INFLAMMATION OF THE FLEXOR TENDONS. 
575 
Zschokke describes a case in the horse, in which the sesamoid 
ligaments were ossified. Boloff found the flexor perforatus changed 
into cartilage. In these thickenings has been found filaria cincinata, 
which has also been discovered in the subcutis of horses. 
“Knuckling over” may either be brought about by shortening of 
tendons, in consequence of their cicatricial contraction, or of contraction 
of muscles. In the first case, only the lower joints take up the position of 
volar flexion; when muscles are involved, the knee-joint is also bowed 
over. All cicatricial tissue, whether in tendons or elsewhere, is inclined 
to shrink, but excessive contraction is only seen when the limb is rested 
and entirely relieved of weight. Fig. 211, which is from a photograph, 
shows to what extent shrinkage may occur. If weight is placed on the 
limb, even occasionally, it never becomes so excessive. After contrac¬ 
tion the fibres of the tendons no longer run in a straight direction, but 
take a tortuous course. 
On account of the peculiar character of the pathological processes, 
tendinitis varies greatly in course and results. Complete resorption 
of inflammatory products occurs in eight to fourteen days when the 
case is favourable, and when rest and early careful treatment are 
adopted, but in most instances some thickening remains. Though 
lameness usually disappears in three to four weeks, the newly-formed 
tissue has not the strength of normal tendon, and a point of less 
resistance results, which explains the frequent relapses. Continuous 
severe pain points to serious local change, and often causes “knuckling 
over”; the prognosis therefore depends chiefly on the degree of pain. 
The results of strains of the flexor tendons depend very largely on the 
region involved; the most serious being those which affect the flexor per- 
forans and its check ligament, in which complete resolution is rare. Next 
comes the suspensory ligament. Inflammation of the flexor perforatus 
is less troublesome. The animal’s usefulness is not impaired, even 
though considerable thickening remains. Needless to to say, the older 
the condition the less the chance of recovery; when lameness is of old 
standing the outlook is bad. The condition is still graver when both 
limbs are affected. In hacks, prognosis is less favourable than in light 
van-horses. When the joints are much shot-over, tenotomy is some¬ 
times successful, but this depends on whether the flexor tendons are 
adherent to one another or to their lower sheaths. Adhesion of the 
flexor perforans to the perforatus is always troublesome, though cure is 
not entirely out of the question. Tendinitis occurring during infectious 
diseases is more obstinate than inflammation mechanically produced in 
otherwise sound animals. Great pain and resistance to treatment point 
to an infectious origin, though such swellings occasionally disappear 
after twelve to twenty-four hours, when the sheath of the tendon is only 
