Dr. Galley,
My partner’s heading horse got into a bunch of baling wire recently and got a bunch of small nicks and scratches on both of his front legs from the knees down. None of the wounds need to be sewn up. His horseshoer used to work for a vet and he put some yellow salve on the legs and wrapped them really tight to keep the swelling down. This morning they took the wraps off and both legs are real swollen and sore to touch. I am pretty sure that they gave him some antibiotics yesterday but do you think they could be getting infected? What else should he do for him? We are entered at the USTRC Finals and really need him.
Answer:
It sounds as if they may have wrapped him too tightly when they “put some yellow salve on the legs and wrapped them really tight to keep the swelling down." Of course I haven’t seen the horse so I don’t know how severe it is.
Wrapping the legs of a horse needs to be done with just the correct amount of pressure to avoid impairing the circulation and/or causing damage to the flexor tendons. The “yellow salve” that they used was probably nitrofurazone ointment. Nitrofurazone ointment was marketed as Furacin ointment and was commonly used as a “sweat” to the legs of racehorses when applied under Saran Wrap and then wrapped with cotton and a regular leg wrap.
You are correct that infection is a possibility that needs to be considered but this is probably not the cause of the swelling, especially since they started the horse on antibiotics and the nitrofurazone has antimicrobial properties as well. With this history and the painful swellings it sounds like the horse was wrapped too tightly. This can be a very serious problem as it can cause a “bandage bow” of the flexor tendons. A bandage bow is just another type of bowed tendon.
The term “bowed tendon” refers to a tendonitis, or severe inflammation along with some degree of tearing, of the superficial digital flexor tendon somewhere in the area between the carpus and fetlock of the leg, usually the foreleg. While the deep digital flexor tendon can also be involved, that is much less common than the involvement of the superficial digital flexor tendon. A bowed tendon can also occur in a hindleg but is much more common in a foreleg. Depending on both the severity and location of the bowed tendon they are often referred to as a low bow, mid bow, or high bow. The cause of a bowed tendon is usually related to excessive loading, stretching, and tearing of a fatigued tendon. Other causes can include direct trauma, as occurs with a blow to the area. An interference injury between the horse’s other limbs or even hitting a tendon on a hard object can be an example of a cause of a bowed tendon as a result of direct trauma.
A bowed tendon, especially a severe bow, is a very painful injury and the horse will often be reluctant to bear weight on the affected leg. In a short period of time the affected tendon tissue becomes very swollen and VERY painful to palpation. The anatomy of a tendon is primarily made up of fibers that tend to be parallel to each other. When an injury occurs resulting in tendonitis of the tendon, the tendon fibers are disrupted. In a mild case of tendonitis only a few of the tendon fibers may be damaged whereas in a more severe case a large number of fibers are often disrupted and torn. When tearing of the tendon fibers occurs there are areas of fluid (blood, etc.) that separate the fibers. These may appear as small multiple holes on an ultrasound exam or they may appear as a large defect (hole) on an ultrasound exam.
As the tendon attempts to repair the injury, the damaged tendon fibers tend to heal in a random fashion rather than in a parallel fashion. When this occurs there is a tendency for a greater amount of scar tissue to form which is very undesirable. Injured tendons don’t heal very well anyway and if the healing is compromised by the random reorganization of the tendon fibers and an increase of scar tissue, then the prognosis for long term soundness is much worse. A bowed tendon is a very serious injury in all cases. Regardless of the therapy, even if it might include one of the tendon splitting surgical procedures or the injection of something like stem cells, the chance of the horse coming back for a successful athletic career is very slim.
A “bandage bow” (or a “wrap bow”) is damage to the tissues surrounding the flexor tendons caused by a bandage that has been applied too tightly or by a bandage that has slipped or rolled following application. While only the subcutaneous tissues may be involved in a mild “bandage bow,” when the excess pressure from a bandage is sufficient enough it can cause damage to the tendon itself, such as would be seen in a bowed tendon. When this occurs to the tendons they will tend to produce scar tissue during healing just as a true bowed tendon will do. Figure 1 shows a horse (in this case it is a racehorse rather than a team roping horse) that had bandages applied too tightly just as you described in your question. The horse in the picture had been rested and treated for eight months prior to this picture. The white lines drawn on the picture shows the hard swelling that remains in both the left and right fore flexor tendons, even after aggressive treatment. Once a tendon has been injured with a bandage bow it will never be as strong as it was before the injury and it will be prone to further injury such as a bowed tendon.
So, as you can see, a bandage bow can be a very serious condition, especially for the future soundness of the horse. You should encourage your partner to take the horse to a capable equine practitioner and have him examined. Follow the instructions of the veterinarian very closely as that will be your best chance to get him sound for the future.
Hopefully this horse is not too severe but you should probably discuss the probability of your partner needing to borrow another horse or take his second string horse to the Finals. These bandage bow injuries can take a long time to heal before he will be able to begin riding him again. Listen to the veterinarian and you will get a better idea of how seriously injured this horse is.
Good luck at the Finals.