Ultrasound-guided tenoscopic decompression of digital sheath synoviocoeles in 10 horses.
Authors: Hawkins Alex, Chapman Lucy, Meter Mark, Smith Roger K
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Tenoscopic Treatment of Digital Flexor Tendon Sheath Synoviocoeles Digital flexor tendon sheath (DFTS) synoviocoeles present a diagnostic and therapeutic challenge in equine practice; these firm, non-deflatable fluid-filled masses develop a pathological communication with the main tendon sheath and cause localised lameness proximal to the annular ligament. In this retrospective review of 10 horses (five forelimb and five hindlimb cases), diagnostic imaging and tenoscopic findings consistently revealed communication between the DFTS and synoviocoele on contrast tenography, with intrathecal flexor tendon injuries identified concurrently in four cases. Ultrasound-guided tenoscopic fenestration of the synoviocoele communication—combined with treatment of any concurrent intrathecal pathology—resolved lameness in all nine horses re-evaluated by a veterinarian, with all ten returning to full athletic function at long-term follow-up (median 5 years; range 1.25–9 years). This minimally invasive approach offers a significant advantage over traditional extrasynovial resection, preserving normal tendon sheath anatomy whilst achieving excellent clinical outcomes; the technique warrants consideration as a first-line surgical option for synoviocoeles when adequate ultrasonographic guidance and tenoscopic expertise are available.
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Practical Takeaways
- •Ultrasound-guided tenoscopic decompression offers an excellent alternative to traditional extrasynovial resection for DFTS synoviocoeles, with all horses returning to full work
- •Intrathecal anesthesia combined with perineural/intralesional blocks helps localize pain source when synoviocoeles are present; always check for concurrent DFTS injuries during treatment
- •This minimally invasive approach preserves normal anatomy and provides long-term lameness resolution (median 5 years follow-up with no reported recurrence)
Key Findings
- •Tenoscopic fenestration under ultrasound guidance resolved lameness in all 9 horses re-evaluated by veterinarian (100%)
- •All 10 horses returned to full athletic function at long-term follow-up (median 5 years; range 1.25-9 years)
- •Communication between DFTS and synoviocoele was confirmed on contrast tenography in all 6 horses examined (100%)
- •4 of 10 horses had concurrent intrathecal injury that was treated during the procedure