Stifle soft tissue injury - worse after rest?!

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Chwee

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Hello! Wondering if anyone has any suggestions or advice please - the short version is:

Can a soft tissue injury can get worse if it has been completely rested?


The long version is...

My new horse was seen falling in the field and came in very lame on his left hind. The vet saw him the following day and advised bute and rest for 7-10 days. After 7 days he was still hopping lame, the vet advised to extend the rest (and restricted grazing in a pen) for another week or so as she didn't was to do a lameness work up (blocking) as she didn't want to put the injury under the stress of being worked between blocks. 3 weeks after the injury vet returned and did one block to anaesthetise the stifle which is now showing some effusion and he showed maybe 60% improvement so we then x-rayed the joint which looked clear and showed he joint in correct alignment (which would indicate ligaments not severely damaged). The vet advised an arthroscopy to see what's going on in the joint through the insurance company are refusing to pay because the injury happened within the first 14 days of the policy which states" only external injuries with an open wound" are covered. Unfortunately I can't fund a £5-7k operation without knowing what the prognosis will be.

So, whilst I argue with the insurance company the plan is to take him in to hospital for an ultrasound scan (which I can fund) with one of the leading experts to see if that gives us any answers.

The vet thinks he has improved since she first saw him however I really don't think so and he's really struggling to weight bare on that leg (refuses or have his opposite hind foot picked out and rests his injured leg when having his front for picked out). What seems odd to me is that he seems pretty flexible in that joint (he is 17h and was scratching his cheek with his lame side hind foot) so that, combined with his reluctance to weight bare is making me worry the injury is higher up and a fracture or something terrible. Would a soft tissue injury get worse if it has been rested?

Being optimistic, I also spent a couple of days soaking and poulticing his foot but sadly no abscess appeared and block to stifle showed improvement.

Any advise or suggestions that will keep me sane until the scan late next week would be appreciated xx
 
Muscular injuries can certainly get worse for being rested and for such a big horse being so restricted could make any general stiffness that is resulting from the fall become worse, being so big and falling plus the probable panic to get back up I would suspect more than just a simple ligament injury in the stifle, the muscles over the pelvic region are likely to have taken some of the impact and could be very sore, box rest will make that area tighten up so it could look worse rather than better.
I had a pony who came in one day on 3 legs, vet diagnosed pelvic muscle strain, box rest, bute, up to 6 months off and poor prognosis for return to full work, physio was not suggested as treatment but I asked if he could have physio just to help once he was past the acute stage, the physio came did a couple of treatments said put him out to keep moving he was back in work within a month as good as new.

As there is obviously something going on in the stifle I would get it scanned but if nothing definitive is found I would ask for referral to a good physio as they are usually much better with muscular injuries than vets especially non specific ones.

You are unlucky with your insurance as I thought most covered for accidental injuries from day 1, as you saw the fall it is an accident not something pre-existing that has flared up for some reason.
 
I always find it really interesting reading this kind of stuff, because it brings up for me the pros/cons of insurance. In NZ very few have equine insurance, so really expensive treatments are usually not an option and we generally make decisions based on what we have available facilities wise.

So for most of us, "rest" means turned out in a paddock and simply not ridden for an extended period of time.

So far I've manged various cuts and injuries, abscesses, one laminitis, two with sticky stfile, one strained tendon and a three year old hopping lame in a hind leg that originated somewhere high up, by just leaving them to it. IME they generally let the pain dictate how much they move and as long as they aren't being bullied they regulate themselves.

Everything has come out just fine - although sticky stifle has caught up with one after a long endurnace career and he is finally retired from riding at 16.

I guess my answer to your question would be yes, IME my horses with the stifles are worse standing around. All the best with your boy.
 
Yes, box rest can make soft tissue injuries much worse.

I had a horse that fell over in the school (with me on him). He was eventually diagnosed with a torn meniscus, he had already been on box rest for 3 months so we started with paddock rest in a small fenced off area, steadily getting larger. Unfortunately the prognosis for such an injury is not good, and he wasn't the type of horse that could remain calm and quiet enough to fully repair, so we had to say goodbye to him.

I hope the ultrasound comes up with some good news for you :)
 
Thanks for the comments and sharing your experiences guys. Yeah, my fear is that he's got a meniscal tear and I know the prognosis isn't good. He's been on box rest for 3 weeks and isn't coping well at all. I've been told that a clear ultrasound doesn't mean there isn't an injury in the joint as it is so complex, it really needs an arthroscopy. Does anyone know if a meniscal tear will show on ultrasound? I guess the best outcome is a minor muscular issue that shows up on the ultrasound that we can work through with some Physio. Thanks again for your replies xx
 
I'm pretty sure it wouldn't show up on ultrasound, Clover had an arthroscopy, but do check the amount you've been quoted as he had quite a few other tests/investigations and he only just went over the £5k annual vets fees limit, and our vets are usually fairly expensive.

Really hope for your sake it's not meniscal x
 
Hello! Just wanted to update this post and let you know that the horse went for his scan and made a miraculous recovery, only showing 2/10 lame - ultrasound also looked really good, a little bit of swelling but nothing really serious. It is possible that he could have injured the meniscus that isn't visible to the ultrasound but the vet would have expected him to be far more lame if that were the case. So, continue with the rest and restricted turnout and hopefully he'll continue to improve and I can start riding him out in walk in a few weeks. Best result I could have hoped for really!

Also, vet has provided a report to support my insurance claim so fingers crossed that works out too :)
 
My horse was found to have a tear in her meniscus plus wrecked all the cartilage around it. It didn't show up on a ultrasound or x-Rays. Her operation wasn't mega expensive coming in around £2k. This was with the best orthopaedic surgeon traveling to her aswell!! Plus Sunday nurse care!
I hate to say but my horse was only ever 2/10 lame on a turn & lived out up until the surgery date as staying on made her really stiff. Vet couldn't belive the state of the stifle considering how sound she was!

She is now back in work; hacking & just started trotting - she frequently gallops & Broncs in her field & still sound now.

She wouldn't have came sound without the surgery & as a time scales she injuries her self in the feb & had her surgery in July after still being unsound. Came back into work in early November & had 4/5 months of box rest.

If you have any questions please ask as I know it's a tricky place to injure plus mine will only be in 'light work' for the rest of her life. No jumping/hunting etc
 
I'm really sorry to hear about your horse - was she ever more than 2/10 lame? What's encouraging my vet and the vet at RVC is that he has made such an improvement that they wouldn't have expected is he had a meniscal tear. I hope they're right, anyway - time will tell and I'll keep you posted :)
 
No she wasn't; even when the injury first occurred - we think in the field or a kick injury. She also came sound enough for them to let me start hacking but she rapidly declined again. She was happy to turn but her leg would give way almost as she was turning. So if your in any doubt I would say the arthroscopy is the way to go as it gives you answers; even if they just flush the joint - my vet said if they didn't find anything sometimes this is all they need to come sound as debris can effect the stifle quite often! Please do keep me posted.
 
Thanks & I will do. Roger Smith @ RVC did his scan and said he wouldn't recommend an arthroscopy based on what he's seen. He looks to have imroved again looking at him trotting up tonight but will continue with rest and get the vet to look at him again in a couple of weeks. If there's any deterioration we can re-think the arthroscopy but (touch wood, fingers crossed etc etc) he might have gotten off lightly.
 
Brilliant news! Fingers crossed for you he just hurt it enough to make him go owes but no damage done! Roger smith did my girls surgery :)
 
Hello all, just wanted to update this thread incase (like me) other people are researching in the future. So he got sign off to start walking just before Christmas (starting at 20 mins straight lines and 20 m circles and building up by 5 mins a week for 6 weeks), at the end of this the vet was really pleased with him, the muscle wastage on injured leg had started to improve and he was looking about 1/10 lame so she wanted me to increase the work to see if building more muscle helped or he got worse - so introduced trotting 6 weeks ago, he's now doing x3 5 mins trots and vet and physio both think he's sound!! Muscles have really built up and he's responding really well to the muscle stim (previously his injured side was v.slow to react). So going to increase to normal workload over the next 6-8 weeks and take it from there. Not home and dry yet, but feeling very positive - advice to anyone having a similar experience is to be patient, go slowly and use lots of Sedalin for t.o and riding until it's no longer exciting :) one other point - where he's been avoiding weight baring on his injured leg, he's over compensated and put more weight through his front leg which has caused his heels to start collapsing - luckily have a fab farrier who is closely monitoring his progress and keeping on top of it but had he not picked up on it, I'm sure that it would have developed into a secondary problem.
 
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