What is Capped Elbow?
Capped elbow is usually a result of too much pressure or trauma to the elbow on a repeated basis. Since horses normally rest on their elbows and use them to push themselves to a standing position, not having enough bedding can cause a chronic swelling of the bursa that can grow to the size of a grapefruit. Although veterinary professionals claim that capped elbow is not painful, if it gets too large, it can affect a horse’s gait, performance, and may cause lameness.
One of the most common limb conditions in horses is capped elbow (olecranon bursitis), which is the inflammation of the elbow. Capped elbow happens when the bursa in the elbow fills with fluid and creates a swelling or lump. The cause of capped elbow is most often from repeatedly putting too much pressure on the horse’s forelimb when lying on hard ground or a stall that does not have adequate bedding. Sometimes this condition is referred to as a shoe boil due to the accidental pressure from the heel of the shoe onto the elbow when the horse is bedded down.
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Symptoms of Capped Elbow in Horses
Some of the early signs of capped elbow can be seen before the swelling is visible such as:
- Scrapes and scratches on elbow
- Baldness on elbows
- Thick and flaky skin
If these signs of irritation are not treated, they can evolve into other symptoms, which include:
- Soft lump filled with fluid (may get as large as a grapefruit)
- Thickened area of rough skin on elbow
- Slight limp or lameness if the bursa grows large enough to interfere with walking
- Warm, red swelling on elbow
Causes of Capped Elbow in Horses
It is possible for capped elbow to be caused by an accident or trauma to the elbow, but it is usually caused by putting too much pressure on the elbow when laying down in a stall or barn with inadequate bedding. A horse needs at least three inches of bedding material to bed down on. Another cause of capped elbow is using horseshoes that project out behind the heels. You can use shoe boil boots, which are rubber rings fitted around the horse’s feet to stop the heels of the shoes from rubbing on the elbows when lying down.
Diagnosis of Capped Elbow in Horses
Your veterinarian (preferably one that specializes in equine care) will need to know your horse’s history, type of work done, and vaccination records. A detailed physical examination will be done next, which includes evaluating your horse’s general condition, appearance, conformation, and behavior from a distance and from close up. In addition, your horse’s heart rate, respirations, height, weight, body condition score, temperature, and blood pressure will be evaluated and recorded.
The veterinarian will ask you to trot your horse a bit to check the movement and muscle function while in motion. Afterward, the veterinarian will give your horse a flexion examination which involves putting pressure on the affected joint and then watching your horse trot to see if there are any gait abnormalities. A nerve block will be injected into the joint to numb the area before sending you to trot your horse again. This will let the veterinarian know whether the capped elbow is causing any pain or lameness.
Laboratory tests are also needed to rule out other illness or injury that can mimic a capped elbow such as infection or fracture. These tests include a blood culture, complete blood count (CBC), glucose level, electrolyte levels, chemistry analysis, creatine kinase (CK), and lactate dehydrogenase (LDH). Also, an arthrocentesis will be performed by clipping and disinfecting the area before using a hypodermic needed to collect fluid from the bursa. This fluid is microscopically tested for bacterial and fungal infections. The final step includes imaging of the affected area using x-rays, contrast x-rays, and ultrasound, but may also include a CT scan, MRI, and bone scan.
Treatment of Capped Elbow in Horses
The veterinarian will use all of the information from the physical examination, laboratory tests, and imaging to create the best treatment plan for your horse. Some of the treatments used may include:
Whatever fluid is left in the knee may be drained to reduce the swelling and inflammation. This is done with a hypodermic needle, is very safe, and only takes about 15 minutes.
Cold water immersion followed by draining more fluid and giving corticosteroid injections. This may be done several times per week until the inflammation is gone. Swimming, water treadmills, and static spas are also good therapy for capped elbow.
Corticosteroid injections, NSAIDS (non-steroidal anti-inflammatories), and diclofenac sodium liposomal cream may all be used for inflammation and pain.
If the inflammation is severe and causes any pain or lameness, the veterinarian may suggest surgical removal with curettage and drainage.
Recovery of Capped Elbow in Horses
Prognosis for your horse is good and there should be no lasting complications. If your horse had to have surgery, you will need to continue to clean and bandage the wound several times a day until the veterinarian recommends you remove it. Therapy may be continued for several months if needed.