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  Discussion on Diagnostic Surgery on Fetlock- Help! Should I Go Ahead
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Member:
Gillef

Posted on Saturday, Jul 16, 2005 - 10:12 am:

I would like to hear anybody elses views on the above surgery. The university vet has given me an appointment for Thursday 21st July for the above surgery on my 14 yr old PBA mare (had her since she was 3)
My own vet says "If she was my horse I would go ahead as (the university vet) is very talented and knowledgeable . Your friend (the horse) deserves every chance of a return to comfort."
The operating vet is saying he doesn't guarantee he can do anything to help but is willing to look.Radiograpphs and ultrasound of the area are described as "unremarkable" so I am assuming previously seen lesions of the flexor tendon and sesamoidean ligament have repaired.
My friend says " in her 30 years of experience vets have never been able to do anything for lame horses that time couldn't do so why waste your money and her mare (sister to my mare) is perfectly happy walking from grass to stable and stable to grass for the rest of her life"

I think that knowing the facts is always beneficial and if it was my leg I would like to leave no stone unturned. Am I being selfish putting her through the ordeal?
She initially injured this area in 2000. after a very long layoff and rehab extended by Foot and Mouth disease (every cloud has a silver lining) she returned to soundness and light work (all I ever do). At this time last year she was a joy to watch in the paddock as she integrated with my new gelding. I was concentrating on riding the new horse so she had a very light work load but was sound . In December she began to look lame and increased to almost constantly resting her rt hind leg. After resting or it or lying down she is hopping lame on it for a few steps and then gradually gets it moving.
After a re-diagnosis of tenosynovitis and 3/5 lame the tendon sheath was medicated with steroid and HA. This reduced the lameness to 2/5 . Further treatment with more steroid reduced trotting lameness to 1/5 but the postural abnormality remains. I am lucky enough to be able to observe my horses a lot in the pasture from the lounge window and I can see this girl choosing not to trot. When I ride her out for her walks and she has a little trot I can't feel her lame but I know she is not normal.
Should I go ahead with the surgery?
Gillian
Moderator:
DrO

Posted on Sunday, Jul 17, 2005 - 7:43 am:

There is a some truth that if rest alone cannot fix it there is little the surgeon can do...except give you a accurate diagnosis, treatment plan, and prognosis. Equine orthopedic surgery with the exception of a few procedures, some of which are quite spectacular, is still largely a diagnostic adventure. Of course in this area there is the possibility he will find adhesions that can be relieved. Though recurrence is common following such surgery it does not always happen.

However your decision should be made considering your goals and resources. Assuming the lameness has been accurately localized to this area, can you afford to spend the money with the guarded chance that he may be able to help you and the good chance he may at least be able to tell you what is wrong?
DrO
Member:
Gillef

Posted on Monday, Jul 18, 2005 - 4:48 am:

Thank You for your response.
It is both helpful and comforting to have a view from the "outside" which is both unbiased and educated (esp. when it echos my analysis the situation)
We will be off to the Vet College tomorrow and the surgery is planned for Thursday. I don't relish spending the next ten to fifteen years wondering if she is in unnecessary discomfort and if I am giving her the best physiotherapeutic excercise.
Gillian
Member:
Gillef

Posted on Monday, Jul 18, 2005 - 4:56 am:

Oh and yes ,the lameness was localised to this area. I had to choke back tears as we watched her rediscover her old self as she floated round on the longe line.
Gillian
Member:
Gillef

Posted on Friday, Jul 22, 2005 - 9:03 am:

Well my mare has come through the surgery OK and we have a diagnosis (never have got it by guessing) but no prognosis. She was found to have a small tear in the inter-sesamoidean ligament. I am told this is very rare and so can find no information at all about it. Cannot even find mention of its existence on the "Advisor" and only one mention via "Google". Any further suggestions on information gathering?
Moderator:
DrO

Posted on Sunday, Jul 24, 2005 - 9:24 pm:

In one study of 5 horses with multiple injuries including the intersesamoidean ligament 4 returned to soundness:

J Am Vet Med Assoc. 2001 Jul 1;219(1):82-6.
Osteitis of the axial border of the proximal sesamoid bones in horses: eight cases (1993-1999).
Dabareiner RM, Watkins JP, Carter GK, Honnas CM, Eastman T.
Department of Large Animal Medicine and Surgery, College of Veterinary Medicine, Texas A&M University, College Station, TX 77843, USA.

OBJECTIVE: To determine clinical, radiographic, and scintigraphic abnormalities in and outcome of horses with septic or nonseptic osteitis of the axial border of the proximal sesamoid bones. DESIGN: Retrospective study. ANIMALS: 8 horses. PROCEDURE: Data collected from medical records included signalment; history; horse use; severity and duration of lameness; results of perineural anesthesia, radiography, ultrasonography, and scintigraphy; and outcome following surgery. RESULTS: Five horses did not have any evidence of sepsis; the other 3 had sepsis of the metacarpophalangeal or metatarsophalangeal joint or the digital synovial sheath. All horses had a history of chronic unilateral lameness. Three of 5 horses improved after diagnostic anesthesia of the metacarpophalangeal or metatarsophalangeal joint; the other 2 improved only after diagnostic anesthesia of the digital synovial sheath. Nuclear scintigraphy was beneficial in localizing the source of the lameness to the proximal sesamoid bones in 4 horses. Arthroscopy of the palmar or plantar pouch of the joint or of the digital synovial sheath revealed intersesamoidean ligament damage and osteomalacia of the axial border of the proximal sesamoid bones in all horses. All 5 horses without sepsis and 1 horse with sepsis returned to their previous uses. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that osteitis of the axial border of the proximal sesamoid bones is a distinct entity in horses that typically is associated with inflammation of the associated metacarpointersesamoidean or metatarsointersesamoidean ligament and may be a result of sepsis or nonseptic inflammation. Arthroscopic debridement may allow horses without evidence of sepsis to return to their previous level of performance.

However much depends on the details of the damage. If the person doing the endoscopic exam cannot give you any help perhaps sending the tape of the procedure to the group above might yield useful information.
DrO}
Member:
Gillef

Posted on Friday, Jul 29, 2005 - 7:32 am:

Thank You again
I got a few more references when I SPELT it correctly. I must have been more stressed than I thought when I looked before or maybe it was a "Senior" moment!!
Getting information from the operating vet was akin to pulling teeth so I think any action like sending tapes of the procedure off anywhere would be out of the question. Apparently, over here, I am only the customer who pays the bill!!
The information I did get eventually ;Everything in the tendon sheath normal apart from the surface of intersesamoidean ligament fibrilated (?sp) Cleaned and smoothed best he could. No idea if it will help as the only similar one he had before went lame again after six months.
Any help in the finger crossing department appreciated.
Gillian
Member:
gillef

Posted on Monday, Jul 23, 2007 - 7:57 am:

Hello again from Scotland.
Just thought I would add a note about the success of the above surgery.
Leila has been sound now for 18 months and back in work since the beginning of this year.
She has never been seen to have any difficulty placing her foot flat after lying down or holding it up for the farrier since the surgery.
In view of the prognosis I was given I felt no need to rush her rehabilitation. She was left barefoot for 6 months and appeared to be comfortable with a very marked decrease in the incidences of resting her right hind and lots of short bursts physio-therapeutic exercise initiated by my bossy coloured gelding.
When re-shod in ordinary shoes she appeared to be a little less comfortable so for the next 12 months we used Aluminium raised heel eggbar shoes on her hind hooves.Over that time she returned to total normality. I began to ride her in january this year with no detrimental signs and so on the last farrier visit we used a flat eggbar shoe.She has continued with her work/fittening programme with no further problems. I plan to try her in an ordinary shoe in the autumn (only changing one thing at a time)
I now feel confident enough to pronounce the procedure a complete success as a few days ago during the picnic phase of a picnic ride with friends she chose to leave me to walk the 4 miles home! We could tell from her tracks that she had trotted calmly (seen by some dog walkers) the entire 4 mile route over very varied terrain, back the way we had come to socialise with a group of mares and foals we had passed on the way out.
Her expensive fetlock is still perfect after this escapade but my legs are really stiff!!
You could say A good result!
I am just a little surprised the Surgeon did not ask for any update on her progress. He may still be telling people it probably wont make any difference
Gillian
Member:
erika

Posted on Monday, Jul 23, 2007 - 10:04 am:

Great news, Gillian! It's nice to hear follow-ups to see how things turn out.
Member:
frances

Posted on Monday, Jul 23, 2007 - 4:29 pm:

That's wonderful! Congratulations, and I'm glad she seems to be enjoying life! She was probably miffed that you didn't ask her to join the picnic or at least offer her carrot sandwiches...
Moderator:
DrO

Posted on Tuesday, Jul 24, 2007 - 7:06 am:

That is a most excellent report, Gillief. Since your experience much more work has been published on the value of tenoscopic examination and treatment of the tissues in the flexor tendon sheath. For chronically lame horses that refer to this area, it has become a ray of hope by doing exactly what was done with your horse: clean up the adhesions and fibrilated areas. Horses that have been lame for some time with treatable lesions have a fair to good progosis following such work.
DrO
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