Intrathecal deep digital flexor tenectomy for treatment of septic tendonitis/tenosynovitis in four horses.
Authors: Marsh Chad A, Watkins Jeffery P, Schneider Robert K
Journal: Veterinary surgery : VS
Summary
# Intrathecal Deep Digital Flexor Tenectomy for Chronic Septic Tendonitis in Horses When conventional management of septic deep digital flexor (DDF) tendonitis and tenosynovitis fails—despite aggressive intervention including systemic antibiotics, tendon sheath lavage, regional perfusions, endoscopic debridement and annular ligament transection—surgical removal of the infected intrathecal component of the DDFT may offer a salvage pathway. This case series of four horses describes partial intrathecal tenectomy followed by cast stabilisation and corrective farriery, undertaken after 10 to 210 days of unsuccessful conventional therapy. All four horses achieved comfortable weight-bearing at pasture within a mean recovery period of 82 days hospitalisation, with long-term follow-up extending beyond 1.5 years (mean 3.8 years) demonstrating sustained functional soundness. Whilst the limited case numbers preclude broad generalisation, the procedure's success in these refractory cases—with affected horses subsequently maintained as broodmares—suggests intrathecal tenectomy warrants consideration in your diagnostic and therapeutic protocols for chronic, non-responsive septic tenosynovitis complicated by deep tendon involvement. The substantial recovery timeframe and ongoing farriery requirements underscore the need for realistic owner expectations and coordinated rehabilitation planning involving veterinary surgeons, farriers and physiotherapists.
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Practical Takeaways
- •Intrathecal tenectomy is a salvage option for chronic septic digital sheath infections that fail standard treatments (antibiotics, lavage, regional perfusions, tenoscopy); it can preserve function for pasture use and breeding
- •Long-term outcome is promising (mean 3.8 years follow-up), though horses were managed for breeding/pasture only, not athletic work
- •Requires extended post-operative care including prolonged hospitalization (mean 82 days), casting, and corrective farriery; consider this resource demand before surgery
Key Findings
- •All 4 horses with chronic septic DDF tendonitis/tenosynovitis refractory to conventional therapy achieved comfortable ambulation at pasture after intrathecal tenectomy
- •Mean follow-up of 3.8 years (range >1.5 to 5.25 years) with all horses functional as broodmares
- •Procedure involved surgical removal of intrathecal DDFT component followed by casting and corrective shoeing
- •Time from initial injury to tenectomy ranged 10–210 days with mean post-operative hospitalization of 82 days