Which is the best imaging modality to diagnose a manica flexoria tear?

The manica flexoria (MF) is an extension of the medial and lateral borders of the superficial digital flexor tendon (SDFT) that forms a sleeve around the deep digital flexor tendon (DDFT), within the digital flexor tendon sheath (DFTS), just proximal to the metacarpo/metatarsophalangeal joint. Tears of the MF have been described associated with cases of nonseptic tenosynovitis presenting with lameness, with ponies and cobs being over-represented. Ultrasonography and contrast tenography are the predominant imaging modalities used to diagnose tears of the MF, with tenoscopic evaluation still serving as the gold standard. However, the sensitivity and specificity of additional techniques such as contrast computed tomographic tenography and MRI are now being investigated as other modalities that could be of value to identify MF tears. Additional techniques have been described to combine with traditional ultrasonography, with the aim to improve the sensitivity of identifying MF tears, such as dynamic extension/flexion techniques and saline injections of the DFTS. The overall aim of this paper was to review current evidence to determine the best noninvasive diagnostic imaging modality, with a high sensitivity and specificity, to more accurately diagnose MF tears and aid more thorough surgical planning.