CASE REPORT SUPERFICIAL DIGITAL FLEXOR TENDON INJURY IN THE DOG M. A. BERNARD Introduction Soft tissue injuries other than penetrating wounds to the tibial tarsal area of the dog are seldom seen in our practice. Five cases of hind leg lameness are presented because of the differential diagnoses involved. An extensive literature search was not carried out.
owner reported normal use of the leg in August, 1976.
Case III - A four and one half year old, female Collie was presented March 27, 1974 for a possible right stifle ligament injury of three weeks duration. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed on palpation and there was a fluid filled bursa over the tuber calcis. Surgical correction was done on March 29, 1974 and the dog would bear full weight on the leg when a support splint was removed April 18, 1974.
History Case I - A three year old, spayed, female terrier was presented as a referral June 20, 1973 with suspected right anterior cruciate ligament damage. Physical and radiographic examination of the pelvis and stifles revealed no abnormality. Flexion of the right tibialtarsal joint caused lateral luxation of the "cap" of the superficial digital flexor tendon where it passed over the tuber calcis. There was no evidence of pain but the dog would not bear weight on the leg. A fluid filled bursa could be palpated over the tuber calcis. Surgical repair as described below was carried out July 24, 1973. A modified Sir Robert-Jones splint was applied for three weeks after the surgery. The dog walked normally on the leg when the splint and skin sutures were removed on August 3, 1973. June 17, 1974 the dog was presented for a similar problem with the left leg. Surgical repair and recovery were uneventful. The right leg was clinically normal on examination and the owner described the gait as being normal. Case II - A fifteen month old, female, Shetland Collie was presented on November 20, 1973 for annual booster vaccinations and the complaint of a left hind leg lameness of ten days duration. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed on physical examination. Radiographs revealed no skeletal abnormalities and the surgical repair was carried out on November 28, 1973. A support splint was applied until January 4, 1974. The joint was initially stiff, but the owner reported normal use ten days later. The
Case IV - A two year old, female, Shetland Collie was presented on April 10, 1974 for a right hind leg lameness of two days duration. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed on palpation, however, in this case there was minimal evidence of a bursitis. Surgical repair was carried out and no external support was applied. Ten days later the dog was using the leg normally. Case V - A four year old male, Shetland Collie was presented on September 8, 1976 for a right hind leg lameness of two weeks duration. The owner pointed out the obvious bursitis at the hock. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed upon palpation. Surgical repair was carried out September 9, 1976 and a modified Robert-Jones splint was used for ten days after surgery. Normal use of the leg was reported by the owner oine week after the splint was removed.
Anatomy the tendon of the superficial digital flexor winds medially around the tendon of the gastrocnemius muscle to gain its caudal surface. On the tuber calcis it broadens like a cap and inserts collaterally in the tuber calcis, united with the crural fascia and the calcanean tendon of the biceps femoris and semitendinosus. ... underneath the tendon on the tuber calcis and extending proximally and distally
'Alta Vista Animal Hospital, 1814 Bank Street, Ottawa, Ontario KIV 7Y6.
05
CAN. VET. JOUR., vol. 18, no. 4, April, 1977
CANADIAN VETERINARY JOURNAL
B
FIGURE 1. Surgical repair of torn superficial digital flexor tendon insertion.
from the tuber, there is an extensive synovial bursa, the bursa calcanei (1)." It is the medial insertion of the tendon on the medial aspect of the tuber calcis which is involved in each case (Figure 1A).
applied in four of the five cases (2). Rolled cotton padding, gauze, Orthoplast3 and elastic bandage was used to immobilize the leg from the stifle to the metatarsal area. Restricted exercise was recommended for two to three
weeks.
Surgical Repair The site was clipped, prepared and draped prior to surgery. A skin incision was made on the posterior surface of the hock extending 2-3 cm proximally and distally from the tip of the tuber calcis. The skin and underlying fascia are bluntly reflected to expose the injured area of the band which inserts on the medial aspect of the tuber calcis. In the six cases observed, the bursa calcanei wall was markedly thickened with granulation tissue at the site of the injury. The amount of granulation tissue and bursa distention was variable. The bursa was opened with an incision through the granulation tissue and all the granulation tissue was surgically debrided (Figures 1B and IC). The bursa was flushed with saline to remove fibrin or blood clots. Three or four simple interrupted sutures of a monofilament nylon' were placed with a bite in the edge of the torn band and bursa and a bite taken in the deep fascia down to the periosteum over the tuber calcis. The sutures were tightened to maintain the cap of the superficial digital flexor tendon over the tip of the tuber calcis and to close the defect in the bursa. In Case IV, chromic gut 002 was used with equally good results (Figure 1D). The skin was closed with vertical mattress sutures and a modified Robert-Jones splint was
Discussion
The etiology is unknown, but is assumed to be traumatic. With flexion and rotation it is possible that the "band" attachment to the tuber calcis would tear as part of a "sprain" of the hock. Why the tears occurred on the medial aspect of the tuber calcis was not obvious upon comparison of the medial and lateral bands. Possibly the injuries occurred when the dogs were turning on the later affected leg which would place maximum tension on the medial attachment. Obesity in Cases I and III may have been a significant factor. Clinical diagnosis is not difficult, but it must be differentiated from or considered in addition to other causes of hind leg lameness. Surgical correction is relatively easy and gives good postoperative results. There is some persistent thickening of the bursa and the nylon sutures are palpable, but this has not bothered the dogs to date. Follow-up checks on two dogs were done at one year and 30 months with excellent results and normal use of the leg. The necessity or duration of postoperative immobilization is open to debate. An approximate period of three weeks has worked well in the five cases discussed and support is more important with obese dogs (Cases I and 30rthoplast, Johnson & Johnson Limited, Montreal, Quebec.
100 Vetafil, S. Jackson Inc., Washington, D.C.
200 Chromic gut, Type C, Davis & Geck.
106
TENDON INJURY
proche chirurgicale et la guerison de cinq chiens qui s'etaient lese le tendon flechisseur digital superficiel. Dans chacun des cas, la lesion consistait en une dechirure de 1'insertion du tendon sur le tuber calcis.
III). Case IV recovered equally as well with no external support. Summary Clinical signs, surgical repair and recovery of five dogs with damage to the superficial digital flexor tendon are described. The damage in each case is a tearing of the insertion of the tendon onto the tuber calcis.
References 1. MILLER, M. E., G. C. CHRISTENSEN and
H. E. EVANS. Anatomy of the Dog. p. 253. Philadelphia: W. B. Saunders Co. 1964. 2. WHITTICK, W. G. Canine Orthopedics. p. 113. Philadelphia: Lea & Febiger. 1974.
Resume L'auteur rapporte les signes cliniques, I'ap-
GAINES VETERINARY AWARD/PRIX VETERINAIRE GAINES To encourage progress in the field of smallanimal medicine and surgery, General Foods Limited, through Gaines Professional Service Centre, has made available the "Gaines Veterinary Award". The award will be made annually to that veterinarian whose work in either clinical research or the basic sciences is judged to have contributed significantly to the advancement of small animal medicine and surgery. The work to be recognized shall have been made known either by publication in recognized veterinary periodicals or presentations at professional meetings. Primary consideration shall be given to work within the preceding five years with secondary consideration given to those individuals still active in the profession, but whose work was from a prior period. Nominations for the 1977 Award may be
made to the CVMA Executive Committee by anyone, no later than April 30, 1977. Each nomination shall include a description of the work done by the one nominated, a statement of how the work has contributed to the advancement of small animal medicine and surgery, a pertinent bibliography (if any), and suitable biographic information. The Award will consist of a gold medallion and a $500 cash award, and will be presented at an appropriate time during the Annual Convention. All communications may be addressed to the undersigned, J. R. Kinney Executive Secretary 360 Bronson Avenue Ottawa, Ontario K1R 6J3
Dans le but d'encourager le progres en m6decine et en chirurgie des petits animaux, la compagnie General Foods Limited, par r'entremise du Centre de Services professionnels Gaines, a institue le "prix veterinaire Gaines". Ce prix sera decerne annuellement 'a un veterinaire dont on aura juge que le travail a contribue eminemment a l'avancement de la medecine et de la chirurgie des petits animaux, soit en recherches cliniques ou soit en recherches fondamentales. La presentation de l'ceuvre a evaluer devra avoir fait l'objet d'une publication dans des revues veterinaires d'envergure ou d'une communication 'a des congres professionnels. On considerera en premier lieu les travaux executes au cours des cinq dernieres annees, bien que, en second lieu, on puisse aussi apprecier les oeuvres anterieures a cette p6riode pour des membres qui demeurent toujours actifs.
Toute personne peut, jusqu'au 30 Avril 1977 au plus tard, presenter des candidats pour le prix de 1977 en s'adressant au Comite executif de I'ACV. Avec chaque recommandation, le proposeur devra soumettre une description des travaux de son candidat. II devra aussi demontrer comment ces travaux ont contribue 'a l'avancement de la medecine et de la chirurgie des petits animaux et soumettre une bibliographie pertinente (s'il en existe) en meme temps qu'une notice biographique. Le prix consistera en un medaillon d'or accompagnant une somme de $500.00. Le tout sera decemer 'a l'occasion du congres annuel. Toute correspondance 'a ce sujet peut etre adressee au soussigne. J. R. Kinney Secretaire executif 360 avenue Bronson Ottawa, Ontario K1R 6J3
107
owner reported normal use of the leg in August, 1976.
Case III - A four and one half year old, female Collie was presented March 27, 1974 for a possible right stifle ligament injury of three weeks duration. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed on palpation and there was a fluid filled bursa over the tuber calcis. Surgical correction was done on March 29, 1974 and the dog would bear full weight on the leg when a support splint was removed April 18, 1974.
History Case I - A three year old, spayed, female terrier was presented as a referral June 20, 1973 with suspected right anterior cruciate ligament damage. Physical and radiographic examination of the pelvis and stifles revealed no abnormality. Flexion of the right tibialtarsal joint caused lateral luxation of the "cap" of the superficial digital flexor tendon where it passed over the tuber calcis. There was no evidence of pain but the dog would not bear weight on the leg. A fluid filled bursa could be palpated over the tuber calcis. Surgical repair as described below was carried out July 24, 1973. A modified Sir Robert-Jones splint was applied for three weeks after the surgery. The dog walked normally on the leg when the splint and skin sutures were removed on August 3, 1973. June 17, 1974 the dog was presented for a similar problem with the left leg. Surgical repair and recovery were uneventful. The right leg was clinically normal on examination and the owner described the gait as being normal. Case II - A fifteen month old, female, Shetland Collie was presented on November 20, 1973 for annual booster vaccinations and the complaint of a left hind leg lameness of ten days duration. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed on physical examination. Radiographs revealed no skeletal abnormalities and the surgical repair was carried out on November 28, 1973. A support splint was applied until January 4, 1974. The joint was initially stiff, but the owner reported normal use ten days later. The
Case IV - A two year old, female, Shetland Collie was presented on April 10, 1974 for a right hind leg lameness of two days duration. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed on palpation, however, in this case there was minimal evidence of a bursitis. Surgical repair was carried out and no external support was applied. Ten days later the dog was using the leg normally. Case V - A four year old male, Shetland Collie was presented on September 8, 1976 for a right hind leg lameness of two weeks duration. The owner pointed out the obvious bursitis at the hock. Lateral luxation of the "cap" of the superficial digital flexor tendon was diagnosed upon palpation. Surgical repair was carried out September 9, 1976 and a modified Robert-Jones splint was used for ten days after surgery. Normal use of the leg was reported by the owner oine week after the splint was removed.
Anatomy the tendon of the superficial digital flexor winds medially around the tendon of the gastrocnemius muscle to gain its caudal surface. On the tuber calcis it broadens like a cap and inserts collaterally in the tuber calcis, united with the crural fascia and the calcanean tendon of the biceps femoris and semitendinosus. ... underneath the tendon on the tuber calcis and extending proximally and distally
'Alta Vista Animal Hospital, 1814 Bank Street, Ottawa, Ontario KIV 7Y6.
05
CAN. VET. JOUR., vol. 18, no. 4, April, 1977
CANADIAN VETERINARY JOURNAL
B
FIGURE 1. Surgical repair of torn superficial digital flexor tendon insertion.
from the tuber, there is an extensive synovial bursa, the bursa calcanei (1)." It is the medial insertion of the tendon on the medial aspect of the tuber calcis which is involved in each case (Figure 1A).
applied in four of the five cases (2). Rolled cotton padding, gauze, Orthoplast3 and elastic bandage was used to immobilize the leg from the stifle to the metatarsal area. Restricted exercise was recommended for two to three
weeks.
Surgical Repair The site was clipped, prepared and draped prior to surgery. A skin incision was made on the posterior surface of the hock extending 2-3 cm proximally and distally from the tip of the tuber calcis. The skin and underlying fascia are bluntly reflected to expose the injured area of the band which inserts on the medial aspect of the tuber calcis. In the six cases observed, the bursa calcanei wall was markedly thickened with granulation tissue at the site of the injury. The amount of granulation tissue and bursa distention was variable. The bursa was opened with an incision through the granulation tissue and all the granulation tissue was surgically debrided (Figures 1B and IC). The bursa was flushed with saline to remove fibrin or blood clots. Three or four simple interrupted sutures of a monofilament nylon' were placed with a bite in the edge of the torn band and bursa and a bite taken in the deep fascia down to the periosteum over the tuber calcis. The sutures were tightened to maintain the cap of the superficial digital flexor tendon over the tip of the tuber calcis and to close the defect in the bursa. In Case IV, chromic gut 002 was used with equally good results (Figure 1D). The skin was closed with vertical mattress sutures and a modified Robert-Jones splint was
Discussion
The etiology is unknown, but is assumed to be traumatic. With flexion and rotation it is possible that the "band" attachment to the tuber calcis would tear as part of a "sprain" of the hock. Why the tears occurred on the medial aspect of the tuber calcis was not obvious upon comparison of the medial and lateral bands. Possibly the injuries occurred when the dogs were turning on the later affected leg which would place maximum tension on the medial attachment. Obesity in Cases I and III may have been a significant factor. Clinical diagnosis is not difficult, but it must be differentiated from or considered in addition to other causes of hind leg lameness. Surgical correction is relatively easy and gives good postoperative results. There is some persistent thickening of the bursa and the nylon sutures are palpable, but this has not bothered the dogs to date. Follow-up checks on two dogs were done at one year and 30 months with excellent results and normal use of the leg. The necessity or duration of postoperative immobilization is open to debate. An approximate period of three weeks has worked well in the five cases discussed and support is more important with obese dogs (Cases I and 30rthoplast, Johnson & Johnson Limited, Montreal, Quebec.
100 Vetafil, S. Jackson Inc., Washington, D.C.
200 Chromic gut, Type C, Davis & Geck.
106
TENDON INJURY
proche chirurgicale et la guerison de cinq chiens qui s'etaient lese le tendon flechisseur digital superficiel. Dans chacun des cas, la lesion consistait en une dechirure de 1'insertion du tendon sur le tuber calcis.
III). Case IV recovered equally as well with no external support. Summary Clinical signs, surgical repair and recovery of five dogs with damage to the superficial digital flexor tendon are described. The damage in each case is a tearing of the insertion of the tendon onto the tuber calcis.
References 1. MILLER, M. E., G. C. CHRISTENSEN and
H. E. EVANS. Anatomy of the Dog. p. 253. Philadelphia: W. B. Saunders Co. 1964. 2. WHITTICK, W. G. Canine Orthopedics. p. 113. Philadelphia: Lea & Febiger. 1974.
Resume L'auteur rapporte les signes cliniques, I'ap-
GAINES VETERINARY AWARD/PRIX VETERINAIRE GAINES To encourage progress in the field of smallanimal medicine and surgery, General Foods Limited, through Gaines Professional Service Centre, has made available the "Gaines Veterinary Award". The award will be made annually to that veterinarian whose work in either clinical research or the basic sciences is judged to have contributed significantly to the advancement of small animal medicine and surgery. The work to be recognized shall have been made known either by publication in recognized veterinary periodicals or presentations at professional meetings. Primary consideration shall be given to work within the preceding five years with secondary consideration given to those individuals still active in the profession, but whose work was from a prior period. Nominations for the 1977 Award may be
made to the CVMA Executive Committee by anyone, no later than April 30, 1977. Each nomination shall include a description of the work done by the one nominated, a statement of how the work has contributed to the advancement of small animal medicine and surgery, a pertinent bibliography (if any), and suitable biographic information. The Award will consist of a gold medallion and a $500 cash award, and will be presented at an appropriate time during the Annual Convention. All communications may be addressed to the undersigned, J. R. Kinney Executive Secretary 360 Bronson Avenue Ottawa, Ontario K1R 6J3
Dans le but d'encourager le progres en m6decine et en chirurgie des petits animaux, la compagnie General Foods Limited, par r'entremise du Centre de Services professionnels Gaines, a institue le "prix veterinaire Gaines". Ce prix sera decerne annuellement 'a un veterinaire dont on aura juge que le travail a contribue eminemment a l'avancement de la medecine et de la chirurgie des petits animaux, soit en recherches cliniques ou soit en recherches fondamentales. La presentation de l'ceuvre a evaluer devra avoir fait l'objet d'une publication dans des revues veterinaires d'envergure ou d'une communication 'a des congres professionnels. On considerera en premier lieu les travaux executes au cours des cinq dernieres annees, bien que, en second lieu, on puisse aussi apprecier les oeuvres anterieures a cette p6riode pour des membres qui demeurent toujours actifs.
Toute personne peut, jusqu'au 30 Avril 1977 au plus tard, presenter des candidats pour le prix de 1977 en s'adressant au Comite executif de I'ACV. Avec chaque recommandation, le proposeur devra soumettre une description des travaux de son candidat. II devra aussi demontrer comment ces travaux ont contribue 'a l'avancement de la medecine et de la chirurgie des petits animaux et soumettre une bibliographie pertinente (s'il en existe) en meme temps qu'une notice biographique. Le prix consistera en un medaillon d'or accompagnant une somme de $500.00. Le tout sera decemer 'a l'occasion du congres annuel. Toute correspondance 'a ce sujet peut etre adressee au soussigne. J. R. Kinney Secretaire executif 360 avenue Bronson Ottawa, Ontario K1R 6J3
107
