Distal tendon sheath synovitis - what is it exactly?

alsxx

alsxx

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I'm hoping some of you may be able to help shed a bit of light on this. My mare has this LH, diagnosed now by 3 vets (v long story...) - since roughly end of August.

She has had the whole LH from hock down scanned (ultrasound) and even had an MRI on it...however I have not been told what it is/could be other than tenosynovitis. She had it medicated back in November and it seemed to improve but keeps flaring up (she has had other issues, particulary RF, so one vet thinks it flares up as a result of compensating). She has done 8 months box rest now (for the combination of issues she has!), if you trot her up after she has been resting, she is sound on it, even lunge on hard, but if you look at her a few days later she will be lame on it.

She obviously has windgalls there, again which go up and down, up and down even when she is in the box. Most of the time they are cold to touch, but can be even when she is seen to be lame on it.

So what I am wondering is could there be anything else other than just the tenosynovitis? Could there be actual tendon or ligament damage....but would this have not shown up on the ultrasound?

If anyone has any ideas on possible treatments, please let me know. At the moment she is going to be turned away at grass as I have come to a bit of a dead end on this now.
 
Sorry not good news but I've been in a similar position though not the same diagnosis. Jesper injured his LH suspensory aged 4yrs though made a full recovery. Then aged 8yrs was diagnosed with collateral ligament damage in his RF. We rested and treated this and he returned to light work aged 9yrs however after six months he was lame on his LH. Vet belives that due to compensation his suspensory has been damaged again. He is sound after periods of rest but if brought back in to work goes lame again. We made the decision to retire him two months ago now as vet believes he now has collateral ligament, suspensory ligament and sacroilliac damage. (He also has windgalls).
Sorry to not be more positive but dealing with diagonal pair lameness is difficult.
 
Thanks Marchtime. To be honest, for all the vets that have looked at her, I dont really know what is 'wrong' in front - she was diagnosed with bilateral front fetlock arthritis which has been treated with injections and seems to have resolved, but she has palmar foot pain RF, and depending on which vet you speak to, is 1/10th lame LF - palmar foot pain.

She has had both front feet MRI'd and although there were some mild changes noted in the feet, nothing that any of the vets looking at her have said 'thats the problem'. On monday she was shod with frog support pads for the first time so I am hoping that will resolve the foot pain, leaving just the LH tendon sheath.

But to be honest, I have spent ALOT of money on her, seemingly got no where and been messed around ALOT by my insurers (which is why so many vets have got involved, all with differing opinions) so she is going out on Monday and if she stays lame she stays lame, I cant spend anymore money on her now, which I find heartbreaking to say as I really do adore her.
 
I know it doesn't solve the problem but is she too lame/old to breed from? Would she be able to sustain a pregnancy and extra weight of a baby? She can be healing in the months before she has to carry the extra baby weight...
Means she still has a purpose and you will have a new focus and mount if she fails to ever come sound? And you can carry on a new fit and healthy blood line from her. Although it is obviously more money!
Have you had any adivce off other professionals or just vets? Sometimes physios (old school horsey people are always good too) etc take a different view point on the issues?
Other than that I would go with the make or break time out in the field, the weather and conditions are good enough just make sure she is getting a good level of vitamins and minerals to aid her healing process. Plus it's the cheapest option!
 
As much as I would love to breed a foal from her, I don't think it would be wise....one vet says she has osteoarthritis in both hocks (although one of te other vets says there is no sign of spavin?). Plus one of the minor changes on her MRI 'could be early stages of navicular' according to report. So I guess I would just be asking for trouble....although it is thought by my main vet that the cause of all her issues is the 18 months of dodgy shoeing she had (which I will never forgive myself for allowing to happen!).

But in terms of soundess at the moment, she could quite happily carry a foal tbh. :-( She will be 6 in July :-(
 
So young; I assume you think that her problems may be hereditary then?
Maybe then you should go with the only simple and probably least stressful option for you both and leave her out in the field and see what happens.
OCD(osteochondritis dissecans) is a condition that can become more pronounced once young horses start working and it affects the cartilage; have any vets investigated that? I don't know a huge amount about it but I know of it as my youngster broke her hock and the vet said it could be that...
Would avoid breeding off her if it is that though as some believe it is hereditary... Do you know of any of her siblings or family in work?
 
I instantly thought OCD when she went lame initially but no its not been really considered/mentioned to me by my vet, but then she has had all manner of x-rays done so would assume that would have picked it up?

Hopefully now she is sound apart from the Lh with the rather irritating tenosynovitis that doesn't seem to want to go away/keeps being irritated...which is why I was wondering whether anyone thought it could be anything else, even though she has had ultrasound and MRI on it?
 
You didn't say if you have consulted any other form of professional for an opinion or not, definately worth while if you haven't?
If you have, then sorry but I don't appear to have been of any assistace at all!
wink.gif
good luck
 
It's so sad that none of the vets have been able to get to the bottom of it. Jesper's RF problem took a long time to diagnose but the MRI was conclusive.
I think you have to listen to your head. It's so hard to call it a day but there's only so much money you can spend. Our vet came out this month t see Jesper and agreed we could continue treating him however it would only be a temporary fix and we're out of insurance so we called it a day.
Maybe some time in the field would work. Would you consider giving her a year off and bringing her back in to work next spring? My vet is of the opinion that provided the horse is 8yrs or younger a year in the field will heal most things. Sadly once you get to 10yrs (which is how old Jesper is) field rest is unlikely to help.
I assume they've ruled out hind suspensory damage?
 
No not consulted anyone else other than farrier who sorted her feet with vets help.

I think half my problem is that insurers have disputed things, gotten another vet involved who doesn't believe she had original probs (as was treated and resolved) and so no one is talking and I'm left wondering what to do with her now, with not much help from vets! My vet thinks I should inject the sheath again, but insurers vet has said no to this so I would have to pay out and I simply can't afford to put any more vets bills on my credit cards!

I'm hoping you are right marchtime and that field rest will sort her out. I'm happy to give her a year (wish I had done that first off instead of all this faffing and spending!) But again my vet thinks I should start walking her from field in a month to get her fit and see what happens. Ugh dilemma!
 
Go with the field rest option, now is the best time for it with the better weather and you don't need to worry about mud making anything worse. You don't really have a great deal to lose other than this season competition, which by the sounds of it, you will be losing anyway.....
I know myself with tendon injuries that I have had that I had to stop doing anything completely for 8 months before it came right (that was my patella tendon) and it still falres up from time to time now. I ice it and don't do anything that aggrivates it for a couple of weeks and it's fine.
My big horse had an unknown issue that was on and off for months but we never got to the bottom of it. my vet told me to leave him in the field and start again the next spring and he has never looked back. He was 12 then and he is now 16 and as fit as a baby (touch wood).
Fingers crossed, just make sure she gets plenty of nutrients to help her body heal. There are loads of products out there that aid the healing of tendenous tissue
 
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