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Discussion on Ligament avulsion
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New Member:
Jenbk
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Posted on Sunday, Dec 11, 2005 - 9:31 pm:
I need some advice!
I took my 2 1/2 year gelding to Texas ATM for recurring lameness. He was injured as an 8 month old and I thought he was limping because of that injury. It turned out, the problem was in the other leg. The diagnosis is as follows:
Lameness exam: Grade III/V lame left front leg (baseline)
Palmar digital nerve block (LF foot) 30% improvement in lameness
Abaxial nerve block (LF foot) 80% improvement in lameness
Radiographs: increased fluid space in the left coffin joint. Small bone spurs present on distal, dorsal aspect of P2. Evidence of ligament avulsion between coffin bone and navicular bone.
Diagnosis: Coffin joint inflamation due to ligament avulsion.
Treatment: Left coffin joint was injected wiht 22 mg Hyaluroinic acid, 12 mg Vetalog, and 125 mg Amikacin. Phenylbutazone was given IV.
They told me he would likely become lame in 60-90 days and I might want to consider a neurectomy at some point.
I lunged him yesterday and he is still bobbing slightly at the trot. It has been 4 days since injection.
I ordered some Rapid Response and was thinking about getting my vet to put Chief (gelding) on Isoxphrine and also buy him a magnetic boot to place on the hoof.
How grim is this diagnosis? The vet said the injection could heal it, but probably not.
What do I do?
Jennifer in TExas}
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Moderator:
DrO
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Posted on Monday, Dec 12, 2005 - 8:41 am:
Welcome Jennifer,
The decision as to what to do depends on these 3 factors: - Your goals for riding and how does this horse figure into those goals.
- Your resources.
- The prognosis for soundness of this horse.
You say that the vet does not give the horse a better than even chance he will become sound and Rapid Response, magnets, nor isoxsuprine are not likely to improve those chances. So what are your goals and resources?
DrO
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New Member:
Jenbk
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Posted on Monday, Dec 12, 2005 - 12:35 pm:
Fortunately, I have resources to fix this horse. My husband is an ER physician. I am attached to the horse. He is my second and last foal I will ever raise. I want to use him as a 4-H horse to compete in pleasure activities like Western Pleasure, Trail and some English. He is very smart, has great conformation and has a nice rocking horse lope. I spent over $500.00 so far on just this one injury and I guess I am not looking logically at this horse. Should I take him to another vet and get a ultrasound? What can I do to get the ligament attached?
What do I do?
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New Member:
Jenbk
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Posted on Monday, Dec 12, 2005 - 1:17 pm:
I just called the vet again and told him that the horse is still lame. He is going to call in some Isoxphrine and then we will just wait until the first of the year before we do anything else. He said he is not sure what is causing the lameness. He said for me to leave the horse if he is still lame in January overnight and he will try injecting the navicular bursa and try some blocks. He says he thinks the horse is fixable and also mentioned he might could do an MRI but that would cost $1,600.00 I am so depressed. please advise.
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Member:
Dres
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Posted on Monday, Dec 12, 2005 - 3:39 pm:
Jennifer, educate me here... avulsion to me means to tear or break away.. so the ligament has torn away from the coffin bone or navicular... the bone is intact, but the ligament is not...??
I ask cus I have a gelding that has an alvusion fracture of the navicular bone... the bone has been pulled slightly away by the ligament... This was found 1 1/2 years ago... with joint injections / proper balanced hoofs / legend and tons of tender loving care he is sound most of the time....
On the first day God created horses, on the second day he painted them with SPOTS..
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Member:
Corinne
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Posted on Monday, Dec 12, 2005 - 4:28 pm:
Ann...
I try to do some research for you in my ortho books until Dr. O writes back....but I would love to share what I have learned this semester in my orthopedic injures class....
In terms of fractures of the bones there many types. They may be classified as depressed, which is when the bone is depressed, like it sounds, transverse which is a fracture across the shaft of the bone, comminuted which is when it shatters in pieces, compacted when the fracture pieces are driven into each other, spiral which results from a twisting of the bone, longitudinal, which is fracture that runs parallel to the side of the bone, and greenstick which is a combination of a displaced fracture on one side and a compacted on the other.
Avulsion fractures, as far as I can tell refer only to the tearing away of a ligaments or tendon from its bony attachment. Now the word avulsion alone also means tearing away…for example like a piece of tissue that is torn off is called avulsed.
Could it be possible....remembering that I am not a vet...that your horse, because of the mechanism of injury, had a small comminuted fracture of the navicular and the avulsion of a tendon or ligament happened at the same time and took a piece with of the bone when it avulsed? And the vet was just using the word avulsion fracture to describe both?
Mind you, I may be completely way off base and sound completely off my rocker but I felt like giving a hypothesis today.....taking a nice break from research.
Hope you find out the answer to your questions.
Take care guys,
Corinne
And good luck Jennifer with the injured horse....my prayers are with him.
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New Member:
Jenbk
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Posted on Monday, Dec 12, 2005 - 6:00 pm:
Hey Guys!
Thanks so much for writing back and offering advice. You don't know how much I am worrying about this and to see that someone cares enough to try to help me warms my heart. I think Corinne could be right about the ligament tearing away with a small piece of bone attached. The area on the x-ray looked cloudy and the vet had to double check with radiologist before he made the diagnosis. I think the vet didn't quite hit on what was making him entirely lame because he didn't go completely sound with both nerve blocks. I am just depressed. This colt had a bad injury to the other leg when he was 8 months old(it's all in an old posting under pastern injury to a yearling) and I barely got him through that. He shows so much promise and absolutely gorgeous, not to mention totally stolen my heart. I just want to know how I can make him well, if I can--- MRI? --- $1,600,00. or just wait and see. The vet said this is an unusual injury and I would like to know just what to do. Ann, how many injections do you give and what kind of trimming does the farrier do on that foot?
Thanks a lot,
Jennifer
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Member:
Dres
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Posted on Monday, Dec 12, 2005 - 7:09 pm:
Corinne, great lesson thanks... and yes, there is a piece of bone split slightly off the navicular.. the way Jack Snyder explained it to me was that the tendon or was it a ligament , I have forgotten, pulled a piece of bone away from the original bone and that they do heal... not always sound but pasture sound forsure...
I will be getting new x rays soon to see where all this has gone in the past year +..
Jennifer, first my horse was put in Natural Balance shoes... and was reshod every 4 weeks like clock work.. he was then put in a bar shoe for support and shod every 4 weeks... he now is in reg. shoes and we are up to every 5 weeks for a reset... I have had his coffin joint injected two times... 11 months apart... and he gets Legend IV every 6 weeks now...
Everyday he is sound and I get to ride him I am thankful.. like you, he is a prize horse and sadly just so much has happened to him.. his other hoof is a mess too.. a totally different issue tho... we have discussed it extensor processor fracture.. 
Don't give up .. .. best advice I can give.... IF IT IS TO HEAL TIME WILL TELL... IF ITS NOT TO HEAL TIME WILL TELL...
On the first day God created horses, on the second day he painted them with SPOTS..
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Moderator:
DrO
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Posted on Tuesday, Dec 13, 2005 - 7:30 am:
The main point here Jennifer is that after having pronounced the horse as having an avulsion of the impar ligament he says that he is uncertain why the horse is lame. I think if he had seen such an avulsion there would not be any question as to why the horse was lame and the prognosis poor.
I would start with having the radiographs reviewed by a veterinary radiologist and equine orthopedic surgeon. If the diagnosis remains uncertain you should consider further diagnostics. Ultrasound by an experienced ultrasonographer and a really good machine might be the next step.
DrO
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Member:
Angel77
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Posted on Tuesday, Dec 13, 2005 - 11:40 pm:
Dear Jennifer,
I am so sorry to hear about your horse. I hope with time and the love and care you are providing will ultimately prevail. I will say I am glad you ordered the Rapid Response!! Maybe your horse will be the one to show Dr.O that this product is a miracle after all.
Good Luck,
WTG
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Moderator:
DrO
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Posted on Wednesday, Dec 14, 2005 - 7:55 am:
Hello WTG,
I can only repeat my recent previous post about RR and reinforce its message:
I took the time to visit the Amerdon site and looked at the pages discussing Rapid Response and have to admit I was not impressed. Much of the text reads like a high school health text on nutrition and the ingredients listed can be found in many regular equine feedstuffs and they don't list the actual ingredient origins nor the amount of the "active elements" that they list. Though they are long on anecdotal stories I don't see any scientific published work on this "scientifically advanced" proprietary process resulting in a unique new dietary natural food supplement. At least that I can find.
Consider your proposition WTG, if Jennifer begins the RR and the horse gets well you are willing to attribute this to the RR and call it a miracle. Is this a reasonable position to take? Statistically 80% of disease can get well on their own. Jennifer's disease remains undiagnosed as near as I can figure from her posts, so this number applies to her problem at this time. This is a product that the company does not list the active ingredients or provide any scientific proof of efficacy, at least any that I can find. I know you think that this product has worked miracles on your horse but I am inundated with thousands of such miracle claims by thousands of similar miracle products. It is funny it is often those folks who have a strong belief in "natural medicine" that are quickest to discount the normal healing process and if all the claims of these type products were true I don't think anyone would ever be sick or die.
DrO
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New Member:
Jenbk
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Posted on Wednesday, Dec 14, 2005 - 9:23 am:
Dr. O,
My husband would applaud your thoughts. He himself being a medical doctor, he too sees lots of claims from "snake oil" type companies. He is especially frustrated with herbal claims. He always wants scientific data in any medical claims. I did order Rapid Response and I am going to try it for one month. Since we really don't know what is wrong with the colt, and even if we did, there are many things we can contribute to his eventual soundness, (prayer, natural body healing, Rapid Response, etc.) should his case go in that direction. I do appreciate your thoughts. It gives me a good balance and a medical background to trust in. I can tell you are a very knowledgeable vet. Believe me, I am as skeptical as the next person, but when it comes health issues, I guess vulnerability plays a big role, and gives a market for products claiming miraculous results. Thanks for your guidance.
I really do appreciate it!
I hope to post soon with good news!
Jennifer
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Moderator:
DrO
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Posted on Wednesday, Dec 14, 2005 - 6:23 pm:
Good Luck Jennifer,
We all hope your horse gets well and I would still be interested in another evaluation of those radiographs.
DrO
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Member:
Angel77
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Posted on Friday, Dec 16, 2005 - 5:32 am:
Dear Dr.o,
To be honest I would probably believe in the stem cell therapy along with everything else Jennifer is doing more than the RR by itself. Stem cell therapy has come along way in the past few years.
I think you may have misunderstood what I was attempting to convey.
I only believe RR aids in healing of tendons, ligaments, muscles, and whole body a little faster with RR than without.
I guess I am hoping that in the coming of 2006 technology has given us many more options than in previous decades. Maybe some of us would like to experiment with the various supplements on the market. That is if the horses are in need of key nutrients they are not getting from the hay.
Where I come from everyone supplements their horses. I guess I thought thats just the way it is supposed to be.
Sincerely,
WTG
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Moderator:
DrO
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Posted on Friday, Dec 16, 2005 - 9:46 am:
I understand the desire for such help when you have problems but your belief in RR has no basis in scientific fact, at least not that I can find.
DrO
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Member:
Jenbk
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Posted on Wednesday, Feb 15, 2006 - 11:18 am:
Well I am back with more news on my 2 1/2 year old gelding. I have been feeding Rapid REsponse for nearly 2 months and though he is a little better, he is still lame while trotting on concrete. My horseshoer came today and trimmed his feet and said that he is really not testing for navicular with his hoof testers, but he found a big knot on his ankle and when flexing the foot back, it has very little flexibility. I am scheduled to take him to the vet next week. Any ideas about now the lameness seemingly to come from the ankle? He has a knot on the front of the ankle, not swollen, but hard. He doesn't have as much flex in the ankle as the other ankle. Thanks
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Moderator:
DrO
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Posted on Thursday, Feb 16, 2006 - 7:45 am:
There are several possibilities here jennifer and we will have to wait for the evaluation to find out what this know is and what its significance is. If there is uncertainty over where the pain is coming from, they should do nerve/intra-articular blocks as described in Equine Diseases » Lameness » Localizing Lameness in the Horse.
Is this the same vet who pronounced a ruptured impar ligament but unsure why lame?
DrO
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