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Ultrasonographic Imaging the Flexor Tendons in a Clinical Context
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Indications for ultrasonographic evaluation of the digital flexor tendons
1) Diagnosis - while most digital flexor tendon injuries are easily detectable by palpation, palpation provides a poor objective assessment of the severity. A base-line scan, often performed 7-10 days after injury because injuries can worsen initially, can provide an assessment of severity that may relate to prognosis.
2) Management – follow-up ultrasonographic examinations (ideally every 2-3 monthly) are used to optimise management decisions during the rehabilitation phase.
Review of ultrasonographic technique (see also ‘Ultrasound in the diagnosis of lameness’)
The limb should ideally be prepared by clipping and washing (with surgical scrub followed by surgical spirit) to facilitate the best quality images. The horse should be standing square and both transverse and longitudinal images obtained in a methodical fashion from the palmar aspect throughout the metacarpal and/or pastern regions. BOTH limbs should be examined as many cases of strain-induced tendon injury have bilateral components.
There is no standardised technique but a system of seven levels or zones is recommended, each of which has characteristic anatomical features. The palmar/plantar pastern region is also divided into 3-5 levels or zones. The distal two zones correspond to the more distal position that can sometimes be achieved with a small footprint transducer, although a more distal examination can be achieved with caudal limb position which hyperextends the DIP joint. At least one longitudinal level is usually achievable with a linear transducer depending on the relative size of transducer and pastern. Easier access can be achieved by raising the foot on a block. Because a number of structures pass obliquely across the first phalanx oblique 45° views should be used to perform a complete examination. [...]
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