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  Discussion on New Tendon Injury
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New Member:
Danad

Posted on Wednesday, Jan 12, 2005 - 2:15 pm:

Dear Dr.O:
3 weeks ago, my horse (19 yr) injured his front Superficial Digital Flexor Tendon and Check Ligament - it was a quick run, buck, punched the air and landed WRONG. I watched it happen. My concern is that even after all the care I've taken since, there is still heat and some swelling in the back mid section(noticeable starting point of bow) and it is very wide. About double the normal tendon. His ultrasound showed about a Grade 3 and small tears throughout as opposed to one large lesion. 155 area, SDFT 8mm, Check Ligament 7mm. What does that mean?? He's been on stall rest, vet said 4-6 weeks (no exercise), JUST discontinued Bute, added MSM to feed (?), has been wrapped every day, cold hosed during first 2 wks of injury (when I could). Now I just started Laser Therapy last week treatments 1-2x daily 10 min. each. But so far I have not seen any change. What else can I do to get the heat and swelling down? I live 1hr from the barn and have a job. I have been going almost every day, but have seen almost no results. Is the heat and swelling causing more damage as the days go by?? Any suggestions would be appreciated. I have read the articles posted.But would like some personal assurance on this. Thanks. I am VERY concerned.
Moderator:
DrO

Posted on Thursday, Jan 13, 2005 - 1:33 pm:

If there continues to be remarkable subq edema, cold hosing might help as would pressure wraps, for more see Equine Diseases » First Aid » Pressure Wraps, Poultices, Cold and Heat Therapy for Swelling in Horse Legs.

If there is heat and swelling I would not discontinue the bute, it helps with the inflammation. Though not harmful, the MSM has no known beneficial effect on the tendintis. Lasering works by stimulating inflammation so may perpetuate heat and swelling. The heat and swelling are a result of damage not really the cause. However the sooner the acute inflammatory stage is over the sooner the injuries can heal.

To learn more about tendon injuries and there significance see, Equine Diseases » Lameness » Diseases of the Lower Limb » Flexor Tendinitis. I am unsure what your vet means be a Grade 3. I use the "mild - moderate - severe" scheme outlined in the rehabilitation section of the article. The measurements are probable the thickness of the structures and when compared to the normal side give an objective measure of the amount of swelling in the tendon.
DrO
Member:
Danad

Posted on Thursday, Jan 13, 2005 - 6:41 pm:

Dr.O:
The vet indicated a 3/5 (which would be moderate I would assume) but the leg has not changed much in size after 4 weeks. Is this a bad sign? How long does it usually take to see a difference in the swelling? In your experience, are smaller tears throughout the tendon easier to repair than the larger lesion type? I've seen some pictures of ultrasounds and have seen the whole/lesion type. I am very nervous about keeping my horse on Bute longer than 4 weeks from so much I have heard. Can you ease my fears? Or can he develop other issues on top of his current problems. Is there a better alternative that won't cause stomach problems for him. Thanks a lot for your answers.
Moderator:
DrO

Posted on Friday, Jan 14, 2005 - 6:36 am:

I think the 3/5 designation might be the degree of lameness and not a grade of the lesions themselves. The questions you ask I cannot answer with any exactness about your horse specifically because I cannot examine your horse. In general it is a better sign if swelling resolves quickly, in general several small lesions will heal better than a single large lesion, most horses will tolerate 4 weeks of bute if the dose is reasonable. To learn more about dosing and monitoring for bute see, Equine Medications and Nutriceuticals » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Phenylbutazone (Bute).

Yes there are alternatives that are not as hard on the stomach for a discussion on the possibilities see Equine Medications and Nutriceuticals » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » An Overview of NSAID's.
DrO
Member:
Danad

Posted on Friday, Jan 14, 2005 - 10:17 am:

Dear DrO:
I have read the all articles you advised- extensively (some of the language was completely over my head when they became "technical"). But from what I was able to gather, it may be a good idea to switch my "19 yr.old" to Ketoprofen for his tendon inflammation. It says it's much easier on the stomach and has great anti-inflammatory results. Why then wouldn't the vet have suggested that to me in the beginning? He is off the bute, just stopped it. But walking a few steps to grooming area(vet said ok to do) he is still mildly lame. He is still on total box stall rest. So I feel he could use something and the Ketoprofen seems like a good choice for him. Do you agree with that or am I missing something?? Thanks soooo much for your interest, patience and concern. Dana
Moderator:
DrO

Posted on Friday, Jan 14, 2005 - 4:03 pm:

Bute should be fine unless your horse is unusually sensitive. Ketoprofen is currently available only as an injectable and is much more expensive that the bute.
DrO
Member:
Eoeo

Posted on Saturday, Jan 15, 2005 - 4:22 am:

Have you pinned down where her lameness is coming from? Could it be an abscess or just goofing around in the field and pulled something? Horses do things to themselves all the time. Sounds like she did something to herself unless she had been on meds when you got her and they have worn off? EO
Member:
Danad

Posted on Friday, Jan 21, 2005 - 9:25 am:

Dear DrO: I have given my horse 5 more days of bute 1x per day. He is very lame without it. Observing the swelling on his leg, the OUTSIDE swelling of the SDFT seems to have gone down, BUT the BACK and INSIDE are still swollen. If you are looking from the back of the leg, there is a definite bow towards the inside of the leg and runs down parallel with the SDFT bow's length. What is there? and why would the inside be swollen? The diagnosis was SDFT and his check ligament. Is that where the check ligament intersects? I am very concerned. Also, when I put Sore No More Linament (Witch Hazel based) on his leg, I see "steam" come off his leg. Is that much heat still expected after 4 weeks?? Thanks. Dana
Moderator:
DrO

Posted on Saturday, Jan 22, 2005 - 8:51 am:

The check ligament lies deep to the DDFT. For images of all these structures see, References » Equine Illustrations » Leg Anatomy and Conformation » Tendons, Ligaments, and Muscles of the Horses leg. Since I do not use Sore No More I am uncertain about the meaning of the steam.
DrO
Member:
Danad

Posted on Saturday, Jan 22, 2005 - 1:11 pm:

Dear DrO: Reference to the Sore No More, when I appy it to my horses' leg (which is very warm) it creates an effect I can actually see that looks like little smoke puffs emitting from his leg, but I am sure it is actually steam from the cool linament on his warm leg. Have you ever seen that before?? I presume that means his leg still has quite a bit of heat in it. Nothing seems to get his leg cool, ie. hosing, ice packs, cold laser therapy, bute, cooling linament. Do you know why his leg would stay warm for so long after his initial injury? Thank you.
Moderator:
DrO

Posted on Sunday, Jan 23, 2005 - 9:59 am:

No I have not seen such an effect off of a resting horse but I don't use linamints often. I would not use this effect as a sign the leg remains hot in fact if your linamint contains any rubrifecients it may make the skin feel warm itself.

The important finding is whether the area feels warm (unwrapped for at least 30 minutes and no medication applied) compared to the othe leg in that place. The reason a leg remains warm following injury is ongoing inflammation.
DrO
Member:
Danad

Posted on Sunday, Jan 23, 2005 - 11:13 am:

Dear Dr.O: My liniment does not contain any rubefacients, as a matter of fact, it is a witch hazel based product primarily used for reducing swelling and inflammation in sensitive horses. I was careful not to use any heat producing liniment especially while using the Laser therapy. I have never seen this before, but I will try what you said, unwrapping for 30 minutes before comparing the two legs. I thought maybe the cooling liniment was "pulling" the heat from his leg and that was the "steam" I was seeing. That would be good.!!! Thanks. After 4+ weeks now, my horse is still lame. No exercise yet. I also noticed the frog on the lame leg seems to be getting smaller ---- do you think that is just my imagination? Or does that tend to happen from not getting exercise? Sorry so many questions.
Moderator:
DrO

Posted on Wednesday, Jan 26, 2005 - 7:23 am:

Perhaps Dana, remember both feet are not getting exercise. OF course he probably bears less weight on this side but unless this is remarkable it is a bit quick to be seeing changes.
DrO
Member:
Danad

Posted on Wednesday, Jan 26, 2005 - 7:57 am:

Hi DrO: The vet came out yesterday and did another ultrasound. Not good. It seems that the second ultrasound looks worse than the first one. The 1st was done the day after initial injury and the vet said sometimes 4 weeks later it shows the real damage. I actually was able to see the scan this time and his SDFT area is mostly DARK, very little white. His DDT and Check ligament are fine. I am so depressed about the SDFT, I was hoping it showed the complete opposite. She said another 5-6 MONTHS!! stall rest. What is your experience with a SEVERE tearing like this? Could he heal and come back good as a trail horse? Of all the treatments, I have been told to use the laser because it produces the best results for healing and preventing scar tissue. Please give me your thoughts, be it encouraging or not. Do you like the results of DMSO/Azium?? That was my other choice to treat but went with the laser. Any helpful info. to lessen his boredom or increase his chances of healing???? THANKS Dana
Moderator:
DrO

Posted on Thursday, Jan 27, 2005 - 6:33 am:

Dana I am sorry to hear you have ongoing degeneration of the tendon. We don't feel there is ongoing damage per se, but in most of these cases the initial amount of damage is not visible on the first ultrasound.

Without seeing your horse I cannot comment on the findings directly but yes severe injury to the flexor tendons could easily take 6 months or more to heal. I don't use lasers personally and you have to be careful with the use of glucocorticoids with these type injuries: the repair may not be as strong as without there use. For our recommendations on therapy for the acute phase, as referenced above, are at, Equine Diseases » Lameness » Diseases of the Lower Limb » Flexor Tendinitis. For information on taking care of long term stalled horses see, Training Horses » Behavioral Problems » Stall Resting Horses.
DrO
Member:
Danad

Posted on Thursday, Jan 27, 2005 - 11:50 am:

Dear DrO: I'm sorry, I didn't understand re the sentence: ..be careful with use of glucorticoids (I assume DMSO/AZIUM use) with these inj:the repair may not be as strong as without their use. Are you saying be careful using, but if I don't the repair won't be as strong? Sorry. Please answer ASAP. Also, I checked out the references and couldn't find my answers re using DMSO. Where can I ask questions regarding ultrasound readings? I am hoping that all the dark I saw was "swelling" and not lack of prominent fiber pattern. That would be better.!! Could that be the case?
Moderator:
DrO

Posted on Friday, Jan 28, 2005 - 6:39 am:

You can ask ultrasound questions here, but I cannot evaluate your verbal descriptions of lesions: I too do not know if you were seeing holes or swelling they are both dark.

Glucocorticoid's may inhibit the healing on the tendon. On the other hand healing is delayed until the acute inflammation subsides. If used very carefully there may be a benefit but this should be done under the supervision of your veterinarian and only for a short period. The DMSO is primarily a carrier for the Azium though may have mild antiinflmmatory properties of its own.
DrO
Member:
Brandi

Posted on Friday, Jan 28, 2005 - 9:34 pm:

Dana, I'm very sorry about your situation. I know 1st hand the fear and heart-ache associated with a tendon injury, and that's why I wanted to share one thought when I read your concern over the time it will likely take to heal your horse.
In July 2004 my horse tore his DDFT where it connects to the coffin bone...6 months to a year of stall-rest and rehab. For someone who believes in 14++ hours per day of turnout on grass to keep minds and bodies healthy, I was shell-shocked at the thought of jail for my boy. We were "lucky" to start out with 20 minutes per day of walking, adding 5 minutes every 2 weeks. In September I got to start riding at the walk, 20 minutes per day 5x per week, adding 5 like before, and in late December we graduated to trotting--2 minutes added to 1/2 hour minimum warm-up, adding 2 minutes every 2 weeks. And you know what? It's been the best time of my life. I love this horse dearly, and being "forced" to spend the kind of low-key time that we've been forced to spend together has been the greatest silver-lining. In the interest of time, I won't go into all the things I've come to appreciate about this time we've spent together, but if you ever need that list to brighten a dark day, just let me know--it's longer than you would think. 2 things I can offer to help the boredom for your horse--#1: he has to have a buddy next to him all the time. I have 2 other horses and they take turns being stalled next to him (1 gets day turn-out the other gets night-time). And #2: a bucket with a tight lid and holes cut in it, I fill it full of his pellets and it takes him hours to empty it. You can pay $45 for the store-bought kind of treat-feeder, but a bucket with the handle removed and holes cut by a utility knife has worked great for me.
Best of luck to you, and I hope that if you do have to go through this, that you have the good fortune I have had by improving your relationship and training with your horse to a level you would have never otherwise acheived.
Member:
Danad

Posted on Sunday, Jan 30, 2005 - 8:47 am:

Dear Brandi: Thanks for the posting. I would like to hear what you went through concerning the long haul and how you best coped with it. I will e-mail you. Thanks. Dana
Member:
Danad

Posted on Sunday, Jan 30, 2005 - 9:01 am:

Dear DrO: My main concern at this point is the conflicting information regarding how long a tendon remains swollen in the acute stage? I can see subtle changes, one day it LOOKS a little smaller) then 2 days later is LOOKS more swollen. I understand that each tendon injury is different but if the tendon swelling looks the same at 5 weeks as it did at 2 weeks, what does that mean? Can I still expect some of the swelling to decrease? And up to how many weeks? I am associating swelling with "damage". I am still treating his swelling as if it were still in the "acute" stage. His last ultrasound showed almost all dark in the SDFT area. I am trying to think positive but need to see a bit of light at this point. He is still lame and uncomfortable and when he tries to rest he shifts he weight back and forth. It is heartbreaking to see him like this and I want to make sure I am doing all I can for him. Thanks you. Dana
Moderator:
DrO

Posted on Sunday, Jan 30, 2005 - 10:28 am:

Dana, it could mean either you had a severe injury or you are not doing a good job addressing the acute inflammation. It strikes me you are really uncertain about the care, perhaps you need to get a second opinion? Even if the confirmed what you have already ben told it might alleve your concern about doing all you can do. While I can make general observations and recommendations I cannot treat your horse without a thorough examination.
DrO
Member:
Danad

Posted on Sunday, Jan 30, 2005 - 5:35 pm:

Dear DrO: Yes, that is exactly my concern. I have been at the barn EVERY day since the injury. Within the past 5 weeks, he had an ultrasound the day after the injury, Bute for 3 weeks, cold hosed for 2 weeks, his supplements are Cortiflx, MSM, B-L Solution, complete stall rest, I have wrapping and unwrapping all 4 legs every day for support because of his age. I started cold laser therapy 3 weeks ago, icing for 20 minutes before and after, along with massaging his leg and a cooling brace applied after the treatments, then wrapped for the night. Another ultrasound 1 week ago. As far as treatments, I don't know what else I can do. After all this consistent "addressing the inflammation", you would think I would have better results by now. As far as a second opinion, 2 vets from the same clinic have seen him. I guess it's time for one more??? I was trying to get some info. on the swelling issue with my horse. I realize you can't examine him. Just thought you would have some more insight.
Moderator:
DrO

Posted on Monday, Jan 31, 2005 - 7:45 am:

Dana you have ignored many of the insights in my posts and the articles:
1) NSAID's and cold hosing should be continued until the acute inflammation is gone.
2) Lasers at the acute stage are probably not helpful. (They may even be continuing to promote heat even thought they are called cold lasers).
3) Poltices might be better than linimints at removing edema.
4) Sometimes injuries are so severe that 5 weeks is not enough time to relieve the swelling.
5) It is a rare case that should not be receiving 15 minute hand walking at this stage.

Of course without looking at your horse I cannot treat your horse and there may be exceptions to these recommendations. I am not sure what else I can give you other than the thought to get now a 3rd opinion so that you sleep better at night.
DrO
Member:
Danad

Posted on Wednesday, Feb 2, 2005 - 5:40 pm:

I do not feel as though I have IGNORED anything. I am simply asking you your "educated opinion". If you don't have one, just say so. I have read all your articles and they don't address all of my questions. Maybe you are lacking a little shut eye yourself, as you are becoming a little tart with your answers.
Member:
Erika

Posted on Wednesday, Feb 2, 2005 - 10:19 pm:

Wow, Dana,
Pretty harsh, don't you think? It seems Dr. O has done everything but drive out to visit your horse.
Member:
Shirl

Posted on Wednesday, Feb 2, 2005 - 10:46 pm:

Dana, I understand how frustrating it can be when you are in the situation of not being able to 'fix it'. Try to take a deep breath, have patience, try to follow instructions and things will get better, but injuries like this take time, lots of time. Dr. O. has given you all the good advice he can without seeing your horse. He's been very patient, kind and caring. The best to you. Shirl
Moderator:
DrO

Posted on Thursday, Feb 3, 2005 - 8:21 am:

DanaD,
I am sorry you feel this way, I was attempting to point out where your treaments have differed from our recommendations which might account for ongoing problems. Which questions have we not addressed that can be answered without examining your horse?
DrO
Member:
Danad

Posted on Thursday, Feb 3, 2005 - 9:09 am:

DrO: I have been following the recommendations by the vet who saw my horse. I was worried because I had not "seen" much results. My questions were to get a better understanding and knowledge of what treatments were the best. Alternatives, etc. I understand there are different degrees of injury to a tendon. Most of what I have read, the heat and swelling subsides after a period of time. I wanted to be sure I was doing the right thing. I am concerned that his tendon is still very swollen and I just wanted to ask you if at this stage, 6 weeks, could he still heal soundly or the longer it stays swollen the less chance for recovery? His ultrasound shows almost no fiber pattern. All black/gray area. Another vet I asked to come out for another opinion said he should be hand walked by now. The "attending" vet insisted he should NOT be walked at this stage until more improvement is seen as it would create more damage. As you can see, there are many opinions on this type of injury. It is impossible to actually follow all of the advice. I am not asking for a diagnosis, or examination. I have already gotton that twice. I just figured the more information I had about this injury, I could decide which treatment would be the best for him. I didn't want 5 months to go by and find out the treatment was wrong. If two (or 3) professional vets can't agree on the same treatment, then I would expect that the horse owner would be very confused having far less knowledge than they do. Thanks.
DanaD
Member:
Cara2

Posted on Thursday, Feb 3, 2005 - 10:02 am:

Hi Dana,

Your horse's injury sounds very much like what I see in my own mare at the moment. 6 weeks after the initial trauma she has a two inch long bow and heat to the inside of the superficial digital flexor, nothing to the back or outside and the whole tendon is thickened from knee to fetlock. Definition over the check ligament, DDFT and suspensory has improved though and they are all easily felt. A scan at 1 week and 2 weeks post-injury showed pockets of fluid which have steadily disappeared but all the structures were clearly visible. The SDFT was distorted towards the inside surface of the leg but my vet was happy that there was no core lesion involved. He has told me 3 months box rest. My horse went from two sachets of painkiller (Arquel, not Bute)to one and now she is on half a sachet per day and steps out well and seems comfortable. She does not get formal in-hand exercise but is taken onto a nearby field and grazed in-hand for around 45 minutes each night (2 hours at weekends) so obviously she is moving about a bit in the process - my vet says no more forced walking than this. Like you I use an astringent gel and paste under compression bandages as it is not practical for me to hose the leg unfortunately. I do carry a bottle of water in my pocket though while she is grazing and squirt the unbandaged leg for a bit of wind chill factor! I am surprised like you that there is still so much heat and swelling but it has improved alot since day 1 and that is easy to forget. Dr O - does a horse's age have any effect on the time taken to heal? Dana, my mare is 22 and like yours was just out in the paddock. My vet says I have been lucky though, it normally takes 6 months of box rest minimum. I just want the old girl to be able to go out and enjoy grazing freely again, I'm not bothered if she is rideable (although obviously that would be great.) I know its hard when you get conflicting advice. Do you have a vet school/hospital/university you could ring and speak to a specialist? We had to ring a local university to find a painkiller that my mare could have as most of them have to be avoided.

You have my sympathy Dana, doing all this nursing and holding down a job as well is plain exhausting. The journey from home to horse to work and the reverse is 50 miles a day for me and I'm never home before 8pm these days but the other option was to have her put down and spend all the hours of "freedom" wallowing in guilt and misery. I'm saving that for another day thanks.
Moderator:
DrO

Posted on Thursday, Feb 3, 2005 - 11:12 am:

Hello Helen,
I think the overall health of the horse is more important than the age in years, you see 22's that are in great shape and probable will not have any more trouble than a middle age horse. The very young probably heals better however.

Dana, are correct in that you need to follow the advice of those who can actually examine your horse.

What I don't understand is you jumping my case when I have given you many pages of information on your problem, dozens of opinions and suggestions (including the last one where the reason you might still be having problems is you are not following well established protocols on getting a tendon healed as best as possible), and have tried to answer your questions as completely as possible.
DrO
Member:
Chohler

Posted on Thursday, Feb 3, 2005 - 1:45 pm:

I have gotten conflicting advice from vets many times, and I just decided to print the articles on this site and use them as guidelines to the best of my ability. You may not see the answers you are looking for, slow down and reread the articles. They are established guidlines. There are no concrete answers, just time tested methods, without seeing your horse.

If they are still doing the lazer on your horse it maintains your inflamation and swelling and it will be hard to see any improvement.

If you cannot hose the horses leg with cold water you can purchase at many horse supplies store a cryo bandage. it is a wrap for the horses leg that you fill with a hose attatched to a cooler of ice water. You can do this a couple times a day if you need to. Also you can freeze bags of peas or get a gel ice pack for $50 dollars from a physical therapist. These are large and will wrap around the horses legs. Put it on the horse while you are doing your daily chores.

I know this is very time consuming and you are very fustrated. Especially when the people you pay are just confusing you. Tendon injuries take a very long time to heal. As long as you absorb all the info you can and treat your horse the best you can then you have done the best you can.

DrO does this site out of his free time, and shares his education with all he can. He undestands your fustration. But cannot give you concrete answers.

Member:
Danad

Posted on Thursday, Feb 3, 2005 - 5:34 pm:

Thank you to all that have tried to help and your KIND words and support. I don't have the time to bicker over words. I was always polite and thanked Dr.O after each post. I thought this site was FOR information. I felt he was getting accusatory because I was listening to my vet and not to his articles or protocol. I looked at all of it with an open mind and spent hours reading, but did as my vet recommended. I do not wish to continue discussions anymore. There are lots of horses here in Maryland and will continue to seek the best vet care for my horse.
Dana D
Member:
Sunny66

Posted on Friday, Feb 4, 2005 - 10:48 am:

I know how frustrating it is to have your beloved horse hurt and not be able to do anything about it. Mine has numerous issues.

The internet is a very informative place, unfortunately it is impossible to "read between the lines" when you don't have the luxury of speaking face to face.

I agree with Cheryl...print out the pages Dr. O referenced and this thread. Make an appointment with another vet from another clinic and have the vet read this thread before he sees your horse so he will know everything that has been done.

Good luck to you Dana.


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