No difficulty is encountered in recognizing these conditions even where considerable organization of tissue overlying distended thecae occurs. In such cases there may be only slight fluctuation of the enlargement, but if necessary, an aseptic exploratory puncture may be made with a suitable needle or trocar.
Treatment.—Complete rest and the local application of cold packs are in order in acute synovitis when there is distension of tendon sheaths. In the fetlock region, because of the ease with which pressure may be employed, the parts should be kept snugly wrapped with cotton, and derby bandages are used to exert the desired amount of pressure over the affected region. The pressure-bandages should be employed as soon as all acute and painful inflammation has subsided; and then they should be continued, day and night, for ten days or two weeks. The bandages should be removed morning and night. After the skin of the leg has thoroughly dried off, an infriction of alcohol or distilled extract of hamamelis is given the parts and the cotton and bandages are readjusted. A good, even and firm pressure in such cases is productive of satisfactory results.
In chronic distensions of tendon sheaths synovia may be aspirated and about five cubic centimeters of equal parts of tincture of iodin and alcohol is injected into the cavity. This is not done, however, without usual aseptic precautions. If no marked swelling results within forty-eight hours the entire fetlock region is thoroughly vesicated and, as soon as the skin has recovered from the effects of the vesicant, pressure bandages may be employed. In these cases, subjects may be put into service after all swelling which the injection or the vesicant has produced has subsided. The pressure bandages are used at night or during the time that the horse is in its stall and they are not worn by the subject while at work.
Where no marked swelling occurs within ten days, as the result of the injection of iodin, the injection may be repeated and, if thought necessary, the quantity may be materially increased. If swelling does not occur it is indicative that no particular irritation has been caused.
Some swelling is desirable and much swelling sometimes results and persists for weeks. This is not in any way likely to cause permanent trouble; and if the technic of injection is skilfully executed no infection will follow.
By persistent and careful use of suitable elastic bandages, the support thus given the parts, together with the absorption of products of inflammation which constant pressure occasions, some chronic cases of synovial distension of tendon sheaths recover in two or three months and this without other treatment. Such good results are not to be expected in aged subjects, nor in horses having at the same time, chronic lymphangitis.
Where bandages of pure rubber are employed great care is necessary, if one is not experienced in their use, lest necrosis result. Where bandages are uncomfortably tight the subject will manifest discomfort, and an attendant should observe the animal at intervals for a few hours (where there may be some doubt as to the degree of pressure which is exerted by elastic bandages) and readjustment made before any harm is done.