collateral ligaments

[annie02]

Does anyone have any experience or suggestions about rehab and treatment for collateral ligaments?

My mare has pulled hers, she is bandaged and on box rest but would appreciate some feedback and pointers...

Thanks

 

[puddicat]

Which colateral ligaments - most joints have them ?

In general, rest followed by gradual increase in work - ask your vet if want sensible authoritative advice on time-scales and work rate for your particular situation.

 

[annie02]

In her left front foot...vet has given me a schedule. I was just wondering if anyone has worked a horse back with this type of injury. She is a big girl, 17hh and broad. Very athletic. But I would be happy if she was pasture sound to play, she doesnt have to work much other than the flat. The vet was vague on recovery, which is why I was wondering what others have found.

 

[brightmount]

My mare had damaged collateral ligaments in her foot, and I have the MRI scans to prove it. The interesting thing was that although my vet had no idea of the cause of her lameness, the Equine Podiatrist who had clients on our yard, and who I spoke to before sending my horse for MRI, said it was a collateral ligament sprain, and although the symptoms were acute, she would recover in about 6 weeks. It was like he had x-ray vision. I put my horse in his hands, as it's crucial you have perfect hoof balance during the rehabilitation process, and afterwards of course. I have noticed how EPs are obsessive with hoof balance; they can't mask anything with shoes.

Taking the shoes off also stimulates circulation to the foot, encouraging the healing process.

If you do consider this as an option, I recommend the EPs in this country that are trained in the KC LaPierre trim:

http://www.equinepodiatry.net/Locate%20DEP.htm

Anyway, be encouraged, collateral ligaments heal and it could be a lot worse

 

[annie02]

Thats good to know, the vet took the shoe off and said similar things. I have an excellent farrier that works with the vet so I am confident in his work. My vet also mentioned that the only way to confirm was an mri b/c you cant unltrasound the area where they are. I'm glad that the two stories sound alike. I am going to look at that website and let my farrier know about it, I'm not sure if he is aware.

Glad to hear about the healing process too! She is such a doll and one of my favorites. I have had a lot of experience with lamness, not only mine but others I have trained with but never have we had a collateral ligament problem....I feel like I am just starting out again!

Thanks lynwood

 

[puddicat]

OK so when vets are vague it is usually because there isn't a precise answer. Ie it's not because there is an answer and they don't know it, it's because they know the recovery time could vary quite widely.

In lynwoods case it is naiive to assume that a equine podiatrist could diagnose something a vet couldn't - what happens is that vets are trained no to give a diagnosis unless there is positive evidence whereas the podiatrist has nothing to lose but guess. In this case he/she happen to be right but to assume there were diagnotic signs that could be recognised to give a differential diagnosis is misguided and wrong.

Of course it will get get better, things do so don't worry in that regard. If someone says "it will get better in 6 weeks" they will be right most of the time for any musculoskeletal injury so it is a throw-away comment that can be made by anybody. Try it on your yard and you'll find people will begin to regard you as an expert as you're proved right time and time again! Taking the shoes off does not stimulate circulation, there are some nice experiments to show this, and even if it did, ligaments are so poorly supplied with blood it would make insignificant difference - that is why ligaments take so long to heal in the first place! I'm afraid no matter how much people would like to believe otherwise, the best course of action is to wait for it to get better

It is true that MRI would be diagnostic and it is probably sensible to make sure that the horse is trimmed to have what farriers would call good medio-lateral foot balance.

 

[josephinebutter2]

My horse was diagnosed with "thickened and swollen medial collateral ligaments and associated soft tissue damage" in both front feet - alongside navicular disease.

Sorry to give a bad experience, but he seemed sound after 2 months box rest (plus thousands of pounds worth of treatment and remedial shoeing), so we started controlled walking, then small amounts of trotting (whilst still on rest) and he went lame again. He has been turned away now and is still lame in the field on 2 bute/day - this is 9 months after original diagnoses and about 12 months since we noticed something was wrong.

When he was diagnosed, I was told he had a "good to fair chance of a full recovery" - unfortunately this has not been the case for me and the prognosis now is that he will be lucky to be a light hack on medication. I am considering having him PTS.

Aparently, the most important thing for tendon and ligament recovery is box rest - it may be that we started this too late, and irreversible damage had already been done.

I do hope it works out for you though! Keep us updated.

 

[puddicat]

Owww that is unfortunate

. Usually MRI isn't a good cost/benefit option when the treatment is going to be the same anyway (rest). However in your case it would at least show the extent of the navicular-related degeneration and amount of damage to the collateral ligaments so if you are seriously considering having PTS at least you would know the extent of the damage (although again, it's not likely to tell you anything about the prognosis that you can't already guess). Your vet would have a view on whether it's worth it.

 

[puddicat]

Just an after-thought since you said your horse came sound then went lame again. It's possible that the ligament recoved in the sense that it healed and stopped being the source of pain, but the consequenses of the damage (such as joint laxity due to a permanently stretched ligament) led to lameness for another reason. There is a theory, for example that arthritis could be caused in this way. I'd be interested to know whether your vet thought the recurrance of lameness was due to the original problem or a new problem caused by the original problem.

 

[josephinebutter2]

We had MRI to diagnose mine - I would recommend you do this if you can afford it, as at least you will know the exact problems and can then treat accordingly.

Yes - vet does think that there may be secondary issues going on here too, but we have done treatment for those too and nothing has worked.

I wish you all the luck with yours and a good percentage of horses do fully recover from this, so don't be too dishartened by my story.

Sounds like you are working closely with your vet and farrier, so you are doing the best for your horse.

 

[annie02]

Thanks, I think we have a good plan of action so far. My vet hasnt pushed the mri but I may ask about it again. Insurance would cover it. But I think as puddicat mentioned the treatment will be the same. Box rest, bandages and a strick rehab program.

My only concern is that she is so large and I am afraid that there may be a high chance that she strains them again before they are fully healed.

I beleive, as the vet explained it, they are stablizer ligaments. I have to ask but I thought that even on box rest if she gets up and down to much or gets up funny she will hurt them again.

You cant put them in a bubble though...her body has to take some responisbility.

The vet and farrier will both see her Monday, I will let you guys know how it goes.

Thanks again!

 

[puddicat]

lateral means 'to the side' and 'co' means together or jointly so colateral ligaments are ligaments to either side of a joint that work together to (1) hold the joint together and (2) restrict the movement to that analogous of a hinge (the joint bends in a front-back direction only).

If the foot is loaded in a way such that the load passes up the centre of the limb the colateral ligaments won't be loaded excessively however, if the foot is loaded unevenly then the joints in the foot will be under a force that will try to make them bend sideways and one or other of the colateral ligaments will be loaded as part of their job to prevent it happening (that's also why mediolateral foot balance might be important). The bad news is that when the horse gets up or down it is inevitable that there will be some lateral loading. The good news is that horses like us will avoid pain so as far as we know nature'snatural method for preventing unintentional tissue damage (it hurts to do certain things!) will probably mean that the horse doesn't damage itself.

The exception is when the horse has been stabled for a bit and is full of energy and then gets turned out and its instinct to gallop off across the field seems to outweigh its instinct for not damaging itself. I guess if its leg has stopped hurting it doesn't think along the lines that it may not have fully recovered and a period of taking it easy might be useful. That's one ofthe draw backs of being a horse.

 

[Ludi-doodi]

This is a long reply, sorry!

My lad damaged his collateral ligament in this near side fore last year. June 19th last year he had an Op - arthoscopy - to clean out the coffin joint as the damaged ligaments had meant the joints were moving in a way that they shouldn't have been. My vet was of the opinion (and this may have just been for my lad and his particular injury), that box rest alone does not sort this type of injury. The joint needed to be cleaned out to offer the best chance of full recovery (which he gave me a 70% chance) and reduce the risk of arthritis in the joint.

Ludo had a cast on for 6 weeks and 3 months box rest. In hand walking and very limited turn out after that for another 2 months. I eventually got back on him late October and since then we've taken it all very, very slowly. By Christmas last year he was sound on the straight but still slightly lame on turns (he'd had a steroid injection to rebalance the fluids in the joint but still wasn't sound). Vet recommended IRAP therapy - basically it's like stem cell therapy. He's had 3 injections since December (they took enough blood and did whatever it is they do and we had enough for 7 injections). The effect is cummulative and he's made huge improvements particulary after injections 2 and 3. The vet is really pleased with progress and we're pretty much back doing everything except jumping. We weren't even allowed to canter until February and no tight turns or small circles, but since April we're now able to do quite a bit of lateral work and turning the pressure on a bit - I've even had a couple of lessons recently, the first since April 2006 and we have great gallops out hacking. Whether we'll be back jumping/eventing again I don't know - he's never been 'right' enough so far to even bother asking the question, but the vet is due out early June so I'm hoping that the time will be right to ask!!

All of this, what with scans, ops, rescans, x-rays, irap etc etc etc has completely used up all my insurance (£5k) and a year down the line we're not quite finished, but I'm hopeful. If we don't return to jumping but can do dressage then I'll be happy - though not so sure Lude's will, he loved his jumping!!

If your mare had pulled hers, the damage is likely to much less severe than ours, and hope your recovery is much quicker than 12+ months - I guess the morale of my story is that there is hope!!

Good luck

Edited to say that he also has a 'special' A-symetric shoe for that foot. It's normal width on one side and much wider on the other. I understand that it's to relieve the pressure on the side where the damage is when on soft ground - the wider bit spreads the pressure. The vet has told me that he'll only need this shoe while he's recovering and should be able to go back to normal shoes in the future.

 

[nelliefinellie]

You can only diagnose this for sure with MRI. My horse was diagnosed with this. He was prescribed 6 months box rest with 1 hour walking each day. He was sound after 6 weeks, but just lke any other tendon '/ ligament injury the horse being sound doesnt mean its healed. With ligament in the leg you would monitor healing with scans, but as not feasible to repeat MRI 6 months is advised for maximum healing to occur. he ws shod with wide webbed shoes with long heels.