HELP!! Advice needed for hole in the Annular Ligament

[Pocket_Rocket]

Hi Guys,

I don't tend to post very often but I really need some advice.

My horse came in from the field lame almost 2 weeks ago now the vet seen him a couple of days after he was lame and confirmed he thought he had strained his annular ligament and would need a ultrasound scan.

The scan was done last weekend which showed a very small hole in the annular ligament. The vet thinks my horse sustained a puncture wound by something sharp e.g. a thorn which has gone in to the ligament and worked its way back out.

He did say the tendon may also be damaged but the scan was not clear enough to show this due to it being a portable machine and also a lot of shadowing due to inflammation.

My vet has given me two options first being surgery (although very vague on exactly what would be done the words were a "tidy up" and whilst were at it cutting the annular ligament). The second option being Shock Wave Therapy. Though before deciding he has suggested my horse has another scan done by a surgeon using the better quality scanner at the hospital.

My horse has been on box rest since he came in lame and I have been cold hosing every day.

I really just want some advice on managing this type of injury/anything I can do to help my horse recover and what the outcome was for horses with similar injuries based on other peoples experiences.

Any advice would be very gratefully received as I am having a bit of a panic I add that my horse is happy in himself and is only slightly uneven when trotted up. Also any ideas on keeping him entertained whilst he's on box rest?

 

[Ditchjumper2]

Well, my boy did his fore and hind on separate occasions out hunting. We did not have either scanned, and did not keep him in either. Vet gave us some DMSO which we applied...left him out all summer and he hunted the following season. and for several seasons after.

As he got older he did lose flexion in the joint, mainly because we could not work him enough and the ligament used to "catch" and he would slightly stumble. Eventually the stumbles turned to major trips and we felt he was unsafe to ride. We had him PTS last Autumn. However he was 21 yrs by then.

 

[dollymix]

My old mare damaged her annular ligament about 4 yrs ago. Hers was scanned to show a slight tear. Her treatment was two weeks complete box rest, only leaving the stable to have it cold hosed for 20 mins 3 times a day.

After that it was walking in hand for 10 mins twice a day, increasing the time gradually until she was walking for approx 30 mins twice a day. She was then allowed half a day turn out in a very small field, whilst introducing ridden roadwork. This increased until she was back out hacking for an hour with a couple of short trots.

It was a long process but she was back in full work and normal turn out etc in less than 6 months and has never had a problem since. My husband went on to jump her round the local farm ride and her loaner who has had her two years does lots of schooling etc with no problems.

 

[Pocket_Rocket]

Aww thanks guys I feel a bit happier my vet has told me to cold hose to get the heat out and to walk in hand 10 mins a day. He is also very keen on surgery because where the hole is the ligament has slightly thickened. I am not keen on surgery if he was hopping lame I wouldn't hesitate but he is just slightly unsound and happy in himself.

Should I be bandaging his leg? And how long should I cold hose him for? I've been cold hosing him since he came in lame for 15 mins twice a day. He also has cold water boots and magnets. I've just put him on Glucosamine, MSM and have ordered some herbal remedies which has to be worth a go.

I am thinking of getting a second opinion as I feel my vet is really only thinking about money and not what is best for my boy. He said that there is no way the ligament will heal on its own because the blood supply is so poor even though the hole is the size of a pin prick I am really struggling to accept this. Also what would cause it to go into a hole in the first place? Vets thinks its a puncture e.g. a thorn had gone in and come back out again.

 

[Pasha]

My boy injured his n/s fore annular ligament in Oct 2010 - I think he kicked it during a rather exhuberant schooling session - he likes to show off his acrobatics lol!

Anyway, he was barely lame and on scanning vet found a small hole. We treated with DMSO and box rest for a couple of weeks. He was no better so he then had a course of shock wave therapy. This seemed to work initially, so we progressed to walk work under saddle. All went well until we started trot work and he became lame again

We were referred to Liphook and the surgeon said he actually had fiborous tissue formed He did give me all the options, but I agreed with him that surgery was our only cause of action really, so he had surgery In April 2011.

He actually had a double palmar annular ligament desectomy as the surgeon found thickening on the other leg and advised operating to avoid future problems - the one with the fiborous tissue was proper surgery and they removed a little honeycomb from his leg which they were all really interested in and took lots of photos of! (I was watching through the window). The other leg was keyholle.

I was advised his annular ligaments would always be thicker and there would be scarring. During his rehab which was 3 months, I used magnetic wraps, back on track boots and MSM.

He came back better than ever! Did an Endurance Ride in the September and it hasn't caused him a problem since... he is now on box rest with a sprained check ligament which i have been told is un-related! The vet is thrilled with how well my boy has healed and there is no swelling there at all now! He even commented that if he were vetting him, he wouldn't know he's had surgery

So a very positive experience from me... although I would think twice about putting him through surgery again as he did not come round from the anestetic at all well

 

[Pocket_Rocket]

Thanks guys anymore experiences?!! The more the better!!! My boy is going for another scan to work out the exact damage he's done and go from there it's so annoying because to look at him he just looks normal no swelling in his leg, no heat just looks like a normal horse. Just slightly unsound in trot but that's all. He's getting more and more difficult to walk think I need to get some strong callers into him before I walk him he's on a calmer twice a day anyway but he just can't help himself! He was playing with his treat ball tonight and had no problems standing on 3 legs favouring the bad leg! This is what I don't get surely if it was so serious then he wouldn't weight bare like that?!!

 

[Doublethyme]

It really depends if it is just annular ligament or if the tendon underneath has been injured, this can dramatically change the prognosis. Also the longer the ligament remains tightened, the more chance of injury to the tendon.

My mare had an impact injury in the field which damaged her annular ligament, but also once the swelling had gone down, showed damage to the superficial digital flexor tendon underneath - this wasn't clear on the initial scans.

She had a year off and shock wave therapy, with regular scan checks. At the end of the year, she showed enough improvement to begin slow rehab. Three months of steady walking and trotting and her scans showed the annular ligament back to normal and the tendon healed, although she still had some minor scar tissue.

She had 6 months back in normal work, although not jumping and just prelim level schooling/hacking. Sadly she then went lame again, 3 months off, long long long rehab of walk work again and came back OKish for hacking and light schooling. Then lame again and is now semi retired and manages some very light hacking to keep her mobile, as she is now 18 and suffers a bit of arthritis.

Sorry not a very positive post, but annular ligaments, with or without the operation I think are successful depending on what is or isn't going on underneath.

 

[Pocket_Rocket]

Thanks DoubleThyme like you say not positive but at least I know what I am dealing with.

I kind of think just turn him away and see what happens if he comes back into work he does if not then i'll retire him as long as he is happy and has a decent quality of life that's all that matters.

I've had a fab nearly 4 years with him so I will cherish them and hope he will go on for many years to come whether ridden or fat in a field! He's taught me so much bless him I need to prepare myself for the worst anything better would be a bonus.

 

[Elf On A Shelf]

Seen a few of them in racing, none op'ed on just got 6-8weeks box rest with gradual walking work before 3months kicked out in a field. All came back into training for at least another year - one is still going 7 years later - and have never had another problem with them or any related injuries.

It's not the end of the world. The op will just be to remove any loose fibres that are hanging about so they don't get in the way of the tissue repairing. The op isn't compulsory abd I have never seen a dramatic difference between a tidied up tissue to one left to heal naturally - both ligament and tendon.

 

[cobwithattitude]

Our horse had this op - removed debris and cut annular ligament to allow it to heal cleanly, this was 3 years ago. He recovered well - is a heavyweight cob) and came back well - swimming helped him tremendously. He was out competing in September, after the op in March and winning. Touch wood, no repurcussions. He's still going strong. Fantastic surgeon from Berkshire and wonderful follow up from vets at Corner House. Hope that helps.