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Liz Brown, MRCVS

Infections of tendon sheaths and joints are serious and potentially fatal conditions. They are also a relatively common condition. We normally see these as a result of injuries such as cuts, lacerations, puncture and overreach wounds in the vicinity of a joint or tendon sheath.

The horse has many joints and tendon sheaths that are very close to the skin surface and therefore liable to injury or penetration. Any wound that is close to a joint or tendon sheath should be treated seriously and the vet called if there is any doubt about the possibility of penetration. In some cases synovial fluid (fluid from the joint or tendon sheath), which is clear or straw coloured can be seen leaking from a wound but this is not apparent in many cases.

When synovial structures (joints or tendon sheaths) are penetrated bacteria enter the cavity and start to multiply. Multiplication of bacteria within the joint results in severe inflammation and infection. If left untreated joint or tendon sheath infections will result in a severe lameness, which sometimes can develop over a few hours, in other cases over 24hours. So if your horse appears to have a small fairly insignificant wound one day and be hopping lame the next, tendon sheath or joint infection could be a distinct possibility and the vet should be contacted immediately.

Treatment for joint or tendon sheath infections involves flushing the joint with large quantities of sterile fluid to remove bacteria. Antibiotics by themselves will not penetrate into the synovial fluid sufficiently to clear the infection. Flushing of the joint is performed through needles or by arthroscopy. Arthroscopy is the treatment of choice for most joint or tendon sheath infections. This involves inserting a camera into the joint, which allows visualisation of the inside of the joint or tendon sheath and removal of any foreign bodies, damaged or infected tissue and inflamed synovial lining. This is performed under general anaesthesia. It allows for a better flush than can usually be achieved with needles. A needle flush is appropriate for very recent wounds which can be flushed before bacteria have had time to establish themselves within the joint. In many cases an arthroscopy may be necessary in addition to fully assess and clean the joint.

There is a so called “golden period” following joint or tendon sheath penetration during which bacteria are present in the joint but have not had sufficient time to multiply and establish an infection. If the joint or tendon sheath is flushed within this time period there is a better chance of cleaning up the joint before bacterial numbers multiply. This period is traditionally quoted as 6-8 hours but does depend on the degree of contamination of the joint by bacteria. Since many horses injure themselves in the field it is often not known exactly how long the wound has been present. However the longer an infection has been established prior to treatment the more difficult it will be to clear up without recurrence.

Following surgery most horses are kept on intravenous antibiotics for five days. In some cases it is possible for infection to recur in the joint or tendon sheath which would require further surgery.

Some penetrative injuries involve other structures such as the tendons, areas of bone or cartilage within the joint or ligaments around the joint. The degree of injury to such structures will affect the recovery period and the long term prognosis even if the infection is cleared up successfully.

If left untreated tendon sheath and joint infections usually result in a severe permanent lameness, which will often necessitate euthanasia. For this reason it is of the utmost importance to assess and treat these injuries quickly. If in any doubt phone the vet!

Liz Brown, MRCVS

Anvil Vets:

Anvil Equine Veterinary Clinic, Tuckmans Farm, Copsale, Horsham, West Sussex RH13 7DL

Tel: 01403 731 213 Fax: 01403 733992

Email anvilvets@freeuk.com

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