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Discussion on Boney growth behind knee.
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New Member:
Alveron
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Posted on Tuesday, Aug 15, 2006 - 5:54 pm:
I have read with interest the message between Cynthia A. Nielsen and Robert N. Oglesby, DVM. I have an 11 year old broodmare who has exactly the same condition as Cynthia's horse. My mare did not have any nerve blocks, etc., done for any conditions. I have had the mare for three years. She is a Zippo bloodline and her front legs are not exactly what you would like to see - but she produces excellent babies. The mare developed a swollen tendon in her right leg at the cannon bone area - was treated with DMSO and stalled (she also hates that)- given bute to reduce swelling - but she could run like the wind if you let her out without indication of pain. She was sent to be bred and stalled for three weeks there to help the leg.
Upon return, I she didn't get any better so I took her to a Vet who indicated she needed corrective shoeing and bute and also gave me an analgesic cream for her. No x-rays were taken at the time, but the knee did look a little larger at that time.
Several weeks later I took her back for an x-ray to determine if there was a broken bone in her knee as she was getting more lame. The x-ray that came out is exactly like Cynthia's horse and no one here can explain or tell me how to treat this. Suggestions have been surgery - but that won't last because it will grow back; injections like were discussed for Cynthia's horse except for the steroid treatments; and just keeping her comfortable as best we can.
She does fine as long as she is not running - but every once in awhile as a horse will do - she loves to run and is very fast - she runs - then the next day she is now holding the leg up and laying down a great deal - unless I double the bute to two in the morning and two in the evening. Then she is better the next day and I cut back down to one a day or so. I have also purchased a joint combination with natural healers from Spring - but have just started using that so it hasn't really had any time to do anything.
My question is - is there some way to dissolve the boney attachment? If it were gone somehow, she wouldn't have the pain because all the ligaments and tendons surrounding it are being pressed upon and now her entire leg is swollen.
Also, we will now have a chore getting the shoes off her since she has difficulty standing.
She is five months pregnant now - due to foal in February 07. Any suggestions or help you can give will be greatly appreciated.
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Moderator:
DrO
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Posted on Wednesday, Aug 16, 2006 - 9:04 am:
Welcome Veronica,
In order to help I need to know which bone in the knee is fractured and the nature of the fracture. Also the part about the bony attachment is unclear: what is attached to where and what soft tissues is this impinging on?
In the meantime you need to keep the horse in a space where she cannot run around on this fracture.
DrO
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New Member:
Alveron
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Posted on Wednesday, Aug 16, 2006 - 2:35 pm:
Dear Dr. O.
Thank you for your prompt reply. The mare does not have a fracture according to the vet and the x-rays taken - she has what appears to be that boney looking thing in Cindy's Cinderella's horses knee as posted on Sunday, MArch 27th 2005. But as I looked in my Horse Owner's Veterinary Handbook, Second Edition by James M. Giffin, MD and Tom Gore, DVM on page 278, that appears to be a normal thing. I have examined all my horses legs and each one has a slight rise on the back of the knee. I must assume that is normal? And that this is not the problem.
I believe what has occured is that she bowed her tendon severely in late December or early January of this year; and I treated it with Bute and DMSO and rest; I also wrapped it with support bandages. Appeared to be better so discontinued that regiment. The horse then got worse and I took her to a vet and he said not to wrap it; give her bute and an analgesic cream on the area. I showed him the swelling beginning on the outside of the knee and he determined it was related to the tendon problem and that it should go away but that the tendon may show as it is from now on.
I then did as he suggested, she did not improve so I took her back for x-rays to see "if" she had a broken leg. She did not reveal that from the X-Rays - but he said she had a boney growth out the back of her knee and was confused by that and was to contact a vet in Tallahassee,FL for a second opinion. My vet said surgery is a possibility but not recommended because there are so many ligaments and tendons in that area and she is pregnant.
He told me to keep her on a regiment of bute up to four a day to try to get the swelling down and just maintain her until she has the baby. When I got her home off the trailer, she could not walk on the leg. I doubled the dose to 2 butes that night and 2 the next day, used linament and wrapped it again. The next day she appeared better and could walk again.
I made a mistake and let the older mare out first and she was across the field when I let the other mare out and she ran (happily to catch up to her) - the next evening she was holding the leg up and leaning back to propell herself forward and using the inside wall of her stall to support herself.
I called yet another vet and asked his opinion. He was baffled by the x-ray and indicated the horse would have to be put down at some time but to try to take care of her until the baby. But not to give her 4 butes a day as it would cause liver problems and any continual bute treatment would be trouble. He suggested I contact the UF Vet School - which I did. Right now they indicate it would be interesting to see the x-rays and they could go from there - but at some point the economics plays a part.
I went home last night and started "my" regiment again with one bute as I had had her on two twice a day for two days and she was standing on the leg (although lifting it every few seconds to relieve pressure, I assume); I push linament on the leg from above the knee to the fetlock as it was beginning to swell just above that as well. I then wrapped it again with support bandage. This morning she is standing on it quite well.
My questions are: Can I continue the regiment of bute and for how long?
Is there any injection or other medication that would work better to get rid of all the swelling and relieve the pressure and pain?
Will epsom salt soak help?
From what I've told you - do you think its a boney growth problem or a strain on the knee now caused by the tendon problem?
I'm sorry to be so vague, but I'm trying to give you all the information I have.
Veronica
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Moderator:
DrO
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Posted on Thursday, Aug 17, 2006 - 6:46 am:
Veronica, I am still unable to tell what might be happening in your horses leg by your descriptions and I am very leary whenever anyone says, if it just like... More often than not they are nothing alike. What we need is the specific diagnosis made as to why your horse is lame. Contact the veterinarians who have examined your horse and write down what they tell you is the location and cause of lameness.
I can help with your questions about medications. We discuss bute and pregnancy at Treatments and Medications for Horses » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » Phenylbutazone (Bute). It is impossible to predict what will be too much as individuals react differently. However I believe keeping the mare comfortable important but should be done with the lowest dose that works, see the article for recommended dosages and once comfortable keep trying lower doses. It appears enforced rest could go a long way to keeping the medication dose low and the mare comfortable.
DrO
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New Member:
Alveron
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Posted on Sunday, Sep 10, 2006 - 9:37 am:
Dear Dr. O, Sorry for the delay - had to get the X-Ray and some photos of the mare. Three Vets (2 have seen mare) indicate she has a boney-growth or as indicated in this copied e-mail form Dr. Alker to me;
"Mrs. Jones
This attached view is the one that the lesion shows up the best.
Dr. Alker
-------Original Message-------
From: Dr. Richard Alker
Date: 07/24/06 08:17:30
To: Dr. Fisch
Subject: Fw: Jones Mare
Steven,
Here is the lateral view of the horse I spoke to you about last week.
This is about 3-4 inches above the accessory carpal bone.
Richard
-------Original Message-------
From: Richard Alker
Date: 07/22/06 20:38:39
To: pcanimalhospital@bellsouth.net
Subject: Jones Mare"
As you can see he has sent this to Tallahassee for review. I have attached the x-ray he sent me and also a couple of photos of the mare's right front leg. I have spoken with U of F Veterinary School in Gainesville as well.
Had Dr. George out yesterday as the mare was flat out and in severe pain - she twisted something last Sunday - was up on all fours most of the week and Friday doing very well - but Saturday AM - could not walk and that is when she was flat out - she could get up - but has sores on back limbs from hard surface - even though she has bedding. Seems to me she has done better in field than in barn and small outside area - 12x12 attached to 12x12 stall. Dr. George gives grave prognosis - says the blood will not flow back up and the swelling is so extreme that she is in much pain. Said afraid to drain because may hit the septic and cause infection and she has no infection now.
She has started with some sores around her ankle now and the fetlock all the way around is swollen as you can see in the photos taken this am.
I continue to give her Bute but have been warned against too much because of liver damage. I also give her a Spring supplement with glucosamine in it. She was off feed yesterday - but back on today and up little weight on leg this am.
Dr. George says the boney growth is pushing against the tendons and ligaments and blood supply and that all her problem started with that - but they say if they cut it out - it will grow back.
Dr. George said yesterday before we "shoot" her - we could drain and inject and hope it doesn't infect it.
She is now confirmed five months pregnant - suggestions please?
Veronica I. "Ronnie" Jones
I'll have to divide the photos up since your upload won't handle them.
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New Member:
Alveron
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Posted on Sunday, Sep 10, 2006 - 10:01 am:
Dear Dr. O,
Sorry for the confusion - here are the photos on Zippo Pine Sonny Two. I hope you can tell me something that will help her and let her be the broodmare she has always been and why such a growth should happen.
Dr. George told me if anyone can tell him anything about such a thing (as he and Dr. Alker have never heard of anything like this before), he would be most greatful.
The x-ray will be by itself.
Veronica I. "Ronnie" Jones
Thank you.
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New Member:
Alveron
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Posted on Sunday, Sep 10, 2006 - 10:07 am:
Dr. O - here is the x-ray of the area in question. I flipped the copy of the photo they sent me as this appears correct to me - but if it doesn't to you - that is the reason.
Any advice you can give me is appreciated.
Veronica I. "Ronnie" Jones
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Member:
Kstud
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Posted on Sunday, Sep 10, 2006 - 6:33 pm:
Hi Ronnie, the x-ray you have sent confuses me as it does not appear to show the carpus at all unless it is upside down and back to front and even then it is not very clear. Is that the affected region, the bony spur in the middle of the x-ray on the left side of the bone?
Catherine
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Member:
Alveron
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Posted on Monday, Sep 11, 2006 - 8:56 am:
Hi Catherine and Dr. O.,
I appreciate your response Catherine. I have attached the X-Ray as I received it from Dr. Alker in Panama City, FL. It is hard to determine the area from the X-ray - but when I saw the original it appeared to be behind and to the outside of the knee area - a little up from the bend area. When you hold your hand on the bowed tendon and push in the swollen back of knee area, you can feel the tendon push out and in as you do this. Dr. George showed me that this all started with the lesion or boney growth developing behind the knee. As I mention, the bowed tendon (not the knee) was noticed the end of last year and handled according to veterinarian instructions - but the knee then started to show and no one really paid any attention to that area - until I asked to have it x-rayed. Saturday - she got up and was up on all fours all day Sunday - I put her in larger field as Dr. George suggested so she could lay down more comfortably and possibly cut down on those "bed" sores - But alas, this morning she was half-way to the barn for breakfast and I had to go get her - she was on three legs - dragging the front one as she came to the barn. She would not eat feed (wherein was her bute) - so I put bute in water and dissolved and put in syringe and put into her mouth (1 bute) - before I left home she was flat out resting the other leg. I also put some linament on the leg. Not sure whether at this point it would be good to wrap it again to hold down the swelling or not.
Any suggestions would be helpful. She is confined to smaller paddock area and can get to stall 12x12- paddock is about 1/8th acre I believe with grass and water. She also has water in the stall. She prefers to lay down in the stall on the hay bed.
Veronica I. "Ronnie" Jones
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Moderator:
DrO
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Posted on Monday, Sep 11, 2006 - 9:25 am:
The last image is much better. This is a proliferative bony response proximal to the knee and appears to be in the area of the superior check ligament. This could be an enthesophyte: calcification of the superior check ligament. The most likely cause is traumatic and would fit with the flexor tendinitis as this is functionally connected to the superficial digital flexor tendon. An ultrasound could make this diagnosis.
If this is in fact as I describe, you might consider having the ligament transected and possibly removed or medically you could try shockwave therapy though more likely to be of temporary benefit. As to whether it will return is uncertain, it is possible but if the ligament is removed, it seems less likely to me.
DrO
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Member:
Alveron
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Posted on Monday, Sep 11, 2006 - 10:31 am:
Dear Dr. O.,
Thank you for your reply - at least I feel there might be something I can do for her. A question I have is, if the ligament is removed, will she be able to function properly as a brood mare. She is not ridden at all, just in the field with my 24 year old mare.
Will surgery at this point injure the fetus? Where would be the best place to have such a surgery done? - since she cannot stand on the leg - it would be difficult to get her trailered if at all possible.
Veronica Jones
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Member:
Kstud
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Posted on Monday, Sep 11, 2006 - 1:06 pm:
Hi Ronnie, that is so much clearer, that is very extensive ossification, the poor mare must be in terrible pain. Surgery would be the best option but if you are worried about the risks to her pregnancy then Shockwave therapy would be worth a try. I have seem some amazing results with very similar type lesions, not as a cure, but as a complete pain relief and after a course of eg three treatments at fortnightly intervals you could get several months of pain relief. This could tide her over in the interim until the operation could be done.
Catherine
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Moderator:
DrO
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Posted on Tuesday, Sep 12, 2006 - 6:48 am:
Yes she would still be functional Veronica. As to the risk to the fetus this would be very dependent on the facilities and techniques available to you which am not aware of. You should discuss this with your veterinarian. But considering the alternatives you propose above wouldn't any risk be worthwhile? Catherine or I should say DrMcC has some very good points in her post too.
DrO
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