Nonseptic tenosynovitis of the digital flexor tendon sheath caused by longitudinal tears in the digital flexor tendons: a retrospective study of 135 tenoscopic procedures.
Authors: Arensburg L, Wilderjans H, Simon O, Dewulf J, Boussauw B
Journal: Equine veterinary journal
Summary
# Editorial Summary: Longitudinal tears in the digital flexor tendons as a cause of chronic tenosynovitis Longitudinal tears of the digital flexor tendons represent a significant but poorly understood pathology underlying chronic tenosynovitis of the digital flexor tendon sheath (DFTS), accounting for 78% of nonseptic cases in this retrospective analysis of 135 tenoscopic procedures across 130 horses treated between 1999 and 2009. The tears predominantly affected the deep digital flexor tendon (79%) along its lateral border (87%), with showjumpers showing a marked predilection for forelimb involvement—particularly the right front (76% of forelimb cases)—suggesting that discipline-specific loading patterns may influence injury aetiology. Preoperative ultrasonography successfully identified 76% of tears, though tenoscopy remains the gold standard for diagnosis and treatment; critically, only 38% of horses returned to equal or higher levels of work post-operatively, with persistence of marked post-operative DFTS distension emerging as a strong negative prognostic indicator. The use of radiofrequency ablation (coblation) during tenoscopic debridement paradoxically worsened outcomes and cosmetic results, suggesting this technique offers no advantage over conventional arthroscopic methods in managing these lesions. Given the guarded prognosis and variable return-to-function rates, clinicians should counsel owners conservatively and consider the discipline-specific risks when counselling on case selection and realistic post-operative expectations.
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Practical Takeaways
- •Expect a guarded prognosis when treating longitudinal tears of digital flexor tendons; less than 40% return to previous performance level
- •Avoid coblation/radiofrequency probe treatment for DFTS lesions due to negative effects on long-term soundness and tissue appearance
- •Persistent post-operative distension of the DFTS is a poor prognostic indicator; focus on managing sheath inflammation as part of treatment strategy
Key Findings
- •78% of horses with chronic nonseptic DFTS tenosynovitis had longitudinal tears of the digital flexor tendons
- •79% of tears involved the deep digital flexor tendon and 87% were located on the lateral tendon border
- •Only 38% of horses returned to an equal or higher level of work after tenoscopic treatment
- •Radiofrequency probe (coblation) use was associated with lower performance levels and poor cosmetic outcomes