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  Discussion on Tendon sheath infection
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Member:
equinkel

Posted on Saturday, Jun 5, 2010 - 1:41 pm:

About 10 days ago (thur) I pulled my horse from the stall and noticed he was stiff and had a puncture wound on the left hind pasturn. It was slightly bleeding but didn't look like it was going to be anything major. It was a very thin slice (small steak knife size). We started him on bute and SMZ tablets, by Sat, 2 days later, he was 3 leg lame and the leg was really swollen. We had the vet come. He said we were dealing with an infected tendon sheath. He treated by tapping the tendon sheat, draining, and injecting antibiotics. Started a catheder, Gentamicin, ceftiflex, banamine. Wrapped the leg. The cultures came back yesterday and it was determined to be negative staff. It's officially been 7 days since the vet 1st checked and diagnosed. When the vet 1st made his diagnosis he was saying that a lot of horses remain permanently crippled from the this. The vet said the number one priority is to keep him moving b/c otherwise adhesions form. Today he is looking much better, the swelling is way down. He is sound enough at the walk to ride him for 1/2 hour for movement. The wound is still draining quite a lot. Based on other horses you have seen with this condition what are the changes of my horse coming out of this sound? Does the treatment sound like the right plan to you? Would you be concerned that the wound is still draining a lot even though the leg is looking much better?
Member:
vickiann

Posted on Saturday, Jun 5, 2010 - 8:16 pm:

This is a pretty serious injury.

A horse of mine had the tendon sheath punctured by a wild animal bite and developed cellulitis, which required extreme antibiotics with IV gentymicin alternating with Penicillin G through a port in the neck.

Very scary stuff and challenging for the care-giver..

My horse came out just fine. I followed what I was told to do and hope that you will have similarly good luck.

Keep us informed as this progresses.
Member:
equinkel

Posted on Sunday, Jun 6, 2010 - 9:50 am:

Vicki- Thanks for sharing your story. It's nice to hear a happy ending. How long did it take before your horse was sound? How bad did the infection get and how long did you administer the drugs?
Member:
vickiann

Posted on Sunday, Jun 6, 2010 - 2:44 pm:

Username: vickiann

Posted on Sunday, Jun 6, 2010 - 7:42 pm:

Hello equinekel,
A infected tendon sheath that began extensive treatment within 3 days of the injury that has responded well has a fair to good prognosis but may require surgery down the line to remove adhesions. The treatment plan sounds Ok, though I would be hand walking rather than riding. Not seeing the drainage I really cannot decide if this is bad or not. But what I know is bad is when a wound needs to drain and can't so keep encouraging it until this heals from the inside out.
DrO
Member:
equinkel

Posted on Sunday, Jun 6, 2010 - 9:15 pm:

Dr O, I'm wondering if the lameness I'm seeing is from the staff infection or the possible adhesions. Today was the first day he was slightly more sore then the day before. Once I get him moving his walk is much more fluid but as soon as I stop him for a minute or two he takes a couple really off steps and then walks out of it again. The swelling is gradually going down more each day. The majority of the swelling is to the inside of the fetlock where it is still very sore to the touch. The wound is still draining more each day. The vet said to move him around as much as possible, even trotting if he's willing, to keep any adhesions from forming. What are your thoughts on this? Would you suspect the lameness is from the infection or adhesions?
Moderator:
DrO

Posted on Monday, Jun 7, 2010 - 7:45 am:

Hello equinkel,
This is no time to conjecture based on incomplete information, increasing lameness at this point should be attended to promptly by your veterinarian.

Movement is a two edge sword in this disease process: it helps keep fibrin strands from forming adhesions by breaking them apart as they form and while fragile, but motion helps spread infection around and therefore makes clearing the infection more difficult. So it is a balancing act that has many variable factors to decide where the fulcrum should lie. Some of those factors would be:
1) where in the disease process you are
2) how well ventral drainage is established
3) how sensitive is the infection to your antibiotic
4) how aggressive the ongoing treatment is.
DrO
Member:
equinkel

Posted on Monday, Jun 7, 2010 - 10:30 pm:

Dr O, My horse was much better today. He looked totally sound at the walk and he only took one stiff step out of the stall. Swelling is down 20% from last night but he still has a significant amount of swelling in the inside pasturn. He is a lot less sore to the touch on that area. The wound drained quite a bit and the wound itself looked smaller and tighter. I called the vet b/c I only have one more dose of the ceftiflex. He said it would probably be ok to stop the anitbiotics but he said he couldn't be sure without looking at it. My gut tells me there is still infection in there b/c before I wrapped I put a little pressure by the wound and a small amount of thick cloudy pus came out. My vet can't make it out until wed. What is your experience with this? Would you keep giving the antibiotics?
Moderator:
DrO

Posted on Tuesday, Jun 8, 2010 - 6:19 pm:

If the tendon sheath is still draining or there is any doubt of whether the infection is cleared and reinfection possible the antibiotic should be continued.
DrO
Member:
equinkel

Posted on Tuesday, Jun 8, 2010 - 9:59 pm:

After speaking with my vet he decided it would be ok to get off the antibiotics. I don't think all the infection is gone but the vet said he didn't feel like the i'm ceftiflex was necessary. He said if he digresses at all to contact right away. My horse was doing better again today.
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