Prior to any treatment regime, accurate diagnosis is the first hurdle to be overcome. Technology has provided a number of new diagnostic innovations capable of much earlier detection to compliment the standard practice of observation and palpation of the tendons in the performance horse. · Ultrasonography or scanning. The most important development in assessing tendon damage and now in everyday use. · Thermography. A developing technique based on temperature detection and has extremely useful capability.
Treatment techniques: The huge wastage of animals with tendon damage within the equine industry has spurned science to develop techniques aimed at the prevention and repair of tendon injury. The greatest problem associated with tendon repair has always been the slow rate of repair of the damaged tissue and the belief that repaired tendons are never quite as strong as was the original tendon structure. This is particularly the case where the damage has emanated from the overstretching of the collagen fibers as a result of over aggressive training or competition pressure. However, the prognosis is somewhat better in cases where the damage has been the result of a direct blow or other blunt trauma. Various treatment strategies have been employed to deal with tendon damage; prevention and repair including those listed below and in some cases combinations of the following strategies:
- Shoeing: The use of corrective shoeing has been instrumental in correcting a number of limb/foot problems in the horse but is possibly more effective as a prerequisite to a preventative strategy rather than a remedy for tendon injury in the horse. · Rest. The common factor in all treatment techniques and quite often sufficient to cure the majority of lesser tendon injuries.
- Bandaging. An art form and an effective preventative technique in the control of swelling in the tendons and associated bursae and sheaths. However, utmost care is essential, to eliminate the possibility of even further damage through ill fitting or over tight applications.
- Poulticing. The usage of topical applications in association with bandaging to reduce swelling and inflammation may also prove useful, often in the form of hot or cold applications.
- Cold treatments, (cryotherapy) water, ice packs and gels. Cold treatment is beneficial, whether swelling has occurred or not. Hosing, with cold water (or standing the horse in a river), treatment with various ice packs and gels cause constriction of the tendon structure and associated blood vessels, which as a result helps to reduce and prevent further swelling.
- Hydrotherapy Spa. A recent development now gaining in reputation as a successful treatment strategy, which utilises computer controlled water temperatures (between 2 – 4C) to encourage reduction in swelling of inflamed tissues. The water is a hypertonic solution or ‘super-salinated’ (very salty) to ensure that any wounds are cleansed thoroughly to promote new tissue growth. Oxygenating jets agitate the water within the spa to massage the lower legs and stimulate recovery.
- Blistering. The application of a hot treatment to the affected area, which causes further inflammation and gross swelling, varying degrees of ‘blistering’ can be effected. The theory is that increased blood circulation and accelerated healing properties will occur at the injury site.
- Corticosteroid injection. This treatment has become widespread in some horse practices to treat inflammation and pain. Animals treated in this manner can appear quite sound and may make a swift return to work. However, excessive prolonged treatment may cause degeneration in tendons.
- Pin firing. Involves the application of a red-hot iron to the skin (also line firing and pinpoint firing) over the targeted structures i.e., tendons, splints, joints, curbs ringbone. The treatment varies from superficial to deeper underlying tissue penetration. This is a horrific treatment which when used, incapacitates the horse and forces the unfortunate animal to rest, which is possibly the only real benefit of the exercise! Some evidence that the veterinary profession now outlaws the practice, although pin firing may still be justified if the only alternative is euthanasia.
- Tendon splitting. Tendon Splitting involves using a small scalpel blade to make minute stab incisions every few millimetres throughout the length of the area of damage in the tendon. Splitting the tendon fibres in the area of the seroma or haematoma, allows some of the fluid in the tendon to leak out. This reduction in fluid within the tendon shrinks the area of damage and as a result allows for faster healing.
- Superior check ligament desmotomy. The severing of the superior or proximal check ligament in the upper part of the cannon bone area that serves to attach the superficial flexor tendon to the back of the bone. The purpose of this ligament is to provide additional support in the weight-bearing phase of the stride. The check ligament eventually heals although it will usually be somewhat lengthened, but the benefit in this surgery is the initial load relief experienced by the damaged area of the tendon during the important early healing phase. This procedure allows the redistribution of weight or tensile load within the leg and takes some of the stress off the superficial digital flexor tendon.
- Laser light. Low-level laser light commonly referred to as cold laser to differentiate it from the hot high frequency laser used to cut metals in industry. Cold laser uses light energy (photons) to penetrate tissue. Light energy converts to chemical energy at the level of the cell itself and the cell becomes more efficient at cellular metabolism and repair. The energy increase also dilates blood vessels, bringing in more nutrients and products for repair. Laser also dilates lymphatic vessels, which allows the area to drain away damaged cellular debris and non-essential fluid. Laser energy also has the benefit of encouraging tendon fibres to repair in a linear more ordered fashion, which ultimately can improve function. Laser is a non-invasive therapy and is becoming more frequently used for rehabilitation.
- Magnetotheraphy. Involves the usage of magnets applied to the affected area and the resulting electric-magnetic field is said to aid with blood circulation and healing properties. Anecdotal evidence to suggest this treatment appears quite effective in mild cases of tendon damage and is also seen as beneficial in the treatment of sore shins. A range of equestrian equipment including rugs and various boots are now available, with magnetic strips already stitched into the inner linings of the products. · Hyaluronic Acid. Moderately successful in some horses when injected into or around the tendon to reduce inflammation with a view to the promotion of healing and limiting healing adhesion.
- Carbon Fibre Implants. Used in cases of severe rupture or severance of the tendon structure. The Carbon Implants are inserted into the tendon to stabilise the structure. This procedure requires effective bandage support or a cast to stabilise the limb structures to facilitate recovery.
- BAPN-F. Innovative medication to speed up healing. BAPN-F prevents new collagen fibres from cross-linking with other fibres for a short time when injected into the tendon lesion. This provides the fibres with an opportunity to align length-wise to correct the defect, with properly aligned fibres. A promising technique, which should improve the quality of tendon healing.
- Equissage Hand Unit. Recent development in equine physiotherapy based on a battery operated massage pad system used for dealing with mobility and tissue damage in humans for more than half a century. The Equissage pad is said to promote healing, improve circulation and lymphatic drainage and may be used as both a preventative method (prophylaxis) or as a treatment for injury.
The likely outcomes following tendon injury vary in accordance with the degree of injury and perhaps more importantly depending upon the time of detection. Early detection of the damage significantly increases the chances of near total recovery. Thereafter the rehabilitation protocol and management of the condition significantly dictate the likely outcome. There seems to be little doubt, a tendon once damaged always displays some slight conformational abnormality and may be more prone to recurrence of the condition unless alternative conditions apply following recovery.
Finally, in keeping with the sentiment of the old adage, prevention is better than the cure and great care should always be taken with the tendons of the horse. Evolution has helped the horse to develop elegant and gracefulz long limbs that may require even longer recovery periods to effect good repair of damaged tendons. Order Windows 7 Ultimate
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