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  Discussion on Unspecified lower limb lameness
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New Member:
Ribbons

Posted on Saturday, Sep 6, 2003 - 12:24 pm:

Thanks for this web-site. I DrOpped all my other horsey mags because this one has the best information.

We have a 9 yr. old TB Mare who has evented to Training Level. My daughter's goal for her is to complete a CCI*. This summer, however, her mare has been suffering from lameness issues, which we can't seem to figure out what is happening.Twice this summer the horse has come out of the pasture with swollen limbs. The first episode resolved itself with rest. The second episode is what is puzzling us. The horse came in with a swollen right fetlock. We called the local vet, he ultrasounded, saw nothing abnormal, and advised cold hosing and rest for a week and then return her to work. We did.

On re-examination a week later,the vet thought she was sound on the front limbs and was slightly positive to flexion on rear hocks so discussed Adequan/Legend and given the go ahead to jump. We went to a clinic whereupon the horse uncharacteristically bucked my daughter off twice while jumping up and down a bank combination. We stopped right there and made an appointment with the AULC.

Here are their findings on August 14, 2003.

"During lameness exam she was mildly sensitive in th right hind, mid to upper suspensory area. The toe length in fore limbs was a little long (This was at the end of her usual four week shoeing period. She does have the long toe/low heel conformation on her left front hoof.)She was negative on all four limbs with hoof testers. She had an inconsistent DrOp in her left hind limb on a straight line trot. She was negative forelimb flexion on in a straight line, and only slight positive for hock flexion in a straight line. She had a 2/5 lameness in the left forelimb on a lunge.there was about a 50% improvement at a lunge when a palmar digital nerve block was performed on the left limb. After the abaxial nerve block in the left forelimb, there was no improvement in the front, but some rear limb lameness was evident. After the low 4-point block of the left forelimb, right forelimb lameness became evident. There was also some improvement in the left frontlimb and the left hock. The palmar digital, abaxial, and low 4-point blocks in the right forelimb were all negative. A high 4 points block partially improved the right front lamenesss. Radiographs revealed a small bone spur on the navicalur bone of the left forelimb and the medial sesamoid bone of the left fore had an abnormal opacity on the abaxail border, where the suspensory ligament attach. Ultrasound of both forelimbs were within normal limits. The intertarsal joint and tarsometatarsal joints in both hindlimbs were injected with depo meDrOl and amikacin. Her shoes were replaced today on owner's request.

On the vets' advice, she was given bute (which we had to stop as it gave her severe diarrhea) and rested for five days. Then she gradually returned to work. A re-check was scheduled in three weeks. She was returned to work (flat work for a couple of weeks and finally a couple of jumps over low cross rails.)She was marginally better, but seemed to be more off as the worked progressed so we stopped.

At the re-check: "Sara" presented to AULC 9/5/03 for a re-examination of a lameness that was first seen here in mid-August. Her physical exam was normal. A lameness examination revealed a grade 2/5 left forelimb lameness on lunge that improved about 70% with a palmar digital nerve black. A grade 2/5 right forelimb lameness was also identified while lunging, although it did not significantly improve with a palmar digital, abaxial sesamoid or low 4-point black. It did improve following a lateral palmar nerve(which innervates the origins of the suspensory ligament) block. The left hindlimb was noted to DrOp when she trotted in a straight line. Ultrasound of the right forelimb revealed a supicious region, possibly ectopic calcification, about 16 cm distal to the accessory carpal bone.(Probably an old injury. We injected the left front coffin joint with hylartin (hyaluronic acid), traimcinolone, and amikacin.

The mare is now 30 days stall rest with 40 minutes of hand walking to be followed by stall rest and 40 minutes of being ridden at the walk.She will be re-evaluted before going further.

Does all this fit in with a diagnosis of Suspensory Desmitis, sprain, or strain? I am concerned because each time a vet gives us the go ahead to return to work, the horse quickly becomes lame again. Should she have total stall rest for a while? We started putting standing wraps on her while stalled this summer to help with the stocking up in her hind legs. Should we still be doing this even with stall rest and for how long? Is it reasonable to expect her to return to Training Level? Are there more tests I should consider? I don't mind spending the money if I can get a diagnosis, but so far I spent big bucks (for me)to only get a "somethings wrong, but we don't know what" diagnosis.She's a really pretty,sweet,CALM mare and used to get "8" on her gaits in dressage and has fabulous form over fences, so I think that is why I consider these lameness issues a bit more seriously than others. I certainly don't want to ask more of her than she is capable is giving.Would the hunter ring be less stressful? She has been on Cortaflex for the last three years just as preventative. We tried Conquer but got no response.If we go with the Adequan and Legend can we DrOp the Cortaflex?

Thanks so much and sorry this is so long.




Moderator:
DrO

Posted on Sunday, Sep 7, 2003 - 9:11 am:

You have at least 3 lame limbs and the L fore may be lame in 2 places. The L fore is mainly lame in the foot but some secondary problem lies above the foot. Both this higher L fore lameness and the R fore problem remains poorly localized. A unhealed suspensory desmitis will worsen with exercise but so do many causes of lameness. Normally a well placed high 4 point will block low grade suspensory lameness completly through the combination on nerve block and the incidental regional block.

If we assume this is all the diagnostics possible (or even if the problem were well defined) I suggest you do as the horse tells you: if what you are doing is consistantly making the horse lamer, stop doing it. Yes a longer rest period would make sense in this case. If you are going the route of arthritis therapy I would not discontinue the oral chonDrOitin therapy even with injections.
DrO

Member:
Ribbons

Posted on Sunday, Sep 7, 2003 - 2:53 pm:

Thanks for your response.I am not ruling out more diagnositics.I have read the all the information on this site on lameness.My children now complain that Mom is always on the internet!Would a bone scan or thermography help localize the lamenesses any better orjust muddy the waters even further? I have had suggestions ranging from EPM testing,to allergy testing, to chiropractic treatments. I just want to do what makes sense.
Moderator:
DrO

Posted on Monday, Sep 8, 2003 - 7:25 am:

Without a good localization yet they may just muddy the waters but as long as you understand the results are not diagnostic for the lameness but may indicate areas for further investigation they may be your next best step. I don't EPM test do to the many nondiagnostic results and neither do I treat horses with pain on trotting for EPM. I see no indication of an allergy and the allergy tests are even more worthless than the EPM test.

Neither am I a fan of chiro as many seem to operate under unproved (and unlikely) diagnostics with untested (and equally unlikely) therapeutic regimens. BUT, these are really questions for those who can examine the horse. What or who is AULC.
DrO
Member:
Ribbons

Posted on Monday, Sep 8, 2003 - 10:01 am:

I agree with you on the EPM testing. I did do a serum allergy testing following two bouts of uveitis approximatley three years ago.The results showed she was allergic to lots of common feeds, grasses ect., so I switched to a beet pulp based feed, put her on aspirin therapy, and eventually bought our farm thus I can pretty well control her living situation. No episodes in almost three years now. I was told at one point she needed a "chiropractic adjustment," which we did with absolutely no results.

AULAC (sorry I left out the second "A") is Auburn University Large Animal Clinic. On their advice and under their supervision, I had her reshod with pads to help with her conformational problems. With essentially no change in the front limb lameness on the second exam though,I don't see that they helped any.What puzzles me is that mid July she was performing well at Training level. It has only been since her field "boo-boo" in early August that I have seen the change in her gaits, but so far the vets feel like any abnormalities on x-rays (save the small navicular bone spur)are just old injuries and have nothing to do with present lameness.

My daughter told me yesterday that when Auburn injected her coffin joint, the vet remarked to the students that her synovial was a bit "watery." She wouldn't have known to inquire further. So at this point to cover all my bases, I will start the Adequan and Legend on the theory that this is just an early and quick onset of arthritis. Who knows, maybe this is joint deterioration due to the aspirin therapy? We are just handgrazing her for 40 minutes total each day and will move on with controlled exercize from there. So we will see. I will take her back down for revaluation before we start with ridden walking in a couple of months,so I may be back in touch with you before I head back down there. Maybe you can help me with a game plan then.

Thanks again for this site and your input. I appreciate the summaries of all the scientific studies as I feel I can make much more informed decisions when speaking to other equine professionals.



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