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  Discussion on Swollen knee on Arabain gelding for about 15months
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Member:
dianes

Posted on Wednesday, Feb 27, 2008 - 8:51 am:

Hi, Dr. O,

Thanks for the direction. Sorry about the previous misplacement. So here we go. I'll paste my first description and then add on.

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?

In answer to your question about location, Dr. O, as you're looking at him face on, the swelling
starts slightly above the knee and is drained at its lowest point slightly below the knee. If let go too long, the inside of the knee area balloons up, too, and he can't bend his knee to walk at all. (Well, he walks, but it's bad.) They're getting about 30 to 40 ccs each time it's drained, about monthly. As to where it's coming from....I don't know. It's just fluid accumulating in that knee. Both vets said it was a ruptured tendon sheath. That's all I know.

Thanks for any thoughts, Dr. O. You're the best!
Diane
Moderator:
DrO

Posted on Wednesday, Feb 27, 2008 - 9:25 pm:

Was the knee ever radiographed? If the radiographs are clean I suspect a careful examination by a ultrasonographer is going to be needed to get a better definition of what is going on before much can be said about prognosis of a surgery.

However if it truly is a ruptured extensor sheath I would consider having this repaired and don't feel in a experienced surgeons hands this should be a problem. Depending on which extensor it is the tendon and sheath could even be removed if not repairable. If you wanted to try more conservative therapy you might try having the knee throughly emptied then pressure bandaging with cotton and a knee boot for a few months, with the hope that once stabilized and not allowed to leak, it might heal but after this much time it may have healed with the defect.
DrO
Member:
dianes

Posted on Wednesday, Feb 27, 2008 - 10:20 pm:

Hi, Dr. O,

I forgot to mention that it was ultrasounded recently and they said it was "normal." The latest approach this past week is exactly as you suggested: Long-term pressure bandaging. It's just gone on so long at this point that we're wondering if it's EVER going to improve. Kind of discouraging.
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