Tendon and Ligament Damage

[IH Health]

Tendon & Ligament Injuries

Also known as
Blown tendon, bowed tendon, Desmitis (Suspensory ligament damage), tendonitis

What is it?
Tendon and ligament injuries are just that – damage to the tendons and ligaments within the horses body, most commonly in the legs. Tendons are structures that connect muscles to the bones whilst ligaments connect bone to bone. Ligaments tend to act as ‘shock absorbers’ whilst tendons act as ‘anchoring points’. The degree of lameness in a horse does not specifically relate to the damage caused – sometimes the smallest area of inflammation can signify a seriously damaged tendon or ligament whilst large areas of swelling or hopping lameness can be less serious.

Types
Vets generally place injuries within three catagories – Mild, Moderate or Severe. The more severe the injury, the less promising the prognosis is.

"The tendons and ligaments in the horse's lower leg include:
• the extensor tendon at the front of the leg
• the superficial and deep digital flexor tendons at the back of the leg
• the suspensory ligament which runs between the bones and flexor tendons
• the check ligament, just below the knee
The superficial flexor tendon and suspensory ligament support the fetlock. Damage to other structures such as the check ligament can occur in conjunction with injury of the superficial flexor tendon. Injury to the check ligament tends to result in swelling centred closer to the cannon bone than with an injury to the superficial flexor tendon, which displays the classic "bow" at the back of the leg. Damage to the suspensory ligament can occur in many sites and the clinical signs may vary. Damage that is limited to the proximal (top) part of the ligament may show only subtle lameness with minimal swelling and is common in the sport horse. This condition can be hard to detect, whereas damage lower down the suspensory usually shows more obvious swelling. Injury to the deep digital flexor tendon is unusual but when it does occur it is normally at the level of the fetlock or below, within the tendon sheath. There is a much poorer prognosis with injury to this tendon and, frequently, persistent lameness. " (Ref Horse and Hound)

For an image of the anatomy of the lower leg please click here .

Causes
Trauma, strains and sprains during movement, physical stress, infection and general degradation of the tendon or ligament

Symptoms
• Lameness
• Swelling
• Abnormal gait
• Inactivity
• Heat
• Care should be taken to note above - minimal amounts of swelling or lameness does not necessarily mean there is minimal injury.

Diagnosis
Diagnosis should be by a vet – the first stage is for the vet to move the horse around and palate the affected area so they may get an idea of what has been affected. The injured part may be compared against uninjured parts. Ultrasounds are often used a week after injuries (to allow most swelling to of gone down and optimum viewing to be achieved) and nerve blocks can be utilised to pin point areas of pain. MRI scans can also be used in some cases.

Treatment
Prompt vet treatment is required in tendon and ligament injuries. Ice packs or cold water hosing may be used to reduce immediate swelling and inflammation. Support of the leg through bandaging is also used for a time. Box rest or reduced turn out is also advised in most cases – sometimes lasting months. Bute or a herbal alternative is often advised to keep pain levels to a minimum A long term prognosis is normally difficult to give as each injury is different and there is no way of telling if the horse will respond to treatment. Controversial treatments such as tendon firing and stem cell therapy are considered by some as a cure but should not be entered into lightly. Some people swear by magnetic boots

Websites (click on title for link)
Horse and Hound Tendon and Ligament Injuries Articles
Global Herbs
Degnerative Suspensory Ligament Desmitis (DSLD) Charity
The Farrier and Hoofcase Resource Center
For a list of ligaments and tendons - The Equestrian and Horse

Previous discussions (click on title for link)
I broke my pony – tips for box rest
Magnetic boots – do they work?
Possible pulled tendon
Another tendon injury
My horse has done her check ligament
Ligament operation???
Intermittant lameness
Lameness equals pain - discuss
Anything to help repair ligaments?
Bioscan Light Therapy
Candy’s Torn Ligament
Possible tendon injury – anyone not done box rest?
Zak

+ lots more on the search facility!

Please post below any information you have on this subject or of your experiences in diagnosis/treatment/aftercare. All information given is for reference only and does not constitute or should replace qualified veterinarian advice.

[Sue Palmer]

Desmitis is inflammation of a ligament, which may include the suspensory ligament. My horse currently has annular ligament desmitis, and is on box rest. She had a steroid and hyaluronate injection into the area last week, and is being reassessed by the vet on 2nd Feb to decide where the treatment goes from there. We are looking at a minimum of 3 months box rest apparently, or potentially an operation or retirement. She did it in the field, she was only in occassional walk work, and it was a gradual onset of symptoms (since we only walked out, I may have noticed more earlier if we had been doing more trot work). I will keep you in touch with how she gets on.
Sue

[chrissiew]

Sue, my mare injured her annular ligament and her superficial digital flexor tendon in November 2007, she had 2 months box rest, and 9 months paddock rest and is now just starting canter work.

Its been a long haul, but worth it, her latest scan on Friday couldn't locate the original hole in her SDFT and her annular ligament has gone back to normal size - which my vet initially said was very very unlikely. She was facing retirement in August, mainly due to the SDFT injury, but a bout of shockwave kickstarted the healing.

For the annular ligament I am as convinced as I can be (without proof obviously) that the Bioscan Light Therapy boot I brought in January last year and have used on her leg once or twice a day for 20 minutes has helped the annular ligament inflammation. It is apparently most unusual for them to return to their original size and yet Minnie's has.

I continue to use it daily when possible, as am aware that any inflammation of the annular ligament will cause problems for her SDFT injury.

good luck with your girl - Minnie also did her injury in the field and wasn't that lame in walk, except she had a windgall type lump just above her fetlock.

[Sue Palmer]

Thanks Chrissie - it's good to hear other people's success stories! It's very frustrating, as I have the equipment I need to offer her both laser therapy and magnetic therapy, but because I've moved to Stafford and she's had to stay on box rest in Bucks, I can't get to her to put it on! Am getting a pair of Bioflow boots for her next week though, so at least she'll be able to wear those.
Sue

[chrissiew]

Oh how frustrating for you, but at least you have it to use in the future for her. I also used Bioflows throughout and continue to use them.

Hope your mare makes a good recovery

[Persianhorse]

HI,
Thank YOU IHH , this is a great subject for us all and most for our dearest four leg friends.
What I am saying here is to prevent most damages not for curing them.

This is what I have learned in my life and experienced in time, from my own knowledge it is the most important action we could ever take and so important because all the blame is up on our shoulders as human beings whom rides them and puts more weight on the poor horse.

Horses did not came to life for man to ride and put weight on their back and run them, jump them and ... with the weight of a rider.
To do so (put our weight on them) we have to teach them how to carry us, How to walk with our weight on their back, How to use their Hind (back legs) as the main source of the power.
Horses don't know how to use their Hind (back legs) as the main source of the power.
Horses don't know how to put most of the pressure on their Hind (back legs) we must teach them.
If we do that in the right way then we could prevent most of these damages which are mostly made into front legs.
The only way horses could get to know how to use their back legs as the main source of the power is when they breed in mountainy areas and when a foal comes to life and walk alongside of her/his mother then he/she learns how to use the Hinds (back legs) as he/she walks up hill and down hill and gradually learns how to use them, this is the only way which a horse naturally without the human interfering could learn how to use their Hinds, other than that we are responsible to teach them.

Thank you,
Wish you the best,
PH.

[calamity]

No one here has had the sort of damage my little horse has suffered. He punctured the tendon sheath just playing in a pasture. The would was only a toothpick stab by a sharp twig or similar. It pierced the tendon sheath (foreleg midway between knee and fetlock) Infection got in before lameness was noticed and it was another two days before the vets, two different ones, saw fit to send him to hospital. Luckily he is insured but two operations later and not much hope in sight, this is nearly used up. Damage was caused, not by strain or even injury but by infection. The infection is gone but the gelding is still lame. We are in day 3 after the most recent op to clear adhesions. Vet thought it was more infection but it was adhesions. The infection is gone. The vet continues to prepare me to put the 2 year old down. The tendon damage is minimal. Surely there is some hope for this lovely Quarter Horse.