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Discussion on Check Ligament Injury?
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Member:
canter
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Posted on Friday, Jun 4, 2010 - 2:55 pm:
Hi DrO,
On Monday, I rode my mare and she was sound. However, when I got off and was brushing her down, I noticed a very slight swelling and thickening of the tendons on her RF, about 1 inch below the knee, more to the outside of the leg than right behind the cannon bone. The swelling itself was about 1/2 the size of an average thumb in length and only slightly noticable in terms of thickness. Worried about a major tendon tear, I cold hosed, buted, wrapped and pulticed and have done so since Monday. Since then, she remains sound and the swelling has decreased a bit, particularly after the wraps are removed. I have been turning her out as she tends to be more quiet in the pasture than alone in a stall, where she will, if left there too long, spin, pace and rear.
I had the vet out this morning and the ultrasound showed nothing on the two major tendons running down behind the cannon bone. He diagnosed a minor sprain to the check ligament and recommended I keep treating as I have been for at least the next week (he did not see any tears/lesions on the check ligament). If the swelling is gone, I can start her back to work in 1 week.
As I read the info here on HA, I'm a bit confused:
~Shouldn't an injury to ANY of the tendons/ligaments in this area of the leg, incl the check ligament result in lameness?
~Are we being a bit optimistic for only another week or 2 off? According to what I have read here, we're talking months of time off...or is the months of time off only for when there is visible damage on the ultrasound?
Sparkles is the perfect example why everyone should have at least 1 horse in reserve...she manages to hurt herself every year at about this time. I am 1 week away from what was going to be our first show of 2010. That's obviously out of the question now, regardless of whether or not the swelling disappears tomorrow or late next week - I just wouldn't push her like that. I think she is quite pleased with herself.
Any thoughts would be greatly appreciated
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Moderator:
DrO
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Posted on Sunday, Jun 6, 2010 - 7:24 pm:
Hello CFran,
Taking your questions in order:
1) I don't know about "any" injury but a sprain of the check ligament should have lameness as a symptom. After all minor sprains of the ICL without remarkable swelling can cause lameness. Without lesions on the ligament this could be a strain of some minor subq connective tissue, a broken small blood vessel, blunt trauma, etc...
2) That depends on the diagnosis and don't see ICL as that likely based on the information you have posted.
DrO
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Member:
canter
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Posted on Monday, Jun 7, 2010 - 10:03 am:
Hmmm, now I'm really confused! From what you're telling me, DrO, is that this is likely a very minor injury (the good news), but unfortunately, the diagnosis is still in question (the bad news).
I have not checked her for lameness at all since the injury occurred, so maybe it's time to do that. I didn't want to put any strain on any injured tissue until I had a diagnosis. Certainly, out in her little turnout area, she appears sound at walk & the little trot I have seen.
The swelling seemed down a bit on Saturday, but I couldn't tell for sure yesterday, which means it was probably the same.
One thing I forgot to mention in my initial post, DrO is that she is not sensitive to palpation of any of the tendon/ligaments in the injured leg. She didn't react immedieately after I first noticed it, nor did she react when the vet really poked & prodded.
Anyway, I'll continue to treat as prescribed and see what happens.
Thanks so much, DrO.
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Moderator:
DrO
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Posted on Monday, Jun 7, 2010 - 7:09 pm:
Keep us appraised.
DrO
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Member:
canter
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Posted on Tuesday, Jun 8, 2010 - 8:26 am:
Will do. As of the cold hosing this a.m., the almost thumb size bump is just about gone - you'd really have to look hard to see it. There is some thickening in the suspensory ( I think that is the correct name for it) compared to the other leg, but again, you'd have to look hard to notice.
It was too wet out to put her on a lunge line to check for lameness, but last night she gave a few trot steps after treatment and she looked fine.
As always, I will err on the side of caution - that has always served us both well - and continue to treat & monitor progress.
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Member:
canter
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Posted on Wednesday, Jul 7, 2010 - 1:52 pm:
Update: Had the vet out an hour ago because the swelling has changed in appearance and stubbornly refuses to resolve. It appears along a larger surface area and has changed shape. The vet ultrasounded again, and is more convinced that it is the check ligament. Again, no lesions or tears visible, but where it attaches to the suspensory (I hope I have the right tendon), on ultrasound, I can only describe it as a bit lumpy, vs what it looks like on the other leg. Horse does not respond to palpation, no heat and she remains sound. I had him watch her trot both on the straightaway and on a longe line, both directions, in arena footing. He did a flexion test as well, and flexed her to feel how everything moves under his hands. All normal.
He has given me the go ahead to slowly put her back to work, starting with 5 minutes of walking/day under saddle, and building up over the next month, cold hosing after work and stopping immediately if she shows any discomfort or lameness.
Despite what seems to be good news, I don't know what to do. The fact that she still is swollen makes me hesitate to make her work, even slowly. Yet she has not shown 1 lame step throughout this whole process. I understand exercise is neccessary to help the healing process and strenghthen the tissue, but don't like that the swelling has changed and not resolved more.
I have poured over the articles, but nothing seems to quite fit.
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Member:
scooter
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Posted on Wednesday, Jul 7, 2010 - 7:25 pm:
Boy Fran that is a predicament, when Flash bowed her tendon she didn't palpate sore either. Not saying she has a bowed tendon! I wonder if it is possible to have an injury US doesn't pick up, since she is sound tho it does make you wonder . What kind of swelling is it? hard, soft, squishy? How has the swelling changed?
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Member:
canter
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Posted on Thursday, Jul 8, 2010 - 7:11 am:
Hi Diane,
When I first noticed the swelling, it was about the size of a thumb, protruding out from the outside of the major structures behind the leg (I can never keep the names of the 2 tendons straight back there). Within 2 weeks, it had subsided quite a bit with treatment to barely noticable. If you looked at her leg straight on from the front or back, you'd have to look quite close to notice anything. From the side, it looked like the spaces between the tendons had filled in. Now, it's longer and wider. Throughout, it's been quite hard, not squishy at all. The vet thought that it is now really just a cosmetic issue, as long as I'm careful with putting her back to work, she should be fine.
So, last night I split the difference, so to speak, on beginning her rehab. Instead of walking under saddle, I hand walked. Don't know if it makes a difference, but I felt better about it!. Unfortunately, I forgot to feel for heat until after I had cold hosed and massaged with Absorbine...will have to be more diligent tonight. Either way, she appeared no worse for the wear...just a tad annoyed that I actually made her do something for the first time in 6 weeks.
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Member:
rtrotter
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Posted on Thursday, Jul 8, 2010 - 7:38 am:
Hmmm,
Fran How long have you been using Absorbine, do you cut it with water or use it straight. I have had horses get a reaction to Absorbine in the past, even though its considered to be a leg brace and should not bother them.
The fact that the swelling seems to be getting larger, but she is not lame, nor responsive to palpation makes me lean toward a reaction of some type to something especially after 6 weeks of basically doing nothing.
Rachelle
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Moderator:
DrO
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Posted on Thursday, Jul 8, 2010 - 7:59 am:
Fran my first post above continues to answer your ongoing questions and would agree with your veterinarians recommendations for preceeding cautiously.
DrO
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Member:
canter
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Posted on Thursday, Jul 8, 2010 - 12:52 pm:
Thanks, DrO. If this is damage to a small connective structure, would it not show on the ultrasound? Or could that structure be hidden / deep behind the suspensory or DDFT thus not visible?
Rachelle, I've used the Absorbine, maybe 3 or 4 times. I am using it straight from the bottle but this is definitely not a reaction to that. This whole thing started long before I started using it. Because my mare is a grey, it's easy to tell that the skin below is not inflammed or bothered. The only reason why I am using it is because a friend is convinced that massage will cure all ills...vet gave the OK yesterday to use, but agreed that it's not likely to help, but won't hurt. Basically, I'm getting my friend off my back and because I feel relatively helpless, massaging the area makes me feel that at least I'm doing SOMETHING...silly...I know!
Will post back if there is any change. Hopefully in a month or so, I'll be able to close out the thread with Sparkles and I being back in full training.
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Moderator:
DrO
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Posted on Thursday, Jul 8, 2010 - 6:22 pm:
Since you have a focal swelling and it has not shown up on ultrasound I guess it is not evident on ultrasound and I find it plausible.
DrO
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Member:
rtrotter
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Posted on Thursday, Jul 8, 2010 - 8:38 pm:
Fran,
Did you know that an old time remedy for treating curbs was to rub them for 10-20 minutes with a dried corn cob to create a blister effect or that you can get a really good blister going by massaging Palmolive dish detergent into a horses legs for 5 or 10 minutes. Within a few hours your horse has legs the size of tree trunks.
So while the Absorbine itself may not have caused a reaction, it is possible that your massaging in combination with the Absorbine could have, especially if your horse was not used to having Absorbine on her legs. Is the new swelling in the area that you are massaging? Are you massaging the whole leg?
I wish you could post a picture of this, I'd really like to see what it looks like.
Rachelle
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Member:
canter
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Posted on Friday, Jul 9, 2010 - 7:18 am:
Hi Rachelle,
I didn't do any massage with Absorbine until weeks after this started (after the vet said I could stop cold hosing, wrapping and giving bute) and based on the feel, look and skin of the swelling, I know that it is not caused (or has not changed) because of the Absorbine. I am just massaging from the knee down to the fetlock, which includes the swollen area. I'm familiar enough with skin reactions to know the difference. Since I pour the Absorbine into my hands and massage both sides down from the knee, and since the swollen area is localized to the outside of the leg, I just know it is not a reaction. And remember, the vet was just out on Wednesday and gave the whole area a very thorough going over.
I actually do have pictures, but because my computer belongs to my company, I am not authorized to load software to downsize the pix to small enough to post. Every once in a while I luck out and get one up, but it doesn't usually work. However, I did take the pix with my cell phone so perhaps they are small enough to post. I'll give it a try.
Nope, it didn't work. Anyway, Rachelle, I do appreciate your thoughts. Believe me - if it was as simple as a reaction to the rub, I'd be jumping for joy!
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