery. For practitioners managing horses presenting with chronic flexor sheath distension and variable lameness, these findings justify early referral for tenoscopy rather than prolonged conservative management, as accurate diagnosis of specific lesion location and type directly influences prognosis and informs realistic client expectations regarding return to work.
Read the full abstract on PubMed
Practical Takeaways
- •Tenoscopy should be used early in cases of noninfected DFTS tenosynovitis as it provides definitive diagnosis and enables targeted treatment that other imaging cannot achieve
- •Prognosis varies significantly: horses with marginal DDFT tears or severe preoperative distension have notably reduced performance recovery compared to those with short lesions or mild distension
- •Expect that approximately one-third of treated horses will have complete resolution of sheath distension, but two-thirds will show improvement; full return to preoperative work level occurs in only about half of cases
Key Findings
- •Marginal DDFT tears (n=44) and manica flexoria tears (n=23) were the most common diagnoses in 76 horses with noninfected DFTS tenosynovitis
- •68% of 61 horses with follow-up >6 months were sound, but only 54% returned to preoperative performance levels
- •Sheath distension was eliminated in 33% and improved in 69% of horses following tenoscopic treatment
- •Marginal DDFT tears, marked preoperative distension, and increased duration of clinical signs were associated with poor outcomes and persistent distension