Septic tenosynovitis secondary to porcupine quills in a horse: case report

Digital flexor tendon sheath (DFTS) tenosynovitis represents one of the most prevalent tendon sheath disorders observed in horses. Its occurrence as a consequence of accidents involving porcupines is relatively uncommon, as are the specific diagnostic and therapeutic modalities employed in its management. This paper aims to report the case of a mare who had sustained multiple puncture wounds in the distal region of the hind limb, resulting in septic tenosynovitis of the DFTS due to an accident with a porcupine. Seven days following the incident, the mare was referred to an equine hospital, exhibiting grade 4/5 lameness (American Association of Equine Practitioners [AAEP] scale) and effusion in the DFTS region. The ultrasound examination revealed a hyperechoic line within the DFTS, identified as a porcupine quill, while contrast tenography corroborated for the diagnosis of a synovial fistula. The quills were surgically removed via tenoscopy. Postoperative antibiotic therapy was conducted via systemic administration, intravenous regional limb perfusion, and intrasynovial medication into the DFTS. Following 18 days of treatment, the mare exhibited no indications of inflammation or infection within the tendon sheath. Consequently, she was discharged to resume her rehabilitation at the property. The ultrasonography and tenography played crucial roles in substantiating the involvement of the tendon sheath and identifying the presence of the quills. This facilitates the expeditious implementation of tenoscopic therapy and the removal of the quills, thereby enabling efficacious treatment and enhancing the prognosis. This report contributes new information and images, which are useful for the diagnostic and treatment approach.