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  Discussion on Diagnosing Hock problem- how far to go?
Author Message
Member:
9193

Posted on Monday, May 10, 2004 - 1:58 am:

Hello All,

I need some guidance as I make decisions regarding my 14 yr old TB's stiffness problem.

Three weeks ago he presented with a stiff right hind leg. I have no idea why, but the trainer, vet and I are hypothesizing that increased training in dressage, trail rding and his age are/were catching up with him.

He was put on a course of 2gms bute/day for 7 days then reduced to 1gm bute/day for 7 days. We cut back on his training, added 30 minute walking warmups and cooldowns, massage, icing his hocks and added four cups/day of LMF SR with glucosamine to his diet. (my idea, not vets)

My daughter had a schooling show this past weekend, so I continued the 1gm/day of bute to stave off discomfort prior to the show. At the beginning of the morning yesterday he was perky, springy and lively. By the end of the sixth class, he was showing signs of "gimpyness" in his hind legs. He was dragging his left toe and did not seem to moving in a way that looked "right". He was moving forward willingly, picked up his leads from walk to canter both ways in one stride and was not bobbing his head, but I could tell he was not right and our trainer stated that she could tell he was "not right" either. We stopped showing, cooled him down, linimented his legs, gave him 1gm bute last night and today as well as the day off.

My trainer is convinced he has hock problems and needs his hocks injected. The vet has told me that Justins response to exercise while off/on the bute is a guide to whether it is necessary to take the step of injecting his hocks. The vets first choice is cortisone injections.

The vet has watched Justin move while on halter only once, so I am hoping that when he sees him next week, the same "problem" will present itself in a way that is visable and helpful.. It is hard to tell whether it is the right or left leg that bothers him the most.

There is a very reputable veterinary clinic near here that specializes in performance evaluations. This vet is well known for his knowlege and there are xray machines available to take xrays as needed. The cost is reasonable to my mind..$275 for an hour visit, plus $30 per xray.

My trainer feels that I would be wasting my time and money to have this performance evaluation. I plan to ask my vet if he feels this would be helpful for him to make a definitive diagnosis leading to hock injections.

Dr.O- in your experience, would this kind of evaluation be of help to most vets or is diagnosing hock problems simply a matter of watching how a horse moves in a round pen and evaluating their response to drug therapy?

I am an RN, so using diagnostics for definitive diagnosis is comfortable for me...Am I making a mountain out of a molehill? I read your article on diagnosing arthritis in horses and how xrays may not always be helpful in giving a true picture of a horse's hock health. Which brings me back to my original question regarding a performance evaluation.

What kind of steps have others out there taken before making the decision to inject their horses hocks? I am not against having the hocks injected if that is the best choice to help him stay comfortable to be ridden. I just keep hearing how many horses at our barn have had injections and it seems like a routine procedure, but this is my first experience having to make this decision and I am trying to learn all I can before I subject him to the consequences of a decision on his behalf.

Thank you all for your thoughts.. I look forward to learning from all of you.

Debra



Moderator:
DrO

Posted on Monday, May 10, 2004 - 7:21 am:

The questions are:
  • where is the lameness?
  • what is the cause?
Your horse presents with fairly classic history and symptoms of early DJD of the hocks, but is it diagnostic? No.

When presented with such a horse I try to rapidly focus in on the hocks to rule them out. First I use a low volar ring block to make sure there is no lameness from the fetlock down, then I use diagnostic anesthesia in the hock to make sure this is the location. If it localizes to the hock I radiograph the hocks to document the location and severity. For more detail on this exam see Equine Diseases » Lameness » Diseases of the Upper Rear Limb » Overview of Diseases of the Hock (Tarsus).

If it turns out to be the hocks this cost an extra 200 dollars, but now we have a much better idea of what is going on, can design more effective programs to improve the arthritis, and provide a more accurate prognosis for the future. If it turns out to be elsewhere I have not wasted time and money on ineffective treatment that is not without some, albeit small, risk.
DrO
Member:
9193

Posted on Tuesday, May 11, 2004 - 11:05 pm:

Dr.O

Thankyou for your timely response. As it happened, my vet was out at the barn today doing an extensive lameness exam on one of the warmbloods at our barn. He was doing exactly what you described in your response. He did a ring block and then took xrays after taking the horse out to see how he moved after the block.

He was very receptive to my questions as to how I could best help him with diagnosing my horse. He suggested that I make notes such as: is the stiffness present at the beginning of a workout or does the stiffness progress as you work the horse? He suggested that bute be withheld for at least 24 hours before the appointment to prevent masking of symptoms. He would like to know how long he is lunged per episode/per week and observe his movement. Is the stiffness worse if he stands in his stall for more than a day or not? Does he present with the symptoms only under saddle or it is the same/different when lungeing vs trail riding vs ring work?

He also clarified a misconception I had that when you inject hocks that a fusing process begins. I now understand that injecting the hocks is a way to reduce the inflammatory process, but it does not cause a fusion of the hocks as I had been led to believe. I feel very comfortable going forward with this procedure based on my vets patience with my questions and giving me something to do/observe to help him help my horse.

I have only used this vet for vaccinations and little checkups, so it was a good way for the two of us to build a rapport which I think is very helpful to build a team approach to tackle these health issues that arise.

Our appointment is scheduled for next week, so I will let you know what transpired. Again, thank you for sharing your knowledge. The waters are much less muddy for me than before!

Debra

Moderator:
DrO

Posted on Wednesday, May 12, 2004 - 6:19 am:

Debra did he inject anesthesia in the hocks themselves to see if the lameness resolved? I consider it an important step because jst enough of these are elsewhere and above the fetlock to make this worthwhile.
DrO
Member:
9193

Posted on Wednesday, May 12, 2004 - 11:50 am:

When I came into the barn, he was injecting the right front fetlock to rule out a front leg problem that the horse was exhibiting before I got there. After they left to check out the front leg, I wandered off to deal with my horse and came back a half hour later to notice that the vet and two helpers were trying to take xrays of both hocks of an increasingly antsy warmblood, so I do not know if he had injected the hocks as well.

What is the first medication you would inject as an anesthesia? Is the sequence of events inject the hocks with anesthesia to see if lameness resolves and then inject with cortisone to reduce the inflammation and provide a longer course of comfort for the horse?

One question I meant to ask him, but perhaps you could give me a ballpark figure... How much time do you give a horse after injection before you resume riding, training, showing ect.. I have heard from other riders that they were cleared to do easy riding as soon as three days after injection to being able to attend a horseshow a week after injection. I know one person in the barn who couldn't ride their horse for three months after injection because of a "reaction".
I am curious what your expectations would be after injection.

Thank you for your time and consideration,
Debra

PS. I printed out the beautiful colored hock anatomy designs so that I have something more to use to better understand what this process involves. (I hope I don't scare this vet away with all my questions)
Moderator:
DrO

Posted on Thursday, May 13, 2004 - 6:49 am:

Debra, the procedure for the whole leg is explained in Equine Diseases » Lameness » The Diagnosis of Lameness in the Horse and the hock in particular covered in Equine Diseases » Lameness » Diseases of the Upper Rear Limb » Overview of Diseases of the Hock (Tarsus).
DrO
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