Pioneering surgical procedure performed at Marion duPont Scott Equine Medical Center resolves one horse's lameness

12 Mar 2010

The surgeons at Virginia Tech's Marion duPont Scott Equine Medical Center were recently able to help Wildfeuer with a bold treatment idea.

Alexa Briscoe says she had high hopes for Wildfeuer when she acquired the four-year old Bavarian Warmblood in 2000. Her plan was to someday compete in Grand Prix dressage with him. But when Wildfeuer was 10, he began to exhibit intermittent episodes of apparent lameness. These instances were so occasional that “we couldn’t figure out what was going on,” Briscoe said.

Then, in 2005, while Briscoe was in Texas with Wildfeuer, he took a bad step and, as Briscoe described it, “went dead lame.” Veterinary specialists in Texas used scintigraphy to diagnose Wildfeuer with a bone cyst in his shoulder underneath his biceps tendon. This was treated surgically with the arthroscope to remove the damaged cartilage and cyst contents in the bicipital bursa, where the biceps tendon moves over the front of the shoulder.

Because this disease was rare, and the treatment was new, the horse’s prognosis was uncertain. After about six months of stall rest, Briscoe took the next year or so to slowly get Wildfeuer moving again, first by hand-walking him and then having him trot.

At this point, Briscoe revisited her hopes of competing with Wildfeuer. “He seemed to be doing so much better,” she said. “It looked like he could return to full work.” And, the two actually participated in shows for about a half a season, until Wildfeuer again demonstrated indications of lameness.

“When the lameness recurred in the fall of 2008,” Briscoe, who lives in Maryland, said, “my veterinarian tried injections and blocks, but since they did not seem to help, I was referred to the equine medical center to see if there were any other treatment options we could consider.”

“After we saw Wildfeuer and reviewed his history,” veterinary surgeon Dr. Nat White, the Jean Ellen Shehan Professor and director of the Marion duPont Scott Equine Medical Center noted, “we performed diagnostic arthroscopy, which is a minimally invasive surgical procedure, where we can go in and see exactly what the problem might be.

“What we found was that the cartilage under the biceps tendon appeared rough around a bone cyst which went deep within the bone. We were able to shave and smooth the bone irregularities and remove the cyst. The tendon was also damaged from rubbing on the rough bone surface. We expected Wildfeuer to have a reasonable chance to resume full athletic activity after that procedure,” White said.

At their routine follow-up visit a few months later, Briscoe and Wildfeuer met with Dr. Norrie Adams, a lameness expert on faculty at the equine medical center. Unfortunately, the horse was not progressing as everyone had hoped; Wildfeuer was lame at a walk. Because the horse had, for years, been suffering from chronic lameness, and quality of life was a genuine consideration, Adams shared a bold treatment idea with Briscoe.

“Dr. Adams told me about a study he had read, but the procedure described in the study was considered ‘radical,’ and it had so far only been used on three horses,” Briscoe explained. “He brought it up as something to think about, given that there were no real treatment options left for Wildfeuer and that he seemed to be getting progressively worse.”

The procedure, known as a biceps brachii tenotomy, would involve the complete removal of the section of the horse’s biceps tendon that was not gliding smoothly over the abnormal bone surface on the humerus. This procedure had been performed on a limited number of horses at Purdue University in an effort to treat chronic damage and infection of these structures, and the results were promising.

Wildfeuer’s comfort weighed heavily on Briscoe’s mind as she thought about whether she would proceed with this radical treatment. “He was only 12,” she noted, “and I thought it was a shame that he would have to retire so young. At the same time, he was uncomfortable, and I really wanted him to be happy, even if he would only be spending the rest of his life in the pasture.”

After careful consideration, Briscoe decided to go ahead with the treatment option Adams had suggested “because it was the right thing to do,” she said. The surgery, performed by Adams with the assistance of third-year equine surgery resident Dr. James Brown, took place in April 2009. His recuperation progressed without complication, and his exercise was gradually increased.

“For several months after the surgery, Wildfeuer still looked uneven in the trot,” Briscoe said. “Then, almost all of a sudden, he looked very comfortable in the walk, so I trotted him on the lunge line for a few minutes. And I thought to myself, ‘You know what? That horse looks sound!’

“Prior to surgery, we were afraid that there might be a hitch in his stride that would impede his career as a dressage horse, but now — less than a year after surgery — his dressage work is better than ever and he can perform a smooth extended trot,” she said “And, he’s so much more comfortable and happy now. I’m very grateful to Dr. Adams for suggesting this treatment.”

Briscoe says she is also gratified to hear from people who have seen Wildfeuer now that he’s fully back to work; they say they can tell how glad the horse is to be back doing what he’s asked to do. “He has such a strong work ethic,” Briscoe said, “and people tell me they can see how much better he feels just by looking at his face.”

“We certainly share the owner’s joy in the success of this procedure,” Adams noted. “It’s just this type of case, in which the medical team’s efforts result in such a dramatic improvement in the quality of life for the patient, that we find the most satisfying.”

Briscoe’s original plans to compete with Wildfeuer have also been restored. “We’ll be involved in the competitions that begin this spring,” she said.