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Lameness - Tendon and Ligament Problems

Lameness - Tendon and Ligament Problems

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Published by S. Bala Dahiya
American Association of Equine Practitioners
American Association of Equine Practitioners

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Published by: S. Bala Dahiya on Jul 20, 2014
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07/20/2014

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Healing the Bowed Tendon
by Maria L. Lewis, VMD
When people say a horse is "bowed" or that it has a "bowed tendon" they are generally re!erring to tearing o! the super!iial digital !lexor tendon in the middle o! the annon bone region# This tear auses a ur$ed bow%li&e swelling on the ba& o! the leg between the &nee and the an&le# 'lthough the swelling is usually in the middle o! the annon bone it may be behind the &nee at the le$el o! the an&le or it may extend !rom the &nee to the pastern# ost people thin& tendon inuries suh as "bowed tendons" only happen to raehorses# *n reality any breed or type o! horse per!orming almost any ati$ity an be at ris& !or tendon inury# Tendon inuries an be more serious than some types o! !ratures beause the tendon heals $ery slowly and replaes torn tendon !ibers with !ibrous sar tissue# The healed tendon is less elasti lea$ing the tendon $ulnerable to re%inury# When there is a signi!iant inury the horse may not be able to return to its pre$ious le$el o! per!ormane due to persistent wea&ness o! the tendon# The super!iial digital !lexor tendon is made o! protein !ibers that are arranged longitudinally!orming a long attahment between the musle abo$e the &nee and the long and short pastern bones ust abo$e the hoo!# The tendon !ibers are somewhat elasti but will tear i! strethed or loaded beyond their limits# *mproper positioning o! the leg in relation to the horse+s body weight an tear the tendon !ibers# This on!iguration may our when the horse lands a!ter a !ene or as the horse beomes tired and hanges its gait# 'ny unbalaned loading o! the tendon une$en !ooting poor on!ormation and,or improper shoeing an also ontribute to tendon damage# *n some ases this o$erload an be the result o! a single misstep and in other ases it an be the result o! umulati$e stress or !atigue o! the !ibers# -ne the tendon !ibers tear bleeding within the tendon auses aute swelling heat and pain# The horse may or may not exhibit lameness# *n !at many horses with serious tendon damage are ne$er lame# Swelling also ours around the tendon due to an aumulation o! !luid (edema)# *n the short term ie or old hosing and bandaging the leg should derease the loal in!lammation and swelling# The horse should be on!ined to its stall with only hand wal&ing exerise# *! the horse is sore or signi!iant swelling is present onsider spea&ing to a $eterinarian about using oral phenylbuta.one !or a short period o! time to derease the swelling and disom!ort# Sine palpation o! the leg is not a reliable method o! determining the presene o! tendon damage ontat a $eterinarian to ma&e arrangements !or an ultrasonographi e$aluation o! the swelling# /ltrasonography allows a $eterinarian to e$aluate the integrity o! the tendon !ibers as well as other important parameters inluding the ross%setional area o! the tendon the alignment o! its !ibers and its ehogeniity# The ehogeniity o! the tendon is related to its density# The0 normal tendon appears bright white or ehogeni and the abnormal tendon appears $arious shades o! gray (hypoehoi) or bla& (anehoi)# Based on the ultrasonographi !indings a $eterinarian anon!irm the presene o! tendon damage and determine its se$erity# Subtle tendon damage may display an inrease in the tendon ross%setional area due to edema without atual !iber tearing# Serious damage may onsist o! total tendon rupture with omplete loss o! the tendon !ibers a mar&ed inrease in tendon ross%setional area and loss o! support in the limb# ost tendon inuries !all somewhere in between with a disrete area o! !iber tearing $isible on the ultrasound image (bla& or dar& gray hole) and enlargement o! the total tendon ross%setional area# The hole seen on the ultrasound is atually an aumulation o! blood and granulation tissue within thetendon where the tendon !ibers ha$e torn apart# *! your horse has su!!ered a tendon inury a $eterinarian will wor& with you to de$elop a rehabilitation plan# ost horses need stall rest with restrited exerise !or at least two months
 
(possibly up to eight months) depending on the degree o! inury and the horse+s temperament# This on!inement oupled with a ontrolled exerise program will enourage healing o! the tendon while pre$enting re%inury# *nitially the horse should only be wal&ed in hand# -ne the tendon has been ooled out old hosing is no longer neessary or help!ul# Topial appliation o! DS- may help derease residual swelling in the leg but the tendon will remain persistently thi&ened in the maority o! ases#  ' $eterinarian will need to ultrasound the horse+s leg approximately e$ery sixty days a!ter the initial exam to determine i! the tendon has healed enough to allow !or an inrease in exerise# 'n inrease in exerise may entail up to !i$e minutes o! ogging exerise or turnout in a small paddo&# This exerise will gradually inrease o$er a period o! months1 depending on the impro$ements seen during the !ollow%up ultrasound exams# Tendon rehabilitation is a slow proess that an be !rustrating i! your horse su!!ers any setba&s due to re%inury# onitoring the horse+s progress with regular ultrasounds an eliminate these setba&s# 2eent researh in $eterinary mediine has !oused on ways o! impro$ing the outome o! tendon inuries# Surgial treatments that inlude tendon splitting and superior he& ligament desmotomyha$e been !ound use!ul# -ther treatment modalities suh as therapeuti ultrasound low%power laser aupunture hydrotherapy and eletromagnets are also thought to promote tendon healing# *n some ases the use o! intralesional mediation suh as '34LL may be bene!iial in impro$ing the 5uality o! tendon repair# ' $eterinarian an help hoose the best treatment !or eah indi$idual horse#  'lthough tendon inuries are serious most horses an reo$er and return to athleti !untion i! gi$en enough time# 4$en in the ase o! a se$ere tear it is li&ely that a horse will be able to return to a less strenuous ati$ity# The best way to ensure a suess!ul outome is through prompt ultrasonographi diagnosis treatment and are!ul monitoring o! the tendon by a $eterinarian# Dr# Lewis a 6776 /ni$ersity o! Pennsyl$ania Shool o! 8eterinary ediine graduate is urrently in pri$ate pratie limited to e5uine diagnosti ultrasound in /nion$ille P'# She trained in diagnosti ultrasonography with Dr# 8irginia 2ee! at 9ew Bolton 3enter !or se$eral years1 and ser$ed as an *maging Speialist at the 677: 'tlanta -lympi ;ames and at the 6777 Pan  'merian ;ames in Winnipeg# 3opyright < 677:%=>>= 'merian 'ssoiation o! 45uine Pratitioners# 'll rights reser$ed#  'merian 'ssoiation o! 45uine Pratitioners ?>@A *ron Wor&s Par&way  Lexington C ?>A66 PhoneE FA7%=GG%>6?@  axE FA7%=GG%67:F e%mailE aaepo!!ieIaaep#org 9-T*34E The 'merian 'ssoiation o! 45uine Pratitioners (''4P) is the opyright owner o! all in!ormation ontained herein# 'lthough the ''4P pro$ides this in!ormation to anyone the ''4P retains the opyright !or all text and graphi images# This means that you 3'99-T distribute the text or graphis to others without the express written permission o! the ''4P1 JmirrorK or otherwise inlude the text or graphis on your own ser$er or douments without our permission1 or otherwise modi!y and,or re%use the text or graphis on this system# ou ' print opies o! thein!ormation !or your own personal use store the !iles on your personal omputer !or your personaluse only and re!erene hypertext douments on this ser$er in your own douments#

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