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  Discussion on Undiagnosed persistant lameness
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New Member:
heathir

Posted on Friday, Jun 27, 2008 - 12:37 pm:

Hello Dr.O. and members,
I have a baffling lameness problem with my 11 yr old 17.3 h warmblood, that remains unresolved and undiagnosed. I'd like to present the sequence of events so far.

I received this horse 5 years ago with severe behavioral problems, and he went to a quarterhorse trainer for behavioral modification. Physically, he was emaciated and had sarcoids all over his chest and groin.
The horse made good progress over several months, until he fell while being worked in the round pen and became lame on the R hind. The vet was called and I was told the horse blocked sound on the hoof. X-rays of the hoof were take but nothing was seen. I was told it probably was some soft tissue in the hoof. I took him home and after 2-3 months he appeared sound again and he was brought back to the trainer.
The horse continued to make progress and was taken to shows for practice. He was now behaved enough for me to start riding him on my own and I began his training. This began an on again, off again lameness sequence handled by several vets that were handled with fetlock, hock and stiffle injections. This continued for 3 years but still the lameness would return. I had multiple lameness exams including blocks and X rays done by multiple vets, but none solved the problem. The horse would become lame if he'd been too wild at turnout, after shoeing and when training him more but became sound after time off. This time off increased. Going barefoot partially solved my problem, now he no longer became lame after every shoeing. But eventually this didn't solve the problem either. The last veterinary exam: hoof testers: sensitive. X-rays: dense object in R fetlock, navicular changes in R hoof, R fetlock remodeling (arthritis). US: healthy suspensory. The vet felt the dense object was a calcification in the suspensory. After a coffinbone injection and a fetlock injection failed to do the trick, I decided to trailer him up to a renouned veterinary clinic. Even there, nothing was found in the lameness exam initially and I was almost sent home. Finally he became suddenly and severely lame under saddle.
A total body bone scan was performed; moderate activity in B hocks, mild activity in SI joints, Lower cervicals, R front navicular activity.
X rays of fetlock: bone chip in fetlock. US on fetlock showed it was loose and had to be surgically removed. To make sure, a block of the fetlock only was performed and the horse went 80% better. Horse had surgery in Oct last year and went back under saddle in January. I had help with this from a western trainer and observed that their way of riding didn't impact this horse as much as the dressage with the increase in contact. He was never completely sound but showed 'off' steps especially in walk-trot-walk transitions, and slow trot. No problem at the walk or canter. It was hard to see if this was lameness or a strenght issue. I consulted the veterinarian and we decided to wait and see if it improved. Next tests: hoof testers negative, flexion tests: B hocks positive, he didn't think it was stiffles,
Block of the hoof and fetlock: negative. Going by the bone scan info, we injected the hocks and both SI joints and the hip triads acupuncture points.
This initially seemed to help, but he never lost that occasional hike in transitions and going slow. We were making improvements until he went too wild in turnout, and I also think going up or down a slope aggravates it, and now I'm back to the status prior to surgery, where he's even stiff at the walk. Lame in the transitions and now even at the trot. Before, his working trot and canter were sound. He keeps rubbing his R hip on the wall and doesn't like standing in crossties; want to lean on L hip and lift both feet up against the wall, standing on tiptoe on the hoof. He doesn't like to back up.
Any ideas?

I think I might have to retire him, because at this point I don't see what's causing the problem and he obviously doesn't tolerate the exercise.
Member:
scooter

Posted on Friday, Jun 27, 2008 - 4:12 pm:

Hi Heather, you sure have been thorough anyway.

Sounds like a myriad of problems, but with horses who knows . In a way it sounds like his feet, especially since you said it was worse after shoeing at one point. Unbalanced hooves can affect the whole body and FME most vets (sorry Dr.O.) don't pay attention to that. A cheap experiment would be to put boots on him or some kind of padding to see if he improves any. Could help eliminate the hoof anyway.

I could go on and on about how poor trimming/shoeing was/is screwing up all 3 of my horses way of going and how many times I had the vet check them for lameness. RX was anything from arthritis, dsld, hocks, fetlocks, ect.

Good Luck with your horse I hope you figure it out.
Moderator:
DrO

Posted on Saturday, Jun 28, 2008 - 9:38 am:

Welcome Heathir,
You need to return to diagnostic anesthesia because until localized you cannot accurately diagnose and I don't find the behavior while in cross ties localizing other than which leg it may be.

Since so much of the previous work up suggest foot to fetlock problems I do wonder how was the last fetlock block done? Blocking the hind fetlock completely and accurately can be tough when compared with blocking the front fetlock. Often a ring block is needed to completely block it out and many horses won't stand for that in a back leg and can enforce their will. But if that was complete last time or needs to be redone the exam needs continuing up the leg until you get to the si joint. There are not many veterinarians capable of this and the upper blocks are best done under ultrasound guidance, perhaps this will require a referral to a major university.
DrO
New Member:
heathir

Posted on Tuesday, Jul 1, 2008 - 5:13 pm:

Thank you Dr.o and Diane,
The last thorough work up was this June and I think a circular block was performed: it blocked out everything below it: the fetlock and the hoof. I trust it was done correctly as I saw the vet test the skin with needle pricks. The horse's behaviour was immaculate. He has been blocked up the leg incl. the stiffle 3 times. I don't think a 4th time is a good monetary investment: I think it shouldn't be necessary to quadruple the same inconclusive tests. Obviously, one has to look elsewhere when that happens.... Instead, we opted to inject the hocks and the SI joints as these were mod active on the bone scan. He also injected the acupuncture points in the hip triades. This initially seemed to work as the horse went better after being off for more then a week, but he was never fully sound. Slightly less lame. When training resumed, he got progressively worse. This is the trend. Now, he also appears to have structural changes in the leg; he stands continuously in external rotation, his gait is always in in ext. rot with shortened anterior stride landing underneath himself on the midline. He does not drag the toe. This gait never changes and does not improve. There is a glitch, or obvious discomfort upon weight bearing of the leg, shortly after placing it.He is very sore upon palpation of the medial gluteus muscle.I think his problem is in or around the hip. This is also the only joint that hasn't been addressed... From research I have done, I learned that any pathology of the hip and surrounding structures does not have a favorable prognosis. So even if I spend the $3000 for yet another vet work up, it will most likely not buy me a sound horse...
Moderator:
DrO

Posted on Tuesday, Jul 1, 2008 - 11:03 pm:

It is true that the specific course you choose to follow will depend on your goals and resources and should be figured in light of the fact he has been lame 5 years which is a poor prognostic sign. Though the information above is incomplete for me to conclude that the lameness is not below the hip, it sounds like you believe the leg has been thoroughly examined and that no other information can be gleaned with further work.
DrO
Member:
stevens

Posted on Wednesday, Jul 2, 2008 - 10:39 am:

Heathir,

If you're determined to figure out what is going on with this horse, you may want to consider some more extensive diagnostics like an MRI or ultrasound. It almost sounds to me like it's a soft tissue issue that just hasn't had enough time to heal before he went back to work or just isn't going to heal.

Good luck.
Member:
paul303

Posted on Wednesday, Jul 2, 2008 - 9:14 pm:

Heathir: Is he at all responsive to bute? Does it help in any way at all?
New Member:
heathir

Posted on Thursday, Jul 3, 2008 - 10:00 am:

Thanks everyone for talking to me about this.
It really helps.
Hi Chris and Dr.O, I know the easiest course of action would be to continue bringing him to the best veterinary hospitals and do extensive and expensive MRI's and US. However, His medical insurance is maxed out already and so far I have spent at least $20.000 on him. And I still have a lame horse...I wanted to pick your brains and see if there are any idea's or if people with a similar problem found alternative solutions, or if someone recognizes this lameness pattern that is difficult to diagnose.

When I use Bute, it helps alleviate the secondary soreness in other joints and muscles, but it doesn't change the lameness problem.
Member:
stevens

Posted on Thursday, Jul 3, 2008 - 10:21 am:

In that case, it really sounds like a soft tissue injury that has not had enough time off to heal, if it is going to.

If you can, you may want to consider giving him alot of time off, like 9 months to a year, and then seeing what you have.

My horse tore a tendon last fall. Never showed up on ultrasound and it took an MRI to diagnose after two very active months of trying (multiple ultrasounds, bone scan). Was going OK, then took a big step backwards. Right now, I'm considering him retired and just riding him at the walk. If he offers a trot in a month or so, I may let him, but I'm not asking.

Good luck, this kind of thing is so frustrating.
Moderator:
DrO

Posted on Saturday, Jul 5, 2008 - 11:05 am:

Heather, yours is a very common problem that when finally fleshed out is found to have many different causes. So picking one is just a poor guess. You might think about trying some of the more potent less toxic but a little more expensive NSAID's. See the antiinflammatory drug topic for more on these.
DrO
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