This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Upper Front Limb » Diseases of the Upper Front Limb topics not covered above »
  Discussion on Return to work after shoulder injury
Author Message
Member:
heidih

Posted on Wednesday, Aug 26, 2009 - 9:12 am:

Hi Dr. O and all,

It's been a while since I've needed any advice. Hopefully someone has some experience with what I'm working with here.

Just over 2 weeks ago my 11 YO Arab mare was either badly kicked or ran into something during a wickedly bad storm here. There's no evidence that anything blew into the pasture. The barn owner tried to get out to bring the horses in, but they were running and lightning started striking nearby and she gave up rather than get herself hurt. After the storm was over, she brought the group up to their night paddock and noticed that my mare's fly sheet was torn (not an uncommon occurance) but she didn't see any obvious injuries, no cuts and she didn't appear to be limping. She left me a message at home about what happened. I wasn't worried and didn't go out that night.

The next night I went out to the barn and brought my mare in. She trotted up to me like she normally does. No obvious limping, just a tear in the shoulder area of her fly sheet. I took her into the barn to work her. After I put her on cross ties and pulled her fly sheet off, I looked her over and still didn't see any obvious injury except a minor straight scratch at about the area where the fly sheet was torn. Just a surface scratch, it really didn't look like it had even bled. I walked away from her to get something out of my tack box and then walked back to her. That's when I noticed the swelling. She had a small fluid "pouch" between her front legs and a small bump on her shoulder. The bump was located low on the shoulder, near where the breast, top of the leg and bottom of the shoulder meet. She had some heat and swelling. On the lunge line she was slightly dragging the toe on that foot (left front). She wasn't head bobbing at the walk or trot.

I put a call in to the vet and asked her opinion. Since I had bute and she was due out later that week for another issue, she recommended cold hosing, bute and rest until she was out to do a good examination. The bute took down most of the swelling, except for what appeared to be a fluid pocket. By the next day my mare was showing no lameness. She was going nuts in the stall (which is normal for her) and was turned, with vet permission in a very small paddock. She is normally out 24/7. She's was left out in the paddock with a quiet old gelding until the vet came out. I had stopped the bute after 72 hours since I didn't feel any more heat and she wasn't acting sore. She did still seem to have the fluid pocket, but it didn't seem to bother her. I continued with the rest and cold hosing.

Several days later the vet was out. She palpated the area and recommended a soft tissue ultrasound. She also watched her move on the lunge line and did a flex test and judged her to be a mild 1 on the lameness scale, with a reluctance to stretch her LF to it's full forward position. Upon ultrasounding, she found a large area of edema throughout the lower shoulder and breast area. There were small (dime size and smaller) pockets of fluid throughout. No evidence of muscle tear or of abscess. What I had thought was a larger fluid pocket was actually a fairly homogeneous area of edema. She advised resuming the bute for another week and rubbing in Surpass 2x a day for 3 days and 1x a day until gone, along with Cold hosing, with some pressure from a nozzle to help the edema break up prior to rubbing in the Surpass.

I followed these instructions and the edema has cleared up.

My questions are coming because I haven't been able to talk with her on the phone. We've played some phone tag, and now she's out of town for a couple of days, she'll be back next Monday and I'm just curious.

Near the lower end of the shoulder, likely where the injury occured, there seems to be a depression in the muscle. Could some of the muscle have died or been pushed out of place as a result of the impact? I asked about Sweeney when the vet originally came out and she said this injury is too low and not presenting correctly for Sweeney. The depression is about about 2 inches around at about the top of the forearm. I'll try to take some pictures tonight so you all can see what I'm talking about.

Also, if it is a muscle injury, can muscle repair itself and fill in a void?

Finally, with all of the edema and swelling gone, what is the best way to start her back to work? I normally drive her with a light weight Jerald Jog cart, we usually go out on trails with mild hills and around farm fields. My harness breast collar sits way above the injury site. I physically cannot ride any more due to a back injury. Is it OK to start with light driving (at a walk) or should I start on a lunge line. I guess I worry a bit at putting her on circles for a shoulder injury.

This Mare is well muscled. We've been training fairly hard in driving with plans eventually to do Combined Driving. We've done several Pleasure Shows this year. I had to cancel our last show of the year due to this injury, but she was in great shape 2 weeks ago when this injury happened.

Here are a couple of pics. showing her conditioning level.


by the watertrot
Member:
heidih

Posted on Friday, Aug 28, 2009 - 6:59 pm:

Hello again,

I'm guessing that somehow my original post was overlooked. I've been offline for a couple of days and didn't check email so I didn't notice.

I do have an update. I did get a call back from my vet late this afternoon with a recommendation for 2 more weeks off work with a follow-up ultrasound at around the 2 week mark to verify whether there is a muscle tear or not and at that point determine a rehab program. Do you concur? If there is a tear in the Bicep how much healing time are we talking?

I was able to get a couple of half way decent pictures. The first shows the depression I'm seeing. The 2nd shows the Lump at the bottom of the depression. I put a red dot next to the lump on the picture to help clarify.

shoulder
lump
Moderator:
DrO

Posted on Sunday, Aug 30, 2009 - 3:38 pm:

Hello Heidi,
I have been traveling the past three days, actually doing some primitive horse camping back in the boonies and did not have any access. But let's see if we can get you back on track.

First let me say that your "could it be" questions can be all answered yes but what this might have to do with your horse is hard to say. All things considered I think it more likely that you are seeing the swelling resolve irregularly causing dimpling but I am only guessing as the photo does not answer that question. Generally just a good palpation can answer many of these questions.

If the muscle were torn I would have expected more lameness than you describe. If a muscle is torn, it is the degree of tearing that will determine how long it takes to heal. As your veterinarian has examined the horse and I have not, I think following the veterinarians advice best.
DrO
Member:
heidih

Posted on Friday, Sep 18, 2009 - 10:46 am:

Hi Dr. O,

Just a follow up. It's been almost 6 weeks since the original injury to my mare's shoulder. Yesterday was the follow up ultrasound. I thought I'd let you know what the final diagnosis was. And I'd like to get the information here in case anyone else has a situation like mine.

She had a partial thickness tear of the biceps muscle. At this point she has some good healing of the tear. The ultrasound pictures were interesting. You can see the straight muscle fibers around and underneath the torn area and then right over the tear you see swirls of scar tissue (it almost looks like the large storm on Jupiter). Where the swirls are on the ultrasound, she has an area on the front of her shoulder that feels like a rope of scar tissue about an inch in diameter running abut 6 inches long. Below and behind that area on the shoulder she has some atrophy of the muscle (the indented area I was worried about in my above post. My vet (who works with Wisconsin Equine Clinic over a large area in SE Wisconsin) says she's never seen a muscle tear quite like this one, that didn't have the lameness and pain she'd expect to see in a tear like this. She also didn't expect to see as much healing this quickly with a tear. My mare is still showing no pain and has no lameness at all on the lunge line.

I have a rehab plan of

Week 1: 10 minutes of walk a day, 3-4 days a week - hitched to the lightweight training cart. as long as no pain or heat are found, proceed as follows.

Week 2-30 days: 15 minutes of walking a day (3-4 days a week), hitched - working up to 60 minutes of walking a day while hitched, by the end of 30 days. if no pain or swelling, can add trot work after 30 days.

Luckily where I board backs up to miles of trails that I can drive with the cart, so I won't be trapped in an arena for the walking part of the rehab. By the time we're working up the the trot work, it may be dark enough during the week that we're stuck indoors but we should be able to get out on the weekend.
Moderator:
DrO

Posted on Friday, Sep 18, 2009 - 7:39 pm:

Thanks for the update Heidi. I would have thought two weeks of hand walking before hitching to a cart but if the vet thinks this is suitable she is making the decision from more information than I have.
DrO
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC