Surgical repair of synovial fistulae between a carpal hygroma, the tendon sheath of the extensor carpi radialis and the antebrachiocarpal joint in a horse
Authors: Rybar M., Fraser B. S. L.
Journal: Equine Veterinary Education
Summary
# Editorial Summary A seven-year-old gelding presenting with a carpal hygroma (fluid-filled swelling over the carpus) proved diagnostically complex when contrast radiography revealed unexpected synovial communications: the hygroma had created fistulous tracts connecting simultaneously to the antebrachiocarpal joint and the extensor carpi radialis tendon sheath, a rare concurrent involvement that increased infection risk and structural compromise. Using arthroscopic guidance, the surgical team visualised these fistulae directly and repaired them under magnification, which allowed precise identification of tract anatomy and confirmation of complete closure before closure. The gelding returned to full athletic function with cosmically acceptable results, demonstrating that whilst carpal hygromas are common, those involving multiple synovial structures warrant aggressive diagnostic imaging and arthroscopic-assisted repair rather than conservative management or drainage alone. For practitioners encountering carpal hygromas unresponsive to standard therapy or showing signs of lameness disproportionate to swelling, this case highlights the importance of contrast imaging to rule out deeper synovial involvement before committing to treatment plans.
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Practical Takeaways
- •When managing carpal hygroma, always investigate for potential synovial communications with adjacent joints and tendon sheaths—these may not be clinically obvious but can compromise outcomes
- •Contrast radiography combined with arthroscopy provides effective diagnostic confirmation and enables targeted surgical repair of complex synovial fistulae
- •Full athletic recovery is achievable even with multiple synovial structures involved when the communications are identified and repaired surgically
Key Findings
- •Synovial fistulae between a carpal hygroma, the antebrachiocarpal joint, and the extensor carpi radialis tendon sheath were successfully identified using contrast radiography and arthroscopy
- •Surgical repair of the multiple synovial communications resulted in full athletic and acceptable cosmetic recovery in a 7-year-old gelding