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  Discussion on Severe tricep sprain
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Member:
Seraph

Posted on Saturday, Nov 6, 2004 - 4:13 pm:

Well, after three weeks of exams, flexions, xrays and various drugs, (and nearly $1000.00 later) my filly has finally been diagnosed as sustaining a serious tricep sprain. I've had couple of different vets and ferriers examine her, because she showed no symptoms other than lameness, and there was growing worry and frustation on the part of all involved. (No heat, swelling, digital pulse, temperature etc.) The diagnosis went from shoulder bursitis (which I originally posted about) to fractured pedal, to sole bruising, then deep abscess, then back to a fractured coffin bone or possibly pastern bone, and then yesterday there was a feeling from the 2nd vet of a sesmoidal ligament injury.

Horse was not improving despite a complete nerve block from the pastern down, and after TEN!! xrays later, (and both vets determined they were totally clean thankfully!) we were back to square one. (Knee is completely normal).

1st vet felt it was in the shoulder but could not find a specific pain response, and the 2nd vet felt it was still a developing abcess in the foot despite the complete blocks. I was frantic trying to find out why this filly was not improving, despite stall rest, and bute, and DEX and confirming xrays. 2nd vet felt if it was any kind of muscle injury, she would have showed some degree of improvement over this time period, so he was convinced it was located in the foot. (Ferrier disagreed with the foot diagnoses after repeated examinations though.)

Anyways, this morning, my 1st vet came back and said it is definitely a movement lameness as opposed to weight bearing, as she will stand on this leg all day long. But this horse is now grade 4 lame and I was getting really concerned. He still felt problem was in the shoulder despite lack of swelling or heat, and now proceeded to ignored the leg. (After checking sesamoidal ligaments on the advice of the 2nd vet)

After several minutes of palpations all over her back and shoulder, she suddenly grunted and raised her front leg in the air and held it there, refusing to put it down. (like a retriever) He palpated deeply in the area again, and she jumped and her eyes became very worried and she was waving her front left in the air again. This was the first pain response this mare had shown, and it was obvious.

I can't seem to find a great deal of information on "tricep" injuries, but I am assuming the treatment is like any other muscle strain. My vet injected some bute (I believe) into her jugular and advised me to give her bute for the next 5 days, allow her out in her paddock for moderate exercise, (she is out 24/7 as per paddock is adjoined to her stall) and to call him again next weekend. My vet feels she did this jumping around in her paddock by herself (she does that alot - but I was concerned perhaps I did this to her schooling at some point) He felt she probably slid while trying to stop quickly in her paddock at some point)

Question - is this specific muslcle injury something like a suspensory problem where it may become an ongoing issue? Or once it is healed, it is not weakened and not something you would have to be overly concerned with out of the orindary? (I ride dressage) Seems to me you would NOT want to bute a muscle injury as she may then overuse it even turned out in a small paddock?.

Can you tell me anything more about this type of injury? Vet says at least a month or more to heal.

Strangely, he can pull her shoulder straight out in front of her and she is fine with that. It is just trotting that is so painful for her. I would have thought that this stretch would have indicated this injury sooner and should have saved me alot of stress and time. Any comments sincerely appreciated!
Moderator:
DrO

Posted on Tuesday, Nov 9, 2004 - 9:33 am:

Hello Seraph,
Antiinflammatory therapy is indicated for muscle strains. The treatment and prognosis depend on the severity of the injury, perhaps a ultrasound could better define the injury. With severe injury to the muscle the biggest concern is the formation of fibrotic myopathy. This is an unusal area for it but I have seen it develop in the large muscle bellies of the front legs before. For a rehab schedule you can talk to your vet about see Equine Diseases » Lameness » Muscle & Tendon Diseases » Fibrotic or Ossifying Myopathy & Myositis.
DrO
Member:
Seraph

Posted on Tuesday, Nov 9, 2004 - 10:38 am:

Thank you Dr. O. Do you think it is reasonable with this kind of injury that this horse does NOT show any pain when her foreleg/elbow is stretched the maximum forward? (She doesn't)

I've consulted with a 3rd vet, and his feeling is that this injury location (without external trauma like a kick) is extremely remote, and is more likely secondary to the original. Would you generally agree? Or although unusual, it is possible in your opinion?

Would you have a suggestion as to what kind of activity would have caused this? Sliding stops? Or getting a foot caught on the top of a gate? There is not a mark on her anywhere to indicate that she was trapped or struggled. (She is always in an individual paddock.)

I don't know what else to do at this point as she still exhibits no other symptoms, and after 3 days of bute @ 4 grams per day, she is still very lame.

Please advise if I need to be more patient, but it's been nearly three weeks. Shouldn't there have been at least some degree of improvement? I'm surprised that this level of bute does not appear to assist her with the pain from her lameness?

Where are the "muscle bellies" of the front legs? (Apologies for the stupid question!)

Thank you SO MUCH. Your information is very helpful for me.
Seraph
Moderator:
DrO

Posted on Wednesday, Nov 10, 2004 - 7:53 am:

Hello Seraph,
All I really know is what you tell me, and you are telling me you have doubts about the diagnosis.

The triceps runs between the elbow and the shoulder in the back of the foreleg: it should be where the vet palpated the pain. From your description above, the vet has found significant pain on palpation andI don't think you can ignore it. If you are suspicious that this is not the case your best bet after several exams is a trip to a referral institution. I really cannot tell if more patience is needed on your part, but serious damage to a muscle can cause severe prolonged lameness.
DrO
Member:
Seraph

Posted on Tuesday, Nov 16, 2004 - 10:40 am:

Hello again Dr. O - I'm confident this is a tricep strain - both my vet and I can palpate a knot in this area. He says it is not a tear as there is no depression in the tissue. Good news is that she is down to a grade ll from a grade IV lameness, and my vet feels there will be 100% recovery in about 3 months. My vet also advised DMSO for 30 days, no pain medication, and 24/7 turnout so this filly can self-exercise in moderation.

I am considering massage and tens therapy, however my vet feels time (and not alternative therapies) is best way to address this. (cost vs benefits) He also feels for example, that ultrasound only penetrates the first few layers of tissue (this is a deep pull) and shockwave may actually be counterproductive.

Would you generally agree? I am open to massage/tens therapy as long there is no risk of further aggravating this injury. Do you feel there are instances where this type of therapy would not be recommended?

I don't care how much time this takes, but I wish to do everything I can to make her recovery easier and of course, reduce the chances of re-injury.

Thank you as always.
Moderator:
DrO

Posted on Wednesday, Nov 17, 2004 - 8:19 am:

Hello Seraph,
It is great knowing for sure what is wrong and congrats on the improvemnt. I do disagree with your vet's assesment of the swelling. While it is true that with time a tear "scars in" and will feel like a depression, initially there is hemmorage and inflammation which can cause remarkable swelling. At 5 weeks out I think this would still be present so the degree of damage remains unknown.
DrO
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