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Discussion on Cunean Tenectomy or other remedies?
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New Member:
Btsmsn
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Posted on Sunday, Sep 12, 2004 - 9:32 am:
I have an 8 yo mare used for dressage. With beginning work in collection, she is developing sore hocks - she is 'straight legged' behind. Last hock injection was 3 months ago, and there were no boney changes then. I read that rather than boney problems, it may be cunean bursitis. I am wondering about 1) scintigraphy to r/o joint (bone) changes, and then2)cunean tenectomy 3) or what about 'freeze firing'? thanx. Beth
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Moderator:
DrO
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Posted on Sunday, Sep 12, 2004 - 11:14 am:
Hello Beth,
The straight forward way to diagnose cunean bursitis is injecting local anesthetic into the bursa to see if the lameness is relieved. If this localized the lameness you might try intrabursal injections before surgery, see Equine Diseases » Lameness » Diseases of Joints » Arthritis and DJD: An Overview for medications used in joints and bursas.
We have an article on cunean tenectomy and you can review it by selecting Cunean Tenectomy for Arthritis of the Hock off the navigation bar above.
DrO
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Member:
Btsmsn
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Posted on Sunday, Sep 12, 2004 - 4:40 pm:
Dr. O - could you help me understand how the differentiation is made between soft tissue strain in hocks vrs arthritic changes? I am not clear whether I should just have her hocks injected again (and resign myself to tx 4 x year) or do further investigation. Without blocking the bursa with a local anesthetic, how would you know it was or was not bursitis vrs arthritis? Thanx for your help. Beth
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Moderator:
DrO
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Posted on Sunday, Sep 12, 2004 - 6:19 pm:
Hello Beth,
A great question Beth that does not have a simple answer. The biggest problem is the term "hock". This is an anatomical location that contains, 4 articulations (joints), 9 bones (off the top of my head), 2 major bursae, 5 tendons and their accompaning sheaths and bursa, numerous tendon insertions, and a plethora of ligaments and their attachments.
Perhaps the best way to explain this issue is for you to read the article Equine Diseases » Lameness » Diseases of the Upper Rear Limb » Overview of Diseases of the Hock (Tarsus). Here is described the common causes of lameness of the hock and how they are different.
This issue of soft vs bony tissue has even a finer point. Arthritis can be of the bony/cartilagenous nature (osteoarthritis), soft tissue (capsulitis), and frequently both. For more on this see, Equine Diseases » Lameness » Diseases of Joints » Arthritis and DJD: An Overview.
DrO
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Member:
Btsmsn
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Posted on Sunday, Sep 12, 2004 - 10:02 pm:
Dr. O - ok, two more questions. 1) would the new topical NSAID (Surpass) be helpful in acute inflammation, as well as joint injection? what about to help with maintenance when she is in work?
2) my mare was injected in mid June.,and started back in training gradually over 5 days. Now she has another flare (tho the other leg), and I am wondering if we need to be more aggressive (injections, + course of Adequan, Legend, you name it) plus a longer period of rest, icing, Bute? What course would you recommend to Maximize effect of treatment, so I can eventually put her back to work? (the periods between injections are shortening - 4 months, now 3.)
oops, I guess its 3 questions - at what point do you consider arthrodesis? Thank you. Beth
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Moderator:
DrO
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Posted on Monday, Sep 13, 2004 - 8:01 am:
1) Surpass (1% diclofenac) is a new product that has little research or is there a lot of field experience behind it that I can locate. One scientific report indicates that the product (a known effective NSAID) is absorbed and retains its antiinflammatory properties. Concerns expressed on the product label are that the blood levels may effect the toxicity of other drugs. Concerns expressed in Horseadvice is that one of our members has had a severe skin irritation associated with its use. Horseadvice has not taken a position on this treatment and suggest if you choose to use it, follow instructions closely an it should be in lieu of treatments not as ancilliary therapy.
2) Not knowing what you did before or being able to examine the horse I cannot know whether you should change your treatment program. You should be aware that recurrence is more likely to be related to exercise that exceeds the joints ability to remain stable and not too little therapy. If to retain soundness injections with strong intra-articular preparations every 4 months is required, I would reconsider the amount of work being asked of the horse.
3) Our article on Arthritis Overview provides our recommendaions for treatment and also present a list of indications for arthrodesis.
DrO
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Member:
Miamoo
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Posted on Monday, Sep 13, 2004 - 9:33 am:
Dr. O,
Beth wrote that her horse was straight legged and that she was having hock problems. My vet said that I needed to watch my mare for hock and stifle problems because she is straight legged but my blacksmith put a instrument that he uses to measure hoof angles on her and her hoof angels were exactly in the middle of normal. The blacksmith said that if she were straight enough to be a problem that it would show up in the angles of her hoof. How straight is too straight? Is it seen through the hock area, the pastern or is my blacksmith correct in that it will also show up in the hoof angle. Where do you look on the leg to determine how straight they are?
Ella 
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Member:
Miamoo
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Posted on Monday, Sep 13, 2004 - 9:47 am:
Dr. O,
I should add that I asked you your opinion regarding her legs when my vet first said that she was straight behind. You had me post pictures. They are on the site under the heading "straight behind".
You thought she was not too straight for my intended use. Beth's post just got me thinking. I look at her and at my other horses and don't see that much difference. I guess I don't know what exactly I am looking for.
Ella
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Moderator:
DrO
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Posted on Tuesday, Sep 14, 2004 - 7:06 am:
Hello Ella,
I have not seen a strong correlation between hoof angle and whether a horse is straight legged. There is a correlation between hoof and pastern angle but when we say a horse is straight or post legged we refer to the angle of the stifle and hock.
DrO
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Member:
Miamoo
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Posted on Tuesday, Sep 14, 2004 - 7:31 am:
Ahhhhh, the mist is clearing.
Thanks,
Ella
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Moderator:
DrO
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Posted on Wednesday, Sep 15, 2004 - 9:42 am:
If you go to References » Equine Illustrations » Leg Anatomy and Conformation we have images and articles illustrating the ideas we have been discussing.
DrO
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