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  Discussion on Unusual lameness
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Member:
Cara2

Posted on Thursday, Dec 16, 2004 - 8:25 am:

Hi Dr O,

Cara came in from her paddock on Tuesday with an extremely obvious gait abnormality. Basically she is walking with her hind legs markedly to the left of her front legs (she does a bit anyway due a bad epileptic seizure and fall a few years ago), and as she steps she hoicks the left hind high a bit like a shiverer would. At rest she is obviously uncomfortable shifting and lifting the leg then putting it well forward under her belly. There is some fluid at the bottom of the cannon/around the fetlock but no heat, the hoof is very warm too but I suspect that is just the fluid above. She was much better the following morning, standing normallly and not exxaggerating the leg lift, although still askew but came in bad again in the evening so is on box rest this morning. I will let her out in a confined corral this afternoon to ease her arthritic knees! I suspect she has slipped and twisted herself (no evidence of a fall as she had no mud on her legs). The paddock is about 1 acre split into 3 sections and is slippery. She and her companion skid just walking about. I think the resting leg position and overnight recovery is suggestive of muscle damage high up, maybe around the pelvis or hip. Do you agree? She doesn't object to me pulling her leg out in different directions and I can't find any tight muscles. Her pelvis is level when viewed from behind. She eats normally and is her usual grumpy self so I can't see it being an abcess in the hoof.
Moderator:
DrO

Posted on Friday, Dec 17, 2004 - 7:12 am:

Not necessarily Helen, many lameness problems and even some peripheral neurological problems worsen with exercise. The resting position of the leg and the heat and swelling is also consistant with lameness at the hoof: it hurts to place it on the ground so the horse is looking for the most comfortable position. So I don't think you can assume muscle disease. I would have the whole horse examined if this does not resolve quickly on its own.
DrO
Member:
Cara2

Posted on Wednesday, Dec 22, 2004 - 7:02 am:

Hi again Dr O. Good news and bad news. Two days of box rest and two days of controlled walking and grazing and she was back to normal. I put her out on Monday for her first full day of turnout with her buddy and she came in 100% lame on the front leg this time. Absolutely hobbling. The vet was hoping that it was a hoof abcess but now we are fairly sure it is her check ligament. Another day on and she can stand on it so rest her back legs a bit but can only put a little weight on it to move. I've never seen a horse so lame from a check ligament sprain. At least though we have found a painkiller/antiinflammatory she can have safely so she starts that tonight (I'll let you know its name etc for the record).It breaks my heart to see her in so much pain. On the plus side she is eating quite well and is quite bright although the pain is very tiring for her. The vet will see her again next week and possibly scan the leg. Right now though I'm deep in thought as to what is the best thing for her. A month of more of box rest even with some controlled walks in a while will be very hard on her arthritic knees and her mind as well. My vet is not pressuring me either way but I suspect he thinks it would be better to call it a day. Not a very happy Christmas or New Year for me in prospect I fear but I'll wish you all the best for yours.

Helen
Moderator:
DrO

Posted on Wednesday, Dec 22, 2004 - 5:16 pm:

Check ligaments can behave this way but that is not the same as saying that is it. If the clinical signs are not clear, block the ankle and below then block the check. On the good side, a check will usually heal with rest and if it doesn't a relatively simple surgery has a good prognosis, see the article on Check Ligament Desmitis. Are you sure she has not exacerbated the arthritis in the knees?
DrO
Member:
Cara2

Posted on Wednesday, Jan 5, 2005 - 5:15 am:

Hi again Dr O. Sorry for the long silence but I only have web access at work and we got an extra day's holiday over New Year.

Right, here is the update. Cara was shaved and scanned last Thursday. The shaving showed up the problem straight away - an indentation in the back of the leg about 1.75 inches below the top of the cannon bone and a small swelling outwards immediately below that. Despite the fact that I put her out in her long combined knee and brushing boots as it was icy, the vet thinks she has managed to kick herself from behind! When I refitted the boot the indentation was just above its top edge but I think it could have saved her from more serious injury. It reminds me of a speedy cut but without the skin being broken. The scan revealed a squashing and distortion of the superior digital flexor tendon and something similar to the inferior check ligament but he couldn't see a core lesion and was therefore quite optomistic of a faster recovery. The painkillers are working well and she is allowed to go for a short walk and be grazed in hand.(ie I shiver in the wind for an hour or more) Originally she was standing on the inside edge of her hoof which reflected the sideways relocation of the structures but that is much less evident now. More than anything else she is ouchy from having a sensitive sole and without the shoe is unbalanced so I may see if I can get that put back on pretty soon. Every cloud has its silver lining and at least we now have a painkiller we can use when her arthritic knees are more sore than usual so she has been lying down a few times. The patient is bright eyed and bushy tailed so I feel a load better. She will be rescanned in a couple of days time and if I can get stills I'll try to post them here.

As promised earlier, here are the drug details:

Arquel V = Meclofenamic acid @ 10g of 5% M-acid BP. For horses that can detect Bute at a sniff this might be a good alternative as it is not unpleasant tasting (slightly sweet) and even old Fussy Chops has eaten it up without complaint.

Thanks as usual Dr O, all the vets involved have been brilliant.
Moderator:
DrO

Posted on Wednesday, Jan 5, 2005 - 6:25 am:

The lesion explains the stance abnormalities in your first post: putting the leg underneath to stand on it puts stress on the flexors. Sounds hopeful Helen and the discussion is a good reminder to not start quessing what is wrong without a complete exam first.
DrO
Member:
Cara2

Posted on Friday, Jan 7, 2005 - 9:55 am:

Hi again Dr O. Lord knows what the silly thing got up to! She was scanned again last night and the vet is pleased with her progress. The dent is still there but the swelling below it has almost gone and although there is fluid right down the back of the cannon the pockets of fluid around the injury site have largely dissipated. I will try to have her shoe put back on as soon as possible which will at least balance her up again and ease her sore-footedness. She is now on half the amount of Arquel V to see if it is sufficient to keep her comfortable. As there is no sprain involved, just bruising and distortion of mainly the superior digital flexor tendon will she be ok to do a little more walking do you think? I understand that you would want to rest a sprained or torn tendon rather more. We got some stills of her leg from the ultrasound but given the site of the injury it was impossible to get pictures directly over it except longitudinally (the back of her knee got in the way of the sensor). I'll see if a friend will scan them for me so that I can post them here. If nothing else they are useful for people who have never seen such a thing before. My vet knows I like to be hands-on and had me doing the scanning myself so I've really learned alot! I just wish it wasn't my horse bored in her stable and my wallet feeling very sick!!
Member:
Cara2

Posted on Friday, Jan 7, 2005 - 9:58 am:

Why do I keep calling it the superior DGF? Its the superficial DGF - duhhhh sorry.
Moderator:
DrO

Posted on Saturday, Jan 8, 2005 - 1:49 pm:

Best Helen would be to follow the advice of the person who can actually see the scans. But a bruise from trauma can have similar problems to that from excessive strain: weakened fibers that may breakdown futher with work. The amount of work to start with depends on the degree of damage seen and hand walking is begun when all signs of acute inflammation have subsided.
DrO
Member:
Cara2

Posted on Friday, Mar 4, 2005 - 10:20 am:

Hi Dr O,

An update for you. Cara's progress has been so good the vet doesn't want to see her again. There is still a bulge to the inside of the leg but our vet thinks that will reduce with increased exercise. Another 6 weeks of box rest with controlled walking/grazing and I can start slow road work with her. He did suggest lunging but she usually takes the opportunity to go bucking and rearing at the best of times and we don't want to go down that route. Also, when I start riding her again she can have a few hours in a very restricted grazing patch. He was pleased to see her looking and feeling so well and told her what a lucky horse she is. Can't tell you how much better I feel now!
Moderator:
DrO

Posted on Sunday, Mar 6, 2005 - 8:15 am:

Glad to hear it Helen.
DrO
Member:
Cara2

Posted on Thursday, Mar 31, 2005 - 10:51 am:

Hi again Dr O,

Another update for you and a question. At the vet's suggestion I tried a little ridden roadwork with Cara last Friday (having done some fairly short in-hand walks down the road and some short spells of lunging - she seemed reasonable and certainly fine on her "tendon" leg) but unfortunately she spotted another horse and as usual started jogging and messing about. I wasn't too surprised to find when I finally got her walking again that she was bobbing her head having jarred her arthritic knee. She quickly got very stiff and uncomfortable so I gave her some antiinflammatory and she settled down. She spent the next day in the paddock and I tried riding her again on the Sunday but within a few hundred yards I could feel her going off on that knee again. I can understand that roadwork is the traditional method for hardening off tendons and ligaments but I was already worried about the concussive effect on her arthritis. My vet thought she could only improve with being ridden, but so far it has drastically worsened things. I'm perfectly happy to retire her to the paddock, she has more than earned it, but do you think I'm being premature? Should I leave her pottering about quietly and try again in a couple of weeks, or just forget riding her altogether? Her quality of life is the most important thing.
Moderator:
DrO

Posted on Friday, Apr 1, 2005 - 6:30 am:

Geezzz that exacerbation following starting back is sure not a good sign Helen. How bad are the radiographs of the knees? Usually early carpal arthritis is fairly managable to allow light riding for years with good care but in time retirement required.
DrO
Member:
Cara2

Posted on Monday, Apr 11, 2005 - 9:06 am:

Hi Dr O, sorry for the long delay in replying. I've never had her knees radiographed. One has obvious knobbly bits at the base of the front, this is the more painful one. The other has a large swollen area across the same place but from one side to the other. It was left after she fell on it and had a generally swollen knee. We didn't have the antiinflammatory drugs for her then so had to rely on cold water therapy only and it obviously didn't do the best job in the world.

I'll try her again on the field next weekend maybe. Trouble is she forgets her age and aches when there is grass under her feet, and tries to gallop off with me!
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