Severe SDFT Injury - Rehab Process

[ottbbabe]

My horse had a severe SDFT injury, is rehabbing, and I am just looking for advice. Bear with me, this is a long one.

A (long) backstory: At the end of November my 17 year old heart-horse that I have had since childhood was in a bad trailer accident (very traumatic for everyone, could have been prevented, I have lasting PTSD, etc but that is a whole different issue…) and ruptured her hind SDFT. She was non-weight bearing immediately after the accident, called the vet ASAP, and she spent a 3 days at an excellent referral hospital. She was heavily evaluated by vets immediately after and during the initial few days after injury - full x-rays, all wounds flushed, joints monitored for infection, etc. She had some pretty serious wounds but nothing along the back of her leg, so everyone figured those structures were not of concern. By day 2 she was able to bear weight and by day 3 she was only about 1/5 lame at the walk, so she was discharged and sent home. She was confined to a 12x24 space and handwalked daily, and continued to improve. About 5 days later I noticed her fetlock dropping, called emergency vet. The initial ultrasound showed a 1-inch space of complete absence of the SDFT - horrifying (trust me I almost passed out seeing this). The most perplexing thing is there is no wound at all in that area- This type of injury is nearly always seen as secondary to a wound- so the vets think most likely it was 75% ruptured during the accident and she did the rest of it later. No one had any way of knowing this before it was 100% ruptured. There is only one research article out there about this exact injury.

I opted to “do everything”. She spent the next week in the hospital, got a distal leg cast placed under complete anesthesia, and then spent the next 3 months at one of the vet’s houses/rehab facility, an “intermediate facility for horses”. She wore the cast perfectly for 4 weeks, which was the surgeon’s goal, and since then has been wearing a cotton RediRoll bandage. She got PRP. By grace, her other soft tissues (now doing the work of the SDFT) have held up perfect and her supporting leg did fantastic in a softride. She did about 2 months total stall rest, a few weeks of hand grazing, and since 3 months has been handwalking. She is now back at our barn and HW about 20 mins 5 days a week. 1-2 mL oral ace takes the edge off and I have started incorporating an equicore into our routine. She is doing very very well. The 6 week and 3 month ultrasounds showed vast improvement - the tendon was reconnected by scar tissue by 6 weeks and the scar tissue was turning into linear tendon fibers by 3 months. We have another U/S in mid may at 6 months post injury. The fetlock drop is nearly gone - not perfect, but I would say about 90% normal. She is totally sound at the walk and has even put in some trot steps here and there (not on purpose of course) and looks very good. The tendon is still quite enlarged and bowed looking, but it is cold and tight. Vets say it may be large forever.

My issue is, I am completely stuck/torn/mentally struggling with the rehab. At the 3 month U/S, the vet’s said she could have a small paddock. However, that seemed extremely early on in the rehab process to me, and since she was doing so well with handwalking and handling stall rest like a champ, I opted to not do that yet. The vet’s agreed that keeping her on stall rest was totally fine, but that was nearly 2 months ago. Our vets are fantastic and I am so thankful for them for saving my horse, but It is hard for me to get a clear, straight answer from them about this because I think it is just an uncommon injury. Its always been “do what is working best for her.” But how do I know if she could be doing even better if she had a paddock? How do I know if I am doing her a disservice by keeping her on stall rest? Resperine is not an option for her and we have an Rx for Trazadone but I have not given it to her yet. It is now been nearly 5 months post injury and I have my trainer breathing down my neck about when I am going to release my mare from the confides of a stall and telling me I am going to effect healing by keeping her in a stall for this long.

Anyone with experience with this injury or even something somewhat similar have any advice about introducing a small paddock? I am talking 12x12 connected to her stall where she would have access 24/7. What do you think of the timeline? I always thought tendons were a 9-12 months in a stall type thing. Any idea if too much stall rest can be detrimental?

[SLW]

Sounds like you are doing a meticulous job in rehabbing your mare.

I think a small run off her stall is ideal if she just chills in it. I’d want to make sure range of motion isn’t stoved up by too much confinement.

When I was rehabbing a large donkey from a torn ligament in a front pastern the clinic gave me an article to use as a guideline for hand walking then work.

[FarmGirl42]

Would like to start out by saying I feel your pain and frustration and I am sorry you are dealing with this.

You will get ALOT of really good and unfortunately very different and confusing opinions. I have researched myself half sick over the last two years over my horse’s SDFT and DDFT severe injury and like you, have thrown all my resources and 100% of my time at my heart horse.

Her rehab is going well, take it one day, one week, one month at a time. It will take longer than you think or hope for. What works for some horses and some situations will not at all work for others. I spent every single day going through that rehab process from beginning to under saddle walking no matter what. The first year I did everything by the book and the second year following the re-injury my horse was in a stall with an attached paddock (14x32) with the same rehab (from handwalking to under saddle) and it the tendons progressed the same way, but my horse definitely was happier with the paddock and the ability to move.
Your vets are being vague because unfortunately there are no guarantees and there is no one solution fits all. If she is sound in the walk she will be able to handle a walk out situation. I agree with your trainer - too little movements are a contradiction to the tendon’s ability to deal with future stress,adhesions are more likely to form, she will likely get body sore and and and.

The rehab itself is a fine line of too little and not enough, it’s hard and its frustrating and it really is one day at a time. If you can afford it - send her to a good rehab place and save your sanity. (I could not) I never used Ace during my rehab and Trazodone has been a life saver for us and yes there are some other posts about conflicting opinions here too. We started out at what the vet considered a high dose (1300lbs - 25x twice a day) and tapered to ~ 13 twice a day. They are very bitter, so I dissolve them in a syringe with hot water and then add a little diluted molasses. We now think its a treat.

Sorry for the long answer, here is the short one: yes too much stall rest in a 12x12 is not healthy for many reasons. Look at it as a room with a balcony instead of a window (if she currently has one) and yes it will be at least 9-12 months.

[fanfayre]

I’m so sorry you’re dealing with this. I’m following along with interest because I’m doing rehab too, but for a different injury. However, my experience is completely opposite to yours- my fellow is NOT coping with rehab and restricted movement at all, and has most likely undone all the treatment. We’ve basically thrown ‘the book’ out the window and trying to do what’s best for him, not what’s typical. Time will tell if it’s successful or just a terminal outcome delayed…
The only thing I can think to suggest to alleviate your worry about extending her turnout area is to try very high-value treats like extra-yummy alfalfa (or something similar) when you DO turn her out into a larger area and do it AFTER her daily hand-walk/exercise, and even top up the Ace before letting her out. You may only be able to let her out for 20-30minutes the first few times, then increasing her time as she becomes accustomed. Also, try to have VERY QUIET, calm neighbours all around her to keep the ‘energy level’ down.
To answer you final question, my vet has said that studies have shown that, yes, too much stall rest IS detrimental, especially for older horses.
Best wishes for a GREAT outcome. You sound like you’re doing a FABULOUS job, and she’s a very lucky horse to have you.
Edited to say I wish I could endorse the trazadone wholeheartedly, but my guy blew through 2500mg AND 1000mg fluoxetine as a replacement as if I hadn’t given him anything, but we’re discovering he really is a “special” case and a total ‘head case’

[IPEsq]

For one that is behaving in the stall, I would want her at least doing a fair amount of trotting if not also cantering in rehab before turning out unless you can make a very small stall-sized turnout paddock. That’s what we did for a not nearly as bad (grade 1 mild disruption vs your total rupture) high DDFT lesion for one of my horses. When he was at the rehab barn to do treadmill work, they were able to transition him to stall sized paddock and then he eventually got to a double stall or so sized paddock after he was under saddle and doing brief trotting. Full turnout did not happen for quite some time later.

The SDFT may never look good cosmetically but if it does finish healing well then I think your longer term prognosis ought to be pretty good. Especially since it happened due to a specific trauma and was not work/movement related.

Signed, person whose horse broke his scapula and wasn’t returned to normal turnout for approximately a year and a half (!) into the healing and rehab process.

[ottbbabe]

I have considered a rehab facility but honestly I do not want her that far away from me. I live about 3 hours from a well known rehab center with a swimming pool, etc. and she did spend some time there several years ago when we were showing on the A circuit. But I just do not want to go down that road this time. She already spent 3 months at the vet owned and run rehab. I do plan on giving her the 12x12 paddock attached to her 12x12 stall this weekend. We started her on trazadone today and she is so far tolerating it well and it seems to be working.

[ottbbabe]

I do not plan on turning her out per-say. I plan on giving her a 12x12 outside area attached to her 12x12 stall. She tolerates sedation very well (2mL of ace given orally knocks her out within 30 mins) so I am not overly concerned about trazadone.

[ottbbabe]

I do not plan on turning her out per-say and agree that a real turn out should not be done until well after the injury is healed. I am talking about extending her 12x12 stall to include a 12x12 run.

[2tempe]

you might start with access to the attached area during the day and closed off at night…At least there would be people around if she gets stupid. But i actually think it would do a world of good

[mrsgrieves]

My horse tore its SDFT and we did everything by the book for over a year. Finally gave up, threw the book out the window, and turned him out. But to answer your question - our vet usually has us hand graze in a small paddock, so they associate being out there and being “controlled”, then eventually let them loose and stand out there with them so they still think you’re hooked to them, then start weaning yourself out of the paddock. Usually once they’re completely by themselves, turned out, they are trotting under saddle at least. And also, I’ve had some horses that Trazadone doesn’t touch. Oral Ace is probably your best bet still for turn out, especially if it’s working.