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View Full Version : Sacroiliac Ligament Tear - Advice?



Pascova
Dec. 4, 2010, 02:19 PM
My 4 year old TB/Conn has a sacroiliac ligament tear in the right hind. Ligament is torn partially off the bone. Right now, we are on stall and small paddock rest with 2 5 min hand walks on relatively flat terrain each day. The plan is to walk under saddle in 6 weeks, start light trotting in the spring, and hope to be back in full work by next fall.
Anyone with experience have suggestions, advice, experience with this type of injury?
Any suggestions for alternative therapies? PRP and stem cell seem risky in this deep area.....thoughts? We have done one session of laser therapy -- but it was a demo laser and I do not know anyone in this area who owns a laser that is strong enough to get into the SI ligament area.

Thanks for any advice!

Lieslot
Dec. 4, 2010, 08:25 PM
Sorry no advice, but if you don't mind I'd love to know how this was diagnosed?

I ask, because my horse was recently diagnosed with SI pain via bonescan, it's assumed OA of the SI joint, because of the area that lit up, however bonescans can't differentiate all that well between SI joint & SI surrounding ligament.

Is the tear in the ventral or dorsal SI ligament? Did they find this via transrectal ultrasound?

We did the ultrasound guided injections, but I wasn't aware PRP or stem cell in this area was possible. I'd love to know more too. We've done mesotherapy so far.
I started longlining him after 2 weeks and he looked to be feeling good, even offering some trot, but at that time he was still on Equiox, within 2 days off coming off Equiox he looked sorer again, so we've now decided to give him the winter off to pasture and restart longlining end of March.

Not relevant to your question, but I need a vent... The pasture rest at present is not going as smoothly as I had hoped. He's so full of himself, galloping flat out, rearing up vertical to his buddy and doing the handstand bucks, stressing me out totally -sigh- :(.
I'll gave to talk to my vet if he needs to go into a small paddock instead.

Lieslot
Dec. 4, 2010, 09:09 PM
http://www.savmasymposium2010.com/site/sites/default/files/proceedings/SAVMA2010-Sat_Equi-1100-Brounts.pdf

I actually don't think PRP or stem cell in that area is done, as the above is fairly recent, I would have thought if it was done it would have been mentioned.

davistina67
Dec. 4, 2010, 09:21 PM
My 4 year old TB/Conn has a sacroiliac ligament tear in the right hind. Ligament is torn partially off the bone.

How do they know this?

SBrentnall
Dec. 5, 2010, 12:08 AM
My horse tore his sacroiliac and after 6 months of rehab, it wasn't healing. We did stem cell and it healed perfectly within 6 months. My insurance covered it, because they said it was the recommended treatment for that injury.

Here's my account at the time: http://www.ultimatedressage.com/forums/viewtopic.php?t=126420

Lieslot
Dec. 5, 2010, 07:01 AM
SBrentnall thanks for that!
Interesting that your scan did show a clear tear/hole. My horse's didn't show a tear, but from what I read it's hard to differentiate that on a scan.

What was your horse like prior to treatment? Lame or still trotting under saddle, but looking NQR? Was he still trotting normally on the lunge or was he visibly not right on the lunge too?

Seems my horse isn't the only one with 'antics' as you described it, that doesn't help.
I'm a little worried about Fluphenazine, but may have to bring this up if he continues the crazies daily.

Hilary
Dec. 5, 2010, 07:59 AM
My prelim eventer did this at the end of his career - he was coming 17 and I did laser therapry and time- a year of turnout. He came back sound enough to foxhunt (very low key) but was unhappy if I asked him to do dressage so I didn't. He had a season of hacking and getting to go gallop around in a group. The following year his other arthritic issues got to be too much, and his feet began to fail so he fully retired. His SI area had been injured in the past and he recovered from that, although he had some mechanical lameness (horky gait but no pain) that he worked around.

That's a hard injury to recover from, but your horse is young. Good luck.

Pascova
Dec. 5, 2010, 11:26 AM
He was diagnosed by ultrasound-- basically, the left side of SI looks smooth where the bone and ligament attach, but the right side looked like stair steps. Before that, Stan Brown has diagnosed it upon palpitation - - he is very well known for diagnosing without "machinery". Dr. Clara Fenger confirmed with the actual ultrasound when she was visiting Dr. Brown the day before Thanksgiving.

For turnout, I am doing a paddock, that I move around daily that is about 30x30 so he cannot run around -- I also put a small pony in with him. I am going to consider giving him reserpine when he resumes larger turnout.

SBrentnall
Dec. 5, 2010, 01:26 PM
SBrentnall thanks for that!
Interesting that your scan did show a clear tear/hole. My horse's didn't show a tear, but from what I read it's hard to differentiate that on a scan.
In the tech's words, the SI area "lit up like a Christmas tree."


What was your horse like prior to treatment? Lame or still trotting under saddle, but looking NQR? Was he still trotting normally on the lunge or was he visibly not right on the lunge too?
He was never lame. In our case, he had a trailering accident so the swelling was visible over his entire lower back. As the swelling went down and we returned him to work, he started randomly rearing and trying to dump people, which was very unlike him. He became difficult to handle, too.

My original vet gave me the complete wrong advice about how to handle the injury. I should have trailered him to the vet hospital right away, but instead I called my regular vet. Despite the severity of the accident, he didn't even ultrasound. He even told me to put him back to full work much earlier than my gut said I should--said I was babying him. He also recommended lunging to start with, whereas the hospital eventually said no, only straight lines.


I'm a little worried about Fluphenazine, but may have to bring this up if he continues the crazies daily.It's VERY important with an SI injury that he not buck or rear. You need to keep him moving, since flaccid abdominals increase the strain on the SI area, but no crazies. My horse reinjured himself once by being stupid, which is why we went to the fluphenazine.

The vet hospital said they've prescribed it hundreds of times and while they've read about side effects, they've never seen any.

foggybok
Dec. 5, 2010, 04:27 PM
He was diagnosed by ultrasound-- basically, the left side of SI looks smooth where the bone and ligament attach, but the right side looked like stair steps. Before that, Stan Brown has diagnosed it upon palpitation - - he is very well known for diagnosing without "machinery". Dr. Clara Fenger confirmed with the actual ultrasound when she was visiting Dr. Brown the day before Thanksgiving.

For turnout, I am doing a paddock, that I move around daily that is about 30x30 so he cannot run around -- I also put a small pony in with him. I am going to consider giving him reserpine when he resumes larger turnout.

If you have Stan and Clara on your team, you are in good hands. I would follow their advice!

Lieslot
Dec. 5, 2010, 05:10 PM
It's VERY important with an SI injury that he not buck or rear. You need to keep him moving, since flaccid abdominals increase the strain on the SI area, but no crazies. My horse reinjured himself once by being stupid, which is why we went to the fluphenazine.

The vet hospital said they've prescribed it hundreds of times and while they've read about side effects, they've never seen any.

Thx SBrentnall, I know.... sigh :sadsmile:.
Unless I handgraze him all afternoon I won't stop him from being stupid. A small paddock may not be the answer for him either, coz then he tries jumping on the spot, and slamming on the breaks constantly is no good either.
They were so quiet all summer long, but winter is the worst to keep them calm.
I need to discuss drugs with my vet once more.
I hope vets are right that it's more in line with osteo arthritis of the joint, in which case he may be able to withstand the bucks & rears better, but I don't know, I'd rather he just quietly grazes.
His scan lit up in a small area that from experience they say is in line with joint inflammation.

M. Owen
Jan. 23, 2014, 01:19 PM
Sorry to revive such an old topic, but my horse was diagnosed with a SI dorsal ligament tear. Following diagnosis at a vet hospital (bone scan which lead to ultrasound due to SI looking lit up on bone scan) she had PRP and will have some sessions of shockwave along with the typical soft tissue protocol over several months (handwalking, limited motion yadda yadda).

So- on to the reason I revived this topic. I am wondering how the OP's horse (or anyone else) recovered from this type of injury?

slp2
Jan. 24, 2014, 05:10 PM
M Owen: I just finished rehabbing my horse through a similar injury. The total healing time took 6 months. The vet I worked with did not prescribe anything but stall rest, bute, icing and a very specific rehab riding program. This vet specializes in backs and doesn't think that SW therapy or any other alternative therapies help with healing at all. My horse was on stall rest with hand walking for 2 months (that was the longest 2 months_ever!). After that we could walk under saddle (circle spirals in and out). After a month we introduced trotting (still spirals) and another 30 days to canter. I was working her under saddle quite hard at the 4-6 month point--but she still couldn't be turned out. Finally at 6 months I could start turning her out. One thing I did (which you might try) is to sew a "pocket" onto the inside of a blanket/sheet so I could insert an ice pack into the blanket and ice her SI while she munched on hay.

My horse has fully recovered and is making a lot of progress. Good luck on your rehab!

cyberbay
Jan. 24, 2014, 05:29 PM
Could you all tell me what the symnptoms were that even got you all to consider an injured SI?

Would a hind leg that gives you that 'dropping off"** feeling be a signal of SI trouble? Did he palpate sore over the SI area?


[** as in: three legs feel square and under the horse and the one hind leg feels as if it's way out behind the horse. Saddle could slip to that side, too...]

rockfordbuckeye
Jan. 24, 2014, 08:33 PM
My mare like slp2 also has a SI ligament tear with scar tissue and I am just starting to work through the same rehab plan. My mare's injury is quite old - so we are starting right away with under saddle walking but she is not allowed in turn out (again, ARGH). I had no joint involvement. I am using same vet as slp2 - we have not done any injections and I am not using any other complementary therapy like chiro/shockwave/massage/etc.

My mares symptoms were: 1) unilateral muscle development 2) overall lack of muscle development in the hind compared to shoulder/chest - which has been a long term problem but was even more exacerbated by a long stall rest for ANOTHER ligament isssue (oh yes, I've been rehabbing for forever) 3) pain for the horse standing for the farrier - he said when her shoes are off she is quite painful standing for him 4) pain on palpation over the SI 5) noticeable pain for vet when he did a deep flexion of her hind on the injured side - she pinned her ears and kicked out 6) cantering with the haunches in 7) failure to track up fully on one side 8) inability to perform lateral work on the injured side - she can do it if you force her but it's obviously uncomfortable for her 9) refusal or attempted refusal to transition into trot or canter (throwing head up going into the trot, kicking out and snaking head transitioning to canter) 10) kicking out when my leg was applied on the injured side (which sadly, I did a lot trying to get her to engage/track up) 11) mild toe drag on the injured side 12) refusal to turn her head in for the correct bend on the injured side - she will tilt her out at an angle to avoid engaging that SI 13) fear of and failure to accept contact and a lot of anxiety around that 14) even when horse is lunged in pessoa like system and is asked to drop head - hind end still trails out behind disengaged because horse cannot do it.

A lot of symptoms accumulated over many years of having this injury missed by multiple vets and trainers before I finally found both a trainer and a vet who agreed with me that it wasn't right, there wasn't anything training wise or rider wise that we could do to get it right and it wasn't a mare being a "b--ch" or lazy which had been the excuse from old trainers for two years. I feel absolutely awful it went this long and I was at a top barn that competes at the big shows and I was seeing a very famous vet. So I was not alone trying to figure this out myself.

cyberbay
Jan. 27, 2014, 04:14 PM
R'ford Buckeye... thanks for your response. With my horse, who has this whole NQR thing that I think stems from his SI, I could identify only with the anxiety about contact and the mild toe drag. He can carry his head to the outside, but with applying the aids to flex and bend, he will readily comply. But, the anxiety about the contact was a big one.

I've bummed out reading about stall rest and easy work and no bucking. Me? I have continued to ride, restricted him to flat turnout (he's mellow outside usually), but this winter, I've let him freelunge in the indoor, and he has done some bucking. Sigh. I've looked at my notes and there could be a correlation between him having a bad riding day and having freelunged a few days earlier...

I just wish I could know exactly what's wrong with him. All I see in this thread are expensive tests with inferred diagnoses...

rockfordbuckeye
Jan. 27, 2014, 04:36 PM
Well you could start with an ultrasound of the SI - that's not tooo expensive. That will at least rule in or out ligament involvement along the SI. The hard part would then be ruling in or out joint involvement. You really can't "see" that from an ultrasound so a bone scan is the only way. But perhaps with clinical history and a strong physical exam your vet could try to draw informed conclusions.

What would suck is like...ok u/s of SI is negative. Then what? It doesn't mean you don't have joint arthritis in the SI. It doesn't mean there isn't a stifle/hock or other back issue. So then you have paid for an ultrasound and still need to fish more for answers.

This is how my vet convinced me to just pony up for the nuclear scan up front b/c he said in the end trying to skip it would cost me more. I think he was right but it was a big bill to swallow.

cyberbay
Jan. 27, 2014, 05:07 PM
Well, we've injected one stifle as well as the SI and lumbar area. I think they helped. So, you could infer that there is some arthritis happenin' there, which is very possible, esp. on a long-standing jumper's bump horse who is now age 14.

My thing is that I want the diagnostic to be definitive. And then I want there to be a suitable, proven treatment for that diagnosis. Possible? I dunno.

As well, I'm in saddle-fitting h***, so that complicates things.

rockfordbuckeye
Jan. 27, 2014, 05:27 PM
Depending on where you would do the nuclear scan (would need to be a place that accepts credit card payment) - you could probably finance it with care credit. I think they will do zero interest if you pay it off in 6 months or low interest if you pay it off in a year. Something to ask about if that would help!

M. Owen
Jan. 31, 2014, 01:15 PM
Cyberbay- my mare's diagnosis was kind of difficult and took a long time. It started with her doing things where I would say "she just isn't herself" but people watching her go kept saying she looked fine. Like others have mentioned, she had trouble with staying steady on contact. She didn't really show much lameness, only on her left front and it was VERY subtle. We tested for lyme disease (neg), did flexions on multiple joints all 4 legs (very mild positive on each leg), more so left front/ right hind. So, we ex-rayed LF/ and RH. Found some inflamation in the LF fetlock and a small bone spur, injected that. Back to consistent work slowly and she felt pretty good. At about week 9 after the injection, we worked her up to jumping 3'-3'3" again, and 3 days later she looked very slightly off again. At that point, the vet said we could try to ID the problem at home but vet recommended the bone scan to see if there was something higher up in her neck/ back/ shoulder causing the soreness. Luckily I had insurance, so we moved forward with the scan. On the scan, she had inflamation in the SI area, so they ultrasounded also to rule out any ligament/ soft tissue problems. The ultrasound is what allowed them to identify the tearing in the right dorsal SI ligament. My horse never had any very clear lameness or soreness. She did not palpate sore across her back or SI area.

Really the biggest signals to me were the unwillingness to go on the bit, her left to right lead change got more difficult (she did it, but was late behind if I didn't set her up properly), somewhat shorter stride at canter (very subtle- but lines when she would have been able to just "flow" before I had to push a little), and she got worse about lateral work (she has never been a fan, but got worse about it).

ETA- people watching my horse go always though she looked fine, and the issues with steadiness on contact and poor lateral work were attributed to mareishness, her being high, laziness, etc.

Jacqui
Apr. 5, 2016, 09:11 PM
After reading the last 2 posts it is much clearer to me that the 9 yr old TB/Con cross I am leasing is exhibiting much of these same symptoms and the owners won't believe me that he is miserable because something in wrong....It has been almost a year of me trying to work with him. His anxiety and tension must be manifesting from this type of issue. Vet comes tomorrow but at least I know where to point her!
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