Tendon injury - your thoughts/experiences?

[J-Lu]

Hi all,

Last late afternoon, my horse finished his ride “off” after a good ride. Mostly just W-T-C because I didn’t ride him for 6 days due to terrible weather and my schedule. Developed swelling on the medial rt leg just above the fetlock suggesting tendon injury. Luckily, a Federal level livestock vet is staying there with her horses. We immediately iced for a couple of hours and we started him on generic previcox, limited his turnout to his small paddock inside his pasture. Today, we iced for about 6 hours and I let him out to graze on the lawn (he’s used to free-grazing and is mellow about this - he was cranky about being in his paddock). The swelling distributed from the medial part of the leg to the more caudal areas.

The vet has Government service work this weekend so I’ll feed am and pm this weekend and be there all day working. I’ll let him self-graze with ice boots much of the day. I restricted his pasture neighbors/shed neighbors into the adjacent pasture. That makes him feel “less alone” and calmer when he’s in his paddock and he’ll just graze on the lawn clover patches calmly when he’s free-grazing. He is weight bearing on that leg.

My vet was on vacation and comes back into town this week. Her husband (a vet) didn’t think that treatment would change from what I’m doing now and opted to wait for my horse’s vet to come back into town and ultrasound early next week. I told him and their other vet that a veterinarian was looking at him now and put him on meds and I think that took the pressure off. They agreed with our interim plan.

Question: It’s a mild injury as the horse is weight-bearing. Early icing, wrapping and meds. Who has had a similar experience? I of course will discuss the path forward with my vet and follow her guidelines, but I’m wondering if anyone has experienced a similar mild tendon/ligament issue and could tell me what your treatment/rehab timeline involved. Reading the internet has made me paranoid and my vet’s husband told me today “don’t pull your hair out this weekend, we deal with this all the time and it is good that he’s weightbearing and comfortable”. I’m trying hard not pull my hair out so thought I’d start a thread!

Thank you!

[PaddockWood]

I had a hind and a front suspensory injury over the years and paranoid is smart. Ultrasound is smart. Yep, get that swelling down and you are doing all the right things as long as he won’t run at all out in that paddock. Then get an image and confirm if you have a problem brewing.

If in fact you do end up having a problem, there’s good info on the internet from Carol Gillis, DVM. She got her phD in tendons from UC Davis. I did a remote consult with her years ago and money very well spent. And it was inexpensive. I had the local vet getting images and advice but also had her opinions and advice too. If there’s one thing you don’t screw around with it’s soft tissue (as I sit here with ice on my shoulder after falling and suspecting I have torn something).

[NancyM]

Huge difference between tendon injury and suspensory injury. Tendon injury has a far better outcome. It will be fine, relax. I’ve had numerous tendon injury cases, I LIKED tendon injury cases as OTTB hunter/jumper potential candidates coming off the track. My favourate type of injury on a potential h/j candidate, short term, good recovery chances to 100% soundness on a basically sound horse before the injury. You are doing it right, ice for the first 3 days. Ultrasound will tell you the extent of the injury, but if you have no pocket of fluid midway down the underneath of the pastern, it’s a minor tear. If you DO have filling there, it’s more major, but will heal in time too. Read up on recovery theories… exercise is key, exercise drives healing. How much and when depends on the extent of the injury, but not enough will result in incomplete healing. Good luck!

[hut-ho78]

I’ve had experience with minor, a few days off, to mild upper suspension to a not sure but worrisome lower suspensory with sesamoiditis and a chip. Everything healed up ok. Controlled exercise, hand walking from day one, etc. was the trick. The part where there is riding at the walk with no lunging or turnout yet is a scary time. Lunging the first time after the injury is a joyous day. Turnout is another joyous day. Mine became ok just using old school methods, time and controlled exercise. Now they have all kinds of helpful treatments that are said to make a big difference. Stem cell. The electric stimulus (I never can remember the term). No worries. Just take your time and get it right. If there is a partial tear, it is possible to heal too tight and tear again. That is not a setback although it feels like a huge one, buckets of tears. It is just the healing process for optimum length.

Good luck.

Oh, handwalking can be exciting. Wear a helmet and gloves. Keep an elbow up to keep the horse’s front and rear end off of you and carry a whip. You may need a nose chain as well. Be safe. Don’t give enough lead rope to allow them to whirl and kick (been there).

[StormyDay]

I highly recommend an ultrasound. Leg injury care can range from needing 6 months off to not needing anything at all.

[J-Lu]

Thanks, everyone! I appreciate your experiences and advice!

He’s free-grazing right now with an ice boot on the grass circle between the house and the barn. He knows there are clover patches there and it is parallel with his pasture neighbors so he is calmly grazing there. He’s getting a bit cranky in his paddock and with hay nets rather than grass, and yesterday tried to follow me out of the run-in so closely that I accidentally squished his head closing the door.

Hopefully vet will come on Tues because I cannot make it out to meet her tomorrow. I’ll keep you posted!

[erinmeri]

Agree with ultrasound so you know what you’re dealing with. I’d also make sure you image adjacent structures. I’ve had one with a torn check that may have coincided with an SDFT injury (or the SDFT happened later). Both healed fine, but we didn’t get good images of the SDFT upon initial imaging, so we’ll never know for sure what exactly happened. We did lots of icing/cold hosing until we could get the vet out.

We did some rounds of shockwave and a slow, steady rehab. Lots of hand walking (Ace is your friend), before eventually progressing to tack walking and a months-long slow return to work.

Good luck!

[beau159]

@J-Lu

My vet was on vacation and comes back into town this week. Her husband (a vet) didn’t think that treatment would change from what I’m doing now and opted to wait for my horse’s vet to come back into town and ultrasound early next week.

Of course, confirm the injury/location with the vet when you get him there.

@J-Lu

Today, we iced for about 6 hours and I let him out to graze on the lawn

Okay, here’s my dumb comment / question : I assume you did 20 minutes ice on, and 20 minutes ice off? Not 6 hours of continuous ice?

@J-Lu

Question: It’s a mild injury as the horse is weight-bearing. Early icing, wrapping and meds. Who has had a similar experience?

My horse had an bad injury of the DDFT above the fetlock. PEMF therapy was instrumental in his full recovery. (and time)

[IPEsq]

Do not ice so much. At this point, icing for up to 20 minutes a couple times a day is fine. Compression standing bandage otherwise during the acute phase. You really can’t say if it’s “mild” or not or what structure is injured without an ultrasound. My horse had a mild (low grade fiber disruption) high DDFT injury and he was on rest 4+ months, then rehab and back almost to full work after about 9 months I think?

[IPEsq]

Adding my horse was grade 1/5 lame in the first days. Progressed to about 2/5 at the worst of it. So definitely no problems being weight bearing. But still a significant injury. He did it running around the pasture. We also didn’t use any NSAIDs (since he was not that off) but treated directly with biologics.

[sorrelfilly721]

I had a very minor superficial digital flexor tendon tear. We are very short on vets out here so it took me a month to get an ultrasound. I handwalked and iced every day until then. After ultrasound, more handwalking and icing and following several rechecks, we progressed to full work. From time of first appointment to full work - seven and a half months.

[J-Lu]

My vet is coming out tomorrow.

I put on ice boots/ice packs for about 6 hours straight initially. Ice boots of various kinds were put on (horse ice boot (only one) and a human wrap that flexible ice pads are inserted into - melts very fast in hot weather and I had multiple ice packs), and they were warm and melted when other boots were applied. It’s been hot here. My friend the vet who is here thought aggressive icing in the first few days would be good, and it looks pretty good today.

@IPEsq, he walks so much better today than last Thursday. We used NSAIDS immediately when it happened to break the inflammation cycle and I’m happy about that.

[J-Lu]

Yikes!

Thanks! I’m so glad that your horse progressed to full work after all of your care.

[IPEsq]

That much ice is not good. It won’t help the injury to do continuous ice and it can irritate the skin.

Quick Guide to Ice Therapy for Horses - Eventing Nation - Three-Day Eventing...

https://aaep.org/issue/cold-therapy-ice-bandages

[sorrelfilly721]

I cried the first day I was able to get back on her.

[beau159]

@J-Lu

I put on ice boots/ice packs for about 6 hours straight initially. Ice boots of various kinds were put on (horse ice boot (only one) and a human wrap that flexible ice pads are inserted into - melts very fast in hot weather and I had multiple ice packs), and they were warm and melted when other boots were applied. It’s been hot here. My friend the vet who is here thought aggressive icing in the first few days would be good, and it looks pretty good today.

That is too long of period with direct ice.

You can do harm by icing too long. You have to give the blood vessels time to “recover” in-between the ice. Cold will constrict them, which reduces swelling and inflammation, but also reduces blood flow.
Blood flow is essential for healing so there needs to be a balance.
And that’s why you want to do 20 minutes ice on, and 20 minutes ice off, if you want to ice for long period. You have to alternate.

I understand your ice melts but then also consider you might indeed be heating up the leg with leaving a warm pack of water on there (essentially).

Things to consider.

[J-Lu]

UPDATE!

My vet came out to ultrasound today.

She thought the aggressive icing and start on meds at the time of injury was great and is a factor in why it looked so good today. She thought he looked good trotting on a hard surface. She sedated him a bit for the ultrasound and could find no obvious damage to tendons and ligaments. She palpated and flexed him and he was negative to everything. The swelling and ultrasound suggest that there is a small tear in the tendon sheath.

We’ll do a total of 2 weeks of daily icing and wrapping, continue on the generic previcoxx, living in his small paddock, and neighbors confined to the adjacent pasture. She’ll recheck him June 16th and, she suspects, will likely clear him for bringing back under saddle.

WHEW!!! Thanks, everyone, for your advice! We dodged a bullet for sure here, and it reminds me of how at anytime, things can go very wrong.

[J-Lu]

UPDATE!!

My vert came out again today to evaluate.

I walked and trotted him for her. There’s a clinic going on at the barn and I had difficulty keeping up with his forward, passagey trot when he got closer to the visiting horses and certainly couldn’t turn him easily to the right and stay to the right of him. I pulled my butt muscle 2 weeks ago and have been dealing with all sorts of compensatory issues since! Ugghh! Palpations revealed markedly reduced swelling (one has to palpate to feel the site of injury), no heat.

I longed him and she said he looked sound and “well that’s an easy 8 trot that he doesn’t have to work for!”. His canter with the injured tendon on the inside was very nice, and he was a dream to longe (he always is, I usually longe without a halter because he goes by voice commands but my vet was nervous because of the activity at the barn today). I was pretty happy that his pent-up self wasn’t itching to run, but I really think the self-grazing gave him a sense of SPACE even though he was only grazing - he is so over the enclosed paddock.

Tomorrow, I’ll ride him mostly at the walk and a little trot, and will ice and self-graze after I ride. I’ll also hand graze him in his pasture. There’s a very interesting clinic going on this long weekend so I’m happy to spend the day out there. Rinse and repeat Sunday and into next week.

I’m so utterly grateful that so far (knock on wood) ;his tendon sheath has healed, he’s not stir-crazy, self-grazes well and was cleared to start a program to bring him back to full work. Of course, I’ll be sure to take things slowly and monitor his progress closely. My vet will be involved at every step.

Oh, how I think the Horse Gods so far!!!

Our guardrails:

1. mostly walk on the rail, some trot on rail but not much. Build on the big figures, see how his tendon responds, ice him for now after each ride and call her if heat, swelling or lameness develops. We’d call in a vet ultrasonographer to re-image.

2. Hand-graze him in his pasture so he’s not thinking he’s “FREEEEEEE!!!” He self-grazes around the property pretty well so I’m thinking he’ll adjust pretty well.

3. BOs horses that have access to his adjacent pasture AND their backyard have been restricted to his adjacent pasture because he gets upset if they are further away. They’ll stay in the adjacent pasture for 5+ days while he’s introduced to his pasture so he’ll remain calm.

THANK YOU all so much for your experiences with tendon and potential tendon injuries. I sincerely hope I will not respond with setbacks and how they are managed. I realize we dodged a bullet, which I know so many other owners didn’t. I had a long talk with a clinic participant whose other horse had a DDFT tear and a very rocky road to what ended up being his state of recovery. I totally realize that so much is just a crap shoot with our large four-legged prey species that we like to sit on the back of and tell them how to move thei r bodies/work with them in how they move their bodies. At the pot-luck tonight, some of us marveled about this.

[J-Lu]

UPDATE! He was sound in our mostly walking and a little trotting under saddle today! Yay! There was a multi-day clinic going on and I rode when it ended, so many friends watched him go and said he looked great.

He was so good, and man, that trot was forward, floaty and he went into medium on the long side. We walked for 20 minutes, maybe trotted for 5 at the most. He needed a bit of a refresher on balance since he’s been mostly confined for 2 weeks, but took it all so well. I think he was happy to be under saddle again. Well, I think he was happy to be back in a familiar routine that includes some “rules?” , “guardrails”? Routine is VERY important to this horse and he tends to get very spooky and tense when he thinks he’s on his own. He’s quirky. He was SO good today.

I put the ice boot on after the ride and let him graze on the lawn and then opened the gate to his pasture and put him in with the ice boot. I thought he’d be less inclined to run with it and would associate being booted with simple grazing. That worked very well, as he was in the pasture for about an hour and never went more than about 30 feet from the gate. He got locked in his paddock overnight. We will rinse and repeat tomorrow. I’ll try to get to the clinic early to watch, ride at lunch, and then stay until the end. I’ll open the gate to his pasture, ride during lunch, and turn him out again with an ice boot into his pasture so I can monitor his actions all day. I’ll lock him into the paddock at night. If all goes well in the next couple of days, I’ll consider opening his paddock to his pasture permanently. I think he is so much happier grazing on grass than eating hay in a confined space. As long as the BOs horses are in the adjacent pasture and blocked from entering their back yard, my horse would have little impetus to run.

So great to report positive news (knock on wood) on a tendon injury thread. Oh horses…oh horses…