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Equine Tendon Injuries: Reducing the Strain

By Sherry A. Johnson
Equine athletes can sustain a variety of orthopedic injuries, but tendons—which attach muscle to bone—are especially prone to strain and damage. Superficial digital flexor tendon injuries remain a frequent and frustrating cause of morbidity (disease) in athletic horses, having been noted as the primary reason for retirement of Thoroughbred racehorses over a 12-year period (Lam 2007). The initial tendon injury leads to not only pain and an inability to work but also re-injury rates as high as 82% (Genovese 1997). Subsequently, tendon healing strategies and optimized rehabilitation have become big-ticket items for the equine sports medicine community.
What Do I Do if I Suspect an Injury?
The classic signs of tendon injury in horses include general symptoms of inflammation: heat, pain, and swelling. Depending on where the injury is located, you might not detect obvious swelling or heat (for example, deep digital flexor tendon injuries within the hoof capsule don’t cause overt swelling and are best diagnosed with MRI). Tendon injuries of the mid-metacarpal (or cannon bone) region, however, often cause noticeable swelling, heat, and pain upon palpation. Initially, tendon-associated lameness can be severe, depending on the extent of the injury and its severity and chronicity.
If you suspect your horse has a tendon or soft-tissue injury, connect with your veterinarian immediately to get an appropriate diagnosis and begin therapy. Most commonly, a complete musculoskeletal and lameness evaluation will help the veterinarian determine which soft tissue structures are involved. Your vet might recommend an ultrasound evaluation as a first-line imaging tool to assess tendinous tissue, but MRI evaluation might also be indicated in some cases to further characterize the injury. Once your veterinarian has made a diagnosis, you can discuss treatment options to get your horse on the road to recovery.
My Horse Does Have a Tendon Injury … Now What?
The body’s intrinsic tendon repair process involves three continuous phases. The initial inflammatory phase typically occurs during the first one to three days following injury. Initial triage strategies usually consist of decreasing inflammation using cryotherapy (icing), rest, anti-inflammatories, and supportive care. The subsequent phases of repair (two to 28 days) and remodeling (60 days onward) are characterized by tissue reorganization and scar tissue formation. Once you and your veterinarian have gotten the initial pain and inflammation under control, you can aim rehabilitation strategies toward encouraging organized scar tissue formation that more closely resembles the tendon’s uninjured architecture.
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