title: The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology.
abstract: BACKGROUND
  The sensitivity of ultrasonography for the diagnosis of manica flexoria (MF) tears within the digital flexor tendon sheath (DFTS) is lower than for diagnosis of marginal tears of the deep digital flexor tendon (DDFT). Additional diagnostic tools would assist in appropriate decision making for either conservative or surgical management.
  
  
  OBJECTIVE
  To evaluate the improvement in lameness of horses with MF or DDFT tears following intrathecal analgesia and to assess the sensitivity and specificity of contrast radiography for the diagnosis of these tears.
  
  
  METHODS
  The case records of horses presented to a referral clinic over a 7-year period that underwent intrathecal diagnostic analgesia, or intrathecal analgesia and contrast radiography, of the DFTS with subsequent tenoscopy were examined.
  
  
  RESULTS
  Fifty-three limbs had intrathecal diagnostic analgesia performed and 23 contrast tenograms were assessed in horses undergoing DFTS tenoscopy. Horses with DDFT tears were significantly more likely to respond positively to intrathecal diagnostic analgesia than those with MF tears (P = 0.02). Using contrast radiography, tears of the MF were predicted with an overall sensitivity of 96% and specificity of 80%; marginal tears of the DDFT were predicted with an overall sensitivity of 57% and specificity of 84%.
  
  
  CONCLUSIONS
  The results of intrathecal analgesia of the DFTS in combination with contrast radiography have a high sensitivity for predicting MF tears. The sensitivity of contrast radiography for predicting tears of the DDFT is lower but the specificity remains high.
  
  
  CONCLUSIONS
  Contrast radiography performed at the same time as intrathecal analgesia provides useful information regarding the presence of MF tears and DDFT tears, which can assist in the decision of whether to manage the lameness conservatively or with tenoscopic evaluation.
authors.affiliation: Equine Referral Hospital, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK. afiskejackson@rvc.ac.uk
authors.forename: A R
authors.initials: AR
authors.lastname: Fiske-Jackson
authors.forename: W H J
authors.initials: WH
authors.lastname: Barker
authors.forename: E
authors.initials: E
authors.lastname: Eliashar
authors.forename: K
authors.initials: K
authors.lastname: Foy
authors.forename: R K W
authors.initials: RK
authors.lastname: Smith
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D000818:Animals; D003287:Contrast Media / Q000494:pharmacology; D003974:Diatrizoate Meglumine / Q000494:pharmacology*; D005260:Female; D006734:Horse Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006736:Horses; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage / Q000494:pharmacology*; D011859:Radiography; D013708:Tendon Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000662:veterinary*
chemical_list: D000779:Anesthetics, Local; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D008619:Mepivacaine