Summary A 6‐year‐old Highland pony gelding was presented with severe left fore (LF) limb lameness of acute onset. The lameness occurred concomitantly with mild digital flexor tendon sheath (DFTS) effusion and focal painful swelling on the lateral aspect of the LF fetlock region. Clinical examination and diagnostic analgesia localised the lameness to the fetlock region and on ultrasound, a cyst‐like structure filled with anaechoic fluid was detected just proximal to the lateral sesamoid bone, at the proximo‐lateral aspect of the DFTS and adjacent to the lateral neurovascular bundle. Communication between the cyst‐like structure and the DFTS was suspected ultrasonographically and then confirmed with contrast tenography. Tenoscopic examination of the LF DFTS was performed and the communication between the fluid‐filled structure and the synovial cavity was detected. The defect in the DFTS wall was enlarged tenoscopically and the lining of the cyst‐like structure was debrided. The horse recovered well post‐operatively and was back in work with no evident lameness 8 months after surgery. This alternative minimally invasive surgical treatment had an excellent outcome and has the advantage of reducing the risk associated with en bloc resection.
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