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Discussion on Possible stifle lock
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Message |
Member:
Caymie
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Posted on Tuesday, Jan 13, 2004 - 8:57 am:
Is injecting Carbocaine into the medial patellar ligament a reliable way to help determine if that ligament is catching slightly? What if the injection results in an improvement in the way the horse is going? Has anyone else ever heard of this being done? Thanks.
Mary
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Moderator:
DrO
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Posted on Wednesday, Jan 14, 2004 - 8:08 am:
I don't know of any work to suggest this might help.
DrO
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Member:
Caymie
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Posted on Wednesday, Jan 14, 2004 - 2:00 pm:
Dr. O,
Can an intermittent upward catching of the stifle sometimes be confused with a rein lameness? In your experience, what does a rein lameness look like?
Thanks,
Mary
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Moderator:
DrO
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Posted on Thursday, Jan 15, 2004 - 8:11 am:
There are no typical presentations so it could be confused, but when you remove all the tack and lunge him a rein lameness by definition should disappear.
DrO
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Member:
Caymie
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Posted on Friday, Jan 16, 2004 - 2:45 pm:
Dr. O.,
How long do you usually recommend that a horse rest after his stifle has been injected? Should they be turned out during that time?
Thanks,
Mary
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Moderator:
DrO
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Posted on Saturday, Jan 17, 2004 - 4:11 pm:
It really depends on the individual case and what was used Mary.
DrO
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Member:
Caymie
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Posted on Saturday, Jan 17, 2004 - 5:06 pm:
Dr. O.,
He was injected with HA and Triamcinilone for a sore stifle. (Which blocked out sound with the joint block). He has been x-rayed, scoped etc. and nothing was found. Surgeon said the joint looked beautiful actually. There is some question as to whether he may be having some trouble with the medial patellar ligament catching slightly. It is not a typical presentation, but my understanding is that in mild cases it can be tricky to diagnose. Is that true? Is it also true that a mild fixation can cause a low grade lameness if it goes on long enough? And how does one definitively diagnose this? I don't want to pursue any more invasive options until I am sure this is the problem.
Thanks,
Mary
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Moderator:
DrO
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Posted on Sunday, Jan 18, 2004 - 9:17 am:
Yes we think mild upward fixation can cause a change in gait that looks like other causes of lameness but since yours blocked out with anesthetic, it seems less likely in your case. Following use of a steroid in a joint I like 21 days pasure rest if I can get it but there is more on this in the article on Arthritis Overview in the treatment section.
DrO
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Member:
Caymie
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Posted on Sunday, Jan 18, 2004 - 2:20 pm:
Dr. O.,
This has been a long and challenging diagnostic adventure. My trusted field vet deserves an award I think. I have a few additional questions: Last May when we first blocked out his stifle this "hopping, skipping" behavior stopped completely under saddle. At that time, it was so subtle that I was really the only one that could feel it under saddle. It had been going on since the previous December (six months prior to blocking it out).
Can a rein lameness develop over time due to an initial soreness in an area? And could continuing to ride him (since it took awhile to figure out it was his stifle) contribute to a worsening of the rain lameness over time? And finally, in your experience, if the horse continued to be ridden with this irregular gait (assuming it is a rein lameness)could that contribute to an ongoing soreness of the stifle to the point where he is obviously off even on the lunge and the flexion? I guess my question is can riding a rein lame horse make him sore in the stifle? Especially if that was where the original soreness was located?
As I said before he has been both xrayed and scoped and nothing was found. So I think we are down to either a riding/training issue, or a slight catching of that ligament or both. Prior to obviously being off on that left hind last week, he only exhibits this hopping while being ridden or lunged with saddle and bridle. Can a rein lameness manifest itself while being lunged under tack with no rider?
Thanks,
Mary
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Moderator:
DrO
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Posted on Monday, Jan 19, 2004 - 6:49 am:
The fact it blocks out in the stifle means it is not a rein lameness. Unfortunately some lamenesses though localized will not be diagnosable from radiographs and scoping. On the positive side with no lesions found the prognosis for healing is better.
DrO
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Member:
Caymie
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Posted on Monday, Jan 19, 2004 - 9:34 am:
Sorry Dr., O., apparently something went very wrong with my previoius post Anyway, that is why I was wondering if an ongoing rein lamenss could be contributing to a recurring sore stifle. Or can it sometimes work the other way around? Could there originally have been pain there and because it took us so long to figure it out, the rein lamness developed as a result of the soreness?
Thanks,
Mary
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Moderator:
DrO
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Posted on Monday, Jan 19, 2004 - 10:05 pm:
No I don't think so.
DrO
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Member:
Caymie
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Posted on Tuesday, Jan 20, 2004 - 1:23 pm:
Dr. O.,
One last question. Will an intermittent catching of the patellar ligament sometimes worsen if you are asking the horse for more collection or he is going around a corner?
Thanks,
Mary
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Moderator:
DrO
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Posted on Tuesday, Jan 20, 2004 - 8:10 pm:
It might but it is not an important diagnostic fact.
DrO
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Member:
Caymie
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Posted on Wednesday, Jan 21, 2004 - 6:31 pm:
Dr. O.,
Well he has responded very well to the injection, he is sound again. I am taking that as a good sign. So, I guess we just keep going and see what happens. If there is something going on with that ligament that is continuing to cause irritation/soreness in that stifle we'll figure out what to do next. If that ligament is catching a bit, could it contribute to an ongoing soreness in his stifle?
Thanks,
Mary
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Moderator:
DrO
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Posted on Thursday, Jan 22, 2004 - 10:34 am:
I have not seen such a situation Mary but it strikes me as possible: you should be able to detect inflammation in the ligament with a good ultrasound set up to do ligament work if this is happening.
DrO
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Member:
Caymie
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Posted on Thursday, Jan 22, 2004 - 1:52 pm:
Dr. O.,
Thanks so much for all your advice. This is a great site. Anything is possible with Caymann-he is the kind of horse that defies all of the "normal" presentations of problems. Which makes diagnosing him quite a challenge at times. He is a great horse-we are keeping our hooves crossed that we will be able to start showing in Dressage this spring.
Mary
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Member:
Caymie
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Posted on Thursday, Jan 22, 2004 - 7:00 pm:
One more thought-
When they ultrasounded his stifle last June, they saw what they described as "debris" and thought they were looking at a damaged meniscus. Upon scoping, they reported that the meniscus looked beautiful, but that there was some inflammation in the stifle. I wonder if what they were really seeing was an inflamed patellar ligament? Possible?
Mary
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Moderator:
DrO
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Posted on Friday, Jan 23, 2004 - 9:51 am:
No they would not be confused with each other.
DrO
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Member:
Caymie
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Posted on Friday, Jan 23, 2004 - 10:09 am:
Dr. O.,
Well I wouldn't think so but that ultrasound in no way correlated with what was actually going on in that joint. I don't think they are experienced enough yet in ultrasounding that area to really know what they are looking at. Or maybe some people are, just not the one who did his ultrasound.
Mary
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Member:
Caymie
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Posted on Sunday, Feb 1, 2004 - 5:37 pm:
Dr. O.,
If a horse had an injury to his lateral collateral ligament (fetlock/pastern area) on his hind leg, could that make his stifle sore due to the way he travels with that leg?
Thanks,
Mary
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Moderator:
DrO
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Posted on Tuesday, Feb 3, 2004 - 10:14 am:
Yes this is possible but if the ligament is no longer sore and the stile is how does this conjecture help?
DrO
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Member:
Caymie
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Posted on Tuesday, Feb 3, 2004 - 10:44 am:
Dr.O.,
I'm glad you asked I took my horse to Littleton Large animal for another look. Since his stifle had been scoped and nothing was found, I wanted to make sure we weren't missing something. They performed all of the usual flexions, and it was the flexion of his fetlock/ankle/foot area that elicited the strongest response by far. He blocked out TOTALLY sound with ring block of the pastern. Radiographs were clean, but the ultrasound showed a strain of the lateral collateral liagmanet of the coffin joint. The vet felt that this particular lameness was an aggravation of an old injury. I do have to wonder if this is what has been bothering him all along. Anyway, they gave him a shock wave treatment and he is being shod on his left hind with a wide web shoe. (Outside branch of the shoe is twice as wide as normal). He has been doing great ever since. The vet believes that the prognosis is favorable with management. One last question-could this type of lameness actually be worse when the left hind is on the outside of the circle?
Thanks,
Mary
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Moderator:
DrO
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Posted on Wednesday, Feb 4, 2004 - 6:11 am:
Yes it could be worse on the outside.
DrO
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Member:
Caymie
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Posted on Wednesday, Feb 4, 2004 - 10:43 am:
Dr. O.,
Would a stifle lameness usually look worse with the lame leg on the inside of the circle? This is all very interesting. I am just very excited to have gotten to the bottom of this. Thanks for all the info.
Mary
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