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  Discussion on Acute Fetlock Jt &/or Digital Flexor Tendon Sheath Injury
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Member:
wolfydoc

Posted on Monday, Sep 17, 2007 - 6:22 pm:

Hi Everyone,
My own horse, a 6 yr. old TWH gelding, sustained an acute injury to his hind fetlock area sometime during the latter part of last week, I suspect on Wed. I was ponying him behind me and he spooked and took off across the desert at a hundred miles an hour when we were about 200 yards from the trailer. He headed for the trailer but spent several hundred yards running off the trail, which is not good here in our area because we have what we call "mole holes" all over.

I didn't detect any injury until ponying him again on Friday evening. I'm beating myself up for not keeping a closer eye on him after the spook, but he's gotten himself in trouble before and always ended up without a scratch or injury. No excuse. Anyway, the entire fetlock swelled acutely that evening. It was very warm, painful to flexion, and painful to palpation on the dorsal aspect especially. The swelling also involved the area proximal to the fetlock, immediately dorsal and palmar to the suspensory branches, as well as over the branches, worse on the lateral side, where I could barely feel the very proximal most aspect of the lateral branch. I could feel the palmar aspect of the SDFT but not the deep, due to the swelling. There was virtually no swelling distal to the fetlock. The proximal edge of the swollen area was well-delineated, and I'm assuming I was feeling at least the distended palmar pouch of the fetlock joint, plus or minus a swollen flexor tendon sheath. He was sound at a walk, moderately lame at a trot especially with the lame leg on the inside of a circle (I only asked for a couple of circles!) No puncture wounds found, no lacerations. Seemed too sound to be a septic joint. I started on Bute, cold hosing, and the next morning hauled him to the hospital I use for lameness issues (I practiced small animal for 15 years and now am going into equine). My usual vet is out of town so one of the other vets at the same hospital examined my horse.

By Sat. am when I took him in, the swelling was much more diffuse, involved the entire distal one third of the metatarsal area and the fetlock joint, down into the pastern. He was still sound at a walk. Radiographs (DP, lat-med, both obliques) were negative. Ultrasound: well, it was a very cursory exam in my opinion, but I'm entirely new at this. No distinct lesion was identified. However, there at first seemed to be a core lesion in the DDFT but the examining vet thought it was artifact because "when I move the transducer it disappears". Dx was an acute sprain of the fetlock joint. Tx: continue NSAIDs, cold therapy, stall rest, and as soon as he is comfortable enough (about 10 days) start physiotherapy i.e. flex/extend multiple times a day to prevent a permanent decrease in range of motion, and eventually start handwalking. Prognosis was good for complete healing and return to work in about a month.

My concern (maybe not realistic) is that the US was not as thorough as I thought it could be - the tendon sheath and its various parts were not really identified and examined closely, nor were the collaterals, the palmar annular ligament, the intersesamoidean ligament, etc. I'm also not sure about the DDFT and that artifact we saw, if indeed it was artifact.

I've been using large frozen gel pacs bandaged onto the area four times a day, as I have ones large enough to wrap entirely around the limb, and it allows me to go about other business at the same time! The swelling did not start coming down until late Sunday night, and now it is about 50% less.

Should I get this re-ultrasounded asap or sit tight with current therapy and only re-ultrasound if the horse doesn't continue to improve? I just don't want to miss a true DDFT lesion (although the prognosis is not really at all good with DDFT lesions in this area if I'm researching/reading correctly), or end up with a chronic tenosynovitis because we missed some lesion that will keep irritating the flexor tendon sheath. Or maybe an imcomplete fracture that din't show up on the initial rads.
Thanks so much,
Cindy Nielsen, VMD
Member:
dres

Posted on Monday, Sep 17, 2007 - 6:43 pm:

Hi Cindy, I can't answer your questions.. but can tell you i am in the process of rehabbing a filly that completely severed her DDFT just above the heel bulb/hind leg.. ''SURGERY/INFECTION/REHAB post.. Knowing what i now know about the rehab.. it is much longer then a couple of months even on a lesser injury.. I think if you are not happy with the Ultrasound reading, i would consult with another vet group and re do it.. Just my opinion of course..
Continue tho with the icing , getting the swelling down is paramount...

On the first day God created horses, on the second day he painted them with spots..
Member:
canter

Posted on Monday, Sep 17, 2007 - 8:55 pm:

Cindy, I second Ann's recommendation for another ultrasound. Being a vet, you have much more knowledge/experience about these procedures than the average horse owner does and if you're uncomfortable with the exam, I would guess it's for very good reason. You don't want to be kicking yourself a month from now because you didn't have it done.
Member:
mrose

Posted on Tuesday, Sep 18, 2007 - 12:15 am:

Here's a third vote for a second ultrasound. I agree with what Fran said; you have more knowledge than the rest of us and you should feel comfortable with the US result. If not, don't second guess yourself. You have enough knowledge that you should respect your instincts. After "umpteen" years, I am finally learning that if I have "a feeling" about something, I need to pay attention to it and if I'm uncomfortable with a finding, or don't agree with it or understand it, I need to have things investigated further. I'd get another US done. What is there to loose?
Member:
dsibley

Posted on Tuesday, Sep 18, 2007 - 7:55 am:

Hello! I'll give a 'fourth' on that one. Would rather error on the side of caution. No leg, no horse!
Moderator:
DrO

Posted on Tuesday, Sep 18, 2007 - 12:14 pm:

You say he is sound at a walk, is he also sound at a trot? With no lameness present it is hard to be terribly worried and I wonder if this might be a hematoma from a broken blood vessel? The bottom line is we really can't evaluate the quality of the work done so far but if you are not happy with it, you should consider repeating it.
DrO
Member:
wolfydoc

Posted on Tuesday, Sep 18, 2007 - 5:51 pm:

Oh no, DrO,
I think I said in my first post, and excuse my mistake if I didn't, that he is definitely lame at the trot, worse when the leg is on the inside of the circle. He just has no obvious lameness at a walk. It's a pretty obvious lameness at the trot, with huge pelvic excursion and head shooting forward and down when bearing weight on that leg.

Thank you everyone for your support. I made the first available appointment with the vet I usually use at the same hospital (he's out of town) next Monday. I'll let you know what he finds. The swelling is coming down but won't stay down unless it's being iced or has a wrap on it.
Cindy
Member:
dres

Posted on Tuesday, Sep 18, 2007 - 6:27 pm:

Cindy, I had a brood mare that had pulled /torn her left hind suspensory, she was never lame at the walk / canter.. only could see it at the trot.. I rode her for a year not knowing what the heck? I had thought it was arthritic hocks? When I had the vet out to inject he suspected her suspensory, and after the ultrasound was done he was correct.. In fact it was a huge core lesion, with the prognoses 'guarded

On the first day God created horses, on the second day he painted them with spots..
Moderator:
DrO

Posted on Wednesday, Sep 19, 2007 - 12:26 pm:

Got it Cindy, my apologies, I missed the second part of the sentence and it certainly increases the concern with so much swelling. As you know a sprained ankle is not really a diagnosis until the tissues that are sprained are indentified. Let us know what they find.
DrO
Member:
wolfydoc

Posted on Wednesday, Sep 19, 2007 - 5:18 pm:

That was my feeling DrO - we didnt' identify exactly what tissue(s) were injured. Hopefully Monday's exam will tell.

Ann, the suspensory ligament splits into two branches in the distal third of the metatarsus where there is swelling, and the branches supposedly looked ok on the U/S, but we'll certainly look at them again on Monday. The swelling now is primarily on the dorsal aspect of the fetlock joint (very very firm swelling) and in the area of the flexor tendon sheath at the level of and just proximal to the fetlock. I'll post on Monday. thanks for all the support.
Cindy
Member:
dres

Posted on Wednesday, Sep 19, 2007 - 6:24 pm:

Cindy take pictures.. we learn a ton by looking at pictures.. Did you look at my post and photos?

On the first day God created horses, on the second day he painted them with spots..
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