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  Discussion on Extensor Tendon Injury Over Knee
Author Message
New Member:
lwalters

Posted on Wednesday, Feb 20, 2008 - 10:09 pm:

Hello, this is a first time posting for me so please bear with me as I figure things out.

I've just taken over the care of a mare that suffered a kick to her left knee about 4-5 months ago. There was initially quite a lot of swelling and over the months she's had a number of problems including a bad reaction to antibiotics. Lots of time spent with the vet. Anyway, the mare still has quite a lot of fluid on the joint. Topical DMSO and oral bute haven't helped. The vet drained the fluid 10 days ago and applied a bandage that was removed after 5 days. The knee looked good after the bandage was removed but it had refilled with fluid within two days. It is warm to the touch.
The vet believes that damage to the extensor tendon was originally missed and that she's now developed tendonitis. They believe that the damaged tendon sheath is continuing to excrete fliud into the joint. She is only slightly off on the leg. They have proposed surgery to remove the tendon sheath. They indicate that the prognosis following this surgery is good. There is not a vet in my area that does this surgery so she would have to be trailered and initially rehabed out of town making this surgery an even bigger issue to deal with.

Has anyone had any experience with this type of injury? Any thoughts on a more conservative approach to treatment? Anyone had experience with this type of surgery?

The mare is a 15 year old TB and has been a A-circuit jumper until a year ago.

I'd appreciate any and all thoughts you'd be willing to share.
Moderator:
DrO

Posted on Thursday, Feb 21, 2008 - 6:06 am:

Hello Laurel,
You may be describing a "carpal hygroma" but the communication with the joint capsule is a bit of a complication: how sure are they of this? It is not unheard of.

An aggressive backyard veterinary surgeon could attack a uncomplicated hygroma with a little help but if there is joint involvement a sterile surgical field a must. To read more about diagnosis, differentials, and treatment of these type swellings see the hygroma subtopic of Diseases of Horses » Lameness » Diseases of the Upper Front Limb » Overview of Lameness of the Knee (Carpus).
DrO
New Member:
lwalters

Posted on Thursday, Feb 21, 2008 - 9:45 pm:

Thanks Dr. O. The vets seem pretty convinced that there is no joint involvement - thankfully. I've read the articles you suggested but I'm still not certain I understand what aggressively treating a hygroma entails. Is there other reading that you could refer me to? Should putting a drain in be considered?
Member:
dianes

Posted on Tuesday, Feb 26, 2008 - 11:53 am:

Hi,Dr. O,

Boy, this is quite a coincidence, because I was going to write today about a gelding with a torn tendon sheath. Perhaps this thread can kill two birds with one stone.

Laurel's post sounds familiar. I'm writing about a knee injury that happened while this gelding was stalled. When he went out to field the next morning, his knee was very swollen and he was lame.
Vet's diagnosis was a ruptured tendon sheath. The skin was not torn and there was no infection in the joint. The swelling was drained and rest was prescribed.
Swelling again accumulated and it was drained again.
When it swelled again, a second opinion was sought and the second vet drained and injected steroids 7 times over a period of about a year, possibly 15 months.
However, this knee continues to swell on what now is a predictable monthly basis, gets better when drained, then reswells.
The question is, is this a lifelong sentence? Both vets have expressed the idea that surgery outcomes for this problem are fraught with problems and neither one feels comfortable advising that course. Could the surgical outcomes be worse than draining this knee monthly for conceivably another 15 years?????
Do you happen to know of another vet in this area (Idaho) who specializes in this type of problem and who might give a third opinion for the horse?
Thank you for your thoughts.
Moderator:
DrO

Posted on Wednesday, Feb 27, 2008 - 7:00 am:

Diane, back up one level and go ahead and start a new discussion. Important to include is exactly where this fluid is coming from.
DrO
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