An anatomical and histological study of the equine proximal manica flexoria.

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The main aim was to describe the gross and histological appearance of the equine manica flexoria and to identify any differences between the forelimbs and hindlimbs. An additional aim was to relate the findings to diagnostic and surgical anatomy of the manica flexoria.


Measurements of the manica flexoria were made on cadaveric limbs from horses free from pathology within the digital flexor tendon sheath. Histological sections, stained with haematoxylin and eosin and alcian- periodic acid schiff, were evaluated based on three micro-anatomical zones from dorsal to palmar or plantar. The prevalent tenocyte morphology, number, and distribution of blood vessels and nerves were described in each zone. Forelimb and hindlimb measurements were compared using a Students T-test.


Proximally, the manica flexoria attaches to the digital flexor tendon sheath via a reflection of areolar tissue. The fibrous manica flexoria is longer in the forelimb (32.0 ± 4.2 mm) than the hindlimb (29.4 ± 3.8 mm) (p = 0.04), with the areolar portion longer in the hindlimb (22.9 ± 5.3 mm) compared to the forelimb (16.7 ± 4.3 mm) limb (p = 0.0005). Histologically, degenerate blood vessels were prevalent in the palmar/plantar regions and were associated with chondrocyte-like tenocytes, indicative of fibrocartilagenous metaplasia.


The study has provided a detailed anatomical description of the manica flexoria relevant for interpretation of diagnostic and surgical evaluation. Fibrocartilaginous metaplasia occurs on the palmar/plantar surfaces of the manica flexoria.

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