"Klass"
9-year old mare - Hunter/Jumper

Deep Digital Flexor Tendon Lesion
20 FES Treatments on legs
9 FES Treatments on top line until sound for jumping competitions

SUMMARY
MRI results indicated lesion of right fore deep digital flexor tendon. Upon initial examination mare was uncomfortable showing Grade 3/5 lameness on right front under saddle. Right scapula was significantly dropped relative to left scapula when standing. L2 - S4 was extremely tender to palpation. Gluteals were also extremely reactive to palpation, especially on right. When riding, mare dropped right shoulder excessively in turns, was stiff to right bend through torso and leaned heavily on right rein.

Shoeing was evaluated and heels of shoes were lengthened for support of fore limbs.

FES treatment began on 6/23/06. Both legs were treated and contractions were not visible during treatments. Edema in right front occurred after 2 FES treatments, perhaps due to running during turnout. Edema resolved 2 days after 2 nd FES treatment. Ice packs were used on both legs daily. Mare was turned out daily and hand walked twice a day for a minimum of 1 hour per day for first month. Mare was walked on varied surfaces and up and down small hills. Anterior, posterior and lateral flexion of fetlock for several minutes was done on a daily basis.

At 2 months, mare continued with turn out and hand walking. Longeing was added and included trotting large circles, a minimum of 20 meters in width for a minimum of 20 minutes on each side. Trot quality improved weekly. Riding at walk and some trotting was started. MRI showed improvement in tendon lesion and fluid was no longer present.

At 2.5 months, canter work was added and longe time was increased to 30 minutes each side. Riding at the trot and canter was also incorporated at this point, with longeing used as warm up when necessary for relaxation before riding. Icing of both legs was done after any longeing or riding session.

At 3 months, mare was trotting and cantering easily under saddle and working on suppling exercises. Ice was continued after riding or longeing. At 3.5 months small jumps were added. At 6 months, course work at 2-3 foot was added. At 9 months mare was back to full competition schedule.

5/1106 MRI Results

• Right fore, Deep Digital Flexor Tendon
  • Focal Core Lesion of medial lobe
  • Degenerative Change
• Right fore, Lateral Collateral Ligament of the DIP Joint
  • Focal Degenerative Change
• Right fore, Navicular Bursa
  • Current or Previous Bursitis
• Right fore, Third Phalanx
  • Focal Defect
  • Inflammation, Stress Related Edema or Contusion
• Right fore, Navicular Bone
  • Inflammation, Stress Related Edema or Contusion
• Right and Left fore, Navicular Bone
  • Enlarged Synovial Invaginations

6/23 FES treatment

• Right front
• Left front
• Movement Evaluation
  • Grade 3 lameness right fore
  • Right shoulder "dropped"

6/24 FES treatment

• Right front
• Left front

6/26 FES treatment

• Right front
• Left front

7/21 FES treatment

• Right front
• Left front

7/22 FES treatment

• L2 - S4 (loins to mid gluteals)
• Right front
• Left front

7/23 FES treatment

• T13 - L4 (behind withers)
• Right front
• Left front
• Movement Evaluation
  • Longeing sound both directions, trot

7/24 FES treatment

• T13 - L4 (behind withers)
• Right front
• Left front

8/25 FES treatment

• T15 - S1 (mid back to loins)
• Right front
• Left front

8/26 FES treatment

• T13 - L4 (behind withers)
• Right front
• Left front
• Movement Evaluation
  • Longeing sound both directions trot and canter
  • Riding sound at trot and canter

8/27 FES treatment

• Right front
• Left front

8/28 FES treatment

• Right front
• Left front

8/31 MRI RESULTS

• "The tendon lesion has improved on T2-weighed and STIR images and does not contain fluid", "the tendon lesion does not appear active"

9/28 FES treatment

• Right front
• Left front

9/29 FES treatment

• Right front
• Left front
• Right front
• Left front

10/3 FES treatment

• Right front
• Left front
• Movement Evaluation
  • Sound trot and canter, some small jumps

12/10 FES treatment

• L2 - S3 (mid back to anterior gluteals)
• Right front
• Left front

12/11 FES treatment

• T13 - L4 (behind withers)
• Right front
• Left front

12/12 FES treatment

• Right front
• Left front
• Movement Evaluation
  • Jumping courses 2' 6"

1/20 FES treatment - normal tendon contractions

• Right front
• Left front

3/20 FES treatment

• Right front
• Left front

3/21 FES treatment

• T13 - L4 (behind withers)

3/22 FES treatment

• T13 - L4 (behind withers)
• Movement Evaluation
  • Returning back to full work and competition schedule