CARPAL TENOTOMY 199 



the bones will favor an early recurrence of the trouble. The 

 operation of tenotomy is, therefore, not highly recom- 

 mended for "congenital knee-sprung." 



The principal indication is "acquired knee-sprung," a 

 deformity due to inflammation of some part of the carpal 

 articulation. It may be an osteitis, synovitis or tendo-syno- 

 vitis. The former, by producing obstructing, encroaching 

 exostoses, is the most common causative disease. The lat- 

 ter, that is inflammation of the extensive synovial apparatus 

 behind the carpus (the carpal sheath), is, however, very 

 frequently the seat of the responsible lesion. These painful 

 inflammations cause the knee to be held flexed, and thus 

 relax the flexor muscles, which in turn shorten to compen- 

 sate for the changed relations. The change in the muscle is 

 a shortening without a morbid entity. The whole structure 

 is too short, not the tendon alone. It is, indeed, quite prob- 

 able that it is the fleshy parts of the muscles that shorten, 

 owing to their natural tendency to maintain a certain state 

 of tension. 



This condition affects chiefly the aged and the hard- 

 worked horse. It accentuates with'hard, arduous work, and 

 improves somewhat with rest and palliative treatments, but 

 the deformity is never entirely cured, except by tenotomy. 

 The young horse that has had only nominal work may some- 

 times become badly knee-sprung, when predisposed to the 

 deformity by the congenital form. That is to say, a horse 

 thus deformed from birth, when worked even judiciously^ and 

 in the absence of any serious carpal disease, may develop an 

 accentuated variety of the deformity. 



The ideal indication for the operation is the "knee- 

 sprung" case that is accompanied with no appreciable 

 structural obstruction, such as exostoses, contracted binding 

 ligaments, etc., but is deformed because of a sub-acute in- 

 flammation that causes the joint to be held forward. Under 

 such favorable circumstances the divisions of the flexor ten- 

 dons, blisters, firing and rest will very often bring a highly 

 flattering result. The permanency of the cure will depend 

 upon the success in curing the causative inflammation. When 

 this is not cured, the deformity will recur, but if aborted, the 

 cure is permanent. 



An inimical circumstance in many cases is the low value 

 of the horse, clue to its age and general state of decrepitude. 

 Very frequently the knee-sprung horse is an old subject, 

 probably suffering from other locomotory defects and gen- 

 eral senile debility. This low value, together with the long 



