A simple swelling can hide a multitude of sins

A windgall or swelling in the tendon sheath bursa if left, can cause fibrous tissue to build up.

This results in the annular ligament causing pressure on the superficial and deep digital flexor tendons. The swelling can look very innocent but it can be hiding a nightmare underneath. 

Fortunately if caught early, physiotherapy can avoid surgery.

Treatment such as longwave ultrasound is excellent for helping to reduce oedema and therefore assist in avoiding fibrin being laid down, which sticks the annular ligament to the tendon sheath. 

Controlled walking is also key in the rehabilitation of these injuries, as walking slides the tendons over each other and the controlled exercise keeps the structures working correctly.


The pictures above show a case two weeks post surgery, to cut the annular ligament in order to release the tendons. 

Sadly a lesion had been caused in the deep digital flexor tendon.  Therefore rehabilitation was aimed at healing the lesion and preventing scar tissue forming around the surgery site.

Good quality tissue repair is vital to reduce the likelihood of injury recurrence in the future.


The pictures above show the results from four weeks in-patient at my rehabilitation centre.

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