MRI results - severe medial collateral ligament damage

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starry23

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My horse had an MRI scan last week because of ongoing lameness after an injury (see this thread: http://www.horseandhound.co.uk/foru...cating-Coffin-Joint-Hyonate&highlight=hyonate)

The results weren't good, she has severe damage to her medial collateral ligament. My vet said I could work towards getting her sound enough to ride in walk on straight lines or put her to sleep. I don't want to put her to sleep as long as she is happy and comfortable to be a field ornament. I do wonder however if there are any success stories out there from owners with horses that had similar injuries. Have you managed to keep your horse happy in the field or did you even manage to help them return to ridden work?

Anyway I have attached the MRI images and some of the report to this post to see if anyone out there has gone through similar. All replies are greatly appreciated.

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"Fig 1: Transverse T2*W sequences showing extensive haemosiderin (green arrows) adjacent to the proximal portion of the medial collateral ligament (arrowheads) of the distal interphalangeal joint."


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"Fig 2: There is marked enlargement of the medial collateral ligament and modelling of the medial collateral fossa of the middle phalanx (green arrows/arrowheads)."


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"Fig 3: Increased signal within the medial collateral ligament on T1 and T2 FSE sequences."


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"Fig 4: Dorsomedial haemosiderin tract that appears to extend to the medial collateral ligament."


This was their conclusion
"There is evidence of severe damage to the medial collateral ligament of the DIPJ that is likely to be a consequence of the initial injury to this horse. It appears that the penetrating tract has passed close to the medial collateral ligament. The ligament is moderately enlarged and of increased signal intensity, indicating active inflammatory change. Treatment of collateral ligament injuries can include strict box rest and immobilisation with a distal limb cast followed by a further period of rest, controlled walking exercise and corrective farriery resulting in a 12-18 month period of rehabilitation. In our opinion, unfortunately the prognosis for return to previous athletic function is guarded in this case. "
 
Well, my gelding had collateral ligament damage in his right fore. I wasn't told whether it was 'severe' but was advised to box rest for 3 months with a guarded prognosis. Unfortunately, we already had arthritis in this foot - upshot was that the box rest did his arthritis a complete mischief as he came out barely able to walk! Initially he was put in a tiny grass pen for turnout with sedation to keep him quiet. Eventually, I was able to allow him out in a very small paddock with my old schoolmaster and he was happy. However, he was still lame, even on one bute per day. I took the decision, on the advice of my vet, to have him denerved - despite having massive worries and reservations. Result was, we never looked back! I was very careful with his feet at the start (still am) but now I treat him just like any other horse, hacking out every day and he is extremely bright and happy. I feel I have given him new life as opposed to being stuck in a field bored and liable to go ballistic and do even more damage. People will argue not to have a horse de-nerved, at worst saying they would not want their horse not to feel their foot, but my horse can feel his foot, its only part of it that is affected by the loss of nerve. I think its worth giving him a second chance over pts. I feel for you but it may not be the end of the world - talk to your vet.

Best of luck.
 
Take a look at Rockleyfarm.blogspot.com and you will see many horses with collateral ligament damage which have been saved. Get in touch with Nic Barker, she is generous with her time even if your horse does not go there.
 
Thanks for the replies.

I emailed Nic before I had the results and have forwarded the MRI report onto her in the hope she may be able to give me some advice. I have a look at the Rockley blog every now and again (more so since Rubic's injury) and think that what they are doing is brilliant. I did find one horse on their blog with a medial collateral injury but it was from incorrect shoeing rather than an injury, I'm not sure if that would make a difference to the damage. I didn't see any others but I wasn't sure if there was a way to search the blogs for certain injuries. I will be keeping her barefoot anyway, she only had shoes in front as we have very gravelly paths and she was a tad footy over them and with the amount of work we were doing I decided front shoes were the best option for us when she was ridden.

My vet has said the only option if I want to keep her (bar the cast to immobilise the joint which I would never put my horse through) is to turn her out in a small paddock and see what happens. I got the results last wednesday and I was slightly hysterical so I'm going to phone him back later this week to let him know what I'm doing and get his opinions on a few things however I think the vets feeling is that the joint will be unstable and therefore may not hold up to much and no therapies will help this injury heal (this may not be totally accurate as like I said I was very upset).
 
How did the injury happen? It sounds like something external went in, and that would change the picture, I guess. I wish you luck with this, horses can be amazing healers given time.
 
I don't know exactly! The horses escaped from the field and Rubic was found with what my friend thought was a tiny little cut just above the coronet band, she seemed totally fine so friend put wound spray on it and put her back in the field. 2 hours later and she couldn't put any weight on it. I got a phone call off another friend telling me I had to get up to the yard asap. They thought she'd broken her leg. The puncture wound has gone straight to her coffin joint and it was badly infected. She had to get surgery to flush it and masses of antibiotics. She came through though and everything was looking fine, got her home and then we've had various issues since. She got a bit of cellulitis in one of the surgical portals, then she needed her joint medicated as it was highly inflamed and after all that she still wasn't right which was why she was referred for an MRI as vet suspected some sort of soft tissue damage either from the surgery or the original injury. It seems she has got her hoof caught when she injured it and that it what has caused the ligament damage. :(

ETA the wound tract doesn't touch the ligament but just curves towards it.
 
She has to be worth a barefoot rehab trial if there was no penetration of the ligament. It sounds like she got her foot impaled on something and ripped the ligament tearing it free. Or she could have been trodden on, a horse of mine had a tract like a puncture wound but I am certain that he was actually kicked.

Try to keep her moving gently. If she's happy to walk then personally I would walk her on hard flat surfaces like a puppy dog, and see how it goes.

All the best.
 
Thanks for posting the images, they were certainly interesting to look at and would be interested to know what Nic thinks about rehab or not.
 
They are very interesting images. They said that Rubic stood so still that they managed to get a lot of really good quality images and it didn't take them too long either!

She is more than happy to walk. She likes going her walk round the farm track (hard and slightly gravelly surface) and she really steps out (and she is acting like a giant dog). IMO the lameness is only obvious in trot and ever so slightly on a small circle in walk. She is so happy to get some turn out but I think she knows her limitations. The other day we were walking to her paddock and her friends started shouting to her, she immediately sped up but under normal circumstances probably would have done a couple of strides of trot in eagerness however just stayed in a slightly fast walk. I'm just taking each day as it comes, if there is anything extra I can do that might help then I'll certainly try it if I can. Will keep you posted on what Rockley suggest. I've also contacted a barefoot trimmer who covers my area.

Here's a photo of her in her little paddock, just because I can post it!
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Just to let you know, in my case, I did speak personally to Nick at Rockley Farm about my horse but unfortunately she said it was unlikely they would be able to help as there is a limit to what they can achieve with this sort of problem. Reading the report from your MRI scan it virtually mirrors what they said about my gelding. Apart from de-nerving (which you may not wish to do) you may find that long term bute can help the healing process as well as dealing with pain. Because my horse also had arthritis it was difficult because the ligament needed rest but the arthritis needed to be kept moving - catch 22!
 
My mare was written off as a 4 year old, 5 years ago with lateral colateral ligament damage in both front legs. I was told she would never return to ridden work because she was so young it didn't bode well. Against my instinct I box rested her for 6 months, she had shock wave and IRAP therapy and remedial shoeing. She hated the shoes and the box rest and was too dangerous to strt hand walking. She ended up coming out more lame than when we started. I then tried field rest, and slow return to work but she was still unsound. After 2 years of battling I sent her to Nic and Rockley. Best decision I ever made. She was sound within 2 weeks and is now back out show jumping with me. She has totally rubbish feet so I have to work hard to keep on top of their health but I have a horse who has a bright future. I wish I had never done box rest of remedial shoeing. In my opinion this causes a lot more un due stress to horse and rider than field rest and sending to Rockley, and quite frankly Rockley farm actually works to help the problem, and keep long term soundness. I hope Nic can help you :)
 
Thanks for all the replies. I'm definitely going to try my absolute best to keep her happy and comfortable in the field and if I get anything more then that is a very welcome bonus!
 
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