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Suspected collateral ligament injury - Nope

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  • Suspected collateral ligament injury - Nope

    My mare was moving the best she ever has after elbow, navicular and coffin joint injections during the previous months. Awesome ride Tuesday, slightly lame Wednesday and abscess (I'm gonna die) lame on Friday. She didn't react to the farriers hoof testers( although the farrier did find later where an abscess had blown out). After weeks of stall rest she was better and I walked her under saddle. She was improving slightly (soft ground) . Vet came out and she was very lame on hard ground. The vet blocked her and she blocked sound at the 2nd level. Vet thought it was collateral ligament and put her on stall rest. Now after 3 months of stall rest she isn't any better. The vet had been suggesting a MRI all along but I just found out that my insurance company won't pay for it.

    Questions:

    With a CL injury do they ever show slight improvement or is it all or nothing?

    Since MRI's are awfully expensive will an ultrasound or xray be able to show the problem? What if the problem is calcium deposits.

    What about foregoing the diagnostic and just plan on giving her another 6 months to a year off?

    If I want to do shockwave therapy do I need to know the exact point of injury or can it treat a general area.

    Sigh.
    Last edited by dbtoo; Dec. 31, 2010, 06:04 PM. Reason: spelling

  • #2
    Which side is the injury - lateral or medial?

    For an injury potentially as serious as this, I would recommend a lameness specialist. The sooner the horse is properly diagnosed and treated, the better. Diagnosis can be made via ultra sound and xrays. Calcification will be visable if it is there. For treatment, shock wave therapy is used, and so is stem cell, IRAP and PRP (platelet rich plasma).

    For suppliments, there is a Platinum Performance product called Osteon, which aids in healing of ligaments and tendons. It is silica based. Success has also been had with putting a horse on P.P. CJ - their joint suppliment.

    What about his feet - what do they look like? Is he high on one side vs the other? By chance did a farrier put him in Truimph (beveled edges, kind of like eventer shoes), and then also have the medial lateral balance out of whack? If that is the case, the high side forced the horse to roll the foot the opposite direction, and puts the breakover abnormally to one side or the other. This medial lateral imbalance often leads to CL injuries.

    I am not sure that just stall rest without treatment to speed heeling would resolve the issue. Maybe someone else will chime in.

    Comment


    • #3
      First off, I strongly suggest doing a search here on collateral ligaments and then set aside some time for a lot of reading.

      Second, the blog that's linked in my signature details my experiences with my horse's collateral ligament injury. In Star's case it was the collateral ligaments between P2 and P3 and both medial and lateral will involved to some extent.

      1. Not sure. In Star's case it was kind of all or nothing on the healing portion of the injury. But we didn't test his level of lameness once we started the treatments until two weeks after we ended them

      2. Assuming we are dealing with a P2-P3 collateral ligament, most of it is within the hoof capsule. Ultrasound won't go through the hoof so it's not particularly helpful unless the injury in near the top part. Radiographs only see bone not soft tissue. The collateral ligaments are soft tissue so you can't directly view the bone. If the ligament has pulled off a chunk of bone you would be able to see that. Generally they will do scintigraphy (AKA bone scan) of the lower leg to pinpoint the area better and then do MRI of the suspicious-looking portion. The MRI instrument can look within the hoof capsule. But it's not cheap. My insurance paid for both the scintigraphy and the MRI.

      3. Some of them do heal on their own. Some don't. My horse's was not.

      4. Depends on your definition of general area. It wasn't a small area like a laser but we did know which portion of the collateral ligament was injured. I think they rubbed the shockwave probe over an area an inch or so in diameter.

      Good luck with your horse!
      The Evil Chem Prof

      Comment


      • #4
        My horse had an undiagnosed lameness for a year and a half before I sprung for the MRI, and I wish I woulda done it sooner because I would have saved a LOT of time and probably $$. Turned out to be a severe ligament tear.

        As Peggy said, it depends on whether they think the issue is proximal to the hoof. You can do ultrasound (relatively cheap) to rule out most soft tissue problems there.

        Nuclear scintigraphy can also rule out bone problems (including incomplete fractures and bone bruises). I will say, my horse (same horse with the ligament tear) presented 3 weeks ago with non weight bearing lameness, and is still non weight bearing when standing. Final diagnosis: bone bruise on the caudo-lateral aspect of the proximal tibia, where the lateral collateral ligament (of the stifle) inserts. He likely fell, yanked the LCL really hard (no structural damage to that), and bruised the bone. I was impressed that a simple bone bruise on the less-weight-bearing lateral side of the tibia caused that much lameness. We all thought he had a fracture. So that would be another thing you could try to rule out bone involvement prior to the MRI.

        Interestingly, his severe core tear of the straight sesamoidean ligament (in the pastern) resulted in only mild lameness and mild effusion. And that injury ended his career.

        But, ultrasound costs a few hundred $, the bone scan costs about $1K, and if you can't find a problem, you'll likely have to do an MRI anyway.

        You could do what I did: year+ off (in a stall!), see what happens. But then when we started a rehab program, he went lame all over again and we were back to square 1. Which was when I sprung for the MRI. Likely, from now on, I will pay for the diagnostics right off the bat (such as paying the $1K for a bone scan immediately after bringing my horse to the hospital). You just have no idea what you're doing until you know what the problem is.

        So, if you vet (and you can/should get a 2nd opinion!) thinks MRI is the way to go, then if it's financially feasible then you should do it, IMO. If you do all of the other diagnostics to rule out everything else, or put the horse on stall rest rehab for a year +, all of that would probably cost as much as the MRI that could (I assume) definitively diagnose the problem. It also depends on the treatment of the worst possible outcome. If it's something that will take years to rehab, would you do it? If not, then perhaps throwing the horse out in a pasture would be a better option. You need to figure out what you can live with. My horse ended up with the worst possible functional outcome: several years of rehab, and he ended up a pasture ornament. But I don't regret spending all that money for a second because he's alive. And continually trying to commit suicide still to this day.

        Comment

        • Original Poster

          #5
          Thank you for your ideas and stories. I hadn't thought of the bone scan.

          I will sit down this weekend end and read the CL threads on here. Unfortunately, I think I was being way too optimistic.

          Comment


          • #6
            And one more thing:
            If you decide for the MRI, do one under anesthesia (the standing ones aren't nearly as good for the $$), and I would pick the facility that has the best ANESTHESIA team, not the best lameness/radiology team. You can always send the images to Washington or one of the other well-known equine radiologists.

            Comment

            • Original Poster

              #7
              In case any one is interested, or if it helps anyone else.

              I did digital xrays of her right front feet that showed old bone spurs near the coffin joint. The vet who took the x-rays, not the treating vet, was sure this was the issue and had me thinking about surgery to remove them. I talked to treating vet who is a track vet and has seen it all. He said yes I know there are spurs that isn't the issue. At that point I decided to spring for the MRI (insurance won't cover her front leg joints).

              I just got the results back and it turns out that there is no ligament or tendon damage but she has pretty good arthritis in both coffin joints, especially the right, which has been the sore foot. Neither the vet who did the MRI nor the treating vet were at all concerned about the bone spurs.There are some other minor issues but that seems to be the biggie. I'll get the written report on Monday and will discuss my options with the treating vet.

              I guess the moral is don't try to be cheap, go with the best diagnositic and most experienced vet available.
              Last edited by dbtoo; Dec. 31, 2010, 06:03 PM. Reason: spelling

              Comment


              • #8
                So none of the arthritic changes were visilble on the digital X-rays? Interesting. I always thought joint arthritis would show up on an X-ray and a MRI was more to get an idea of the ligament issues going on in the foot.

                Let us know what they suggest treatmentwise. Thx for sharing.

                Comment

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