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  Discussion on Swollen previously injured knee
Author Message
Member:
mrose

Posted on Tuesday, Oct 30, 2007 - 9:36 am:

As you may remember, our young gelding ran into a wheel line the end of last May and severely cut himself up. He eventually healed and was moving without any sign of injury.

The last month or so, however, his right knee has become very swollen. The swelling starts a little above the knee and continues down a few inches below the knee. The worst of it is around the knee itself. The swelling is so bad that he can't bend his knee and so walks swinging his leg out from the shoulder and dragging his toe.

Initially, the swelling would go down with turn out and get worse if he was confined for longer than overnight. Then, he came in from turn out with his knee very swollen and we tried keeping him in. This seemed to make it go down, but not all the way. The last two weeks it seems like no matter what we try the knee remains swollen. There doesn't appear to be any heat in the area, and the swelling feels pretty firm with the softest spot being right over the center of the knee. This knee, by the way, took the longest to heel and has the most scar tissue of any of his wounded/healed areas.

We took him to our vet clinic, which now has a young vet working with our old vet. The young vet was on duty when we went in. He examined AJ and then took x-rays from several different angles. The x-rays, according to the vet and from what I could see, didn't show any fluid in the area but instead it looked like tissue that was either swollen or scar tissue that had built up. (Our vet has only a portable x-ray machine and no sonogram machine.)

The vet was uncertain about treatment, but said we could try a pressure wrap to see if that would help. He said he'd have our old (and older) vet look at the x-rays when he came back, which he did. Our old vet called and said that he agreed with what we were told about the x-rays, but said he didn't think pressure wraps, cold hosing, poltices, etc. would do any good at this stage of the game. He said the best thing would be to give him as much turn out as possible. So, we turned AJ out each day with the other horses, but after a week of this, there is no improvement and in fact, the swelling to me looks worse.

To the best of my knowledge the tendons weren't cut when he injured himself. At least the attending vet never said they had been.

Do you have any ideas and suggestions about what we can do about this swelling and what might be the cause? In this case would further diagnostics like a sonogram be helpful? Would it be worth the trip down to S. Calif. to the clinic where I took Libby? Or, is there something I can do for him at home?

Thanks for your input and help.
Moderator:
DrO

Posted on Wednesday, Oct 31, 2007 - 7:12 am:

Hello Sara,
One problem is the amount of time that has gone by with this swelling in place. After a few weeks tissues loose elasticity and after a month or two the body starts replacing the fluid in the tissues with fibrous tissue resulting in a stiff swollen area that does not resolve. The question is how much of this is reversible and you will not know this until you try aggressive treatment.

A good stab needs to be made at why this area has begun swelling by those who can examine the swelling. To get you started on this step first you have to decide whether this is dependent or inflammatory edema. For a detailed discussion of this, Diseases of Horses » Skin Diseases, Wounds, and Swellings » Swellings / Localized Infection / Abscesses » Diagnosing and Assessing Swellings in Horses.

Once we know the nature of the swelling proper treatment can be formulated but unless it is very painful, which would indicate infection, proper treatment is likely to include pressure wrapping. If the veterinarians you are relying on don't seem to be able to get a handle on the cause or a aggressive plan to reduce the swelling it would be indications for a referral.
DrO
Member:
mrose

Posted on Wednesday, Oct 31, 2007 - 9:59 am:

Thank you Dr. O. I guess I'll be making another 10 hr. trip to S. Calif. I'd give any thing for a good "leg man" with up to date diagnostic equipment within a 3 hr. drive.

Would you also keep him in a stall with just hand walking? I assume "yes?"
Member:
juliem

Posted on Wednesday, Oct 31, 2007 - 9:46 pm:

Sara, this would be closer for you by half.
https://www.idahoequinehospital.com/ I've never used them for anything very serious, but they certainly have the capabilities and staff. Check them out and maybe someone else has more experience with them and can chime in. Hate to think of you going over the mountains as winter closes in.
Member:
mrose

Posted on Thursday, Nov 1, 2007 - 12:33 am:

Julie, this looks like a great facility. I know our local vet has referred people to them in the past. However, it is actually 50 mi. further than it is to Alamo Pintado! I'm down in So. Utah, about two and a half hrs. north of Las Vegas. If I'm going to drive that far I'd rather go to a clinic where I know the vets, etc. I have heard, however, that the clinic in ID is really good with repro problems and colic surgeries.
Moderator:
DrO

Posted on Thursday, Nov 1, 2007 - 8:14 am:

No I would not assume stall resting is required, it will depend on the nature of the swelling and how it responds to exercise. For instance noninflammatory swelling might improve with exercise and increased circulation.
DrO
Member:
mrose

Posted on Thursday, Nov 1, 2007 - 10:19 am:

Thanks, Dr. O. (Maybe you could move out here along with Dennis??)
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