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Discussion on Biaxial bone cysts in the insertion of the collateral ligaments
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New Member:
abel
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Posted on Friday, Apr 10, 2009 - 12:06 pm:
Dr O, I'd welcome your opinions
Our homebred 12 thorobred of 12 yrs has developed 2 bone cysts in her left fore foot. This suddenly caused acute lameness in January 2009.
The MRI scan revealed biaxial bone cysts in the insertion of the collateral ligaments possibly due to desmitis (what is this?).
She has been treated with Tildren 1/3 by regional perfusion 2/3 systemic.
The next step is 6 weeks box rest with weekly injections of 'irap'
In the region of the insertion of the medial collateral ligament there is a bone cyst 7x15x15mm.
In the lateral aspect of the pedal bone the bone cyst is 7x7x15mm.
Both merge with the collateral ligament of the distal interphalangeal joint - level with the coffin joint.
The proximal collateral ligaments are normal.
The right fore foot is normal.
I'd be pleased to hear your opinion to obtain the best outcome for this highly skilled athlete.
Norma - 2nd post; 1st wrong as advised by you.
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Moderator:
DrO
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Posted on Friday, Apr 10, 2009 - 7:25 pm:
Norma, do you have the actual MRI report, posting it may be of more benefit as I am uncertain about the relation between the cysts and desmitis.
A desmitis in a inflamed ligament. Remember that ligaments connect bone to bone at the joints often forming the hinge of the joint. Often chronic desmitis does cause reactions at the insertion on the bone and while these reactions can be a bit irregular the predominant reaction is that of bone deposition with in the ligament and is called an enthesophyte. Posting the whole report may provide me with clues as to what is going on.
DrO
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New Member:
abel
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Posted on Saturday, Apr 11, 2009 - 11:50 am:
Here it is Dr O. I have the entire clinical history from the date of this lameness on Dec 8th 2008.
Many thanks for your interest and help. Norma
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New Member:
abel
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Posted on Saturday, Apr 11, 2009 - 12:10 pm:
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New Member:
abel
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Posted on Sunday, Apr 12, 2009 - 3:34 pm:
DrO, the attachment exceeds the maximum allowable upload size of 64 kilobytes so I will type the details word for word later today!I have also requested further details from my Vet.Norma}}}
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Member:
abel
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Posted on Sunday, Apr 12, 2009 - 3:55 pm:
Dr O, Is it possible to mail or fax you with the Vet Report & pictures of March 27th as I have printed these? The pictures state 'Above T1 and STIR sagittal sequences showing bone cyst in the insertion of the collateral ligament of the coffin joint. Below T1 frontal and Proton Density transverse sequences showing biaxial cysts, the lateral smaller than the medial.The lameness happened the day after 2 intensive days of Arena Polo, became transient, developing into marked lameness at walk in early January. Is previous history part of the picture? If so we've got it as home-bred. Norma
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Moderator:
DrO
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Posted on Monday, Apr 13, 2009 - 8:58 am:
I won't be able to do much with a fax but if you could email the images and report as a text document. I will see what I can do.
DrO
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Member:
abel
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Posted on Tuesday, Apr 14, 2009 - 1:33 pm:
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Member:
abel
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Posted on Tuesday, Apr 14, 2009 - 1:47 pm:
Spice was re-admitted to Donnington Grove Veterinary Surgery on Thursday 26th March 2009. The horse underwent an MRI scan which revealed biaxial bone cysts in the insertion of the collateral ligaments in the left fore foot. I have advised that this disease is likely to be caused by collateral ligament desmitis. I have advised that treatment would be difficult. Medication of the bone cyst directly by an arthroscopic approach through the coffin joint would not be possible and medication via an extra articular approach would be challenging. In the first instance I have advised that Spice should be managed with box rest for six weeks followed by six weeks turnout into a restricted paddock. The horse should have the coffin joint medicated with a course of irap injections, one weekly for approximately four weeks. The horse was treated with Tildren including one third of the dose by intravenous regional perfusion while at the Surgery. This treatment should be repeated in two to three months. The prognosis is guarded. Bruce Bladon BVM&S. Scan details to follow, Norma
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Moderator:
DrO
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Posted on Wednesday, Apr 15, 2009 - 9:45 am:
Hello Norma,
I must say this is a foreign presentation to me so I went and did some research and there has been a case reported in the literature (1998 Equine Veterinary Education V10 pg 114) and in this case of cyst and desmitis there was also an avulsion at the insertion of the collateral ligament. Unfortunately that is where information ends and supposition begins. They were uncertain if the cyst was the result or the predisposing cause of the fracture. The horse did not come sound.
Norma has pain or inflammation originating from the coffin joint (arthritis) by IA anesthesia or desmitis of the collateral ligaments seen on the MRI? Do the cysts communicate with the coffin joint?
DrO
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Member:
abel
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Posted on Sunday, Apr 26, 2009 - 10:51 am:
here is the report
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Member:
abel
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Posted on Thursday, Apr 30, 2009 - 4:39 pm:
DrO, I hope you got the e-mail with the pictures. I'll get my Vet to explain & get straight back.
What is 'IA'? Had 1st Tildren (Unlicensed in the USA - why) What are 'irap' injections? Noted she may never come sound. Then a neurectomy? Norma
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Moderator:
DrO
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Posted on Friday, May 1, 2009 - 9:38 am:
I received the information Norma but have not been able to get to it.
Concerning IRAP you will find an article on this at Diseases of Horses » Lameness » Treatment Methods » IRAP Therapy for Arthritis in Horses. Concerning neurectomy we never recommend it in cases where there are significant structural weaknesses in the foot. Neurectomy leads to overloading of those structures and there eventual total failure. For more on this see the subtopic on Neurectomy in the article Diseases of Horses » Lameness » Diseases of the Hoof » Navicular Disease / Chronic Heel Pain SynDrOme
DrO
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Member:
abel
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Posted on Sunday, May 3, 2009 - 2:17 pm:
DrO, I intend to examine all the links you've suggested so I understand more of this disease.My last question is if corrective shoeing would help the mare i.e. bar shoes on both front feet to stabilise any concussion that will occur when she's out of stable rest and into walking in hand.Norma
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Moderator:
DrO
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Posted on Monday, May 4, 2009 - 9:14 am:
I would look at corrective trimming to be making sure the horses feet are very well balanced and to ease breakover as much as possible by rolling the toe and rockering the bottom of the shoe. I don't really see the desmitis and bone loss at the attachments as a disease of concussion so much as one of abstraction: the collateral ligaments are stressed during break over and when the foot is placed on uneven ground.
DrO
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Member:
abel
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Posted on Friday, May 8, 2009 - 3:38 pm:
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Moderator:
DrO
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Posted on Monday, May 11, 2009 - 10:30 am:
Hello Norma,
Thanks for the prompt. I spent some more times with the images this morning and see clearly the areas of decreased signal intensity (bone loss) and increased signal intensity (distal ligament insertions). I do not get to read many MRI's but their description seems to follow what we see. The one problem I see is that this being a relatively recent tool it is hard to prognose based on the images but to the degree their interpretation is correct and it relates to the few cases reported in the literature they seem right on. The tiluDrOnate use is even more experimental but does have a rationale in that part of the pathology here has been bone resorption at the insertions and this drug slows this down. I do not have better suggestions than the ones you have been given and wish I had better news for you. We are getting almost weekly questions on tiluDrOnate so I am putting together an article on it that should be up later this week.
DrO
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Member:
abel
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Posted on Saturday, May 16, 2009 - 1:17 pm:
DrO, Firstly I want to thank you for your interest in this rather unusual case. In my experience most Polo Owners do not insure for Vet Fees because it is so costly. That means there are a heck of a lot of dodgy lame polo ponies that come in/out of work all thro' the season! The good news is I'm a member since 2002 and you helped me with my other horse very successfully! Even better is that Spice has MRI images from her left forefoot pedal bone fracture 3 years ago & treated by the same Vet. So we know she didn't have any tendon problems then - or bone cysts. She had 12 months off then a clear scan then re-training for Polo. She remained sound until 8th Dec 2008. So, we've got lots of info on this case. What I plan to do is take her thro' the Tildren & Irap treatment until the insurance lapses. Then consider a neurectomy with annual MRI's + Tildren & Irap as she will be uninsurable with the prognosis. But this way we can be very aware of the internal situation & if we can get 3 more years of controlled usage from her before breeding her we'd all be happy. I'd be very pleased to receive your thoughts of this as a plan. Norma
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Moderator:
DrO
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Posted on Sunday, May 17, 2009 - 9:19 am:
Neurectomy worries me when a horse is lame and has structural weaknesses such as seen at the insertions here. The lameness protects the weakness. Removing the pain without curing the weakness may be a prescription for complete rupture of a collateral ligament and such instability might require euthanasia. I don't have a accurate prognosis for this, just a concern.
DrO
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Member:
abel
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Posted on Monday, May 18, 2009 - 2:04 pm:
DrO, This is exactly what I needed to know. I can discuss this exact point with my Vet & take the time to make certain that any decision I make is made in full knowledge of the potential outcome. With the MRI scan facts we can obtain a very accurate understanding of the nature of the injury. If the animal means so much to us then to contemplate a neurectomy followed by euthanasia is very dumb when we can breed her which will give our daughter so much pleasure. I'll let you know the outcome - although I still don't fully understand how this occurred after the MRI showed full healing of the top left wing pedal fracture & a very cautious re-introduction into a less stressed polo career with fitness monitored to work, arena surface & Prof Choice SMB 2 protection? Thanks again, Norma
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Member:
dzaccheo
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Posted on Tuesday, May 19, 2009 - 2:12 am:
Hello, I do not want to be speaking out of turn as I do not fully understand the problem your horse has, but with my horse who has coffin joint arthritis and due to improper shoeing, strained his collateral ligaments, the Colleoni Rock and Roll B shoe put on a perfectly balanced hoof has brought my horse back to completely sound. It took a couple of months for the joint to calm down and I am very careful how I use my horse, but it seems almost miraculous as he was very lame before. My vetrinarian/podiatrist who has extensive experience with these shoes says he can go on another 10 years with careful management.
Like I said, I do not know if it relates to your situation, but I am eternally grateful for having my horse back, and if this could help someone else...
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Moderator:
DrO
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Posted on Tuesday, May 19, 2009 - 9:40 am:
Note we have that article up on TiluDrOnate in the Medications: Other Medication topic.
DrO
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Member:
abel
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Posted on Monday, Jun 8, 2009 - 11:41 am:
Hi Danita, Many thanks for this information as I've been looking at shoeing as a supportive way to stabilise any further stresses on the collateral ligament of this horse. So, your input on the Colleoni Rock & Roll B shoe is very welcome as is the picture of what it looks like. I'll give this to my Remedial Farrier. My only concern is that I may have to have it sent from the US to the UK - so can you let me know where you get them from? I'm grateful for this. Norma
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Member:
abel
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Posted on Monday, Jun 8, 2009 - 11:48 am:
DrO, I've printed the article for my file which I'm creating so I'm fully informed about the case when I meet Bruce, my Vet with Spice next Wednesday. She's 100% sound & I suspect pain-free just now. I'll up-date as appropriate. Thanks so much creating this web-site which is an invaluable source of shared advice for dedicated horse owners world-wide! Norma
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Member:
dzaccheo
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Posted on Tuesday, Jun 9, 2009 - 7:18 am:
Hello. I am actually in Italy and the shoe is made in Milan, however they do not have a web site. Thier phone number for colleoni is 0039 0331 201000. Hopefully someone speaks english and they can tell you if they are available in the UK or they can send them to you. The website of my vetrinarian/podiatrist who designed the shoe is www.farriery.eu. He has an article on how to fit the shoe on his site and also many other great articles.
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