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  Discussion on Suspected stifle injury
Author Message
New Member:
Spruss

Posted on Wednesday, Sep 1, 2004 - 3:25 pm:

Dear Dr. O,
I have a 20-year old appendix quarter horse mare. She has been retired for quite some time, but as a young horse was jumped aggresively. I have had her for 15 years with occasional lameness problems here and there, but nothing extensive. Over the course of the last couple years, she has had increasing problems with soundness, particulary in the back. Flex tests revealed high grade lameness bilaterally where she essentially hobbled off three-legged. My vet suspected arthritis in her hocks secondary to DJD, but my gut feeling was lameness as a result of a structure higher up. X-rays showed mild arthritic changes, but nothing comparable to the clinical picture she was portraying. My vet explained that the X-rays sometimes took time to reflect what was observed clinically. I switched around on several different supplements in which I saw little to no improvement. I finally decided to have her hocks injected with cortisone per the vets recommendation. My mare was sound for about 8 weeks when the lameness re-evolved, more subtle this time.

Recently, I had my shoer out. As he was trimming her hind end, she was leaning extensively on him (she'd done this before for several times), when she lost her balance and went partially down on the right side before she could catch herself. I recieved a call a couple days later to find out she was three-legged going outside. As I examined her, I found minute swelling and some heat around the stifle area on the left, however when I palpated with even the slightest touch, she would quickly abduct her leg (fairly high) taking a lot of time to place it on the ground again. She constantly rests her left back leg and remains lame even at the walk. She has been on moderate doses of bute on and off for about four weeks and Devil's Claw Plus which I started her on when she initially started having problems. Hot/cold therapy, mineral ice and linament have only had short term effects. She gets worse with turnout, so she has been on stall rest. My vet recommends bute and stall rest, but my horse is still in pain and appears depressed since she has been unable to go outside. My suspicion is that this is an acute stifle injury either from a previous problem or from trauma to the joint during shoeing. Either way, I suspect that she may already have had DJD in the stifle before these events occurred. Do you have any suggestions on how I can keep her more comfortable? Is it worth injecting interarticularly to verify my suspicion? Based on how my mare is presenting, would it be more likely to have had truama on the actual joint or the soft tissue surrounding the joint and if so, do you think she may benefit from muscle relaxers? I really want her to be outside as it helps her arthritis, but I am fearful this will do more damage on her stifle especially since she is worse after coming in. Any suggestions? I realize you cannot diagnose without a clinical exam, but I would like a second opinion. Thanks so much.

Sherese
Moderator:
DrO

Posted on Thursday, Sep 2, 2004 - 7:44 am:

Sherese do you know what type cortisone, dosage, and whether hylauronic acid was used? You provide little detail on prior attempts at treatment so perhaps you should review the recomendations in the article on arthrits to see if what you have been doing is similar to what we recommend.

All of your treatment and prognosis questions require a diagnosis in order to answer and general attempts at treating this lameness to achieve your goals has not worked. The presentation does not answer the question as to whether this is articular or not or even which area of the leg this is coming from. I think a thorough exam aimed at precisely locating the source of the lameness is worth undertaking as it may lead to more effective treatment.
DrO
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