Adhesions in fetlock joints/fetlock chips due to OCD

nonnyno

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Hi everyone

Does anybody have experience of adhesions in fetlock joints? I am in desperate need of some kind of reassurance/guidance :(

I’ll start from the beginning! I bought my 6 year old warmblood in July last year and he passed the 5 stage vetting though it was noted he was slightly toe out behind. With the intention of doing mostly school work over the winter, I decided to take his shoes off as I’d be on the surface. Big mistake – due to the way he was distributing his weight, his hooves wore incredibly unevenly in both his hinds. The right was far worse than the left and he wore away the outside wall very quickly. We put the shoes back on straight away but by this point the ‘damage’ had been done and it either compounded matters or made it more obvious that there was a problem, and as a result he became 2/10 lame on his hind left.

I got the vet out the next day and after 10 days bute and grass rest, he still didn’t feel right. Not really visibly lame but didn’t want to strike off on to left lead canter and seemed generally tense and reluctant to work which is very unlike him. I got the back man out wondering if he’d put his back out due to the imbalance of his feet. The back man corrected this but my horse still didn’t feel quite right. I got the vet back out and he suggested X-Rays to see what was going on in the back legs to cause him to carry himself that way. We also noticed him twisting his hind hooves inwards as he walked.

X-rays showed chips in both hind fetlocks due to OCD, the right chip was larger than the left. Thankfully it hadn’t started causing any damage to ligaments etc. This was about 2 months ago and he went in for surgery straight away. Everything went well, he came home and as per the surgeon’s instructions, we built up to 25 mins on the horse walker twice a day over the space of 6 weeks. He was sound and everything was fine, he seemed happy and comfortable and was moving a lot straighter than he had been before surgery (less twisting of his hooves.) The farrier was happy with his progress, legs seemed to be coming straighter and hooves were starting to grow back to be more even, though he still builds out the shoe to the right of the right hand hoof to provide support until it has come fully right again.

We then progressed on to ridden walk and I could tell something wasn't right on day 1. On day 2 he was similar, didn't seem to want to move forwards and then his hind right leg slipped under him. I got off straight away and walked him out of the school and he was back to twisting his legs (this was about 3 weeks ago now.)

The vet told me it didn’t mean the surgery had been unsuccessful but that he may have adhesions after the surgery. He told me to discontinue the ridden work and walker work and put him on restricted turnout (a pen 2-3 times the size of a stable) so that he could move around in his own time and hopefully break down the adhesions at his own pace. However, the yard owner wouldn’t let me make a pen (she said he wouldn’t respect electric tape) so the poor boy has had to spend most of his time stuck in the box. I’ve now moved him to a new yard and new yard owner is much more helpful, though he has only been in his new pen (with electric fencing!) 1 day, and is already starting to churn up the ground from pacing around, so I’m not sure how sustainable this is going to be and if she will allow him to stay in there. The vet is due to come out and review progress in 2 weeks but I don’t think much will have changed given that he’s been stuck in. I’m so down about the whole thing I just really want some other peoples experiences.

The main questions playing on my mind: Would he have been less likely to get adhesions if he had been on box rest for longer, i.e. are they a result of movement when the area was healing? Or is it simply scar tissue after the surgery? Are adhesions after this kind of surgery common? How long did it take for other horses adhesions to break down? And were they on restricted turnout or box rest and what kind of daily exercise? Surely if movement alone can break the adhesions down and they didn't do so after 6 weeks of built up work on the walker, there is something wrong? What else can I do to help him?

I'm really sorry for the essay. If anyone could tell me this is completely usual after surgery and will go away with time, and that my boy will be completely sound and we’ll live happily ever after…. I’d really appreciate it!!!! :(

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BDyasmine

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I'm not sure about the adhesions but i have had experience of OCD...
in my experience the surgery isnt a quick fix. i turned my horse away for 6 months after her bilateral stifle arthroscopy and when she came back in she was better than she was but still not 100%. on vet advice we decided to start very light work anyway to try and build up muscle, and slowly but surely she came a lot better, after 4 months she was amazing and not a lame stride in her. unfortunately now lame due to a different problem :( but don't give up as in my experience recovery from the op is not plain sailing. I certainly wouldn't write it off just yet :)
 

applecart14

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Small calcification adhesions can be broken down by the use of shockwave therapy as my horse had one on his near fore suspensory branch which was causing him to hop on the right rein. Its not really noticeable now unless he runs on a little on his forehand.
 

old hand

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I had a horse with adhesions in his navicular ligament. Cortavet used him as a free trial and it worked. he was about to be put down as he was right up on his toe and in a lot of pain. Three days on Cortavet and he was supposed to be trotted up, he exploded ( that is how he did it in the first place) and was very lame. The vet came back in the morning with a view to putting him down and he walked out heel down. He returned to full work and although rehab took some time , three or four months of hand walking and then ridden work. I was advised by the vet to ride him when he was still a little lame and not to back off the work - all in walk and he trotted up totally sound after three months. He jumped and hacked for hours so it can be a success but we never box rested him or penned him, my vet advised he should use it. It was never worse after work and he progressed all the time but he was always turned straight out in the field. He was a big boy and I only weighed ten stone so the vet decided that as I could make him walk properly and load his front legs from on top that was the best plan of action. He had his horses next door so saw him every few days ( nice man didn't charge me either!).
 

noblesteed

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My horse has/had adhesions in his tendon sheath area on rear hind.
From what I understood from the vet, adhesions are formed from scar tissue that forms after an injury. If the scar tissue is allowed to form wherever it likes it can create connective tissue that restricts tendon/ligament etc movement in the joint. The way to avoid adhesions like this is to ensure the healing tissues are correctly lined up, and the only way to do this, according to my vet, is regular walking out/physio during box rest recouperation.
In my horse's case he damaged his annular ligament which was misdiagnosed as a foot problem. So initially treatment wasn't as good as it could have been. After injury he was box rested and cold hosed but as he has arthritis he was turned out again after a few weeks. In hindsight he should have been on box rest with controlled walking out immediately - wish I had asked for the better vet!!!! During this time scar tissue developed uncontrolled, and adhesions formed in the fetlock joint and tendon sheath.
A second vet suspected annular ligament problems so horse was scanned and this was confirmed. Top vet man took over and decided to operate to remove the scar tissue adhesions and cut the annular ligament.
The operation was apparently unsuccessful as there were too many adhesions for the vet to be able to remove them all. The prognosis for my horse was very poor. However we gave horse the best chance we could and he had controlled walking out over raised poles and 4 months box rest then slowly back into riding and turnout. Initially I turned him out in support boots. The poles were to 'snap' any unwelcome adhesions that were forming during the healing process. So only good elastic tissue could form.
It's been 9 months since the op and despite the poor prognosis and offer of euthanasia, horse is fit and well and we are hacking up to an hour and a half, started cantering in straight lines, and beginning to work 'correctly' in the school again. Touch wood, he's been ok even in the deep mud this winter. He has a lump on his fetlock and I always use support wraps, he gets a joint supplement, turmeric etc but so far so good. The next step is to try a jump!
I think that possibly the adhesions that the vet couldn't remove are now slowly breaking down through exercise. He's certainly not lame on that leg and flexes the joint well. He also has spavin so he's not 100% anyway. I am very careful not to overdo it or ask too much, I only ride him 3-4 times a week, I don't lunge or do small circles yet, but as the vet says if he's going to break down again it will most likely happen when he's being daft in the field! He's on unrestricted turnout too. He's no longer insured so if the joint goes again it's curtains for him, but he's doing fine. Just take your time and do everything carefully. There's no rush.
 
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