A Case Study in Flexor Tendon Sheath Problems

Inflammation from repetitive trauma of the flexor tendon sheath can result in a career-threatening problem. This month, I would like to take you through the clinical signs, diagnosis and treatment of this condition with accompanying photos to help describe the problem.

This photo shows the classic distention of the tendon sheath when you’re likely to have clinical problems (lameness or impaired performance). This horse had some relative distention for close to two years before the condition flared to this state.

Ultrasound is a critical diagnostic test used to reveal the extent of the condition, which then dictates the type of treatment indicated. The ultrasound image of the affected structures revealed extensive scarring (adhesions) between the flexor tendons and surrounding sheath. Therefore, it was decided to surgically clean up these structures with use of an arthroscope to visualize and access the tissues to be worked on. (Dr. Dave Bogenrief at work here.)

This horse was anesthetized and prepared for the surgery. The arthroscopic camera (about the size of a No. 2 lead pencil) was then introduced into the sheath, and the lesions were projected onto the monitor screen. A second small incision allows the instrumentation to access the lesions and do the desired job.

Post-surgical care involves heavy protective bandaging for two reasons. The first is to help prevent infection of the surgical sites. Just as importantly, the bandaging helps prevent excessive swelling that tends to occur in the lower limbs. After the surgery, stall rest with hand walking to help prevent recurrence of the adhesions i in order. This horse will be given several months of rest and rehab before being brought back to athletic endeavors.

Editor’s Note: Every story is personal to me, and this one especially so since that horse on the operating table is the one my son Lane heads, heels and hazes on. His name is Hammer and, naturally, he’s the best one we own. Though his future in the arena isn’t yet known, I’d like to send my sincere thanks to my dad (Dr. Santos) and Dr. Dave Bogenrief for doing everything humanly possible to extend a great horse’s rodeo career. I am deeply grateful, as is Lane. – Kendra

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