Knee Injury - advice please!

Sparky86

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I could really do with some advice on my horse’s knee injury. In July I bought back a horse which I had previously owned a few years ok. When I went to seem he was sound and there was no swelling on his knee. I went to pick him up a month later and his knee was huge, there was some swelling on the outside but most noticeably there was a big, firm lump on the inside of his leg. I was told he had escaped into another field and got a bit over excited and this was when the swelling appeared, apparently he had only been lame for one day but had been fine since. I took him home and for a week he was almost 100% sound but there was no change to the swelling (obviously it’s not normal to buy a horse like this but it’s a bit of a long story that I won’t bore you with!). The vet saw him in this time and said he thought there had been some trauma to the knee but it didn’t look like there was anything to worry about, the swelling would go down & the lameness was due to an abscess in the other foot. To be honest I wasn’t convinced by this but we poulticed his foot for a week to see what happened. About a week late he went completely lame, would not put any weight on the swollen leg at all and we took him to the vets for scans & x-rays. The x-ray showed up an old fracture to a bone at the back of his knee (sorry, can’t remember the name), this had healed fine but there were some bone fragments which the vet thought might be causing the problem. The vets initial advice was to try and create a small paddock that he could be rested in and not move about too much, however, he would not stay in it and managed to jump out every time. We put him on box rest instead and the lameness did get a lot better for a couple of weeks but then suddenly he was completely crippled again. The vet came out and injected some steroid/anti-inflammatory into the joint, the swelling did improve slightly and he was almost completely sound on. He was on box rest for 2 weeks before going out again but after about 2 weeks he went lame again. This time the vet advised Bute morning and evening for 2 weeks and more box rest. We tried to keep him on box rest but it got to the point where he was so wound up that he was actually causing himself more harm being in, everyday he would have a new cut on him where he had bashed himself in some way. At this point I spoke to the vet again as I really couldn’t see we were making any progress, he had become a lot more sound but he had every other time before becoming completely crippled again. He said he could operate to remove the bone fragments which appear to be causing the problem or try and manage his problem with a steroid injection into the joint whenever it flared up again. I wasn’t particularly comfortable with this, I don’t want to keep a horse that could be in pain, but the vet did not want to operate and advised we give him some more time. So basically I decided to wait but if he went lame again insist they operate or we would have to consider PTS as I don’t think it would be fair on him to keep going like this. As I couldn’t keep him on box rest or on limited turnout I just decided to turn him out 24/7 and see what happened if we just gave him some time. He’s now been out for about a month and in the last couple of weeks there has been a massive improvement, most of the swelling has gone down now, the lump on the inside is still there but it is really soft now and there is no heat at all. We trotted him up yesterday and to us he looks completely sound now. Obviously time and rest are great healers but I don’t really understand why there would be such a big improvement suddenly, even though by giving him unrestricted turnout we have done the exact opposite of what our vet advised. I’m just not sure I’m 100% convinced by my vet’s diagnosis. It seems really strange to me that when I saw my horse before we got him back his leg was completely fine and then suddenly it was twice the size and the vet is saying this is due to bone fragments from an injury that happened years before. Surely if this was the case it would have flared up at some point before now? I know it could have done and the previous owners are lying but I’m 90% sure this isn’t the case as unbeknown to them a relative of mine worked at the vet they used and the only lameness on record is the fracture a few years before.

Sorry, I know this is really long and probably doesn’t make any sense! I think what I’m trying to say is, is it possible that the bone fragments are not causing the problem and it’s actually some sort of strain or something? My vet said that once he was sound he would be fine to do some hacking with but I don’t think I’m ever going to be happy with this not knowing for sure what exactly is wrong. I just wondered if anyone had experienced a similar problem? Any advice would be greatly appreciated!
 
I can ofer no sensible advice on the specific knee problem; but am a strong believer in 'time being a great healer'. We, thank goodness, have a vet who is not obsessed with box rest except in dire emergency, and we've found over the years that quiet turnout with quiet companions, over a length of time, with appropriate pain relief, often works better than box rest and throwing the entire chemist's shop at them.

Your's is a very odd situation, and I agree with you that the story doesn't really hang together. Do you think the former owners were telling the truth?
 
The only reason I have for thinking they are telling the truth is that I know quite a few people who are friends with them and so i've found out what I can through them. She has been in contact quite a few times which I don't think I would be brave enough to do if I was lying! She also said we could claim on her insurance (which obviously i'm not doing) which suggests they at least haven't declared any problems (They didn't claim for the fracture because I don't they didn't bother with x-rays, he was just left in the field and luckily it seems to have healed ok). It's quite a complicated situation and they didn't treat him very well but that seems to be more through ignorance than actual cruelty, when I picked him up they really didn't seem to think there was much of a problem with his knee or the fact that he was emaciated which makes me think they wouldn't have bothered trying to cover up any problems. The fact that he wasn't with me when he did it has made it so much more difficult, at least when they're at home you can have a good guess at what happened!

I agree about rest with quiet companions, it's done him the world of good it's just that because I don't really know what the problem with I kind of feel on edge every time I go and see him in case he's on 3 legs again!
 
Odd. :confused:

Has the knee actually ever been blocked with local anaesthetic during lameness.

The old bone chips could move and flare up a soft tissue injury but if old then more likely they could be a red herring. I think you're referring to the accessory carpal bone, and fractures of this are not uncommon in the knee, but can be a problem to fix. :(

Moving bone chips in and out of the joint space can mean the difference between a non-weight bearing lameness and soundness within a very short period of time...or there could be something else that would cause the lameness. :o

The only way to be sure is to do further workup if the lameness recurs...meanwhile I'd recommend smiling and lots of finger crossing! :D
Best of luck
Imogen
 
Thanks for your replies!

Yes, the knee was blocked before he had the steroid injection and he did go sound.

Definately smiling! Tonight the swellingseems to have gone down even more! It seemed so awful for so long and now suddenly there's been this massive improvement in what seems like days! There were times when he was on 3 legs that I really thought this is going to be it so right now I couldn't be happier with how things are looking!
 
Thanks for your replies!

Yes, the knee was blocked before he had the steroid injection and he did go sound.

Definately smiling! Tonight the swellingseems to have gone down even more! It seemed so awful for so long and now suddenly there's been this massive improvement in what seems like days! There were times when he was on 3 legs that I really thought this is going to be it so right now I couldn't be happier with how things are looking!

That's great news.

If the block worked then it's is highly suspicious that the chips may be contributing or causing the problems. Fingers crossed again and if it flares up then your vet's approach is probably the best one!
 
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