This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Upper Rear Limb » Stifle Lameness » Overview of Stifle Lameness »
  Discussion on Structures on outside of stifle?
Author Message
Member:
kjthoma

Posted on Monday, Oct 1, 2007 - 11:27 am:

So I have a mare that has been having difficulties since I've had her, stifle and hock on right, and had a suspensory injury on RH.

We've gotten the suspensory and hock under control, but the stifle isn't cooperating and has gotten worse over this last summer (lots of mud this year, in addition to harder work).

Finally went to a sports medicine vet - who did blocks. She blocked mostly sound on the outside portion of the stifle. He also noticed some joint effusion which the other vets had missed. However - injections to both inside and outside aspects of the stifle have not seemed to help.

Vet had us take her off all anti0-inflammatory supplements to make sure we weren't masking anything (MSM, lubrisyn, Adequan). She gets somewhat better on bute - but then goes downhill when we take her off.

Symptoms - DrOpping the croup and doing something that looks like an attempt to gait w/ the rear legs at the trot. Canter w/ the bad leg inside is EXTREMELY short on the bad leg - and basically refuses to canter at all w/ the bad leg to the outside.

I have read the 'overview of stifle lameness', but am not sure what structures there are on the outside of the stifle that would be most likely to suffer damage. Am at the point of trying to decide whether to try surgery for diagnosis (x-rays don't show much, if anything) or to just retire the mare.
Member:
hwood

Posted on Monday, Oct 1, 2007 - 12:29 pm:

How long has the mare been ridden with her lameness? What kind of riding is being done with her? How much time has she had to recover from her initial injury(and subsequent injuries if she has been reinjured by riding again too soon)?
She may not need permanent retirement. She may need more time off to heal. It seems that time, rest, and slow, careful rehabilitation are key. The supplements and injections may help, but won't help permanently without the natural healing that sufficient time and rest may bring.
Member:
kjthoma

Posted on Monday, Oct 1, 2007 - 1:28 pm:

Nobody knows when the initial injury was. She had some 'issues' that showed up after I bought her She probably had them when I tried her out, but I was ignorant at the time. Her trot felt kind of 'side to side', but I didn't know to think much of it - especially as there was snow on the ground. Also - she hadn't been under saddle long at the time - only about 3 months of work and had been off for 4 months.

Took 2 vets and about 4 months to find the suspensory (which was already old) - found the hock issues at the same time. Did a slow rehab plus ESWT for the suspensory, and then injected hocks. Pretty sound at the trot after that - but had a lateral canter. One vet said 'she'll work out of it with conditioning'. Instead she started getting angrier and angrier - so took her to one of the lameness guru's in the area. She thot it was stifle - but subtle - and possibly catching stifles and recommended splitting the ligaments. Also re-injected the hocks at the time.

Back to sound at the trot but with an iffy canter. Everybody is still thinking that the canter is lack of training/conditioning.

Started to get generally sore again about a year later and took her into our regular vet - canter was a little better by then but still not right. He said 'stifle looks iffy - has a flattish spot on x-rays - recommend injecting'. Did a regular injection - helped for a couple of months.

Got a referral to this sports medicine guy when it started wearing off.

So basically - this has been going on since I've had her....and given that the leg w/ the arthritic hock is the same leg as everything else, I'm thinking that she has been compensating for quite some time....
Moderator:
DrO

Posted on Tuesday, Oct 2, 2007 - 6:06 am:

Hello Kimberly,
The list of common causes of stifle lameness and their frequency of occurrence as listed in the article would apply whether the horse blocked out on the inside (medial) or outside (lateral) joint capsule. Though I agree that surgery may be the only way to get a firm diagnosis I would be slow to spend the money on stifle surgery if the horse does not block sound in the stifle as this suggest there may be other areas causing problems.
DrO
Member:
kjthoma

Posted on Thursday, Oct 4, 2007 - 6:22 pm:

Thanks Dr. O...I'll talk to the vet again next week. I wasn't at the session where she got blocked - just talked to the vet on the phone.

He had also told me that the steroid injections wouldn't help with anything 'bad'....I'm also somewhat reluctant to do any surgery from the standpoint that I haven't heard too many 'return to soundness stories' from 'bad things'.
Member:
kjthoma

Posted on Thursday, Oct 4, 2007 - 8:04 pm:

Just got a printed review from the Dr's...was wondering if you had anything to add based on everything else I've written?

Mild effusion bilateral stifles - mild swelling extensor tendon below hock - no other palpable abs - not driving well on lunge line with RH. Hopping at canter on both directions RH.

Block Femoral Patellar - 90% improvement. It sez both RH and LH on the block - but he only blocked the right leg - I assume that that means both the inside and outside aspects.
Moderator:
DrO

Posted on Thursday, Oct 4, 2007 - 8:59 pm:

Kimberly I would clarify what is meant rather than guess otherwise there does not seem to be anything to add.
DrO
Member:
kjthoma

Posted on Sunday, Oct 28, 2007 - 9:09 am:

We finally got as far as we're gonna get w/ reasonable cost.

Mare never got much better after the injections, took her back for another set of blocks Friday.

She was 3+ out of 5 lame on a 'churchill' flexion.

Blocking still helped - altho not as much as previously.

Vet managed to get some x-rays from the back that showed the beginnings of calcification where one of the collateral ligaments hooks to the inside of the joint. Showed up on multiple x-rays....this wasn't apparent 8 months ago. Said that this is indicative of injury to that ligament.

Said some trail riding on flat probably OK - but no training/precision type riding.
Member:
frances

Posted on Sunday, Oct 28, 2007 - 11:27 am:

Very sorry to hear that, Kimberly.
Moderator:
DrO

Posted on Tuesday, Oct 30, 2007 - 6:54 am:

Kimberly, did you get clarified what was done on the former exam? You continue to find evidence of disease in the stifle but I am a little unclear about the location of the enthesophyte (calcification of a ligament). The collateral ligaments are on the outside of the joint while it is the cruciate that is inside the joint.
DrO
Member:
kjthoma

Posted on Tuesday, Oct 30, 2007 - 11:47 am:

My bad - he said cruciate - NOT collateral!

Former exam he flexed, and then blocked both inside and outside to look for improvement in gait - but did not take additional x-rays. We had some digital x-rays that had been taken previously that my husband had brought over. It was my husband's impression that the 'improvement' was from the outside block - but he apparently misunderstood what the vet said (I was out of town at the time). It was just 'general improvement' - not specifically from one block or the other.

This time he flexed, lunged, and re-blocked, and when the gait improved both lunging and after flexion, he took additional x-rays specifically to look at the cruciate ligament insertion(?) to see if he could see evidence of calcification. The previous set of x-rays had been taken by another vet and are now 9 months old (and I'm not sure that we had the same view on those). He took several different angles from the rear of the stifle looking sort of 'down and in'.

You could see where the ligament 'hooked on' inside the joint was VERY pointy and sharp looking. It was also stair-stepped. Vet said that this was bony changes in the ligament from chronic inflammation....Said it could be that the ligament was 'frayed' or that it was 'ruptured', but it would take arthroscopy to find out which. And that I'd just know which - it wouldn't make his recommendations any different.
Moderator:
DrO

Posted on Wednesday, Oct 31, 2007 - 6:45 am:

That is a bummer Kimberly. I agree with your veterinarian a cruciate enthesophyte is indicative of a guarded prognosis for riding sound. Like he said, a bit of light riding perhaps but normally I would expect worsening arthritis of the joint over the years. For more on conservative treatment see Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » Arthritis and DJD: An Overview.
DrO
Member:
maggienm

Posted on Wednesday, Oct 31, 2007 - 2:54 pm:

KImberly, sorry to hear about your mare.
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC