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HorseAdvice.com » Diseases of Horses » Lameness » Treatment Methods » Rehabilitating Injuries to the Tendons and Ligaments »

	Discussion on Severed long extensor tendon
Author	Message
Member: Presario	Posted on Monday, Apr 21, 2003 - 9:00 pm: I saw one of these a couple of years ago and thought "Gosh, I hope that never happens to my horse", but here it is My 5yo Oldenburg severed his right hind long extensor tendon, running in the mud, slipping, hitting a fence :\ I'm not asking for a diagnosis (already have that) or a prognosis (you can't see him), but just want to hear similar stories, what you've done, what the horse was like before and if he went back to that level of performance after, etc. This just breaks my heart - I've been soooo careful with him, and then this. Even my vet was upset about this whole thing as she knows how much I love him, what high hopes I had (and still have) for him, and the level of care I have always tried to give him from the day I got him at 5 months old. sniff
Moderator: DrO	Posted on Tuesday, Apr 22, 2003 - 6:19 am: This is a condition that is a pretty easy diagnosis from just the description: a deep cut across the front of the cannon and now the toe does not extend. Take heart Jordana, assumming no other injuries the prognosis for your horse to recover 100% is good to excellent. I will see if I can put up an article in the next few days...I think I have one started somewhere. DrO
Member: Presario	Posted on Tuesday, Apr 22, 2003 - 7:36 am: Thanks DrO, you have greatly lifted my spirits this morning! :-D I know you don't give a "good to excellent" prognosis without seeing the horse often. There are indeed no other injuries (well, none other than some skinned places), and his toe actually extends quite well - the lateral extensor tendon was unharmed. He is walking normally on 1gm bute a.m. and p.m. though in the mornings I find him a bit stiff. Here's something my vet was a little unsure of - the entire tendon wasn't cut, but the little shred that was left, on the lateral side, was very stretched out, sort of like you see a pull in a sweater - the loop just pokes out. Because she felt like she could always cut it later if it started dying, or kept wanting to poke out of the drainage hole she left, she just stuffed it back into the leg. She was waiting for a consulting surgeon at NCSU to call her back on that, but she was in surgery and my vet needed to do something, so that's the decision she made. As of yesterday's bandage change - a little over 48 hours after it was first wrapped, this "loop" wasn't showing any signs of poking back out (knock on wood). Any thoughts on that?
Member: Presario	Posted on Tuesday, Apr 22, 2003 - 10:04 pm: Just thought I'd let you all know that I found it amusing tonight when Rio was able to scratch his right ear with his right hind leg, the injured one. He can't be that bad off right? ;) On another note - When my vet wrapped his leg Saturday, she wrapped from his heel bulbs to above the wound. The entire wrap stayed put for 48 hours, but the lower part slid above his heel and bunched a little at the back of his pastern. She didn't like that, so when she came and rewrapped yesterday (I wanted her to come so she could see how it was doing this soon) she didn't go so low. This morning the entire wrap had slid down GRRRR I rewrapped just like she had, and tonight the entire thing had slid down again - double GRRRR. We have been using cotton sheeting, 4 layers, with about 1.5 tubes of vetrap. The barn manager theorized that it was sliding down because it didn't have enough to support it from the bottom. I suppose I could believe that combined with what seems to me a slightly slick (as in no grabby pills/nicks/fibers such as with a no-bow or similar) cotton wrap. Is that a possibility? I wrapped tonight a little lower, hoping to use the top of his heel as sort of a stopping point. I am in the process of washing/bleaching my pillow quilts and no-bows, which the vet said I could use with a track bandage, in case I find tomorrow morning that it's slipped again. Any tips to help this out?
Member: Gjungle	Posted on Tuesday, Apr 22, 2003 - 11:55 pm: Jordana - Dr. O is right - prognosis is quite good. My then 9yo TB severed his at his left hock last summer. It was pretty nasty, about 6" wide and almost to the bone. I posted pics here - try doing a search for "anterior hock laceration". The only way we could keep a bandage up was to wrap the lower leg in a standing bandage, then use gamgee & vetrap around the wound (amongst other types of bandages also). And I hear ya about the amount of bandaging...I figured that it was costing about $20 a bandage change (each day). Yikes! But he's made a complete recovery, with no trace of the injury, save for a ugly scar. Doesn't bother him=doesn't bother me . Hope this helps...
Moderator: DrO	Posted on Wednesday, Apr 23, 2003 - 4:10 am: I have trouble getting a bandage tight enough with just vet wrap over cotton. See � Equine Diseases � First Aid � Bandaging Horses for our suggestions on bandaging the lower legs. Though I know you do not want to hear this I would be treating the wound daily, other than that sounds like you are doing fine.
Member: Dartanyn	Posted on Thursday, Apr 24, 2003 - 7:03 pm: My 9 year old Arabian tangled with electrical fencing and "lost", his extensor tendon on his back left leg. Bandaged daily, quilts or cloth diapers were used to pad over the top of the dressed wound, and everything was held in place with standing wraps that were "tabbed" under the last roll of diaper/quilting and "tensioned" to hold in place. Never slipped on me! Tensioning takes a feel, but the padding underneath allows a forgiveness to prevent any tendon injury problems. Healed up 100%, minor scarring occurred because I was chicken to really scrub the wound as I have since learned from more severe leg wounds - makes all the difference! Hope this little bit helps; you're probably already getting a feel for bandaging by now anyway! Dawn
Member: Presario	Posted on Friday, Apr 25, 2003 - 12:02 pm: Thanks Dawn for sharing that I have wrapped Rio's legs with nobows and track wraps many times, left him overnight, and never had any problem slipping. I don't know if the problem was him stomping (stinging? ticking? itching?) or the moisture from the wound making it slide down. We have now added a layer of Kling gauze under the vetwrap, overlapping by 50%, in the hopes of making the wrap stiffer and less likely to bunch/slide/whatever-the-heck-it's-doing, and so far knock knock on wood that seems to be working - has been on for nearly 24 hours now :-D Unfortunately the skin flap has started pulling away from the stitches My vet removed about 1/2 the staples, mainly in the area it was coming loose, but left the stitches. She told me to expect the flap to have come completely off when I re-wrap tomorrow :\ DrO - I found reference to the Specialist Cast Bandage - if I run into a slippage problem again, is this something (assuming I can find a source for it) that could be used in this case? Is it's purpose to "stick" to the skin so slippage is reduced, or does it "stick" to the bandage on top of it?
Member: Dartanyn	Posted on Friday, Apr 25, 2003 - 5:37 pm: I guess that's why I mention the quilt or diaper padding; I have no-bows too, but they are just enough slicker to slide or move slightly if the horse does any aggressive leg work while you're not around. Even when I used the no-bows, I was using them over the top and tabbed under a cotton quilt or diaper to prevent slippage. Also, the stitches pulled apart on my Arabian's injury too. Left with a gapping wound that had to be scrubbed down and cleaned daily until filled in level with proud flesh. Worth the effort, however, so keep up the aggressiveness on it - it'll pay off in the long run. Went down to every other day on cleaning and re-bandaging at about 3-4 weeks. Here's hoping the best outcome for you! Hang in there! Dawn
Moderator: DrO	Posted on Saturday, Apr 26, 2003 - 8:33 am: Jordana, I am not familiar with Specialist Cast Bandage. When push comes to shove Elastikon will usually stay up but it is an expensive bandage. Since the problemis on the cannon why not just apply good standing wraps. Of course the wound should first be medicated and a dressing placed over it. You should be able to get good support and protection economically. DrO
Member: Presario	Posted on Sunday, Apr 27, 2003 - 10:29 pm: But Dr O, it's in YOUR article! ;) It's listed under Padding in the Bandaging Horses section. I was just curious about it. We seem to have a handle on the slipping by adding a layer of very overlapping Kling gauze - over the cotton (or nobow) and under the vetrap. The gauze is overlapped by about 50%, and the vetrap by about 75%. This has seemed to make thing stiff enough to keep the whole thing from slipping. It was a disheartening bandage change though, for me. But it was as my vet expected, as she told me when I called her in a panic Saturday evening :\ With all the skin flap having died, and pulled away from the stitches, and granulation tissue starting and bleeding at the stomp of his foot and it all just bulging out :\ I was really just a bit freaked out Saturday. I will be asking my vet tomorrow when I talk to her again, but what might be a reasonable time frame to think this might start looking better instead of worse? It's been 8 days. I am in no way expecting to unwrap one day and have it magically improved drastically, but I need something to look forward to, just so I know whether I'm looking at another week, 2 weeks, a month, whatever. I don't care how much rehab I have to go through with him - icing, hand walking, massaging, whatever it takes, but PLEASE let me get him through this wound healing, it's scaring me to death!
Moderator: DrO	Posted on Monday, Apr 28, 2003 - 5:53 am: You are misreading this Jordana, it is not the Specialist Cast Bandage the article is discussing but the SCB PADDING that it is recommending. It has wonderful handling qualities but kind of pricey and don't think it is likely to help you situation. How large is the wound and would a picture be possible? DrO
Member: Presario	Posted on Monday, Apr 28, 2003 - 9:21 pm: I don't have a picture, yet. I didn't have my camera on D-day, and actually didn't remember it until today. As of today, there is a great deal of proud flesh. DANG that stuff can come on in a hurry! It wasn't there Saturday, or was there but underneath what I could see, and this morning's unveiling showed it was bulging out about the size of 1/2 a golf ball :\ We have started using Panalog to try to get at the proud flesh. In talking to another vet today, just by chance, he swears by a scarlet oil mix (not sure what the other part of the mix is) for taking care of proud flesh quickly and efficiently. Have you heard of anything like this? The other thing he suggested was hind shoes, set a little forward, to help prevent the fetlock joint from buckling over at some point and delaying healing. I've never seen him do this while he's wrapped, but if he's not paying attention he'll knuckle over a little in between wraps, in the time it takes me to get everything organized again. It would seem to make sense, and again have you heard of this? He is still in good spirits - his neck got quite sore between the time I left him yesterday morning, quietly munching his hay, and last night when I found hay strewn everywhere. He's on 1gm bute twice a day now, and after last night's and this morning's doses he's again able to eat hay off the ground (had a hay net up earlier). We have stopped the gentomycin and continuing with the 13 tabs trimethoprim/smz's twice a day for probably at least another 2 weeks (for a total of 3 weeks). So far (knock on wood!) no diarrhea, but I'm also giving him a good dose of probiotics daily. I did take pics today, but since it's not a digital camera, it will be several days before I get them developed.
Moderator: DrO	Posted on Tuesday, Apr 29, 2003 - 4:13 am: 7 days into this you should not be having proud flesh issues so quickly Jordana. Panalog would not so much be a treatment for it as it would be a preventive. Scarlet oil is a rememdy that has been around for a long time but I have never had an occasion to use it myself so cannot comment. Of course the best preventive and treatment are the ones outlined in our articles. You want to change his shoeing because he rests the foot while changing his wrap? As long as he has normal extensor function, I think I would leave the shoes the same. You have been worrying a little too much about all this that is going to be just fine. DrO
Member: Presario	Posted on Tuesday, Apr 29, 2003 - 3:03 pm: I wish we weren't dealing with excess granulation tissue so soon. Isn't proud flesh just the normal granulation tissue gone haywire? I will see if I can quickly get this roll of film used up. Rio isn't shod and never has been. I don't WANT to put shoes on him, that was just something that was suggested. He walks and stands just fine, even resting the other leg, as well as the injured one, normally. I'd really like to leave well enough alone, but was just curious if you'd heard of this shoeing treatment as prevention or what. And of COURSE I worry about my kidlet! :D
Moderator: DrO	Posted on Tuesday, Apr 29, 2003 - 10:01 pm: Yes, that is what proud flesh we have a article explaining this seem Equine Diseases � Skin Diseases � The Treatment of Proud Flesh or Exuberant Granulation Tissue. In the scientific section is a recent work that strongly suggests unbandaged (but well treated) wounds form less proud flesh. I think swelling reduction and protection during the first week more critical but if you have a good bed of granulation tissue to prevent infection and the swelling under control ... you might try it. DrO
Member: Gjungle	Posted on Tuesday, Apr 29, 2003 - 10:33 pm: Jordana, FYI - I'm not sure the extent of your horse's injury (depth/length/width of the cut), but my gelding's cut took almost 4 months to completely scab over. It didn't start to look "good" for at least a month and a half. I was on constant proud flesh & infection lookout, but as long as you keep it clean, you should be ok. Once it looks like it's starting to close, leave it to the open air & sunshine. Oh and my vet suggested using Schreiner's Herbal Spray -worked like magic to keep the proud flesh down (and out for the count), plus it keeps flies away!
Member: Presario	Posted on Tuesday, Apr 29, 2003 - 10:41 pm: Interesting about the unbandaged wounds forming less/no pf. We are still keeping this wrapped because there is still the exposed tendon, though not nearly as much due to the pf :\ As of tonight's re-wrap, the pf looks to be somewhat reduced. I'm changing daily now so will quickly see if it's diminishing or gaining ground. I will certainly be talking to my vet about when we might be able to leave it unwrapped, at least during the day when he doesn't (or is less likely to) lay down, and possibly wrap again for the night. Liz - the entire wound is about 2" x 2" almost directly on the front of the cannon bone. It severed the tendon and went a little deeper, but did not damage the bone itself. I have come to expect 4-5-6 months before it's not a "wound" anymore, so I guess it's comforting to hear your 4 months! What did your gelding do - was his tendon severed?
Moderator: DrO	Posted on Wednesday, Apr 30, 2003 - 6:27 am: I think there must be confusion here Jordana: if you still have exposed tendon, then excessive granulation tissue is forming...where? YOu are right as long as the wound is not completely granulated in, it should not be left open. Shreiners Herbal Spray gets the standard cautionary statement: we have no research on the ingredients of this product to indicate a good or bad response. Most likely Liz your good care was 99% responsible for the outcome and the Spray may have not get in the way though 4 months is a long time to scab over. DrO
Member: Presario	Posted on Wednesday, Apr 30, 2003 - 11:46 am: I know it's confusing - a picture would really help I know! There is excess granulation tissue on the lower part of the wound, attached to the skin. There is excess forming over the tendon, but still a small piece of tendon exposed. I have another question that I could not readily find the answer to - I am having trouble keeping the gauze in place over the wound, even when the bandage is not slipping - I unwrap it and the gauze has slid down. I would like to put a piece of tape (surgical? not sure what it's called, it's the white stuff that sticks but not like, say, duct tape) to hold the gauze in place (obviously not wrapped around the leg, but perhaps vertically on each side). Is that safe? I've never done that and certainly don't want to risk binding his leg in any way. I'll ask my vet the same thing if I should talk to her before hearing back from you.
Member: Dartanyn	Posted on Thursday, May 1, 2003 - 5:14 pm: Jordana, maybe I could share just a couple of more items I may have neglected to mention: Soft Kling Gauze worked terrific at holding the pads in place! I highly recommend it, but it was not easy to find - I purchased rolls off my vet as he could get it bulk. Also, I used a watered-down, warm bentodine solution for cleansing the wound before putting triple antibiotic cream over it and then the pads on top (which thankfully stuck on before he'd start messing around some), Kling Gauze over that, then the quilt/diaper layers held in place with standing wraps. Worked terrific, got it down to a 5 minute process almost; and have had practice since with a severed DDF tendon down on the pastern that was much more challenging. Hang in there - this will pay off! Dawn
Member: Gjungle	Posted on Saturday, May 3, 2003 - 9:05 pm: Jordana- my horse tried to jump New Zealand fencing (6') and lost. At least it was a clean cut, but it was about 6-8" in length. He did sever his extensor, but shows not aftereffect now. If you'd like to see the pictures, do a search for "anterior hock laceration" under my name. Dr. 0 - I meant 4 months from time of injury to complete scarring over. It scabbed over I'd say at month 3 or so. But since my horse is pretty hot and liable to open it up whilst cavorting around, he was kept on stall rest until it completely healed.
Member: Presario	Posted on Tuesday, May 6, 2003 - 10:05 am: Well, the panalog (actually dermagen, same ingredients though I think) did a great job of getting rid of the proud flesh in about a week So I'm not using that any more and am wrapping every other day now. My vet will hopefully be out Friday to take another look. The roll gauze really did the trick in helping keep the wraps up. I've also been using 2 strips of surgical tape, on the inside and outside of the pad gauze, to keep that in place and that's working great too. Dr O - on another bulletin board where I'm getting more stories and experiences with this injury, someone mentioned that their vet kept the entire leg, from foot to groin, wrapped so there wouldnt' be any movement at all, thereby theoretically (?) allowing for a faster tendon healing. That particular injury was much closer to the fetlock joint - is that the reason? Rio's is about 2/3 the way up his cannon bone. Also, do you know what actually happens to the tendon? Do the 2 sections grow back together as tendon tissue? Or is it all scar tissue? Some of both?
Moderator: DrO	Posted on Tuesday, May 6, 2003 - 6:10 pm: I have never seen a recommendation for immobility, with a simple extensor tendon injuries of any location. The ends are reattached by scar tissue that forms from the granulation tissue that spans the two ends. DrO
Member: Presario	Posted on Tuesday, May 6, 2003 - 8:28 pm: Thanks for the answers. One more question (for now), bear with me! ;) I assume that scar tissue of this nature, in general, is less strong than the "real thing", in this case a tendon. If that is correct, is it correct to think that scar tissue that is forming under stress, such as movement, say in a large stall or small pen, is stronger than scar tissue that forms under no stress at all?
Moderator: DrO	Posted on Wednesday, May 7, 2003 - 6:12 am: Yes the fibers in the scar tend to organize along the lines of stress. But it is a balancng act: too much stress and the granulation / early scar tissue repeatedly tears and a knot of scar tissue will form. DrO
Member: Presario	Posted on Sunday, May 18, 2003 - 10:54 pm: I hope I can get these pictures to show up. They aren't the MOST recent, but show a progression. These first pictures show the wound fairly early, in the first week-10 days I believe, before the onset if the initial proud flesh lump (I thought I had pictures of that, but apparently I don't ). Here are 2 more that were taken at about the 3 week mark: and again a little further away: The wound is looking a lot better these days. There is about 1/8"-1/4" new pinkish-purpleish skin around the top and sides of the wound. The second week the proud flesh initiall reared its ugly head, and a week of dermagen got rid of that. After another week of using Nolvasan, the pf came back, though not nearly as quickly or as a bad, so since then I've been using the dermagen. The vertical damage on the left side is now back at skin level, and the granulation tissue over the tendon is nearly back down to skin level. The vet is coming back out tomorrow so I'll see how we proceed from there.
Moderator: DrO	Posted on Monday, May 19, 2003 - 6:19 am: It looks very good Jordana. DrO
Member: Presario	Posted on Friday, May 30, 2003 - 12:48 pm: Thought I'd give an update - 6 weeks tomorrow (my how time flies!). The wound looks sooooo much better these days, but since I don't have a digital camera I must always wait to finish a roll of film before getting the pictures. There is a good amount of new skin growing around the top and sides of the wound, and a teeeeensy bit at the bottom. He has been off the smz's since last Tuesday night, as it was obviously upsetting his tummy and he just didn't want to eat anything, much less his meds. I've continued to use the panalog/dermagen and have been using another concoction sprayed on the wound to help with any infection problem. I am letting him out into an attached pen while I clean his stall and do other chores (Dr O you know the pen ) so he's getting out for 30-45 minutes a day now. I had gotten him up to 10 minutes of grazing out on the GOOD grass (where you walk up to the barn) but that proved a little too much and he developed some diarrhea, so I backed off that for a couple days and started at 5 minutes on it last night. While he is out there, he occasionally gets goofy and will trot high-headed from one end of the pen to another, and he's pretty darn sound. The other day he got some bug up his butt (figuratively) and decided to buck :-O Of course he then realized that hurt a little and settled down. The vet will be coming out this afternoon for another checkup, and I'll ask her this too, but is there any detrimental effects of him trotting around a little? I am of the school/thought that controlled movement is good for healing, but I don't know if the bursts of energy are setting him back or just delaying healing a little. He is quite a good patient still, not tearing up his stall, not developing vices, very content when he's got hay, standing very still while I change his wrap so I have lots to be grateful for
Moderator: DrO	Posted on Saturday, May 31, 2003 - 10:08 am: This should be fine since the tendon was not completely severed. DrO
Member: Presario	Posted on Tuesday, Jun 3, 2003 - 9:08 pm: But is was completely severed Well, ok, there was the little thread left, but it was so stretched out it was just poking out there. The vet stuffed it back in when she stitched it, and we've seen no sign of it since. Does that make it not completely severed? ;) Anyway, thought I'd post a new picture and ask another question. At the bottom of the wound, you see waht still looks like a fresh cut. Ignore the bleeding - it was slight, and I think he stomped his foot or something. Anyway, that part of the wound has some skin folded over into the wound. Needless to say it's not growing any new skin. Have you ever dealt with this? My vet was going to consult with Dr. White in Leesburg to get his advice. She's pretty sure he'll say to cut the fold off and proceed from there. Thoughts? The other 3 sides have about 1/8" new skin. Does that seem about right for 6 weeks? Slow? I think it's a little slow, but maybe it's not.
Moderator: DrO	Posted on Tuesday, Jun 3, 2003 - 11:07 pm: No it does not sound like it was completely severed. If the skin is straightened and bandaged with a bit of pressure it will granulate down and you won't have as big a hole to heal through contraction and migration so your scar will be smaller. I think the wound looks Ok but it is hard to tell about progress as pictures can be misleading due to angle and distance. DrO
Member: Presario	Posted on Monday, Jun 16, 2003 - 4:36 pm: Time for an update Friday the vet was back out and under the recommendation of a consulting vet she cut that piece of skin that was rolled under. Turns out it was a fairly large piece of skin, so this really needed to be done. It was probably about the size of a nickel if you were to make it round So, that is now healing, and I fully expect to see some really speedy recovery now. We're up to about 1/4" new skin growth on the other 3 sides. Starting this weekend I've been told to start taking Rio for hand walks, so yipee! Some more recent pictures tonight I hope.
Member: Presario	Posted on Monday, Jun 16, 2003 - 9:31 pm: Here's a picture from I think 1 weeks ago. The bottom portion, where it looks different, is where the skin was rolled under. That's what got cut off Friday. It's looking really good as of today!
Moderator: DrO	Posted on Tuesday, Jun 17, 2003 - 2:41 am: The wound looks very good Jordana. DrO
Member: Presario	Posted on Monday, Jun 30, 2003 - 11:18 am: Just thought I'd give a little report if anybody cares A couple weeks ago the vet gave us the go-ahead to start hand walking. So I've been doing some of that, and I tell ya, it's hard to keep up with him! He tracks up really really well, like by about 3 hoofs or so, and doesn't seem to move any differently with his boo-boo leg. I've also been turning him out in a small pasture while I'm there so he can keep up with his grass and get some more out-of-stall movement. Only occasionally will he be a snot and act up, so I yell "RIO! You are supposed to WALK!" To which he screeches to a halt, flings his head up, looks at me with wide eyes and I just know he's saying "What! Do you SEE me doing anything? I'm STANDING here!" Good grief... Anyway, weeks ago when he'd fart around like that he'd hobble about for a few/6 strides or so (uh-huh, TOLD you you need to chill out ). Yesterday he did the same thing but when he came back to the trot he was nearly sound and certainly not hobbling on 3 legs So the next time the vet comes out she'll ultrasound so we can see how things look inside. The wound itself is healing really well now that we got that flap cut off
Moderator: DrO	Posted on Monday, Jun 30, 2003 - 6:49 pm: How about a picture Jordana? DrO
Member: Presario	Posted on Monday, Jun 30, 2003 - 9:10 pm: Well if you'd like to loan me your digital camera I could take one and have it asap couldn't I? I'm stuck with the good old fashioned camera and have to wait to finish this roll before getting them developed. I must say though, the skin is closing in a lot faster these days
Member: Presario	Posted on Monday, Jul 7, 2003 - 6:05 pm: sigh if it isn't one thing it's another While the vet is very pleased with the wound healing, she's concerned about some swelling on his fetlock joint. I thought it had always been there, and looked bigger now because the swelling that's been higher up in his leg has been dissipating. She doesn't think so. She thinks that due to the structural change in his leg from the tendon being cut that his fetlock joint is being stressed. Nothing he's consciously doing, just something going on inside. She likened it to a tent - you stake it all up and it's all fine and dandy. Cut one line, and while the tent may stay up, it will tend to lean to one side or another. So, she took a bunch of xrays to see what's going on and put him on 6 shots of Adequan, 1 every 4 days. She'll have xrays back later this week, and will be back next Monday to check again. She's never seen this happen with this type of injury Figures I'd be the first. So Dr O, what's your take on this?
Moderator: DrO	Posted on Monday, Jul 7, 2003 - 8:33 pm: We are back to taking a picture Jordana to see the swelling. Since the horse never lost the ability to extend the foot, I am unsure what the difficulty here might be. What structure does the vet think is changing and in what manner? DrO
Member: Presario	Posted on Monday, Jul 7, 2003 - 9:34 pm: Well of course I forgot my camera this afternoon for when it was unwrapped, but I'll be sure to have it Wednesday when I change the wrap again, and hopefully I'll be close to the end of the roll, so by the weekend you'll get a new picture. The swelling is on the fetlock joint, all the way around, but most prominently at the front. It truly looks like someone stuffed something down the front of his leg right at the joint :\ So if you are looking at his leg from the side, the cannon bone is nice and smooth, and where the fetlock joint normally "bumps" out a little bit, it "bumps" out a lot. The vet thinks there might be swelling due to excess stress on the joint, perhaps because the tendon does not support the joint like is used to (and hopefully will again!), perhaps because of something else, she's just not sure.
Moderator: DrO	Posted on Tuesday, Jul 8, 2003 - 6:34 am: Sounds like swelling and inflammation around the extensor tendon at the level of the fetlock. The question is why now? Is he still occasionally stubbing his toe on the ground? The extensor tendon does not support the joint: it wants to move the joint, the surrounding ligaments and opposing tendons help stabalize the joint. DrO
Member: Presario	Posted on Tuesday, Jul 8, 2003 - 9:09 am: Nope, he doesn't stub his toe or knuckle over any more - hasn't for quite a while.
Member: Proctor	Posted on Saturday, Jul 19, 2003 - 10:48 am: Dr. O, I have been treating an injury of this nature (much worse, degloving of dorsal cannon with severing of both extensor tendons) for the past 6 weeks. The mare is coming along very well, and with a full granulation bed, I would normally stop bandaging at this point to reduce proud flesh buildup. However, if I remove the bandage on this mare, within 5 minutes she is chewing (picture a dog gnawing a bone) on the wound aggressively. I obviously could use a neck collar or just continue bandaging, but was wondering if you had heard of this problem, and if so, know of any reasons for this behavior.
Member: Lilo	Posted on Saturday, Jul 19, 2003 - 12:16 pm: Jennifer, Earlier this year my mare had pigeon fever, with the abscess at the top and front of one of her front legs. Poor place to bandage - she messed with it for about two weeks - kept pulling the scabs off with her mouth. I was thinking what kind of contraption I could come up with (short of a neck collar) when it finally started healing up and closing up. I found it strange - figured that the taste of blood must be awful to a horse. Maybe Dr O knows a reason. Lilo
Moderator: DrO	Posted on Monday, Jul 21, 2003 - 6:20 am: Certainly the most common reason is probably the wound itches or hurts stimulating the oral mutulation. There is a device called a "cradle" that is specifically made to prevent this. You will find them in some horse catalogs like Nasco and Valley Vet for less than 20 dollars. DrO
Member: Presario	Posted on Thursday, Aug 21, 2003 - 12:51 pm: Time for an update but once again no pictures :\ Anyway, the fetlock swelling is still not resolved. I am going to request an ultrasound in the next couple of weeks. However, the swelling has gone done a little bit, particularly side to side. He has had 5 shots of Adequan, first 4 were every 4 days, the 5th was 2 weeks after the last, and the next one will be 1 month after that one. I have also started him on Cosequin as a "can't hurt, might help" thing this past weekend. After having him on a turnout schedule of 1 hour twice a day, unwrapped for about an hour a day, I sort of by accident ended up talking to another vet in Georgia who has dealt with lots of leg injuries, including this kind. His thoughts were that under saddle work should have started a while ago, once the wound itself was well on its way to healing and the tendon was fairly well healed, and would slowly work up to w/t/c for 45-60 minutes before starting any turnout. The thought being that by the time they are ridden that much they aren't as likely to do stupid stuff in the pasture and undo lots of healing. When I told him that Rio was fully capable of galloping from one end of the pasture to the other, bucking, rearing, all that fun horsie stuff, and come up about a 1 to 1.5 grade lameness at the trot, he fully thought he should start under saddle again. So, last Saturday we started with 5 minutes walking for 4 days, did 6 minutes yesterday, and 10 today. My plan is to add 5 minutes every 5th day. Probably a bit conservative, but that's ok. At 60 minutes of walking I'll come back to 15 minutes and add trotting, working back up to 45-60 minutes. Then back down and add canter, and work back up. How does that sound? I have been trying to wean him off being wrapped but short of starting with having him unwrapped while turned out, which I wasn't too keen to do, I gave up the weaning process and started leaving hm unwrapped all night (in his stall, but access to a small pen as well). This has lead to some swelling in the entire lower leg, which I pretty much expected. After his short morning ride, and wrapped all day in turnout the swelling is down about 75%. I feel certain that as this routine continues there will be less swelling in the mornings, but... To my real question, finally ;) From this description, can you tell if this swelling is more of the stocking up variety and as he gets used to be unwrapped will dimish? Or is it swelling due to something else that is doing more harm than good at this point? I am trying to balance between what is best for his recovery and what is best for my sanity. I just cannot end up going back to wrap him for the night at midnight or later which is what it was going to come to. I sure hope you can put my mind at ease at least on this!
Moderator: DrO	Posted on Monday, Aug 25, 2003 - 7:00 am: Hello Jordana, To the degree that the swelling resolves with exercise you have regular stocking up. DrO
Member: Presario	Posted on Monday, Sep 8, 2003 - 10:30 pm: Well, the vet did an ultrasound today and took more xrays. The first set of xrays were taken with poor power in the barn, so were no good. I should have the results later this week. I actually do have a picture now of the swelling, but haven't scanned it yet :\ Anyway, the diagnosis is villonodular capsulitis. The u/s showed nothing earth shattering, just some thickened joint capsule and some fluid. The swelling is not squishy, but fairly firm. The vet feels like it's gotten bigger since she last saw it, but I don't really think so. But, since I see it every day, I could be totally wrong. We did agree that when viewed from the front the swelling looked reduced from side to side. So, I'm off to research this and see what possible resolutions, if any, exist.
Moderator: DrO	Posted on Tuesday, Sep 9, 2003 - 9:47 am: Bummer Jordana, but it is consistant with the appearance you describe above. What do you feel was the initiating cause of the capsulitis? I really don't think instablity from a partial severance of an extensor tendon is likely. Trauma around the time of the appearance of the swelling seems more likely to me. Since the problem has not yet resulted in remarkable proliferation of tissue, I would consider starting with a injection or two of hyaluronic acid and steroids, some very careful pressure bandaging, and stall rest. But we have specific information at � Equine Diseases � Lameness � Diseases of the Lower Limb � Overview of Fetlock (Ankle) Lameness. DrO
Member: Presario	Posted on Friday, Sep 12, 2003 - 10:30 am: Just FYI - my vet reviewed the xrays and can see where the joint capsule has been torn. I have not seen them so don't know the size of the tear. She said it is impossible to know if he tore it when he fell during the initial injury, or if, as he started to feel better and move around more, perhaps even during one of his leapings around as I was hand walking him, he knuckled over to such a degree that he tore it. I am quite depressed about this She is sending the xrays to Dr White in Leesburg (do you know him?) for his opinion. She definitely wants to continue Legend shots for a while, and is leaning towards dmso applied to the joint (mixed with azium? I don't know, that is just my speculation, nothing she said). I'll be asking her about injecting the joint too. Pressure bandaging, which continued for at least a month after the swelling was first noticed, seemed to have no affect on it. After this weekend he and the other 2 horses will be forced to be confined to a much smaller pasture, and I suppose it is possible that he may be confined to his stall and a pen about 3 times his stall size. Just thought I'd keep you updated.
Moderator: DrO	Posted on Saturday, Sep 13, 2003 - 10:02 am: Yes, Dr Nathaniel White taught me equine surgery and was a constant presence during internal medicine rounds. A very bright man. It was he that really got me looking at the localization of hind limb lameness when it became obvious one day that even very experienced clinicians miss the lame rear leg. We have information on DMSO/dex combinations: it does deliver the medication into the joint, but I have to admit for me this is a pretty clear indication for intrarticular Depo (betamethasone for the faint of heart) in combination with Legend. Let us know what they say and how it works out. DrO
Member: Presario	Posted on Monday, Sep 15, 2003 - 4:40 pm: Thought I'd post a front and side view of the offending fetlock :\ I realize in the front view picture the wound still looks pretty ugly, but it's really not. I had some goop on it to keep the last little area, about the size of 1/2 a dime, moist, and the hair has not grown back yet, and it was a little dirty, so... The swollen joint is 15" in circumference, the healthy joint is 13".
Moderator: DrO	Posted on Tuesday, Sep 16, 2003 - 8:16 am: Good photo and it does look like the fetlock joint capsule and not enlargment of the extensor tendon. DrO
Member: Presario	Posted on Wednesday, Oct 1, 2003 - 11:45 am: 2 weeks ago I put Rio back on restricted turnout (his stall and a small pen) and wrapped his leg. After the first night, the swelling was reduced by an entire inch. In the time since then, it has gone down in 2 almost-1/4" increments, so now it is down nearly 1 1/2" total. My vet is supposed to be investigating whether shock wave therapy and/or theraputic ultrasound would be beneficial for him. I don't know when she will take new xrays and/or do another ultrasound to see where healing is (or isn't) going. I am pretty certain Rio is doing nearly as much walking as he was in the bigger (though still small, roughly 1 acre or less) pasture, so I can only assume that the wrapping is largely responsible for the reduction in swelling. I have not let his wrap off long enough in these 2 weeks to see if the swelling increases again. He is SO bored in his confinement! But fortunately he is a sane gentleman and is handling it calmly.
Moderator: DrO	Posted on Thursday, Oct 2, 2003 - 6:25 am: Glad to here things are looking a bit better Jordana. Shock wave does not make sense to me and from what is published its use would be experimental. There may be some use to the US if some of the troubles have become chronic: on the othe hand it may induce some acute inflammation, causing increase swelling. Still no specific intraarticular treatment? DrO
Member: Presario	Posted on Monday, Oct 6, 2003 - 3:06 pm: Can you take another update? Vet saw him today for a 3rd Legend shot. The swelling is now at 13 1/4", down from the worst of 15". There is minor heat still. He is still sound. The prescription is at least 2 more months of restricted turnout, and then we'll see about taking the wrap off and seeing what happens. She also indicated that ESWT probably isn't warranted, nor is the u/s. Still no specific intraarticular treatment - she was very hesitant to do anything like that since the initial wound was not far away- something about a greatly increased risk of infection, or something like that. So, I guess I'll post back in a couple of months on any progress, or lack thereof!
Moderator: DrO	Posted on Tuesday, Oct 7, 2003 - 6:20 am: If she worries about septic arthritis secondary to injection how about DMSO/cortisone paints?. DrO
Member: Presario	Posted on Tuesday, Dec 9, 2003 - 12:38 pm: I thought I would dredge this up for an update. It's been 3 months since the xrays confirmed the torn joint capsule. The radiographs didn't actually show the capsule torn, but showed some calcification where the capsule joins the pastern bone. 2.5 months of "stall rest", which entailed a 12x20-ish stall and a roughly 30x60 (?) attached pen during the day, and locked in his stall at night. I moved him and my other horse to the back neighbors (actually good friends of yours Dr O! ) 3 weeks ago. Attempts to keep Rio in a round pen for "confinement", or a temporarily fenced off small section of pasture were disastrous, as he either went round and round, or raced the temp pen, looking for his new-found friends rolling eyes So, he went into a paddock - less than 1 acre, maybe 3/4 or so, I guess - where he has been much calmer - walking and eating. Anyway, to make a long story short, after talking to my vet again we decided to see what leaving the wrap off overnight would do. I accidentally left it off for a few hours this past Thursday after I brought him in from the freezing rain, and the leg was no worse for the wear. During the last 2.5 weeks he's been in the pasture, the fetlock showed no increased swelling or heat, and remained wrapped. I took the wrap off Friday night around 10pm, and Saturday morning at around 9 am the leg was swollen all the way to the hock. Now here is where I'm looking for some guesstimates and/or opinions, or anything: I am fairly certain the swelling above the fetlock was due to "normal" stocking up from being wrapped for so long, then suddenly unwrapped and in the stall. But I'm not so certain about the fetlock swelling - it was back to nearly what it looked like in the last picture I posted. 24 hours later, after wrapping it back up and putting him back in the pasture, it was back down to it's current "normal" state which it slightly larger than the other fetlock, and the cannon bone area swelling is gone again. Is there something I can wrap with that isn't as much as a nobow (a thin one at that) and a standing wrap to possibly wean him off the wrap? My choices right now (without getting up in the middle of the night to un/wrap) are 1) no wrap from 10pm-7am 2) turn him out for an hour in the morning with no wrap 3) turn him out in the morning without the wrap and go home at lunch and put it back on 4) take his wrap off some X hours between the time I get home and when I put them up - this could be anywhere from 1-5 hours or so. I realize we're just playing "try something and see what happens" game right now, but it was so frustrating and disappointing to see his leg like that again Saturday morning. I am inclined to try #2 or #3 above, thinking that the movement of being out and walking will help offset some of the effects of being unwrapped, but it does leave him open to stupid moments of racing around unwrapped. I must add that Saturday afternoon he decided to train to be a racehorse and GALLOPED around his small pasture for a good 15-20 minutes, both directions, both leads, screeching to a halt, careening back the other way, and draining the blood from my face I'm sure. He seems to show no ill effects from that escapade. Sorry this got so long, but I know how you love details! ;)
Member: Presario	Posted on Tuesday, Dec 9, 2003 - 4:09 pm: Ok, just spoke with my vet. Her thoughts are to leave him wrapped for another month and try again, and to try to leave it unwrapped for an hour to a few hours at a time to start with, while he is turned out. She also suggests possibly taking him to the vet school for the digital xrays and the super ultrasound machine they have to see what more can be seen. As I am pretty sure insurance will cover that I am inclined to do it. It has been 8 months total, if you assume this particular problem was caused with with the initial injury. Does that seem reasonable, or unreasonably long, for recovery from a torn joint capsule?
Moderator: DrO	Posted on Tuesday, Dec 9, 2003 - 8:39 pm: A bit long. For a reasonable prognosis you will need a thorough reexam of the fetlock, including radiographs and ultrasound. The fetlock has a unusual response to chronic inflammation: the synovial line proliferates and distends the fetlock joint capsule, see � Equine Diseases � Lameness � Diseases of the Lower Limb � Overview of Fetlock (Ankle) Lameness for more on this. I am wondering if this has happened and it may change the therapy. DrO
Member: Presario	Posted on Wednesday, Jan 21, 2004 - 1:55 pm: Time for another update! Great news! I took Rio to the Marion duPont Scott Equine Medical Center on Monday for a Tuesday appt with Dr. Nathaniel White. I must say Rio was a real trooper. He went from 7 hours in the trailer, straight to his stall, where he spent from 5pm Monday to 10:30 am Tuesday. At 10:30 his tech got him out to jog him. The temps were in the low 20's with wind chills around 0. He jogged down and back on a concrete aisle with nary a head flip, I was so proud of him! Anyway... After watching him jog soundly, after xrays, after ultrasound, Dr. White pronounces him all healed and ready to go back to work to get the tendon and the fetlock joint strong again :D:D:D He attributes the prolonged and pronounced swelling (if left unwrapped) to a combination of (to a lesser degree) having become dependent on the wraps and to(to a larger degree) some damage to the lymphatic (sp?) system which is causing a "clogging" of blood/fluid flow in and out of the leg. His scar turns purple after about 1.5 hours out of the wraps, which he says indicates and area where the blood is being prevented from easily traveling around. So... He wants the leg unwrapped for about an hour before riding, ride unwrapped, and leave off as long as swelling doesn't start getting out of control again. The goal obviously is to increase that time until he no longer needs the wraps. He says it could take as long as 6 months before Rio's body finds some sort of equilibrium, and that his leg may always be prone to stocking up/swelling under certain circumstances. Interestingly, the calcification that my vet found on xrays in Sept is nearly gone - only the smallest spot remains. Dr. White didn't have an explanation for what happened to it - do you? Anyway, I hope this is the end of my reports on this thread except to come back and say how well he is doing in the hunter world :D
Moderator: DrO	Posted on Thursday, Jan 22, 2004 - 10:26 am: No I really don't, calcification is an end stage result of inflammation. Delighted to hear it has worked out Jordana. DrO
Member: Presario	Posted on Friday, Jul 16, 2004 - 11:58 am: I thought I would wrap this up and hopefully get it bumped back into "current" discussions since there are now 2 other posters with this same problem. I started Rio back to work FINALLY, for real, the first week in May. Things were delayed a bit - when I was on him in Feb to get his walking rehab going, he spooked and did sort of a wheelie, smashing his withers just right into my hand, breaking my hand - a "boxer's break" at the 5th metatarsal. Anyway, between that, the cast, the rehab of ME, and putting my fencing up to get the boys home, May it was. Anyway, we spent 2 months progressing up to a fairly normal w/t/c routine. Every day I measured is fetlock before and after each ride,and a couple times a week measured where the tendon was severed as well. There was no change at all, except for perhaps a small reduction in circumference AFTER the ride. 2 weeks ago we started jumping again Hopefully this picture will upload... The first couple of days we jumped, even these little fences, I iced his leg just to be sure. The scar is still there and it's "lumpy" and probably always will be, but that's ok. The fetlock also seems to have settled into it's final stage of "bigness" - from the front and back you don't really notice anything unusual unless you really look, but from the side you can still see the protrusion on the front. The only issues I've seen so far is that if I DON'T ride him for 2 days, the fetlock swells a little more, but comes right back down to its new "normal" after the ride. He is out 24x7, so it's not simply a matter of standing around. I will try to get one last picture of his leg so you can see where it has found its comfort zone. My vet says she wishes it were smaller, and of course so do I! But I can live with a cosmetic imperfection if it means he will be sound.
Moderator: DrO	Posted on Sunday, Jul 18, 2004 - 8:50 am: Super Jordana, DrO

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