Woods Thomas David Chisholm, Dixon Jonathon, Fraser Barny Simon Lovat, Melvaine Chris
School of Veterinary Medicine, Murdoch University, Murdoch, Western Australia, Australia.
Rainbow Equine Hospital, Rainbow Farm, Old Malton, Yorkshire, UK.
Vet Radiol Ultrasound. 2025 Mar;66(2):e70019. doi: 10.1111/vru.70019.
Exploratory tenoscopy is considered the gold standard technique to identify intrathecal pathology of the equine carpal flexor tendon sheath (CFTS). Preoperative diagnosis allows for more precise prognostication and surgical planning, potentially associated with improved surgical outcomes. This prospective, descriptive, anatomical study aimed to describe the anatomy of the equine CFTS using noncontrast and contrast CT in clinically normal cadaver limbs. Ten pairs of equine forelimbs free of gross external abnormalities were examined from mid-antebrachium to distal metacarpus. Specimens initially underwent noncontrast CT examination using 135 kVp, dynamic mAs, and 1 mm slice thickness. Contrast media (iohexol) diluted in saline (total 60 mL, final concentration 75 mg/mL) was injected into the CFTS from a lateral approach before the CT examination was repeated. Tenoscopy was then performed using the conventional lateral approach. Dissection was used to compare the gross, tenoscopic, and imaging findings. The combined noncontrast CT and contrast CT examinations provided excellent anatomical detail of intrathecal and extrathecal structures. Detailed anatomy of the previously undescribed proximal mesotenon and manica of the common mesotenon were also identified. The distal termination of the CFTS was beyond the mid-metacarpus in most specimens, which is significantly more distal than previously reported. This is an important consideration when administering local anesthesia in orthopedic examinations to prevent potential iatrogenic CFTS penetration, which may induce sepsis if the aseptic technique is not followed. Noncontrast and contrast CT can be used to accurately identify CFTS anatomy. Documentation of new intrathecal structures provides a greater understanding of CFTS anatomy.
探索性腱鞘镜检查被认为是识别马腕部屈肌腱鞘（CFTS）鞘内病变的金标准技术。术前诊断有助于进行更精确的预后评估和手术规划，这可能与改善手术效果相关。这项前瞻性、描述性、解剖学研究旨在使用非增强和增强CT描述临床正常尸体肢体中马CFTS的解剖结构。对十对无明显外部异常的马前肢从前臂中部至掌骨远端进行检查。标本最初使用135 kVp、动态毫安秒和1毫米层厚进行非增强CT检查。在重复CT检查之前，通过外侧入路将稀释于盐水中的造影剂（碘海醇，总量60 mL，最终浓度75 mg/mL）注入CFTS。然后采用传统外侧入路进行腱鞘镜检查。通过解剖来比较大体、腱鞘镜和影像学检查结果。非增强CT和增强CT联合检查提供了鞘内和鞘外结构出色的解剖细节。还确定了之前未描述的近端系膜和总系膜的腱鞘膜的详细解剖结构。在大多数标本中，CFTS的远端终止位置超过掌骨中部，这比之前报道的位置明显更靠远端。这是在骨科检查中进行局部麻醉时的一个重要考虑因素，以防止潜在的医源性CFTS穿透，如果不遵循无菌技术，可能会导致败血症。非增强和增强CT可用于准确识别CFTS的解剖结构。记录新的鞘内结构有助于更深入地了解CFTS的解剖结构。
