# Medicating tendon sheath - what exactly does that mean? Risks et



## acw295 (13 July 2016)

Hi all, I have a previous thread regarding my pony's inflammed tendon sheath (tensynovitis) in her near fore http://www.horseandhound.co.uk/forums/showthread.php?731366-Lameness-in-near-fore-thoughts. 

She's almost at the end of 10 days of 2x daily bute with daily ridden walking but I can see no improvement to the inflammation. Vet back out on Friday to review. 

Last time he mentioned that one possible plan of action is to medicate the tendon sheath. What exactly does that mean and what are the risks? He has already ruled out steroids due to lami risk so curious as to what they medicate with? 

They've not yet scanned her and so can't completely rule out tendon injury as well- but the lack of lameness (and lack of pain on palpation) makes vet optimistic it is jut the sheath and not the tendon itself. As she is only lame after flexion vet wanted to try the bute/walking route first before anything more invasive.


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## Scatterbrain (13 July 2016)

A long time ago now, but I'm pretty sure medicating the tendon sheath involved injecting steroids to reduce the inflammation. My boy wasn't lame but had what appeared to be a windgall. Ultra sound scan showed up nothing. No pain on palpation. Medicating did indeed take the inflammation away and I continued to ride until he eventually did go slightly lame. Further scan didn't show up the damage, so I opted for the vet to go in and take a look via keyhole surgery and as he suspected a DDFT injury. He was unfortunately spot on.


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## JanetGeorge (13 July 2016)

I've just had a 5yo here on follow up TLC - he had a 'Lesion of the lateral digital flexor tendon'.  It was treated with Stem Cell Therapy and followed up 4 weeks later with injection of Hyaluronic Acid and Corticosteroid into the tarsal sheath.  Lots of rest and in-hand walking (no turn out for 6 weeks) then turnout into a grass patch half the size of a manege!  He's totted up sound but is still on VERY restricted turnout for more months - and it's cost her a fortune.  But he WAS very lame!


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## Harriettie (13 July 2016)

Hi there (I'm sure we know each other......). My lad has had both hind tendon sheaths medicated in the last 5/6 years. One using IRAP amd the second using HA - both options because I wouldn't use steroids. The only risk was of infection into the tendon sheath from the actual injection, so the site was simply kept covered for a day or so (actually, the other risk is to the vet - of being kicked in the head while injecting). In both instances before treatment he was 1/10 lame with slightly inflamed tendon sheaths, one in one year, the second the next. He is now fully sound, and has been since then. Usual box rest then in hand walking for 8ish weeks, until he took matters in to his own hands and galloped down the road, at which point I gave up and turned him out. He's 21 now and no follow on problems at all.  I'd go for it if I were you.


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## Tyssandi (13 July 2016)

acw295 said:



			Hi all, I have a previous thread regarding my pony's inflammed tendon sheath (tensynovitis) in her near fore http://www.horseandhound.co.uk/forums/showthread.php?731366-Lameness-in-near-fore-thoughts. 

She's almost at the end of 10 days of 2x daily bute with daily ridden walking but I can see no improvement to the inflammation. Vet back out on Friday to review. 

Last time he mentioned that one possible plan of action is to medicate the tendon sheath. What exactly does that mean and what are the risks? He has already ruled out steroids due to lami risk so curious as to what they medicate with? 

They've not yet scanned her and so can't completely rule out tendon injury as well- but the lack of lameness (and lack of pain on palpation) makes vet optimistic it is jut the sheath and not the tendon itself. As she is only lame after flexion vet wanted to try the bute/walking route first before anything more invasive.
		
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 Mine has had 3 steroids in one sheath and 1 in the other,  2 years off and still not up to doing much so retired.  The risk is lami and infection of the tendon sheath after steroids so you need to keep diet bland for a few days after and reduce the grass intake.


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## acw295 (13 July 2016)

TYSSANDI said:



			Mine has had 3 steroids in one sheath and 1 in the other,  2 years off and still not up to doing much so retired.  The risk is lami and infection of the tendon sheath after steroids so you need to keep diet bland for a few days after and reduce the grass intake.
		
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Thanks, yes I'm aware of risks with steroids, she had to have them years ago when she had splint fracture surgery but I'm keen to avoid and this vet has already said no to steroids, so I was curious what they will medicate with instead. She's already on restricted grazing anyway, always is!


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## acw295 (13 July 2016)

Harriettie said:



			Hi there (I'm sure we know each other......). My lad has had both hind tendon sheaths medicated in the last 5/6 years. One using IRAP amd the second using HA - both options because I wouldn't use steroids. The only risk was of infection into the tendon sheath from the actual injection, so the site was simply kept covered for a day or so (actually, the other risk is to the vet - of being kicked in the head while injecting). In both instances before treatment he was 1/10 lame with slightly inflamed tendon sheaths, one in one year, the second the next. He is now fully sound, and has been since then. Usual box rest then in hand walking for 8ish weeks, until he took matters in to his own hands and galloped down the road, at which point I gave up and turned him out. He's 21 now and no follow on problems at all.  I'd go for it if I were you.
		
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Thanks that's useful, will google IRAP and HA options, perhaps that is what he meant. So far vet has said no to box rest as he feels movement more beneficial, so she is in by day and out at night as usual and hacked out in walk. I'd do short box rest if needed, she had 8 weeks in with her splint fracture so I know she can manage it, but at her age I'm as interested in quality of life as much as return to ridden work so if necessary she'll have a year off and a wait and see.

Umm, not sure if we know each other, PM me! Am new to Leics, used to be in Beds/Bucks if that is any help?!


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## applecart14 (14 July 2016)

The risks with any injections are risk of infection entering the injection point although this is neglible and is more likely with an injection into a joint, hence why I have always chosen to take my horse to the vets to have a joint injection purely because its a more sterile environment.

My horse had his tendon sheath injected and I am pretty sure it was with HA and steroid, although it was a long, long time ago so I am not really clear on that.


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## milliepops (14 July 2016)

My horse with tenosynovitis had her tendon sheath medicated with HA and corticosteroids a couple of weeks ago.  This was follow up from a tenoscopy so we did know the extent of the injury. The procedure went as planned, but just to be an odd ball, she had a rare reaction to the HA and was absolutely crippled lame 12 hours afterward. Few days of bute helped her along, but just shows things are never simple!


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## acw295 (15 July 2016)

Thanks for all your input
Vet was out today to review and he is pleased with the progress on bute and walking alone- so we're continuing with gradual increase to work and no further treatment required at the moment. There is potential that it will flare up again and then they'll investigate immediately - but at the minute vet is convinced it was mild tenosynovitis with no tendon damage and that it has responded very well so no need to delve further. There is one visible area that I was worried about (as bigger than her existing windgalls and is one-sided) but it goes down with movement and vet says this is probably going to remain so not to worry about it. There is still some inflammation lower down but he expects this to continue to improve by itself. 

As I am a paranoid owner I got him to give the rest of her a good check over too and he says that apart from some very slight arthritic changes in her hocks (no surprises there as she is 18) she is otherwise as fit as a fiddle and no reason not to just get on with it, although being careful with ground.

So phew. Now we can get on with the hillwork and fittening up. Much more interesting than the 10 days of walking around the village which we were both mightily sick of!


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