Annular ligament - Cortisone

[Naunie]

Hi everyone
Newbie here but Ive been searching through old posts about annular ligament injuries to get a further understanding

My 14 yr old ISH was diagnosed with a hind right annular ligament injury with thickening of the tendon and some scar tissue. Vet proposed surgery with cutting the ligament to relieve pressure or trying cortisone injection and box rest with slow return to work.

On advise we went the cortisone route and got a good 10 months out of it before I could again feel issues under saddle with his movement. They continued to worsen with him showing resistance to transition to trot and to even turn to the right.

On assessment with the vet he found he was better than last year but in need of another round of cortisone. He classified him as 1/10 lame which I know isnt bad but he feels worse than he ever has. On this round the advise was only 48 hours rest for the injection to settle and then back to work. So following this time frame I started back working but he felt just as bad as before the injection. Now today a week after the injection his leg is swollen with heat. Im walking him and hosing to see if a little extra time may help as it did last year.

Now whilst I know this treatment has limits on how long it may work for and long term treatment is not ideal.
My question is have you any other treatment suggestions I could try to help manage this - poultice, new supplements, tumeric etc???
Surgery is the last option I want to take as my understanding is it is a big surgery and the success rate is 50/50 (vet described it to me like carpal tunnel surgery a human has)

Im finding it really hard right now as Im so worried that this time round it's not working and I cant do anything to help his pain without medicating him. He really wants to be out & loves to jump but we havent managed to jump anything other than 50/ 60's while schooling in 12 months. We've done some dressage to try and build him up too. He doesnt do well with box rest & I find myself getting more heartbroken everytime I see it swollen and his unhappiness when its bothering him.

Sorry this turned into a longer post than I planned

 

[SusieT]

if its h and swollen after being injected you need to ring your vet as there is a strong possibilty he has an infection in the joint.

 

[Marigold4]

I dithered about whether or not to have this op. My horse also 1/10 lame. Went ahead last summer. Op v straightforward but it took a LOT longer for horse to become sound than vet said so rehab postponed. Now 7 months later she is rideable again. I think success rate for this op is higher than 50/50.

 

[meleeka]

I too think the success rate is higher than 50%. My cob had the op. It wasn’t a particularly big op although a general was required. His was complicated because he re-injured himself while hand walking, but I know others that were back in work in a few months.

 

[AandK]

My horse had the op in August ‘15. My vet never gave a success rate as low as 50/50, he was quite optimistic that he would come back to the level of work he was in before the op. I chose not to medicate for various reasons, which was the right choice as his annular issue was secondary to a sesamoidian ligament injury. This added to his recovery time (he had PRP for this at the same time as the op), he was sound by mid Dec of the same year. Ended up having another 6 months off due to an unrelated issue and made a full return to work. Did dressage end of 2016 and then started jumping again May/June last year. He did 3 ODEs in Aug/Sept/Oct last year too, not bad at the age of 20!
Not done anything yet this year, as sadly had to have his left eye removed a month ago, due to a malignant tumour on his theirs eyelid. Although we have been out on some short hacks since then (typically he has a bruised foot so been in for a week!)

 

[AandK]

Just to add, it’s keyhole surgery. I have posted about my experience before but he was on box rest for two weeks and then went out into a pen once the stitches were out. We then started walking 5 min a day building up to 30 mins after 6 weeks. If it had just been the annular, at this point we could have carried on building up and back into work, but due to the other issue he had another two months field rest.
Honestly if the injections haven’t worked twice, I’d be seriously considering the op, I’m not aware of any other options, they were the only two given to me by my vet. I’d also consider asking your vet about the possibility of this being secondary to another tendon/ligament injury.

 

[Naunie]

Thank you all for replying with your experiences and the options you had tried and from the post surgery plans.

The first injection worked for 10 months which is apparently a good time frame to get without recurring issues. His tendon sheath does have damage done to it and has further thickened and granulated since last years scan.

I appreciate all of your advise since you have all been down this road. No one in the yard I’m in currently has experienced this problem so it’s a learning curve.

 

[Marigold4]

My horse had two weeks' box rest (one at the hospital but that was my choice). Then a small paddock for another 4 weeks. No complications. wound was tiny and easy to take care of. I'm not at all keen on surgery for horses but this one was really simple and she is 100% sound now having been 1/10 lame for months before.

 

[Sussexbythesea]

If you search on “annular” you’ll find a fair few posts with more detail.

I think the success rate is a lot higher than your vet says, I don’t think the surgery is major compared to other types but a GA was required. Mine had both hind legs done at age 19 he’s 23 and still hacking. He’s had various hind limb issues over the years I’ve had him including SI injury yet he’s still sound enough for hacking and the odd show.

If your vet doesn’t sound confident I’d be thinking about a referral to a specialist for surgery.

 

[ester]

Ditto another that thought it was higher and I would probably operate on a 14 year old especially as there has been further thickening since last year (how thick is it?). I didn't operate on a 23 year old but that's a rather different kettle of fish.

I agree that with swelling and heat I would be concerned about infection at this point.

 

[Naunie]

Thanks yes I’ve searched and read all the post with annular appearing.

My vet is a specialist - he’s me of the best and is highly recommended from anyone you speak to. Perhaps it’s to do with jumping post surgery. I’m not the best hacker having suffered a pretty bad fall some years ago on the road.

 

[Lyndab22]

I dithered about whether or not to have this op. My horse also 1/10 lame. Went ahead last summer. Op v straightforward but it took a LOT longer for horse to become sound than vet said so rehab postponed. Now 7 months later she is rideable again. I think success rate for this op is higher than 50/50.

My cons just had this op, he was 1/10 at walk and 3/10 at trot but had a big thickened fetlock, he had op six weeks ago and is now in rehab, two walks a day at moment of ten mins, plus two hours turn out in a taped of area in paddock, he had three hours yesterday and was a bit stiff this morning, so will reduce his turn out back to two hours for another week
He is doing good but I know it’s gonna be a long haul and it’s 50/50 riding again, but the more I read about this op, the more I hear if horses becoming sound even after a yr, so I guess it’s gonna be a along slow process

 

[Lyndab22]

I too think the success rate is higher than 50%. My cob had the op. It wasn?t a particularly big op although a general was required. His was complicated because he re-injured himself while hand walking, but I know others that were back in work in a few months.

Hi can I ask, what did yours do to reinjure himself, did he come sound eventually, did I drop back his rehab program whilst re injured, I’m asking as my cob seems a bit stiff today and am a bit concerned, he seemed ok yesterday and this morning looked a bit short in his leg that’s been operated on, thinks he might have done the fandango lol, I’ve brought him in and a will give him some turmeric in his tea

 

[meleeka]

Hi can I ask, what did yours do to reinjure himself, did he come sound eventually, did I drop back his rehab program whilst re injured, I’m asking as my cob seems a bit stiff today and am a bit concerned, he seemed ok yesterday and this morning looked a bit short in his leg that’s been operated on, thinks he might have done the fandango lol, I’ve brought him in and a will give him some turmeric in his tea

The vets thought he’d trodden on himself when doing his airs above the ground because they found a bone chip 🙄 he was a nightmare to hand walk whereas he’s usually no problem. He didn’t mind box rest. It was when he came out that we had a problem. the swelling didn’t really go down until he had a fairly high dose of Bute for a week and all in all it took a year before he was fully sound again That was 5 years ago and he’s had no trouble since

 

[Lyndab22]

I’ve finally got my cob out, made him a pen with poles tape and an energiser, he did a bit dance first but did settle to graze, he seems happy out,and I still do his inhand walk when I bring him in for the night, he gets a ten min walk,

 

[Lyndab22]

The vets thought he’d trodden on himself when doing his airs above the ground because they found a bone chip 🙄 he was a nightmare to hand walk whereas he’s usually no problem. He didn’t mind box rest. It was when he came out that we had a problem. the swelling didn’t really go down until he had a fairly high dose of Bute for a week and all in all it took a year before he was fully sound again That was 5 years ago and he’s had no trouble since

Did your horse appear stiff on the operated leg, mine is walking ok but looks stiff today, he’s on his second day out in a penned of area and I suspect today he may have some the fandango while I have been home, he seems very stiff on that leg, I know it’s only six weeks so still early days, hope to god he has t injured anything inside? I’ve been so very carefu with his rehab to the letter

 

[meleeka]

Did your horse appear stiff on the operated leg, mine is walking ok but looks stiff today, he’s on his second day out in a penned of area and I suspect today he may have some the fandango while I have been home, he seems very stiff on that leg, I know it’s only six weeks so still early days, hope to god he has t injured anything inside? I’ve been so very carefu with his rehab to the letter

He looked stiff in walk but very lame in trot. I did have a bodyworker to him who improved the stiffness but the leg was still puffy.

 

[Lyndab22]

My boy has been out today and came in limping, he’s in a poorly paddock, and I think maybe it’s too large,and he’s had too much space to wander and has been out too long, 10 am till3 so, I’ve made his paddock half the size it was , I’m using poles tape and an energiser, and tomorrow he will only have three hours max, I’ve gave him devils claw and turmeric tonight in his tea

 

[Marigold4]

Hi I would get the vet out to take a look, if he were mine. My horse who had the same op as yours was never visibly lame at walk or trot in a straight line after the op even though she had some fun moments in her very restricted grazing pen. I think i would want this checked out.

 

[Lyndab22]

He looked stiff in walk but very lame in trot. I did have a bodyworker to him who improved the stiffness but the leg was still puffy.

Hi update on my cob with the annular ligament desmotomy
He’s doing really good, he’s now sound at walk, and is. Or was 2/10 lame at trot in straight line, he had the cortisone injection and hyarulonic acid injection three weeks ago, no issues of lami etc, he was monitored and hay was soaked for two weeks, he’s now out in paddock but in a big taped off area, he’s in on a night but out from day 10 am to 1600 daily
He’s full of beans and bounce and he’s a bit of a canter himself in his paddock then decided to buck his height complete with dragon snorts lol, I was worried he would injure himself but he is ok, I’ve emailed vets who did his operation to see what we can do now, re inhand walking to continue or full turnout, I’m not sure wether to leave him to winter out and have winter off doing nothing, or I’d bet says after three months check he can be ridden to start and do his inhand walks under saddle

 

[meleeka]

That’s great news that he’s improved so much Has he had a physio/Chiro visit? A gentle McTimoney made a big difference to my boy. The lady said she always recommends after an op under GA.

Our rehab was endless walking so I would probably get that out of the way over winter if it were me.

 

[Lyndab22]

That’s great news that he’s improved so much Has he had a physio/Chiro visit? A gentle McTimoney made a big difference to my boy. The lady said she always recommends after an op under GA.

Our rehab was endless walking so I would probably get that out of the way over winter if it were me.

He’s having cold
Laser therapy, at minute, I know his last report said effusion , and I know that’s caused by the watery synovial fluid filling the joint capsule , I’m not going to go down the prp route etc or shockwave, I think times. Gonna be a healer ,

 

[Lyndab22]

Well it's now 14 week post op for my cob, he's doing really good, he's thnrwd out all day and night now as we only have a herd of three horses and lots of grass, he come in for his tea, and a haynet to. Munch for an hour, while he stands with his magnetic boots on, alos I use the photonic torch on his repaired leg, then once that's all done he is turned back out, it's his six month check in Feb, then I plan to start him off at riding again, I've saw him canter g round his paddock doing dragon snorts lol and he isn't lame, so I thi k his 50/50chnace of being ridden again has erred on the good side