|
|
Discussion on Interpretating Joint Fusion
|
| Author |
Message |
Member:
Suzeb
|
Posted on Thursday, Jun 17, 2004 - 3:58 pm:
Hello Dr.O and all,
I have a 15 year old QH gelding who does have bone spavin in his hocks. His right hind is visible while his left is not. I have chosen to let them fuse naturally as putting him on stall rest for the required surgical healing time is contraindicated for his other health condition (heaves). I can and do maintain him on IV injections of HA and Bute from time to time. Also, controlled or light excercise.
My question is about what determines that hock fusion is complete.
Is it Radiographs alone?
Nerve blocking to determine that there is still pain somewhere?
A combination of both?
My gist of this post is that Radiographs always don't correlate well with degree of lameness. Should I be relying on Nerve Blocks alone?
A caveat to this scenario is that he has underrun heels and long toes. While some expert farrier work can alleviate this situation, we can't cure what genetics has dictated. He does have sore heels in his front end as well. Navicular bones are very clean.
At present he is only shod in the front with supportive shoeing. I have been entertaining the idea of shoes in the back to relieve some of the pain or give him better support.
Thanks in advance and do look forward to replies.
Susan B.
|
Moderator:
DrO
|
Posted on Friday, Jun 18, 2004 - 6:29 am:
Fusion from a practical standpoint is when pain from the joint no longer occurs do to calcium bridging of the joint space. Radiographs can tell if the bridging is occuring at any significant rate but it is the relief of pain from the joint that indicates a good fusion has occured. There can be several ways you might determine whether lameness is coming from the hock or not but a combination or nerve and intraarticular blocks is the most specific.
DrO
|
Member:
Suzeb
|
Posted on Friday, Jun 18, 2004 - 10:33 am:
I am still a little confused. Here is an excerpt taken from the above article:
Indication
Arthrodesis can happen naturally but is unpredictable. The time table is always uncertain because the radiographs do not correlate well with the degree of lameness. If natural arthrodesis is to be allowed, you want to promote exercise but avoid strong anti-inflammatory treatment like intrarticular injections. Bute is OK to help the horse get around. In general, the fusion of the low motion joints listed below do not effect movement noticeably.
DJD of the low motion joints should be managed as long as possible with systemic and intrarticular medications for as long as possible. However when the pain becomes uncontrollable surgical or medical arthrodesis is a viable alternative. Specific treatment depends on the area to be fused.
My confusion arises from the fact that you state in the first paragraph to avoid intrarticular injections. Is this the same as a Hock Injection?
In the second paragraph you state DJD should be managed with systemic and intrarticular medications. Could you clarify the difference?
|
Moderator:
DrO
|
Posted on Saturday, Jun 19, 2004 - 8:46 am:
Susan, arthrodesis is not always an option with arthritis. Those cases where it is not an option, or even cases where it might be the best long term therapy but the horse needs to be sound now, are managed by aggressive antiinflammatory therapy including intraarticular injections. In cases where arthrodesis in being encouraged this type therapy will slow the process.
DrO
|
Member:
Suzeb
|
Posted on Saturday, Jun 19, 2004 - 11:35 am:
Dr.O,
I do want my horse to be sound and pain free. Am I doing him a disservice by having his hocks injected and slowing down this natural fusion process?
We are not in the show circuit and he doesn't have to chase cows for a living so I am not concerned about performance issues.
Exercise is encouraged, but pleasure riding and flat school work only.
I asked my vet about Hock Injections (and my horse has had 3) about whether they speed up or slow the process of fusion. She said it speeds it up because if the horse is moving better and more frequently the fusion process is faster. Does this make sense? 
Susan B.
|
Moderator:
DrO
|
Posted on Sunday, Jun 20, 2004 - 9:23 am:
It is an interesting question that has not been studied so we don't have a clear answer and there is no doubt a lot depends on the case and what you do in response to lameness in your horse.
It is inflammation that causes the fusion and the purpose of these drugs is to decrease inflammation so there use, with all other things being equal, should slow down the process. But that is not what your vet contradicts: she says if you will use these drugs you will ride more, resulting in more inflammation, and therefore speed up fusion. I suggest you first determine your goals then design a program that obtains your goals and allow fusion, a process that varies from horse to horse tremendously, to take place at it's own rate. If speeding up fusion is your goal I recommend you use a minimum of antiinflammatory therapy.
DrO
|
Member:
Suzeb
|
Posted on Monday, Jun 21, 2004 - 8:48 am:
Thank you Dr.O
The goal is to reduce or eliminate the number of hock injections. Sticking to the program to obtain this goal can be a little hard. I have seen this horse in enough pain to last me a lifetime. So far he is maintained on IV Hyaluronic Acid, Hoof Supplements, Therapeutic Shoeing in front only. The jury is still out on the Oral Joint Supplement with me. He is also on a cubed diet because of hay sensitivities. We keep his weight down so it is less stress on the joints. He can go out in the pasture for short periods of time. Movement seems to be better for him than standing around all day.
I also give him low dose Bute from time to time.
He has also had massage therapy and accupuncture with some good results. Other than working closely with the vet and farrier, this is the best I can do for him.
If a hock injection is going to help him over a really rough spot then so be it.
Thanks for your advice Dr.O 
Susan B.
|
|
|
