Tendon Sheath Infections - Update :)

[Nevada10]

Long story short, a horse got a wound just below his hock. We initially had the horse on doxy, but the infection persisted. Wound was debrided, xrayed, ultrasounded, and cultured and 3 bacteria were found; vet added metronidazole. wound showed some healing but I started seeing white “fluffy” stuff in the wound (vet determined it was tendon sheath sloughing off). Switched to enrofloxacin and metronidazole… no change… horse went 3 legged lame 3 weeks into treatment with suspected tendon sheath infection. Switched to penicillin, gentamiacin and metronidazole. Tendon was flushed and 3 regional limb perfusions were performed. Horse seems to have good days and bad days…

Just wondering how your experiences with tendon sheath infections have gone and what was the outcome? 3 vets have been involved in treating this horse and all have given the horse a very poor prognosis (though the are shocked that he is walking comfortably on his good days, even before his breakfast Banamine… other days he’s 3 legged lame).

[kiwichick]

Not good that its gone on this long.
ive not had one, but known one or 2, and the prognosis is bad enough that the words ‘tendon sheath infection’ get my attention.

Can you take the horse to a specialist?

Horses (and people) defy the odds all the time, so my fingers are certainly crossed for you

[kcmel]

This happened to my horse and we finally had to have the vet out daily for IV antibiotics. You could have them put in the shunt (or whatever it’s called) in so that you could do it yourself. My outcome was not good–my horse injured himself in his stall and had to be euthanized.

But an acquaintance’s horse had this, and he recovered fairly quickly. I don’t know what the treatment was.

[somanyhorses]

I know more about tendon sheath infections than I’d like to, because I went through this with my then yearling last year. I did a lot of research and posted here, if you’d like to read the thread: https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/9899464-tendon-sheath-infection

My horse is now 2 and seems to be totally sound and the swelling is all but gone, however it has taken a full year for the swelling to go, and it hasn’t been ultrasounded since. I will have it scanned before breaking him in, 12 months from now.

Two of my friends have recently lost horses to tendon sheath infections. One after a 3 month battle, after which the infection was controlled however the damage left behind meant a life time of pain. In her poor horse’s instance, there were extensive adhesions, damage to the tendon, and damage to the joint cause by the infection. The other was euthanised a week post surgery as the skin on the horse’s leg started sloughing away under bandages, the tendon became exposed and was about to snap.

Your first challenge is eliminating the infection. Have vets recently drawn samples of fluid to check this? The next challenge is assessing the damage the infection has caused. As yours, like mine, is a hind leg this is a good thing as they cope better with hind leg issues and there are less risks of supporting leg laminitis.

My research and personal experience did tell me that tendon sheath infection healing is a roller coaster, but your horse’s extremes are, well, extreme, ie comfortable some days and 3 legged on others. Is the wound still draining? My friend who’s horse was euthanised 3 months post surgery found her horse was more comfortable when the wound was draining, but once it sealed up it was extremely painful. Another factor that can cause the ups and downs in comfort levels is adhesions, these are very painful as they inhibit the gliding of the tendon in the sheath, however, sometimes they can break loose (a good thing).

I would suggest discussing with vets ultrasounding it at this point to get an idea of what’s going on in there, and sending a fluid sample away to ensure the infection is under control.

I mentioned in my thread that PEMF therapy seemed to work wonders with my guy, reducing swelling, and improving movement and pain levels.

I am sorry you are going through this and hope it is a good outcome. Tendon sheath infections are more serious than joint infections - I count myself extremely lucky to have a horse that’s survived one, and that will hopefully be sound enough for a performance career. Keep us posted.

[Bluey]

The problem with those injuries is the pain level some times is hard to control reliably.
How much do we want to have a horse suffer hoping he may get better?

Long ago we hauled a new horse home and, since we had a vet check for him next morning, we didn’t bring him all the way home, but left him closer to town.
As we went by to pick him up next morning, he was very lame.
Someone had just seen him and he was fine a bit earlier.
He had now a puncture wound right above his ankle, right into the tendon.
We never could find where he did that, will always be a mistery.

Once at the vet clinic, they went to work right away on that.
The vets gave it a cautious prognosis, saying those injuries could go either way.
They consulted with TX A+M vets, installed a protocol of testing and perfusion of the leg, decided what antibiotics to try, etc.
Nothing seemed to work and, after five weeks of fighting that and considering the intense pain the horse was in, they had to euthanized him.

Today they have so much better medications, maybe they can save more horses than they could then.
Those injuries are very serious, sorry we can’t be more encouraging.

[NancyM]

I got lucky with mine. Horse ran through a barbed wire fence (shearing a post off at ground level), laid open his shoulder. Superficial, but needed stitching. 30 stitches went in from a local vet (small animal vet). But I had seen the bubbles coming from the extensor tendon (a barb going straight into the tendon, and out again- a puncture) before loading him to take him to the vet and bandaged it, and started bute and penicillin. Pointed it out to the vet who was stitching the shoulder, and asked if that was tendon fluid. " Yes". Was then told that it was unlikely that the horse would recover from this without going to a clinic. (There really isn’t a clinic nearby). I took him home and called my previous equine specific vet, 5 hours away, who told me that it would be OK, and to treat the horse myself, bute and penicillin, and sweat it to draw. Which I did. Healed up fine. Slight scar tissue on the tendon sheath left a small bump there. He was sound throughout.

[Nevada10]

I wanted to post an update… we had an appointment to euthanize the horse about a month ago, but was having a good day so we postponed… he was up and down for about a week after that, but has been doing great ever since. Back on full turn out, off all meds, totally sound at the walk, pretty sound at the trot, and gallops around like nothing ever happened. All of the vets to worked on him are shocked. The wound is still healing (it got a little proud flesh, which delayed things, but that’s been taken care of now). I’m still cautiously optimistic, but things are looking really good for him, and I’m so glad I trusted my gut and didn’t euthanize him!!

[quietann]

It’s nice to see such a great update!

[Skeezix]

Glad to hear the great update.