Swollen tendon sheath - Annular ligament desmotomy query

ILuvCowparsely

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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.
Having had both Annular ligament injury and current horse has two tendon sheath injuries, my advice is rest and lots of it and don't try bring them back into work to soon (I did as per vet and it was too soon and it broke down).


The boy :

I have since tried 3 times to bring him back into work and did not get very far before swollen again so retirement looks inevitable. Annular one too back in the 80's also took a while but the mare did come back to sound hacking but nothing else.

First time it went and diagnosed, steroid injection - back into work after rest we got to a 45 minute walk with rider and 3 one minute trots and it broke down
Second time steroid - rest back into walk exercise in hand at first then under saddle we got to 45 minutes walk plus 1 one minute trot, and it broke down.
Third time steroid - then walk in hand - chased another horse round the field steroid again
fourth time - after 3 months off - lunged - back into walk no steroid as too close to the last one rest in the field and it went down
fifth time( this year) went after running round the field for 10 minutes flat out bucking and bronking, ice boots - rest ok again.
I know this seems a lot but this is over a 5 year period.

I found these the best boots as they don't sweat and very supportive.
http://www.ebay.co.uk/itm/Equilibri...381221&hash=item3f87c8ee65:g:psYAAOSwVJRZeKMT
 
Last edited:

acw295

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Having had both Annular ligament injury and current horse has two tendon sheath injuries, my advice is rest and lots of it and don't try bring them back into work to soon (I did as per vet and it was too soon and it broke down).


The boy :

I have since tried 3 times to bring him back into work and did not get very far before swollen again so retirement looks inevitable. Annular one too back in the 80's also took a while but the mare did come back to sound hacking but nothing else.

First time it went and diagnosed, steroid injection - back into work after rest we got to a 45 minute walk with rider and 3 one minute trots and it broke down
Second time steroid - rest back into walk exercise in hand at first then under saddle we got to 45 minutes walk plus 1 one minute trot, and it broke down.
Third time steroid - then walk in hand - chased another horse round the field steroid again
fourth time - after 3 months off - lunged - back into walk no steroid as too close to the last one rest in the field and it went down
fifth time( this year) went after running round the field for 10 minutes flat out bucking and bronking, ice boots - rest ok again.
I know this seems a lot but this is over a 5 year period.

I found these the best boots as they don't sweat and very supportive.
http://www.ebay.co.uk/itm/Equilibri...381221&hash=item3f87c8ee65:g:psYAAOSwVJRZeKMT
Thanks - we've had the surgery now so we're following the post surgery rehab route and the prognosis looks promising
 

Sussexbythesea

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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.
So pleased she's doing well and that NFU are paying out. I forgot my bill included platelet-rich plasma therapy on the sesamoidian ligament too.

I used Premier Equine stable wraps after the bandaging phase to prevent knocks. It took ages for his hair to grow back I think mainly from the pressure of them. Also the vet missed a stitch when taking them out and so some scar tissue formed around it which was annoying.

When he went out again I used to bandage and I used Golly Galoshes gaiters over the top to keep them dry. After the 6 weeks walking in hand twice a day he went out in the field for a month and so it was in total 3 months after the op before I was advised to ride.
 

acw295

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So pleased she's doing well and that NFU are paying out. I forgot my bill included platelet-rich plasma therapy on the sesamoidian ligament too.

I used Premier Equine stable wraps after the bandaging phase to prevent knocks. It took ages for his hair to grow back I think mainly from the pressure of them. Also the vet missed a stitch when taking them out and so some scar tissue formed around it which was annoying.

When he went out again I used to bandage and I used Golly Galoshes gaiters over the top to keep them dry. After the 6 weeks walking in hand twice a day he went out in the field for a month and so it was in total 3 months after the op before I was advised to ride.
Thank you - I think the final bill won't be too bad. Probably over the £3k mark but not as bad as I'd feared. But it is still good to know the insurance is covering it!

I tried the PE stable wraps but they don't fit her legs (Small are not wide enough but Medium are far too long). Shame as I really fancied them and also the option of magnetic liners. I have some cheaper Roma ones which fit better (but not as nice) so will use them if I think she needs them - I think as it was so itchy she is pleased to have some time with it naked! I can bandage so will do that if the swelling gets worse, but as it is a rush in the morning to get everything in before work it helps to have a faster option and naked is even easier.
I got the impression from the vet that as her tendons were fine and the only issue was the constricted annular ligament that the return to work will be far quicker than if anything else was damaged - so that is good. Mainly because she is far easier to ride out than lead. I am happy to take it very slowly with regard to proper riding - but it will be a relief to be able to ride her up the lane.
 

ester

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Thanks for the update :) its nice to see how these things progress. We have a bit of swelling ATM after 15 odd months clear so just keeping an eye.

Fingers crossed for October check.
 

acw295

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Thanks for the update :) its nice to see how these things progress. We have a bit of swelling ATM after 15 odd months clear so just keeping an eye.

Fingers crossed for October check.
Thank you
Yes I always find it annoying when you find a thread because you have a similar issue but don't find out what happened!
 

AandK

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Thank you - I think the final bill won't be too bad. Probably over the £3k mark but not as bad as I'd feared. But it is still good to know the insurance is covering it!

I tried the PE stable wraps but they don't fit her legs (Small are not wide enough but Medium are far too long). Shame as I really fancied them and also the option of magnetic liners. I have some cheaper Roma ones which fit better (but not as nice) so will use them if I think she needs them - I think as it was so itchy she is pleased to have some time with it naked! I can bandage so will do that if the swelling gets worse, but as it is a rush in the morning to get everything in before work it helps to have a faster option and naked is even easier.
I got the impression from the vet that as her tendons were fine and the only issue was the constricted annular ligament that the return to work will be far quicker than if anything else was damaged - so that is good. Mainly because she is far easier to ride out than lead. I am happy to take it very slowly with regard to proper riding - but it will be a relief to be able to ride her up the lane.
The vet first thought my horse's AL issue was primary but further scans at the horspital showed the other ligament damage. If it had just been the AL then vet said only 2 months recovery needed, as his was secondary to the sesamoidian ligament damage, it was doubled to 4 months. Although my horse was out into a small pen once his stitches were out, with in hand walking daily. Once we were up to 25mins walking on week 5, vet said I could jump on to make it more interesting for both of us. After 6 weeks (8 weeks post op) he had a scan and then it was 2 months field rest. Slowly, slowly is definitely the key with ligaments.
ETA once stitches were out we had naked legs, although as per above he was in a pen so able to move about a bit more than stabled.
 

acw295

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So another update - vet out today, 5 weeks post surgery. We are allowed to start ridden walk and turnout! That the lordy for that as the hand walking was getting tedious (we used to stable next door to the Devil's horsemen and they often commented that Molly would make a good stunt pony - I now see why!). We've had rather a lot of Passage, air boxing and even Capriole as we frequently meet the racehorses on the lane and she gets a tad excited. Luckily we have survived to tell the tale though.

She trotted up sound from the stable but slightly positive to flexion - vet not worried about that though as thinks she just needs to start moving more. Didn't bother scanning as she has very thick skin so scans are very hard to see and her tendons were fine. I can't turn out until Sunday as we are going to sedate her for it (Sedalin) and I want to be around all day to keep an eye (working until Sat). Will start the ridden walk tomorrow though. She's perfectly chilled on box rest so a few more days isn't going to make any difference.

Shoes can go back on and we are to build up over 6 weeks, 20 mins for 2 weeks then add some trot and extend the walking until we are up to a "normal" length hack. Just need to avoid soft ground.
 

noblesteed

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Great news! I posted before that my horse recovered well from the same op. The vet advised using fleece bandages when we initially started riding out. I swapped these for some stretch and flex training wraps. We don't need any support now, he's totally healed!
 

acw295

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So a final update to this thread I hope (which may benefit anyone that experiences this in future).

We are now 10 weeks and 2 days post surgery and have completed 5 weeks and 2 days of ridden work. I have ridden every day (in the week at silly o'clock) apart from 1 day off where she was sedated for clipping. We are both tired and blinking fed up of riding around the village (everywhere else too muddy). However she looks and feels marvelous, so it is definitely worth it. During this time she has been on her "normal" turnout in the big field with the others and has been seen having a proper gallop about at times. All seems to be fine. Fetlock does fill quite a bit overnight and is a bit of an odd shape - but it seems to be fully functional.

After we complete the final week of hacking we will start with some work in the school as it will by then be too dark for me to hack during the week (but will do longer weekend hacks). I am aiming to start lessons again at the beginning of Feb but we have no specific plans.

Our longest hack to date has been about an hour and 15 mins but during the week it is more like 35-45 mins, but we can do a fair amount of trotting now and also had our first little canter (just 10 strides on some lovely going).

So 100% positive so far! Final bill was under £3k too so bargain I reckon.

So another update - vet out today, 5 weeks post surgery. We are allowed to start ridden walk and turnout! That the lordy for that as the hand walking was getting tedious (we used to stable next door to the Devil's horsemen and they often commented that Molly would make a good stunt pony - I now see why!). We've had rather a lot of Passage, air boxing and even Capriole as we frequently meet the racehorses on the lane and she gets a tad excited. Luckily we have survived to tell the tale though.

She trotted up sound from the stable but slightly positive to flexion - vet not worried about that though as thinks she just needs to start moving more. Didn't bother scanning as she has very thick skin so scans are very hard to see and her tendons were fine. I can't turn out until Sunday as we are going to sedate her for it (Sedalin) and I want to be around all day to keep an eye (working until Sat). Will start the ridden walk tomorrow though. She's perfectly chilled on box rest so a few more days isn't going to make any difference.

Shoes can go back on and we are to build up over 6 weeks, 20 mins for 2 weeks then add some trot and extend the walking until we are up to a "normal" length hack. Just need to avoid soft ground.
 
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