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  Discussion on Ultrasound showed impar injury, need some advice
Author Message
Member:
Lisam

Posted on Wednesday, Nov 24, 2004 - 5:13 am:

Hello Dr. O and all,

My 18 y/o mare has ben on-and-off (mostly off) lame on her RF since February of this year. Radiographs were negative except for mild age-related changes on her LF. Shoeing changes and 2 g/day of bute are not keeping her sound for more than light ridden walking. Coffin joint injection appeared to help for about 10 days and then she was off again. She head bobs slightly at the trot when not mounted.

I recently learned of the availability of ultrasound and had a vet who specializes in it do an u/s of both forefeet. There were marked abnomalities in the RF impar ligament compared to the LF -- tissue density, striation pattern -- that the vet said indicate injury. (She did not grade the damage consistent with the article on ligament injuries.) There is also navicular bursa inflammation that the vet said is probably secondary to the impar injury, and some mild degenerative changes to the coffin bone at the impar insertion point.

This vet said that there is probably no point to taking the mare completely out of work at this time, although it would have been the right thing to do back in Feb had we realized what happened. I am wondering whether you agree with this.

She recommended a navicular bursa injection because, even if the bursitis is secondary to the impar problem, it's probably increasing my horse's discomfort at this point. Am I reading the scientific abstract at the end of the article correctly, that 80% of 25 horses who had the bursa injection got better, but three ruptured their DFT? That sounds catastrophic to me! I would love to know your view on these odds. Does technique make a difference? I also saw the abstract about the article comparing the five different techniques for bursa injection, but could not find the results.

Finally, she suggested trying Arquel instead of bute because Arquel is better for soft tissue in her experience. Is this also your experience? Is there a difference between the two that would account for that?

Thank you!

Lisa
Moderator:
DrO

Posted on Wednesday, Nov 24, 2004 - 9:45 am:

The relationship of the rupture and "numerous injections" is uncertain and probably has more to do with continued use of a horse with a disease flexor/navicular appartus. Yes Arquel does have a reputation for slightly better pain relief than bute but it is hard to justify the extra cost in a chronic case. I would look into the use of generic naproxen, for more see Equine Medications and Nutriceuticals » Anti-inflammatories (NSAID's, Steroids, Arthritis Rx) » An Overview of NSAID's.

The response to navicular bursal injection is quite remarkable when bursitis is present. Also key to the treatment is proper shoeing to relieve the stress of breakover as described in the article.

With acute injury to a ligament rest is logical but there is no way of knowing if your impar ligament was acute or chronic that finally became dysfunctional so in your particular case this is uncertain. On the other hand any acute onset of lameness when undiagnosed should be rested.
DrO
Member:
Lisam

Posted on Friday, Dec 17, 2004 - 9:38 am:

Dr. O, sorry that it has taken me so long to say "thank you" for your response. I would not have known about the availability of ultrasound if not for your site, and now I finally have some good info on helping my horse.

I do have another quick question. My vet says that anatomically, fluid injected into the coffin joint will communicate with the navicular bursa and thus there is no reason for an injection going through the DFT right into the bursa. This is not consistent with what I've read here (unless I am misunderstanding) and I am wondering about your view. This vet has already injected my mare's coffin joint without effect.

Thanks again and happy holidays!

Lisa
Moderator:
DrO

Posted on Sunday, Dec 19, 2004 - 12:20 pm:

Your vet is correct. It is interesting to note that though things do travel from the coffin to the navicular jt, recent research suggests this may be a one way door and things do not travel so readily from the navicular space to the coffin joint.
DrO
Member:
Lisam

Posted on Sunday, Dec 19, 2004 - 1:11 pm:

That is interesting, Dr. O. Thanks again.

Lisa
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