Annular Ligament Thickening - no easy answer

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l_i_z_z_i_e

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Hello all,

Wondered if I could ask some advice regarding my horse, who went in for nerve block and scan yesterday on a lame hind leg.

Scans showed thickening of annular ligament, which is causing lameness and swellings around rear of fetlock. Normal is apparently less than 0.2mm, and hers were 0.31 at thickest point.

My horse is 22 years old, and literally my horse of a lifetime, really is part of the family.

Treatment options are:
- Field rest long term (20-30% chance of recovery)
- steroid injection into area to try to bring down this swelling. Catch with this is horse had oral steroid induced laminitis 18 months ago. Therefore increased risk of lami again. More chance of recovery than rest, but prob only 50%
- surgery to cut annular ligament. Again horse is 22 yrs so not sure this would be right or fair.

If this was your horse what would you do? She is currently 3 weeks after injury, just as lame (3-4/10 in trot).

Really don't know what to do for the best :-(

Thank you
 
My very special 16 yo gelding is recovering from an op to cut his annular ligament which was thickened with scar tissue. He also had scar tissue in his tendon sheath so he had a tenoscopy as well.
He was getting worse so an operation was the only option. I REALLY didn't want him operated on as he has spavin in both hocks. The vet assured me turning away would probably make him worse and I tried a couple of months in a tiny paddock to see if it helped - he got worse and was miserable. So operation was the last resort.
He had the op 6 weeks ago and so far has been fine, but he's on box rest. His op was not very successful and after £3000 worth of treatment he's 'not likely to come sound', according to the surgeon who operated. But we are trying with the rehab anyway as there's a chance he will be ok and I owe him a chance!
He's got a fat fetlock but he's walking on it confidently during his twice daily exercise, so so far so good but there's a long way to go.
I will make a decision in the spring as the vet said to give him 6 months - if he's sound then we carry on as we were. If he's not he will go out in the field with his mates on bute for a few weeks and then we will call it a day.

He, like yours, gets steroid induced lami. However he did have steroids when he had spavin injections and although he had lami changes, because he was box rested and very controlled diet plus anti lam supplements he was fine. In fact it was only the farrier who could tell. He was totally fine after.

So if you REALLY don't want the op, and I can totally understand why, you could box rest and try the steroids. Just be well prepared for lami - it took 2 weeks to show itself in mine.
 
Depending on what sort of work you expect she'll be able to do IF she comes sound, I would opt for field rest.
Perhaps surgery would have a better prognosis (although I've yet to see it to believe it), but at 22 I'd rather see my best friend wandering round the field being a horse, not having been through the stress of surgery....
I wouldn't risk the steroid injections either as having to see my horse stand in a stable with sore feet would make me feel too guilty!
Just my opinion, she's your horse, you know her best! Good luck, hope she comes right for you :)
 
what has your vet said about the best course of action for your boy given his history?

I have just put my 18yo (also horse of a lifetime, had him since 5yo) through the op, his AL thickening turned out to be secondary to some small tears in his distal sesamoidian ligament, this was treated with PRP at the same time as the op. He had the op on 11th Aug, which was a success (apart from him having a seizure coming round from the GA!) and he is now on pen rest with increasing daily walks, we go up to 20mins tomorrow (which means I can get back on him, yay!). As my vet and the surgeon advised, he has been left with a bit of a fat ankle, but that is just cosmetic. He is walking out well on it, but then he was sound in walk before. He will be assessed in 3 weeks time, and will then be allowed into a small field. His rehab period was extended due to the additional ligament issue (which was not discovered until he went in to have the op). I was advised rest was not really an option, as this type of injury tends not to recover without intervention. Steroids were my other option, but I went for the surgery as I felt they would only mask the issue, not fix it long term. It was a wise decision, as the surgeon advised that due to DSL tears, the steroids would not have helped. My boy has been given a fairly good prognosis as we treated the injury quickly and aggressively (op done about 3 weeks after swelling first appeared on leg).

Only you can make the right decision for your boy, as you know him best. I am lucky in that my horse is superb on box rest (apart from the mess he makes!) and just takes everything in his stride, and this helped reassure me that he would cope just fine with the op mentally.
 
Vets are sitting on the fence really have said every option has its merit and I wouldn't be wrong choosing any of them.

Difficulty with my girl is she has a lot of allergies. She has come back from half a day at the vets for the lameness workup/scan to be so itchy I cant put her in the stable as she will scratch herself to pieces, and is covered in lumps. This is when she should be on box rest.

I'm so scared she will be allergic to the GA or something, she is literally the most sensitive horse I have ever come across with her skin.

I wonder whether to give the steroids a try - treat her like she has laminitis a week before to limit the risk (?) and for 2 weeks after, and if that doesn't work go for the op.

from what I have read and everyone is saying it is unlikely to heal alone, and I wouldn't turn her away lame forever. Equally if I never ride her again I will still be glad to have her
 
To add to my comment.
Yesterday I had the vet out to look at my horse's healing fetlock. He needed an injection of lubricating fluid into his tendon sheath. This injection also contained steroids. SO I am now on lami watch but he's being treated as lami and I am sure he'll be footsore in a few days. But hopefully he'll be fine! I've cut his feed completely and he's just getting a few equibites in his bowl and a handful of chaff to carry his joint supplement, with a smallish haynet and as much barley straw as he wants to eat.

He now has to wait 4 weeks or so and then he will need to go in for a scan. All being well with that ****FINGERS CROSSED**** he will be allowed some turnout.

SO in my case opting for the operation has involved steroids anyway!
 
I had my 19yr old now 20 operated on for this end of Aug last year on both hind legs. He also had platelet rich plasma therapy on his oblique distal sesamoidian ligament I had a terrible time making the decision due to his age. I've had him 10 years and he's the apple of my eye. The vet said GA is no more risky in an otherwise healthy older horse. He coped really well with the operation and 6 weeks box rest with in-hand walking twice a day after 2 weeks. I had my first ride on Xmas eve about 3 months post op the best present ever. Vet said I could compete again but I don't want to risk it I'd rather have more years with him just hacking. He also had steroids in injected about 6 weeks after starting riding but hasn't had anything since.
 
At 22 and with all her other posssible/problems I would turn her away. It's not a nice thought but far better imo to have to decide to pts, if it comes to that, after some time in the field with friends than after a series of unsuccessful procedures. For a younger horse, I might choose a different option, although I would weigh up all the pitfalls very, very carefully.
 
Thanks everyone. Really am no further ahead as to what to do with her right now. Vet is calling me back today for a chat so hopefully i'll get a few questions answered which may help.
 
Just spoke to the vet again, and having spoken to some others they are now recommending to avoid steroids...too much of a risk.
So I think my option now is 1 month box rest on bute and see how she is after that. If more sound that will be good and she may be looking at a bit longer in, but if no better then realistically we will be looking at surgery.
She is too lame for me to comfortably retire now out to a field so really unless she gets a bit better from the box rest that isn't an option. :-(
 
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