If the sac is punctured or opened by the trauma, it can become infected and may be very difficult to heal. When these hygromas first occur, they are usually hot and tender and the horse may be lame. With time, they cool and there is rarely any lameness associated with an old or chronic hygroma. Treatment in the initial stages should consist of eliminating the cause of the trauma, cold hydrotherapy and rest. Later, when the swelling is cold and non-painful, treatment can be expanded to include topical DMSO applications and injections of steroids into the bursa.
Steroids reduce the irritation and lessen the swelling of the sac.
Most problems in the horse are better avoided than treated, and hygromas certainly fit that picture. As the enlargement gets older it becomes smaller and harder, but is always liable to re-injury. Correct shoeing and pastern roll guards can help prevent elbow injuries. Another method of preventing further aggravation of a capped elbow is to shoe the horse with a special shoe from which the inner quarter and the heel have been removed. It is this part of the shoe which will cause or exacerbate this injury.