General Overview
Tendon avulsions and avulsion fractures are very serious injuries that require immediate care. If these injuries are not adequately treated a horse will experience lameness (the extent depending on the severity of the injury) and perhaps even permanent damage. When a horse suffers from a tendon avulsion, its tendon pulls away from the bone. Oftentimes, a portion of the bone will break off. The latter is referred to as an avulsion fracture because the bone actually breaks.
Both tendon avulsions and avulsion fractures are very painful. When a horse has either or both of these injuries, it will be obvious that something is wrong. As soon as there is evidence of something is, it is important to take the horse to the veterinarian for a proper diagnosis and treatment. A treatment plan will be developed by the veterinarian that is appropriate for the horse and the injury it has sustained.
A horse that experiences a tendon avulsion or avulsion fracture may do so after falling, kicking or running into another object. Strenuous activity can cause this type of injury. A sudden, forceful movement or stop may be enough to pull the tendon from the bone, tearing off a portion of the bone in the process.
As mentioned above, tendon avulsion and avulsion fractures are extremely painful. The area where the injury has occurred will be very tender and the horse may exhibit lameness. There will also likely be swelling and the area may feel heated. Touching it may cause the horse a severe amount of pain if the injury is especially serious.
Athletic or performance horses are at an increased risk for developing tendon avulsion and avulsion fractures because they often running, jumping and making swift, powerful movements. However, any horse, even those who are only ridden leisurely are at risk of suffering from these types of injuries. Getting spooked, hit or running into an object can result in tendon injuries.
A veterinarian will be able to make the final diagnosis regarding tendon avulsion and avulsion fractures. He or she will first, manually examine the injured area and then perform further diagnostic testing to be sure of his or her diagnosis. This is a pretty easy injury to diagnose and vets have a standard protocol to determine if an injury exists and the extent of it.
Tendon avulsion injuries and fractures are very serious and can even ruin a horse’s career. Because this is true, it is very important for horse owners and trainers to be very in tune with their horses and their horse’s body. As soon as they begin to notice any sort of abnormality, limping or lameness, they need to call a veterinarian who will be able to make a firm and accurate diagnosis. He or she will, after diagnosing the problem, create a treatment/rehabilitation program for the horse. It is important that it is followed to the letter, so that a horse’s chances of coming back strong increase.
Causes
Anytime a horse over-stretches a tendon, there is a risk that it may eventually rupture. Any movement that causes the tendon to be stressed can result in a tendon avulsion and/or avulsion fracture. Jumping and landing can cause this type of injury as can brisk running and sudden stops. Performance and athletic horses are at the most risk but this type of injury can occur in any horse.
Any strong or powerful action produced by the horse can cause the tendon to tear or pull away from the bone and cause the bone to fracture. If a tendon has been injured in the past, the risk of re-injuring or rupturing it is increased. This is because the elasticity of the tendon has been compromised. Subsequently, the risk of the tendon tearing from the bone (a tendon avulsion) increases. When this occurs, there is also an increased risk of the bone from which the tendon is torn, to break, known as an avulsion fracture.
When a horse begins to exhibit changes in gait, some measure of lameness, the injured area feels warm to the touch and is swollen, it is important that the horse be seen by a veterinarian. It is not advisable to ignore the symptoms. Doing so can cause the injury to worsen. It is important to note that a tendon avulsion and avulsion fracture, especially a severe one, can ruin an athletic/performance’s horse’s career. Such injuries can quickly go from bad to worse if not immediately treated. To reduce such a risk, it is a good idea to check a horse’s legs everyday, prior to exercise, and afterward. The faster the problem is diagnosed, the sooner the horse can receive necessary treatments.
In summary, Tendon Avulsion and Avulsion Fractures, in addition to being caused by strenuous activity, can occur after a fall or from kicking or running into an object. All horses are susceptible to these types of injuries. Even non-performance horse can and do experience tendon injuries.
Symptoms
A horse that experiences a tendon avulsion and avulsion fracture may experience the following symptoms, heat, inflammation, lameness and pain upon palpitation. When a horse’s owner suspects that their horse is injured, these are some of the first symptoms that are likely to be exhibited. When these symptoms are present, it is necessary to contact a vet so that further, more definitive tests can be done. Below, we will take a closer look at some of the aforementioned symptoms.
Heat: One of the most notable symptoms is a sensation of heat when touching the injured area. The area is likely to feel a little bit warm. This is often true of equine injuries. It is one symptom that vets, horse owners and trainers look out for when they suspect an injury. It doesn’t always occur but when it does, it is typically a sign that something is wrong and a veterinarian needs to be called. Ignoring this symptom and hoping that it goes away, is not recommended. In fact, doing so can result in further harm. The horse may further damage the injury prolonging its recovery and healing time.
Inflammation: Inflammation is another common symptom associated with a tendon avulsion and avulsion fracture. The area where the injury occurred may swell. This inflammation may be slight but is generally noticeable. How noticeable will depend upon the severity of the injury. Anytime inflammation is present, it’s a good idea to get the horse to a vet. When it occurs alongside heat, lameness, chances are the injury is at least fairly severe and the horse needs to undergo treatment.
Lameness: A tendon avulsion and avulsion fracture can cause lameness. A horse that experiences it may limp and have difficultly walking. Lameness should be a sure sign that a horse’s injury is serious and requires attention. The severity of the lameness a horse experiences after having a tendon avulsion or avulsion fracture will depend on the severity of the injury. The worse the injury is, the worse the lameness will be.
Pain Upon Palpitation: Once there is a suspicion that a horse has suffered a tendon avulsion and/or avulsion fracture, one of the first things an owner, trainer or veterinarian will do is palpitate the injured area. This is done to see if the horse reacts with pain upon the palpitation. If it does, this is a signal that something is wrong and further diagnostic testing is needed. If the horse does respond in pain, signaling that that the area is tender, typically, some type of imaging testing will done to determine the type and extent of the injury.
Diagnosis
When attempting to diagnose a tendon avulsion or avulsion fracture, the first step is to physically examine the injured area and the horse’s behavior. When a veterinarian or owner does so, they are looking for a few specific symptoms. These symptoms include, the behavior of the horse, (whether or not they exhibit lameness, even mild levels), inflammation, heat and pain upon palpitation or touch. If any of the above is present, the vet will begin more in-depth diagnostic testing. This will typically involve ultrasound examination.
Ultrasound examination will allow the vet to scan the tendon for damage. After treatment, it may be used to determine how well and at what pace, the tendon is healing. When a vet uses ultrasound, they are looking at the severity of the tear (is may be mild, moderate or severe?), where the tear is located and the percentage of tendon that is compromised.
Treatment
Platelet rich plasma (PRP) is one of the newer treatment options for a tendon avulsion or avulsion fracture injury. It is a non-invasive procedure that is growing in popularity and acceptance amongst veterinarians and horse trainers and owners. PRP is a procedure which involves the use of a horse’s own blood for the purpose of treating its injuries. The procedure is pretty simple but in many cases, highly effective. To begin, blood is drawn from the horse. It is placed in a centrifuge machine which spins it, until all of its components are separated. Once the platelets are separated, they are removed and then re-injected into the horse, at the site of the injury.
PRP is a good option for tendon avulsions and/or avulsion fractures because it can help speed up the healing process. Coming back from a severe avulsion and/or avulsion fracture can take some time. If an owner has some concerns about the length of time their horse will be out of commission and wants to shorten it as much as possible, for whatever reason, PRP therapy may be a good way to treat the injury, in conjunction with other forms of care.
In addition to PRP, a horse that has experienced a tendon avulsion and/or tendon fracture may be given anti-inflammatory medications. A common one is phenylbutazone. The injury will likely be bandaged, iced on a regular basis and the horse will be required to rest. Full stall rest may even be necessary. Controlled exercise will eventually be prescribed. Most horses will need at minimum, 3 months of restricted exercise. PRP therapy would be used in conjunction with the aforementioned, not in lieu of it.
PRP can be used to speed up the healing process because of the growth factors contained in the horse’s blood platelets. Whenever a part of the body is injured, growth factors are a major player in the healing process. They help jumpstart the healing process. PRP is so effective because it collects and uses a concentrated amount of these platelets. The higher the concentration of the growth factors, the more likely expedited healing will take place.
PRP therapy has proven to be successful for the treatment of tendon avulsion and avulsion fractures. It is this proven effectiveness which has made the treatment more and more common. An increased number of veterinarians are opting to use it to treat this particular injury and other equine injuries. Again, it is used in conjunction with other forms of care, not alone. However, many vets believe that its use helps to speed up the healing process.
PRP treatment is performed by a veterinarian in his or her clinic. He or she will begin the treatment by drawing about 52 mLs of blood in a 60 mL syringe that contains 8 mLs of anticoagulants. This blood is placed in a centrifuge machine, which spins it until all of its components are separated. Once the latter has occurred, it is injected into the injured tendon and fracture, if one exists. Ultrasound guidance is not normally necessary.
After a horse has undergone PRP therapy, they will be required to rest. Full stall rest may be required. The severity of the injury will determine how much rest is needed. Assisted exercise will be a part of the recovery process. The use of anti-inflammatory medications is helpful as well and is likely to be a part of the aftercare. The injection site will be covered to help avoid infection. Multiple applications may be necessary. Whether or not they are, will depend on how the injury is healing and whether or not the vet treating the horse believes further injections would be helpful.
One of the best things about PRP therapy is that there are few complications associated with it. Because a horse’s own blood is used in the procedure, the likelihood of complications occurring is small. There is a possibility that an infection could develop at the injection site. However, that could occur anytime a horse has an injection of some sort and is not cause for serious concern.
