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  Discussion on Annular Ligament Constriction
Author Message
New Member:
jimmann

Posted on Sunday, May 27, 2007 - 1:18 pm:

I have a 21 year old appaloosa gelding that has been used for trail riding, cattle penning and some gaming. About six or seven months ago, he began to exhibit signs of lameness in his right front and had some heat and swelling above the fetlock extending up the superficial flexor tendon. The first recommendation was rest but the situation did not improve. We then took some x-rays and found some old scar tissue and the vet advised that there was some degenerative joint disease of the right MCP joint and recommended a very low dose of bute daily to help deal with the inflammation. There was no improvement. We then did some ultrasound and the diagnosis of the chronic swelling of the right front MCP joint.

The report from the ultrasound was "marked effusion MCP joint & effusion distal tendon sheath, medial sesamoid is enlarged. Marked thickening of annular ligament. Annual ligament constriction & degenerative joint disease of right MCP joint. The treatment attempted at that time (10 weeks ago) was draining 12 ml. of fluid and a cortisone injection continuing daily low low doses of bute. There has been no significant improvement.

From reading other discussions, it would appear that the treatment options to date have had very limited likelihood of success. The vet has advised that the surgical option exists but that on a 21 year old horse (even who has been very healthy otherwise, vigorous with a great heart), that this horses future is very limited.

I cannot turn a horse out to pasture that is going to be in pain and lame but it does not make sense to pay expensive boarding fees for a horse that is unable to be ridden.

Do you have any other suggestions and what do you think about the surgery option. From other reports in this discussion area, it appears that surgery has been an effective solution.
Moderator:
DrO

Posted on Sunday, May 27, 2007 - 7:31 pm:

Welcome to Horseadvice Jim,
I am uncertain what the vet meant by the "very limited future". If he means this horse does not have as many useful years as a 5 year old well no one argues that point but maybe the idea of a good chance of buying this horse a few more years is OK with you. But if he may mean the other complications (particularly the DJD) are likely to be performance limiting and therefore the prognosis for the surgery is not as good, this needs to be carefully considered. It would be difficult to differentiate pain from either source as they are so close but I wonder if a flexor sheath block might differentiate pain from the joint and the constriction of the annular ligament. I will have to get into my library for this.

You can pretty much read what I think about the surgery in the article but the real question for me is are you and your vet on the same page with this "very limited future" pronouncement? Once you understand exactly what he is saying you can make a better decision and if you don't like his opinion try a referral to a well respected orthopedic facility.
DrO
New Member:
jimmann

Posted on Sunday, May 27, 2007 - 8:41 pm:

Thank you for your response. Perhaps I did my Vet a disservice in my statement of the prognosis and I do believe we are on the same page. I believe that he, like I, am concerned that with the surgery, that the horse may still not be able to work as a trail riding horse (in any case whether the existing treatment worked or not, I had no more plans for more vigorous work than light trail work (walk, trot and lope) for this horse. Prior to this, based on the nature of this horse, I had expected that he would have had at least five good years left in him on the trail.

I am looking forward to more information on the flexor sheath block. thanks.
Moderator:
DrO

Posted on Thursday, May 31, 2007 - 7:02 pm:

Hello Jim,
I have not forgot you. I have been looking this week for a good reference concerning this point but have not turned it up yet.
DrO
Moderator:
DrO

Posted on Friday, Jun 1, 2007 - 10:15 am:

It is opinion that the digital flexor block does not block the fetlock joint however I cannot find any specific studies for this. The fetlock joint blocks does block the origins of the suspensory.

I would like to comment that the combination of a response to the flexor sheath and ultrasound will not accurately diagnose some common complications of chronic problems in this area. Flexor tendon tears and adhesions can be missed for more on this see the article on flexor tendinitis.
DrO
New Member:
octavius

Posted on Friday, Jun 1, 2007 - 12:06 pm:

Jim, your post sounds exactly like the prognosis given to me for my 16 year old eventing horse and that was 9 years ago. Over that time he's been a wonderful trail horse with only 2 episodes that each warranted a 30 day rest. He does puff up a little above and below the fetlock but it really doesn't seem to bother him at all. I always keep an eye on the leg and cold hose and wrap when necessary and avoid deep footing. I started out with a 1/2 gram of bute too but soon that really wasn't even necessary.
New Member:
jimmann

Posted on Sunday, Jun 10, 2007 - 1:55 pm:

Thank you very much for the research and the opinion on the digital flexor block. I am currently leaning towards having the surgery done as after six months, he has not improved.

Denise - thanks very much for your comments. Appreciate the positive feedback.
Member:
octavius

Posted on Monday, Jun 11, 2007 - 10:30 am:

Jim - While my own horse was at New Bolton a few months ago I got to see some amazing orthopedic surgery. Frankly, although I was able to manage the condition I regret not having pursued the surgery when it was first diagnosed. Good luck and I would love to know how it turns out.
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