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  Discussion on Swollen Tendon Sheath
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New Member:
Cmitch

Posted on Sunday, Feb 13, 2005 - 7:06 pm:

My horse had an injury to his back left hind in the trailer in October 04. Was a very bad cut, right above the joint (not on it thank goodness) but required about 60 days of stall rest, and a slow return to work. After I started him back to work, I noticed a swelling on his right front leg---not hot and not painful, as he was not lame on it. I called the vet, and she said it looked like a stretched tendon sheath?? She said some horses have them when the tendon sheath gets stretched out, and it may or may not go back to normal?? I continued working him; however, since I paid a LOT of $$ for my horse, I called her back up after 30 days, and told her to come out again and look at it. She then said to be absolutely safe, I should get it ultrasounded at the horse clinic. We did, and they found some minor changes in fiber patterns, but nothing significant, they told me to continue turnout, and no riding for 30 days, which I did. Swelling always stayed the same this whole time, although seems better in the cold weather. Went back for a recheck 3 weeks later, and the fiber patterns looked more normal this time on the ultrasound, so improved, BUT when they did a lameness check, he was 1.5/5 lameness on that leg....this was really stange b/c he had never been lame this whole time, even riding him as normal (really seemed like a fluke....they jogged him on concrete, so I almost think he was afraid he would slip, b/c he was fine on the straight-away, and only lame on a tight circle on the concrete). They ended up injecting it with steroids, and told me 30 MORE DAYS OF STALL REST?? The swelling is better, 5 days after the injection, it is still slightly more swollen than the other one but a marked improvement. My regular vet seems to think that after 10 days of stall rest to let the steroids take affect, then test for lameness, and if he sound, s slow return to work. She feels that if nothing significant has shown up on the ultrasound, it is this stretched tendon sheath that many horses have???? What ar eyour thoughts? I am all for keeping a horse resting, but if the ultrasound was better, and he is sound, shouldn't he return to work. Have you ever heard of swollen tendon sheaths that do not cause problems???
Moderator:
DrO

Posted on Monday, Feb 14, 2005 - 8:30 am:

The decision to rest or not really depends on the physical exam and likely diagnosis. There are some soft tissue injuries that need to rested past the point of the return of soundness to complete the healing. Yes you can get a swollen tendon sheath that does not cause lameness. These are usually cases where the synovial lining to the sheath is traumatized but the tendon itself is not.
DrO
Member:
Cmitch

Posted on Monday, Feb 14, 2005 - 12:01 pm:

Dr. O,

Thanks for the feedback. Do you know of cases where a horse has this swelling and it does not go down, but never bothers the horse, or keeps them out of work?

Just for your information, the first ultrasound revealed mile enlargement of the proximal annular ligament, with normal fiber pattern, and the medial sesamoid bone appeared irregular at the attachment of the annular ligament, with mild changes in the fiber pattern of the superficial digital flexor tendon at the proximal extent of the digital tendon sheath and an increase in tendon sheath fluid both proximally and a tthe level of the pastern.

The second ultrasound revealedthe border of the seasamoid bones were regular at the attachment of the annular ligament and the fiber pattern of the superficial digital tendon at the proximal extent of the digital tendon sheath appeared normal.

Although it was still swollen, but a significant imrpovement on the ultrasound.... Is it possible it will just be something he lives with?

THanks,
Cindy
Moderator:
DrO

Posted on Tuesday, Feb 15, 2005 - 7:15 am:

Yes I know of such cases and this is possible but how this might relate to your case is purely hypothetical.
DrO
Member:
Cmitch

Posted on Tuesday, Feb 15, 2005 - 2:56 pm:

My vet is telling me it is just something he has and will live with, and the hospital is telling me it is an injury that will heal w/rest(even though nothing of major significance --ie a tear) was found on any of the ultrasounds. I guess I just don't know what to do. In your opinion (I understand you haven't seen the horse), given what the ultrasound says, what would you guess? Also, in the cases you have seen where the sheath is swollen and the horse works on anyway, were these older horses?

Thx,
Cindy
Moderator:
DrO

Posted on Wednesday, Feb 16, 2005 - 6:20 am:

Why your vet would send the horse to these folks and then ignore their advice is confusing. I cannot see the ultrasounds so must rely on the assessment of those who can and they are telling you the horse needs further rest. If the horse is still lame, as you state in your first post, I would continue to rest him until the horse is sound or you are sure it is not progressive.

Younger horses can also have chronically distended flexor sheaths.
DrO
Member:
Cmitch

Posted on Wednesday, Feb 16, 2005 - 7:43 pm:

Good point on the not listening part.... After reading your response, I ended up calling the clinic, and asking them what they thought of my vet coming out Friday to do a lameness test, and if he is sound, doing a recheck with them earlier than the 4 weeks they suggest.... They said if I wante dto come in earlier to see if things have changed on the ultrasound, that was fine by them....they weren't willing to change their treatment suggestion, based on just the lameness exam my vet would do. They felt 2 weeks wouldn't show that much of a change on an ultrasound, BUT I think differently, caus there was a marked improvement from the first ultrasound to the 2nd after 3 weeks, and they had let him go out and be ridden at the walk after the 1st ultrasound to the 2nd (that is really why it was especailly confusing.... 2nd ultrasound looks better than the first one, yet the treatment they prescribed was far more strict this time...) Anyway, I shall keep you posted, after the re-check- Thanks, Cindy
Member:
Dres

Posted on Wednesday, Mar 2, 2005 - 10:49 pm:

Any news on your horse Cindy?

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

Member:
Cmitch

Posted on Thursday, Mar 3, 2005 - 12:25 pm:

Well, I left him in for the 30 days. The swelling is completely gone. He is going insane, but trying to manage it. He is on Reserprine--sp??, which is a tranquilizer that works OK, but he still has crazy attacks every so often. We are going back tomorrow. My major concern is that things look fine now, but with a return to work, the sheath will become distended again. My thinking is that if it does, and he is sound, I am going to just live with it, until it presents a problem. i will wrap his legs in standing wraps after I ride him, and just watch it. Ann, have you had a similiar problem?

Dr. O, do you think my concern about it going back to being distended is valid, or would your thinking be if it looks good now, it was probably something acute that has healed?

Cindy
Member:
Dres

Posted on Thursday, Mar 3, 2005 - 12:56 pm:

Cindy I asked becus I am dealing with an interesting swelling on a 4 year old of mine... note, her leg has never really been 'clean' since a 3 day horse starting clinic I took her in as a 2 year old... she hit the round pen bars hard with her hind legs learning how to round pen (( all tho I had her wrapped )) she came out of it with swelling mostly on the left hind... I never pressured wrapped it and she was never lame on it... she was put back out to pasture to grow up...

last summer I brought her in and started light riding noticed then that the leg was still larger then the other, again not off... back to pasture for this past winter ...

She is now 4 and ready to be worked more consistently... BUT I brought her in from pasture and she is now limping at the trot, not at the walk.. and the leg is more swollen, tree truck like...

I have been keeping her in a stall now for a week, the equine dentist and vet are coming out this AM to work on some other horses, I will have my vet give me an educated guess without ultrasound what I am dealing with...

I saw your post and was curious....

thanks for responding....

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

Member:
Cmitch

Posted on Thursday, Mar 3, 2005 - 4:39 pm:

Interesting. My horse's swelling is in his Right front, and it is not at all massive. Although, I had never seen one, I thought initially maybe it was something like a "windpuff". It looks just like a pocket of fluid, not like an entire swelling of the leg, so I am not sure that your's is the same. I would definitely call a vet out, if he is lame. My guy was actually not lame at all from this EXCEPT on the one lameness exam the clinic did, which I reallyt think was a fluke. Is there any heat?
Member:
Dres

Posted on Thursday, Mar 3, 2005 - 5:40 pm:

Cindy vet and dentist just left.. yikes.. equine dentistry,,, must we really use them? the costs are almost prohibitive... anyway.. vet looked at the mare.. .. at this point it looks like a tree truck so she really could not give me an educated guess to what might be wrong... told me to sweat wrap it to get the swelling down.. a long with cold hosing and of course, take her in for an ultrasound...

Yes, there was heat Saturday when I brought her in.. has not had any since then.. but I have been cold hosing and giving her bute while stuck in the stall...

So not knowing what I am dealing with, I will keep her in the stall and treat her as if it is a tendon tear.. will take her for an ultrasound later after I regroup from the dentist visit..

Not looking forward to that trip after being stall bound, this mare is 16'3 hands tall and can be a handful on a good day..:-(

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

Moderator:
DrO

Posted on Friday, Mar 4, 2005 - 9:00 am:

Cindy, swelling can come back following reintroduction to exercise and should be aggressively managed as you try to get your horse back in work: NSAID's, cold wraps / hosing, standing wraps at night, splint boots all could be part of the management. See the articles on wrapping and cold therapy for the particulars.
DrO
Member:
Cmitch

Posted on Thursday, Mar 10, 2005 - 4:38 pm:

Ready for this one.... Went back to the clinic, tendon sheath looked better, had really responded to the steroids (at least without movement, since he was in the stall). They re-did the ultrasound. I had failed to mention in earlier posts, that throughout this process they also found a small lesion (or what they thought was a lesion) on the suspensory ligament of the same leg. It was never made to me as a big deal, so I didn't think anything of it. Well, now they are saying, the tendon sheath looks better, but he needs another 6 weeks stall rest for the suspensory "injury" they found on the ultrasound. Based on that disappointing news, I took the ultrasound to 2 VERY well known vets in the area. The first, who deals with horses in the Olympics, said that in his opinion, based on the longitudinal view of the ligament on the ultrasound, that the suspensory did not look injured, just normal wear and tear or perhaps an old injury. The second vet said the same thing--- That the measurements on the ultrasound appeared normal, normal on palpation, and the horse was not lame on it or showed any signs that it was bothering him. She also didn't see any improvement from the 3 ultrasounds, as the clinic had noted they had seen this. She said on one of the shots it appeared that the annular ligament was a bit thick, and that perhaps there was scar tissue there, makeing it difficult for all the fluids to move through, causing the swollen tendon sheath?---any thoughts on this one?

I am going back to the first vet on Tuesday for an ultrasound done by him, since his equipment is cutting edge, in hopes he can clarify this for me. My gut tells me there is nothing wrong with this horse's suspensory ligament. Dr. O, your thoughts? How is it that this clinic (well known) can see this ligament as an acute injury, and 2 other vets think it is normal changes!! So, here sits the horse, sounds as can be, in his stall. Really bothersome!
Moderator:
DrO

Posted on Friday, Mar 11, 2005 - 6:47 am:

I don't think the annular ligament actually forms a physical barrier to the movement of synovial fluid in the sheath, after all the tendon is moving through there, but certainly a thickened annular ligament can irritate the flexor structures and cause distension of the sheath.

The problem we have nowadays is lots of folks have ultrasound units but almost no one has the proper training and the daily use required to be proficient at it. Mistakes are common.
DrO
Member:
Cmitch

Posted on Wednesday, Mar 16, 2005 - 11:00 am:

Just to wrap my story up, went back for 2nd opinion/ultrasound yesterday. Horse was not found to be lame on a very thorough lameness exam, and ultrasound showed that he has dark areas in BOTH legs in the same place on the suspensory, which this vet calls "excessive muscle tissue", common and normal in horses. Soooo, the clinic should have examined both legs, and they would have seen this was not a suspensory lesion or injury. I am so glad I took the bull by the horns for the 2nd opinion, or my horse would have been stalled up another 6 weeks, and then some, since this dark area is not going to go away (it is part of him!). Message to all, if it doesn't add up or make sense, go somewhere else for an opinion. Additionally, this vet said it lokoed like they weren't 100% comfortable with the ultrasound machine, as it was new and they had several of the shots mislabeled--meaning on the clinic's they said it was a picutre of one thing, when it was really of something else. Thanks for all the time listening.... Oh, and the swollen tendon sheath (why I was there to begin with) is a wind puff--- just need to watch it and manage it. And, Dr O, the annular ligiment was only VERY slightly imflammed, I think like a 2.2, so he didn't think it should cause me worry.
Moderator:
DrO

Posted on Wednesday, Mar 16, 2005 - 7:01 pm:

AHHH..very good Cindy, somehow this is not surprising a bit.
DrO
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