Daily Vet Life: A Collateral Ligament Injury With Curveballs 

In 2023, Rachel Buchholz, DVM, a senior associate veterinarian at NW Equine Performance, in Mulino, Oregon, received a call about an all-around show horse with an ongoing intermittent right-front lameness. She was the third opinion on the 8-year-old Paint gelding’s case and recommended he come up from his home farm in California to the clinic in Oregon for advanced imaging. 

Radiographs from a few months prior showed almost negative palmar angles and moderate navicular bone changes. The horse’s care team had been treating him as a podotrochlosis case, administering Osphos and injecting steroids into the coffin joint and bursa with inconsistent results. 

Interestingly, said Buchholz, after doing a palmar digital nerve (PDN) block, the horse appeared 2 out of 5 lame on the left front. When she flexed the horse distally, he was 3+ out of 5 lame in both front limbs. After performing a standing MRI, she discovered a lateral deep digital flexor tendon lesion in the left front, moderate to severe collateral ligament injuries in both fronts, and large cyst lesions in the coffin bone where the collateral ligament attaches. 

“On the left front, the medial collateral ligament was much worse, and on the right front, the lateral collateral ligament was much worse,” Buchholz explained. “Both of them had pretty moderate fiber changes in both medial and lateral collateral ligaments and cyst changes at the insertions. So the horse that we had been treating as a navicular case was not navicular at all—that was a surprise that we were not expecting.” 

With an accurate diagnosis in hand, she could now prescribe an individualized treatment and rehabilitation plan. It included injecting platelet-rich plasma into both front coffin joints, both front fetlock joints, and regionally into the collateral ligaments. 

“In my mind, with collateral ligament injuries, if I can keep the joints happy, then maybe I can give the collateral ligaments a bit of a chance,” Buchholz added. 

She treated the left front DDFT with shockwave and sent the horse home on a walking rehab program for several months, accompanied by shoeing changes and joint therapies.  

Her biggest takeaway: “Even when we think we know what’s going on, horses are humbling. If we have further questions, things like advanced imaging and MRI can be super helpful.” 

Listen to the full episode to learn about this gelding’s return to a full work program and his ongoing maintenance plan. 

About Dr. Rachel Buchholz  

Rachel Buchholz, DVM, is a senior associate veterinarian at NW Equine Performance, in Mulino, Oregon. Originally from Howell, Michigan, she attended Michigan State University, receiving both her bachelor’s in animal science and her Doctorate of Veterinary Medicine. During her time at MSU she worked under Dr. Hilary Clayton and Dr. Narelle Stubbs studying equine spinal anatomy, pathologies, and therapies.   

Following veterinary school, she moved west and has been with NWEP ever since. Dr. Buchholz splits her time between clinic cases and farm calls and regional horse shows. She travels throughout Oregon, Washington, and California seeing horses. She also runs NWEP’s advanced imaging, both bone scan and standing MRI, providing diagnostic imaging support, treatment, and rehabilitation advice for clients and referring veterinarians. 

Dr. Buchholz’s professional interests include equine physiotherapy, regenerative medicine, advanced diagnostic imaging, and western performance horse issues.  

Related Reading

• Daily Vet Life: Rehabbing Suspensory and Sacroiliac Injuries
• Daily Vet Life: Using PET to Diagnose Equine Lameness
• Rehabbing Equine Hind Proximal Suspensory Ligaments

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