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  Discussion on Swollen accessory carpal ligament
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Member:
Jivete

Posted on Monday, May 1, 2006 - 12:11 pm:

One of the problems my vet diagnosed this weekend following a long vague lameness on my young mare (see "Not lame just not right" thread)was a mild knee lameness. She was swollen very slightly behind the knee and had a low grade lameness after she was flexed. We took x-rays and the vet diagnosed a strained accessory carpal ligament (It was a ligament that was strained but I'm getting the exact one from the knee diagram associated with this web-site). He is coming out today or tomorrow to inject the knee with a steroid and I'm to confine her to a small paddock for a while.

My question is this, I think she's had this for a long time (along with the other problems I talked about in my other posts), but it's very mild. She does not have a head bob, but has decreased flexion in her affected knee (I've noticed this for a long time but have been unable to pin-point the source). Since it is so mild (the vet was pretty unconcerned about it initially, her other problems are worse) how does she fair for healing? Especially for a soft tissue injury that might be pretty old?
Moderator:
DrO

Posted on Monday, May 1, 2006 - 6:24 pm:

With the information you give us Mckenzie we cannot answer your question. We don't what type damage is present in the ligament, known as pathology, and how severe that damage is. To answer your questions on a more accurate diagnosis and prognosis will require an ultrasound by an experienced ultrasonographer with good equipment.


Perhaps some explaining of the injection may clear your head a bit. The steroid injection is not a medication that directly stimulates healing. It is a potent anti-inflammatory drug.

Inflammation has many beneficial and a few deleterious effects particularly when chronic. Acute inflammation needs to subside somewhat before healing can get on and if it goes on to long it cam become a source of pain and poor healing outcomes. The veterinarian is hoping that the lameness is due largely to some inflammation, and that attacking it directly will relieve some lameness.
DrO
Member:
Jivete

Posted on Tuesday, May 2, 2006 - 10:38 am:

The vet was out yesterday and injected her. He told me as long as the chiropractor gives the go-ahead, I'm okay to ride in one week. I believe he thought it was secondary to the other problems the mare was/is having and minor in nature. The chiropractor is coming out this afternoon to adjust her. I think the theory is her altered gait was causing the knee problem. I guess I will know for sure in a few weeks.
Moderator:
DrO

Posted on Tuesday, May 2, 2006 - 10:47 pm:

I still have problems with this Carla: what is the cause of the altered gait? How will you know the altered gait causes the poorly defined knee problem?
DrO
Member:
Jivete

Posted on Wednesday, May 3, 2006 - 10:06 am:

I don't know for sure. This vet (a highly respected lameness vet in our area) thinks her problems come from her being out of alignment, especially in her pelvis. Her movement tends to be shorter and less fluid on the left side. The first vet thought it was her left stifle which was causing the right front to come down harder. This vet didn't think there was anything wrong with her stifles. He did 6 flexions, differentiating between stifle/hock and hip. She was not lame on the stifle/hock but was on the hip. The vet blamed this on the pelvis being "out".

The knee seemed secondary and possibly separate. He took four x-rays and determined there was a little inflammation. She is on one week mild rest (24x24 paddock although she apparently jumped out yesterday to join her pasture mates) and then I can start working her again as long as the chiropractor gives the go ahead. I won't know if her movement has improved until next week and I won't know for sure if the knee injection or the chiropractor makes the difference if there is any.
Moderator:
DrO

Posted on Wednesday, May 3, 2006 - 9:52 pm:

How do you stress the hip without stressing the other areas of the leg? Flexion tests are pretty non-specific in the rear leg because of the reciprocal apparatus: it may lead you to an area to begin investigation but far from something you can hang your hat on. And how do you diagnose inflammation from a radiograph? I don't Carla I see lots here that that makes me wonder: the horse is lame in a fore leg and you are looking at the hip.

If this is something you can live with, I guess it does not matter what is said. If this is something you want to pursue and if this does not make sense to you either, I would seek a second opinion other than from a chiropractic.
DrO
Member:
Jivete

Posted on Thursday, May 4, 2006 - 10:28 am:

From how it was explained to me and how I remember it, if the leg is held too high during the rear limb flexion it will flex the hip as well as the stifle/hock. He did two different tests on the hind leg, one with the leg flexed as a lower angle and one with the leg held really high.

She has no head bob and no hip hike. The other vet I had look at her didn't even see a lameness in the front end. He saw it as a hind leg making the opposite front leg come down heavy. This vet felt swelling in the knee and then took radiographs. He said something (I was on my cell phone and driving so I didn't write it down) about the bone being slightly displaced indicating swelling.?. I would assume he meant the accessory carpal bone but I'm probably not remembering it correctly or accurately. The problem is I hadn't researched anything about the knee so I couldn't begin to ask the necessary questions. I thought it might be the shoulder. Knee makes sense because she does not seem to flex as well on that knee but I hadn't looked at it because there is no head bob or other distinguishing features.

Unfortunately this is my second opinion. I am not convinced one way or another about chiropractors. I understand that there is not scientific evidence supporting it. I myself am a civil engineer so I don't think I'm illogical and I can't discount the positive recommendations I've received about this chiropractor in general. I also can't ignore that she was prescribed to me by the vet instead of a series of nerve blocks, etc that would have made him more money.

I do have one question about the injection. How soon would an injection decrease pain/inflammation in a joint (this is only pain on flexing not weight bearing)? How detrimental is it for a horse to get out and run (or possibly jump over a gate) on a limb that is supposed to be rested after being injected?

Thanks for all your input.
Member:
Jivete

Posted on Thursday, May 4, 2006 - 10:48 am:

I re-read one of your responses above so I realize my question about pain in the joint being relieved by the injection is not applicable. Although I would still like to know how detrimental it is for a horse that is supposed to be rested to accidentally get out and run around on the recently injected joint. She is back in the pen resting with a friend to keep her company. So far there have been no other escapes. I plan on letting her back into the pasture on Sunday.
Moderator:
DrO

Posted on Thursday, May 4, 2006 - 10:53 pm:

As inflammation is resolved pain does subside and most horses with active inflammation improve in 2 or 3 days, others a week or two. There is variation. I don't think a one time run around is anything to worry about.
DrO
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