Gross anatomy, computed tomographic contrast tenography, and needle endoscopy of the equine medial digital flexor tendon sheath.
Authors: Kerbert Maria P, Delling Uta, Verhaar Nicole
Journal: Veterinary surgery : VS
Summary
# Medial Digital Flexor Tendon Sheath: Advancing Diagnostic and Therapeutic Approaches The medial digital flexor tendon sheath (MDFTS) in the equine hindlimb has remained relatively understudied compared to other synovial structures, yet septic tenosynovitis of this region presents significant clinical challenges. Kerbert and colleagues conducted a detailed anatomical investigation combining gross dissection, computed tomographic contrast tenography, and endoscopic examination of twelve cadaveric hindlimbs, establishing the three-dimensional relationships of the mesotenon, synovial plicae, and the variable communication between the MDFTS and tarsal sheath. Their work demonstrated that needle scope endoscopy—rather than conventional arthroscopy—provides adequate visualisation of the complete MDFTS sheath when using two portal approaches, with consistent identification of key intrasynovial structures achievable through this minimally invasive technique. A clinical case of septic tenosynovitis secondary to laceration illustrated the potential for endoscopic lavage as a therapeutic intervention. For practitioners managing hindlimb flexor tendon sheath infections, these findings represent an important expansion of diagnostic and treatment options, particularly where traditional approaches may prove inadequate or where early intervention could limit tissue damage and improve clinical outcomes.
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Practical Takeaways
- •Needle scope endoscopy provides a viable diagnostic and therapeutic option for septic tenosynovitis of the medial digital flexor tendon sheath, enabling direct visualization and lavage
- •Be aware that tarsal sheath communication with the medial digital flexor tendon sheath varies between individuals, affecting how infection may spread and how treatment approaches should be tailored
- •Two separate portal approaches are required for complete visualization of the medial digital flexor tendon sheath during endoscopy
Key Findings
- •Mesotenon in proximal recess and two synovial plicae surrounding the medial digital flexor tendon were consistently identified on dissection and CT imaging
- •Communication between medial digital flexor tendon sheath and tarsal sheath varied among individual horses
- •Two endoscopic portals were necessary to visualize the complete length of the medial digital flexor tendon sheath
- •Needle scope endoscopy was feasible for examination of medial digital flexor tendon sheath anatomy, whereas conventional arthroscope was not