Injury - cellulitis or joint?

My mare (13 year old Welsh cross) managed to cut the upper portion of the inside of her right hock. She has a few small abrasions but none are full thickness except a puncture-like wound on the hock. I hauled her into the vet first thing Monday morning and they were worried because there was significant swelling of her entire limb and she was lame (2/5). They sedated her, clipped and cleaned it, probed it (sterile), and took radiographs (everything looked clean). They said that the puncture seemed to be above the joint capsule and because she wasn’t extremely lame, to treat it as secondary cellulitis. She has a full limb (hoof to gaskin) compression bandage to try to reduce swelling, is getting banamine (bute wrecks her stomach), and Excede as an antibiotic (one dose Monday and one on Friday). They said that if the lameness doesn’t improve significantly by the weekend, there is a probable chance of the wound involving the joint.
I changed her bandage today and the swelling has gone down (to be expected, I know) but she is still very painful and mildly lame (1/5) with the banamine. Is it reasonable to be worried that she’s still so sensitive and sore with Banamine? At what point do I take her back in? I did call the vet and talked to her and she said to give it a day or two. I’m worried that the joint may be affected by the wound (infection or otherwise).
If it ends up being just cellulitis, does secondary cellulitis become chronic? I know primary cellulitis often does but I’m not sure about secondary. Also, what is the prognosis for an athletic career after a bout of cellulitis? Can it cause any long term damage? How do you manage it if becomes chronic or during flare-ups?
Thank you for any advice or information!

Fingers crossed your mare’s comfort levels and swelling improve. Have the vets ruled out a tendon sheath infection? This should be considered a possibility for any puncture wound near a joint. Unfortunately tendon sheath infections are as serious, if not more serious, than joint infections. Unfortunately, I know this only too well, as I have a yearling that is now 6 weeks post surgery for a tendon sheath infection, caused by a puncture wound that was not visible for the first few days. My horse’s puncture wound was above the coronary band and affected his digital sheath. He improved (comfort and soundness) with painkillers and it took a few days for the infection to set in, and therefore for the puncture wound to be discovered and the issue to be correctly diagnosed. Mine was on broad spectrum antibiotics however the bugs in his tendon sheath were not responsive to these.

Good luck - hopefully it is cellulitis and nothing involving the synovial structures.

The vet never mentioned tendon sheath infection. What would be signs of that? Discharge/drainage? Also, to give a little more context (I’ll also post pictures tonight), the wound is slightly above the talus on the tibia. When they did radiographs, they did use a sterile probe to mark depth and try to rule out possible joint involvement. They said that it looked high enough that it shouldn’t be around the synovial capsule but because of the angle of the other abrasions, to not rule it out.

OP - short answer to your questions is that cellulitis can become chronic (not sure what primary is; as the ones I’ve known have gotten it from a scratch, cut, etc). Those that I have seen that are on the younger side - say under 20 -have recovered nicely, gone back to full work, competition etc. As they get older and their systems are not so strong, things can be more difficult. There is another thread floating around that touches on this.

My personal horse had it first at about 18 or 19. Fine for several years; at 25 got a bad case, wouldn’t heal, complicated by cardiac issues so we put him down.