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  Discussion on Sesmoiditis
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Member:
Lwillis

Posted on Saturday, Jan 22, 2005 - 1:12 pm:

My 13 year old pleasure horse suddenly went very lame on his right front with no prior symtoms. My vet never did figure out what was wrong but said as a side note that he had an old sesmoiditis change, and pointed out the jagged edges of the sesmoid bone.

I think the thought was that the suspensory ligament may have been affected by the jagged edges of the sesmoid bone. We did ultra sound, but found no suspensory damage.

We have had him on stall rest for 4 months (he is sound while on stall rest) and have started a 10 day treatment of Tildren hoping that it will help with the bone repair.

I am nervous that when we put him back to work that the sesmoid problem will continue to aggravate the suspensory ligament again (if that was even the cause for lameness!)

My vet seems confident that soundness is an option, but I don't understand how that jagged sesmoid bone can heal without presenting more problems. It seems impossible for a jagged bone to smooth out without surgery.

Dr. O, I am hoping that you have some thoughts on this.
Moderator:
DrO

Posted on Sunday, Jan 23, 2005 - 10:34 am:

WIthout heat swelling and pain on palpation in the area of the sesamoid the diagnosis is uncertain and I think you need a good diagnosis before contemplating treatment and prognosis Lauren. For a logical plan to localizing the lameness see, Equine Diseases » Lameness » Localizing Lameness in the Horse. If it does localize to at least the ankle, or even better to the sesamoid, you should have the radiographs sent to radiologist/surgeon and they can advise what treatment might be possible.
DrO
Member:
Lwillis

Posted on Sunday, Jan 23, 2005 - 1:07 pm:

Thanks Dr. O., and I have read that article already!

Your response reminds me that my gelding did have pain upon palpation in the area of the sesamoid. We did send radiographs to be examed and the response was to ultrasound the annular ligament, which was fine.

During the discovery process, my horse became sound with stall rest, so we haven't been able to get any more specific information about where or what the lameness is caused from.

What I was hoping that you could shed some light on for me was wheather or not the remodeling of the bone might possibly smooth out those jagged edges or not.

I realize that you have limited information, but clinically, is this even possible?
Moderator:
DrO

Posted on Monday, Jan 24, 2005 - 5:52 pm:

Lauren that is really an evaluation that has to be made looking at the radiographs. I have to say it is not a diagnosis I make often. Why have the sesamoids developed a ragged edge and where exactly are they roughened?
DrO
New Member:
Azray

Posted on Friday, Nov 25, 2005 - 5:19 pm:

Hi Dr. O. New to the site, but a wonderful wealth of info. Great service.
Writing to inquire on treatment regimen for a diagnosis of sesamoiditis. Subject is a 7year old Appendix QH gelding, with a recent history of lower joint problems. We picked up this fellow 7 weeks ago and found significant misrepresentation in his condition. Short of it is that for the prior 6 weeks we've been isolating joint issues, and have found the following:
Both rear and left front pasterns swelled after workouts in first week. We put him on Legend intrarticular 3 x at 2 weeks. The swelling was eliminated by the third week and he's been limber and appears normal movement on the rears. The left front remains with pulling shoulder/lameness at trot. Our vet x-rayed the joint and came back with a diagnosis of sesamoiditis - general description, specifically ragged edges and a spur evident at the top of the sesamoid bone, with some calcification in the surrounding tissue. He sumises that the was an earlier injury that has calcified and is the cause of the problem.

The vet has reccomended a treatment program of HA injection of the joint / tendon sheath for lubrication purposes, steroid injection to minimize swelling and icing twice daily, along with 90-120 days rest / walking.

In asking about treatment options, he stated that surgery tended to create as many problems as it might cure, but did not rule it out. Other options included ultrasound treatment of the calcified tissue in an effort to break up and dissolve the scar tissue and calcification.

I'm wondering about your impression and possible treatment plan for this condition, recognizing that you do not have the benefit of x-rays and the animal for first hand diagnosis. I'm looking to find all alternative as the vet is open to what ever works best for the animal.

Thanks for the super website. Ray.
Moderator:
DrO

Posted on Saturday, Nov 26, 2005 - 10:28 am:

Welcome Ray,
Thank you for the kudos. Though there is a radiographic evidence of sesamoiditis were nerve blocks and regional anesthesia done to confirm the location of the pain? For more on this and treatment suggestions see, Equine Diseases » Lameness » Diseases of the Lower Limb » Diseases of the Sesamoid Bones it directly addresses the questions about diagnosis and treatment. If after reading the article you still have questions there is a list of discussions under the article and you can post a new discussion using the link at the bottom of the list of discussions.
DrO
New Member:
Azray

Posted on Saturday, Nov 26, 2005 - 10:34 pm:

Hi Dr. O..
On nerve blocks and other localization techniques, the short answer is no. Several flexion tests over the last few weeks is all else that has been accomplished as far as diagnostics. (The results of the Legend injections and behavioral issues having been relayed).

I did meet with the Vet today and we looked over the x-rays together to show me specifically what he is looking at. While it might sound a bit strange, I have a lot of experience reading x-rays from structural inspections, so short of the norms for living tissue and bony structure, I could easily interpret.

The bone spurs were visible (ranging from shadow to dense) on the tops of both sesamoid bones and into the tendon. The edges were certainly rough and appeared to have sharpness. I can easily understand the pain resulting from these structures.

The treatment plan remain to flush the joint with HA, followed by DMSO / Cortisone applications, and icing. Stall rest for four weeks rest and brief intervals of walking. Your article "Rehabilitating Injuries to the ligaments and tendons of horses" is the closest thing I can find to a clear treatment protocol, with the exception that it is directed at Tendons and Ligaments. Understanding that the sesamoid bones are integral to the tendons/ligments (?) (attatching tissues), then I am left to wonder if this is infact the correct protocol.

From your definitions of mild, moderate, and severe, it is difficult to state which is the case as the bone spur does not seem to fit any of the definitions. Both bone spurs are measured at approx. 3/8" in length, vertical and on the inside face of the tendon. Including the side view, it would appear that the bone spur actually is inside the tendon and growing vertically. Tough to say without having seen a normal physical specimen.

So, I an wondering then, is the protocol in the mentioned rehab sufficiently accurate for sesamoid bone spur? Also, in researching this subject, it sounds as if diet and specifically mineral balance is a factor? At what point are bone spurs permanent? Do they go way or just stay there? It seems to the me that there is some form of staging to the whole bone spur development / treatment process. Would it be too much to identify this, or perhaps you can refer me to a link with more information. Lastly, does the treatment plan (such as it is thus far) sound reasonable to you?

Thanks once again.. Ray.
Moderator:
DrO

Posted on Monday, Nov 28, 2005 - 6:35 am:

Ray, I cannot make specific recommendations for your horse without an examination, And even with a firm diagnosis I can only give you general principles that you and your vet must apply to your particular situation.

If I understand your descriptions correctly these spurs are called enthesiophyes and represent calcification of the attaching suspensory ligaments. They are permanant and, I repeat, the radiographic changes you see are not likely to be responsible for causing the pain at least not in the way I think you mean: they don't actually "poke" anything. It is the trauma and the inflammation that occurs with work that causes the pain, the calcification is the end-stage response of this trauma and inflammation. The calcification does represent a weakness however that in more likely to be reinjured. There is not a staging/treatment protocol for such enthesiophytes because they don't correlate with the degree of weakness present.

Assuming it is a lameness associated with the sesamoid/suspensory apparatus there seems to be two possibilities here that require completely different therapeutic approaches:
1) is there an acute injury to the suspensory or that requires enforced rest to get complete healing, as you read about in the article you reference.
2) is there a chronic weakness that has healed as well at it is going to that has to be managed with controlled work and anti-inflammatories more like is described in the article on Sesamoiditis I reference above.

I don't see the information needed to answer this question clearly or even to localize to this region. That you have only 7 clear weeks of history it complicates such an assessment. Diet is a unlikely cause though certainly early malnutrition can contribute to such a problem. Before proceeding I would want a localization done by your vet and ultrasound done by a qualified ultrasonographer. This should generate enough information to accurately dignose, prognose, and possibly treat the problem.
DrO
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