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  Discussion on Navicular lesion
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Member:
Brandi

Posted on Friday, Mar 17, 2006 - 3:47 am:

Dr. O., My horse (who owns the foot in the photos under Ann's "X-ray" post), is a big 10yo Paint gelding with navicular disease diagnosed per radiographs and ultrasound (who spent the past 18 months rehabbing from a DDFT insertion tear and subsequent impar tear) had a new ultrasound today (Carol Gillis has treated him since the 7/04 DDFT injury). A previously noted lesion on the flexor surface of the navicular bone shows advancement, it is bigger, at least deeper. His navicular bursa also showed marked effusion (fluid, right?). His lameness, which was mild and "workable", took a fairly dramatic turn for the worse just 3 weeks ago.
History out of the way, I know the gravity of this situation, but I am trying to remain realistic but positive, so I want to arm myself with as much information as possible. Carol was more optomistic than I expected. She recommended we inject the bursa (we did that just post-injury in 7/04, and the bursa remained "quiet" until now), and see if it returns him to his previous level of soundness.
I am curious what causes the lesions to change/grow? Though I fully support the injection route, what are your thoughts on the bursa injection at this time? Do lesions only cause pain because they tear the DDFT fibers? If the fibers are being torn, would we have seen that on ultrasound or are they too small to see in that situation? She also mentioned that the lesion could be filling in with a...calcified cartilage or something--which can cause pain. What do you think of that?
Carol also mentioned that there is a surgeon who is doing a radical arthroscopic surgery on this type of situation (unfortunately he is only doing this for the Sheik of the Emeritus, so I'm guessing this is slightly out of my financial league), but she suggested that our local, incredibly talented and well-respected surgeon might be interested in attempting the surgery. Though that is not something I think I can seriously consider as an option, it can't hurt to ask you if you've heard of it and if it sounds promising (even if only 5 years from now). I appreciate whatever you have to offer on this matter. Thanks.
Moderator:
DrO

Posted on Friday, Mar 17, 2006 - 9:58 am:

Hello Brandi,
The constant trauma of everyday work is the biggest reason nb flexor surface lesions grow. Once the cartilage is damaged it heels very slowly and not as strong as before.

Without seeing the lesion I really cannot comment on therapy and prognosis but often with such lesions lameness is permanent. How big and deep is the defect?

If you are asking will there be damage to the DDF if there is a defect in the flexor surface of the nb the answer is yes. As to whether it should be detectable these type questions really need to be directed to the operator of the ultrasound as their answers depend on the equipment and the operator. Pain is thought to originate from both the defect in the nb, the flexor tendon damage, and the inflammation created by the ongoing damage. No I have not heard of such surgery Brandi nor have I seen any reports on it.
DrO
Member:
Brandi

Posted on Wednesday, Mar 22, 2006 - 12:49 pm:

Hi DrO, thanks for the response. Sorry I haven't gotten back to you to answer your questions. If I scan in the ultrasound would that be readable to you? I don't see in the write-up that she states how deep it is. I'll see what I can come up with.
I had his nav bursa injected yesterday so we shall see what relief that brings.
And just to share what I think is very interesting, I also asked Dr. Yarborough about the arthroscopic surgery that Dr. Gillis mentioned, he admitted that he and a colleague have performed 2 similar surgeries themselves. One was debriding a radically infected navicular bursa caused by a puncture wound, and the other was a large navicular cyst. They simply (ha) smooth the area around the cyst (is that the same as a lesion?) so that it no longer tears at the ddft. Both horses recovered and are comfortable but not sound, and the procedure leaves the ddf tendon sheath (could have been a different tendon sheath) and the nav bursa communicative forever, making subsequent injections of the nav bursa easier because you can do it through the tendon sheath. He said if my horse were facing euthanasia he might offer it as an alternative, but it is too new and experimental to consider a "treatment" at this time. Both horses in this case were donated to them for the experiment.
Moderator:
DrO

Posted on Thursday, Mar 23, 2006 - 8:17 am:

Thanks for the updates on the navicular surgery and frankly that is what I would expected: even smoothing the edges would not prevent irritation. Ultrasounds do not read well as static images Brandi because there is continuous artifactual material in the shot that is filtered out by looking at the shifting patterns as you move the probe around. Best would be to consult with the person who actually did the US for specific information.
DrO
Member:
chance1

Posted on Wednesday, Mar 14, 2007 - 2:16 pm:

Hi Brandi,
I am curious to see how your horse is doing almost a year later. I had a follow-up appointment with Carol Gillis yesterday and she found a lesion in the navicular bursa and prescribed an injection of HA and steriod. She was VERY encouraging and feels with correct rehab, the injection and a wedge pad without frog support will result in a sound horse. My Luke is a 3.5 yo QH. He also has a tear in the impar ligament (on the mend). I also know Tom Yarborough and agree with your description of him!
Looking forward to hearing a good report on your guy!
Thanks, Ruth
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