Stifle Injury

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Stifle Injury

Post by Sunny Admin on Sat Feb 20, 2010 4:17 pm

Dear Dr. Pike:



My gelding (BB), 27 y/o, last Thursday night between 6 & 8:30 PM injured his left stifle and would not walk - could not straighten it or bear weight. I got him to his stall - not an easy task - he hopped/walked. My equine vet was out of town (4th of July) for the weekend, so I called my small animal vet, Dr. R. He said to start him on bute 2gms, and see how he is in the AM. BB was no better the next AM so Dr. R came out. After a full eval of the leg he could not figure it out. He said to continue the bute and see how he is in a few days. BB stocked up in the rear, so I iced both legs several times daily. Sunday, no better. I called my equine vet, Dr. S, he said to back him up since BB is probably "locked up". We tried it - nope - no change, no "unlocking". Dr. S came out Monday AM - BB tore his patellar tendons per his physical exam. There is not access to ultrasound where we live. He said to keep the bute @ 2gm BID, put a standing wrap on his right hind (this leg could go, since it's bearing ALL his weight) and give it time to heal (He said it would in 4-6 weeks).



Any advice to maybe ease his discomfort or is this just a waiting thing???? I do not want BB suffering - he means too much to me!!!



Thanks,



Jenn
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Re: Stifle Injury

Post by Dr. Daniel Pike on Sat Feb 20, 2010 6:22 pm

Jenn, It sounds as though the injury has been diagnosed as a traumatic stifle injury with possible damage to the patella or patellar ligaments. Unfortunately, these can be very difficult injuries to treat, especially in our geriatric patients. The best thing we can to manage this would be to have an accurate diagnosis. I would definitely find a way to at least have the stifle radiographed to check for articular femoral or tibial fractures (fractures involving the joint) or patellar fractures.

In the meantime, here are my thoughts. Stall rest is definitely imperative. NSAID treatment, ie Bute, Banamine etc is also indicated, and although we may see GI side with longer term administration, the benefits probably outweigh the risks in this particular instance. As long as he remains stall rested and is not required to move excessively, then his pain level will be minimal. You can monitor his pain level by checking his heart rate, which should remain 36-40 beats per min. If the leg is causing excessive pain, his heartrate will rise to 50-60 beats per minute. The stocking up is expected, as inflammation is present, but is worsened as the stall rest has impeded his lymphatic system. Mild stocking up is acceptable and should be managed via standing wraps and cold hosing. If the limb swelling has extended into the hock, It may be benficial to ice wrap his legs. To do this most efficiently, fill a large container with ice water, then soak 14/16" quilted cotton wraps in the water for 5 min. Use these cold wrps on the leg for 30 minutes. After the ice wraps, place dry wraps on the legs. You can repeat the ice wraps 5-6 times daily if time allows. If this does not solve the swelling, it may require a follow up visit by your veterinarian for further evaluation.

If the injury is limited to soft tissue damage, improvement should be seen in 3-4 weeks with a large improvement seen in 4-6 months. If long term lameness results, then therapeutic shoeing on the affected limb may allow for more comfortable movements. I cannot stress enough the value of determining whether the source of lameness is intra-or extra-articular. I hope this helps...let me know how he comes out...good luck!!

-Daniel R Pike DVM
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