aid =102457 All you need to know about windgalls

Dr Sue Dyson FRCVS Many horses will suffer from windgalls at some point in their lives. But why do they occur and are they a cause for concern? The word "windgall" is used to describe either an enlargement of the fetlock joint capsule, a socalled articular windgall, or of the digital flexor tendon sheath, the more common non-articular windgall. Many apparently normal horses in full work have slight windgalls due to digital flexor tendon sheath swelling, especially in the hindlimbs. The amount of swelling may vary according to the environmental temperature, being less obvious in cold weather and frequently far more filled in hot weather. The degree of distension may also be influenced by exercise. Work often results in some reduction in swelling, whereas stable rest may result in accumulation of fluid and greater swelling, which is often queried if the horse is being vetted for purchase. Usually these swellings are similar in size between pairs of limbs, and symmetrical swellings are no undue cause for concern. These swellings in clinically normal horses are usually readily compressible and the fluid can be moved between different outpouchings of the tendon sheath. For example, if the top part of the tendon sheath is compressed by finger pressure, then increased bulging will be seen on the back of the pastern. To some extent, the size of the windgalls can be controlled by the application of snug stable bandages, but daily use of stable bandages often results in ridges in the hair coat, a tell-tale sign of regular bandaging.

The presence of a tear in the tendon is likely to result in recurrent distension of the tendon sheath. Small tears on the margin of a tendon may be invisible. Consideration can also be given to cutting the palmar annular ligament to relive pressure on the digital flexor tendon sheath. seen as a windgall. thick pressure bandage and restrict the horse to box rest. If short tears are identified. Confusion arises because similar signs can be seen in association with damage to the superficial or deep digital flexor tendons. There is localised heat and the horse may resent passive manipulation of the fetlock. The tendon sheath may feel very hard because it is being stretched by the amount of fluid within it. the prognosis should be favourable. I expect to see very considerable improvement within a week. for example. Injection of high molecular weight hyaluronan into the tendon sheath may help to normalise its own production. . potent anti-inflammatory drugs. since the onset of lameness coincides with the development of swelling. can be inserted into the tendon sheath so that the external surfaces of the tendons can be inspected and probed to identify damage. This can be sudden in onset as a result of overstretch of the tendon sheath because of a mis-step. which are inside this tendon sheath.Windgall worries Inflammation of the lining membrane of the digital flexor tendon sheath will result in increased production of synovial fluid and therefore swelling. and with a slow resumption of controlled exercise. but the presence of long or deep tears warrants a more guarded outlook. I believe recurrence of lameness merits surgical intervention. An arthroscope. The quality of hyaluronan decreases with inflammation. It usually results in the sudden onset of lameness. Diagnosis is usually obvious. I generally recommend treatment of the tendon sheath with a combination of corticosteroids. It is therefore prudent for a vet to check the tendons carefully using an ultrasound scan. If no abnormality of the flexor tendons is found. Tendon tears Even with high-quality ultrasound scans. the horse getting a leg trapped over a fence. or as a result of blunt trauma. and associated lameness when work is resumed. a telescope-like instrument. the horse may have a reasonable prognosis for return to athletic function. Damage to the tendons on the back of the fetlock at the level of the ergot will be missed because the ergot gets in the way of an accurate scan. Hyaluronan is a normal constituent of synovial fluid and helps with lubrication of the tendons. it is not always possible to detect all tendon injuries. and hyaluronan. If there is no primary tendon injury. I also apply a very firm. Torn fibres can be surgically removed. This is called tenosynovitis and is very common.

acute tenosynovitis is associated with strain injuries to either the superficial digital flexor tendon or the deep digital flexor tendon that can be detected using an ultrasound scan. the prognosis for large lesions is much more guarded. Tendon tears are not usually suitable for treatment with stem cell therapy because there is no normal tissue around the tear to keep the stem cells within the damaged tissue. These require surgical treatment. Such lesions are easily missed when performing an ultrasound scan unless the scanner is moved round from the back towards the side of the limb. constricting the tendon sheath. surgical treatment may be required. y This veterinary feature was first published in Horse & Hound. alternatively. The ligament becomes swollen and painful. Injuries of the superficial digital flexor tendon occur most commonly in show jumping horses where the tendon is widest and thinnest and usually involve the margin of the tendon on the outside or inside. This may result in the development of a convex swelling on the back of the fetlock centred over the ligament. Annular ligament damage The main annular ligament itself can be injured by overextension of the fetlock. but often respond less well. the sheath may be injured at the same time. These may be candidates for treatment with stem cell therapy. Related articles: . Such cases also usually need surgical treatment. with long-term resolution of lameness. The swelling and pressure on the tendon sheath may cause secondary inflammation of the sheath. with most horses being able to return to full athletic function. Dressage horses seem particularly at risk. With severe injury. Although small core injuries may heal spontaneously. These injuries occur much more commonly in forelimbs and usually respond well to rest. focal ultrasound therapy and rest may resolve the problem.Tendon damage In some horses. But if marked enlargement of the ligament persists. Deep digital flexor tendon injuries occur in horses from all disciplines and affect both hindlimbs and forelimbs. Central core injuries range from small focal injuries within a normally sized tendon to large injuries associated with enlargement of the tendon. or. a reaction beneath the skin can cause the development of a layer of fibrous tissue between the skin and the palmar annular ligament. but often respond rather poorly. Treatment such as anti-inflammatories.

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