Lameness- MRI, complimentary therapy and questions, questions and more questions.

[Worcester_cat]

My horse became lame due to a Plantar annular ligament injury. He had his op to cut gaps to reduce swelling and that went well. There was a small leison on the ligaments up the back of the leg but nothing the surgeon was worried about. After 4 months of a combination of box rest and limited grazing, he was still slightly lame in trot so we had the tendon sheath medicated because blocking identified around the tendon sheath as an issue (fetlock). He then had 4 weeks of walking, building up to 30 minutes. He is in a box in the day and has 4 times the size in an indoor barn. Anyway, recent vet assessment has shown he is slightly more lame. So now, I am completely at a loss for the next steps.

Vet has suggested either an MRI or turning him away to let whatever it is, heal on its own. I am open to an MRI but also need your opinion on. So far, the operation, rest and now rehab has only reduced swelling from the Plantar Annular ligament so far.

What are your thoughts on any of these:

1) Your experience of PAL related injuries?
2) Likelihood of MRIs finally identifying the actual issue?
3) What action might you take?
4) Would you turn him away for some time? If so, how long and how long before reassessing him?
5) Would any complementary therapy help like infa-red etc?
6) Any other thoughts?

I am so worried about what to do next as I have limited experience in this area.

Thank you so much for your time.

 

[nutjob]

Have any nerve blocks been done to assess where the lameness is coming from now? If it's above the hoof, including something related to the previous issues I would have expected a soft tissue injury could be assessed by ultrasound. I've had 2 mri's done which were both to check what was going on inside the hoof and also went up the leg to just above the fetlock. It does give a lot of information (at a cost) but unless the lameness blocks to the foot now I'm surprised that the vet doesn't recommend an ultrasound scan first of all.

 

[maya2008]

I would expect soft tissue lameness to improve with box rest and bone related issues to worsen. I would want a scan to see what is going on with the original issue and then nerve blocks again. There could be something else like arthritis that has worsened with box rest.

 

[Worcester_cat]

Have any nerve blocks been done to assess where the lameness is coming from now? If it's above the hoof, including something related to the previous issues I would have expected a soft tissue injury could be assessed by ultrasound. I've had 2 mri's done which were both to check what was going on inside the hoof and also went up the leg to just above the fetlock. It does give a lot of information (at a cost) but unless the lameness blocks to the foot now I'm surprised that the vet doesn't recommend an ultrasound scan first of all.

Thank you for your reply. The nerve block to the tendon sheath was 4 weeks ago, after box rest and reduced time and space turn out.

Since then, rehab has been slightly increased to barn turn out space (larger than previous turn out) and building up to 30 mins a day walk in week four.

From what you have said, it sounds like ligaments still which the vet also said. Your experience of MrI is useful to hear. I will ask if another scan would help but I think she may have considered that.

 

[Kirstd33]

Potted version of events - 16 yr old Coblet became lame approx. 12 months ago bilaterally in his hinds, with the left being the worse of the 2. A full lameness work up identified it being his annular ligaments, so he had them both operated on last May 2024. 6 months of box rest, followed by small paddock turnout and controlled rehab (namely walking increasing distances twice daily) ensued to the letter with the vet seeing him every 3-4 weeks throughout meant that I did manage to get back on him by the autumn and started some short and slow hacks, however he went lame again when we started the trot/canter work, and it was a constant yo-yo of 2 steps, forward, 2 steps back and his behaviour was suggesting he wasn't comfortable or happy in ridden work. The vet was dissapointed with the outcome after what he felt was successful surgery and rehab and gave me 3 options at that point:

1) Get him back in for more scans, investigations, blocks etc however I had max'd out his £7K insurance and spent also another £2K of my own money
2) Inject with steroids to see if any improvement
3) turn-away/retire

I've chosen option 3 and he hasn't been ridden this year at all, and is currently stabled at night/out in the day but as of next week will be completely turned away to grass 24/7 for at least the summer. He's comfortable on 1 bute/day and is field sound as long as he doesn't hooley about too much. I doubt he will ever come sound enough to be ridden again and in my mind he can have a lovely summer out on a hill side with company and if he worsens then he will be PTS before the winter. I strongly believe in quality over quantity pf life and would absolutely hate to think he's in any discomfort.
Sorry its not more positive, if yours is younger then never underestimate the healing properties of time and Dr. green.

 

[Worcester_cat]

Thanks for your reply. The pony has just turned 9 so I will likely try a few more options you have suggested.

 

[Worcester_cat]

Have any nerve blocks been done to assess where the lameness is coming from now? If it's above the hoof, including something related to the previous issues I would have expected a soft tissue injury could be assessed by ultrasound. I've had 2 mri's done which were both to check what was going on inside the hoof and also went up the leg to just above the fetlock. It does give a lot of information (at a cost) but unless the lameness blocks to the foot now I'm surprised that the vet doesn't recommend an ultrasound scan first of all.

Could an ultrasound show ligament problems that are connected to the sheath that was blocked successfully?

 

[ycbm]

Could an ultrasound show ligament problems that are connected to the sheath that was blocked successfully?

Yes, I think i would be asking for another scan and then probably turning away for a good period of time.

I hope that works out for you both.
.

 

[nutjob]

Could an ultrasound show ligament problems that are connected to the sheath that was blocked successfully?

I've had multiple ultrasound scans on ligament and tendon injuries and recently I had a horse who'd been kicked and this had resulted in a bone sequestrum and the roughened surface of the bone could be seen where the fragment had detached. However, none of these have been in the specific situation you have. It's one to ask your vet if there's a reason why they don't think ultrasound will be helpful.

It's also been my experience that soft tissue injuries take a long time to heal and easily get reinjured. If he was well behaved on a small area of turnout I'd give him some more time with this and keep up the walking exercise and see how he goes in the next couple of months.