Swollen tendon sheath - Annular ligament desmotomy query

acw295

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Hi, my pony has a very swollen tendon sheath (near hind) likely due to Annular ligament thickening (not been scanned to confirm yet) as symptoms were completely typical and she is a Welsh cob type which are prone to this apparently.

We're trying a 2 weeks conservative management (box rest, cold therapy, bute and bandaging) before taking it further. Vet wants to avoid steroid injections due to laminitis risk.

If no improvement she'll need a scan to see what the damage is - as I'm aware there could also be damage to the annular ligament as well as thickening and that will impact on what we do next. Vet mentioned surgery might be an option, but she may not be insured for it as we had a milder episode of this on a front leg last year (which only required a short spell of rest and bute so not claimed for).

Pony is 19, fit(ish) and active with no other issues apart from this (although no longer competing as won't blinking load and I found it too depressing missing events). I'd love her to remain in full work for as long as poss but she can be a retired pampered pet for as long as required. Her welfare is my biggest priority rather than my riding.

So to stop me fretting does anyone have a ball park figure for cost and prognosis? She had a GA 5 years ago for lower third splint fracture on same leg, so anxious about the thought of another GA but if the prognosis is good enough we will do it and I believe the op is done as keyhole so recovery is quick. My local vets are a large vet hospital so no referral required.
 

ester

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When I looked on here last year for my own welsh cob there were quite a lot of experiences, so probably worth a search too :), some more successful long term than others.

Mine was older (23) and developed the swelling after a week in the new forest on some heavy going. He has thickening to both but the side with swelling is the opposite to his spavin so suspect compensation effects.

For him because he is older (though had hunted that winter) we did the conservative approach- he did have some steroid bit then he moved to the flat (we were in wilts so all hills!) where he could be turned out 24/7 and just hack. After a couple of weeks the swelling had totally resolved.
 

AandK

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My now 20yo had this op aged 18 almost 2yrs ago (11/08/15). His AL issue was secondary to a small tear in his distal sesamoidian ligament, which he had PRP injected into at the same time as the OP, the PRP was about £500 extra.
Unfortunately (for me) his issue was on the only leg where his ligaments were not insured! Fortunately I got an interest free loan from the bank of Mum and Dad, the op was his only chance of long term soundness. I have just gone through my old invoices and all in (so including diagnosis, scans, the op, PRP, hospital stay of 3 days/2 nights, and 2 weeks of bandage changes done by the vet/removal of stitches) it was approx £4k.

ETA - forgot to say how he got on! Vet said his prognosis was good to make a full return to his previous level of work (eventing at BE90 level), the op and recovery was textbook (apart from him having a seizure coming round from the GA!) and he was 100% sound by mid Dec of the same year. He had some unrelated issues at the beginning of last year that rumbled on for a few months, so I started bringing him back into work in Aug last year. He is now back in full work, including jumping, and looking and feeling amazing!
 
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Sussexbythesea

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I had an almost identical experience as AandK above 3 years ago. Horse was aged 19 both hind legs done for annular ligament and also PRP therapy on distal sesamoidian ligament. I fretted terribly about whether to risk the operation but was assured by my vet that age isn't a major risk factor in an otherwise healthy horse.

Anaesthetic wasn't a problem, rehab went smoothly and fully recovered and sound (touch wood). Hack mostly as I''ve done enough with him dressage wise at lower levels and don't want to risk further damage by overdoing the schooling.

At 22years he recently did a showing show for fun and he did really well including winning the ridden veteran. I can't quite recall the total price of treatment but it was around the same as AandK. I do remember the initial lameness work up and scans etc. Came to about £800 on its own. Petplan covered most of the costs.
 

ester

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FWIW I think if F had been 19 we might well have gone ahead, at least given it serious consideration as he didn't have any other creakinesses that meant he needed to think about slowing down at that point, but that he did have at 23.

He is still sound (for his age, the other hock might be a bit off now too) and winning veteran showing classes :), he just doesn't do proper circles anymore. I suspect if we hadn't done the new forest trip I wouldn't have known until the following winter.
 

carolineb

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My old anglo arab tore her manica flexoria and had major thickening/swelling of the annual ligament. She was operated on and had the manica flexoria removed and annual ligament cut and has been used as a pc pony ever since (2 years) jumping and hacking etc. It cost about £4k too I think from memory and she was operated on at Donnington Grove vets in Newbury. Rehab was very straight forwards and she's been fine ever since. She was 16 at the time.
 

meleeka

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Mine had surgery to his annular ligament. I can't remember the cost but I'm sure it wasn't as much as £4K. His rehab didn't go well. He turned from a dope on a rope to a fire breathing dragon and was still lame a further 6 months later. When he was re-scanned a bone chip was found. The vet thought he had done it during handwalking by treading on himself, but I think it may have always been there. A high dose of Bute and the swelling went and he was sound.

Would I do it again? I'd probably go with turning away for 6 months and reassess. This is what happened ultimately and I wouldn't put my boy through the handwalking needed with the box rest.
 

Jazz2984

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I'm going through the same thing with my boy, he has been scanned but just found a slightly thickened tendon sheath, nothing much to shout about. We are box resting for another week then vet back out to assess. I'll be interested to know how you get on, I have never experienced anything like this before so I have no idea of the prognosis.
 

acw295

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Thank you all, that is really helpful. £4k is ok - we can manage that if the insurance won't pay.

I feel really up and down about another operation for her. One part of my brain says that she is fit and well and definitely not feeling her age (people are always surprised to hear her real age as she is in great condition with very little hint of ageing) - so if an op is the vets recommendation then I should do it. The money can be found if needed and we got through the last time so we can do it again.

On the other hand I wonder if it is worth it as she may not have many ridden years left and it might not be kinder for her to just let her retire rather than go through the inevitable box rest, walking rehab thing for weeks and weeks which she will hate. She had several huge tantrums in hospital last time and caused all sorts of drama for a 14.2hh (v.embarrassing to be her owner at that point). And then I actually have to get her there too (could take days to load her).

Ho hum! Vet is back out on Monday (14th) so I will know more then. But good to know that horses of a similar age have had the op and returned to some level of work. As she is prone to fatness and work is really the only thing that works to manage it (with restricted grazing, molasses free low calorie feed and careful management) in the long run it would be easier if she was sound enough to be regularly hacked in walk and trot 3-4 times a week - otherwise we risk more issues.

Life does not permit a second horse for the time being (although it might be an option in a few years) so I'd love to keep her ticking over for a bit longer yet.
 

ester

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I think it is normal to be conflicted, despite his age I still had the shockwave/OP discussions with my vets as he was so fit and well otherwise. I too was also worried about the weight situation having always kept him super fit to manage it - and also tricky that if you are retiring you do rather want them to have a nice time rather than be super restricted. It got away from us this spring so he was muzzled for a while but all seems to have settled down now.

As it does tend to be an older cob thing, at least most of the experiences of others and from your vets will be for these types and whether it is therefore worth it and the feeling when I discussed it on here was that most people would do it again.
 

AandK

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Just so you have an idea, this is the rehab program my boy had. He was on box rest for 2 weeks until the stiches came out. Then he went into a small pen and started 6 weeks of walking. 5 min for week 1, 10 min week 2 and so on until we were at 30 min on week 6 (vet said I could get on him when we were up to 15-20 mins if I wanted to, so I did at 20min to make it more interesting for both of us). After the 6 weeks he had a check up and then went back out in the big field and was on field rest for 2 months.
 

acw295

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Just so you have an idea, this is the rehab program my boy had. He was on box rest for 2 weeks until the stiches came out. Then he went into a small pen and started 6 weeks of walking. 5 min for week 1, 10 min week 2 and so on until we were at 30 min on week 6 (vet said I could get on him when we were up to 15-20 mins if I wanted to, so I did at 20min to make it more interesting for both of us). After the 6 weeks he had a check up and then went back out in the big field and was on field rest for 2 months.
Thanks that is useful to know, that sound similar to her fracture op. Apart from she had 4 weeks box rest then walk work and she kept up the walk work for 3 months even once back on turnout.

I might have to put her on rehab livery if we have the op as yard offers no options to create a small pen and if it has got dark by the time she starts the walk work I will struggle. When she had her op last time I lived very near to (different) yard and work so it was much easier and I could go up 3 times a day. I now have a 1hr commute and work some long days so only go up once (on assisted livery). But if she needs the op and it is done early Sept then we might just manage to get the walking in before it is too dark!

Depends how vital the the small pen arrangement is - we only have big fields and not allowed to section off. And tbh the little sod would just jump out anyway I expect. She has form and happily hops over electric. What with needing sedation for clipping, very hard to load, a muzzle houddini and a fence hopper it is a good job I love her......
 

acw295

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So vet has been back out today - 60% improvement seen so we have 2 options:

1/ Book in now for scan with surgery scheduled for the next day (necessary to do them on consecutive days due to Molly being a nightmare to load - that way we only have to make 1 trip)
2/ Field rest for 3 weeks then re-assess. If no improvement go ahead with Option 1.

It seems likely that surgery will be required so field rest is effectively delaying it - but there is a chance we can avoid the op and rest will be enough. Vet says turn out won't make it worse, so in effect all you are losing is time. As we no longer compete and any hunting this year is now out of the window it seems like I have nothing to lose by waiting, so expect I'll go down the field rest route first and even if we do end up in surgery at least we know we tried to avoid it.

Molly will be thrilled with field rest so at least we both get a rest from box rest and bandaging for a little while! I'll update this thread when there is something to tell.
 

ester

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Why can't they scan at home? it was helpful to us as it confirmed it was all probably older damage so nothing much if anything acute going on for which turnout would be an issue.

If you've managed 60% improvement I'd do a bit longer rest like you plan too as not losing anything for it.
 

acw295

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Why can't they scan at home? it was helpful to us as it confirmed it was all probably older damage so nothing much if anything acute going on for which turnout would be an issue.

If you've managed 60% improvement I'd do a bit longer rest like you plan too as not losing anything for it.
They can scan at home but the quality is much poorer so they'd prefer to do a better scan in hospital and then get on with operating straightaway. Vet seemed to think it is better to either just field rest or operate, and no point in scanning for just field rest.

But yes I think it makes sense to just wait and see. If it was 3 months that might be different but 3 weeks is not long to wait. It is hilly where we are but we have large fields and the herd are generally quiet until hunting starts! We won't actually be doing 24/7 field rest as her usual routine is stable by day, turnout at night with muzzle (fat club) so we will do that.

Husband will be pleased - the lack of riding has resulted in actual wife behaviour including house chores and baking! On the flip side the wine consumption due to worry has rocketed.......
 

claracanter

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i know exactly where you are coming from, so stressful. My boy did something to his tendon sheath( swelling and hopping lame) about 8 weeks ago. Vet scanned, medicated and did a contrast X-ray to check manika. Everything was intact and nothing unusual on the scan. After a couple of days on box rest because of steroid injection, he was then turned out on very restricted turn out (box rest turns him into a monster!!). We have gradually increased the size of the pen and he is now sound and I have been advised to start riding him for 10 min sessions this week and then gradually increase. There's a slight increase in the swelling this week so we talked again about operation to clean everything up but are going to wait and see how things progress this way. Vet says we won't know until we test it. Fingers crossed for you which ever route you go down.
 

acw295

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A quick update
Molly has made things a lot worse for herself - on first turning out she got away from me at the gate and went full force galloping, bucking and farting around the field with leadrope still attached. Took a while to catch and unclip and in the process she went back to very lame. She had a few more bute last week to help it settle again and she is sounder but still lamer than when vet last saw her so I decided to bite the bullet and book her in for the scan and surgery.

As luck would have it the next slot is on the 5th Sept anyway which is when the 3 weeks would be up anyway - so if on scanning they are happy to not operate then we will be in the same position - but seeing how lame she has made herself again I cam convinced she'll need the operation. Claim registered with the insurance so now just wait until the 5th.

As she is awful to load to go away from home vet is coming out to sedate for travel as we can't risk her galloping off on the leg (rear, spin and gallop off is her way of avoiding loading), so hopefully she will go on easily.

Burst into tears after booking her in as it brings back all the memories from the last operation in 2012. But what will be, will be. So best to just get on with it.
 

meleeka

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Do you have a plan for afterwards? Handwalking was by far the worst thing for us and if I did it again I'd book my boy in to go somewhere else for his rehab. He's normally a dope on a rope and did box rest really well until it came to hand walking. My advice would be to at least have some Sedalin just in case.
 

acw295

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Do you have a plan for afterwards? Handwalking was by far the worst thing for us and if I did it again I'd book my boy in to go somewhere else for his rehab. He's normally a dope on a rope and did box rest really well until it came to hand walking. My advice would be to at least have some Sedalin just in case.
Thanks
I will wait and see what the vets plan is but I will probably ride her as soon as possible, even if it is for 5 mins. She had surgery in 2012 and had to be walked and I got on to do it straightaway (with vets permission). She was angelic in the saddle.

She's actually fine on box rest though, she had 5 weeks where she didn't even leave the stable and I could graze in hand easily enough afterwards. She was sedated up to the eyeballs when turned out though for the first few times and I wish I had sedated her this time as she went nuts with excitement at seeing her best friends. So I think the hand walking will be ok as long as it is nowhere near her field, but if vets allow I will jump on to do it as she is 1000% easier onboard!

But yes if it has to be inhand then it will be sedated. We always have sedalin on hand at home as she needs it for clipping etc (she is quite high maintenance!!)
 

acw295

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So Molly is now at the vets, surgery tomorrow. On scanning her annular ligament looks very abnormal, there seems to be quite a bit going on in there. Tendon sheath is huge! Bit concerned at what they will find, we are hoping that it is just the annular ligament and/or the mania flexoria that are impacted as they have the best prognosis. Vets were quite concerned that they couldn't exactly see what was going on. She is second on the list so hopefully not too long a wait.

Aside from it being stressful it was very interesting, particularly listening to the vets account of Burghley (Molly's vet was the onsite vet). She is at least in good hands!
 

acw295

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Surgery done, Molly up and all went to plan. Phew! Her annular ligament was very constricted so has been cut but no other damage found so that is a relief and means the prognosis is promising. I'll update this thread with her rehab in case it helps anyone else trying to make the same decision as I know it is a fairly common injury.
For now though I am feeling very relieved!
 

ester

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Surgery done, Molly up and all went to plan. Phew! Her annular ligament was very constricted so has been cut but no other damage found so that is a relief and means the prognosis is promising. I'll update this thread with her rehab in case it helps anyone else trying to make the same decision as I know it is a fairly common injury.
For now though I am feeling very relieved!
Great update, fingers firmly crossed for a trouble free rehab :)
 

Sussexbythesea

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Surgery done, Molly up and all went to plan. Phew! Her annular ligament was very constricted so has been cut but no other damage found so that is a relief and means the prognosis is promising. I'll update this thread with her rehab in case it helps anyone else trying to make the same decision as I know it is a fairly common injury.
For now though I am feeling very relieved!
Great news - for me the surgery was the worst as it would be my fault if anything went wrong and I lost him. My boys rehab went very well. My first ride after surgery was Christmas Eve and was a fabulous feeling. With any luck (knowing what horses are like at last minute injury!) I'm doing the Sunshine Tour Champs Veteran classes at Hickstead in two weeks which wouldn't have been possible without the op.
 

AandK

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Surgery done, Molly up and all went to plan. Phew! Her annular ligament was very constricted so has been cut but no other damage found so that is a relief and means the prognosis is promising. I'll update this thread with her rehab in case it helps anyone else trying to make the same decision as I know it is a fairly common injury.
For now though I am feeling very relieved!
Great news! Getting through the op is definitely the most nerve wracking bit. And great news there is no other damage. Good luck with the rehab!
My boy did an ODE August bank holiday weekend so there is hope after this op!
 
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Good luck with the rehab. Please keep posting. My horse has a similar issue. I don't think the op is an option for him as he won't do the box rest afterwards.
 

noblesteed

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My horse had annular ligament desmotomy and scar tissue removed from tendon sheath 3 years ago. He came back to full soundness afterwards. Make sure you do all the walking out during the recovery, we had my boy stepping over raised poles after a week so the scar tissue aligned itself correctly. I also booted him in training wraps for 6 months after starting riding again. Never bothered him since. Cost just under £3000. Good luck
 

acw295

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Quick update - we are 2 weeks post-op and all has gone like clockwork so far.

Molly came home 5 days after the operation, had her dressing changed 4 days after that and today had her stitches out (14 days post-op).
She's been on box rest but we've been doing 20 mins hand grazing twice daily every since she came home. Luckily we have some grass in near reach of her stable so she's not had to go far for it. She is walking really well on it now.
I can take this dressing off myself on Friday and then we start 5 mins in-hand walking daily for a week, then 10 mins for another week. Stable bandages if it swells but no more dressings after Friday.

After 2 weeks of walking in-hand she'll be trotted up, flexed etc and if all is well we can start the ridden rehab and turnout.

She is being saintly to box rest as per usual and very good to hand-graze. Not so sure the walking will be as easy as she is grass obsessed but we will see what we can do. If she really won't behave we can use the school but they'd much prefer a hard surface. Luckily the yard is on a long tarmac lane so we have some safe space to walk on with the only cars being traffic for the yard and adjacent farm. The only issue is the lovely grass verges!
 

acw295

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Another quick update, we have nearly finished week 1 of hand walking (5 mins) and she is being really good. On day 1 we had rearing and she was very, very sharp - but it was short lived and she now seems perfectly happy to do it although it comes with snorting and very fast walking! I am still doing 2 x daily hand grazing for 15-20 mins too but I separate it from the walking which seems to help her differentiate that they are different tasks.

I've not bothered stable bandaging so far - it is still swollen but not horribly so and improves with movement and I think her skin is benefiting from some air after so long in the big bandage (we've got a few patches of soft, peeling skin).

NFU have confirmed they are paying out - woo hoo! Can't sing their praises high enough as this is my second big claim and they have been marvellous both times. I've not had to do a thing apart from make 1 phone call to start the claim off, the rest has been done directly with the vet and no forms. When I know the final bill I will post - it is around £2.5k up to and including the hospital time but there is the aftercare to come.

Next milestone is w/c 9 Oct when she has trot up, re-scan and potentially ridden work can start. Also perhaps some turnout.
 
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