What to do now. ...3 month bowed tendon

[SquishTheBunny]

Acquired a lovely track horse last month. He had bowed his tendon in early may. No ultrasound was done but was treated at the track with afternoon poultice and Bute.

4 weeks ago I got him, transitioned him off Buteand switched him to EOD previcox and started wrapping leg with equitite instead of poultice. He has been sound at the walk and is 9n stall rest with short hand walks.

Ultrasound was just done and confirmed it was the Superficial digital flexor tendon and there is no obvious tear but still inflammation. Vet has recommended another 8 weeks rest then reassess.

He suggested just using a leg tighter (like equitite) and no wrapping or antiinflammatories. I’m a bit concerned since the swelling has become really pronounced with no leg wraps (still.comfortable ).

At what point do you stop wrapping?

Also, since there is no way this horse can rehab under saddle and he goes absolutely bananas with longer handwalking, what are some suggestions to keep the tendon from developing adhesions? He gets ace for his walks but is definitely becoming immune to it!

Also since there is still swelling if not wrapped (but no lameness!) Would previcox still be indicated?

[Twigster]

Since the name of the game is calm and quiet, I just did what was necessary to get that from my horse when I rehabbed the bowed tendon that ended his racing career last summer. He was stalled at night and wrapped, and then turned out in a small paddock with calm friends over the fence. The vet wanted to check back more often than if we had stuck to stall rest, but it kept us all more sane, and the rehab went swimmingly. YMMV of course.

[IPEsq]

Increase in swelling when you take the wrap off is normal. It will get big as it adjusts to not being under compression and then will go down after time. If there is no tear still visible, you probably don’t need to wrap.

It will probably still heal ok without walking. If he can’t walk without going crazy, no need to walk until inflammation is gone.

I don’t think giving NSAIDs is worth it either right now. If you want to target the inflammation directly, you could do PRP or IRAP in the tendon sheath. Or not and just keep waiting.

[arabiansrock]

If you can find a vet with a cold laser (a GOOD one), that may be very helpful. We have a mare at our barn whose bow was not healing at all until her owner switched vets and new vet started cold lasering it, and within a month there was significant healing.

[NancyM]

Read Tom Ivors “Bowed Tendon Book”. It’s not a new book now, but has some interesting key issues regarding bringing a bowed horse sound and strong again. Don’t wait too long to take the plunge and get exercising the horse. Exercise while healing is the key to driving healing to completion and full strength. Careful exercise. It’s scary, the first time you do it. But it does work. Good luck, an injury like this usually heals up FINE for a non racing future for the horse (and sometimes even for racing again too). Standing in a stall for too long can be counterproductive to healing.

[Canterwell]

I second Tom Ivors’ book. Lots of wisdom there, and he explains well the importance of hand walking on a hard surface as soon as possible to help the tendon fibers remodel and straighten as they heal.

I successfully rehabbed a front DDFT lesion and must have hand walked a hundred miles! I walked my horse twice a day starting 10 minutes each session, and working up to 45 minutes.

My vet did not recommend turn out until I was riding my horse, and able to trot sound under saddle. That way, the tendon was healed enough to weather whatever high jinks occurred in turn out.

[gumtree]

There are numerous books, schools of thoughts on the subject. A number of which I have tried. None of which made any difference with the end result than that what I was taught as a kid.

Depending on the ultrasound report 4-8 weeks stall. Ice/hose and Butte or Banamine (Flunixin) the day it happened and for several days after. What ever the vet suggests. It is important to nip the swelling and reduce as much as possible as quickly as possible to avoid anymore damage.

The leg will be quite large for weeks to months. In almost cases depending on the size of the tear or “pull” the leg will never look “good as new” to the knowledgeable eye. In most cases even a un-knowledgeable eye.

There are some procedures that are, can be somewhat beneficial IME, tendon splitting seems to give a better quality of healing on some horses. PRP promotes better healing, less scaring in some horses.

There is another procedure, the name escapes me, that is done shortly after the injury that basically goes in and reduces, draws out the accumulating blood fluids. This is done more for end result “cosmetic look” than adding to the quality of the healing.

There is laser, ultrasound not the imaging type, one that can be rented, shock=wave, etc. IME none made much if any difference in the end. Personally I find a mild blister is beneficial and so do a number of sports vets that I have worked with over the years.

I rarely wrap and after stall rest the horse is kicked out into the paddock/field with others and lives out 24-7 for at least 9-12 months before I put a saddle back on them and start legging up. Some go back to racing most become sport/pleasure horses. The tendon rarely if ever bothers them again.

As I said above depending on the size/nature of the injury regardless by and large of how one goes about re=habing. The tendon will always be on the large side of things for the rest of the horses’s life.

One of these days I will take a picture of a filly/mare we have that double bowed 2 years ago, (both front legs), 75% tear in one, 50% in the other. Her tendons are large but not ugly and she is perfectly sound. Have several others also. All sound as the dollar.

I am not telling, saying how one should go about it. Just sharing my experiences with lot of different horses. All TBs.

[Manni01]

[QUOTE=gumtree;8760693]
There are numerous books, schools of thoughts on the subject. A number of which I have tried. None of which made any difference with the end result than that what I was taught as a kid.

Depending on the ultrasound report 4-8 weeks stall. Ice/hose and Butte or Banamine (Flunixin) the day it happened and for several days after. What ever the vet suggests. It is important to nip the swelling and reduce as much as possible as quickly as possible to avoid anymore damage.

The leg will be quite large for weeks to months. In almost cases depending on the size of the tear or “pull” the leg will never look “good as new” to the knowledgeable eye. In most cases even a un-knowledgeable eye.

There are some procedures that are, can be somewhat beneficial IME, tendon splitting seems to give a better quality of healing on some horses. PRP promotes better healing, less scaring in some horses.

There is another procedure, the name escapes me, that is done shortly after the injury that basically goes in and reduces, draws out the accumulating blood fluids. This is done more for end result “cosmetic look” than adding to the quality of the healing.

There is laser, ultrasound not the imaging type, one that can be rented, shock=wave, etc. IME none made much if any difference in the end. Personally I find a mild blister is beneficial and so do a number of sports vets that I have worked with over the years.

I rarely wrap and after stall rest the horse is kicked out into the paddock/field with others and lives out 24-7 for at least 9-12 months before I put a saddle back on them and start legging up. Some go back to racing most become sport/pleasure horses. The tendon rarely if ever bothers them again.

As I said above depending on the size/nature of the injury regardless by and large of how one goes about re=habing. The tendon will always be on the large side of things for the rest of the horses’s life.

One of these days I will take a picture of a filly/mare we have that double bowed 2 years ago, (both front legs), 75% tear in one, 50% in the other. Her tendons are large but not ugly and she is perfectly sound. Have several others also. All sound as the dollar.

I am not telling, saying how one should go about it. Just sharing my experiences with lot of different horses. All TBs.[/QUOTE]

The bold paragraph THIS!!!

[jawa]

Not the same injury, but mine 14’2" gelding strained both front suspensories, one worse than the other. He was wrapped for some time and then he was "weaned "off of the wraps. 4-6 hours unwrapped, then longer as the days progressed. This was most likely to keep me “happy”, not because it was absolutely necessary.

OTTB gelding was trying to keep up with now healed aforementioned pony (not successful) and strained his deep digital. Stall rest and wrapping and then weaned off wraps.

They do become conditioned to the wrapping to keep everything tight, so once they come off it can take a bit to come back.

I’d look into a long acting sedative to keep him sane so you can safely do the hand walking.

[SquishTheBunny]

I can’t wait to put him out 24/7. It’s been not quite 3 months of stall rest yet. I CAN NOT ride him. He is a race horse who is already insane with a ton of ace on board so turnout is probably safer lol!

[NancyM]

What I don’t understand about your original post is that you report that the US scan showed “no tear”, just inflammation? If no tear, why such a long stall rest already? No tear = no bow, and very little actual damage done. Large tears, like Gumtree describes, take longer to heal enough to turn out or restart exercise, but “no tear” is a completely different situation… much quicker to heal and get back into work. Are you sure that you are not blistering this leg or bandage bowing (bruising) with all the bandaging, and that swelling is what you are seeing?

When a trainer receives a scan that there is “no tear”, he heaves a sigh of relief that it is NOT a bow, gives the horse a bit of time off in a paddock, and exercise starts again soon… within a week or so. Because there is no actual tendon damage, fraying, tearing in the fibers. If there WAS a tear originally, and no tear is now showing on US 3 months later, why is this horse still on stall rest? With a horse who is bent on self destruction, getting him OFF stall rest and relaxed in turn out tends to be safer for him than keeping him cooped up. IMO. Putting him outdoors, and leaving him there (not putting him into a stall at night, and turning him out again in the AM) avoids the celebration time of “being turned out” and tends to keep them quieter.

[jetsmom]

Drugs are your friend. Maybe reserpine?
I agree that staying out 24/7 with lots of free choice hay and quiet neighbors can eliminate the running and “I’m FREE” playing. Just make sure he has a quiet neighbor out all the time too. If you rotate his neighbor the neighbor may run upon turnout and get him riled up. You need very quiet neighbors.

[Rooty]

My horse had a tendon strain awhile ago - he was on stall rest for 3 months. Banamine for the first week, but no NSAIDs after that. Ice as much as possible and hand-walking starting at 5 minutes a day once the acute inflammation was under control. Hand grazing was also allowed. Turnout in a small, ie close to stall-sized paddock was also allowed but at that time was a mythical creature… Add 5 minutes a week up to 20 minutes hand-walking providing there was no increase to inflammation. He was never lame on it, even when he first injured it.
Interestingly, my GP vet recommended wrapping, while the lower leg lameness specialist racehorse vet we saw 6 months later for a check ligament injury did not. He said it doesn’t help and that the horse would be more likely to get a bandage bow or do himself some other type of harm from the bandage than receive any benefit from it. As my horse was pulling on the bandage I stopped wrapping.
Luckily even though my guy is used to all day turnout he is the type of horse who is content by nature and he adapted to the stall rest easily - good thing as between the 2 injuries he was only out for 6 weeks in an 18 month period.
Definitely we made liberal use of Atravet for out of stall activities. By the end of the check ligament recovery he was getting resistant to it and we thought for turnout we might have to switch to Dermosedan but lo and behold the small paddock appeared and we were able to do readjust him to turnout with Atravet only.
I agree with keeping yourself safe, but you need to find a way to avoid explosions when first turning out. I was lucky with my guy that as long as I rode outside the Atravet was enough as long as nothing happened to set him off. Forget the arena, so I was out riding in the driveway in snowstorms in March and April. Then once the small paddock arrived I was able to reduce the drugs.

[csaper58]

[QUOTE=SquishTheBunny;8761036]
I can’t wait to put him out 24/7. It’s been not quite 3 months of stall rest yet. I CAN NOT ride him. He is a race horse who is already insane with a ton of ace on board so turnout is probably safer lol![/QUOTE]

Can you, or someone else, on a large, calm horse… lead/pony the injured one?

Can you haul to a walking wheel?

[Rooty]

Good thought - he is OTTB so he would be familiar with this.

[SquishTheBunny]

[QUOTE=NancyM;8761602]
What I don’t understand about your original post is that you report that the US scan showed “no tear”, just inflammation? If no tear, why such a long stall rest already? No tear = no bow, and very little actual damage done. Large tears, like Gumtree describes, take longer to heal enough to turn out or restart exercise, but “no tear” is a completely different situation… much quicker to heal and get back into work. Are you sure that you are not blistering this leg or bandage bowing (bruising) with all the bandaging, and that swelling is what you are seeing?

Also edited to add, the trainer at the track never had an original ultrasound done so we had nothing to compare it to…don’t know if there is healing of a lesion or if it was always a really bad sprain. He is sore on that leg after he had a bit of a bucking spree after getting lose from me on a handwalk, but has otherwise looked sound at the walk.

When a trainer receives a scan that there is “no tear”, he heaves a sigh of relief that it is NOT a bow, gives the horse a bit of time off in a paddock, and exercise starts again soon… within a week or so. Because there is no actual tendon damage, fraying, tearing in the fibers. If there WAS a tear originally, and no tear is now showing on US 3 months later, why is this horse still on stall rest? With a horse who is bent on self destruction, getting him OFF stall rest and relaxed in turn out tends to be safer for him than keeping him cooped up. IMO. Putting him outdoors, and leaving him there (not putting him into a stall at night, and turning him out again in the AM) avoids the celebration time of “being turned out” and tends to keep them quieter.[/QUOTE]

Vet said he couldn’t find an obvious tear but he was tender on the superficial digital flexor tendon and and there was an awful lot of swelling (black and white mottled look to the tendon). He also said it was a classic low bow - sp I guess now I’m confused. He said another 8 weeks stall rest then reultrasound. If there’s no tear, but a ton of tendon inflammation, that means there ok for turnout??

[SquishTheBunny]

[QUOTE=csaper58;8763518]
Can you, or someone else, on a large, calm horse… lead/pony the injured one?

Can you haul to a walking wheel?[/QUOTE]

I’d love to try this - he is very aggressive towards my quiet older horse though. the one time I had him sedated with ace and dermosedan he still came flying backwards at him kicking. I think he needs some alone turnout time before being able to go with another horse…don’t want the older guy getting injured.

[SquishTheBunny]

And just got a call that ace is on back order hope to try reserpine and may have some expired ace kicking around!

Weating him off wraps - unwrapped during the day and he seemed to be ok. Some fill in the leg but nothing crazy.

I just can’t wait to get him out - some say just toss him out - but we’re this far in and I really don’t want to have to start back at day 1. He is explosive, bucking in his stall and going bazerk when I come see him…when he’s alone I believe he’s fairly quiet.

Even if it is a tear that has healed, I had thought it was minimum 6 months stall rest before going out - more like 9-12 months? Please someone tell me 6 months is more than enough lol.

[IPEsq]

Sounds like fiber disruption but no tear, so a low grade bow. My horse had that of the DDFT and was on rest 4 months. 1/2 day on 1/2 day off with bandages isn’t really doing you any good. At this point I’d stop bandaging. Put on something for walks to help protect against any interference or bangs if he has a moment if you want.

My vet won’t prescribe reserpine but does Prozac often. It did help my guy keep from being too self destructive although he wasn’t exactly quiet. Some horses have a better response in that regard but I do think it helped keep my guy from endlessly winding himself up.

[NancyM]

[QUOTE=SquishTheBunny;8765580]
Vet said he couldn’t find an obvious tear but he was tender on the superficial digital flexor tendon and and there was an awful lot of swelling (black and white mottled look to the tendon). He also said it was a classic low bow - sp I guess now I’m confused. He said another 8 weeks stall rest then reultrasound. If there’s no tear, but a ton of tendon inflammation, that means there ok for turnout??[/QUOTE]

I know of horses with a small tear who continue training and RACING ON IT, while fresh, who heal without any time off at all. A scary thought, for sure, but I’ve seen it. While most race trainers consider a “small bowed tendon” like being “a little bit pregnant”, there are those and there are times when someone takes a chance (by NOT resting the horse), and it pays off (it heals while still in training and in competition, rather than getting worse). My point is, there is no hard and fast RULE that works every time. A chance is always necessary, at some point, to turn the horse out, or to end stall rest and go back into rehab or training. Appropriate training. Read the Tom Ivors “Bowed Tendon Book”. It encourages physical exercise long before the regimen you are following does. To back this theory up, hospitals for humans also get patients out of bed the day after many surgeries, to start to walk the halls in the hospital. Human medicine has found that movement is necessary to stimulate healing and avoid negative cascade effects of inactivity, that staying in bed is counter productive.

Confusion reigns supreme. There is no right and wrong. What’s good is what works. Everyone has an opinion, and not all are wrong. Your vet has a theory. Tom Ivor’s theory and practice has had success, in bringing bowed horses back to racing sound. The theory is basically that the injured tissue needs to experience an approximation of what WILL BE necessary in terms of strength WHILE IT IS HEALING, to heal to that strength that will be necessary for long term soundness. If left to heal while standing still, THAT is how strong it will be when healed… sound enough to stand still on. If you want to do more than standing still, then it won’t be strong enough. Same theory with bucked shins actually, and bone densification. That full and enforced rest is counterproductive. If your horse is sound enough to move, he should move. Atravet is useful with the first few days of turn out or exercise, because your horse is already crazy due to the stall rest that he has already endured. The avoidance of cascade effect problems is VERY important in dealing with all injuries. Risk is unavoidable. Choose the risks you wish to assume, what you feel best with, and go with that. If that is keeping the horse in a stall for six months, go with that. But don’t think that that is EVERYONE’s choice, and know that there are risks involved with that choice too.

Did this horse ever have a pocket of filling under the pastern? When the tendon issue is severe, this pocket of filling will be evident, fluid dropped down from the injury collects there. For serious bows, large tears, the pain will keep the horse still, quiet, looking after itself until such a time when motion is less painful, and at that point, motion is a good thing (IMO). If your horse has intelligence, he will choose to do the right amount of activity. If he is a stupid horse, he may do too much and make it worse. Darwin’s theory in action.

Good luck.