Lengthening the tendon

[Finns]

My horse has had a tendon sheath infection and was operated on. He has been on box rest for several months (obv very closely monitored by vet) and has been slowly been allowed out - we are now doing 35 mins walk twice a day (being ridden) and 30 mins walking in hand. However he's 2/10 lame. Vet says this is due to shortening of the tendon (caused due to op and box rest). He tends to rest the leg a lot. I have tried to encourage him to walk around his stable by giving him a nut ball and spreading his hay around the stable, and he's now allowed out in a pen to graze for 30 mins, but it makes no difference. He has massage every 6 weeks and chiro treatment every 6 weeks to try to correct what he's dong by resting his leg. Vet is out regularly to see how he is doing. Has anyone had any experience of this kind of thing and any suggestions? Is it possible to lengthen tendons? All the things I've seen on the internet seem to talk about shortening tendons! Our vets are fab, but I just wanted to pick anyone's brains to see if there's anything we're missing.

Thanks in advance for any help.

 

[shazza283]

Hi

Can you give a little bit more info? Was it a flush or more severe surgery? Was there a big or small wound - did they manage to close the sheath during surgery or did it heal afterwards- ie was there any fluid leaking out post-op?

Any other damage involved? tendons?bone?joints?

Which tendon sheath? Which leg? 2/10 lame at walk or trot?

Just helps to understand what could be going on.

And same old advice as well - have the same chat with your vet - if you have concerns he/she is the best source of advice because they have the first hand knowledge of the whole story.

<<healing vibes>>

 

[Finns]

Sorry should have put more details - there were two flushes, first one didn't clear the infection, which came back after a couple of days. They operated using keyhole surgery. They spent about 4 hours doing the second op, and it was make or break time at that surgery. They never found the wound, even after second surgery and came to the conclusion that it was a pin prick puncture wound (and that we would never have seen it as they hadn't found it - made me feel slightly less awful). It wasn't closed completely after the second op, was kept in a sterile bandage for about 3 weeks (he stayed at the hospital for 2 of those weeks) as he had antibiotics being put directly into the sheath on a drip. It closed up pretty soon after the drip was taken out. Not aware of any damage to bone or joint. Hind tendon sheath is the one affected. He is sound in walk, but 2/10 lame in trot and worse after a flexion.

We are very much in communication with vet - they are our main practice (as well as being referral centre for lots of people), so he's had good continuity of care, and the vet has been out very regularly (and been in phone contact on a daily basis at the beginning). Spoke to him at weekend and he said we have to be realistic about fact he is 2/10 lame. I guess I am clutching at straws to see if there is anything additional we can do to help him, as this horse is my horse of a lifetime and owes me nothing. I just want to make his life as lovely as possible.

I should add, he has a magnetic rug and magnetic leg wraps on for a couple of hours per day. We have the option of equissage and solarium on the yard as well, but I didn't think they'd make much of a difference to him as it's nowhere near the leg (and they add up in price). I do have the equilibrium massage pad, which he has had on time to time. He has mctimmoney chiro and equine massage every 6 weeks.

Suggestion was made on my other thread in comp riders that more turnout may help lengthen it, I am going to speak to vet about it. Just wasn't sure if I should try anything else, or if anyone had any suggestions. Was wondering if devils claw might help him, or say blue chip mobility etc. As I say, I know I'm clutching at straws.

 

[shazza283]

Thank you for all that - it helps understand what might be happening.
I wonder if your vet is really talking about lengthening any adhesions which might have formed due to the infection - these are more common the longer infection is present and especially if tendon sheath is open during healing.

I hope i'm not teaching you to suck eggs(!

) - adhesions are caused by the healing process which will often make fibrin links between the tendon and the tendon sheath during an infection - if these form as time goes on they harden and shrink - because they are attached to the tendon and sheath as the tendon moves in the sheath it yanks the adhesion which in turn yanks the sheath - the sheath has all the nerves so when this happens it hurts. flexion often stretches the adhesion - hence it hurts more after.

The exercise will hopefuly help to stretch the adhesion or at least stop it getting any shorter.

The tendon probably never shortened unless it was damaged (you said it wasn't) or he had heel wedges on for some reason (or spent ages non- weight bearing).

No one has yet found anything that makes adhesions any better other than exercise and physio but devil's claw etc may help to alleviate some pain.

I asked front or back as they always cope better with this sort of problem in a hind limb than a front limb.

Keep your chin up - tendons and associated structures can take ages to finally settle.

I only mentioned asking your vet as sometimes people feel like they've bothered the vet too much, or are asking stupid questions etc etc but in my books that's what they're there for!

 

[Finns]

Thanks for replying I appreciate any advice.

I think there was some damage to the tendon in the period the infection came back, but it is the adhesions which are causing more of a problem now. I will def get some devils' claw just to see if it helps.

When you say physio - do you mean any particualr kind? Or should I search the internet for someone who describes themselves as an equine physio? Is this to do with stretches etc? Sorry for bombardment of questions. My poor vet has to put up with millions of queries from me, and bless him is always amazing about calling back!

 

[shazza283]

No worries at all.

Can your vet recommend a physio? We use a brilliant lady who is ACPAT registered/certified etc and she works out a plan of stretches/ massage and exercises (sometimes using duck tape on their bums which is ace!!

) for each case as necessary.

Adhesions are tricky things but the are a bit like tendons and ligaments when healing and they take around 2 years to settle to their final state (initial changes v fast then slows right up by 6 months or so, but is ongoing)

If adhesions exercise/ movement is best once original severe damage and wounds have healed up (which it sounds like yours have)

Devil claw can't hurt so long as horse fit and healthy - it might also be worth asking your vet if a bit of 'bute might help to get him moving a bit more easily.

Loads of luck - I know a bit how your boy feels having ruptured achilles tendons 9m ago and having some adhesions which I'm stretching now!!!

(p.s. advice is based on horsey knowledge not my own human experience btw!!)

 

[Finns]

Hi, I spoke to the vet again (poor man called me back at 7pm on a friday evening, what a star) and he said it was def the adhesions causing the problem now. I asked him re physio, and he said that the bit that needs stretching is the fetlock joint and it only goes two ways, so he gave us an exercise to do twice a day (bit like picking out hoof position but holding it for a minute) - he said he didn't think physio would make a difference to his situation and he didn't want us spending money. He said the trotting, which we're doing now, would make the most difference to the adhesions. He said there was no scientific evidence re devils claw but that it wouldn't do any harm at all and might make him more comfortable, so have gone and got some. He also thought longer turnout would help, although cautioned that if he goes silly and twists himself he might rip the adhesions rather than lengthening them. But he said we'd have to take the risk sooner or later so we are off to get electric fencing and have asked yard to bring him in asap if they see him doing anything silly (luckily you can see horses most of the time, so that are in good position to do this).

Thanks for your advice, and I hope your adhesions stretch well!