Tendon Swelling - What Would You Do?

[PrinceSheik325]

So, here’s the situation: bought a new horse, who promptly jumps out of the field and tears around the farm. Two days later, the horse comes in with some minor swelling with a little heat around the tendon sheath (roughly 1/3 of the way between the fetlock and the knee), but no obvious sensitivity on palpation. I cold hose and trot him up. He’s sound, so I handwalk for 20 minutes. Swelling increases slightly. I keep the horse in overnight with a standing wrap. The leg looks about the same, so we handwalk again. Again, the swelling increases slightly. I have the on-call vet out the next day. She agrees there is minor swelling, but he’s perfectly sound on the lunge and passes his flexions with flying colors. I decide to ultrasound just to be sure. The ultrasound shows minor effusion, but no damage whatsoever. The vet recommends bute, one week of stall rest followed by turnout with two weeks of walking under saddle. She consults with my usual vet, who is their lameness expert, and he says he doesn’t think we need to be so conservative and instead recommends turnout with walking under saddle for a week.

I opt to be conservative and keep the horse in for a week with cold hosing and handwalking. On day 2 of stall rest, the leg was back to normal. We are now a week in, and there’s no swelling or heat whatsoever, even after 30 minutes of handwalking. At this point, I am considering turning him out again and then walking under saddle for two weeks. At the end of that period, I’m having the vet come out for chiro anyway, so I’ll ask for another ultrasound before doing anything other than walk under saddle.

The only tendon injuries I’ve ever dealt with have been far worse, so I’m starting to second guess this approach. Are we moving too quickly? Should I keep him on stall rest just to be safe? What do you think? Anyone have experience with this kind of minor swelling with no visible damage?

[Jealoushe]

I always like to err on the side of caution. What’s the rush? Would you rather take some time and have a sound horse, or risk going back to early and then possibly causing a more serious injury?

I like to give a few weeks off any sign of injuries that aren’t just scrapes. Keep in mind that if the horse is uncomfortable this can sometimes lead to favouring the leg and causing issues elsewhere.

While it sounds like it’s not a big deal, maybe just banged the leg, I would still give minimum around 2 weeks off after the swelling is gone and be cold hosing or poulticing for the first week to be sure it’s fine.

As long as your horse isn’t an idiot, I think turn out is fine and probably good for the leg, especially if it happens to be cold and snowy where you are.

[PrinceSheik325]

Thank you! Agreed - I’m in no rush here. I think what’s throwing me off is that the vets seem to think it isn’t a big deal as there was no lameness and no evidence of damage on the ultrasound. The only concern I have about turnout is that he may try to jump out again, but hopefully we can avoid that.

I have been cold hosing every day and treating it with a little Surpass. It’s cold and tight now, which is great. Thinking we may go ahead with turnout perhaps at the end of the week once the weather clears (yes, it’s cold and snowy here!) and then wait to ride. By the time the vet comes back to reultrasound, we’ll be at 3.5 weeks post-injury.

[Renn_aissance]

@PrinceSheik325

Thinking we may go ahead with turnout perhaps at the end of the week once the weather clears (yes, it’s cold and snowy here!)

See, if I have a fat leg, I hope it’s snowy. I turn them out and let them ice it for me.

He won’t be harmed by turnout if you can get him to stay in the field and not be stupid. Stall kept horses turn into kites and get stupid, even if they weren’t stupid before. Even for confirmed soft tissue lesions my vet wants them out (on decent footing and minimal hills.) It minimizes both scar tissue and the horse’s likelihood to perform airs under saddle. So I would hook him up with a buddy, watch him for escalating anxiety, and put him out to hopefully make better choices.

[NancyM]

What actually “heals” tendons, is exercise. Especially if the damage is only minor. “Major” tendon damage needs “some” stall rest, but the key is to get that tendon moving as soon as possible. Because it is the movement that “directs” healing… shows the tendon how strong it needs to be AS IT HEALS. If not enough exercise is started soon enough, the tendon completes healing without being strong enough to hold up to work.
So I’d turn the horse out (especially if there is snow!!!), and leave him out. Don’t put him back into a box stall. Because that “moment of release” from a box stall is exactly the time that a stupid horse will do “too much”, and injure himself in celebration. A dose of acepromazine for that first release from the stall to keep things from getting too crazy.

Trotting is the best mild exercise for tendons that have been injured, and no “sharp” corners. Racehorses rehabbing from tendon injuries often trot beside a lead pony, but less racy horses can usually do the exercise carrying a lightweight well balanced rider, maybe better than on a lunge line, but YMMV.

Tom Ivors (Ivers?) book “The Bowed Tendon Book” is interesting reading on this subject. I don’t take it as gospel, but it’s interesting. It’s an old book now.

[PrinceSheik325]

I agree. We opted for stall rest and handwalking mainly because of the concern he would try to jump out again (and also because it’s been so slick). But, it’s going to be sunny all week here, so I think he’ll be fine with a buddy.

[PrinceSheik325]

Thanks, Nancy! What I’m struggling with is deciding how quickly to add back in exercise and in what amounts. My vets feel that since there’s no evidence of injury on the ultrasound, he can go back into work after two weeks of walking under saddle. I’m thinking I would feel more comfortable with a period of light trotting before getting back into it. What would you do given these facts?

[Critter]

I tend to err on the side of caution with tendon/ligament stuff…unless they are retired pasture puffs (then I might not fuss as long as they are sound).

Case in point - in Nov. my gelding came in from turnout with a missing bell boot, swelling around the pastern on the front leg and a chunk of the opposite hind hoof missing. Now, he tends to swell up like a balloon with even tiny cuts, so I did the usual…and he was sound. After a few days, I still didn’t like the swelling, even though it came down some. Called the vet…she sort of blew me off…but knows me and was willing to come ultrasound anyway.

We ended up finding a tear in the medial branch of the suspensory. So, I am glad I pushed for the diagnostics…as he was 100% sound and everyone was just going “he’s fine just ride him”…including the vet.

So, go with your gut…and an ultrasound is way cheaper in the short term than the long term loss of time and having a more permanent injury to manage.

[joiedevie99]

I tend to double whatever the vet says for soft tissue injuries. If the says one week of rest, they get two.

[PrinceSheik325]

@Critter

So, go with your gut…and an ultrasound is way cheaper in the short term than the long term loss of time and having a more permanent injury to manage.

Agreed. We already did an ultrasound, which showed minor effusion and no damage. I’m planning to have another one done just to be sure in a couple weeks. In the meantime, my vet thinks he could be turned out and under saddle at the walk. I’m struggling with whether to do that or just let him be until the second ultrasound. Either way, I think I’ll do the turnout.

[PrinceSheik325]

@joiedevie99

I tend to double whatever the vet says for soft tissue injuries. If the says one week of rest, they get two.

So, would you do two weeks of stall rest followed by four weeks of walking under saddle here since the vet recommended one week of stall rest and two weeks of walking under saddle? Since the ultrasound shows no damage, I’m wondering whether I’m being a complete hypochondriac!

[Jealoushe]

I would do turn out, and four weeks of walking.

[joiedevie99]

I would probably do one week of stall rest assuming good footing and a sane horse, and four weeks of walking under saddle.

The fact that the ultrasound shows no damage is great - but that doesn’t mean there is no injury. If you have swelling, you have a strain. I’ve had bad experiences pushing through these kinds of things.

[NancyM]

If the ultrasound shows “no damage”, there is no “discernable” damage… the tendon fibers are not torn. They may be bruised, like from a blow, fluid, which is what you are seeing. But if there was “damage” it would show up on the ultrasound. That’s why we “ultrasound” tendons, looking for torn fibers. If the horse is sound, I’d ride it, quietly, trotting. Giving her a “week of rest”, or “stall rest”, or any other perscribed action won’t hurt her, but should not be necessary if there is “no damage” on the scan. It will do “no harm” to rest the horse, though there is no reason to do so.

I had my race mare, who came back from a workout with a “too heavy” (135lb) rider (my fault- but the jock was not available, and we had shipped in from the farm for the workout), with the slightest knot on her tendon the next day. Not lame. Scan showed the smallest amount of tendon damage, the smallest grade of damage on the scale. We missed the next scheduled workouts for the next two weeks, trotting at home instead, then back to the track for a workout 3 weeks later. Came back good, no change, slight knot still there but sound and not sensitive on it. Entered her the next week, she ran third. Entered her again 2 weeks later- win Maiden Allowance. By then, the tendon was flat again… it was gone. No further problems, she raced on with no further tendon problems ever. And that was with actual “damage” present. It doesn’t always go this way, small damage can become larger damage especially with racing. But if “no damage to tendon fibers” is what the ultrasound says, you are OK… it’s just a bruise. To gain this knowledge is the reason why ultrasound is so useful.

[candyappy]

@PrinceSheik325

The only concern I have about turnout is that he may try to jump out again, but hopefully we can avoid that.

I would put him in fencing that is more secure from here on out. What type of fence is he trying to get out of?

[LittleMare]

No recommendations re specific approach for the tendon but would highly recommend trazodone for first week of turnout. It allows them to acclimate in a much more sane way IME.

[PrinceSheik325]

@candyappy

I would put him in fencing that is more secure from here on out. What type of fence is he trying to get out of?

A 4.5 ft high coated wire fence with electric on top.

We are going to switch fields so there’s not an inviting open space in view.

[candyappy]

@PrinceSheik325

A 4.5 ft high coated wire fence with electric on top.

We are going to switch fields so there’s not an inviting open space in view.

He might do better with a more visual, intimidating traditional fence especially after coming off of stall rest.

[PrinceSheik325]

@candyappy

He might do better with a more visual, intimidating traditional fence especially after coming off of stall rest.

I agree, but unfortunately, there are no fields that have 100% board fencing. Some have one or two sides of board fencing, though, so we might try one of those.

[PrinceSheik325]

Thank you, NancyM, for sharing your story! This is so helpful!