Name: Bee
Age: 6 / Height 16 Hands
Breed: Thoroughbred / Ex racehorse
Presenting Case: Tripping onto knees particuarly in walk and trot.
Treatment: Following review by Veterinary Surgeon surgery recommended. Bilateral Carpus Arthroscopies performed. Debri and fluid found in right carpus joint. Advised 2/52 boxrest until sutures removed.
Drug History: Metacam for 10/7/days. IRAP Injections followed by Serequine joint supplement long term.
Physiotherapy: Full assessment and advised to keep both legs bandaged due to soft tissue swelling with associated heat ? superficial haematoma to right carpus. Commenced Pulse Electromagnetic Flow (PEMF) on week 2 and treated twice daily for 6 weeks. Given full body massage weekly paying particular attention to tension neck, shoulders and muscle spasm in epaxial thoracolumbar soft tissue. Ultrasound performed neck, and thoracolumbar long back muscles.. Owner advised to perform daily rounding dynamic neck stretches and whole spine stretches. Chaffing caused by bandages now evident on palmer aspect of lower limbs. Tubigrip applied prior to bandaging which prevented further deterioration of tissue.
3 weeks following veterinary review commenced 5 minute twice daily in hand walks for one week keeping to straight line work only, and slowly increasing length of time each week by 5 minutes with each session.. Commenced rocking exercises for forehand and include daily dynamic neck stretches - rounding and lateral bending stretches.. Dedicated owner shown how to perform daily passive flexion exercises to carpus joints as reduced flexion particularly to right knee,. Week 4 frightened by another horse whilst walking in hand and fell onto concrete onto both knees resulting in heat but minimal swelling. Continue to bandage legs and PEMF applied to vasoconstrict for 72 hours and then setting adjusted stimulate vasodilation...Commence weight shifting forehand once comfortable following fall. .
6 weeks after surgery walking out for 20 minutes twice daily in hand and sound. to commence pole work, and introduce to different surfaces.and include figures of 8 and serpentines in work. Wear white boots to improve proprioception and co-ordination . Not to perform lunging/circle work until improved flexibility, balance,, strength and condition. Incorporate backup 6 - 10 steps daily to lift off forehand and continue with daily stretching plan. Turn out for short periods each day in a small paddock with companions in adjacent field.
8 weeks after surgery walking for 30 minutes twice daily in hand. Sound with 90% flexion and vitrually no swelling of both knees and has not tripped again. Following veterinary review can be ridden in walk once saddle checked and reviewed by farrier. At 12 weeks sound and owner reports that not tripping in walk and trot when ridden.
Example of tubigrip used underneath stable bandages to control chaffing and swelling
Routine review of horse at 1 year and remains sound and is back competing in showjumping, dressage and hacking.
Bilateral carpus joints 1 year after arthroscopy surgery with physiotherapy
Name: Chloe
Age: 12
Breed :Warmblood
Presenting Case : Used for elementary dressage and showjumping. Suddenly refusing at showjumps and difficulty with lateral work.
Treatment: Reviewed by Veterinary Surgeon and arthroscopy recommended. Arthroscopy performed and debri flushed out of joint. Robert Jones bandage applied for 1 week, box rest for 2 weeks and rehabilitation plan as above but no physiotherapy.
Drug History: 10/7 days Metacam. IRAP injections
Physiotherapy: Asked to review at 8 months following surgery but on examination severe chronic soft tissue swelling, scar tissue and adhesions with reduced flexion of the carpus joint. Given 6 weeks of PEMF and twice weekly Ultrasound treatment together with passive flexion exercises of the joint. Advised to perform twice weekly pole work in hand or under saddle to improve proprioception and flexion.
Although now sound still has difficulty with lateral work due to reduced flexion although physiotherapy has helped with a reduction in soft tissue swelling and scar tissue.
Left carpus joint prior to physiotherapy
Left carpus joint following physiotherapy showing reduction in soft tissue swelling, adhesions and scar tissue.
