Management of Intra-synovial Tendinopathies Current State of Knowledge and Methods of Treatment

Aetiology
Common clinical features contrast with extrathecal injuries: intrasynovial injuries appear not to be related to speed (and presumably high strain and strain rate), with racing breeds underrepresented. there is much lower bilateral affliction, suggestive of a lesser role of preceding degeneration. peripheral rather than central location of injuries, and high incidence in compressive (vs tensile) regions are suggestive of a different mecha- nism of injury. Structural and mechanical features logically are contributory.

Clinical features
Common presenting signs include lameness, synovial distension and variable heat and pain on palpation. Current state of knowledge comes from observations from clinical case series. the anatomic regions most commonly affected are the digital flexor tendon sheath (DftS) and navicular bursa (nB). other less commonl locations include the car- pal extensor sheaths, tarsal sheath of the lateral digital flexor tendon, bicipital bursa, calcaneal bursa, and long digital extensor sheath. the deep digital flexor tendon (DDft) is more commonly injured than the superficial digital flexor tendon (SDft), although the manica flexoria is frequently injured within the DftS.

Diagnostic imaging
Ultrasonography is currently most useful for assessment. Common non-specific features include sheath wall and mesotenon thickening, and intra-synovial deposits of echo- genic debris. identification of the primary lesion is often possible, although diagnostic accuracy is commensurate to experience of the imager. Critical evaluation of lesion predictability lesions is confined to the DftS; for tears of the DDft, ppVs of 71% and 90% and npVs of 55% and 37% have been reported 1,2. [...]