INTERNAL BLISTER
Iodine 2% in Almond Oil
By Malcolm Borthwick, Jr. VMD

Basic Information

Iodine 2% in almond oil injection is an internal blister and has many uses including setting up a splint or to speed up the healing of high suspensories. This is a treatment handed down from practioner to practioner for many years. There was, at one time, a commercially available Iodine in Almond Oil product called Hypodermin® manufactured by Haver-Lockhart. I find its best use is in treating sore gluteal muscles or in horses with loose stifle ligaments.

Off-Label Use

Loose Stifle
Loose stifle is often seen in a horse that is stumbling or knuckling over behind. These symptoms can also be caused by sore hocks or back toes that are too long and these causes should be ruled out. When the cause is determined to be loose or sore stifle ligaments, I treat the condition with injections of Iodine 2% in Almond Oil.

	Inject 5cc per site in five sites, making an arc over the lateral side and above the stifle joint.

First, I palpate the three patellar ligaments: the medial, the middle and the lateral patellar ligaments. I inject 5cc at the site where these ligaments meet over the tibeal tuberosity. I then inject 5cc at each of the three sites where the ligaments originate from the patella. The 15cc (from each of the three injections sites) over the patella are concentrated at the site of origin but some is infiltrated over the surfaces of the patella. I then infiltrate 5cc at the site of the lateral femoro-tibial ligament over the lateral femoral condyle. The remaining 20cc I use to infiltrate the muscle mass around the stifle. I use 4cc per site in 5 sites starting a few inches above the point of the stifle and make an arc over the lateral side and above the stifle joint. This is shown as dots in Fig 1. I then take another 50cc vial and repeat this procedure on the other leg. Following the injection, the horse should then be worked. This would be a 4 or 5 mile jog for a standardbred or even a training mile. A riding horse should be saddled and ridden for 25-30 minutes with intermittent walk and trot, depending on the horse's condition. If the horse is not fit I would actually have recommended that the work load be increased to see if that would alleviate the problem before I would recommend an internal blister.

	Inject 4cc per site along three lines.

Gluteal Muscle
The other important use for Iodine 2% in Almond Oil is in horses that are sore in their gluteal muscles. It can be a primary soreness or soreness secondary to another problem. These muscles are very sore with pressure from palpation. It is often on only one side but can be bilateral. I use two 50cc vials on each affected side. After the area has been washed and wiped well with alcohol, I mark the area to be injected by running my finger against the grain of the hair to leave a line to follow. I start just above the Tuber Ischii and draw my line to just above the Tuber Coxae. I then draw another line about 2-3 inches above the first, and then a third line about 2-3 inches above the second. I then inject 4cc per site along the 3 lines until I have used my 100cc (as seen in Fig 2). After this the horse should have light work immediately following the injection and should be worked lightly, but kept at some motion for a week to 10 days before going back to full work. If gluteal soreness was the primary problem you should be fine. If it is secondary to another condition, it will recur in several weeks.

Technique and the use of a quality sterile product is important in the success of this procedure.

About the Author

Dr. Malcolm Borthwick, Jr. is a veterinary practitioner in New Hope, Pennsylvania. He completed his VMD in 1969 from the University of Pennsylvania School of Veterinary Medicine.

Dr. Borthwick has been in private practice since 1969, specializing in sports medicine. He is a member of the American Association of Equine Practitioners, the Pennsylvania Veterinary Medical Association, and the American Veterinary Medical Association.

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