All treatments were performed under the supervision of Steve Adair MS, DVM, DACVS, DACVSMR,
Professor of Equine Surgery and Rehabilitation at the University of Tennessee Knoxville
Patient
13-year-old Quarter Horse gelding (Western all around)
History
Patient was presented on 11/17/24 for a hygroma of the left olecranon. He was treated five years ago for this same condition. The area recently was re-traumatized and was surgically excised at another referral hospital. He was referred to our hospital for treatment of olecranon hygroma recurrence following surgical excision.
Upon presentation he was bright and alert with a slightly elevated rectal temperature (102.4*F), which returned to normal several hours after intake (100.4*F). Over the left olecranon, there was a firm, moveable soft tissue mass.
Diagnosis
Ultrasound of the left olecranon bursa revealed heterogenous soft tissue material and thickened capsule, which appears to be chronic. No obvious signs of infection were noted.
Lameness evaluation revealed Grade 3/5 RH and a mild Grade 3/5 RF (AAEP scale). Flexion tests were positive in both distal forelimbs (R>L). The distal left hind flexion test was positive, and the right hind distal limb flexion worsened the lameness significantly. At this time, the limb with the hygroma (L) appeared to not be the source of lameness.
Treatment plan
The left elbow was initially treated with therapeutic radiofrequency (11/20/24-12/18/24 M-F) with minimal improvement. It was decided to change therapy from radiofrequency to Low Frequency Ultrasound.
Measurement at the start of Low Frequency Ultrasound Treatment: 11 cm x 13 cm
Treatment plan
On 12/19/2024 Low Frequency therapeutic ultrasound was instituted on weekdays (Mon-Friday). At the time of the first treatment, it measured 11 x 13 cm and when discharged on 1/7/2025 it measured 8.5 x 10 cm. This was approximately a 40% reduction in size for the 12 treatments he received. The protocol used (soft tissue softening) consisted of 5 minutes with the white transducer at 70%, followed by 6 minutes with the yellow transducer at 70%. Additional therapies that were being performed included underwater treadmill 5 days per week, active stretches and lunging over poles. Due to financial constraints the patient was discharged on 1/8/2025.
Conclusion
We feel that the Low Frequency ultrasound treatment made a significant impact on the size of the hygroma and that if treatment was able to be continued, further reduction in size would have occurred. The owner was very happy with the results that we had received.
The following are before and after images.
