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  Discussion on Subchondral bone cyst
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Member:
Mcarna

Posted on Tuesday, Dec 30, 2003 - 9:26 pm:

Dr. O,
I have a 2 year old mare who was just diagnosed with a subchondral bone cyst in her back left stifle. The vet suggests sending her to a clinic out of state for an injection of depo(sp), then 2 follow-up treatments of shock wave therapy on the injured area. This would be followed by 90 days of stall rest, with gradual exercise after that, but nothing before 6 months. Because this is an expensive procedure (all said and done, it will cost me about $2,000), I have contacted 2 other vets, who have suggested 6 months in a small paddock with no treatments of any kind. They both feel that 50% of the time, the injection/shock treatment therapy does not work, and a lot of horses heal on their own with rest.

I would really like your opinion/experience in this matter. The first vet did x-rays, and says the size of the cyst is about a 7, on a scale of 1-10. It is leaking fluid, which is causing inflammation, thus lameness. I don't want there to be any further damage, but I also don't want to spend a lot of money on something that only has a 50% success rate...the same rate as doing nothing.

She is a thin mare, very gangly, and is hard to put weight on, should I start her on a weight-builder, and just give her rest? Thanks so much.
Moderator:
DrO

Posted on Wednesday, Dec 31, 2003 - 8:12 am:

Since everyone agrees on the rest the only real difference of opinion is the steroids and shockwave. Shockwave would be purely experimental in the case and I have never thought it made good sense to “create” this much tissue disruption in the joint.

The steroids is a different matter. The steroids do not help the cyst per-se but what they will do is attenuate the active inflammation in the joint. If the joint is acutely inflamed this is logical so as to try and prevent degenerative joint disease (chronic arthritis). Personally I would prefer the stall rest while lame. Once sound at the walk and light trot begin extended small paddock rest with some dietary modifications, see Equine Diseases » Lameness » Diseases of Joints » OCD and DOD in Horses.

The real question is whether you should have real surgery done on this. The pros and cons are discussed in the article but it really takes a thorough review of your radiographs by someone who is very experienced with this. I suggest you have your vet send the radiographs to Colorado State and have either Dr. McIlwraith or Dr. Trotter review them and get their suggestions.
DrO
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