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 » Muscle & Tendon Diseases » Muscle & Tendon Diseases not covered above »
  Discussion on Tendon Adhesions
Author Message
New Member:
Terip

Posted on Tuesday, Sep 20, 2005 - 5:34 pm:

My 4 year old Morgan mare has recently been diagnosed, via ultrasound, with adhesions on her common digital extensor tendon at the knee. She evidently had an injury some time before I acquired her as this spot has swollen off and on and I'd had it x-rayed some months ago. At that time the vet told he didn't see anything but if it kept happening I could get an ultrasound. A couple of months ago she was running around and aggravated it worse than ever. It was the first time I'd ever seen her limp and the swelling was twice what I'd seen.

I took her to a different vet for the ultrasound, and he prescribed bute for the swelling (I also use an ice pack), Glucosamine/ChonDrOitin/MSM supplement. He said I could try to keep her still or take her home and treat her like a horse, continue with her training and "see what happens." Her training is very light, beginning under saddle training and ponying sessions on the trail, a flat trail at that. The vet also said the adhesions could be removed arthrosopically but would more than likely return so would be a waste of money.

I thought I would be able to find something more about this online or in books but have found very little and nothing about prognosis or treatment. All I've seen is that you want "to prevent adhesions which cause permanent lameness". It's a bit late for that. Any} info would be greatly appreciated. I would particularly like your opinion on having them removed, good or bad idea?

Teri
Moderator:
DrO

Posted on Wednesday, Sep 21, 2005 - 6:30 am:

Welcome Teri,
Though trauma and/or laceration of the extensor tendons is a common injury I have neither have I seen nor can I find another case of an adhesions of the extensor tendons causing chronic lameness. But that does not mean there is not a solution to your problem. In cases where chronic infection has gotten into the common extensor tendon sheaths, they simply remove the infected part of the tendon with a good prognosis of return to soundness:

Vet Surg. 2004 Mar-Apr;33(2):107-11.
Treatment of septic common digital extensor tenosynovitis by complete resection in seven horses.
Booth TM, Abbot J, Clements A, Singer ER, Clegg PD.
Royal (Dick) School of Veterinary Studies, Large Animal Hospital, University of Edinburgh, Roslin Midlothian, Scotland. tbooth@staffmail.ed.ac.uk

OBJECTIVE: To describe and evaluate a technique for radical resection of the entire intrathecal component of the common digital extensor tendon (CDET) in horses. STUDY DESIGN: Prospective clinical study. ANIMALS OR SAMPLE POPULATION: Seven client-owned horses. METHODS: Seven horses with wounds that resulted in septic tenosynovitis of the CDET sheath were treated by complete surgical resection of the affected tendon and ablation of the tendon sheath; 5 had previous surgery that was unsuccessful. Time from initial injury to complete resection was 1-22 weeks. In 6 horses, the wound was closed primarily using a closed suction (4 horses), penrose (1), or passive open drainage system (1). In 1 horse, the surgical wound healed by second intention. All horses had postoperative bandaging, antibiotic administration, and physiotherapy. RESULTS: Surgical wounds healed primarily in 6 horses and by second intention in 1 horse. Follow-up (mean, 26.4 months; range, 18-38 months) was available for 6 horses; all returned to their athletic performance level without lameness or gait abnormality. CONCLUSIONS: Complete resection of the CDET was an effective surgical technique for management of chronic septic tenosynovitis. CLINICAL RELEVANCE: Horses with infection of the CDET and its sheath may be returned to long-term soundness without gait abnormality after radical resection.

My biggest concern Teri is if the diagnosis is correct but if it is your horse can be made sound.
DrO
New Member:
Terip

Posted on Wednesday, Sep 21, 2005 - 6:00 pm:

Thanks Dr. O,
I do have a photo from the ultrasound if you would like to take a look. If it is not adhesions what type of other things could it be? The vet said there is a lot of fluid, and I think maybe the sheath is "stretched" so that it's always filled with fluid. Anyway, the swelling never goes completely down but it is not hot nor appears painful. I can feel a thickening of the tendon as well. Will the fluid cause further damage. Should I be trying to wrap the leg or something to get rid of it, or can I ignore it unless it swells more?

Assuming the diagnosis is correct, I have heard it said that one could exercise the horse in order to detach the adhesions. It seems to me that to do so could cause further injury, depending on the size of the adhesions.

Other than the surgery, which would be something I'd have to save up for, what can I do?

Teri
Moderator:
DrO

Posted on Thursday, Sep 22, 2005 - 7:44 am:

I tell you Terry, there is nothing harder than trying to make a judgement from a static ultrasound. It looses 90% of the character by not being able to move it around seeing the adjacent structures. Certainly post it and we will see, just don't expect much judgement.

The fluid can cause further problems and if acute should be addressed with antiinflammatories and pressure wrapping.

I really cannot help much with therapy Teri, I don't have a lot of confidence that this is the only thing going on. If adhesions are the only problem, it might be possible to break down newly formed adhesions then with ongoing exercise prevent them from reforming. Let me ask you is there any reduced flexion in the knee or ankle?
DrO
New Member:
Terip

Posted on Thursday, Sep 22, 2005 - 10:28 am:

No, there does not appear to be any reduced flexion. And no lameness now, however, occasionally she'll make a movement that makes me think she's favoring that leg when she turns her front end. I think she's still recovering from the last episode. I'll have to scan the ultrasound and post it later.

Thanks,

Teri
Moderator:
DrO

Posted on Friday, Sep 23, 2005 - 8:02 am:

Teri, in order for the leg to flex, the extensors have to slide smoothly through there sheaths. Since the motion of the tendon is not impeded how can there be an adhesion? Perhaps the recent flare up was when it was torn? Was there limited flexion before?
DrO
New Member:
Terip

Posted on Friday, Sep 23, 2005 - 10:42 am:

Well that certainly makes sense. Shouldn't my vet know all this though? I took her to a veterinary hospital that is also a teaching facility so I should think they aren't idiots. It could get pretty pricey hauling from one vet to another and having the same tests done. I am thinking of having a local mobile vet come do another lameness exam, but honestly I trust the hospital I took her too more. I guess I need to do whatever it takes though.

So in your opinion, where do I go from here and what should we be looking for? What's the best way to test the amount of flexion? She doesn't try to pull away when getting her hooves trimmed and her joints bend all the way if I bend them. She doesn't seem uncomfortable with that and it didn't cause a limp after the vet did that and held it a while. I haven't noticed any problems there.

Teri
Moderator:
DrO

Posted on Saturday, Sep 24, 2005 - 10:33 am:

Well, yes and it makes me wonder what am I not understanding about this case, after all they are sure to have a better picture. You need to address these questions to the clinicians who actually saw the horse for the answers to these questions.

But the bottom line is if you have a focal lesion in the CDE tendon you can remove it and the horse has a very good chance of coming sound.
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