Advice please - SSFT injury

[S_N]

A friend’s lovely TB gelding was brought in from the field on Friday very lame on his near fore leg. Further investigation revealed a relatively small, but fairly warm swelling behind his knee. He was box rested over the weekend on bute and the vet returned yesterday afternoon to scan the area. Prognosis was damage to the SSFT, requiring a year off and he’ll at best only be a light hack. Understandably she is devastated. If it comes to him only being field sound his old owner will happily have him back as a companion. However, she has the next year to get through and would like any advice anyone can give her please. He is currently on box rest for the next month, when the vet will return to re-scan to monitor his progress. The horse is obviously bored atm too. So if anyone can give advice on a) similar injuries, b) keeping him entertained and c) offer her some hugs, she’d really appreciate it.

P.S. She is a regular lurker, but is too scared to post daft bat

 

[Maesfen]

Tell said 'daft bat' to get herself on here pronto to get some personal support; it'll be much better and not such a daunting issue with some moral support! You know what it's like SN yourself, the support on here is second to none.
Would a Bonnr Bandage help with something like this? If so, she's welcome to mine except that Tophorse still has it; if she's finished with it, DB is more than welcome to it.

As to boredom breakers, I could lend her two hooligans if that would help!

Oh and the hugs go without saying!

 

[lisaward]

can't offer advice but hugs being sent

oh and love your reply MHF,made me chuckle

 

[RachelB]

Am I being stupid here - SSFT?? Or are we talking SDFT? If we're talking SSFT, that's not good from an equine degree student that I have no idea what it is!

If however, we're talking SDFT, then I could spend about a year posting the hugest long reply (obsessed almost covers it). To save my typing fingers, I've resorted to saying that if she has any specific questions I know a fair bit about tendons and tendon injuries and would be happy to have a crack at answering anything

If we really are talking SSFT then ignore the last paragraph, tell me what it stands for, and slap me on the wrist for not knowing!!

 

[S_N]

[ QUOTE ]
Am I being stupid here - SSFT?? Or are we talking SDFT? If we're talking SSFT, that's not good from an equine degree student that I have no idea what it is!

If however, we're talking SDFT, then I could spend about a year posting the hugest long reply (obsessed almost covers it). To save my typing fingers, I've resorted to saying that if she has any specific questions I know a fair bit about tendons and tendon injuries and would be happy to have a crack at answering anything

If we really are talking SSFT then ignore the last paragraph, tell me what it stands for, and slap me on the wrist for not knowing!!

[/ QUOTE ]

TBH I did question this, as I am an ex-equine degree (well HND, but topped up to a non-specific BSc) student and have not heard of the Superficial Suspensory Flexor Tendon either and I was always pretty hot on the anatomy of the lower leg.

However, she has just e-mailed me this link to the possible operation that her vet was on about.

Superficial Flexor Tendon Injuries
http://www.horsebc.com/kvs/tenoscopy.htm
Even with optimum healing there is less elasticity in an injured superficial flexor (SFT) resulting in a higher chance of re-injury. Dr. Larry Bramlage's technique of cutting the superior check ligament under general anesthetic allows an extra centimetre or so of give that compensates for the loss of elasticity. Statistics have shown that a thoroughbred racehorse treated conservatively for an SFT injury still has an 80 % chance of re-injury within the first three races after recovery. Cutting the check ligament reduces the re-injury rate to 20 %. Horses that need to pursue athletic careers will greatly benefit from this surgery.

 

[RachelB]

That's talking about the SDFT though... as I'm sure you already know, there are only four tendons of the distal limb, two extensors and two flexors, of which there is one superficial digital flexor tendon (SDFT) and one deep digital flexor tendon (DDFT). SDFT is also commonly called the SFT (missing out the 'digital' part which is often deemed too obvious to include!). The closest you can get to a "superficial suspensory flexor tendon" is the suspensory ligament of the SDFT, which is as the name suggests a ligament and not a tendon. All this, and the contents of the webpage, would indicate that the link you posted is referring to the SDFT/SFT.
So new question, are we talking tendon or ligament?

 

[TayloredEq]

first off big hugs.

Second - is said horse insured?

Thirdly - how good is the vet? Is it worth asking for a referral to a specialist leg vet?

Fourthly - consider using a hydrotherapy spa, very good on taking inflammation and pain away from problem areas. google ECB and look at the case studies on their web site to show how useful spas have been in the recovery of tendon issues.

If horse is insured and vet will refer to specialist therapy centre then insurance companies will often pay for this sort of treatment.

I would have thought that a program of box rest followed by controlled exercise would be a prefered route rather than just a year out. By controlled exercise I refer to walking in hand rather than a horsewalker.

If horsey doesn't settle on box rest then I would also discuss the use of ACP with the vet. It can be used for a long term rest and I would think that he needs to be kept calm so as not to put further strain on the leg.

Good Luck!

 

[S_N]

[ QUOTE ]
That's talking about the SDFT though... as I'm sure you already know, there are only four tendons of the distal limb, two extensors and two flexors, of which there is one superficial digital flexor tendon (SDFT) and one deep digital flexor tendon (DDFT). SDFT is also commonly called the SFT (missing out the 'digital' part which is often deemed too obvious to include!). The closest you can get to a "superficial suspensory flexor tendon" is the suspensory ligament of the SDFT, which is as the name suggests a ligament and not a tendon. All this, and the contents of the webpage, would indicate that the link you posted is referring to the SDFT/SFT.
So new question, are we talking tendon or ligament?

[/ QUOTE ]

LMAO!! We had this discussion earlier on - but after your response - and Yes, she does mean tendon. She was obviously confused/upset/distressed (take your pick) when we were talking this morning - which is perfectly understandable IMO!

 

[S_N]

[ QUOTE ]
first off big hugs.

Second - is said horse insured?

Thirdly - how good is the vet? Is it worth asking for a referral to a specialist leg vet?

Fourthly - consider using a hydrotherapy spa, very good on taking inflammation and pain away from problem areas. google ECB and look at the case studies on their web site to show how useful spas have been in the recovery of tendon issues.

If horse is insured and vet will refer to specialist therapy centre then insurance companies will often pay for this sort of treatment.

I would have thought that a program of box rest followed by controlled exercise would be a prefered route rather than just a year out. By controlled exercise I refer to walking in hand rather than a horsewalker.

If horsey doesn't settle on box rest then I would also discuss the use of ACP with the vet. It can be used for a long term rest and I would think that he needs to be kept calm so as not to put further strain on the leg.

Good Luck!

[/ QUOTE ]

Thanks for all of this TE! You can be assured that this post id being read by her - I double/triple checked earlier, which was fairly easy to do, seeing as we share an office, LOL!

 

[Marchtime]

Whilst I don't have experience with this particular injury what is worth noting is that vets will often give worse case scenario. My horse was diagnosed with collateral ligament damage last year. Whilst my vet was hopeful we could get him sound, the specialist told me it was best if I considered retiring him now (he was 9yrs old at the time). It's been a long and slow recovery but he is back in work. So he'll never jump and to be fair I'm unlikely to push him but my vet maintains he could do more than hack. It's just worth noting that vets can be over cautious especially with the initial diagnosis. Give the horse some time and love which I'm sure he'll get lots of! Sending positive vibes.

 

[RachelB]

[ QUOTE ]
LMAO!! We had this discussion earlier on - but after your response - and Yes, she does mean tendon. She was obviously confused/upset/distressed (take your pick) when we were talking this morning - which is perfectly understandable IMO!

[/ QUOTE ]
Definately understandable, when I put the phone down on the vet who had done Maiden's MRI scan I went to tell my mum what he had told me and had completely forgotten. It took me a good three minutes to remember what he'd said! All I can remember of the phone conversation is thinking he sounded like he was shouting all the way from Newbury to Salisbury, not talking on the phone!
In which case I stand by my original post that I am open to PMs as I have a little experience and a little knowledge of the area.

The most important thing with tendon injuries is the initial healing period. I missed this entirely with my mare, as I had no idea she'd torn a tendon. From the research I've done, 99.9% of studies say that cold therapy (ice bandages, hosing etc) can be very, very beneficial. As soon as a tendon is torn it begins to start to heal itself, starting with the inflammatory response (which is partly a good thing to restrict movement, let the horse know it is in pain and to stop further damage, etc - but excessive and prolonged inflammation can hinder the healing process). The actual process of healing is in the most crucial stage up to about a month after the injury (I think it's about that long, not entirely sure) although the actual healing of a tendon takes anywhere from a year plus. Depending on the severity and site of the injury, there are different routes to take in order to help the tendon heal as best it can. There are, sadly, NO shortcuts and time should NEVER be compromised during healing. That's probably at least partly why firing and blistering became so popular, some believe it was to harden the skin around the injury to support it, others think that it was to make the injury more visible to force the owner to give the horse the necessary time off as otherwise you could look at the horse and assume it's fine. Another old horseman's tale is to cut the horse's tail off at the point of the dock, and stick it in a field and not work it until the tail had grown right to the ground. It is very tempting to take shortcuts (trust me, been there!) but it really can shorten the horse's working life (and even it's entire life in desperate situations).
Thankfully times have (mostly) moved on since the days of firing and blistering, and research has shown that although time is the single most valuable tool when dealing with tendon injuries, there are strategic exercise plans that can be used to enable the tendon to heal as best as it can. The second option (it's easier to talk about this one first!) is to turn the horse away. It's not as commonly used as the first option as the risk of the horse running around and damaging itself is far, far greater unless the horse can be properly managed and carefully monitored to reduce the risk (again, trust me, been there!) My horse for example tore her deep digital flexor tendon right down below the navicular bone in February last year (the 4th to be precise). She came sound fairly quickly (within a week) as is common with tendon injuries, then worked as normal for about three weeks until she went lame again and went on box rest. She stayed fractionally lame (half a tenth) until about September. She was on box rest from February 26th until July 6th, with two hours of turnout in a small pen each day. She had a friend to go out with as my friend's horse had strained her check ligament and been diagnosed with two hock spavins at the same time (poor girl) so we had two of them in their two pens close by, which undoubtedly helped to keep both of them sane. The trouble came when Maiden was diagnosed with the torn tendon (and degenerating cartilage between the distal end of the DDFT and the pedal bone, which made her prognosis even worse - "20% prognosis of return to full ridden work" aka not a chance!!) because I then had decided, with my vet, to turn her away. Because of the nature of her injury, being kept confined to a stable all day and turning sharply would not have helped the tendon, and walking her out in-hand each day for controlled exercise would not have been a option because of her nature - she is THE sweetest mare EVER, and if she was being walked out and she tweaked the tendon again, there would have been no grumbling from her, she would have just walked on. Vet and I decided she needed to be kept quiet enough to be turned away for nine months until she could be re-assessed. I had to let her get fat (I mean really fat) so she would be quiet enough to be turned out, which was a success apart from the extra strain then put on her tendon. Catch 22 but it was the lesser of two evils. She has now had nine months less a week turned out and was re-assessed in February, and was given the go-ahead to start controlled exercise at the end of this month. Sadly she went lame two weeks after being re-assessed and I made the decision to semi-retire her, leave her fat and happy in a field until next year, then she may potter about after that.
Anyway the point of the essay about my horse was to show you one option. My mare had a rather bad injury, I'm 99% sure it was a recurrence of a previous injury (which is common in tendon injuries, once they break they are never quite the same again, although with careful management some can still perform well). The othe thing to note from that is that my mare had a DDFT injury, which are for the most part worse than SDFT injuries - it may not be possible to lacarate a DDFT from external physical trauma (unless you're very determined!) but due to the nature of the DDFT they generally require more time off than SDFT injuries, and generally have a much poorer prognosis.
So, on to the second option - box rest and controlled excerise. Prittstick on here is rather an expert on this option, her horse tore his DDFTs in both forefeet and has been on an extended period of box rest and controlled walking exercise. She is also rather an expert on how to control a horse during box rest (although she hasn't yet figured out how to stop the stable being demolished!

) Durnign Maiden's box rest, the best thing I could do for her was give her my time - I was at the yard whenever I could be, grazing her in-hand. The more she came out of the box, the better she was each time. I also gave her Equine America So Kalm powder in her feed and had a tube of it handy at all times, along with a tube of ACP paste. Anyway, being stupid I've forgotten the period of total box rest a horse should have before starting the controlled exercise - the most important thing here though is to work with your vet and decide together what the plan should be. I think exercise can start pretty much immediately though. Once exercise does start, it WILL be very, very boring (again Prittstick is an expert and can tell you exactly how tedious the process is!) but it is very, very essential. If the horse stands in all day, not only will inflammation and swelling be encouraged to continue to the detriment of the healing process, but any new collage the limb is trying so desperately to produce will be laid down in any old fashion. What controlled exercise does is place a small amount of stress on the tendon, which encourages the new fibres to be laid down in a more linear fashion, following the lie of the existing fibres. This is the "normal" way for tendon fibres to lie, and so the tendon will return to more of a "normal" state once healed and should hopefully be able to withstand more stress as a result. After about six months, the tendon should look fairly "normal" in appearance on ultrasound. However this does not mean it is fully healed - even 12-14 months after injury, the tendon may still have only laid down type III collagen fibres which are weaker and thicker than type I (normal) collagen. Type I also has a sort of crimp to it, aiding with the elastic properties of the tendon, which type III does not have. This is where a lot of owners fall, by bringing the horse back into harder work before it has had an optimum healing time to allow the tendon to become as strong and elastic as it can. It will never heal to normal again but it can certainly be given as damned well a good opportunity as possible.
So the point of that long ramble was to illustrate why it is essential to stick with the walk work for as long as possible, as to bring the horse into trotting and cantering work too soon will just make it far more likely that the tendon will be re-injured. It is common with rehabilitation programmes of this sort that the horse should walk for up to six months, gradually increasing to an hour. The vet will (hopefully) want to re-assess the tendon every three months, and adjustments can be made to the rehab programme depending on the progress shown on ultrasound examination.
So, because I've rambled far too much I had better re-cap on the important points:
Cold therapy can be very beneficial especially in the very early stages.
There are two main options - box rest with controlled exercise, walking for up to six months in-hand and then ridden, and regular re-assessments; or complete turnout for suitable horses usually with severe injuries with very poor prognoses.
Whichever route you and your vet decide on, don't give up hope. The very best thing you can do for your horse is give him time, love and attention. There have been very many horses who have had SDFT injuries who have come back into full work - I personally know of an eventer who is now at 3*, and very many racehorses have come back into racing. All is not lost. The main thing is to take it one step at a time, and keep your fingers firmly crossed.
Oh, and most importantly (now this is a VERY important point), DON'T scare yourself by reading things on the internet! I did that... not nice...!
I hope I haven't waffled too much

and you managed to extract something useful out of that, again if you think I may be able to answer a specific question then send me a PM

Edited to add - oh my GOD if only I could write that much on my dissertation!! I thought I'd add a *hug* because they were requested, and if she doesn't post now after I spent ages writing that, I'll be very disappointed!!

 

[S_N]

WOW!! That has to be the mother of all posts and also the winner for content!

If she doesn't register and post now, I will have to steal her food supply whilst in the office - lucky begger is stick like, yet eats for Britain!

So, in short, thank you HUGELY from me and she WILL register and post her thanks!! It will also mean that she can pm you or even me. Though the latter would seem daft, seeing as we spend all day in the same room, we do e-mail.... All work related though, honest

 

[S_N]

Oooo forgot to say, he is being hand walked/grazed and cold hosed, though I don't know how often or for how long.

 

[joannemarson]

I thought you might like to hear a happy tendon injury story!my welsh mare she went lame with a nasty swelling just above the fetlock on each side. She went to the vets and he scanned her and said she had a tightening of the annular ligament round her fetlock, hence the swelling and pressure above joint. She was injected with steroids and box rest for two weeks to go back if no improvement.
there was no improvement so she went in for surgery to cut the annular ligament, i was told she should be ok to return back to work within 2 months and prognosis was really good.
Got a phone call after the op to say they had found a longditolional tear in the deep digital flexor tendon and her prognosis was not good.
I was devastated. she had to have 3 months box rest with a further 6 months rest after that. she did have to be hand walked though for the first 2 weeks.
I made her a little pen in the field so she could have her rest in there so she didnt go mad.
Also she had a magnetic wrap on 24/7, which although no benefits are proven im sure this contributed to her outcome.
We took her back to be re scanned 9 months later so we could write her off for loss of use and put her in foal.
He flexion tested her twice, lunged her for 15 mins and she was 100% sound. He couldnt believe it and neither could i.
She was scanned and he could see no evidence of any damage to the tendon which looked completely normal and the adhesions that he expected to be there was minor.
I was allowed to start working her slowly which i did after another 3 months in the paddock and on saturday we are doing a 14 mile pleasure ride on the most rough hilly terrain there is!
We are starting some showing this year too.
Im convinced that the magnetic wrap helped no end, or maybe shes just a good healer but they dont all end up unrideable and mistys was a nasty injury of the worst tendon.

Good luck with the recovery.
Hide some carrots in his haynet it keeps them entertained for hours!

 

[Doublethyme]

My mare is currently recovering from an impact injury to her annular ligament and also damage to the medial branch of the SDFT (pastern area). Apparently where she has damaged her SDFT it is quite a rare place according to my vet, so his prognosis has been guarded to fair.

However, she has been on two months box rest with 10 mins in hand walking after the first 2 weeks and then 3 months small paddock rest on her own with no other exercise. Back to the vets yesterday and she is progressing nicely, the annular ligament is less thickened and the SDFT injury has filled in a repaired about half now. She is now on another 4 months paddock rest to allow the rest of the healing hopefully and my vet is quite positive that she will come back into some sort of work - I won't be asking anything big of her like jumping anyway, but am hoping that she will be OK for hacking and low level dressage.

Time seems to be the biggest factor with these injuries.

 

[RachelB]

I did say I had a *little* knowledge of tendons...!!

I am actually looking forwards to writing an assignment on this in the next few weeks!
[ QUOTE ]
Oooo forgot to say, he is being hand walked/grazed and cold hosed, though I don't know how often or for how long.

[/ QUOTE ]
My vet advised me that little and often was the key with walking and grazing. Not only to keep the mind occupied and to ensure that good old trickle grazing is kept to, but also because small amounts of strain on the tendon little and often such as 10 minutes twice per day is better than doing a longer stint of walking for 20 minutes once per day. I've not found any scientific evidence yet to back that one up (but that'd be because there's so much to look at and I haven't got round to it yet!) As for cold hosing, the more the better I imagine!
I do hope I didn't waffle tooooo much, I've never been known for being conscise. I hope even if it was waffly that it was helpful nonetheless.

 

[henryhorn]

One of our horses got a 6% tear in her SFT and we were advised box rest then controlled excercise.
We took her for a week's daily treatments of hydrotherapy which I have to say reduced the swelling dramatically and was well worth the money.
I think they now recommend cold laser treatment as the best option, but then it wasn't that widely known, perhaps that would benefit your friend's horse?
We tried following the regime of box rest and the mare wouldn't tolerate it.
The answer was to turn her out in a small paddock with the min shetland for company, and feed her off the fence and gate so he couldn't get any fatter.
After a few months we turned her out with the remaining horses, and despite being observed tazzing about she seemed fine.
It took just over a year before the scan showed virtually nothing, it got better every scan but it was a slow process.
It may have been quicker had we kept her in but she got so stressed she kicked the stable walls, so we decided the risk was worth it.
The mare has since completed two Hunter Trials at a fast pace, galloped on hacks etc and jumped with no lameness at all.
It's hard to advise but if his best scenario is only ever going to be a light hack I would keep him in three weeks then after giving him some sedalin turn him out with a companion in a small area. It's a lot of time and effort for a year for what's essentially going to be a semi retired horse.
A stable mirror may be the best bet for keeping him calm, nothing however worked on our mare...