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Member:
Wolfydoc

Posted on Tuesday, Jun 29, 2004 - 9:43 pm:

Hi there all,

Even after reading all the articles on lameness diagnosis, and after 16 years of being a small animal vet, I still have a hard time telling which leg is lame!

My TWH Elvis, about whom I've posted a lot of questions in the recent past and who supposedly has mild early DJD in both hocks, has the following signs while free-lunging in our roundpen: completely normal at the trot going around clockwise (right), smooth as silk. Going counterclockwise (left), his head comes UP from "baseline" simultaneously with the lifting of his right front (and therefore his left hind) leg. It looks as if his chin is attached by a string to his knee (carpus) and they move up in synchrony. I cannot tell if he has a hip hike, since I am in the center of the pen.

His latest vet, who has never seen him in a roundpen and who diagnosed him with hock DJD (based only on a positive spavin test, holding the hind leg up for 2 full minutes and radiographs, but no nerve blocks), says he is unloading his left hind when Elvis does this, i.e. that that is the lame leg. It seems to me that to unload a hind leg, a horse's head would go DOWN when the sore leg hits the ground, shifting his weight more forward, just like going downhill gets weight off the hind end?? In Elvis' case, his left hind leg is coming UP when his head is coming up. To me it looks like he is trying to get weight off a front leg - ? Maybe I just plain old don't have a good eye for this type of stuff but I've watched this over and over and come up with the same scenario. I don't trot him under saddle because we're still polishing his gait. I can't feel any abnormalities otherwise under saddle, up or down hill or flat or on asphalt at a walk.

I am taking Elvis to Univ. of CA at Davis to see the orthopods there next week. He has had this gait abnormality in the roundpen off and on for months. I'm hoping they can give me and Elvis some peace of mind and confidence in a diagnosis. This horse is so unusual - crosses metal bridges no problem, opts to take the trail going AWAY from home when out on trail rides just to go check out new things, spooks at almost nothing! This is driving me crazy not being able to even figure out WHICH leg is hurting myself!
Moderator:
DrO

Posted on Wednesday, Jun 30, 2004 - 8:02 am:

Hello DrN,
The reason you have such a had time Cynthia is your horse does not have a regular trot where lameness is easy to see.

I am lucky (?) in that we ride gaited breeds extensively and as a result am sought out for gaited lameness but admit despite decades of riding behind TWH's it still takes time and testing to accurate localize subtle lameness in the gaited breeds. For a hind limb lameness quit looking at the head bob, it will be of no use with a TWH.

Rule it into your list of possibilities by selecting the leg with greater hip excursion and shorter leg flight. Then confirm the location by normalizing the limb motion with diagnostic analgesia. I have gone in and edited the article to include some tips on seeing this easier, reread the section on the description of hind limb lameness and let me know if it helps.
DrO
Member:
Wolfydoc

Posted on Wednesday, Jun 30, 2004 - 11:32 am:

Thanks DrO for the advice. I read the article again. I will probably be at UC Davis before I get a chance to evaluate via video.

One more question/explanation: Elvis's head bob (i.e. lifting his head up) is so dramatic going to the left and so dramatically not present going to the right, that I have a hard time ignoring it. He looks exactly like the schematic in your article showing a front left lameness. Head up when the left front hits the ground. Going right at the trot, his head is on the horizontal and stays that way. No head bob at all. But I will focus on the hips and see what I come up with. And I'll definitely let you know what UCDavis comes up with. I just hope Elvis cooperates when they start sticking needles in his leg, if needed!

Thanks again,
Cindy
Moderator:
DrO

Posted on Thursday, Jul 1, 2004 - 8:23 am:

Sounds like a left front limb lameness to me too DrN. Is your vet using this head bob to id the back leg or is he seeing something else?
DrO
Member:
Wolfydoc

Posted on Thursday, Jul 1, 2004 - 10:55 am:

Hi DrO,
When I first saw this most recent vet, I told him the history (Elvis had had a lameness previously diagnosed back in January '04 as a right front lameness, that seemed to resolve temporarily with a month's rest, but would pop up every now and then), and also that he had recently developed bilaterally symmetrical mild windpuffs on the front legs after we moved to north Reno, NV, which is deep sandy terrain. I was also concerned that every time I looked at him free standing in his field or hitched, he had his left hind leg camped under him. Rarely was it the right, and he almost never stood square in the hind. At the time, I had no convenient access to a roundpen, but under saddle he would frequently walk with his head and neck slightly to the left. He also frequently stumbled on the front legs (this was prior to getting my current farrier who seems to have fixed this) and had a small hitch of some sort intermittently on the hind, either side, every so often (more so than my other 3 horses).

He took a look at Elvis trotting/gaiting on the asphalt parking lot, said his problems were his hocks, likely brought on due to his sickle conformation. Personally, I couldn't hear any lameness as we trotted on the asphalt, but this was 2 months ago when I wasn't able to lunge him and did not suspect he had the old problem back. Then he did a spavin test on each hind limb, holding it up for 2 minutes straight and trotting off. I could hear a gait abnormality (I couldn't watch as I was the one leading Elvis along on halter). No nerve blocks. No flexion tests on the fronts. Radiographs showed (and I saw them and agreed with the vet) very mild changes indicative of early DJD. His hocks had no effusion on physical or rads.

We put Elvis on ChronDrOprotect and eventually I got my round pen. I noticed no head bob about 3-4 weeks ago in the roundpen, but I admit I did not test this very often, as Elvis gets easily bored in the roundpen. We continued riding consistently but going easy, no more than an hour to 1 1/2 at home 6 days a week, with occasional single hills, at a walk and then added short stretches of gait work. On weekends we'd go trail riding with others at a faster pace, gaiting a bit, never cantering.

Then I lunged him about a week and a half ago and there was that same lameness as in January, only at a trot to the left. I took him back to the vet and described the lameness. There is no roundpen where this vet is located, but he had me trot him out straight away on the asphalt. Again, he said Elvis is unloading his left hind, but I honestly did not see the head bob during this straight away jog even though I was in a good position to see his head. He said it is easy to confuse a hind leg lameness with the opposite front leg at a trot. He thought Elvis was doing very well overall and whatever lameness he was seeing in the parking lot was very very mild. I had him radiograph the stifles just to be sure they were ok. This was before I REALLY started to think while watching him in my roundpen, and became convinced that he couldn't be trying to unload a hind leg by lifting his head UP, which would only shift weight onto the hind end, and that the head coming up occurred while the left front was hitting the ground on a left circle. I've never seen the head bob when Elvis is playing in his field with the other horses, and man, they can get ripping around out there when it rains a little and cools down!

My farrier, who just started with me 2 shoeings ago and who politely pointed out during this first visit numerous problems with his previous shoeings, used the hooftesters just yesterday on Elvis before trimming/shoeing him, and low and behold, Elvis was fine with the right hoof, but reacted consistently with squeezing on the outside heel area of the left front. He did not watch Elvis in the roundpen, but listened to my explanation and felt that Elvis was indeed trying to get weight off a front leg. While shoeing, Elvis got really fidgety with his right leg being held up (standing on his left front), but even with his hind legs cocked way up, sitting on the stand, he was fine. The farrier said his hinds are "like spaghetti" they are so flexible!

We go to UCDavis next Tuesday. I just hope that if they have to do nerve/joint blocks, Elvis cooperates so they can get a better idea of where the problem is!

Cindy








Moderator:
DrO

Posted on Friday, Jul 2, 2004 - 5:02 pm:

If it wasn't for one horse about 10 years ago I would say I have never had trouble separating a front limb from a rear limb lameness in a trotting horse. They really almost never look anything alike. TWH horses are tougher however. Good luck and let us know what they find.
DrO
Member:
Wolfydoc

Posted on Sunday, Jul 11, 2004 - 9:43 pm:

Hi DrO,

Well I got some bad news regarding Elvis.

I actually went to a state-of-the-art equine hospital about an hour and a half away that I had heard rave reviews about, especially lameness, from friends and from the one local vet whom I trust to tell me when I should see a specialist. UCDavis is at least 3 and a half hours from me so I decided to try this vet and I was thrilled with his knowledge, experience, skill, and bedside manner to boot!

Anyway, he did the whole workup, step by step, exam, nerve block, exam again, next nerve block, etc. until Elvis went completely sound, then ultrasound to confirm his tentative diagnosis.

Elvis has proximal suspensory desmitis on both the front RIGHT and the LEFT hind. Fooled even the intern who thought, as I did, that it was his left front.

Dr. Marti Gardner feels Elvis's conformation predisposes him to this injury, at least in part. I can honestly say I have not pushed this horse at all to do anything difficult or work harder than he was slowly conditioned for. In fact, I probably have been more cautious than need be in slowly conditioning him, and not overdoing it.

Interestingly, after reviewing the AAEP/Carol Gillis protocol on this site for rehab of tendon/ligament injuries, I had to call the doc back and ask why we were not going as slow as her protocol. Dr. Gardner has recommended stall rest for the next 3 months, hand walk 20-30 minutes per day the first month, ride at a walk half hour daily the second, and ride at at walk an hour the third month, then re-ultrasound in order to assess progress. His reasoning: based on the thousands of cases of soft tissue injuries he has treated (he sees lots of competitive cutting horses), he feels ligamentous injuries can be rehabilitated at a faster pace than tendon injuries, especially if the horse is in good condition, i.e. fit, already.

I am just very bummed because Elvis has these injuries at the age of five with not much hard work at all! I have no idea how/when he injured himself. The doc thought maybe while out playing with buddies in the field. And if he is this seriously injured at such a minimal level of work, how can he and I ever even think of doing harder mountainous trail riding, which was my goal with him? Should I just limit him to riding locally, on flats and easy hills occasionally, and seriously consider getting a more sound horse for hard trails? I mean, is this unusual in a strong, well-conditioned but admittedly poorly conformed (sickle-hocked) horse?? I am so reluctant to give up the future of adventures with this particular horse, who has bonded with me and who is my friend, but I will do it in a heartbeat if it means preventing re-injury and dooming Elvis to a life of lameness and pain.

Cindy
Moderator:
DrO

Posted on Monday, Jul 12, 2004 - 9:29 am:

Well I am delighted to hear you have some answers and understand your concern. These injuries are more likely the result of accidents and not inherent weakness in the horse. The question is how well they heal: this will determine what the horse can do.
DrO
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