Swollen Foreleg?....

[Rissa]

Hi,

I have a young TB who bowed his SDFT in 2005 while racing. The horse was spelled straight after the injury (and retired) and we got him earlier in the year after the owners gave him to us so that I could re-train him for dressage/showing. He was given the all clear to begin work again in late 2006 and has only had very light work since Feb/Mar 07... only walk & trot work so far.

Last Monday I bought him out to start working him and noticed he had a slight limp (or a bit sore footed) while walking and subsequently noticed that his foreleg which he bowed the tendon on was a little bit puffy looking... only a little though. So back to the stable he went and luckly our vet was over looking at a dog and he had a quick look, flexed him up and didn't think there was anything wrong but he gave him a shot of finidyne(sp?) just in case. Next morning the leg was noticably swollen on the inside & outside of the foreleg so I started icing the leg and putting rapid gell or DMSO on it and banaged it up with a lintex so try and bring the swelling down. It had some heat in it for a couple of days and he was one bute for 5 days for the inflammation. The swelling finally went down last Thursday and has been fine with no heat since so I stopped giving him the bute but contined with the DMSO and ice or cold water treatment.

This morning it was a bit swollen up again... :eek: not as much though so I am just a bit baffled what he has done! There is no swelling along the back of the SDFT and it doesn't seem to be sore or anything when you squeeze or flex the leg... the horse is getting around fine although I have confined him to a small yard. There is no cuts or puncture wounds however there are a couple on miniscule stratches on the inside of his leg (probably from kicking flies) but they haven't broken the skin. The swelling just looked like he had cut his leg and it had swollen up as a result... I am just concerned that maybe he has been running around in his yard and strained the old tendon injury or done something else to his leg...:confused: I haven't seen a case where a horse has had a flare up of an old injury so I am not sure what to be looking for... And to make matters worse our vet has gone away for a few weeks and our closest vet (with an ultrasound scanner) is 7-8 hrs away... So in the meantime if anyone out there has had any experience with flare ups of old tendon injuries or anything similar any feedback would be appreciated! :)

[Subby]

He has had alot of time off I would think that he has done somethinh in the paddock. I am rehabing a 2nd time bow from Nov 06 and we are doing canter work with no issues. You often have to push through small issues and make the tendon flex again. I wouldn't be confining too much as you must enourage flexion even if you manipulate it yourself.

[Zephyr]

The problem with tendon injuries is that tendon is a very elastic tissue, and when tendon fibres are torn they heal with fibrous tissue, which isn't elastic, and will never stretch and recoil the way healthy tendon tissue does. With a decent tendon injury you are always going to have issues with flaring up.

Very mild tendon issues that are rested immediately and rehabbed appropriately over 6 to 12 months have a very good prognosis, and may never become a weakness, but a bowed tendon indicates a very severe injury and often involves a very weak 'core' in the middle of torn fibres that will just never be the same again. Treated quickly with rest, icing, and last I heard, making longitudional incisions into the core to remove the blood and other inflammatory fluids, these horses could be gradually rehabbed, but are always going to be at risk of repeat injury, and should never be worked in very deep surfaces etc.

Rehab for these guys does involve confining, rest, slow introduction into work with gradual loading of the limb over 6 to 12 months, depending on the severity of the lesion. If it were my horse, I'd be either floating it 7 hours to get the limb scanned, or confining it for the 6 weeks with gentle hand walking until your regular vet gets back.

[Subby]

On retrospect they are all different as well...I suppose my thoughts came from the concept that gentle (as you said Z) is important and not to leave horse bottled up in stable. As you probably aware they are doing some great work on tendon rehab through ensuring the horse is gently exercised once heat is removed.

[Zephyr]

They differ in degrees of tearing, with mild tearing (a few fibres + inflammation) right through to bowing (major fibre tearing, usually in the middle of the tendon, with severe inflammation, deformity of the tendon (bowing), and development of a significant core lesion), and of course, complete severing.

The rehab is all much the same, it just depends on the severity of the lesion as to the length of time rehab is required. Even very mild fibre separation should be rehabbed over 6 months, with only straight line walking for 5 minutes initially, gradually building up over time, then introduction of small amounts of straight line trot, then building up at the end of the 6 months to some canter and large circles. Any decent lesions require 12 to 18 months of the same stuff, just more time taken. Small circles and lateral work are not beneficial to horses with recovering tendon injuries, especially suspensory injuries.

I forgot to mention before that a lot of work is being done with stem cell implantation into the lesions, which shows some great results and much faster return to work.