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  Discussion on Diagnosing OCD via scope?
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New Member:
Lucassb

Posted on Thursday, Dec 19, 2002 - 12:26 pm:

We have just had a prepurchase exam done on a young warmblood gelding we intend to point toward a jumper career. He is quite tall - nearly 17 hands as a 2 1/2 year old - although he is not heavy or bulky.

The prepurchase vet told us that she found OCD in a front fetlock which she suggests would do well with a surgical intervention. She also found the same in the L hock, which has some filling in it although the horse is not at all lame. She did feel that this one would not require surgery although if we wanted to treat it aggressively and do so it would likely be fine.

At this time he is absolutely sound and his flexions show no lameness at all.

The other finding, and the one that most concerns this vet, is that she says the scope shows some erosion of the stifle. The vet feels this would be potentially quite limiting and she cannot recommend the purchase of this horse for anything like our intended use.

The sellers are being quite nice about the whole thing but have expressed surprise that this diagnosis/determination was made without the benefit of xrays but just using a scope. I am having xrays taken and sent to my vet along with the tape of the scope exam, but meanwhile, can you help me understand if this is something that can only be diagnosed properly with regular xrays?
Moderator:
DrO

Posted on Friday, Dec 20, 2002 - 7:52 am:

Hello Susan,
I am not sure I know what you mean by a "scope".

Erosions of the cartilage, being soft tissue surrounded by bone, are not easily seen with radiographs and are best diagnosed with a arthroscope. What I cannot get over is the arthroscope, being an invasive procedure and usually requiring general anesthesia, was done on a otherwise healthy joint. It makes me wonder if this is what you are talking about, possibly a fluoroscope?.

We have more specific information about the other OCD lesions in the lameness articles. Look up the particular joint in question.
DrO
Member:
Lucassb

Posted on Friday, Dec 20, 2002 - 10:43 am:

Thank you, Dr. Oglesby,

Yes, I am sorry... it was a fluoroscope. The vet said that due to the angle required, it would not be possible to get an xray of that area, but she got a "good picture" of it on tape from the fluoroscope exam. The explanation I got from her when I asked for greater detail was that there is some roughness on the inside, rounded edge of the femur. She said there is a very small flap there. Her assessment is that it would not rule out a conservative career as a lower level (3') hunter but it would be risky to consider him as a jumper prospect or for any career that would involve more strenuous training.

I have read a lot of literature on this in the last few days and have seen some articles which discuss arthroscopic treatment of this condition. This vet says in her experience treating this type of thing is not particularly successful.

The sellers have come down substantially in their asking price as a result of this, so I am wondering how big a chance I would be taking. Of course I understand that there is no way to really make an assessment until after he is in real work, which due to the open growth plates would not be for at least another year or 18 months.

From your reply I gather we will not be likely to have much more information from the review of the xrays? Has it been your experience that this type of lesion in the stifle area is not treatable?

Thank you in advance!
Moderator:
DrO

Posted on Saturday, Dec 21, 2002 - 12:14 pm:

Hello Susan,
Unless she has some very new equipment that I am not aware of that type of specific information about the soft tissue of the stifle would be difficult to determine from a fluoroscope.

Fluoroscopic images are grainy and not as well defined as they would be on a good radiograph, think of a TV image versus a good photograph. If the lesion is visible on the fluoroscope, yes there would be more information on a good radiograph taken from the same angle. But even radiographs are known to not be of sufficient quality to make a prognosis: though certain lesions in certain areas may be more or less associated with problems.

I question the ability of a fluoracope to make this diagnosis and am positive that a accurate prognosis from a floroscopic exam is not possible: it misses to much. I recommend you have the tape reviewed by a equine orthopedic surgeon for a second opinion.

In order to judge such a lesion I would have to see it or at least a good description of location and size.
DrO
Member:
Lucassb

Posted on Thursday, Dec 26, 2002 - 6:12 pm:

Dr. Oblesby,

Thanks again for the quick response. I had the tape and the xrays sent to an orthopedic specialist and was advised against purchasing the horse. The rationale was, any ONE of the issues probably could be dealt with, but taken as a whole, it was too much to take a chance on. (The orthopedist found other things on the tape that were of concern, including another area of the stifle, that the first vet had not identified...) As he said to me "this is a horse that likes to shed his cartiledge - not a good tendency!" So we are sadly going to pass, darn it all.

Thanks again for your help. There is quite a lot of good info on your site, and I am sure I will consult it regularly.

Susan
Moderator:
DrO

Posted on Friday, Dec 27, 2002 - 6:15 am:

If we have 2 concurring opinions that sounds best, but I want to get this straight: the specialist determined that the taped fluoroscopic exam elicted useful information about the cartilage from the stifle? Wow... I went and did an informal look at a new portable fluorocopic equipment and do not see much change.
DrO
Member:
Lucassb

Posted on Saturday, Dec 28, 2002 - 7:05 pm:

Dr. O -

Now you are making me second guess myself!!

Yes, they scoped the entire horse and that tape went to the orthopedist, along with xrays of the areas that were judged to be of concern from a review of the tape.

I was told that, on a scale of 1-5, where 1 was excellent/sound and 5 definite problems, this horse was a "4" which was defined to me as, having issues that were LIKELY to cause soundness problems in the future (meaning when the horse was put in serious work.)

The second vet who evaluated the tape said he could see "angry looking" areas of several joints and was of the opinion that the horse was likely to continue to experience additional problems as he grew and was put into training.

This differed from the first vet's opinion, for whatever that is worth - Vet #1 said "this is what he is, and it is not likely to get worse - but what is already here could cause problems once he is put into training."

I don't know if it matters or not... the exam was not done with a portable unit. The horse was vetted at a very large clinic. Vet #1 did say that had the vetting been done at the seller's barn with a portable unit, this would not likely have shown up. In fact, she said not too many years ago, with the equipment she would have brought to a normal vetting at someone's barn, this horse would have passed, without concern.

I am just miserable about the whole thing, to be honest. I have been looking at quite a lot of prospects, and this one fit the bill in every way... and gosh, to look at him today he is 100% sound...

ACK.
Member:
Dres

Posted on Saturday, Dec 28, 2002 - 10:18 pm:

Susan, take it from a horse breeder... there IS another perfect prospect out there, one that does not have the 'issues' this one does...

Ann
Moderator:
DrO

Posted on Sunday, Dec 29, 2002 - 9:06 am:

Let's try this Susan,
Get the vet you think most qualified to write down exact descriptions of the lesions they found. Then if you will transcribe them here I would be glad to comment.
DrO
Member:
Lucassb

Posted on Sunday, Dec 29, 2002 - 5:27 pm:

Ann,

Thank you for the encouragement. I know there are other horses out there - we are just looking for a fairly unique combination of talent and temperment, and they are few and far between, so we were disappointed that it did not work out. We will keep looking!

Dr. O,

I will try to get a better description from the orthopedist. I know he is on vacation til after the New Year, but will try to get more accurate/complete info for you when he returns. Thanks again!
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