Lameness case 4

Case Overview

  • Patient: 6-year-old Thoroughbred mare named Poor Investment

  • Situation: Called to assess after racing 2 hours ago on soft ground

  • Concern: Groom suspects injury due to poor performance

  • History: 15 previous races with 3 wins, previously no injuries

Initial Clinical Examination

  • Observation: Obvious swelling on the palmar aspect of the right front metacarpus

  • Findings upon palpation:

    • Diffuse oedematous swelling over tendons/ligaments

    • Area warmer than contralateral limb

    • Signs of discomfort on pressure application

  • Lameness: Obvious lameness noted during walking, trotting not conducted due to discomfort

  • Conclusion: Signs indicative of inflammation present

Initial Management

  • Suspected injury: Tendon or ligament damage

  • Immediate therapy recommendations:

    • NSAIDs: Provide analgesia and anti-inflammatory effects

    • Corticosteroids: Single IV dose for potent anti-inflammatory effect

    • Bandaging/Splinting: External support to reduce swelling

    • Stable confinement: Absolute rest to prevent exacerbation

    • Re-examination: In 1-3 days

  • Feedback: Highlighting the importance of NSAIDs in treatment

Re-examination Findings (2 days later)

  • Appearance: Bandage removal shows significant swelling on palmar aspect of the limb

  • Palpation Results::

    • Swollen area warmer than contralateral limb

    • Pain response when pressure is applied

  • Indication: Significant localized inflammation still present

Dynamic Exam Findings

  • Walking Assessment: Comfortably walks straight, discomfort turning right

  • Trotting Assessment: Severe 4/5 lameness observed

  • Behavior: Head drops when left front hits the ground, indicating pain

Diagnostic Imaging

  • Initial Imaging Modality: Ultrasound preferred for soft tissue injuries

Ultrasound Examination**

  • Findings:

    • Transverse section shows single large oval hypoechoic lesion in superficial digital flexor tendon

    • Lesion indicates fiber separation (tendinopathy)

Assessing Severity of Injury

  • Measurement Comparison: Cross-sectional area of injured vs non-injured limb

    • Left fore: 1.0 cm²; Right fore: 1.4 cm² (40% increase)

  • Lesion Coverage: 0.35 cm² lesion covering 25% of total tendon area (1.4 cm²)

Management During Inflammatory Phase

  • Duration: 2-4 weeks of the inflammatory phase

  • Required Therapies:

    • NSAIDs (oral or topical)

    • Cold therapies (ice application)

    • Bandaging to reduce swelling

    • Strict box rest required until inflammation subsides

Management During Repair Phase

  • Exercise Progression Plan:

    • Month 1: Box rest, no exercise

    • Months 2-3: Box rest, hand walking

    • Months 4-5: Small pen rest, ridden walking exercise

    • Months 6-9: Small pen rest with trotting

    • Months 9-12: Field turn out with canter exercise

  • Expected Return to Racing: Approximately 1 year post-injury

Intralesional Therapies for Repair Phase

  • Indications for Therapy: Lesions with a 'hole' in the tendon/ligament

  • Biological Therapy Options:

    • Mesenchymal stem cells (MSCs)

    • Platelet-rich plasma (PRP)

    • Bone marrow aspirate concentrate (BMAC)

  • Objective: Promote improved healing and reduce recurrence

Prognosis

  • Chance of Recovery: 80% chance of returning to racing

  • Performance Impact: Initially unlikely to alter performance

  • Re-injury Risk: 53% chance of re-injury within 3 years

  • Reference: Equine Vet J 2010 May;42(4):322-6.