Page 335 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

310 CHAPTER 1

VetBooks.ir 1.601 scavenger. Its usefulness for tendon injuries is still
open to debate. Cold water hosing, bathing or ice
packs (for 20 minutes 3–6 times daily) is probably
the most efficient local anti- inflammatory treat-
ment: cold induces vasoconstriction, thus decreasing
haemorrhage and oedema. Reducing the tempera-
ture partially inhibits enzyme activity. Counter
pressure (pressure bandages) may help to decrease
haemorrhage and oedema and thus tendon swelling
in the early stages.

Subacute phase
As soon as local signs of inflammation have receded
(oedema and local heat), controlled exercise should
be instituted in the form of hand-walking or use
of walkers, treadmills or underwater treadmills,
according to a graduated programme (see below)
Fig. 1.601 Colour flow or power Doppler imaging over 6–8 weeks. The horses may be ridden at a
can be helpful to assess lesion vacularisation. Flow walk 4 weeks post injury. Walking exercise helps to
in small diameter vessels of normal tendon or early improve tissue organisation and fibre alignment in
scar tissue cannot be detected with Doppler imaging. the early stages. It also reduces adhesions with sur-
Large calibre vessels are detected in chronic, active rounding structures and paratenon fibrosis. Pasture
disease and are associated with a poorer prognosis. turnout is not recommended. Horses may be turned
out in very small paddocks only if calm and sensible.
Management Physiotherapy techniques may be used at this
Tendonitis is divided into three phases: an acute stage, although there is little scientific evidence to
(inflammatory) phase lasting 7–10 days; a subacute or determine their impact on the recovery rate or rate
repair phase lasting 2–4 months; and a remodelling of recurrence of the injury. Laser, shock-wave and
phase (2–18 months). therapeutic ultrasound treatments have been advo-
cated and may help to reduce pain and oedema. Their
Acute phase effect on the healing quality is unclear and probably
Aggressive anti-inflammatory treatment is para- limited. The use of therapeutic ultrasound has been
mount to reduce the release and activity of delete- said to help reduce adhesions and fibrosis in chronic
rious pro-inflammatory mediators, growth factors cases. It has been shown that controlled exercise is
and enzymes. The horse should be box rested to superior to box or field rest or other treatments alone
limit mechanical strain and repeat haemorrhage. at this stage. Cold water hosing should be used after
Any form of exercise may aggravate the severity of exercise throughout the recovery period to limit
the lesion at this stage. Steroidal anti-inflammatory recurrent haemorrhage.
drugs have been shown to interfere with fibropla-
sias and probably delay the early repair phenomena. Controlled exercise programme
Systemic NSAIDs are used for analgesia as they have If ultrasonography shows adequate repair, a con-
little effect on local inflammation. Some molecules, trolled exercise programme should be instituted
in particular carprofen, have shown superior anti- and adapted to each particular case. It is altered
inflammatory effect. Topical NSAIDs may also be of as deemed necessary through regular follow-up
use in the early stages, although it is not clear whether examinations. The aim is to enhance repair tissue
they reach the tendon tissue. Dimethyl sulphoxide organisation, decrease unwanted fibrosis and yet
(DMSO) is often used and is a potent free-radical prevent reinjury or chronic reactivation of the lesion.