Severed Hind Extensor Tendon

[dapplegray]

Looking for any advice on dealing with a severed hind extensor tendon.

My mare severed her left hind extensor today while rolling into her pasture fence. She broke three fence posts in half trying to freeing herself and I found her about 20 mins later. She skinned her hock down to the bone and exposed a portion of the lower half of the joint, my vet was hoping to try and salvage her extensor but it was completely shredded. We are currently looking at stall rest for 2 months give or take depending on how she heals, my vet is hoping I’ll come out of this with a mechanically lame but rideable horse. Vet currently has instructed me to continue packing the wound with derma-gel, figured 8 wrapping the hock then covering with elastikon, stable wrapping her leg and casting the front of the hock with a no bow and then elastikon over everything for more support. I’m supposed to start my daily wrap changes tomorrow and we’ll have a vet check exactly a week from today and will then consider hock x-rays due to how hard she was obviously struggling since she broke three fence posts in half. She’s on a regime of SMZ’s twice daily, and on equioxx once daily for the pain as I’ve always been wary of putting her on banamine/bute as she is ulcer prone. I’m wary of only having her on SMZ’s but my vet assured me it would be enough. She had a super rough night tonight, and wasn’t feeling her dinner but I hardly can blame her after the day she has had. Just trying to get ahead of the game and make sure she’s getting the best care possible

[Mango20]

I had one sever the extensor tendon on a trail ride - an old barbed wire fence was down and under some leaves and she snagged it and got stuck at the front of the hock. Her skin tore in an L shape, but that flap eventually died. She was bandaged for a while and ended up with a hairless scar there. She became rideable again, and was only visually lame at the canter. When she would canter on the lead where that leg would be on the ground alone, she would put the other hind down almost immediately, so there was a little hopping feel to it. She looked fine at the trot, and enjoyed trail rides until her final days about 10 years later.

[beowulf]

that protocol sounds about right for a severed hind extensor – sorry you’re going through it. no joint involvement, right?

they don’t usually need the bells and whistles to heal - just keep them quiet and keep the laceration clean and under control. granulation is normal but keep an eye that it does not turn into proud-flesh – as the tendon “heals” (it does not grow back) scar tissue will reconnect the loose ends - scar tissue by nature is not very elastic, so ask your vet about hand-walking to keep the tissue conditioned. one of the cases I dealt with, we splinted (if that is the right word) the limb – IIRC, she was in a cast/splint for about four weeks and then graduated to full-limb wraps for another fourish weeks. complete stall rest the initial weeks followed by a very tiny medical paddock the rest of the layup. her owner opted to have her on reserpine to facilitate keeping her quiet… better living through chemistry, right? i don’t know if it’s relevant but once the cast was off, the owner bought her some BOT wraps that i do think helped.

some vets say it’s good to get them out of the stall, i think it depends on the horse. a quiet one can be hand-walked just fine, and might even enjoy being outside in a small medical paddock - quiet non-repetitive movement is really good during the layup portion, but you have to make sure you are balancing healing with conditioning. a horse that is rowdy or prone to doing antics even in a small paddock should be aced or reserpine’d up as too much movement, especially repetitive, will antagonize the healing process.

the good news is, I have seen some fantastic recoveries from this injury. Some have gone back to their previous level of work (the mare above did) and higher. honestly, it’s probably one of the best tendons to injure if you have to injure one. and… it’s going to look a LOT worse before it looks better… like knuckling, limb flopping, the works… as your vet noted, the horse might be ‘mechanically’ lame – as the tendon and laceration heals it will scar and scar tissue has less elasticity than normal tissue, which might present in gait abnormality.

in general, it is not a quick recovery – usually, i think it takes about 6-9 months for full recovery from the laceration depending on the severity and how well the horse heals… it takes much longer to bring them back. make sure to stock up on bandages… you will go through a lot…

ETA: re: SMZs, if you are worried about ulcers, make sure to pop her on a pro-and-prebiotic. it would not hurt to drop her grain (if she is on a lot of concentrate) and swap with something like alfalfa cubes or pellets - this is what we do when horses are on layup… and i actually add oats, as i think it does help their digestion with all the medication that is being pumped in them.

[JB]

I’ve posted my experience on this several times, so there are quite a few threads on this which will come up easily in a search

Short story - almost all these end well.

I would NOT look at that much stall rest, barring other injuries along with this. Once the acute phase of the injury is over, the tendon scar tissue needs light, quiet movement in order to properly develop scar tissue that will be strong.

I was riding my horse lightly at about 4 months.

Nutrition needs are high for healing - about what it takes for that horse in moderate work. Protein and amino acids are particularly needed. At the very least I would use a ration balancer.

Wrapping the wound is of course important. But just as important, even MORE important for a few months, is snugly wrapping the fetlock so it has limited flexion while scar tissue is forming to reconnect the tendon ends. So make sure you do a snug wrap on the lower leg, down to the hoof. I used a nobow, then almost a full roll of 4" brown gauze, then about 3/4 roll vetrap, for a about 6 weeks, then changed to a regular standing wrap. But SNUG, so you limit that joint movement.

IMHO your vet is being pretty pessimistic about this. Horses really do heal very well, and none of the growing number I know now have any mechanical hitch in their gait

SMZs may be enough. Mine was on SMZs and penicillin, but then again that was a t-post laceration, so not sure if that matters. You’ll know if the wound needs more. The fewer abx you can get away with, the better. Most definitely get a good pre- and probiotic to give her in between abx doses though.

[JB]

These should help
https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/78824-severed-extensor-tendon
https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/314876-extensor-tendon-injury-asking-advice-from-those-who-have-dealt-with-this
https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/270971-severed-extensor-tendon-long-term-prognosis
https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/194317-talk-to-me-about-extensor-tendon-tears

[jetsmom]

We had one sever the front at my barn and recovered completely either no lameness, back to jumping 3 ft courses.

[pattnic]

I agree that your vet sounds like they are being a bit overly pessimistic, but I suppose they are trying to prepare you for the worst. beowolf is right - if you’re going to have a tendon injury, an extensor tendon injury is the one to have.

My gelding also severed his LH extensor tendon (along with having other injuries and setbacks, including a sequestrum) when he was four. This was over 8 years ago, so I don’t clearly recall all of his after-injury care, but I don’t recall that he was on stall rest that long - I think he was in for about a month. The timeline of light riding at about 4 months sounds about right.

My gelding had not yet started jumping at that point, but did recover sound enough to not only be rideable, but also to jump (he started jumping about two years post-accident). He did, about a year later, have his hocks injected (there hadn’t been any actual joint involvement) because his way of going as he recovered did stress his hocks and make him uncomfortable there. He hasn’t had any problems since (knock on wood). He can be a bit “draggy” with LH sometimes, but he’s not really unsound and his gaits are basically even. Cantering right (LH working independently) is easier for him than cantering left, but he doesn’t feel or look lame or uneven. Lateral work helps with this. He is generally a bit better wearing shoes, but is currently barefoot and seems to be fine.

I will say that I don’t know that he was able to attain his full potential; he is very athletic, and I expected him to be able to do more (jump higher/more easily) than my mare, but he seems to have topped out at a lower fence height. Whether this would have been the case if he hadn’t been injured, I obviously can’t say for sure, but I have my suspicions.

[dapplegray]

Thanks for the advice!! I do love and trust my vet, I just like to learn on my own sometimes to make sure we’re all on the best track for her recovery The planned two months of stall rest would include some hand walking, I didn’t ask much more than that because I was pretty scatter brained while the vet was out here. I’ll sit down and make a schedule with her of her goals exercise wise for her when she’s out again on Wednesday. I think she’s being pessimistic because the mare was my Small Junior Hunter last season. I just don’t think she wants me to get my heart set on her coming back to be my AA 3’3" hunter again after this. I obviously don’t have any experience with this type of injury, is there a chance she could come back from an injury like this to be 100% sound again? My vet had me under the impression that this would be career ending for her.

We aren’t currently wrapping for support of the fetlock, so I’ll definitely make some changes there.

She’s currently getting 2.5lbs Babington Mill’s Omega H, 2.5 lbs Triple Crown Low Starch, 0.5lb flax & 2 ounces of cocosoya oil for breakfast, 3.5lbs Timothy Balance Cubes, 1lb beet pulp, 1 ounce cocosoya oil for lunch, dinner is the same as breakfast and she gets another 3.5lb of Timothy Balance Cubes at night check. She’s also on SmartFlex II, Mare Magic, Aloe Vera Juice, Probios, DePaolo’s Excel, and gets a quarter tube of UlcerGuard every night. She gets truly unlimited hay but has never a big hay eater ( unless it’s alfalfa) in the four years I have owned her, I’d estimate she probably eats 5lbs per day tops regardless of how long she is kept in. Haven’t changed anything as this all just happened yesterday. I want to look into supplementing more for rebuilding the tendon and I was going to throw her on alfalfa again now that I don’t have to worry about her getting too hot to do her job.

Her first day of stall rest was pretty rough, she’s always been on private turn out but she loves her pasture neighbors. We had a lot of pacing around her stall (to the best of her abilities while 3 legged) and whinnying, I gave her a dose of perfect prep this morning and it chilled her out enough to stop calling for her buddies and pacing so I’m hoping I’ll be able to keep her off reserpine which would be our next step. I’m putting a cam in her stall this coming Monday so I can see how much she is truly pacing around on it over the course of the day.

I’ll post some pics of her current wrap job and of the injury itself once I’m home, I’m planning to do my first wrap job on her after she gets her dinner tonight so cross your fingers for me lol!

[JB]

@dapplegray

The planned two months of stall rest would include some hand walking, I didn’t ask much more than that because I was pretty scatter brained while the vet was out here. I’ll sit down and make a schedule with her of her goals exercise wise for her when she’s out again on Wednesday.

Oh yes, it’s a lot to take in when there’s an injury like that, especially when you have no frame of reference Definitely talk to her about the movement. My guy started at about 3 weeks with being let into a small attached paddock when I cleaned his stall twice a day. Then half a day, then all day, then he graduated to a bigger paddock (about riding ring size) for the day, and the smaller paddock/stall at night, then by maybe 3 months (?) he had all that 24x7. I didn’t hand walk him. He moved enough while quietly grazing, and yes, occasionally getting a bug up his butt and running around (and regretting it lol) that it wasn’t necessary. I honestly don’t remember doing any hand walking but I suppose it’s possible I did it maybe the last week or so before getting back on him, but it definitely wouldn’t have been longer than that.

I think she’s being pessimistic because the mare was my Small Junior Hunter last season. I just don’t think she wants me to get my heart set on her coming back to be my AA 3’3" hunter again after this. I obviously don’t have any experience with this type of injury, is there a chance she could come back from an injury like this to be 100% sound again? My vet had me under the impression that this would be career ending for her.

There’s really no reason she can’t get a 3’3" horse again. Really. MOST horses with this injury return to their previous level of performance. As in, over 75% of them. It’s not a weight-bearing tendon. It’s only necessary to flip the foot up when the leg moves forward. Is it possible she might have a little bit of a funny leg movement in that phase of flight that would deem her “unsound” by Hunter standards? Sure, possible, but not probable.

We aren’t currently wrapping for support of the fetlock, so I’ll definitely make some changes there.

Good, and keep it wrapped 24x7 for a few months. That fetlock can hyperflex in a heartbeat if she catches a toe, since there’s no tendon to stop it. If that happens, not only will it tear whatever tenuous scar tissue has started to connect, she can tear the fetlock joint capsule. My guy actually did that, though we were never sure if he did it during the accident, or in a moment of his stupid farting around. It healed very well, regardless, though it did leave him with a permanently enlarged joint capsule, though by now you’d never see it unless you were actively comparing the 2. But it’s just not something you want to invite happening, so definitely get it all wrapped

She’s currently getting 2.5lbs Babington Mill’s Omega H, 2.5 lbs Triple Crown Low Starch, 0.5lb flax & 2 ounces of cocosoya oil for breakfast, 3.5lbs Timothy Balance Cubes, 1lb beet pulp, 1 ounce cocosoya oil for lunch, dinner is the same as breakfast and she gets another 3.5lb of Timothy Balance Cubes at night check. She’s also on SmartFlex II, Mare Magic, Aloe Vera Juice, Probios, DePaolo’s Excel, and gets a quarter tube of UlcerGuard every night. She gets truly unlimited hay but has never a big hay eater ( unless it’s alfalfa) in the four years I have owned her, I’d estimate she probably eats 5lbs per day tops regardless of how long she is kept in. Haven’t changed anything as this all just happened yesterday. I want to look into supplementing more for rebuilding the tendon and I was going to throw her on alfalfa again now that I don’t have to worry about her getting too hot to do her job.

That’s a lot of stuff LOL Why such a mix of the more basic feedstuffs?

She gets 5lb of feed, plus “stuff” for breakfast and dinner, do I read that right? What made you choose those 2 different feeds?

Her first day of stall rest was pretty rough, she’s always been on private turn out but she loves her pasture neighbors. We had a lot of pacing around her stall (to the best of her abilities while 3 legged) and whinnying, I gave her a dose of perfect prep this morning and it chilled her out enough to stop calling for her buddies and pacing so I’m hoping I’ll be able to keep her off reserpine which would be our next step. I’m putting a cam in her stall this coming Monday so I can see how much she is truly pacing around on it over the course of the day.

Is there a way to bring another horse closer to her so she’s not so “alone”? That’s good that just a dose of PP helped. The first few days are always the worst, so hopefully she’ll settle down into her new routine pretty quickly.

I’ll post some pics of her current wrap job and of the injury itself once I’m home, I’m planning to do my first wrap job on her after she gets her dinner tonight so cross your fingers for me lol!

You’ll quickly get really good at it lol I’m assuming you already know how to wrap, at its basic, and are just having to deal with this new situation with more wraps and a “lively” mare LOL

[ddashaq]

One of my friend’s mares had this exact injury as a 2 year old in 2001 or 2002. She was away at college so the barn manager and I took care of it, under the vet’s supervision. I don’t recall the exact treatment other than it involved A LOT of bandage changes and we never had her on complete stall rest. We were afraid she would get too hot and hurt herself worse so she was turned out in a small enclosure from day 2. It took 7 or 8 months for it to be completely healed and she certainly looked totally sound, although it did leave a bit of a scar. She was eventually sold on and last I knew, was a stellar trail horse.

[eclipse]

Mine severed his left hind extensor tendon when he was 4. No hock involved but he did spend a month at the vets and had a bone sequestron removed after week one. 3 years later he’s become a successful hunter, moves like a dream and is currently jumping 1.10m with ease. Basically my vet just said “he won’t do big jumps” and when I asked what he meant he said "oh you know he will probably not be able to do the 1.50)… yeah l laughed as I’d hoped to make him a 3ft hunter!!!

sully was on stall rest the first month and then limited turnout in a “rehab paddock” for 2-3 months. We kept his leg fullly wrapped 24/7 and every 2weeks had proud flesh removed. He severed the tendon in July and we got to start riding him in December, once the wound had filled in. I have some pictures if you want to see them!!! Rather gruesome looking but it’s an injury that heals well!

[Curly_Feather]

@dapplegray

In regards to having a buddy in with her, barn owner and boarders are not willing to sacrifice turnout time for their horses unfortunately. Wish I had a friend to keep in with her but just isn’t an option. She seems to settle after the first 30 mins/1 hour of being in alone, I’ll continue to stay with her till she settles and leave the radio on all day for her until the horses come in for the night.

If we have horses on stall rest at our yard, we use a rotating buddy system, where the buddy is swopped out about 3 or 4 times a day. Not that much extra work, really, and then the sacrificed paddock time of the buddy is minimal.

[dapplegray]

@eclipse

Mine severed his left hind extensor tendon when he was 4. No hock involved but he did spend a month at the vets and had a bone sequestron removed after week one. 3 years later he’s become a successful hunter, moves like a dream and is currently jumping 1.10m with ease. Basically my vet just said “he won’t do big jumps” and when I asked what he meant he said "oh you know he will probably not be able to do the 1.50)… yeah l laughed as I’d hoped to make him a 3ft hunter!!!

sully was on stall rest the first month and then limited turnout in a “rehab paddock” for 2-3 months. We kept his leg fullly wrapped 24/7 and every 2weeks had proud flesh removed. He severed the tendon in July and we got to start riding him in December, once the wound had filled in. I have some pictures if you want to see them!!! Rather gruesome looking but it’s an injury that heals well!

I’d love to see pics! Would be nice to have something to compare to. So glad that your guy made such a full recovery, really nice to hear!

[JB]

Poor girl, yikes what a wound Be prepared - in about 10 days or so it will actually seem like it’s worse.

Are you using non-stick gauze over the wound? That’s a must. There’s going to be a LOT of exudae for weeks while that thing heals and drains and everything under the sun will stick to it.

By buddy, I initially meant just a way to have someone closer to her in turnout. If possible, a temporary paddock set up near her, a round pen, something. If not, that’s understandable, but then as Curly said, even rotating a horse in every couple of hours won’t kill the horse, and may do a world of good for her. But, if she’s really becoming ok after 30-60 minutes, that’s really the best situation, and over the next few days, that time should start to shorten.

[dapplegray]

eclipse: it is so awesome that he recovered so fully!! Also nice to see the timeline of the progression of his injury Thats basically exactly how my elastikon wrap looks before I put the no-bow overtop of it too, we’ve also been putting another no-bow directly over the cite of the injury for her. Did you supplement/make any diet changes to aid in his recovery?

We had a really good wrap change last night, I decided to give her 1.5ml of the dorm just to be safe and to give us both a good experience for our first time doing it without the vet. Feeling a lot better about the whole thing, we got the wrap change/wound cleaning done in about 20 minutes total and she just stood there super sleepy and quiet with her head on the ground for the whole ordeal. The next couple of months were looking quite daunting after our Thursday night attempt, the vet even wanted me to consider just sending her to a lay-up farm after her behavior during so this is a huge step for both of us.

Stall rest is also getting increasingly easier to deal with, she calmed down within about 15mins of the horses getting turned out yesterday and was super relaxed for the rest of the day off of her one dose of PP. Having the most trouble just getting her to take her meds at this point, she thinks I’m hiding drugs in everything and will no longer even take treats from me She’s been very suspicious of breakfast and dinner and I’ve had trouble getting her to completely eat either meal.

Anxious to have more diagnostics done on the joint itself this coming Wednesday, her level of soundness has me pretty confident that the visible injury is our only issue right now but that doesn’t stop me from worrying!

[JB]

That’s awesome to hear she’s adjusting to her stall rest

Have you gotten her on a good pre/probiotic yet? Abx can quickly make some horses (and people!) get a sour stomach. You’ll definitely have to syringe her abx if she’s not eating treats with them. You might consider lacing her meal with a little molasses or something else yummy to entice her, or even try smaller meals for a while.

Fingers crossed what you see is the only injury she has!

[eclipse]

Sully was very calm during the entire ordeal so little did we realize it was the start of a long battle with ulcers! In hindsite, I wish I’d at least done a course of Ulcerguard just to see if it would of helped alleviate some of the gastric and pyloric ulcers we’ve battled with since the injury!

[dapplegray]

Just wanted to post an update! We took her to MidAtlantic Sunday night to see the head surgeon there as I spoke to a friend of mine who rehabs track horses for a living (can’t believe it slipped my mind to contact her!! I totally forgot about her) and she was extremely concerned with my vets overly casual treatment of this entire injury. So we hauled her to NJ for a visit to MidAtlantic and had the surgeon ultrasound her leg. She said she couldn’t have possibly gotten luckier with the placement of this injury, literally mm away from destroying other tendons and interfering with the joint. They were also not happy with my vets treatment, didn’t like the way she was being wrapped, the antibiotics she was on, or the fact that my vet was allowing us to wait an entire week to look into further diagnostic when if it had infact gotten into her joint by now she would’ve been too far gone to have done anything. She was already brewing some cellulitis in there, and they said if I had allowed my vet to test joint fluid on her the infection would’ve no doubt been drug into the joint and it would’ve become septic and I would’ve been looking at a permanently lame horse. They also all totally agreed with you guys that, with meticulous wound care, she can have a completely full recovery and go back to her job. MA placed her on 35 cc Gentocin, 10 cc Naquasone, and 10cc of Banamine all IV. We were told to disregard the SMZ’s and that it was a joke to have had her on them in the first place for this severe of an injury. They were all AMAZED at the level of soundness she has right now. They said if they hadn’t seen it on the ultrasound they wouldn’t believe she had a severed extensor. Her ultrasound showed air in her tendon sheath, it blocked a portion of her cannon bone from our view but we are hopeful that it is free of any fractures. She went home with my friend who rehabs and will be spending her layup time with her since she and her staff can provide her with meticulous care that I simply cannot at home. Rehabber will be getting a third opinion on her when she has Wade Wisner out this week for stem cell therapy on another horse, and she will get weekly checkups done by him from now on. Looking to possibly get the leg cast on Thursday to prevent any knuckling over and to stabilize the hock to prevent any further disruption to the healing process. If the swelling continues she will have a joint culture done, but we’re relatively certain from her ultrasound that the joint capsule is still intact.

Went to visit her for the first time last night, I had such a hard time sending her away but she honestly seems so much happier in a barn FULL of rehab horses who are all on stall rest with her. No stress of her friends leaving her for turnout every morning, I honestly don’t think she even missed me very much I can go visit her anytime I want for some snuggles, just difficult with her an hour and a half away. Rehabber is sending me home with another horse she rehabbed and purchased from the owner because she loved him too much to send back home, so I’ll have a greenie to bop around on this summer until my little mare can come back home. Just a perfect situation for both of us, hard having her away but so great knowing she’s in experienced hands and being seen by an exceptional vet.