Tenosynovitis Tenosynovitis is defined as inflammation or synovitis of the tendon . A tendon sheath surrounds a tendon as it crosses over a bone or a joint. It is similar to a joint capsule as the lining secretes a synovial like fluid for lubrication and nutrition of both the sheath and the tendon it surrounds. This lubrication allows the tendons to glide smoothly over the underlying bone. Tenosynovitis can be caused by direct trauma or repeated micro-trauma. Acute tenosynovitis can be classified as when the tenosynovitis occurs alone. This can be the result of a strain or inflammation of the sheath. tenosynovitis occurs as a result of another condition. Commonly it will be associated with a tendonitis, strain or annular ligament . Septic tenosynovitis results due to a bacterial infection from a wound or unsterile injection. Chronic tenosynovitis can result from an untreated acute case or result from repeated strain of the tendon sheath that stretches and fills continually. Inflammation of the sheath results in fluid accumulation or effusion within the tendon sheath. If the effusion persists, the tendon sheath may become which remains filled with fluid. In chronic cases, fibrin will leak into the sheath causing adhesions to form between the sheath and tendon. Fibrosis will result in restriction of the tendon.
Anatomical predispositions for tenosynovitis is the dorsal carpus, palmar/plantar fetlock and dorso-plantar hock.
Signs and symptoms include a well-defined, soft, fluid filled swelling. In acute there maybe heat, pain on palpation and mild lameness. In chronic cases fibrosis and adhesions can be seen & felt. Cases of septic tenosynovitis will result in severe lameness, heat, pain, swelling that may involve the entire limb, cellulitis and systemic signs of fever, depression and anorexia.
Diagnosis involves case history, signs & symptoms and ultrasound. For septic tenosynovitis, analysis of the fluid for bacterial culture is necessary.
Treatment for primary tenosynovitis involves stall rest with hand walking, support bandaging and NSAIDs. of fluid can improve the cosmetic look but effusion often returns with work. Injections of corticosteroids or hyaluronic acid can be used to reduce inflammation and prevent adhesion formation. For secondary tenosynovitis, treat the primary condition. For septic tenosynovitis draining and flushing of the sheath is necessary with antibiotics and symptomatic treatment (Rest, bandaging, NSAIDs). Prognosis for acute cases with no tendon damage and prompt treatment is excellent. If the condition is not managed well or the horse returns to work too soon it may become chronic. In many chronic cases the effusion is only a concern, so long as no adhesions have formed. For septic tenosynovitis, return to athletic work is guarded.
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