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What Can You Do About Bowed Tendons? (Part II)
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Alternative Treatments
There are various other means of treating bowed tendons, including some older methods such as pin firing or blistering. These procedures are designed to interfere with the old scar tissue and artificially improve and increase the circulation through this altered healing process. These efforts have proven to be of little success since they often cause more damage or other scars and adhesions.
Another alternative involves injecting the injured tendon with sodium hyaluronate or glycosaminoglycan polysulfate, substances that have been used successfully to treat joint ailments. Recent studies performed at the Centre for Equine Studies in Newmarket, England, however, suggest that this treatment is ineffective for tendon injuries.
Below we have compiled a small list detailing other options available to the horse owner that are still being studied and evaluated as treatments for bowed tendons.
Surgery
Additional research has been conducted on different surgical options. As with the pin firing or blistering, the goal is to interfere with the healing and “new tissue” formation processes. One of these options includes tendon splitting or grafting, which is intended to encourage increased circulation and “organize new forming tissues.” Unfortunately, this procedure tends to cause more adhesions and additional scarring to form.
A recent study has been performed on a new procedure called a “superior check desmotomy,” in which the superior check ligament is completely severed. In this study of 137 race horses conducted by Michael Ross, DVM, of the New Bolten Center at the University of Pennsylvania, 71% of the horses raced again while 51% of those horses had at least five (5) starts after the surgery. He concludes that the ligament heals in “an elongated fashion that would increase the elastic limit of the damaged tendon,” which, in turn, counteracts the “loss of normal elasticity due to the formation of scar tissue during the healing process.”
Dr. Ross also refers to the annular desmotomy, in which the annular ligament is severed. Located in the lower part of the leg around the fetlock, this ligament often restricts movement once the injured tendon becomes inflamed and swells. By severing the annular ligament, the tendon’s movement is unimpeded, thereby enabling it to release some of the toxic fluids that build up and hamper the healing process. It also prevents additional damage to the tendon that often results from the constriction of the annular ligament.
Beta-aminoproprionitrile (BAPN)
Perhaps the most promising alternative is a relatively new drug identified as beta-aminoproprionitrile fumarate (BAPN-F). Introduced to research as a “scar-remodeling” drug, this new treatment has been implemented in blind clinical trials performed at New Bolten and UC Davis. Results have shown considerable improvement to the quality of the repaired tendon and ligaments in the horses. Moreover, 68% of all the horses treated in the study were able to return to an equal or higher level of performance.
BAPN is found in the seeds of wild sweet peas, lathyrus odoratus, which inhibits the production of the enzyme, lysyl oxidase - an enzyme that produces collagen cross-links in the affected area. It is these collagen cross-links that form the adhesions and scar tissue. If BAPN-F is administered early enough (optimally, one to four months after the injury), the “brief interruption” allows the more beneficial scar-remodeling to occur and permits the regrowth of fibrous tissues within the tendon to be more properly aligned. Prior to that first injection, conventional treatment of ice packs, cold therapy, and non-steroidal anti-inflammatory or systemic corticosteroids should be administered.
Extensive research has been conducted by Virginia B. Reef, DVM, Department of Clinical Studies at the New Bolton Center, University of Pennsylvania. The drug is administered via an injection into the tendon at the site of the tear or rupture in doses of 7 to 8 milligrams every other day for a total of five treatments. This dose results in a rapid healing and return to soundness, while the pain and sensitivity disappears. Though some swelling appears at the point of injections, that quickly decreases. In comparing the treated and control group, researchers have found that the injuries of the BAPN-F horses were virtually undetectable in almost all instances after two months, while those treated with a placebo or smaller doses of 3 milligrams still showed signs of the injury after that same period.
A major part of the treatment is a low-level, controlled training program with constant monitoring through ultrasound to check on progress. The horse is slowly re-introduced to exercise, starting with walking, which is gradually upgraded to jogging, and then eventually galloping – all of which is based on the ultrasound results at each stage in the treatment and training.
Hyperbaric Oxygen Treatment (HBOT)
This therapy, which has been used for humans for some time, has only recently been introduced to horses. They key problem has been to create a chamber large enough for the horse to receive the treatment. The chamber is designed along the lines of a horse trailer, but with special features to enable safe and comfortable delivery of the treatment.
HBOT is based on the theory that normal atmospheric pressure forces oxygen into the red blood cells. Increased pressure, or high pressure, forces the oxygen not only into the red blood cells, but also into the blood plasma - the fluid that carries the red blood cells. Since oxygen, under pressure, can also mix with other lymph fluids and the fluid surrounding the brain and spine, as well as bone marrow, it can better reach injured sites where circulation is impaired. With increased oxygen, the tissues heal faster, thereby allowing the regrowth to occur more quickly, which, in turn, reduces the amount of adhesions and scarring.
In one instance, a 5-year old gelding race horse suffered what the veterinarian believed to be a career-ending bowed tendon. The horse received daily treatments in the equine hyperbaric chamber for fourteen days, and then every-other-day treatment for another two weeks. The third 2-week session reduced the treatments to every third day. After the initial six weeks, the horse was returned to training after the ultrasound revealed improved healing of the tendon. The hyperbaric treatments continued with two sessions each week, while the tendon withstood increased exercise, including daily jogs and eventually a full series of work-outs. By the end of the six-week full-track training, the horse was deemed sound and ready to race. Other horses have demonstrated similar results, with one horse, which had bowed the same tendon three times.
Unfortunately, the procedure is costly. The equine hyperbaric oxygen treatment chamber is valued at $100,000, with the oxygen treatment itself costing between $40 and $90 per session. The device is most frequently found at racetracks where the treatment has proved successful for other types of injuries that result in a reduced blood supply and oxygen to the affected area.
Electrical Stimulation
Another treatment for bowed tendons that has been introduced from England, where trials were conducted, is electrical muscle stimulation or transcutaneous electrical nerve stimulation. This involves a device that sends electrical impulses to the muscles controlling the affected tendon. The device, which is used for three and a half to four months, massages the muscles in the injured region. In the case studies performed, the swelling and toxic fluids virtually disappear within the first week of treatment, but the healing has not yet taken place. Once the healing begins, the new fibers are unimpeded and free to align properly. This process seems to prevent or reduce the formation of adhesions and scarring since the toxins are removed and the swelling has disappeared by the time the tissue regrowth begins. After that first week and thereafter, the horse may be re-introduced to some light exercise and gradually returned to its training level – all the time monitoring the progress with ultrasound images. By the time the tendon has healed, the horse is back to “race-level work.” According to the studies performed, on average, Thoroughbreds were able to return to 100% sound status within 5 months.
Of course, these are a few of the possible treatments that are available to the horse owner - some more readily than others. It is important to note that some of these treatments have been more closely studied than others, with more scientific interest and research behind them. Regardless of the course of treatment you choose, however, there is no guarantee that the horse will return to his previous performance level. Also, once such an injury has occurred, there is a greater risk of re-injury. The most important step, though, is to immediately consult your veterinarian in order that you may discuss the most appropriate course of treatment for your horse and his injury.
For Part I of the article: What Can You Do About Bowed Tendons? (Part I)
Please note that any material on horse health and horse care that has been presented here is offered as general information only and shall not be construed to be professional veterinary advice or care. When dealing with any injury, it is best to contact your veterinarian to establish a treatment that will be most beneficial to your horse.
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