Can she come back from ligamant probs a 2nd time

[roxy007]

My mare had the following problems when we got her back in 2005. She has been lame for about 8 weeks now for no reason that i can pinpoint. She has windgalls on her right fore which I haven't seen before but they seem to have occured after her latest lameness problems are beginning to resolve. When she was really lame she had major probs turning left or right. For example if she was standing at the gate to her field she would take a few seconds to sort out her footing to enable herself to move away either to the left or right. She is not an ancient mare being 13 years old. Does anyone have any good advice or experienced similar problems. I've undernoted an extract from her very first veterinary report not long after we bought her. As her injuries are long standing from before we got her it doesn't look like stem cell therapy would have much to offer but I am still looking into this. Her report from 2005 is as follows but she did come sound from all of that and repeat scans and x-rays should significant improvement enough for our specialist to advise bringing her back into light work. She did really well with no probs light hacking mainly walk and the occasional short burst of trot to get her fitness levels up but unfortunately she has become lame again but as I say unsure if she has re injured her ligaments. Any help much appreciated. What I really want to know is if there is any other options we could explore for her to try to get her sound and also if anyone else has had these problems and if so what they tried. Thanks folks folks

Distension of both metacarpo-phalangeal joints and digital flexor tendon sheaths in both forelimbs. Distension of both femoropatellar joints in both hindlimbs, tarsocrural joint effusion and digital flexor tendon sheath distension (more obvious on the right hindlimb than the left) Mild coffin joint distension of the right forelimb. When examined on hard ground in a straight line a 3/5 right forelimb and 1/5 right hindlimb lameness was observed. Radiographic examination revealed radiolucent areas on the attachment of both collateral ligaments on the distal phalanx but no other abnormalities detected. Ultrasound of the pastern region and collateral ligaments revealed heterogeneous echogenicity of the digital flexor tendon at the level of the pastern and an enlarged andhypoechoic medial collateralligament. Roughening of the middle phalanx was also noted.

 

[silvershadow81]

My girl is currently having problems turning right, she is lame on the left fore.

I would be interested to hear what people say on this.

I dont think my girls is related to lower ligaments as when walked her left fore swings forward and to the right slightly..... we think this is due to a higher injury (shoulder) and am awaiting a physio visit to confirm.

Can i ask if your horses foreleg moves forwards in a straight line or not?

sorry i cant help from your OP, just like to know what others say to see if any can apply to my girl. Good luck x

 

[Llwyncwn]

I so wish that vets would speak English

We have a number of vets on here who could decipher this and offer an opinion. PM Star or Ann-Jen or Halfstep who could help, or Jet-Set and Silmarillion who have lots of personal experience. Hope you get some positive results.

 

[roxy007]

Thanks so much - will try and contact one of those suggested - you're right! Wish they would speak English!!!

 

[RachelB]

The long words are just a case of re-learning

I get confused with joints unless they are called their "proper" names! The helpful thing about "proper" names is that you can place them within the body and know which angle you are meant to be looking at them from, and exactly where the problem is, without a long explanation. So basically:

[ QUOTE ]
Distension of both metacarpo-phalangeal joints and digital flexor tendon sheaths in both forelimbs.

[/ QUOTE ]
Swelling of both fetlock joints and tendon sheaths in both forelimbs.

[ QUOTE ]
Distension of both femoropatellar joints in both hindlimbs, tarsocrural joint effusion and digital flexor tendon sheath distension (more obvious on the right hindlimb than the left)

[/ QUOTE ]
Swelling of both stifle joints, leaking of the joint fluid from around the top joint in the hock, and swelling of the tendon sheath which is more obvious in the right hindlimb.

[ QUOTE ]
Mild coffin joint distension of the right forelimb.

[/ QUOTE ]
Some swelling of the coffin joint (right down in the hoof) of the right forelimb (it gets me when vets use mostly the "right" words and then don't bother calling some things by their "proper" names... continuity please! Distal interphalangeal joint!)

[ QUOTE ]
When examined on hard ground in a straight line a 3/5 right forelimb and 1/5 right hindlimb lameness was observed.

[/ QUOTE ]
Me thinks that one is obvious

[ QUOTE ]
Radiographic examination revealed radiolucent areas on the attachment of both collateral ligaments on the distal phalanx but no other abnormalities detected.

[/ QUOTE ]
X-ray showed up abnormalities where the collateral ligaments attach to the pedal bone.

[ QUOTE ]
Ultrasound of the pastern region and collateral ligaments revealed heterogeneous echogenicity of the digital flexor tendon at the level of the pastern and an enlarged and hypoechoic medial collateralligament.

[/ QUOTE ]
Ultrasound of the pastern and as far as they could get into the hoof capsule showed that the DDFT was abnormal where it passes over the pastern joint (heterogenous echogenicity basically means that the ultrasound image didn't show the tendon as one "shade" as it should be, but as different "shades"). Also, the collateral ligament that attaches to the pedal bone on the "inside" of the leg wasn't very visible on the ultrasound as it wasn't reflecting many of the ultrasound waves back, which is abnormal.

[ QUOTE ]
Roughening of the middle phalanx was also noted.

[/ QUOTE ]
The short pastern bone is rough where it should be smooth.

When my horse went into the clinic for X-rays and ultrasound etc. my vet was very relieved when I told him I was doing an equine degree so not to try to put everything in layman's terms

Anyway, so basically your horse has a lot wrong with her

I'm not sure from your OP, have you had your vet out to see her since she went lame? Eight weeks is a very long time... it only took three weeks for me to completely miss the vital initial period of healing when my horse tore her tendon.
Anyway, a summary of what was wrong when you bought her - front fetlocks and all four tendon sheaths, stifle joint, leaking hock joint, coffin joint in right fore, DDFT at pastern, collateral ligaments attaching to pedal bone, short pastern bone damaged. Very lame right forelimb, slightly lame right hindlimb. Poor horse

TBH mostly people only have one or two problems to deal with at a time and as such can give "advice" from their experiences of those problems. I have experience of DDFT problems and my horse also has/had cartilage problems on her pedal bone. I believe Jetset's mare Grace has proximal suspensory desmitis (which your mare doesn't have from that list, although Jetset will obviously know more about ligaments than I do

)
TBH the only way to do it is speak to your vet. They are extensively trained for this type of thing. I could tell you what I'd do to help heal the tendons but there is far too much else going on there to be able to confidently say that treating the tendon in the normal way would be beneficial to the other problems. Being the pessimist I am, I would say your best bet is to hope she comes field sound and not bother riding her until she has been sound for a very long time.

 

[roxy007]

Hi - Thanks so much for getting back to me on this

I did have our vet out (well his new assistant newly qualified) who I was not impressed with - sorry
As soon as she got out of her car she let two dogs run riot in the field chasing the other mares there and in the midst of all the chaos she was wanting me to walk and trot my mare up in hand in the field rather than in the yard. i was concerned that her dogs were gonna get kicked but she was not bothering at all not even when I asked her to put them back in the car for their own safety. Said she would just have to fix them if they got hurt (fab attitude). One did get kicked in the head and went off to the car howling - so sad and unneccesary). Anyway She tested my mares hooves which were fine with the testers then said she couldn't feel anything obvious apart from a little heat (right front) around the coronary band. She gave me some bute and told me to give it to her for a week and then take her off it and ride her out at walk trot canter and then faster work for about an hour and see how she was the next day (clearly she'd read her records then).......magic stuff that bute as she wasn't doing canter and faster work before or being schooled. I chose not to give her the bute as I was concerned that she may do more damage due to her past history and therefore wanted to try a wait and see approach for a bit longer. She is improving but it has taken a long time. I can take a short video clip of her in the field where she is happier to trot and canter down again to greet us and it may show something to a trained eye that I am missing. She can't be insured so I'm currently saving up to have her fully reassessed at the specialist centre near where we are again but MRI etc will be expensive so I reckon it will be around August / Sept before i can do that. Just wondered if there was much we could do for her until then. I'm hoping its a good sign that she has improved over the period since she became lame again but its such a long process and obviously keen not to aggravate any further problem. From your experience what would be the long term prognosis for a horse with problems such as these.......its ok you can be honest......biting lip hard and stiff drink on hand

 

[roxy007]

Meant to ask but missed it from my last novel sized post -

re this bit - Also, the collateral ligament that attaches to the pedal bone on the "inside" of the leg wasn't very visible on the ultrasound as it wasn't reflecting many of the ultrasound waves back, which is abnormal.


Why would the ligament not be very visible and not reflecting the ultrasound waves back? Could this be partially detached and if so would her symptoms of lameness be more persistent and severe.

 

[RachelB]

Hmm, not being an expert I would imagine that as ultrasound waves have to have something to bounce back off to make the image (waves are "shot" from the transducer head into the leg, some waves will hit structures close by and bounce back to the transducer quickly so they produce a certain "shade" on the picture (a certain echogenicity), and other structures further in will take longer for the waves to get to them and bounce back). I would at a guess say that the ligament is damaged or degenerated and so there is less "solid" ligament for the waves to bounce back off. Total guess though!
I had many vet problems last year. I would be kicking up a HUGE fuss about being given such an obviously useless vet (but then I'm mean, my old vet practice knows that!) I can't believe you were told to "give it [bute] to her for a week and then take her off it and ride her out at walk trot canter and then faster work for about an hour and see how she was the next day"!!! I would have told my vet to s*d off if she expected me to hammer my horse into the ground and see whether it damaged anything any more

What a ridiculous attitude, especially as the horse has only been in light work before the lameness, and especially as the horse has been off work for eight weeks and will have lots some of the limited fitness she already had.
It's a difficult situation, you really need a diagnosis of what exactly is causing the current problem but without money enough for an MRI...

Although, a good vet should be able to give you a sort of "provisional" diagnosis and plan of action, which should probably include bute and box rest if your horse is liable to be silly in the field. You definitely don't want to see her trotting and cantering about - my horse was only allowed out because she is FAR too lazy to bother trotting!
As I said, my experience is limited to tendon injuries so I cannot really say much. I am also not a vet and do not know your horse so am not qualified to say much from that respect either. All I can really say is that I wouldn't be surprised if, once you complain to the vet practice and get a half decent and experienced vet out, the prognosis wasn't good. That is far too many problems for a horse to deal with, and if one or two of them have suddenly flared up I wouldn't be surprised if the other issues started coming back too where she is holding herself differently and walking lame.
Another thing I can say is that one of the things I regret doing last year was holding back with the bute. My vet, trying to do the best for my horse, had a "wait and see" attitude and wanted me to keep Maiden off the bute so we could monitor the true extent of her lameness. Nothing that could have been done really... but I am now quicker to give bute when it is needed (within reason). I think my vet was looking at it from a completely "clinical" point of view, whereas I needed to be the one to say "you know what, my horse is in pain and I can help her by giving her painkillers".

 

[Halfstep]

As far as I understand collateral ligament injuries are very difficult to diagnose without MRI for various reasons to do with "shadowing" on the ultrasound. This is why they rarely were diagnosed until the onset of MRI!

For what its worth, collateral ligament strains would usually be treated conservatively with a LOT of box rest, bute, followed by very, very carefully controlled exercise (hand walking on even, hard ground) over many, many months. I don't know if shockwave is effective on them, doubtful because of where they are located. Remedial shoeing is also used.

It sounds like your horse has a lot of problems around the DDFT, coffin joint and pastern region. The root cause of this could easily be the collateral ligament strain, or this could be secondary to some other problem. I would question the roughening of the middle phalanx and want to know why this has occurred. The hind leg lameness (effusion of the tarsocrural) sounds like compensatory - this is the upper hock joint and is probably a strain to the joint capsule.

If you were insured, I'd be looking for a referral to a major equine veterinary hospital for MRI scans and a full second opinion. If not, discuss with your vet, but I think you will be looking at a lot of box rest and careful exercise.

Disclaimer: not a vet or scientist, just someone with working knowledge of anatomy and a horse with porcelain legs.

 

[roxy007]

Hi - I've had my mare assessed at the two major specialists centres here in Scotland. After the first report (the one I have included extracts from on my first post) I was advised by the three vets that assessed her to put her to sleep. I wasn't keen to do this at that stage as its a major decision obviously and having only had her a short time (weeks literally) I didn't want to give up without trying everything for her.

At the second centre she was reassessed again and showed significant improvement - enough for the vets who were looking after her to suggest bringing her back into light work to see how she coped. We did the walking in hand 5 mins every day and gradually increased this over a long time to the stage where she could happily be ridden 4 times a week for almost an hour at a time and from this she was not stiff or lame and was thoroughly enjoying herself. She is not and was not miserable or depressed looking at all - in fact quite the opposite and she perked up even more when she was getting out and about again. She has been competed at international level as part of 4 and 6 in hand carriage team so she's had a lot of stress and strain on everything really.

I'm really disheartened as its been a long road to get her to the stage she was at and now it seems we're back to the start again. Neither veterinary centres offered me the options of any treatment whatsoever for her ....... not even bute and I'm unsure why. I am planning to take her here as it seems to have a fabulous reputation
http://www.clydevetgroup.co.uk/equine/equine.htm
once I have the funds to do so to see once and for all if there is anything at all that would be of benefit to her. She's a real pet, very calm and really looks after her rider.......obviously she knows I can't be allowed out on my own......

 

[Flame_]

I don't know if this will help at all but my horse has just been diagnosed with severe collateral ligament injuries in both front feet and damage to the DDFT in just one foot. She is having shockwave therapy for this and controlled exercise. It has been advised that following this she will need a minimum of six months field rest before any attempt is made to see if she stands up to work. I'm putting her in foal while she has even more time off to recover. However the prognosis I've been given is pretty bleak with only a 35% success rate, and it sounds like your horse has a lot more wrong with her than mine. Sorry

 

[roxy007]

Thanks for your post - I hope all goes well with your mare and hopefully foal next year too

I'm not giving up on my girl yet and by the way she looks right now I know she's up for whatever we can do for her - she has such a tremendously strong will and I am sure that will help her enormously as it has done in the past - fingers crossed for her but In reality I know that if life stops being fun she will be the FIRST to let me know.

 

[Marchtime]

I'm so sorry to hear about your mare. I'm not a vet, nor do I have extensive knowledge but I have much experience with this sort of injury.
I lost my TB to a very similar diagnosis six years ago. He had huge collateral ligament damage in his left fore and it had caused the coffin joint to basically begin to collapse. The vet report read like yours - a list of problems with both feet all of which stemmed from the original injury. We tried six months box rest but eventually we were advised his pain could no longer be managed and he was pts. He was only 8yrs old.
Whilst I'm sure you love your mare and are doing everything you can for her you need to be realistic about how much pain she is in. Don't hold back on the bute. You could probably treat one or two of her problems but I would suggest that getting her sound to ride is probably unrealistic. Maybe I am wrong but in my experience ligament damage alone is hard enough to treat. Has she had any joint injections or shock wave or does the vet not think this will help?
Whilst an MRI would give you an idea what is going on I don't think it would necessarily provide you with many useful answers. A lot of injuries that require an MRI to diagnose cannot be treated as such. The treatment is simply rest and more rest. My current horse has just come back from collateral ligament damage and is hacking but it took nine months off work.
Be prepared to spend a lot of time waiting. And please don't hold back the bute. By the sound of the diagnosis I would imagine your mare must be in some level of pain.
Good luck.

 

[wjgfred]

Hi,

I read a recent reply you put on another posting, and hope you dont mind me getting in touch as you talked about tendons.

My horse was diagnosed via MRI 2 weeks ago and I am still trying to get over it. The vet speak was as follows on report from MRI
"This revealed a core lesion progressing to a sagittal plane split in the deep digital flexor tendon and considerable bony reaction around the origin of the medial collateral ligament of the coffin joint with evidence of damage in both collateral ligaments."

I do understand the vet speak (just about) as my vet is very good and I have a reasonable knowledge of horse anatomy. Freddie has been on 2 months box rest with 20 min x 2 walks each day. He had weekly cartrophen for a month and then monthly and has just started 12 months field rest. By field rest he is out for16 hours and comes in during the day for a rest (he sleeps and snores all day!!).

He has been sound for 3 weeks in both walk and trot,although I have only tried him on the straight (for obvious reasons).

I do understand the seriousness of these injuries, I was recommended to have a neurectomy by the MRI vet but having read this up decided this was not a good option as I believe his tendon will just break down in a short time and the other complications seemed to outweigh the positives. My own vet did not recommend it either and suggested the above as the best option.

I have considered/are considering all options such as stem cell, hydrotherapy etc. Also he is shod with bar shoes and wedges due to the fact that that although his feet look good, his pedal bones were completely flat. This is being monitored via x-rays as his heels grow, in order to check the angles.

I guess I am just desperate to try my best for my horse, he is a working (low level) competition horse and very bored at the moment and I just want to know I have tried everything I can. I am sorry to bore you with my story, but any advice you can give would be greatly appreciated. I have been given a 30 per cent chance of getting him back into work and I want to try to up the odds. I am also slightly confused by the fact that my horse is consistently sound at the moment and everyone elses with tendon injuries seem to be lame in walk.

Thanks for any help you can give - Wendy