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PRP vs IRAP for Deep Digital Flexor tendon tear.

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  • PRP vs IRAP for Deep Digital Flexor tendon tear.

    Soooo my horse has been diagnosed with a DDFT tear by MRI. Have gotten opinions from a few vets, and researching online I am looking at treating him with PRP or IRAP. The research I see online says PRP has the best success rate of all the treatments. One vet recommended this. Another says PRP is garbage and recommends IRAP and Shockwave. 3 treatments of IRAP 3 weeks apart with about 4 shockwave treatments.

    From what I have read and heard from other people's experiences Shockwave really isn't very successful in this type of injury.

    I know time is key for healing as well as a slow careful return to work, Already planning on giving the guy at least a year off so no rush, I just want the best chance for healing I can get, and I am well aware this is a total crap shoot anyway but I'm going to give it a try.

    The horse is insured, both treatments are pd for at 100%. Anyone have any experiences, recommendations they would care to share?? I am open to hear them. If anyone has had a success story that would be great to hear too but I know that those are few if any. He is my heart horse and I just want to hopefully be able to keep him comfortable. My daughter and I ride him each once a week or so, he was jumping 2'6 -3' prior and my ambitions aren't really much higher than that. I don't heavily show just do this for fun so I am not looking to return him to a high performance high showing level of functioning, just as a fun hack, low jump kinda ride. Horse is 17.2 hands so 2'6 isn't much effort for him, but I realize the landing is where the strain is.

    He is on stall rest now with a little bit of calm hand grazing daily (like maybe 15-20 min), Farrier has adjusted his shoeing to relieve pressure on that injury which seems to be making him more comfortable already.

    I have no idea how he sustained this injury, must have done it in the field playing or running somehow.

    Sorry if this is rambleing on.. I am running on no sleep and information overload so any input would be helpful.
    Thanks so much
    ___._/> I don't suffer from insanity.. I enjoy every
    ____/ minute of it! Member stick horse art lovers
    ';;;;;;; clique
    //__\\<-- Don't feed the llama!

  • #2
    My understanding is that they do different things. PRP provides structural support for healing whereas IRAP is an anti-inflammatory protein. But given that it's all a bit new and experimental I am not convinced that they know what works consistently for various injuries, let alone why it does.
    The Evil Chem Prof

    Comment


    • #3
      My vet is pretty experienced/up on technology and he didn't feel either was truly likely to benefit my horse with a DDFT injury (strain, not tear). We did a year of stall rest, with anti-inflamatory meds for the early stages (bute and Equioxx), then a very slow/conservative period of bringing the horse back to work.

      Mine also never runs in the field, doesn't jump huge jumps, and is generally sedentary animal. He not only injured it once originally, but after a year of stall rest and close to 6 months of slow rehab before bringing him back to regular work-- he came in from turnout with the SAME INJURY a week ago. I can't explain it.

      Back to stall rest.
      ~Veronica
      "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
      http://photobucket.com/albums/y192/vxf111/

      Comment


      • #4
        we just did PRP for a suspensory tear

        i used shockwave for the very first suspensory injury she had on her other leg. that leg healed nicely but whether it was due to shockwave or just luck who knows.

        she tore a suspensory in her other leg last december. it seemed to be healing but then there was a slight setback, vet wasn't thrilled with progress. i had 3 options with stem cell being most expensive. i opted for the combo of PRP and tendon splitting which was affordable (it's all relative i know) and my vet has had good success with it. we'll see what it looks like in 4 weeks.

        as i understand it, the idea is to stimulate healing which is what the infusion of blood flow and plasma is supposed to accomplish.

        but then again that's the purpose of the more expensive
        treatments too.
        http://www.eponashoe.com/
        TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique

        Comment


        • #5
          My vet said I could do shockwave, but it was unlikely to have much effect because unlike the suspensory which is relatively accessable externally, the DDFT is inside the foot and pretty tough to reach.

          Now I am second guessing not using using PRP/IRAP the first go-round (when I had insurance!) but I really trust this vet and he did not recommend either.
          ~Veronica
          "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
          http://photobucket.com/albums/y192/vxf111/

          Comment


          • #6
            vxf111

            Originally posted by vxf111 View Post
            He not only injured it once originally, but after a year of stall rest and close to 6 months of slow rehab before bringing him back to regular work-- he came in from turnout with the SAME INJURY a week ago. I can't explain it.

            Back to stall rest.
            don't want to hijack OP's thread but my heart goes out to you. i've been in what now feels like perpetual suspensory rehab since may 2008. yes, we had a nice little break last year when we were back to light hacking and even went roading with the hunt. all was well until a freak accident last december when she had a horrific slip under saddle. it's a miracle all she did was tear the other suspensory. but it's been back to rehab for us since.

            i just said to a friend the other day that i'm feeling emotionally exhausted from this. i think the constant worrying is taking a toll.

            so (((hugs))) to you. i feel your pain. hope it heals fast and well.
            http://www.eponashoe.com/
            TQ(Trail Queen) \"Learn How to Ride or Move Over!!\" Clique

            Comment


            • #7
              Originally posted by marta View Post
              don't want to hijack OP's thread but my heart goes out to you. i've been in what now feels like perpetual suspensory rehab since may 2008. yes, we had a nice little break last year when we were back to light hacking and even went roading with the hunt. all was well until a freak accident last december when she had a horrific slip under saddle. it's a miracle all she did was tear the other suspensory. but it's been back to rehab for us since.

              i just said to a friend the other day that i'm feeling emotionally exhausted from this. i think the constant worrying is taking a toll.

              so (((hugs))) to you. i feel your pain. hope it heals fast and well.
              Thank you, that is very sweet. Hugs to you and also the OP!

              If it cheers you up at all, I had a VERY good suspensory experience. My older quarterpony was a barrel racer in his younger days. He had a LOT of wear and tear and pretty sub-par care at times (not the people I bought him from, but prior to that). When he was 18, he strained his suspensory being chased and bullied on turnout. He was non weight bearing and was in terrible pain. When he was ultrasounded, they did the "normal" leg as well. Both suspensories were shot. They actually called in the vet techs to see the scan for the experience because the vet had never seen that much wear and tear before. Both suspensories were full of built up damage from over the years, and then of course the injured suspensory was blown up like a banana on his leg.

              Did 6 months of stall rest, wrapping, and Surpass. Then a slow rehab. That 18 year old pony with TONS of miles and wear-n-tear came back totally sound and jumped around with a kid after the injury. That was never a problem for him again. He was eventually retired due to arthritis/overall wear-n-tear but that suspensory came back really well. So there's hope!
              ~Veronica
              "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
              http://photobucket.com/albums/y192/vxf111/

              Comment


              • #8
                Well when my eventer had the same injury, plus injured another tendon, we did cortizone injections, laser therapy, sweating with DMSO, and the horse pretty much lived in standing wraps and stall rest for 6 months and then turnout in different pastures increasing size over time, lots of hand walking, and a year later we competed again and even did a few Grand Prix jumpers. Came back sound on tendons, but had to be retired from jumping due to hocks.

                Comment


                • #9
                  I did all three- IRAP, PRP and shockwave for DDFT inside the hoof and did not see much improvement from any of the option. If the inury is within the hoof and vets could see adhesions between navicular bursa and tendon on MRI, which often happens after repeat and or prolonged untreated injury the only solution is to have a surgery and get rid of as many of them as possible.
                  My gelding had 6 months of sitting in the pasture after initial stall rest with IRAP, PRP and shokewave without any improvement. The vet who did a surgery actually had a theory that the above treatments could have actually "helped" adhesions to form.
                  Another thing to consider- vets have to be very precise with the place of IRAP and PRP injection and in injuries anywhere BUT the hoof this is done with help of ultrasound. So, you are looking at 50/50 chance of vet hitting the right place.

                  I was very conservative with rehab, and even though he has been sound for the last 10 months there will be no jumping in his future, turnout is 30X30 and only after excercise and he is warmed up for 20-30 mins in hand and at walk under the saddle. Considering it took us more than 2 years of stall rest-retirement-rehab to get where we are and since his past is blurry and most probably he has already had this injury before I am not taking any chances.

                  OP, is the insurance is covering 100% why dont you do all 3 procedures? I assume they covered MRI, so that leg will be excluded during insurance renewal, so you might as well take a shot at all three PRP, IRAP and shockwave.

                  Comment

                  • Original Poster

                    #10
                    I think we are going to go with PRP placed with US guidance and 3 weeks later doing stem cells to the tendon sheath. And injecting the navicular bursa with some steroids and HA since it is inflammed. I too figure while it is covered might as well go for broke. (Literally ) Doc also recommended Tildren since he did manage to bruise his P3 a bit gotta check to see if that is covered first since it is so expensive.

                    Thanks for all the input. I am so scared of making the wrong choice but am thankful he is insured so I have a choice to make and can at least try to give him the best hope for recovery.
                    ___._/> I don't suffer from insanity.. I enjoy every
                    ____/ minute of it! Member stick horse art lovers
                    ';;;;;;; clique
                    //__\\<-- Don't feed the llama!

                    Comment


                    • #11
                      horse-loverz.....so sorry you are going thru this. I am too. My guy is about 3 months into it and is now walking 20+ minutes. Our vet found a small tear and treated it with steroid injections. YOu are lucky that your insurance is paying 100% .Our insurance won't cover the steroid injections and has a cutoff period of 4 months from the initial injury. Sadly, this is the only claim we have ever had. He is worth every bit though and we will see it through.

                      Good luck to you.

                      Comment

                      • Original Poster

                        #12
                        Thanks! and good luck yourself..
                        ___._/> I don't suffer from insanity.. I enjoy every
                        ____/ minute of it! Member stick horse art lovers
                        ';;;;;;; clique
                        //__\\<-- Don't feed the llama!

                        Comment


                        • #13
                          Horse-loverz,
                          we should keep in touch. My horse was just diagnosed with a tear to his deep digital flexer tendon near the navicular bone on Friday by MRI. The vet is recommending stem cell therapy using bone marrow vs. fat derived and shock wave. I also have insurance only after the deductable, I have a 30% copay (I just found that out - need to read the policy more closely next time). I'm struggling with what to do and waiting to hear back from other vets I have called to get second opinions.
                          ~I didn't say it was your fault. I said I was blaming you.~

                          Comment


                          • #14
                            Could all of you with DDFT injuries post back from time to time and update us on how you're doing?

                            Somerset is about 2 weeks into his first 6 weeks of stall rest. After that, I take him back for a revaluation and find out how long the total stall rest is going to be. The first time, he was laid up for nearly a year. This time, the vet is hopeful we caught it early and perhaps the duration of the layup will be shorter.

                            I will say, the first go round-- he was quite obviously NQR walking out into the aisle from his stall when I hand grazed him. This time, he strides out happily and is eager to move. He's on Equioxx this go-round, the first time we used bute. I don't know that it makes a difference, I always actually though bute was slightly more effective than Equioxx. I am trying not to get my hopes up but I am happy that he seems more comfortable from the start, this go round.
                            ~Veronica
                            "The Son Dee Times" "Sustained" "Somerset" "Franklin Square"
                            http://photobucket.com/albums/y192/vxf111/

                            Comment


                            • #15
                              Hi horse-loverz
                              Have you thought about stem cell therapy? that has been used quite successfully i think to treat tendon and ligament injuries. there's a company called VetCell that do it in the US and UK (read something recently about a racehorse called dream alliance who had it done and then won the welsh national!!). they also sell prp so perhaps they would be the best people to speak to for some advice on possible treatments for your horse. not sure how it all works but their website would prob tell u www.vetcell.com. good luck! x

                              Comment


                              • #16
                                My 3'6" hunter tripped one day while schooling and ended up with a huge core lesion in his check ligament. We did stem cell therapy (with marrow from his sternum and cells grown at Cornell) and followed the rehab instructions to the T (maybe even a bit more conservatively than recommended). He finally started jumping after 15 months, and appears to be handling it well, i.e., no heat or swelling after schooling. It may be a while before we are back up to 3'6", but (knock on wood) so far, so good.

                                Another horse of mine with a somewhat less acute injury -- also to his check ligament -- had only the PRP. It was less invasive and more cost effective, and his follow-up scans show the fiber pattern to be almost completely restored.

                                In both cases, we might have gotten by with just stall rest. But, the studies show a much lower incidence of re-injury with either procedure, and a higher percentage of horses returning to pre-injury performance levels.
                                www.deuxchevauxproducts.com
                                For riders of every discipline and those who simply appreciate the best that a life with horses can offer.

                                Comment

                                • Original Poster

                                  #17
                                  Well Harry had the PRP with bone marrow aspirate last Tues. They put him under anesthesia and used Ultrasound to place the PRP/Bone Marrow at the sight of the injury. They also gave him a dose of Tildren for the bony changes they saw to P3 ? bone bruise. They also injected Cortisol and HA into his navicular bursa for the inflammation.

                                  He is only allowed 3 5 min hand walks a day for 3 weeks then we can had walk for 10 min 3 times a day.

                                  He is also feeling much better. He is walking out completely sound. He has that nice big swinging walk back . He even bore his weight on his "bad foot" briefly while grazing .. even cocking his good foot.. So I am pleased with those results after only a week. Even my BO/BM who does his walking said she had forgotten which foot was his bad one so she looked for the special shoe.

                                  He goes back in 2 more weeks to have the Stem Cells they harvested placed in his tendon sheath area to also help him and they will evaluate how it is going so far.

                                  They did some shoeing changes too. They put a wedged aluminum shoe on his bad foot, brought his toe back and kept the steel shoe on the good foot. They are going to re-evaluate the shoeing too when he goes back.

                                  So overall so far so good, he is handling stall rest well so far. Hope he keeps up the good work

                                  And just wanted to say how awesome Markel has been with helping me with this.
                                  ___._/> I don't suffer from insanity.. I enjoy every
                                  ____/ minute of it! Member stick horse art lovers
                                  ';;;;;;; clique
                                  //__\\<-- Don't feed the llama!

                                  Comment


                                  • #18
                                    Horse Loverz - so glad to hear that your horse is making progress. We just had ours reevaluated today. We were supposed to start trotting in a straight line a couple of weeks ago, but found he was still lame. So sad, as his walk was showing promise.

                                    Our vet found that he blocked out and after another xray, saw just a little fluid indicating he still has some healing to do. His recommendation is to go with the PRP first to see if we can stimulate the healing. This is so frustrating for us and for the horse, but hopefully we will see positive results as you have.

                                    I'm wondering, what other things have you done on your own? Supplements etc? Ours is on Recovery EQ. I've also wondered about magnetic hoof boots, accupuncture, etc. Any thoughts?

                                    Comment

                                    • Original Poster

                                      #19
                                      So far we have only done the special shoeing and the Stem Cell and PRP, He has injected the Navicular bursa twice with HA to help with the inflammation that was there. I have my horse on Adequan already and am continuing that. The vet also has him on a low dose of Previcox (the box was for dogs and he is only getting 1/4 tablet) and even though it is a small dose it really seems to be helping with the inflammation.

                                      I'm on the fence with magnet therapy's effectiveness but would not rule out using it. I have used acupuncture in the past and would probably try it again if I feel it's necessary once he can do more.

                                      Right now I am in that frustrating place of waiting since he just got the stem cells injected last week so we are still barely into the loooong waiting period.

                                      He has been handling stall rest very well so far, so I am hoping his good humor about it continues. Good luck with your recovery period too the waiting sucks..
                                      ___._/> I don't suffer from insanity.. I enjoy every
                                      ____/ minute of it! Member stick horse art lovers
                                      ';;;;;;; clique
                                      //__\\<-- Don't feed the llama!

                                      Comment


                                      • #20
                                        We are over 3 months into it. He has had the steroid injection, is on Adequan, MSM & Recovery EQ. Now the PRP. This is a highly respected clinic so my trust is in them. I'm just wondering about the accupuncture because we have seen that help alot with other inflammation.

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