Deep Digital Flexor Tendon Tear - Tell me your experience

[scrbear11]

After sudden swelling (very minimal lameness) Little Red Mare was initially diagnosed with a torn DDFT sheath. After my vet reviewed the ultrasound images at the clinic, she found a very small tear. The phone call was probably one of the most heart wrenching I have ever received. Re-ultrasounded concentrating on the DDFT, and sure enough, there is a tear. Visible to anyone on ultrasound, but you have to look for it. Only 2cm long and VERY narrow.

My vet has consulted with two of the top vets in the area (one being the top vet in the country, IMO). Both gave the same opinion.

Tell me your experience with DDFT tears. Treatment plan? How did the horse do after healing? Did the horse return to use? Give me the nitty gritty, I can handle it.

Thanks

[TWH_Girl]

Not my horse, but trainer’s horse had this. She opted to not to PRP therapy, but maybe something to consider for you. I know she rested him for a while, and then had Acuscope therapy done on him. Over the course of about 6 months, she’s back to riding him and hoping to show him. He’s a large almost 18hh warmblood.

I’ve also been doing research (for my own guy) and have come across a lot on class iv laser therapy and shockwave.

I think whatever treatment course you do would be based on:

• Is the horse insured?
• Cost of treatments?
• Timeframe involved?

No matter what you do, time is your friend even though you will hate him along the way…

[AKB]

My daughter’s 8 year old had a front deep digital flexor tendon lesion about 4 months ago. He was minimally lame for 2 days, but swollen and tender over the tendon. Ultrasound showed the lesion. He was on paddock rest for a few weeks. Then, he was on full turnout with increasing amounts of timed walking under tack. Next he had to do increasing amounts of timed trot sets. His ultrasound a few weeks ago showed the lesion has filled in completely, but there is still some thickening of the tendon. He is doing small amounts of cantering on a straight line on good footing on the trail, as well as a lot of trotting and walking. Jumping will wait another few months.

I suspect our guy’s rehab plan is more aggressive than some in that there was no stall rest and no hand walking. No special injections or therapies were recommended, as long as the tendon was healing on ultrasound. Apparently one of the vet schools is recommending this rehab program, as they feel the tendons heal better in many horses if the initial rest period can be minimized.

[scrbear11]

AKB- That’s very encouraging.

Little Mare was very slightly lame, but presented with swelling. She is on stall rest with an hour twice a day in her lay up pen (round pen). She’s not quiet enough on small paddock turnout to be trusted and she’s happy in her cave. (She’s always preferred her stall to turnout). I have been given the OK to either ride her at the walk for 10-15 minutes a day, but since she’s not quiet under saddle I am going to start hand walking her. She’s 10 days in so far.

Shockwave treatments will start next week.

Top vet who my vet consulted with agreed with our plan of rest and shockwave. He did say her prognosis is “questionable”. I’m not sure if this is because the tendon sheath is reputured as well as the tendon tear, or if he is taking the tendon tear only into consideration when he says this. Should she not heal well, or not stay sound once work under saddle has started, he recommended a Prostride injection. If that isn’t effective, he did recommend a tenoscopy. My trainer thinks at that point, if she’s not staying sound she will not return to her prior level of performance (jumpers).

[Jungle_Monkey]

[QUOTE=scrbear11;8790711]
After sudden swelling (very minimal lameness) Little Red Mare was initially diagnosed with a torn DDFT sheath. After my vet reviewed the ultrasound images at the clinic, she found a very small tear. The phone call was probably one of the most heart wrenching I have ever received. Re-ultrasounded concentrating on the DDFT, and sure enough, there is a tear. Visible to anyone on ultrasound, but you have to look for it. Only 2cm long and VERY narrow.

My vet has consulted with two of the top vets in the area (one being the top vet in the country, IMO). Both gave the same opinion.

Tell me your experience with DDFT tears. Treatment plan? How did the horse do after healing? Did the horse return to use? Give me the nitty gritty, I can handle it.

Thanks[/QUOTE]

Where is the tear located?

[scrbear11]

Right above her fetlock joint

[Jungle_Monkey]

[QUOTE=scrbear11;8791866]
Right above her fetlock joint[/QUOTE]

No experience with torn tendon sheaths but my horse tore his DDFT at the navicular bone and P2, pretty good tear and terrible location apparently. He also had medial collateral damage and distal sesamoid damage. Prognosis was not good at the beginning.

He was on stall rest with hand walking only from end of September 2015 until mid March. He had Theraplate treatment every day and shockwave once a month on all locations and massage therapy.

I had him in Back on Track wraps every night and Magnetik booties for 4 hours per day that supposedly stimulated accupressure points. It may have done nothing but made me feel better.

He then began tack walking after follow up MRI showed excellent healing and minimal scar tissue. He began trot work at the beginning of May and we are at 15 minutes of trot and 1 canter lap each direction. We’ve had some ups and downs but he is doing well. He is still not on turn out. We are waiting until he is in full flat work to try to minimize possibility of other injuries and re-injury.

I expect to be at least another 4 months to hopefully have elasticity where there was scar tissue and 6 months before he is “fitter” and feeling like his normal self. He is a big, long horse so we are going slow.

A few things I would emphasize:

1. Use sedatives if you need to. Do not be proud. Not worth the risk of them doinking around and hurting you or themselves.
2. Proper nutrition-make sure you cover all the basis…not a lot of “feed” but supplement to make sure they have what the body needs to heal.
3. Do whatever you need to do to keep them as quiet as possible and happy-lots of hay, toys whatever.
4. Take your time-TAKE MORE TIME THAN THEY TELL YOU! I cannot emphasize this enough. My experience is double (or more) what the vets say.
5. Listen to your horse-you know him/her the best.
6. Properly balance feet…I cannot stress this one enough for soft tissue injuries. Speak to vet and farrier to see if the angles needs to be higher at the beginning for the injury you have.
7. If you think you can’t get through it you can! Miracles can happen…not very often but they are possible.
8. If you have the luxuty to hrow as much time and money as you can, do it.

Just my experience.

[scrbear11]

[QUOTE=Jungle Monkey;8791937]
No experience with torn tendon sheaths but my horse tore his DDFT at the navicular bone and P2, pretty good tear and terrible location apparently. He also had medial collateral damage and distal sesamoid damage. Prognosis was not good at the beginning.

He was on stall rest with hand walking only from end of September 2015 until mid March. He had Theraplate treatment every day and shockwave once a month on all locations and massage therapy.

I had him in Back on Track wraps every night and Magnetik booties for 4 hours per day that supposedly stimulated accupressure points. It may have done nothing but made me feel better.

He then began tack walking after follow up MRI showed excellent healing and minimal scar tissue. He began trot work at the beginning of May and we are at 15 minutes of trot and 1 canter lap each direction. We’ve had some ups and downs but he is doing well. He is still not on turn out. We are waiting until he is in full flat work to try to minimize possibility of other injuries and re-injury.

I expect to be at least another 4 months to hopefully have elasticity where there was scar tissue and 6 months before he is “fitter” and feeling like his normal self. He is a big, long horse so we are going slow.

A few things I would emphasize:

1. Use sedatives if you need to. Do not be proud. Not worth the risk of them doinking around and hurting you or themselves.
2. Proper nutrition-make sure you cover all the basis…not a lot of “feed” but supplement to make sure they have what the body needs to heal.
3. Do whatever you need to do to keep them as quiet as possible and happy-lots of hay, toys whatever.
4. Take your time-TAKE MORE TIME THAN THEY TELL YOU! I cannot emphasize this enough. My experience is double (or more) what the vets say.
5. Listen to your horse-you know him/her the best.
6. Properly balance feet…I cannot stress this one enough for soft tissue injuries. Speak to vet and farrier to see if the angles needs to be higher at the beginning for the injury you have.
7. If you think you can’t get through it you can! Miracles can happen…not very often but they are possible.
8. If you have the luxuty to hrow as much time and money as you can, do it.

Just my experience.[/QUOTE]

THANK YOU!!! Being a five year old, we had big plans for next year, but we will put those on hold and take all the time she needs for the tendon to heal. Hoping to have plenty of years left.

[Sport]

Sport tore his DDFT about 4 years ago now. Being Sport he did a great job of it and was not projected to come back sound. He was 17 at the time, so I figured if I ended up with pasture sound we were good. We didn’t do any special therapies, but we did give lots of time off.
We were told from the start to plan with a minimum of a year to heal. He was on full stall rest for 4 months. He is an amazing patient and handles stall rest incredibly well. About that time though we noticed he seemed depressed, he needed interaction with other horses. We started letting him wander the barn aisle and visit with friends while we did his stall. This seemed to help.
At 8 months we were hand walking if we can call it that.
At 10 months he had turnout in a very small area.
At a year we started walking under saddle, gradually increasing work to full flat work at 16 months after his injury.
Around 20 months we started playing around with jumps.
He showed over fences 2.5 years after injury. Not back to original height. The decrease in height had more to do with age and other factors than the tendon.
I used back on track wraps the whole time and I would swear by them.
He was never expected to be sound, so we lucked out. Our vet is still amazed by his recovery and calls him her wonder patient.

[IPEsq]

Mine had a DDFT lesion right above the fetlock, although tendon sheath was ok (aside from the initial swelling). 4 1/2 months stall rest with minimal walking (he was WILD), we did PRP right after the injury, then 3 rounds of IRAP about a week apart. All of those in the tendon sheath. This was during the acute 24/7 wrapping phase (with some icing/cold hosing) to reduce swelling. Then we did 2 rounds of stem cells over a month apart. Would have been fine with one, because ultrasound looked good by the time we did the second round, which resulted in a flare that was scary for a few days.

Injury was right about Oct 1st. By Feb 15th he was off to a rehab facility to walk on a treadmill (where he’d behave). Beginning of April, started under saddle. He has jogged sound since January, except for the flare from the 2nd round of stem cells, which set us back a couple weeks. He was only a 2/5 at the worst during the injury. It was considered grade 1 lesion.

He is still doing well and we are back to jumping very small things…about to move up to 18"-2’ soon. He could have been doing more in terms of soundness, but he has been growing, is difficult to put muscle on to begin with, and we have some teenage attitude, so the fitness building is taking longer than anticipated. But that has nothing to do with how the leg is holding up.

He was not jumping big things yet to begin with due to age and not being physically or mentally mature enough, but prognosis is good. Considering that we have jumped some 1’ things more like 4’ in the air so far (other times, we knock it down ), I am optimistic.

The reason we did stem cells was due to the location of the injury being very close to the fetlock. I had 2 vets review the ultrasound, and the thought was if the lesion extended behind the fetlock where we couldn’t image it on ultrasound, then it would be more important to go for the best quality tissue (less scarring), but he probably would have healed fine without it. If he was one who could tolerate hand walking without big leaps in the air, that probably also would have helped tissue quality just as much.

[AKB]

Be careful with hand walking. It is easy to get hurt if they act up.

[scrbear11]

Well Little Mare has been doing really well. She’s been quiet in her stall, quiet out in her lay up pen (a little larger than her stall, set up outside so she can get some fresh air), and has been quiet on our hand walks and out grazing. Sunday I noticed swelling again, this morning her leg was huge. Of course my vet is on vacation and will not be back till Friday, so I have a call in to another vet in the clinic. Her skin is really irritated from her leg being wet all the time. Maybe she has some cellulitis? Waiting for a call back from the other vet.

Fingers crossed that she hasn’t done something to re-aggravate her tendon. My normal vet will be back in the office Friday and is coming out for her first shockwave treatment.

[Jungle_Monkey]

@scrbear11;8800330

Well Little Mare has been doing really well. She’s been quiet in her stall, quiet out in her lay up pen (a little larger than her stall, set up outside so she can get some fresh air), and has been quiet on our hand walks and out grazing. Sunday I noticed swelling again, this morning her leg was huge. Of course my vet is on vacation and will not be back till Friday, so I have a call in to another vet in the clinic. Her skin is really irritated from her leg being wet all the time. Maybe she has some cellulitis? Waiting for a call back from the other vet.

So happy to hear she is being a good quiet girl.

Why is her leg wet all the time?

[scrbear11]

[QUOTE=Jungle Monkey;8800793]
So happy to hear she is being a good quiet girl.

Why is her leg wet all the time?[/QUOTE]

I am poulticing at night, wrapped. She’s iced in the morning. Then I poultice again, open, during the day. Then iced again in the evening. Her leg dries during the day when the poultice is open, but staying moist overnight, so maybe I’m not giving it enough dry time? It doesn’t help that it’s really hot and humid here so she is sweating under her standing wraps.

Other vet in the practice seemed to think it could be cellulitis. Going to leave open for 24 hours, then start wrapping with poultice at night only.

[IPEsq]

I would stop wrapping over poultice effective right now. Dry standing wrap only if you wrap.

[scrbear11]

A different vet (not our normal vet) was out yesterday afternoon to see her after her leg blew up to stovepipe status. Cellulitis, as suspected. This morning her leg is even bigger- even after a long acting antibiotic and Banamine.

Her normal vet will be out tomorrow afternoon. That was supposed to be her first shockwave treatment, but I now think that appointment is going to be a Cellulitis re-check.

Ugh… Sorry Little Mare.

[onthebit]

[QUOTE=IPEsq;8800956]
I would stop wrapping over poultice effective right now. Dry standing wrap only if you wrap.[/QUOTE]

I was going to say the same thing. Hope the cellulitis gets cleared up quickly and you can move on to shockwave. Rehab is the pits.

[scrbear11]

Cori had her first shockwave treatment last Friday. Cellulitis and all. It was pretty amazing, the swelling from the cellulitis was reduced drastically after the shockwave treatment. She finishes up antibiotics on Friday, and swelling from the cellulitis has been down since last Friday.

Plan is to do two more shockwave treatments. Next is scheduled for Monday, then third will be 10 days after that. After the third shockwave we will re-ultrasound her leg.

She does still have swelling around the area of the tendon tear. We are now 24 days into stall rest. Re-ultrasound will tell us whether or not we move on to step 2 (Pro-Stride injection), or if we continue the modest route (rest).

She’s been a really good girl, but has started to get antsy in her stall. She has a jolly ball, lick-it, and two salt blocks. Any ideas for toys or things to keep her busy? She is a busy-minded, 5 year old, chestnut mare- lots of attributes in that statement working against stall rest.

[IPEsq]

I got my horse a traffic cone to play with, though only when supervised because knowing him he’d get it stuck on his foot. He also liked bashing one of those Jolly Apples against the wall (it was hung on a rope). We did have to put him on Prozac to keep him from really losing his mind.

[findthedistance]

I’ve done two DDFT rehabs. Both were hind limb at mid-cannon level, 2-2.5cm in size.

Victim #1 tore his having a horsefly-induced meltdown in a hilly pasture. He received three rounds of shockwave. He was a horrible stallwalker and obsessive about routine. As such, he was not a candidate for stall rest, so he stayed on his normal schedule of in during the day, out at night, with turnout in a round pen or small grass paddock. He was very quiet, required no drugs, rehabbed uneventfully, and returned to his previous level of work (mostly walk/trot lessons) at about the 6 month mark. Ultrasound was not repeated, all decisions were based on his staying sound.

Victim #2 came to me with a history of a nonspecific hind limb soft tissue injury. She had been sound for a year when I got her, and she stayed sound for about another year before she gradually became more lame and eventually was ultrasounded. She got a few weeks of Previcox and was on round pen turnout for about three months. Again, very quiet at baseline, no sedation needed. Ultrasound was repeated, everything was well-healed, and under-saddle rehab began. It lasted a year before becoming acutely (but not horribly) lame again, and ultrasound confirmed reinjury. At that point the decision was made to retire her.