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Discussion on Shoulder Sweeny

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Abel A Duran
New Member
Username: Pduran

Post Number: 1
Registered: 8-2005
Posted on Friday, Aug 19, 2005 - 1:19 pm:   Edit PostPrint Post

Dr. Oglesby,

This is the history as best as we can recall it of my wife’s horse, Maverick and hopefully you can help us with the best course of action going forward. My wife purchased Maverick, a quarter horse paint, when he was only two weeks old on May 2003…it was love at first site. She has watched him grow into a beautiful horse.

Unfortunately on June 16, 2005 approximately at 7 pm he incurred a serious injury on his left front leg. He was limping and his leg was pushing out profusely around the shoulder area (very painful to watch). My wife found two hot spots and marked them with silver spray for the vet, who was scheduled to come out the following morning. When the vet did come out, he diagnosed Maverick as having muscle and nerve damage. He immediately began his treatment which included dosages of DMX via injection and DMSO via intubation for a duration of two weeks. He followed that with prednisone to help manage inflammation for the next three weeks.

On August 10, 2005, the vet came out again and diagnosed him with shoulder sweeny and severe muscle and nerve deterioration (which may be one and the same), atrophy and muscular plexious (sp?). He also added that he had 100% nerve damage and that his shoulder was rotating profusely.

On August 16, 2005, Maverick showed slight control problems with his hind legs, which included a bit of swaying and stiffness. Another vet was called out for a second opinion and he concurred with the first and added he might also have a neck injury (fracture possibly) which is causing the hind leg problems. He suggested an x-ray to confirm.

My wife is very attached to this horse and is in need of direction on where to go from here. Any honest, truthful suggestion of our options is greatly appreciated. We are try to keep up our hope and spirits, but the vets prognosis are not very encouraging. We have heard surgery, acupuncture, wait-and-see, etc. and have read your article on Shoulder Sweeny in Horses. Thank-you very much in advance for your advice and assistance in this very trying challenge we have before us.

Sincerely,

Abel & Pat Duran & Maverick.
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Kim Fotter
Member
Username: Fpony

Post Number: 357
Registered: 9-1999
Posted on Friday, Aug 19, 2005 - 1:48 pm:   Edit PostPrint Post

Hi Abel and Pat,
I'm a human physical therapist and depending on the nerve damage and how much sheath of the nerve is left, the nerve can regrow, but it takes time. I get tell you about the hind end but depending on the severity of the sweeney there are rehabilitation techniques that can help your horse. Some times splinting the knee will help give stability to the shoulder while it is healing and range of motion to the limb will help decrease contractures which may already be present since the injury occurred in June. Depending on where you are located there maybe a physical therapist that works on horses. He/she could work with you and your vets to help you rehab the shoulder.
Good luck.
PS you could even call a local Sports or Orthopedic Physical therapy practice and one of there staff members might be willing to advise you.
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Abel A Duran
New Member
Username: Pduran

Post Number: 2
Registered: 8-2005
Posted on Friday, Aug 19, 2005 - 2:00 pm:   Edit PostPrint Post

Kim,

Thank you for your quick and informative response. The hard part, especially for my wife is seeing Maverick in obvious discomfort. We are located in the Dallas/Ft. Worth area, so hopefully there will be physical therapist willing to help with the rehab. And to be sure, as you mentioned, we should work with the vet to make sure the therapy will not cause further injury. I will discuss with my wife. Thanks again.
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Kim Fotter
Member
Username: Fpony

Post Number: 358
Registered: 9-1999
Posted on Friday, Aug 19, 2005 - 4:13 pm:   Edit PostPrint Post

Here is a place that has pre-made splints if your vet thinks locking the knee will help stabilize the shoulder. Due to the stay(reciprocal) apparatus locking one joint can help stabilize another.
http://www.equinebracing.com/myweb/index.html

This might help with discomfort if the shoulder isn't stable. Also, therapeutic ultra sound and certain forms of e-stim(for pain relief-later can help stimulate the nerve if not completely de-innervated)) can help with any muscle damage and relief pain. Horses tolerate this quite well.
Kim
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13562
Registered: 1-1997
Posted on Saturday, Aug 20, 2005 - 10:02 am:   Edit PostPrint Post

Welcome Abel,
I am sorry to hear about your problem. Concerning the pain bute or banamine should be added to the above mix to help the prednisolone and provide some pain relief. It is hard to understand why the neurological problem behind would show up so much past the original injury, are they sure there is not some lameness behind that appears neuro because the front is so unstable. If they are convinced it is bilaterally neuro, trauma to the spine of the neck would be first on my list and if you are going to pursue it, radiographs would be next.

Are you following the recommendations in the article for the Sweeny?

I disagree with this knee locking idea Kim. Work is pretty clear that rest improves the prognosis. By locking the knee you give the horse 2 choices: either use the leg fully or not at all. There is much less in-between that can be generated by "cocking" the knee some.
DrO
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Kim Fotter
Member
Username: Fpony

Post Number: 360
Registered: 9-1999
Posted on Saturday, Aug 20, 2005 - 11:03 am:   Edit PostPrint Post

The thought for locking the knee (with brace-cast that can be removed to allow range of motion to the knee) is to take some stress off the shoulder during the rest phase. I would think this is probably needed more if there is no innervation at all. Of course I'm speaking strictly as human PT trying to modify for a 4 legged horse. I do think passive range of motion of all the joints in that limb is important. Kim
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Lee
Member
Username: Paul303

Post Number: 536
Registered: 9-2002
Posted on Saturday, Aug 20, 2005 - 12:19 pm:   Edit PostPrint Post

Wow, what comes to my mind is: could a neuro problem ( hind end ) have come first ( with slight to almost no - visible symptoms )- causing a fall, complicated by difficulty rising due to hind end incoordination? The shoulder pain might then cause considerable stress which might worsen the neurological condition thus bringing it to a noticeable level.
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Abel A Duran
New Member
Username: Pduran

Post Number: 3
Registered: 8-2005
Posted on Saturday, Aug 20, 2005 - 6:40 pm:   Edit PostPrint Post

Thanks for all your advice and concern. Please if you can come up with anything else anything I'll check into it ASAP.

Dr. Oglesby,
Lone Star Park Vetanarians will be doing some x-ray's. If they show no neck injury, my second step is surgery. Do you agree or do you know of the stat's of the possibility of full recovery? what's involved in the surgery? I'd like your recommendation. And do they ever recover fully
without pain?

Thanks again
Pat Duran
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13568
Registered: 1-1997
Posted on Sunday, Aug 21, 2005 - 8:57 am:   Edit PostPrint Post

I see where you are coming from Kim with comparing the human knee (the stifle in the horse) with the horses knee (the wrist in the human). Where as the "stifle" in the human collapses with neuromuscular action the equine "wrist" can remain "locked" with almost no neuromuscular action though must be set in place by nerves to the carpal extensors (and secondarily the digital extensors) not usually effected in Sweeny cases. I have not seen an inability to stand on the effected leg a problem with Sweeny but if other nerves are effected there may be exceptions.

I am confused Abel by your post, don't you mean if they see a problem on radiographs then surgery is an option? If so the prognosis will depend on the radiographical findings and the surgery done.
DrO
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Lee
Member
Username: Paul303

Post Number: 537
Registered: 9-2002
Posted on Sunday, Aug 21, 2005 - 2:27 pm:   Edit PostPrint Post

Re: your question on recovery. A friend ( our farms adjoin and our horses intermingle sharing pasture and turnout )had a 19 yr old roping horse that he switched to team penning on as they both aged. When the horse was 19, about 6yrs ago, he was diagnosed with shoulder sweeny. He was told that the chance of the horse working hard again was very iffy.

My friend traveled to Kentucky for a new competition horse with the idea of retiring the old man. I remember the vet checking him a lot, and I remember taking turns with a pulsating massage head on the hose. I remember very obvious muscle atrophy and movement difficulties - but never any standing problems.

It seems like a year or so passed, and every time the trailer left for a competition, the old guy was beside himself. We were afraid he would cause himself further damage, so he was taken to the pennings, where he would stand quietly at the fence and watch the action. Because it was tiring to hold him all day, we started to saddle him and sit on him all day. This led to walking him, then jogging, then trail rides.

Eventually, he seemed so improved that he was ridden regularly on trail rides ( very sane trail rides ), until person new to team penning needed a mount to try some basics at a clinic. Now this was a horse who, once put on a cow, just took over and got the job done. This person wanted the horse, but my friend keeps his competition horses forever - however, the horse was performing superbly and enjoying it, so my friend agreed to allow her to use the horse.

All went perfect, until Sept. 2003, when, in a slick arena during competition, a calf cut back and the old horse cut back with it-fast as lightning like he always did. We will never know if the shoulder gave, or he hit a slick spot, but he went right down on that shoulder pinning his rider while flailing about trying to rise. Miraculously, the rider suffered only a horribly bruised leg, a broken collarbone, and six broken ribs. Really, it could have been much worse.

The horse, aside from being stiff and sore for a few weeks, was fine. He was even ridden again, but just lightly and gently.

So was it a wrong step on slick ground, or did the bad shoulder give out? I don't know, but as that rider gained confidence, she began to develop complete confidence in that horse and I believe all caution was thrown to the wind - and the original diagnosis was allowed to fade and pale in importance in the light of successful competition.
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Abel A Duran
New Member
Username: Pduran

Post Number: 4
Registered: 8-2005
Posted on Wednesday, Aug 24, 2005 - 12:19 am:   Edit PostPrint Post

Dr. Oglesby

My second opinion vet came out and said that surgery is not an option for him. Basically stall rest is all we can do at this point. I did read the study and have a couple of questions. My horse is only 2 so he has not been ridden. I've done ground work with him and has been saddled without incident. Will stall rest, acupuncture, massage help his condition? Will he ever be able to be with other horses? He is a very social animal. Will I ever be able to ride him, especially since he's not fully trained? Will he always be lame?

Thanks again for all of your support.

-Pat Duran
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13589
Registered: 1-1997
Posted on Thursday, Aug 25, 2005 - 8:28 am:   Edit PostPrint Post

Taking your questions in order:
1) The recommendations in the article are the only things I am aware of that might help. Massage may further irritate the nerve, acupuncture is not known to improve nerve healing.
2,3,4) Assuming this is a simple sweeny the prognosis is fair to good he will recover completely if you treat it properly.
DrO
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