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  Discussion on Untreated Stiffle Injury
Author Message
Member:
Kami

Posted on Thursday, Jul 8, 2004 - 5:58 am:

I'm working with a 1yo filly that has a stiffle injury that happend 4-6 months ago. The story provided is that she flipped while being trained and later cast under a stall door. At her prior home, she was on hilly terrain, in deep spring mud, had to travel down a steep slope to a creek for water, and was in a large group of horses with competitive feeding for low quality round bales. At this point, I feel like her growth is stunted (she's out of two 16+h horses, but only about 400# and @13h at 12mo). When I first saw her, she was significantly more weak on one side than the other and if she reared, would colapse down onto her hind end.

In the past 15 days, she has been wormed, on a balanced sweet feed and alfalfa hay and isolated in a 40'x60' level paddock. She's seems to have picked up about almost an inch of height in her rump. She doesn't seem to be in significant pain (because she will run, buck, and play). She doesn't colapse if she rears, but is not strong either. Her gate is even on both sides, she still hikes her hips to walk. She drags both toes when not excited. When she trots or canters, she seems to loose coordination and interfere, especially in tall grass. I can turn her in a tight circle at a walk w/o any interfering. At first, it was very hard for her to get up if she fell or laid down. Now, she doesn't fall, is routinely laying down in the evening and can get up with only slightly more effort than an average horse. She still can't support her weight to pick up a hind foot.

I've also been doing massage. She gets tight in her neck and shoulders (her fronts are toed out) and her entire rump. When I message just below her stiffle area, at first she pushed into it with all her weight and seemed to loose control almost knocking me over. Now, she still pushes hard, but I can stablize her by holding her tail, which is extremely strong (she can trap my hand with it so its hard to pull it out).

I've read your article on stiffle and spinal injuries and understand her prognosis is generally not be good. The vet is not scheduled until next week (on 15th), and I am wondering if the significant delay in treatment is going to make her a lost cause (where she might have had a better prognosis) or if its possible that her body will try to heal at this point?

Also if there is anything that I could or should do in advance of the vet's visit? She seems to be making improvements and I considered a smaller space (based on your article), but this is not a fresh injury and the paddock is significantly smaller than the 5 acres she was in for the past 4-6 months.

She also has an untreated hernia (about 1 finger), at this age will reduction have any effect or is that a definite surgery? I check it for hardness or heat at each feed, but she doesn't seem to be having any problems with it.

Kami
Moderator:
DrO

Posted on Thursday, Jul 8, 2004 - 7:28 am:

The problem Kami is you are trying to prognose before you diagnose. In order to accurately predict this filly's future we will need a accurate diagnosis of what is injured and how badly. I have had stifle injuries that came back after 6 months but I stall and small paddock rested them and the tissues were just bruised and not torn. Though it should be evaluated by your vet, a stable hernia that size poses little health risk so fixing it would be elective and cosmetic.
DrO
Member:
Kami

Posted on Thursday, Jul 8, 2004 - 1:48 pm:

Thanks, I agree. I guess I will have to be patient.
Member:
Kami

Posted on Thursday, Jul 15, 2004 - 2:53 pm:

Just a quick update.

In the past week, the filly was 'startled' on two ocassions and when this happened her hind leg seemed to spasm. It is almost like a reverse of a locked stiffle (that would trail behind). The hoof was raised and held up in the forward position (like a stringhalt position) for about 15 stride and 5 strides. There was no movement to lower it, like it was locked there, even though she was attempting to flee what had scared her. Once it released her gait was back to her version of normal. -- So I've been through the tying up EPSM and many muscle sections of your site now.

Today the vet came out, what he suspects is OCD, but didn't have x-ray equipment. Because of what I think is spasm (and her background) I asked him to pull bloodwork for CK, SE and vitamine E. -- So I've been through the OCD section of your site now.

The vet brought up WMD, but she swollows okay and has a strong regular heart beat and rises better now than when she first arrived. He agreed that is would normally have been a progressive disease that would not respond to simple diet/environment change.

I want to thank you for this site. It helps me to work with the vet and to recognize what may be pertinent symptoms. I'm fortunate because I have a vet who thinks its OCD, but is willing to do the bloodwork, even if to rule out EPSM/nutrition issues.

So, now I continue to be patient, again :-)

Kami
Moderator:
DrO

Posted on Saturday, Jul 17, 2004 - 7:14 am:

Thanks for the kudos Tami. Continue to keep us appraised.
DrO
Member:
Kami

Posted on Tuesday, Jul 20, 2004 - 1:08 am:

This filly is turning out to be a big puzzle.

On Thur she was stocked up in the fetlock of the same leg that I thought was having spasm. Vet checked it, but no heat and she could bear weight on the leg while opposite leg was lifted. So we thought maybe it was related to activity the day before. Fri am feed, when she was taken out from the stall to her paddock, she was going to run and buck, but only got about two strides, then was not pulling her hoof forward on that leg (the hoof from the fetlock down stayed pointed rearward). She did about three strides directly on her fetlock before going down. When she got up, she favored that leg a little, but not significantly. I gave 1gm bute and tried to get a vet out, but they were swamped. Then Fri pm feed, I found her in the paddock with a dislocated fetlock. Then the vet came out on emergency/after hours call and splinted her. The vet came back Sat morning to x-ray and cast her.

The x-rays (taken in both directions of each joint - 12 total) of her stiffle, hock and fetlock are clean with the exception of a small chip in her hock that is not displaced. This is not what I or the vets were expecting, especially since this poor filly has been falling so often in the last 7 months. Sat we also got the bloodwork (CK test) everything is in normal ranges and showed no signs of muscle spasm. Vitamine E and Selenium tests just went to MI today. The vet that treated her fetlock and the vet who saw her on the first two visits are going to get together to try to figure out what might be going on.

The vet said ankle pain could have caused what I throught was spasms in the last week. The vet seems to think that it could also cause the hip hike, short stride, swinging feet out and around, and toe dragging (when on flat ground, this is bilateral and pretty even amounts).

She is weak side-to-side in the hind end, but I forgot to ask him about that. Basically, if she were to walk across a grade (instead of straight down it), her hind end will swing down hill. On the flat, she can walk in tight circles, swing her hind end around with some force (to demand rubbing) and back up without stepping on herself, so she does seem to know where her feet are.

At this point, we know that she will be cast and stalled for 6-8 weeks and there are three working theories:

(a) The ankle caused the rest of the problem?

(b) The ankles are in addition to the original problem that must be in the hip (since the other joints are clean)

(c) The original problem is a neurological issue. The vet said he didn't know of any on-farm diagnostics that can be done for neurological.

I'm working with a nutritionist to ensure that she gets good/balanced nutrition during the healing period. My hay just went to MI for testing today as well. She's on a balanced sweet feed. And I had just started adding oil/E to her diet (based on the EPSM assumption). Now I'm re-evaluating the EPSM issue and other minerals/vitamines such as maganeses (helpful for ligaments?), Vitamine E (because of stresses), etc.

I've never had to take a horse to a university. At what point do you decide that? My closest is OSU about 5 hours away. So this will be new for me.

Kami
Moderator:
DrO

Posted on Tuesday, Jul 20, 2004 - 9:00 am:

Kami,
In your first paragraph you describe upward fixation of the patella, then you go on to say she dislocated her fetlock? This is not a simple injury that horses just recover from: usually dislocation (luxation) involves tearing of ligaments that do not heal completely with arthritis being the outcome. Is this what happened and if so why the concern about anything else(?): she will be lame permanantly from the luxated fetlock.
DrO
Member:
Kami

Posted on Thursday, Jul 22, 2004 - 1:02 pm:

It wasn't that her stiffle locked, she had normal leg movement above the fetlock, it was more like she dislocated the fetlock and in the fall it went back in place. The vet came and diagnosed it. He was able to pop the joint in and out with very little preasure and getting practically no reaction from her.

The vet was also expecting fractures from it, but none showed up on the x-rays taken at a couple differnt angles. He said he'd had one other case where an adult horse got it's foot stuck in a way that leveraged the joint out of place. In that case, he cast the horse for several weeks and it recovered for the most part. I understand that her recovery will not be complete on this issue.

The concern about 'anything else' is because she was lame before this incident (and believed to be from OCD) We had just started trying to figure that out. X-rays also showed no OCD leisons in her stiffle, hock or fetlock.

Now it isn't understood if the fetlock is something separate from the original problem, related to it or the cause of it.

Kami
Moderator:
DrO

Posted on Saturday, Jul 24, 2004 - 9:32 am:

Here is one of the retrospective studies I can find on fetlock luxation Kami with one horse actually becoming sound enough to ride:

Equine Vet J. 1987 Jul;19(4):295-8.
Luxation of the metacarpophalangeal and metatarsophalangeal joints in horses.
Lateral or medial luxation of the metacarpophalangeal or metatarsophalangeal (fetlock) joint in 10 horses is presented. Closed and open fetlock luxation each occurred in five horses. Horses were treated by cast immobilisation after debridement of soft tissue and joint lavage in cases of open luxations. Suture apposition of a ruptured collateral ligament was attempted in three cases. Antibiotic therapy was used in all cases of open fetlock luxation but non-steroidal anti-inflammatory medication was used inconsistently. Whether closed or open, fetlock luxations had a good prognosis for return to breeding status. After treatment, seven horses were used for breeding, one horse was ridden for nine years, one horse remained lame and was destroyed and one horse was lost to follow up.
Member:
Kami

Posted on Friday, Jul 30, 2004 - 11:31 am:

Thanks for the info Dr O.
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