equis - Articles
MCP / MTP joint: flexural deformity
Introduction
- Common condition of growing horses in which the joint is held in an abnormally flexed position Musculoskeletal: flexural deformity.
- Called “contracted tendons” which implies a defect in the tendon itself but this is incorrect in light of the proposed pathogenesis – this term should consequently be avoided.
- Affects soft tissue structures and occurs in the sagittal plane.
- Cause: relative shortening of the musculotendinous unit.
- Signs: flexural deformity Musculoskeletal: flexural deformity:
- Congenital: present at birth.
- Acquired: develops during the growing phase.
- Metacarpophalangeal joint more commonly affected than metatarsophalangeal joint in the acquired form but vice versa in the congenital presentation.
- Diagnosis: physical examination.
- Treatment: farriery, analgesics, controlled exercise, external coaptations, IV oxytetracycline/tetracycline Therapeutics: tetracyclines. Surgery may be warranted in chronic or severe cases.
- Prognosis: good to poor depending on the degree of deformity, presentation and response to treatment.
Print off the factsheet on Flexural limb deformities to give to your clients.
Presenting signs
- Flexural deformity of the fetlock joint/s. Other deformities may be present elsewhere in the limb/s.
Acute presentation
- Can present at birth as a congenital defect.
Age predisposition
- Congenital: present at birth.
- Acquired: during the first 18 months – period of rapid growth. Acquired fetlock deformities in foals between birth and weaning are less common than those noted post weaning, when substantial and rapid growth occurs between 4 and 18 months of age (varies between breeds and with different management and feeding regimens).
Breed/species predisposition
- Possibly more common in rapidly growing breeds.
Cost considerations
- Cost of treatment.
- Loss of use of animal.
Pathogenesis
Etiology
Proposed etiopathogenesis
- Congenital:
- Uterine malpositioning.
- Abnormal development of fetus in mare due to:
- Exposure to teratogens.
- Dominant gene mutation.
- Disease state or malnutrition in mare such as an influenza outbreak Equine influenza.
- Neuromuscular disorder.
- Majority of causes unknown.
- Acquired:
- Multifactoral and complex but several theories have been proposed:
- A mismatch in bone and tendon/ligament growth associated with periods of rapid and excess growth. Overnutrition, incorrect nutrition including trace element or mineral imbalances, and genetics may play a part.
- Contraction of the musculotendinous unit in response to pain in the affected leg decreasing normal weightbearing over a prolonged period. Pain can be related to physitis or other developmental orthopedic diseases in the young growing foal or yearling.
- In the older developing animal and adult, the flexural deformity may also occur secondary to long term injury and subsequent disuse/weightbearing of the affected limb.
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- Multifactoral and complex but several theories have been proposed:
- Described in adult horses secondary to desmitis of the ALDDFT Accessory ligament DDFT: forelimb – desmitis.
Pathophysiology
- Shortening of the musculotendinous unit:
- Although traditionally associated with the superficial digital flexor tendon (SDFT), flexural deformity of the fetlock joint often involves a number of tendons and associated ligaments.
- Congenital deformities of the fetlock have been noted alongside carpal, and more commonly, distal interphalangeal flexural deformities.
Diagnosis
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Treatment
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Caldwell F J (2017) Flexural deformity of the distal interphalangeal joint. Vet Clin North Am Equine Pract 33 (2), 315-330 PubMed.
- Gaughan E M (2017) Flexural limb deformities of the carpus and fetlock in foals. Vet Clin North Am Equine Pract 33 (2), 331-342 PubMed.
- O’Grady S E (2017) Routine trimming and therapeutic farriery in foals. Vet Clin North Am Equine Pract 33 (2), 267-288 PubMed.
- Levine D G (2015) The normal and abnormal equine neonatal musculoskeletal system. Vet Clin North Am Equine Pract 31 (3), 601-613 PubMed.
- Kidd J A & Barr A R S (2002) Flexural deformities in foals. Equine Vet Educ 14, 311-321 VetMedResource.
- Kidd J A (2002) A new method of splinting a congenital metatarsophalangeal flexural deformity in a foal. Equine Vet Educ 14, 308-310 WileyOnline.
- Adams S B et al (1999) Management of flexural limb deformities in young horses. Equine Pract 21 (2), 9-15 VetMedResource.
- McDiarmid A (1999) Acquired flexural deformity of the metacarpophalangeal joint in five horses associated with tendonous damage in the palmar metacarpus. Vet Rec 144, 475-478 PubMed.
- Lokai M D (1992) Case selection for medical management of congenital flexural deformities in foals. Equine Pract 14 (4), 23-25 VetMedResource.