Case report: Horseshoes

Although the game of Horseshoes is less well known in recent years (fewer horses perhaps), it remains in the memory and hands of many “old-timers.” In fact, it is still played by the few who have retained the equipment. Throwing a 2.1 pound semi-circular steel horseshoe 40 feet towards a steel stake and competitor, conjures up the sort of potential for injury that one might encounter (see attached picture). A cheerful 82-year-old fair-skinned man came to our clinic following the development of a lesion on his right arm two days after playing horseshoes for the first time in many years. He had not experienced a known injury and his arm was not painful. The patient—although physically active—suffered from COPD and hypertension, even carrying portable oxygen for occasional use when short of breath. He had no known allergies and was taking Altace, hydrochlorthiazide, Losec, Breo, Spiriva and Ventolin inhalers. No aspirin or anticoagulants.As the “rash” developed on his right arm, he had applied cold packs and taken Tylenol (not sure why—since there was no discomfort—Tylenol seems to have a universal healing aura). The area on his arm had continued to spread slightly, hence his visit. He feared the dreaded “blood clots.”Examination revealed the subcutaneous, painless, bright red slightly swollen sharply demarcated area proximal to the antecubital crease and over the right biceps of the patient’s arm. I was pretty sure that he had torn a few blood vessels during the exertion of throwing horseshoes. Cool packs and rest were recommended.Physical activity is promoted in maintaining function and health in the elderly. This is commendable and no doubt usually helpful. But continuation of previous activity, not sudden adoption of something new and demanding extra exertion, is highly to be recommended.I wonder how often physicians are consulted about a problem resulting from an activity which—while remembered fondly—had been resumed on the “spur of the moment.”

Case report: Horseshoes

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