"Joint swelling after hunting immediately rings alarm bells"

Nancy from XLVets equine explains all about her concerns following a horse who went lame after hunting. 

Today was a busy day on our routine 'zone' days. These days are made up of routine procedures such as vaccinations, dental examinations, blood tests etc. and give our clients a saving on call-out fee, providing they can be flexible and available in the two-hour time slot we give them the day before. 

My zone day is a Wednesday and although I cover about 130 miles per day, it does allow me to plan a logical efficient route for my calls.

Wednesdays are inevitabley one of the busiest days of the week for me and I may see between 20-30 horses per day, but these days only work well if clients and horses are well behaved!

A client of mine rang my mobile when I was just packing up after my 12th call. She was concerned that her horse, Sally, who'd hunted at the weekend was lame with a swollen knee.

As a vet, lameness with joint swelling after hunting immediately rings the loud 'blackthorn alarm bells' in our ears.

Due to the terrain horses are ridden through and the amount of hedges jumped, we often see septic arthritis following blackthorn penetration into a joint cavity after hunting.

Lameness is usually rapid in onset and severe. I've seen several horses that actually present initially with false colic as they are so painful on the affected limb.

As I was in the area, I went straight to see Sally. Sally had been given some Bute over the weekend by her owner for the lameness.

On examination, Sally's off fore knee was grossly swollen. She was lame in walk and trot, and was reluctant to flex her knee.

Due to her severe lameness, localised to the knee, I decided to take synovial samples from her knee and extensor tendon sheath that overlies it, to check for any inflammation or infection.

This involves taking samples of the joint and tendon sheath fluid aseptically, under sedation. As I had some more calls to do, I sent Sally and her owner into the surgery, along with the synovial samples so they could be run at the lab before I got back to the clinic.

By the time I'd got back to the surgery, the results where back from the lab. Thankfully, there was no evidence of infection, but the tendon sheath fluid showed evidence of inflammation within the tendon sheath.

We did an ultrasound examination of the extensor tendon and sheath, which revealed a small tear in the extensor tendon sheath - the cause of the inflammation.

Thankfully, I couldn't find any evidence of thorn penetration. Annie was sent home with some anti-inflammatory medication, and physiotherapy exercises to do, to help maintain good range of motion through the knee.

She'll be paddock rested for a month, before she is re-scanned to check the healing of the tendon. If all is well she can be turned away to enjoy her summer holiday.

Horses with swollen joints with associated lameness should be seen as a matter of urgency, especially if there are any wounds near the joint, no matter how small.

The quicker you can treat and flush out a joint with septic arthritis, the better the long term prognosis.

When I got home it was my turn to present at 'Journal Club' for my Certificate in Advanced Veterinary Practice.

This is an online Certificate and I presented a paper on cheek tooth fractures in horses. Journal Club involves presenting a paper to an online conference video call. Public speaking is not something I particularly enjoy, so I was glad to get it over and done with!