Plan Treatments And Time For Lay-Ups

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A horse with an old injury, no matter how well healed, will always have a weakness at that location. Extra care in the form of bandaging, massage, liniments and protective boots is a good investment in preventing re-injury. Most important is to keep a close eye on the area, even if the horse has been sound a long time. Early warning signs of heat and/or swelling will tell you to back off and assess the area before serious re-injury occurs.

New injuries will give you similar warnings, and all horses being regularly worked should have their legs checked religiously, both morning and night. Tendons and ligaments have a nasty habit of not showing much for the first 24 or even 48 hours after they are overworked, so be cautious the first day or two after a hard work.

Fatigue is the leading cause of serious injuries. As the horse tires, muscles and ligaments don’t support the joints as intended. Reflexes slow and gaits become less steady. If speed and/or uneven ground are added to this equation, injuries easily occur. Be alert to breathing patterns, amount of sweating and subtle changes in how smoothly the horse is going — all red flags to ease up.

How Long'
Once a horse is injured, one of the most common first questions is how long will it take the horse to recover. Closely related are questions about horses who are dealing with plateaus, set backs and complications in their struggle to return to full work.

It’s important to realize there are no set formulas when dealing with injuries. Young horses, horses receiving extra attention and care, and horses with injuries that are perhaps not as extensive as another’s may all sail through their lay-ups in record time. But for others, inadequate nutrition, concurrent stress, existence of other chronic problems and even the horse’s personality may cause a delay to full work.

Diagnosis
If there is one thing that has the greatest impact on the success of the lay-up treatment program it is accurate diagnosis. There is no substitute for knowing what you are trying to treat. A horse with a fat tendon may “only” have a severe sprain and little actual tearing of the tendon fibers. But the only way to know for sure is to have a diagnostic ultrasound done. Size, heat and degree of pain in the leg are not necessarily accurate indicators.

A foundered horse has ample justification to be lame and a prolonged recovery is expected. However, an undetected ascending infection along the white line can seriously complicate his recovery. X-rays, ultrasound, even specialized techniques such as bone scan sometimes must be done in order to formulate a sensible lay-up plan.

Acute Treatment
Acute treatment almost always involves direct veterinary intervention and concentrated attention. Splint-bone fractures are removed, other fractures screwed, abscesses pared out, and so on. While these procedures are important to the eventual outcome, they are only a small part of the total treatment. Both delay in getting diagnosis/acute treatment and improper care of the horse in the weeks or months that follow can — and do — change the expected outcome from the acute care.

Ongoing Treatment
Care of an injury after veterinary treatment often means the difference between success and failure, partial return of function or full return to work. Pushing the horse too soon is certainly the major mistake made most often, but even basic care, such as improper bandaging, ignoring correct foot care, inadequate nutrition and so on, all interfere with healing.

Return to Exercise
The road from stall confinement to full work is a long one for many injuries. Often the horse is as sick of his confinement as you are of waiting, but the adage “time heals” holds true. You must give the body enough time to repair the damage.

Don’t mistake disappearance of pain, heat and swelling for a return to normal, and don’t let the horse’s understandable impatience with getting back to being a normal horse deceive you into assuming he is capable of doing more than he should at any stage.

Complications
Complications relate directly to the type of injury (e.g. infection of a puncture wound) as well as mistakes in management. By far the most common complication/set back is re-injury because the horse was pushed too far too fast.

However, you should be prepared to expect some reactivation of inflammation, pain and swelling in many types of soft tissue injury as the horse progresses to each higher level of work. This is normal and part of the remodeling of new tissues in a way that will strengthen them to carry normal loads.

Indicators of Healing
As we said, the horse’s attitude and the outward appearance of the injury may be deceiving. Devise a set plan with the treating veterinarian for follow-up testing. For example, an injured tendon or a ligament needs repeated ultrasound examinations, perhaps every month or so to start and then before beginning any significant increase in work, in order to assess real healing.

Bone injuries should be confirmed to be completely healed before work resumes. Even serious wounds can benefit from a veterinary check to make sure healing beneath the surface seems to be progressing as well as healing at skin level.

Note: We’ve included non-hoof problems here. Hoof-related lay-ups and disease/illness layups will appear in upcoming issues.

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Abscess (not foot)

PROGNOSIS: Good to excellent with proper care.

ACUTE TREATMENT: Hot packs to encourage drainage; surgical incision and drainage by vet if needed.

ONGOING TREATMENT: Continued hot packing until wound healing and drainage stopped. Flushing as directed by vet. Injectable or oral antibiotics as directed by vet. Bandaging as directed by vet. Take temperature twice a day.

STALL TIME: Until wound has completely healed or can be protected when horse is out of stall. Days to weeks, depending on size of abscess.

PADDOCK TIME: See stall time.

WALKING: OK

SLOW WORK: After wound healed or as cleared by vet.

FULL WORK: After complete healing.

POSSIBLE COMPLICATIONS: Spread of infection locally or via blood stream. (Symptoms of fever, loss of appetite, increased local swelling.) Wound may heal before abscess is completely drained; abscess will reform.

INDICATORS OF HEALING: Shrinking of abscess size, drainage stops.

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Arthritis, newly diagnosed

PROGNOSIS: Good to guarded with removal of all contributing causes and intensive treatment.

ACUTE TREATMENT: Rest. Anti-inflammatories for short course (3 days). Ice/cold hosing/cold poulticing to control inflammatory reaction. Intra-articular injection as determined by vet. Course of injectable Adequan or Legend. Joint nutraceutical support.

ONGOING TREATMENT: Joint nutraceutical support. Avoid excessive body weight. Rest for 4 to 6 weeks (no formal work). Correct any shoeing problems.

STALL TIME: 1 to 2 weeks or until inflammation controlled.

PADDOCK TIME: After 1 to 2 weeks.

WALKING: Begin 3 days after intra-articular injection or when acute inflammation controlled. 15 to 20 minutes twice a day to start.

SLOW WORK: In 4 to 6 weeks at the earliest.

FULL WORK: In 6 to 8 weeks at the earliest.

POSSIBLE COMPLICATIONS: Disease will progress if insufficient rest, inadequate treatment, poor shoeing, uncorrectable conformation faults causing problem.

INDICATORS OF HEALING: Degree of soundness.

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Blunt trauma to bone

PROGNOSIS: Excellent with proper care and no fracture.

ACUTE TREATMENT: Ice ASAP and for first 48 hours, anti-inflammatories for 24 hours, compression wrap. X-rays indicated if lameness is severe.

ONGOING TREATMENT: Continue ice until swelling is resolving. Compression with soft inner wrap to control edema and hematoma.

STALL TIME: A few days to a week, until lameness improves.

PADDOCK TIME: OK after swelling improved if horse is sensible.

WALKIN G: After first 72 hours if swelling controlled.

SLOW WORK: May need to wait 10 days to 2 weeks for bone pain to resolve.

FULL WORK: Not for at least two weeks.

POSSIBLE COMPLICATIONS: If swelling slowly increasing, especially after a week and/or if lameness marked and/or extreme local tenderness get X-rays. May have bone chip or crack.

INDICATORS OF HEALING: Decrease in local swelling and tenderness; improved lameness.

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Blunt trauma to soft tissues

PROGNOSIS: Good to excellent with appropriate care and if no extensive deep scar tissue.

ACUTE TREATMENT: Ice and/or cold-water hosing ASAP and for as long as possible during first 48 hours; analgesic/anti-inflammatory (Banamine preferred) for first 24 to 48 hours; gentle compression if area can be wrapped.

ONGOING TREATMENT: Alternate cold and heat treatments after first 48 to 72 hours to control pain and encourage circulation.

STALL TIME: Highly variable, depends on extent of the injury; minimum of 72 hours to avoid disrupting any damaged blood vessels and causing larger hematoma.

PADDOCK TIME: Varies. Consult with treating vet about exam findings.

WALKING: Not for first 72 hours; then as vet orders.

SLOW WORK: Not for at least a week or two.

FULL WORK: Varies. Consult with treating vet. Areas subject to a lot of movement will require longer to completely set up.

POSSIBLE COMPLICATIONS: Reactivation of bleeding; can occur deep into the tissues and show few outward signs.

INDICATORS OF HEALING: Local tenderness and heat disappear; may be able to follow healing with ultrasound in some areas.

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Bowed Tendon

PROGNOSIS FOR FULL RETURN OF WORK: Good for light to moderate work; guarded for speed work and jumping.

ACUTE TREATMENT: Rest, ice, anti-inflammatories, support wraps; correct foot angle.

ONGOING TREATMENT: Controlled exercise, support as directed, you may try PMF therapy, laser, electrical stimulation. High-quality diet (especially high-quality protein sources. Be sure lysine and trace minerals are adequate in the horse’s diet and consider antioxidant supplementation, especially vitamin C.

STALL TIME: Acute phase only. Usually days, may be weeks depending on severity.

PADDOCK TIME: None until cleared by vet, usually by 3 to 6 months at earliest.

WALKING: When cleared by veterinarian, in days to weeks; important to good healing.

SLOW WORK: In 9 to 12 months.

FULL WORK: In about 12 months.

POSSIBLE COMPLICATIONS: Flare-ups of inflammation common when reintroducing work. Treat as for acute injury, stall rest or decreased exercise as directed, vet exam if not resolved in three days.

INDICATORS OF HEALING: No pain on palpation, tendon returns to looking more like normal. No signs of inflammation with exercise. Only reliable measurement is ultrasound exam.

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Bucked shins

PROGNOSIS: Good to excellent with proper care and no fracture.

ACUTE TREATMENT: Ice/cold water/cold poultices. Rest.

ONGOING TREATMENT: Continue cold therapy until shins remain cold between treatments.

Have diet analyzed to be sure all minerals are in appropriate amounts (not too high or too low) and balanced. Rest. You may try ultrasound, PMF therapy, laser to encourage healing. Rolled/square toe encourages easier breakover.

STALL TIME: 30 days average.

PADDOCK TIME: None before 30 days.

WALKING: May begin after acute inflammatory stage is over (legs stay cool). 20 to 30 minutes twice a day of hand walking.

SLOW WORK: After approximately 30 days.

FULL WORK: After 45 to 60 days.

POSSIBLE COMPLICATIONS: Problem will recur if not given adequate rest or if same training methods are resumed. Fracture lines may be present but missed on regular X-rays. Severe lameness initially or with a recurrence of problem is indication for repeat X-rays and/or specialized techniques (bone scan or Xeroradiographs)

INDICATORS OF HEALING: Soundness (of course). X-rays.

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Curbs - plantar desmitis

ACUTE TREATMENT: Rest, ice, anti-inflammatories, correct foot angle.

ONGOING TREATMENT: Liniments and hock sweats. Vet may recommend counter irritation or freeze firing.

STALL TIME: Days to weeks, depending on severity.

PADDOCK TIME: When cleared, days to weeks. Avoid if horse “acts up” too much.

WALKING: When cleared, days to weeks.

SLOW WORK: When tolerating walking, usually after 3 to 4 weeks of no signs of inflammation on walking program.

FULL WORK: Weeks to months. Stubborn cases may require prolonged turn-out, especially if a young horse

POSSIBLE COMPLICATIONS: Incompletely healed ligaments may flare up again when work introduced that requires horse working well underneath himself.

INDICATORS OF HEALING: Ultrasound only reliable proof of healing.

PROGNOSIS: Good for full return to work but conformation defects predisposing to curbs may also predispose to other hock problems.

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Osselets

ACUTE TREATMENT: Rest, ice, anti-inflammatories. Correct hoof angle.

ONGOING TREATMENT: Support wraps or boots if ordered

STALL TIME: Days to 2 weeks, until acute inflammation is gone.

PADDOCK TIME: Not recommended until acute inflammation is gone.

WALKING: Within a few days.

SLOW WORK: Vet’s decision, after all acute inflammation gone and horse is tolerating walking; usually within 3 to 4 weeks.

FULL WORK: 1 to 2 months.

POSSIBLE COMPLICATIONS: Slow recovery or greatly increased signs with slow work may be caused by coexisting problems in the joint - e.g. chip fracture.

INDICATORS OF HEALING: Disappearance of heat, pain, swelling. Joint stays cool and pain-free with light work.

PROGNOSIS: Good for full return to work if predisposing shoeing is corrected (long toes, low heels) and conformation not a major factor (overly long pasterns).

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Osteochondrosis

ACUTE TREATMENT: Stop formal training, if any. Evaluation for possible benefit from surgery (only indicated for loose pieces of cartilage that are causing irritation). Initial intra-articular therapy with Adequan or hyaluronic acid.

ONGOING TREATMENT: Long-term intramuscular/intravenous Adequan or hyaluronic acid. (Series of 6 injections, 1 to 2 weeks apart.) Long-term joint nutraceutical support with glucosamine and chondroitin sulfate supplements. Meticulous attention to mineral amounts and balance in the diet.

STALL TIME: For 1 to 2 days after intra-articular injection. For 5 days to 2 weeks after joint surgery (depends on extent and nature of surgery).

PADDOCK TIME: Turn out, preferably in large field to encourage exercise, for two months.

WALKING: Turn out preferred. If not possible, must be walked minimum of 30 minutes 2 to 3 times a day to encourage joint health.

SLOW WORK: After 2 months.

FULL WORK: After 3 to 4 months.

POSSIBLE COMPLICATIONS: Failure of lesions to heal. Problem may surface in other joints.

INDICATORS OF HEALING: Soundness. X-rays, Xeroradiographs, bone scan or diagnostic arthroscopy (scoping joint) to follow progression of healing.

PROGNOSIS: Guarded, but some horses have shown dramatic improvement and healing of lesions with intensive therapy.

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Quittor, collateral cartilage necrosis

ACUTE TREATMENT: Tetanus vaccine. Clip entire area around opening and on pastern. Vet may anesthetize and probe the opening for loose pieces of cartilage. Daily flushing with solution of vet’s choice (e.g. iodine, peroxide, enzymes, silver nitrate) followed by saline. Bandage to protect area. May require surgery to remove dead and infected cartilage.

ONGOING TREATMENT: After drainage stops keep clean and covered with antibiotic and bandage until healed.

STALL TIME: Keep confined to clean stall until opening is healed, usually several weeks, with hand walking only.

PADDOCK TIME: Only after opening is healed (2 weeks or more after all dead cartilage removed).

WALKING: When advised by veterinarian. Usually after drainage has stopped or judiciously earlier to encourage circulation and drainage.

SLOW WORK: After opening has healed (2 weeks or m ore after all dead cartilage removed.)

FULL WORK: When tolerating slow work easily.

POSSIBLE COMPLICATIONS: Opening may close before all dead cartilage is removed; problem will recur.

INDICATORS OF HEALING: Opening becomes more shallow and heals.

PROGNOSIS: Good to fair, all unhealthy cartilage must be removed.

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Ringbone, high

ACUTE TREATMENT: Icing, pressure, anti-inflammatories, rest.

ONGOING TREATMENT: Normal foot angle for the horse’s anatomy, be on the alert for signs of reactivated inflammation.

STALL TIME: Week or less.

PADDOCK TIME: When inflammation is controlled.

WALKING: In about a week.

SLOW WORK: In two weeks.

FULL WORK: In about four weeks.

POSSIBLE COMPLICATIONS: Reactivation of inflammation.

INDICATORS OF HEALING: Heat, swelling and pain gone; X-rays show no active bone inflammation.

PROGNOSIS: High ringbone (does not involve coffin joint) is usually the result of trauma and has an excellent prognosis for full work; may leave a visible swelling.

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Ringbone, low

ACUTE TREATMENT: Rest, short course of anti-inflammatories or intra-articular injection (as determined by vet), begin Adequan or injectable hyaluronic acid product.

ONGOING TREATMENT: Rest, continue injectable joint support drugs, oral joint nutraceuticals, restore normal angle and normal heel and toe length, may round or square toe of shoe for easier breakover, cold poulticing of feet.

STALL TIME: Minimum one week or until horse is more comfortable and necessary changes have been made to feet/shoes.

PADDOCK TIME: After 1 to 2 weeks.

WALKING: After 1 to 2 weeks.

SLOW WORK: In 3 to 4 weeks. Wait until horse has been reset for the first time with any corrections to trimming and shoeing. Stop if lameness returns.

FULL WORK: In 6 to 8 weeks.

POSSIBLE COMPLICATIONS: Recurrent lameness if you begin work too soon. Ringbone will be progressive unless feet are corrected and horse given proper medical/nutraceutical full support.

INDICATORS OF HEALING: Return of soundness; X-rays show no active bone changes.

PROGNOSIS: Guarded. If diagnosed early and correctly treated (especially correction of feet), prognosis is much better.

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Sesamoid fracture, apex

ACUTE TREATMENT: Ice, anti-inflammatories, support, surgery and/or casting.

ONGOING TREATMENT: With surgery, cast or heavy support wrap for 10 to 14 days, support wraps for another 30 days. Complete rest with cast change every 2 to 3 weeks if cast only, adequate diet with careful attention to mineral levels and balance. PMF therapy may speed healing.

STALL TIME: 12 to 16 weeks if cast is only treatment (will be in cast this long).

PADDOCK TIME: Usually not before 10 to 12 weeks.

WALKING: Controlled hand walking in 4 to 6 weeks after surgery, but not for at least 3 to 4 months if casted only.

SLOW WORK: Resume very slowly after fracture is confirmed on X-rays to be healed and all signs of inflammation and pain are gone. Leg will be very weak.

FULL WORK: 5 to 6 months.

POSSIBLE COMPLICATIONS: Infection (surgery). Nonhealing. May also be damage to ligaments in the area.

INDICATORS OF HEALING: Inspection of the leg; X-rays.

PROGNOSIS: Poor if large portion of bone was removed; guarded-to-favorable if large fragments screwed back in place or if a small portion of bone was removed.

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Sesamoid fracture, base

ACUTE TREATMENT: Stall rest with heavy-duty support wrap (e.g. Robert Jones dressing) or cast; trimming/shoeing as for sesamoiditis.

ONGOING TREATMENT: Rest, adequate diet with attention to mineral amounts and balance.

STALL TIME: 6 to 8 weeks.

PADDOCK TIME: As dictated by X-rays and degree of lameness; after 9 to 12 weeks if attempting to get healing.

WALKING: Hand walk after 9 to 12 weeks.

SLOW WORK: Possibly never; only after healing.

FULL WORK: Possibly never; only after healing.

POSSIBLE COMPLICATIONS: Non-healing.

INDICATORS OF HEALING: X-rays.

PROGNOSIS: Very poor. Horse’s career under saddle is probably over.

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Sesamoiditis

ACUTE TREATMENT: Rest, anti-inflammatories, icing, support wraps, keep angle of foot above 52 degrees and make sure horse has adequate support through the heels. Discuss the use of an egg-bar shoe for support with your farrier and veterinarian.

ONGOING TREATMENT: Prolonged rest and support; close attention to mineral levels and balance in the diet.

STALL TIME: 2 to 6 weeks. Keep in stall until all heat, swellling and pain are gone or dramatically decreased.

PADDOCK TIME: No unsupervised exercise until X-rays confirm inflammation no longer looks active (usually about 6 to 12 weeks).

WALKING: After two to six weeks, may begin short sessions of hand walking. Must keep animal controlled at all times.

SLOW WORK: In 9 to 12 months.

FULL WORK: After 12 months or more.

POSSIBLE COMPLICATIONS: Sesamoid fracture if work is not stopped. Horses with sesamoiditis also commonly have splint and/or suspensory problems at the same time.

INDICATORS OF HEALING: X-rays best indicator. May gauge advisability of walking or turn out on external signs (heat, swelling, pain)

PROGNOSIS: Poor for return to full work. Best chance of full recovery if horse is given lots of turn out (at least a full year of turn out suggested).

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Sidebone

ACUTE TREATMENT: Rest. Restore balance of foot. Anti-inflammatories if indicated for active cases.

ONGOING TREATMENT: Careful attention to trimming and balance of foot.

STALL TIME: Up to a week.

PADDOCK TIME: After a week.

WALKING: After a week.

SLOW WORK: In 2 to 3 weeks.

FULL WORK: In 3 to 6 weeks.

POSSIBLE COMPLICATIONS: Progression of condition.

INDICATORS OF HEALING: Soundness. X-rays show no further calcification.

PROGNOSIS: Usually good. Sidebone rarely causes lameness unless it was caused by trauma.

Most common cause is an unbalanced foot. Check for other conditions that may be making the horse land unevenly.

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Splints, splint bone periostitis

ACUTE TREATMENT: Rest, ice, anti-inflammatories.

ONGOING TREATMENT: Mild counter irritant if ordered; may try laser, PMF, ultrasound. Weight reduction if needed. Be certain calcium and phosphorus in diet are balanced and not excessive. Adequate trace minerals.

STALL TIME: Days to weeks, until acute inflammation is gone.

PADDOCK TIME: OK if horse is quiet; otherwise avoid in favor of controlled exercise.

WALKING: Begin when inflammatory reaction is starting to quiet, usually within days with intensive therapy.

SLOW WORK: About a month, when all signs of inflammation are gone.

FULL WORK: Usually within two months.

POSSIBLE COMPLICATIONS: Continued work may cause splint fracture or increasing size of the splint, as can resumption of work too early.

INDICATORS OF HEALING: X-rays are best but changes seen on X-rays lag weeks behind true condition of the bone. Repeat indicated anytime condition worsens when appropriate measures are being taken to rule out fracture. Bone scan or Xeroradiography if fracture suspected but no clear on X-rays.

PROGNOSIS: Good unless severe conformation faults are causing the problem (offset knees).

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Splint fractures

ACUTE TREATMENT: Surgery.

ONGOING TREATMENT: Bandaging and inflammation control as directed by surgeon.

STALL TIME: 7 to 10 days, until sutures out, for uncomplicated fractures.

PADDOCK TIME: None until slow work has resumed.

WALKING: Begins once sutures are out, if all signs of inflammation are controlled.

SLOW WORK: In 4 to 6 weeks or as directed.

FULL WORK: In 8+ weeks, as directed.

POSSIBLE COMPLICATIONS: Infection of surgical wound. Excessive callus formation at surgical site from excessive movement during the lay-up period will result in a bony lump. Infection or callus may secondarily involve the adjacent suspensory ligament.

INDICATORS OF HEALING: Decreasing heat, swelling and pain.

PROGNOSIS: Excellent for full functional recovery if suspensory ligament is not involved. Good to guarded for perfe ct cosmetic result.

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Suspensory ligament desmititis

ACUTE TREATMENT: Rest, ice, anti-inflammatories, support wraps; correct foot angle.

ONGOING TREATMENT: Controlled exercise, support/compression wraps as directed, may try PMF therapy, laser, electrical stimulation, ultrasound.

STALL TIME: Acute phase only; usually days, may be weeks depending on severity.

PADDOCK TIME: None until cleared by vet, usually by 3 to 6 months at earliest.

WALKING: Begins as soon as cleared by vet, in days to weeks; important to good healing.

SLOW WORK: In 9 to 12 months.

FULL WORK: In about 12 months.

POSSIBLE COMPLICATIONS: Flare-ups of inflammation common when reintroducing work.

Treat as for acute injury, stall rest or decreased exercise as directed, vet exam if not resolved in 3 days.

INDICATORS OF HEALING: No pain on palpation, ligament returns to looking more like normal. No signs of inflammation with exercise. Only reliable measurement is ultrasound exam.

PROGNOSIS: Fair-to-good for light-to-moderate work; guarded for speed work and jumping.

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Thoroughpin

ACUTE TREATMENT: Ice. For cosmetic results, may have fluid drained +/- local injection of corticosteroid.

ONGOING TREATMENT: Raising angle of the back feet may help relieve hock stress. Compression for first 3 to 5 days (roll of gauze wedged into thoroughpin area then a figure-eight wrap.

STALL TIME: 3 to 5 days.

PADDOCK TIME: None for two weeks.

WALKING: After 3 days.

SLOW WORK: In 1 to 2 weeks for best cosmetic results.

FULL WORK: Reintroduce gradually; avoid collected work or jumping until cleared by vet.

POSSIBLE COMPLICATIONS: Local infection. Fluid may re-accumulate despite any treatments.

INDICATORS OF HEALING: Normal appearance.

PROGNOSIS: Excellent for any work. Guarded-to-good for best cosmetic results.

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