I have a 26 year old Western pleasure gelding who is still in amazing shape. I have owned him for 17 years. He has never been abused or pushed, but he has however developed arthritis in his left hock. I injected him for the first time last year with amazing results. After two weeks lameness was gone and he was much more comfortable. I don't think this should be a first resort for anyone, but it has made my boys life much more enjoyable and comfortable in his golden years. He was able to return to the show pen and is still being lighty shown by my 9 year old daughter.
The care of the hand in the post-operative period is very important in helping to ensure a good result. Initially the aims are comfort and elevation. These are met by keeping the hand up (elevated) especially in the first few days and by use of a long acting local anaesthetic (Bupivicaine). The local anaesthetic lasts at least 12 hours and sometimes 48 hours. Patients should start taking painkillers before the pain starts . on return home and for at least 24 hours from there. This way most of our patients report little or any pain.
The patient is reviewed in clinic after about 1 week following the operation. Typically dissolvable stitches are used so they should not require to be removed. A splint will be provided by the physiotherapists. Careful follow up is required to ensure a successful result with good relief of pain and a good range of movement. The wire if used is removed in clinic at about 3 weeks form surgery. Therafter the hand can be used whilst still wearing the splint protecting against over straightening. Most of the movement gained following surgery occurs in the first 6 weeks and this time must be used productively to ensure a good result. The key is regular long gentle stretches both into straightening and into bending. Ideally these should be performed for 5 mins in each direction (feeling the stretch but without pain) once an hour. In practical terms most people mange 5-6 times a day. Elevation and icing the elbow also help reduce swelling and thus pain and improve movement.
Most patients can drive after a 4-5 weeks. Most patients return to work in 5-6 weeks, but this varies with occupation; heavy manual work usually takes about 3 months if ever. The wound should be massaged by the patient 3 times a day with a bland soft cream for 3 months once the wound is well healed (typically after 2 weeks). This reduces the scar sensitivity which can be a nuisance. If this is marked a Physio may be organised to help reduce the scar tenderness but this is rarely required. Patients should avoid pressing heavy use of the hand for a good 3 months from surgery.