Tendons 2

 thing I cannot emphasise enough is that you must be extremely careful with the bandaging. Owing to the swelling caused by the injury, bandages are often applied too tightly which can result in some horrific pressure sores. I have seen some cases where these sores have resulted in worse damage than the initial tendon injury. I would therefore recommend that when bandaging one should preferably use a soffban followed by two layers of gamgee under a bandage.

During this initial inflammatory phase, which lasts 1 to 2 weeks, the horse should be stabled. It is often thought that a raised heel or rest shoe should be fitted, but this is contra indicated since by raising the heel one is reducing the tension of the deep flexor tendon and increasing it of the superficial digital flexor tendon.

Following the inflammatory phase, within a few days the repair phase begins during which the formation of scar tissue occurs. Finally there is the remodelling phase when the nature of the tendon fibres change and the tendon begins to fine down and take a better shape.

During these latter two phases the horse can and should have controlled exercise and can then progress to being turned out in a confined area, before eventually going out to pasture.

In addition to conservative treatment various other procedures are often carried out in an effort to improve the healing process and possibly reduce the rest period such as tendon splitting, check ligament desmotomy, physiotherapy or pinfiring, the efficacy of which are debatable.

For many years the hunt has been on to find drugs which would improve the quality of healing and reduce the convalescent time. One such drug which has been available for some time is Adequan which can either be injected into the lesion or given by intramuscular injection. This is believed to improve the quality of the repair tissue but does not reduce the rest period. The latest drug to be tested which was heralded as a “miracle cure” is called BAPTEN (Beta-aminoproprionitrile fumarate). This drug prevents the formation of cross links and therefore improves re-modelling of the tendons, but it does not accelerate healing; it is administered intra tendinously 1 to 3 months after injury via multiple needle punctures every other day for at least 5 treatments. However this drug is still experimental and is not licensed for general use.

Tendons have a relatively poor blood supply and therefore are slow to heal and, to date, there are no medications or treatments which can greatly reduce the convalescent times, which are roughly as follows;

Mild injury 6-9 months

Moderate injury 9-12 months

Severe injury 12-18 months

Tendons which have been injured should be scanned prior to the horse being put back into work, in order to establish that healing is complete. The scans will also show the quality of healing which will be a good indication as to the future ability of the horse.