okay days later we are picking back up where I left off on this lecture so um on part one we left off here on common injury types so we talked about tendonitis desmitis um and so again we talked about that the itis part is just letting us know there's inflammation in the area so if we have a bode tendon we'll look at pictures of that here in a second um that's like a tail tail sign of um an issue with horse's tendon so it looks like it's bowed out instead of being straight down like flat on the back of their legs we'll see it be bowed um they can also have lesions or tears that will cause that tendinitis and then for ligaments we've got the most common type of ligament issue would be with the suspensory ligament so suspensory desmitis is just meaning inflammation in the suspensory ligament and then also lesions or tears in the ligaments so let's look here at tendon Ines so here let me get my little pointer guy out here on the right we have a um bod tendon so we can see here how the back of that tendon is bowed out um and then here is just the same not obviously not the same horse but the same issue they just have shaved this area so you can see it a little bit more pronounced here um so it's most common for horses to have tendon in injuries on these flexor tendons that run down the back of their leg so The Superficial digital flexor and the Deep digital flexor um it's more common so um let me just take a brief look at my power point oh there it is um and just see if we've talked about already what can oh yeah oh we already talked about what can cause so um horses are more likely to get injuries on the the ligaments and tendons that run down the back of the leg versus the front first of all there's more um there's more soft tissue on the back of the leg so right there's a greater chance that that's what would be injured but also um like a horse's front legs especially can be more susceptible to trauma if like their back legs reach up and clip the front of their or the back of their front legs um as opposed to it's less likely they would like bump the front of their legs to a point where it would cause an issue on this extensor tendon um and then the back of this leg um is helping to support all these um bones in here and so anyways the the tendons on the back of the horse's front legs are under more stress they're also more susceptible to injury um and so it's more common for us to see injuries here on these tendons running down the back of the leg so again bod tendon just looks like this and so I remember one time in like my very early days of teaching um riding lessons this wasn't when I was uh teaching out of college but I was teaching a private riding lesson and I was like maybe like 17 or 18 and this family had just bought a horse and I remember watching the horse trot around and like she looked a little off and I didn't know hardly anything about horse um Anatomy or injury she just looked a little off and so I was like I finally made the lady stop and the horse had like dark legs like this and it was kind of dark in the arena and so I remember just not being like I couldn't see anything from a distance and I got close and I saw the back of that May's leg looked about like this actually hers had kind of gone down even further it was bowed more all the way down to her fetlock and anyways I just I'll never forget that it was like my first exposure to like a a serious injury and um I didn't know I like had vaguely heard the term bow tendon um but I remember when I got close and I could see it I was shocked that the owner had not noticed it when the owner was like cleaning her feet and grooming her and stuff so anywh who and I also was surprised at how you know severe of an injury like it it looked you know that that doesn't look good right and I was also surprised at how well that horse was able to move um so the boat tended in itself is showing the inflammation in the area due to the injury um so anyways we'll move on it's just a little whenever I see this picture I just like have a flashback to like that first time I saw boat tendon in person I was like oh my goodness um so keeping along the same line of a bode tendon so this is an image of what is happening so this would be a superficial digital flexor tendon lesion here um and so we can see here we've got like a tear in this tendon and there's inflammation surrounding it and that's what's causing this Bode out look um and so here on this image this is an ultrasound image and so this is like a crosssection of the H's uh deep digital flexor tendon and so that's the tendon right that runs here so it'd be like if you cut off off the top of this leg and we're looking down like a bird's eye view down the back of this leg here this is what we're looking at and so um you can see here this dark place that's showing us a lesion so like a a a hole essentially in the ligament and You by taking that ultrasound probe we've got you like here would be our ultrasound probe here if we move that up and down the leg we'd be able to see like where does this dark spot start to go away and so we'd be able to tell um where like how far down that tear goes deep digital flexor tears uh normally happen below the fet lock down here and so sometimes you can't get the ultrasound to show you know this this uh you can see here this bad boy runs all the way down back here beneath that coffin bone and so sometimes on the ultrasound you can't see exactly how far down that tear goes but you can get some indication of it there so um I just wanted to show youall what this image is and that's just showing you can kind of see how it um the Deep digital flexor kind of has two sides this is kind of the part that's going around um that Canon bone or or laying kind of it's centered on the Canon bone so here's our bone here and that flexor Tenon kind of is has two sides to it almost um okay let's go to our next oh get rid of that okay so ligament injuries we could have desmitis again is just saying there's inflammation in the ligament and so the most common is the suspensory desmitis remember when we talked about the suspensory ligament its job is to keep um The fetlock JO joint from overextending so remember let's go back here I think this previous picture actually shows so this is the suspensory running here and it wraps around this fetlock joint on either side and so if we have an issue with that suspensory what it does is it is no longer able to do its job of keeping this fetlock joint from overextending and so what we'll see in cases like this is that horse's fat loock drops down um it's no longer being supported by that suspensory ligament so they'll have this um overextension of um The fetlock Joint so that's a a a sign of a horse that has a suspensory injury um and upper Li injuries are more common so upper higher up in the leg are more common um and then you can see here this is just showing uh before and after three months of treatment so this horse had huge Improvement in that suspensory ligament being able to be more upright here just make sure I didn't have um and is this let's go back um so there's different ways we can treat sorry I had to pause I was trying to look at my next slide to make sure I didn't miss something there's different ways we can treat um suspensory injuries or ligament injur injuries um and so sometimes what they'll do is intravenous pain medication so on this particular horse um they're showing what they did and what happened with their treatment so they did an intravenous pain medication so that horse was like getting continual pain meds to help um mitigate the pain associated with this injury they also gave this horse plasma injections then you can see the horse had custom shoes here um to help support it and get it back um on a more stable um angle to that fet lock so this was a cool kind of study that was done or or I guess analysis of treatment that was done in the suspensory to show the progress this horse made in 3 months with those treatment methods and so um this can be caused due to like a traumatic injury right so horse hyperextends or um is overstressed and so there's an issue with that suspensory that causes that fet lock to drop because there's um a tear in the suspensory but you can also have degenerative suspensory ligament degeneration and so what that means is over time that suspensory becomes more and more compromised and so there's some research to show that it's actually there's genetic factors that go into horses that are more susceptible to that um again that's still being researched but there is some appears to be some sort of correlation um between certain breeds or or lines of horses that are more susceptible to suspensor ligament uh degeneration so that's interesting to think about it's always so interesting to me just that like like anything like the human world there's so much about horse um health and illnesses and treatment methods that's unknown and I think I've if you've been in a lecture with me you know I've said this before but it's because horses aren't food animals they're not used you know we don't consume horses here in the United States so they're only used for rec recation and you know or mostly for recreation or Sport and so there's not as much um funding available to fund research projects and so um it's hard for people to get the money to run research trials and things like that and um so we just don't know as much and so it's it's interesting just how much if you start really getting into the science of horses and um horse nutrition or reproduction or um horse Sports Medicine you'll find there's a lot of questions that are unanswered and it's kind of exciting too because it means like we're constantly finding out new information and learning how to take care of our horses better but okay let's get into some diagnostic methods so what do we do when we suspect a horse has a soft tissue injury so this protocol is very similar to what we do with any any kind of lameness on a horse right um so we're always going to start with the lameness exam um and then we'll move into palpation maybe nerve blocks and then some Imaging depending upon what we find out in each of those stages and it also depends upon your client and how much money they are willing to spend on um this so I wanted to I'll uh we're going to use my mayor as a as like kind of a case study on this and um I want to just pull up yeah boom I'm going to pause this real quick okay we're back I just wanted to get a screenshot ready for this so this is obviously not my horse this is not my Ved this is just showing what a part of a lameness exam would look like so let's take a look at a lameness exam so some things we'll do or the vet would do is do um have the horse be walked and jogged both directions straight sometimes they have them go in a circle and so this is something we'll practice in lab as well y'all have to do some lameness identification as we move into the coming weeks um but as a Vette Tech um this would be something you would be doing so you would be this is one of Independence equin vet techs and she's the one who's leading this horse around and as a Vette Tech it's your job to handle the horse not get in the way of the vet um so that the vet can see the horse you can see here she's got a nice loose um hold on the horse cuz part of doing a layus exam as we'll learn in the coming weeks is watching the horse's head movement as it steps and if you've got a tight hold of that lead rope the vet's not going to be able to properly look at the horse's head moving up and down if you're putting pressure on the horse's head um but typically they'll walk and Jog the horse have the horse go straight away from them straight towards them have the horse go past them both directions and then in a circle both ways to kind of look and see if there's any differences um side to side and so on so um this will happen first and then the vet will move into palpation and flexion and so palpation is something we're familiar with right so we'd take our hands we'd feel down the horse's legs um or across their back and we're looking for heat swelling we're looking for sensitivity um to some of those issues some of those areas excuse me not issues and so remember we talked about before that swelling isn't always associ iated with heat sometimes we'll see swelling or um puffiness in an area that area isn't necessarily hotter um sometimes we'll have heat with minimal swelling um and then something else they'll be palpating for is feeling like the T tissue density so sometimes you may see something that looks like swelling but then you go to palpate it it can actually feel like calcified so maybe it indicates scar tissue or something else um and then something else they might do is get a hoof tester to test the bottom of the hoof as well um um but then they'll do a flexion test and so the point of a flexion test is the image you see here is they're going to over stress a joint to try to pinpoint the affected areas so they will uh this first image here he's stressing a joint higher up in the leg versus this one he's stressing joints lower in the leg and so the vet will take and they have different holds for different joints um and they'll take and and bend and flex that um joint for 30 seconds sometimes a minute and then they'll release and have the horse be trotted off right away so they can see if that horse seems extra sensitive after flexing that joint um to try to pinpoint if there's an issue in a joint or a bone or um um the flexion test is to check joint injuries um but that's what that image is here so um that was done on my mayor we uh this is her um so we did the lameness exam they walked or I should have I halfway into this is when I I was like I should use this as a case study so there's not as much content as I was hoping for but hindsight's 2020 next time I take her in I'll take more content but um so the vet trotted her off and she was very very lame and this left hand at the jog so much so that he we just jogged her for a little bit like hard way at all um and we brought her right in to start x-raying her um well we jogged her a little bit and then he did a little bit of a flexion test um and then we took her in for x-ray so um so it kind of depends on what the vet find sometimes they'll go into um a nerve block and so in this case uh uh we [Music] did this flexion and so um we then did the flexion test good we're still sharing my screen my screen share like blinked that's why I paused right there because I wasn't sure if it actually still um showing all the right image but any who so we did this flexion test and so from here um we went into x-rays on the horse because we thought I had seen this horse had seen a chiropractor a couple times and like a massage therabis kind of person everybody thought she had an issue in her stifle so uh let's go back to to we everybody thought she had an issue in this joint up here high in her leg and so we went into X-rays and so we x-rayed her stifle joint it was clean and so then we just started doing x-rays down the body we did stifle Hawk fetlock and coffin bone so we did quite a bit of xrays on this may and all of her joints looked really good and so then it was like well um we ran into the issue of okay now what it's not the joint issues that we all thought it was and so the chiro fractor thought it was a joint issue the massage therapist thought was a joint issue and the vet after his lameness of V he also thought it could be a joint issue he had felt some um sensitivity in the lower part of her foot but he thought also was higher up and so after we didn't run into any luck finding anything with the x-rays then we went into doing a nerve block and so this is my mayor um that's Dr Matt and so what a nerve block is is when they'll put a reg anesthetic into part of the leg um and what that does is it blocks the nerves right and so it makes if that horse has pain um that anesthetic will you know numb the area and so the horse won't be in pain from that joint down so we always start low in the leg and then work the way up and so um he started low in her fet Lock And if um you know he puts the nerve block in her fet lock and she trots off way more sound we can say okay we know that that pain must be lower down in the leg because we numbed that part of her leg and she was off she was she trotted off more sound um and so that's what he did and um you can see here just some restraint methods while we're sitting here this is a good time to talk about it is this mayor is in a set of stocks um so you can see we've got this closed behind her these stocks open on the sides every side opens and the front and back can open as well so if there's an emergency we need to get get this horse out horse gets hung up or something all the sides of this come apart um and my May stood so good for everything the ultrasound um the X-ray she didn't move a muscle they didn't have her in the stocks for the x-rays like she stood perfectly still until he went to do the nerve blocks and I've had her nerve blocked before years ago and I knew she was not going to be happy about it um and so we've got her in the stocks here we have a twitch on her and then you can't see but there's actually someone standing on the other side of this horse who's pushing her hip over pushing her hip towards Dr Matt so that that mayor can't lift her leg and kick out um this took a while this Mary hated this and um yeah it was not fun so we put the nerve block in her fet lock so we knew was the back left leg we thought hey joints are clear must be um but there's still an issue going on so maybe it's a soft tissue is soft tissue issue um because our x-ray showed us you know Bone and Joint and there was no issue there so put the nerve block in and then took her and walked her out afterwards and we can see here she's not 100% sound but if we look at that back left leg she's moving fairly sound um and so the nerve block has to sit in for about five minutes so this is a few this is about 5 minutes later um and when she Trot it off she Trot it off much more sound as as well so um that let us know okay the issue is likely something lower down in the foot and since we know her joints are clear down in the foot now it's time to move on to an ultrasound so we'll learn more about Diagnostic Imaging in the coming weeks but um uh ultrasound allows us to look at soft tissue um and so the ultrasound um lets us know where the soft tissue injury is and the severity of it and so since we had localized that pain due to the nerve block we knew it was in the fet lock or lower and so that's where Dr Matt started his ultrasound um and so ultrasound would let us see where it is how bad it is and this is not her image um but her image looked very similar to this so this is her deep digital flexor tendon and we can see this black mark through here um and so that is showing us where that tear is and so hers was about like this um I was going to hers actually went all the way so it was like black through here and all the way through her leg here about like so and um so not great um and so as he moves that ultrasound up and down he couldn't see because it goes down into the foot like into the hoof wall right um or or below the hoof wall I should say he wasn't able to see quite how far down it went but we definitely knew it was below the fetlock and it was a deep digital flexor tear um so the ultrasound was the right type of Imaging device to get us that information and so in discussing with Dr Matt um that tear um we were able you know he thinks it's something that's actually been there for a while and she's been coping with it okay um and kind of hiding it um and that's why everybody kind of thought us higher up in the leg and so anywh who really fun to find that out that it was actually a deep digital flexor tear um but I want to show you this next image is super cool so um this is that same ultrasound from a different horse not my horse um but they did this study on these horses and did this thing called a tenoscopy put into the horse's leg and so here we can see this is this image is a camera image of this same tear on this horse so you can see here here's all our little fibral we talked about um in our tendons that um are all connected together in those bundles right and so here we can see this actual tear in this deep digital flexor tendon so isn't that crazy this camera view you can see all those little tendrils that have ripped um and this camera is put at the base of this horse's fetlock and it's directed proximally so it's it's at the base and it's looking up like towards the top of the leg here's like the top and this is running here um isn't that just so that just image to me is just mind-blowing and um here's another one since this same study they tenoscopy that we're looking like if we're looking straight up the horse's leg with that camera we can see here the Deep digital flexor um and then here is a tear on the tendon sheath so that little protective sheath that goes all the way around the tendon we've got a tear there as well and this is the xray image of that so isn't that just so wild that you can get a camera and put it inside a horse's leg and look at that so crazy um so anyway so my mayor's diagnosed with a deep digital flexer tendon tear so now what what are the treatment options she looks like she's dead she's just resting she loves her stall time um so um soft tissue injuries take a long time to heal they can depending upon the surity and so stall rest is the first order of business and the horse can be on stall rest for three months nine months a year really depends but the first thing we're going to try to do is limit the amount amount of stress on that um tendon or ligament whatever is injured give that horse time standing still and then the horse will be put on some anti-inflammatory medications so um but banamine equo and surpass are all anti-inflammatory medications most of us are probably most familiar with but um it's kind of like horse Tylenol U and then we have banamine as well banamine is used more of course is colicking and equioxx is what we use if we need a horse that needs but essentially for a long period of time because what but actually does will go into the details of it later in the semester but VI helps with um inflammatory response but it also shuts down the cells in the horse's stomach that produce mucus to keep um the stomach acid from eating away at um the upper section of their stomach essentially and so if you give a horse be for too long they're very likely to develop ulcers because their mucosal production and their stomach slows way way down and so if we're going to be putting a horse on an anti-inflammatory medication and they need it for a prolonged period of time bets will recommend equioxx um and then surpass is an anti-inflammatory ointment that is put directly on um the skin of the area that's outside the injured um tendon or ligament so my that subscri or prescribed not subscribed prescribed equo um for 3 weeks and then surpass as an ointment to be put on um daily and so once the inflammation has gone down in um that soft tissue injury the horse can begin active Rehabilitation um and so that could be anything from the horse can be handw walked regularly the horse can go into therapy sessions um aquatherapy that kind of stuff it can start slowly rehabbing and building back up but again until that inflammation goes down there's nothing to be done except let the area just kind of calm down um and we already kind of touched on the time to Hill it depends on the severity of the injury the location and some horses you know you put them on stall rest and they're starting to heal and then you know they buck and kick in their stall because they're excited and then you're kind of starting back over um and so it really depends on the horse too if the horse is able to you know stay quiet stay fairly you know in Mobile in the stall and this mayor we'll see how she does she's got her checkup ultrasound coming up in a couple weeks um and so my vet wants to do ultrasounds of her every 30 days and so um that's coming up here soon we're about at the 30-day Mark now and so some alternative therapy measures we can do on soft tissue injuries would be Shockwave therapy laser therapy or therapeutic ultrasound um all of those just increase um blood flow to the area they can really help with regenerating tissue um but they can be expensive so it kind of depends some shock wve my vet recommended shock wve therapy it sometimes can cost anywhere from like a100 to $200 a session and they recommend multiple sessions a week um so that's not always a viable option um and so that's something to keep in mind as we move I mean in this class we are assuming the roles of vetmed professionals right and so that's a discussion that um either your vet will have or if you become a vet um you will have to have with your clients of what is realistic in terms of their um finances in the treatment process for these horses so not everybody's going to want to spend you know $200 bucks or 300 bucks a week on Shockwave therapy treatments for a horse that just lives in the pasture right um some people have the money to do that and they want the horse to be healed as quickly and as well as possible and they're willing to drop you know several thousand dollars on the healing process and we'll take a look in a minute about what I decided on for now um but that's a discussion that has to be had and needs to be had with your client about what they're comfortable with with and kind of you know be realistic about okay you don't you know these are alternative therapy things that they're proven to help but also you know maybe that horse has just as good a chance as being sound without them so let's talk quickly about just the healing phases so like we talked about um the inflammatory phase is phase one so that's associated with the initial injuries so whether it's due to um a sudden trauma you know a horse kicked something a horse got its leg cut caught in the fence whatever they pulled something they you know their back leg hit the front of or hit their front leg um we've got that inflammatory phase where that leg is reacting to that trauma and then phase two is the proliferative phase so this is when the inflammation goes down right we talked about until that inflammation goes down there's not much we can do in terms of um rehabbing but once the inflammation goes down then the body will start to create new blood vessels and new cells that help create new tissue to heal um the injury so this is just a venogram of just showing blood flow to the foot I just thought it was a cool image for you guys to see um and then phase three is the maturation or remodeling phase so that is the time when the tissue is actually healing so in the proliferative phase it's new blood vessels new cells are being made that are going to heal and then phas three is when we're actually that tissue is actually healing um so in summary um we need to be able to Define what soft tissue is identify the various tendons and ligaments in a horse's leg and then be able to diagnose some of these more basic um injuries so knowing the difference between tendonitis versus desmitis B pend then um if I showed you an image of this versus this you should be able to tell me which one is associated with suspensor ligament injury versus this one would be um a bow tendon either superficial digital flexor or deep digital flexor um and being able to talk about in general treatment options you know so treatments go here this is what we would be doing regardless of where the injury is we're going to do stall rest we're going to give that horse some anti anti-inflammatory medications and then look into active rehab and I just wanted um in this kind of case study of my maror to kind of take a look at um the cost associated with this so the only one we are not going to take a look at is Nigel because this was this is his uh his um this was his um allergy shot that had nothing to do with this I just bought another one while was while I'm already spending all this money might as well spend more okay so this is what she got so the ultrasound itself just the ultrasound of her left hind leg cost $217 the Nerf block was $27 and then the um radioraps we did four single views um and so those were about 60 bucks a piece for each um each x-ray was about $60 the lamus exam just him um you know trotting her having her be Trot around doing the flexing and palpating that was almost $90 um so we worked our way like this right we did a $90 lameness exam and then we move so that was just so he could say okay I think it's this leg then we moved into some X-rays and every x-ray he took so he took an x-ray of a stifle it came back clean that was $60 65 bucks that was spent and it showed nothing and so it was 65 bucks every time he clicked that um machine and then those all came back clean and so then we had to move into doing a nerve block to try to isolate where it was the nerve Block's only $27 um but the ultrasound was 217 bucks for him to take that ultrasound machine and locate that that tear and her deep digital flexor and then that uh tube of the surpass anti-inflammatory cream was uh 120 bucks and then her um equo meds came out to 40 bucks so the money the the expense for this this type of exam adds up quickly and you can see the most expensive part of this is those diagnostic images because they have to be able you know they have to pay for not only the machine um but the software that goes to run the machine you know the the maintenance it costs to maintain those machines as well and so um as as silly as it seems not silly I guess it's just good to kind of wrap our heads around the reality of of the price of things a lot of times we can think oh my gosh this vet charged me so much money but we started with the cheapest option we could find which is just dra it around see what that's like right and then we went into what we thought was the most obvious problem which was a joint issue and so we had to do x-ray to determine the joint issue that didn't get us anywhere so now we've got to move into Nerf blocks and ultrasounds and all that kind of stuff so um while it's you know never great to go spend $800 on a um you know a Mustang that's ridden hardly ever um that's what needed to be done and um so you know my vet talked to me about doing options like doing the Shockwave therapy and things like that and I talked to um a family friend of mine Dr Willard who's um a vet and the chiropractor that saw this horse before and we talked about the shock wave thing as well and um he said it could be helpful but you know he was going to kind of ask around and price out some options for me to see if maybe that would be something you know that was reasonable so for me this is not a show horse this is a horse I hardly ever ride her and part of the reason I haven't ridden her recently is because she has been lame um you know and the advice of um uh people that I knew and my own kind of um thought was this is a pasture horse you know I hardly ever ride her when I have arrested her she seemed to have gotten a little bit better and then I went out of the country for a month and I came back and she was very very lame and so that's when I was like okay we need to take her into the vet if this had been um a show horse a school horse we would have taken her in sooner probably um the vet does think she has some other things going on that may contributed to like her her mild lameness before I went out of the country but anywh who just a long roundabout way of saying that vet Med is um it's not always clearcut right it's an exploratory thing you're not always going to look at a horse and trop them off and be like I know what the issue is um and that's where you know the more digging you have to do to find the problem the the more the bills add up and um it's good to be able to be able to have the conversations with your clients about what you're doing why you're doing this procedure how much it's going to cost if there's options like hey I'm fixing to do a $217 ultrasound if you don't want to pay for that here's what we could do instead you know I have a relationship with Dr Matt you know we we know each other for a while now he knows that I'm familiar with um the protocols and the things that go on and so um we have a a a working relationship enough that he he knows and is aware of what I do and don't want to do with these horses I want these horses to be comfortable I want to take good care of them I do not want to spend a grand on Shockwave therapy for this particular horse and he's understanding of that so anywh who that was a long roundabout way of going through all that stuff so let me get out of this um and believe that's all for part part two