Progressive Deep Digital Flexor Tendon Injury Evaluated with Standing CT

Patient: 11-year-old Hanoverian gelding
Primary Complaint: Chronic right front lameness (initially 3/5 in 2021)

Background

The gelding first presented in 2021 with a shifting forelimb lameness pattern. Diagnostic nerve blocks localized the source to the palmar digital region, prompting MRI evaluation. The MRI revealed an extensive DDFT tear from P2 to the tendon’s insertion, with minimal findings in the left front.

After a full year of rest, a follow-up MRI in 2022 showed both progression of the primary DDFT lesion and the development of a new tear in the mid‑pastern region. Despite ongoing rehabilitation efforts and intermittent management with PRP and bisphosphonate therapy, the gelding continued to show mild to moderate lameness over the next several years.

2025 Clinical Deterioration

By 2025, the horse again presented with a more pronounced 3/5 right front lameness. A standing fan‑beam CT scan was performed to evaluate disease progression.

CT Findings

The CT exam demonstrated:

  • Moderately progressive DDFT tearing now originating at mid-P1, extending to the distal navicular bone

  • A full-thickness parasagittal suprasesamoidean tear

  • Evidence of advancing soft tissue distortion and core lesion development

Clinical Significance

This case underscores the diagnostic value of standing fan‑beam CT for:

  • Monitoring progression in horses with chronic or recurrent lameness

  • Providing high‑resolution evaluation of soft tissue structures within the hoof capsule

  • Serving as a practical recheck modality following low‑field MRI

  • Offering a primary diagnostic option when MRI access or patient suitability is limited

david ergun