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Discussion on Bone spur
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Member:
sondra
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Posted on Monday, Dec 8, 2008 - 9:38 am:
My 5-year old jumper was exhibiting very subtle signs of discomfort (not all-out lameness) under saddle. My vet pointed out that he was not extending his left front well and to me he had a 'flatter' way of moving where normally he is very sound and floaty. The other sign of something amiss is he developed a tendency to hang on the right rein and tilt his head, making him hard to steer and causing the rider to want to straighten his head as he hangs on the rein. I had my dentist come last week but the hanging/tilting still remain.
Vet came and found a minor but definite swelling or fluid in the left knee. He took xrays and indeed they show a spur near the lower joint. He said it appeared that the spur may be close to coming off but is as yet still attached. He'll be sending the radiographs to a radiologist/surgeon for input.
While at this point perhaps there is no guarantee that the spur is causing this minor lameness (as opposed perhaps some sort of more transient soreness) he plans to come back to block him. The horse however is so stoic that sometimes it is hard to get him to show his lameness.
In any case, Dr. O what is your experience if any with knee bone spurs and the best treatment and prognosis? This is a very athletic young jumper prospect who I've taken pains to bring along slowly and carefully and the thought that his career is going to be limited is very hard to swallow.
My vet said he sees spurs in this particular area of the knee all the time in TB racehorses but rarely in hunters/jumpers. My horse is a Hanoverian/TB cross.
He said I have a few options for dealing with the spur: inject with time off (turnout); just time off (I'm not sure what purpose that would serve?); and most likely, surgery to remove the spur. He said the procedure is quick and common but it is the recovery and risk of arthritis that are the question marks.
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Member:
rtrotter
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Posted on Monday, Dec 8, 2008 - 2:46 pm:
Sondra,
I am looking at the information in your post from a standardbred racehorse perspective ( from behind and not on top of the horse), but perhaps what you are experiencing with him being on the right line and tilting his head can give you another perspective to look at.
When I have a horse that does this, I look for the reason to be somewhere on the right side. What you may be seeing with the fill and the spur is your horses attempt to get away from something on the right side, thus putting more pressure on the left side to compensate. We call this primary and secondary lameness problems. Most people treat the obvious problem without looking deeper into what else can be wrong. The obvious problem will somewhat dissipate with treatment but unless the primary problem is found may return with a vengeance and be worse than originally diagnosed.
I have a very good diagnostic vet that I work with on my horses. Almost all of a Standardbreds power comes from behind, when they get sore behind, they throw their weight on the front. He has been very consistently right when he has told me that in order to fix the front the back needs to be fixed as well.
Now correct me if I am wrong because I am not really a riding horse person but don't jumpers rely on their hind ends too, in order to power their front ends off the ground and into the next set of strides to the next jump?
I am not saying my take on this is correct, but I'd have your vet go over your horses rear end- Gluteals, stifles, hips and back in order to ascertain that his front end soreness is not coming from the rear.
As far as spurs go, the jury is still out on how to treat these because it depends on where they are. Some horses can go with them because they are not within the joint and the horse is not lame, but if the joint is affected then this creates a problem. I would bet that just about every horse has some type of spur at some point in their lives that go unnoticed or undetected because they never bother the horse. I also think in some cases the spurs go away by themselves and we never know about them.
In your horses case, you are looking at a problem and you will know as soon as he is blocked whether that is the extent of it or there is more involved.
Just my thoughts
Rachelle
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Member:
sondra
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Posted on Monday, Dec 8, 2008 - 2:46 pm:
Edited to add: if this add'l info helps at all - my vet indicated that the spur is not floating or displaced, but it did fracture off of the main part of the bone so far. Also, he did do flexions yesterday and the horse did not show much of a reaction jogging off.
I realize that you would need to see xrays to respond more specifically however any input or advice is welcome. I did read your articles discussing osteoarthritis and plan to take measures that are warranted in any case - including adequan, legend, icing after work, etc. I will resort to surgery I suppose if the surgeon agrees the spur is coming off.
Another question is, can a bone spur of the knee be catalyzed by one event such as a period of running and stopping hard in a turnout paddock a few weeks ago? I'm trying to identify when he possibly could have sustained an injury there and this is all I can think of.
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Member:
sondra
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Posted on Monday, Dec 8, 2008 - 2:57 pm:
Thank you Rachelle. Interesting perspectives. To be honest, they may give me some hope 
To answer your questions -
- Yes, jumpers do rely on their hind ends to power them into a jump. Historically, in my horse's case, he has always been a bit lazy (though he can jump the moon) and therefore a bit weaker behind than we'd like him to be. It takes a strong rider to encourage him to really use himself behind.
- Hind end indicators that I have noticed that may be worth mentioning are that he tends to rest his right hind a lot (his stifle seems ok but I've not xrayed them); and, he has tended to drag his left hind toe at the trot especially without a strong rider getting him to use himself behind.
- I have not noticed any (obvious) other signs on the right hind areas.
- He does have a history of getting cast in his stall...
- I have a chiropractor work on him 4 times a year and he is always out on his left poll/jaw area
- He has an extremely strong and sound back
- He does have a bit of a roach in his back
Sondra
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Moderator:
DrO
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Posted on Tuesday, Dec 9, 2008 - 8:44 am:
Hello Sondra,
Bone spurs by themselves are not very dependable diagnostic indicators of lameness, though large actively remodeling ones are suspicious of a active arthritis but not confirmatory. Swelling certainly increases the suspicion of the joint. Does this joint have limited flexion or flexion may the horse lamer? But it is very easy to rule this in or out as a cause of your horses lameness using diagnostic intraarticualr anesthesia as described in Overview of Lameness Diagnosis.
This should be your next step and if it is arthritis in the joint you should review our recommendations in the article on Overview of Arthritis.
DrO
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Member:
sondra
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Posted on Tuesday, Dec 9, 2008 - 9:53 am:
Thank you Dr. O. He palpated the knee and yes there was effusion in it however it was very mild/subtle. It was enough however, coupled with the lack of full extension of that limb while trotting under saddle, & the tendency of the horse to tilt his head and hang on the right rein, which led the vet to take xrays of the knee which revealed the spur.
Yes, he did a flexion test too on that leg - interestingly it did not make him lamer.... I don't know how much a horse being stoic can affect the outcome of this sort of thing upon flexion (?)
In any case he will be blocking the knee tomorrow or Thursday, assuming the horse shows some lameness beforehand. I will let you know how that goes...
I guess my concerns and questions are: IF the horse has only very mild arthritis in the knee joint AT THIS POINT, and the spur is or is not removed surgically, does that mean his program going forward needs to change significantly and my expectations of his future career as a jumper should be quashed? Or should I go forward as planned and just keep an eye out for any developing arthritis, and manage with the usual joint supps and treatments etc.? Also, would there be some benefit in giving the horse a few months off this winter (turnout)? Obviously, I'm insecure about what to plan and expect going forward with my investment horse.
I realize many of these questions can not be answered but putting down my concerns and questions anyway...I bred the horse myself and all signs of talent/ability pointed to a career in grand prix jumping. 
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Member:
ekaufman
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Posted on Tuesday, Dec 9, 2008 - 12:48 pm:
Hi Sondra,
I'm with Rachelle in that I'd extend the lameness exam to include the back end of the horse, in particular hocks and fetlocks; stifles too if possible. It's possible that the mild knee problem is compensatory to a problem behind.
Of course horses do go off in front and not behind, but hanging on the rein is a weight displacement *forward.* I'd expect a horse with a sore knee only to invert and DrOp his back rather than come onto the forehand, though horses have their own ways of thinking about these things.
As to why, well, who knows. If dreams were horses, beggars would have lame horses. The high performance models seem to have more soundness problems than the bricks.
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Member:
sondra
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Posted on Tuesday, Dec 9, 2008 - 7:51 pm:
Hi Elizabeth -- thanks - other than very mild toe drag when not engaged, his hind end is totally sound at the walk, trot and canter -- making it hard to identify what to explore there that might be causing the knee in front or the head tilt. The only thing I can think of is to do flexions behind and/or a set of xrays of stifles, hocks, etc... also I will look more closely at his hind end the next time someone else is on him.
Dr. O: vet came to today to block the horse. I rode him at the walk, trot and canter prior. What do you know, the horse was sound. There was nothing to block. Additionally there was no more effusion in the knee, nor noticeable heat. The only remaining thing was his hanging on one rein when tracking left and tilting the head accordingly.
I'm feeling better but stumped. My vet surmised that the spur or any arthritis that *may* be there means at this point the horse may just exhibit good days and bad days. The horse did have yesterday off, as it was Monday (handwalking only). If things were as acute as I thought before, I can't imagine a day off had that much to do with him today being sound? My vet recommended that we monitor things going forward, and apply Surpass to that knee prior to riding from now on.
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Member:
ekaufman
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Posted on Tuesday, Dec 9, 2008 - 8:16 pm:
Hi Sondra,
Glad he had a good day, though it slows your diagnostics.
I would have done flexions behind as well as in front, especially if he was having a good day in front. X-ray findings aren't all that useful, IMO, unless they're associated with a finding of lameness. It's just sort of a free floating piece of bad news, and who needs that?
Of course rein-hanging in a 5 year-old can also be a training or even a riding issue, so I'd pursue those paths as well. Does he hang at every gait? In both directions? On a straight line? With all riders? Without a rider? On bute? If you can establish his pattern, it will give more to go on either for training or for a more thorough work-up.
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Member:
sondra
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Posted on Tuesday, Dec 9, 2008 - 8:40 pm:
Elizabeth, good thoughts. Vet will be at the barn again within a few days. I'm hoping the horse stays sound but in any case I'll ask if he will do flexions behind.
I agree that the rein-hanging could be a training or riding issue, as he is 5, green, and not always the easiest ride in the world  Historically he has always been stiff to the left and recently I have found him very hard to bend left or even steer left. He acquiesces eventually however. My chiro usually has to do some adjusting on his left poll and/or jaw. One tidbit of info regarding riding: for the last couple of months I was unable to ride and his rider (a professional) exercised him for me. She unfortunately had the head-wagging habit and I wonder if all the handsy-ness caused him to want to hang on that rein when she tried even harder to loosen him up to the left, with too much seesawing. 
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Member:
ekaufman
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Posted on Tuesday, Dec 9, 2008 - 9:10 pm:
Hi Sondra,
Well I'll continue to weigh in, though my opinion is completely inexpert.
Not sure what a "left poll" is! Horses have only one poll. From my unprofessional view, I'd discard the chiropractic feedback, since it doesn't seem helpful to the issue at hand.
Your horse has intermittent mild swelling in his left knee. He also leans on the left rein under saddle, and has been wrestling with his rider for a while. The question is whether he's lame or just somewhat over-faced/defensive under saddle, with an unrelated boo on the knee. Do I have this right I hope?
If he were mine, I'd put him in long lines and ground drive him to see if the left-rein leaning is consistent and un-fixable on the ground. All horses have a stiff side, and need careful development to learn "true" bend rather than leaning, over-flexing etc.. If I could get him even in the reins and bending properly on the ground, then I'd get back on and continue under saddle. I personally wouldn't fight with his face until his body and neck were bending correctly-- back to front, not front to back.
Essentially, I'd treat it as a training problem unless/until he presented me with a consistent lameness. Absolute failure to correct this on the ground could be a lameness, but you should be able to see something-- an unevenness, short-stridedness, something. Lameness is visible. If that happened (hope it doesn't), I'd work-up the whole horse with flexions and blocks.
I'm no expert, so I'm just going off my own experience with training and with rein-leaning lameness (which for me always ended up in the hind-end, even when there were additional compensatory front-end problems). Rachelle and I are pointing at the right hind because a horse that hurts on the right hind will overcompensate on the LF to spare that sore leg behind. That should be visible to someone with a good eye watching the horse go and listening to footfalls.
Have you ever done baseline x-rays on your horse?
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Member:
sondra
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Posted on Tuesday, Dec 9, 2008 - 9:48 pm:
Hopefully this is clearer, he was "out" at the poll more on the left and required adjustment on that side/meridian. But that is chiro related...
I do not know how to do long-lining and this horse is a handful so I'm not sure I'd feel safe even trying it, and not sure anyone at my h/j barn does this. I'm sure I could get someone from Lendon's to come over and try it though...it's a good idea, but I don't have daily/easy access to that technique though I wish I did.
There is no lameness visible other than what we saw last Saturday... however as I mentioned I will be looking very carefully especially at his right hind when my trainer gets on him on Thursday (I ride him tomorrow). I'm pretty good at identifying lameness as I work at the racetrack and I've seen everything there in all severities and subtleties. Also, I know how the horse feels like a book under saddle and can tell when he's even slightly off. Easier to identify where, specifically, from the ground though!
As for being overfaced... nope -- a 5-year old doing w/t/c for 30 or so minutes and small jumps and gymnastics/cavaletti a couple of times a week isn't overfaced. We have tested him and know he can jump the moon (and his 6-foot paddock fence) and we do not drill him over fences. I have a new trainer as of 10 days ago, who is focusing on basics with him (more flatwork), and yes he knows how to ride a horse properly from back to front, inside leg to outside rein. I will be making sure to ask my trainer on Thursday if he feels as much of the rein-lameness as I do.
The horse requires a strong rider which he is.
I value all of your input!
*edited to add* I have some baseline xrays from when he was a 2-year old that I will pull out.
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