Vet case study: a ruptured tendon [H&H VIP]

  • The horse

    Promise Me III (Harry), a 16.1hh thoroughbred-warmblood (born 2000), bought by vet Natalie McGoldrick as a 4-year-old to event. Harry progressed gradually through the grades to open intermediate and in 2011 was 2nd at Hambledon (pictured above) and 4th at South of England. He also showed an ability in dressage and competed regularly at the national dressage championships up to advanced medium level.

    The history

    137On 3 August, 2011, Harry and Natalie were part of the British team competing at the European CIC2* at Aston-le-Walls. Harry was team trailblazer and everything was going well as they went down to fence 10, one of the biggest on the course. However as Natalie made a sharp right turn towards the fence, Harry became so strong that his rider felt she couldn’t have pulled him up.

    “It felt as if he was running away from something,” says Natalie.

    Harry took off, got over the fence and she pulled him up immediately on the other side. He was on 3 legs.

    Natalie knew straight away what had happened: “I took his boot off and the right fore fetlock had dropped due to a ruptured tendon. It was the worst day of my life.” (See picture above.)

    Harry was ambulanced off the course and the course vet, Charlotte Sinclair, scanned his leg to confirm there was a serious rupture. As Natalie was a vet herself “everyone seemed to leave the decision [whether to have Harry put down or not] to me. But there was no way I was going to put him to sleep.”

    Natalie knew that Harry was a fighter and had she thought him to be in unbearable pain, she would have taken that most difficult decision. Instead she gave him something to relieve the pain and began to work out how she was going to get him home.

    The treatment

    Natalie stayed at Aston-le-Walls for the final day of the competition to give herself time to try to stabilise Harry’s leg and improve his level of comfort but 24 hours later, this still hadn’t happened. During that time, she injected him with intravenous pain relief and made good use of another rider’s Zamar machine, used by riders to reduce heat and inflammation in a leg.

    There was no easy way to make the journey home. Natalie applied a Robert Jones bandage [a multi-layered soft splint bandage that provides support and restricts movement], “loaded him up with pain relief”, covered the lorry floor with left-over shavings from the stables, donated by the show organizers, and set off for the 3hr drive home.

    “It was a long-old trek,” she recalls. “I stayed in the back with him all the way. He’s such a tough horse, such a fighter. He just stood there. The support enabled him to rest his leg on the floor.”

    Natalie’s next concern was getting him off at the other end.

    “We just got him down and straight in to his stable,” she says.

    Harry spent the next few days non-weight bearing on the injured leg. While maintaining the pain relief, Natalie first continued with the bandaging and then tried putting a cast on — but neither encouraged Harry to take weight on the damaged leg.

    The main concern at this stage was that he would develop load-bearing laminitis in the opposite leg. Natalie’s farrier tried to get a bar shoe on to the other foot to give support to the pedal bone and reduce the risk, but that proved impossible, as he couldn’t bear weight on the bad foot long enough to get the shoe on.

    Days passed and while Harry seemed quite bright in himself, he was still on the same amount of pain relief and wouldn’t bear weight. On one occasion he even made a break for it into his field, with his cast on, hopping as fast as he could.

    “I thought that would be the end of the story,” says Natalie.

    Despite this break for freedom and contrary to what Natalie expected, Harry was a good patient on box rest.

    The breakthrough came following a chance meeting at the British Equestrian Veterinary Association’s conference in early September. As Natalie went around the trade stands she spotted one for a tendon support boot that was then still in the trial stages.

    Natalie spoke to Andrew Daly, the creator of this system — the Equestride support system — explained her situation and 3 days later Andrew flew back from his home in Ireland with a boot for Harry to try.

    The boot has been designed to help vets rehabilitate flexor tendon and suspensory ligament injury. It limits tendon strain while allowing the horse to exercise safely throughout the rehabilitation period. It has 4 different support settings that are adjusted as the injury heals. Andrew fitted the device (pictured below) on to Harry and he immediately took the weight on to his bad leg.

    DCIM100MEDIA“It was as though he said, okay, I can do this now,” says Natalie.

    Harry was about 8/10th or 9/10th lame at this point. 6 weeks later he was 3/10th to 4/10th lame. And when Natalie took the boot off he was exactly the same. From this stage on he gradually improved. As soon as he started bearing weight, he was grazed in hand for 4 or 5 hours a day with the help of Natalie’s mum. This went on for 3 months. During that time, Natalie also hired a Zamar machine for a couple of weeks to help keep down any swelling.

    Once he was sound in walk, Natalie turned him out into a small paddock, wearing the boot and on a low dose of bute. He was still lame in trot, but as they gradually increased the size of the paddock, he found his canter. Harry went from his accident to being paddock sound in 5 months.

    At this point Natalie hoped to be able to hack him again one day, but after a year he was still slightly lame in trot. She decided to give stem cell treatment a go. The x-rays were still showing that the tendon was torn, so Natalie injected the stem cells into the tendon. She decision to give him another year to come sound in trot, but within 6 months that had happened.

    The outcome

    Natalie allowed Harry to rest for 2 years before bringing him back into work on 7 July 2013. From the moment she got back on him and walked out down the roads, it was uphill all the way. They began with 10min walk under saddle. Trot was still a problem and it was a further 6 months before he was sound in trot under saddle.

    HARRY TODAY“The more he has done, the sounder he has become,” says Natalie. “The scar tissue within the tendon is breaking down and the leg looks much better now than it did even a month ago. We are now working on our trot and canter and have begun working on flying changes.

    “I will never risk jumping him again, but he is a very good dressage horse. He was competing at advanced medium before the injury and we are working towards prix st georges. We’ll see how he goes, but we’ll take it steadily. He owes me nothing.

    “At first my dream was to have him paddock sound, a year later my dream was to get back on and now it is to canter down a centre line.”

    The costs

    Natalie is insured by NFU who were helpful all the way through Harry’s treatment. They covered all the costs of Harry’s pain relief. The Equestride device can be leased under veterinary supervision for £100 a month and the Zamar machine cost £500 for 2 weeks. NFU covered all these charges.


    Andrew Daly www.equestride.com; info@equestride.com Tel: 00353 86 8336677

    NFU Mutual: www.nfumutual.co.uk