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Hi Dr. O,
I have a 15 year old palomino who has been off for about 1.5 months. My first guess was him racing around in a hard (think dirt concrete) full speed downhill and playing with friends. Initial heat showed up at L3-4-5 and square in the middle of his hindquarter about the bottom of the pelvis on either side. So I thought he was out.
Life happened (weather/work) and while I had a vet out a few times, we still do not know what is wrong. On the initial exam Vet maintained it was his left hind and to put back shoes on. Farrier did not get back to me in a timely way, so instead of having him out every three weeks, I elected to wait and just have him shod a week early. Shoes did not change his gait.
Then I had a chiropractor come out and she said he was ouchy in his left fetlock.
Stifle/hock/fetlock and hoof Xrays show (per the vet) a horse with bone like a five year old on the left hind. Really good.
Ultrasound was unremarkable.
Vet did an abaxial block and he said he was 80% improved, so we did a coffin joint injection.
It’s been two weeks and this is what I have now. It’s been raining like crazy here so this was the dry/safe patch of ground. Arena is closed.
First I thought pelvis/sacrum, then stifle, really worried about suspensories but I’m told no…Now I’m wondering if it’s the right front…
Once the weather calms down I will haul him for a more thorough exam, but in the meantime, I would like your opinion of what it could be and what I should be doing for him.
He is currently on Osteomax, farrier’s forumula, horsetech’s Pre Ox and waterwerks. I will be starting him on a tendon/ligament support supplement, so if anyone has any recommendations I would appreciate hearing them. This is a super sweet, super safe, great horse that has had past trauma.
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Hello Aileen,
I have been unable to view the video it is labelled private; I would be interested in viewing it. First should be that you cannot tell by the appearance of the lameness where the lameness is. Yes, there are some general rules but defining the place in the leg that is lame requires a examination possibly with nerve blocks. You did not describe the results of the coffin joint block, and this is important following a positive(?) response from the abaxial block. If there is a question about the response it should be repeated, possibly advancing to a complete ring block of at the level of the abaxial (sesamoidean) block. Taping the before and after is a good way to help decide response. Best is to start distal on the limb and proceed proximally to better localize the problem. As to what to do at this time read, https://horseadvice.com/horse-equine/diseases/lameness-in-horses/first-aid-for-the-lame-horse/ there is a section on treating the undiagnosed lame horse.
DrO -
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Ok, that one worked. Here is the vet’s summary from the last visit
Owner requested reexam lameness Gold Nugget. History- was sole sore left hind but not responsive to conservative treatment. Exam- negative to hoof testers, 2/5 left hind 3 months, owner not willing to let me do flexion tests, abaxial nerve block and 80% improved, joint effusion noted DIP. radiographs hock, fetlock and foot done as requested by owner as chiropractor diagnosed as fetlock problem. DDx OA LH DIP. 3mg detomidine iv, 3m torb iv, 6 mg triamcinolone IA DIP. Rest 10 days, call with response.
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Aileen,
No I don’t think this is a referred lameness with the front end causing a hind limb lameness. I just don’t see any evidence of the front being off. You have a pretty solid 2/3 degree lameness with a weight bearing hip hike and shortened stride on the LH. This would have to be confirmed with a more complete exam of watching the other side and seeing the horse trotting straight away. He appears worse during the brief view 2 weeks after injection. Except for the extended trot following the Yee-haw moment in the last video he is mildly to moderately lame every step, walking and trotting. We are back to needing a good diagnosis.
DrO -
Thank you Dr. O, that helps.
His walk is better, more even on both left and right hinds; but I agree his trot is worse. His tail carriage is interesting to me, could it indicate an issue high, not below the stifle?
Also, before the injection he seemed more willing and comfortable at the canter, than at the trot, is that indicative of anything?
If this horse is truly painful he will hesitate to move and will trail behind me. Currently, he does not hesitate and walks right beside me evenly now.
I will get a video of him trotting away, but likely will not able to use the round pen this week. The good news is it’s drying out, but money is at issue with the full diagnosis. I understand it could be up to $2000 to find out and tax season is right around the corner… so I need to wait for the accountant to find out how much I will have to pay this year.
The vet that saw him said another option would be to just give him a year off in his paddock, not confined. I know it’s hard to say without seeing him and I completely hear you on needing a diagnosis, but in horses you have seen in your practice, does allowing them to be a horse ultimately make it worse? or should I be more conservative?
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Hello Aileen,
None of the above observations localize the problem in any actionable way. As to turn out as a solution and if you are asking, have I seen horses get well with turn out(?), absolutely. But it all depends on the nature of the lameness and the behavior of the horse when turned out. Some injuries that need time to repair and don’t mind some amount of stress will respond, think bruises and mild sprains. But moderate to severe soft tissue injuries need enforced rest to allow the tissues to heal, of course osteoarthritis will not go away. Without a diagnosis, treatment and prognosis are just guess work, but you can only do what you can do. Paddock rest is a good compromise when a diagnosis is not possible. Important is to monitor response. Continued improvement suggests continuing the course, worsening lameness needs reconsideration.
DrO -
Thank you Dr. O,
That makes sense. He’s fairly sensible, but does get a bug up his bum every once in a while. I will see if I can borrow some panels to make his enclosure smaller. He was looking great for a few days, trotted across the pasture very evenly, then yesterday it was bad again 🙁
I should know in a few weeks if I can afford it soon.
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Well, I took him to a lameness specialist. It’s both the suspensory just above the left hind fetlock, medial, it also says enthesopthy – AND the sesmoidian ligament just below the left hind fetlock-medial, desmopathy. What is the difference between enthesopthy and desmopathy?
He gave it a 3 out of 5 and said it’s old, consistent with the onset in late October. There is already remodeling of the tissue.
I elected to do the Platelet Rich Plasma, so he will need to be wrapped for 30 days.
I’ve emailed these questions to the vet, but since I have not had luck in trusting one vet, I would like your opinion/answers to the below questions for my horses’ situation.
Wraps for the 30 days
Should I get a cooling no bow for daytime use since he needs to be wrapped 24/7 for 30 days?
Do I have to wrap below the fetlock?Bute
If, after 3 days, he still has swelling, do I continue the bute or will the wrap be sufficient?Wraps after 30 days
Would a benefab wrap be ok after the 30 days?
Would a back on track wrap be ok after the 30 days?Infrared Therapy
I know not to apply infrared therapy to his leg for 30 days, but can I apply an infrared blanket to his back?
May I start the infrared on his leg on day 31? Does it depend on if he has swelling?Stall or Paddock for 30 days?
I do have the possibility of keeping him in a stall/paddock, would that be better than his large paddock where he can get up a good gallop?Thanks Dr. O for any insight/opinions you provide.
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Desmopathy is a disease of the ligament and enthesopathy is a disease of the point where tendons or ligaments attach to bone.
Aileen, I cannot make specific recommendations on your horse, but I can say:
Chronic cooled-out injuries generally need to develop blood supply and stimulate circulation through warm treatments. NSAIDs are used for treating inflammation and pain. NSAIDs may not be indicated if there is no sign of inflammation or acute pain. I see no reason for the use of (or no reason not to) use an infrared blanket on his back. As to those specific wraps, I have no experience, and as to the amount and type of exercise, those are questions for the examining vet, and that far out from now, best decided after a recheck. I hope this helps.
DrOPS, The vet’s recommendation on exercise terrain makes sense to me during the early stages of rehab.
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Yes, this helps. The farrier was out today and we decided to leave off the hind shoes to eliminate torqueing in the future. I will try to keep the toe/heel back per vet. Farrier back out in five weeks.
Thank you!!
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Trying again, photo was too big.
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Hello Aileen, is it different than the other side? The vein does appear congested; if it is, the cause should be determined. Some signs of more severe disease would include heat, pain, and edema forming in the surrounding and distal (to the enlargement) tissues. With the enforced rest, it may be slowed venous blood return from decreased exercise.
DrO -
Hi Dr. O,
Yes it was different from the other side. I did some light massage, trying not to stimulate the prp area and it did get a little better. It has not come back to the degree it was in the picture but is raised a tad. Could bad wrapping cause that? I had to be gone for a few days and someone else wrapped him.
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Hi Dr. O,
I took him back for a recheck yesterday. The severity decreased from 3 out of 5 to 1 out of 5. Super happy about that.
Because I had a hunch about his back, he did a pelvic ultrasound and found lumbosacral arthropathy. He said there was a spur close to the nerve, so he injected cortisteroids in the sacrum area, not exactly sure where.
Does this make sense for the back soreness on a horse that was never sore on his back before this accident?
He also did multiple xrays: neck, back and right hind. C5-6-7 has minimal arthritis as does his right hock of no concern to the vet. But otherwise bone looks great.
He is a happy horse this morning, moving with confidence.
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