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  Discussion on Annular ligament ?
Author Message
New Member:
Hally

Posted on Tuesday, Jul 25, 2006 - 6:21 pm:

Hello Dr O,

I have a ten yr old mare that I have had for 2 yrs and have never had an unsoundness issue until 6 weeks ago when she came out of the pasture, mildly lame at the trot, sound and stepping well under her self at the walk. Also her fetlock was swollen. One of the vets at the barn diagnosed it as a DDFT. She only palpated the area but did not US it. She gave me the usual instruction to walk 20 minutes, cold hose and confine her in a small paddock during the day. I decides to call my own vet in after 3 weeks had elapsed and he did an US and told me that the DDFT showed
no sign of damage however the annular ligament was approx 20% larger on her injured fetlock compared to her other leg. At that time we trotted her out and she showed no signs of lameness at all. He told me to continue the same treatment. He is coming back next Monday to re US her and give her a shot of cortisone and Hyaluranic acid (not sure of spelling).

I read your article on annular ligaments but have a few questions. Do this type of injury heal by itself given time or is surgery the only way to fix this problem? When she stands in her box stall for any lenght of time her injured fetlock swell up a bit, mind you she does have a tendency to stock up even on her good leg. However after walking her for 20 minutes and applying ice packs for another 15 minutes you can barely tell the difference between both legs. Does this mean the leg is on the mend and is it a good sign that the injury is not of a severe type? Does the swelling indicate that the problem is still ongoing or once injured does it always remain enlarged? At what point do you know when start upping the load on the injured leg? When do you back off? Sorry to ask all these questions but in the 30 yrs I have had horses I have never had a ligament/tendon injury and feel rather helpless.

Thank you!
Moderator:
DrO

Posted on Wednesday, Jul 26, 2006 - 7:31 am:

The article only addresses a chronic form of lameness caused by the annular ligament LLV. Acute injury could presumably heal. The swelling changes are encouraging but not diagnostic for a problem that will heal with conservative treatment. In short, with an acute injury, you increase work loads when the area has returned to the preinjury state from a lameness and physical inspection stand point, you decrease work when symptoms worsen. If you would like to review what a specific rehab program might look like you should review Diseases of Horses » Lameness » Treatment Methods » Rehabilitating Injuries to the Tendons and Ligaments. It should be easy to adapt this to your situation.
DrO
New Member:
Hally

Posted on Thursday, Jul 27, 2006 - 10:20 am:

Dr O,

I read the articles and have a few more questions. I am a dressage rider and was wondering when my mare's leg is healed will I have to watch out for re injury? Will this injury be a weak link and if so what happens if it is re injured is it then considered chronic? What are your thoughts on injecting cortisone and hyaluronic acid into the ligament? There seems to be a bit on difference of opinion on that. I dont want to be overly aggresive in the treatment if nature is doing its job. Time is not an issue with me, just as long as she heals well.

Thanks.
Moderator:
DrO

Posted on Thursday, Jul 27, 2006 - 7:08 pm:

Your questions on prognosis are best answered by those doing the exam LLV. The extent of the lesions present in the ligaments determine the prognosis.

Treatment with intrasynovial cortisone and HA injections depends on the involvement of the synovial sheath surrounding the flexor tendons as they travel through the annular ligament. If this sheath is distended with synovial fluid, I would think this logical otherwise I would rely on systemic anti inflammatories for the acute stage of inflammation. Sort of an in between would be treating the inflammation with DMSO and dex paint which could be applied to swollen warm areas.
DrO
Member:
Hally

Posted on Wednesday, Aug 2, 2006 - 1:05 pm:

Well I had great news from my vet! My mare had a US on Monday and her annular ligament is back to normal, no lesions, tears etc. He told me that I could ride her again as normal. Meaning start her going as you would any horse that has had a lay off for 6 weeks. Having said that I am now really nervous about the whole thing! I trotted her last night for about 5-8 minutes with lots of walking then iced her leg afterwards (just to be sure) She felt great but I am really scared its going to blow up again. Am I being silly about this whole thing ? I did ask my vet and he didnt seem fazed about her going back to regular work. What are your thoughts about this? A second opinion would be appreciated. There never was a tear in any ligaments and I wonder if the annular ligament was a result of a kick from another horse as my mare was the new kid on the block and had only been in the pasture for over a week. Would a direct blow to the annular ligament cause and inflammation?

Just sign me off as LLV nervous in Alberta!
Moderator:
DrO

Posted on Thursday, Aug 3, 2006 - 8:32 am:

A second opinion? We cannot really second guess what is happening with the horse, we only know what you tell us. Concerning the us results, you do the best you can with the information you have but it is not surprising that a diagnosis of a certain pathology that could not be visualized was wrong. And yes, direct trauma to a ligament will cause inflammation.
DrO
Member:
Hally

Posted on Thursday, Aug 3, 2006 - 9:12 am:

Fair enough. I understand that the US results cannot be visualized 100% in all cases, however given the results would you start legging a horse up with this history or would you still be cautious and only walk?
Moderator:
DrO

Posted on Thursday, Aug 3, 2006 - 6:56 pm:

LLV, since I don't know what was wrong I would have to vote for cautious. If you go 3 weeks without the lameness returning you can carefully start more.
DrO
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