Modified tenoscopic method for carpal flexor retinaculum release in a horse.
Authors: Byron Christopher R, Benson Britany M, Karlin William M, Stewart Allison A
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Modified Tenoscopic Carpal Retinaculum Release Carpal canal syndrome, typically resulting from inflammation or trauma within the carpal flexor sheath, can severely compromise performance and welfare; this case report describes a refinement to the standard surgical approach for managing the condition via endoscopic retinaculum release. A 4-year-old Thoroughbred with carpal canal syndrome secondary to suppurative tenosynovitis underwent tenoscopic surgery using an unconventional portal configuration—a proximolateral endoscope portal combined with a distolateral instrument portal—rather than the traditional dual proximolateral approach, allowing simultaneous visualisation and instrumentation whilst minimising optical and mechanical interference. The horse achieved complete resolution of carpal sheath effusion and lameness, returning to racing within 14 months, with no iatrogenic damage to neurovascular structures or other complications attributable to the distolateral portal placement. The distolateral instrument portal offers particular advantages for accessing the distal carpal sheath compartment and manipulating instruments in tight anatomical spaces, potentially improving surgical precision and reducing operative time. For practitioners managing carpal canal syndrome, this modified technique represents a valuable addition to the surgical toolkit, particularly when distal sheath pathology requires instrument access that the traditional approach may compromise.
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Practical Takeaways
- •Distolateral instrument portal is a viable alternative approach for carpal sheath surgery when distal retinaculum access is needed, with lower risk of instrument interference
- •Tenoscopic carpal retinaculum release can be successful for treating carpal canal syndrome secondary to tenosynovitis, with good functional recovery for athletic use
- •This modified portal placement may improve surgical ergonomics and visualization during distal carpal sheath procedures
Key Findings
- •Distolateral instrument portal for carpal retinaculum release proved safe with no iatrogenic neurovascular damage in one Thoroughbred
- •Modified tenoscopic approach resolved lameness and carpal sheath effusion, allowing return to racing 14 months post-operatively
- •Distolateral portal reduced endoscope-instrument interference and improved access to distal carpal sheath compared to standard proximolateral approach