Tag Archives: chronic cellulitis

Research, Research, Research

Tendon Injury Handbook

After I left the barn, I drove home and went straight to my computer.

What was happening?  What are the masses? Scar tissue?  Nothing was able to be extracted out of them…How can I get rid of them in order to see behind them?

Again, I stayed up until the sun came out the next morning.  I already had two binders full of research and now I had a third.

Research made me believe that C has an infection in the Synovial Tendon Sheath that was being masked by the masses on the outer lining of the SS. The masses could be scar tissue from his MANY past Lymphangitis flare-ups. Perhaps, his immune system was not able to fight last attack and the infection settled in the SS and was walled off.  Thus his CBC & WBC were normal and no fluid was extracted from SS masses due to the large size of the scar tissue.
C has a major hx with his RH and “flare-ups” and lameness. I never realized this until I took the time to study his past records from the first 5 years I owned him.

Symptoms are similar to an infection- what if we proceeded as if it were?
Lack of a positive culture does NOT mean that there is not an infection in the sheath!

Current Symptoms:
1. Swelling decreases after being active
2. Fails to extend fetlock
3. Lame- exasperated by flexion
4. Positioning for fetlock flexion

Septic Synovitis: Cartilage degradation ischemia, Fibrin deposition lead to lameness to pannus form and adhesive form

Entrobacteriacaea
Strep
Staph
Most common is Staph

Treatment: 

Systematic Procaine Penicillin 22000 iU/kg or Sodium Benzyl Penicillin & Gentamicin 6.6 mg/kg for 2-9 days

Then change to oral potentiated sulfonamides 5mg.kg Trimethoprim and 25 mg/kg of Sulphadiazine

Other potassium penicillin w/ Amikacin Cectiofur or Enrofloxacin

IV antibiotics for 7-10 days switch to oral for 2 weeks

Regional limb profusion or placement of impregnated Polymethyylmethacralate or PMMA

I immediately called Vet4 and told him my theory.  He said that it was possible and that we should begin treatment asap.  He was still out of town so I called Vet3 to order Baytril. Vet3 felt my theory was legit and immediately ordered the antibiotic!

Answers

Vet4 came out immediately.  I was beyond grateful!

He did an ultrasound of the back right leg and called me.  He found that Chance has Chronic Cellulitis and that there was Vascular constriction, and masses on the tendon sheath between the superficial and deep tendon sheaths.  The Doppler showed good blood flow and a thickening of the synovial lining. Hoof testers- Negative

We spoke about my opinions- MRI, Arthroscopic surgery, Regional Diffusion, Cold Compression Therapy, Nerve Block Injections, Steroid Injections

We decided  to try the Steroid Injections into the 3 Synovial masses to hopefully reduce the size and thickening.  Thus allowing us to see behind the masses to see what is actually happening.

Injections were into the Proximal Digital Flexor Tendon Sheath with 6mg Betamethasone and d100mg of Amikacon. Leg was covered with SSD and DMSO and bandaged.

Once injected, cold compression therapy for about 5 days twice a day and stall rest. Banamine daily.