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  Discussion on Suspensory or hock issue?
Author Message
Member:
scrupi1

Posted on Wednesday, Aug 26, 2009 - 4:09 pm:

I recently had the vet out to examine my mare who was slightly off in the left hind at the trot and looked very uncomfortable at the canter on the left lead. The vets report reads: there is a grade 1/2 lameness of the LH, the horse "bunny hops" in canter both directions, the mare is very "hocky" in that she is hypermetric (slightly spastic) with the hindlimb gaits, stabs the ground when the hindfoot lands and lands with the inside hindlimb lateral of midline. She trots with the hocks out behind her. Flexion tests: LH lower: moderate positive, LH upper: mild positive, RH flexions: negative.
The vet also did a neuro screen which she said was negative. I had recent pre-purchase x-rays of all joints available and she said that everything looked good. She told me that there was a possibility that this was a suspensory injury but that we may not be able to see a difference if we tried to block out the lameness because the lameness was subtle on the longe line. She also said that it could be her hocks and that hock injections may be a combined diagnostic and therapeutic option so we decided to inject. I have never had a horse injected before and she said that it could take up to a few weeks to be able to tell a difference. The mare was out of all work for 4 days and than lightly started back at the walk and trot. The vet said to try a bit of canter the second week which I did and it feels a bit better but not great. Her trot does definitely feel better.
I guess my question is (it has now been just over two weeks), how long should I give her before having the vet back out just in case it is the suspensory and not the hocks? I do not want to be riding her if I am only making things worse. Does anyone have any experience with this kind of situation? Thank you!!
Member:
mrose

Posted on Wednesday, Aug 26, 2009 - 6:55 pm:

Hi Susanne, I was just wondering if their was a possibility of spinal/back injury?
Member:
scrupi1

Posted on Thursday, Aug 27, 2009 - 1:17 am:

There is no injury that I know of but I have only owned her for 5 months. The vet did say that she was sore over the back, more so on the right and that her pelvis had reduced motion on both sides. I am not really a true believer in chiropractic but the vet suggested it and I wanted to help the mare in any way possible so I had her adjusted and the chiropractor said the pelvis on the right was rotated back and the ribs on the right were not in good alignment. I did notice a difference in her willingness to bend through the trunk tracking right after the chiropractic adjustment but no real change in the quality of the canter.
Moderator:
DrO

Posted on Thursday, Aug 27, 2009 - 2:50 am:

Hello Susannne,
Undiagnosed hind limb lameness is one of the most common problems you see in equine medicine and I am not sure you are asking the right questions.

For instance two problems in particular occur to me. I am a bit unclear as to how the rule out list in your case became focused on the hocks and suspensory. There are no characteristic gait patterns for lameness in these areas. For more on the diagnosis of lameness see Diseases of Horses » Lameness » Localizing Lameness in the Horse. As to whether you can rule in or our arthritis of the hock joint I would note that injections are not uniformly effective and fail to provide soundness is a significant portion of cases. I would also note that rarely is the distal intratarsal jt injected do to difficulty of entering the jt. For more on this see Diseases of Horses » Lameness » Diseases of the Upper Rear Limb » Overview of Diseases of the Hock (Tarsus).

To get back to your question, there is no good single answer. It really depends on your goals and resources available. If your goal is to solve this problem as quickly as possible, resources are not a problem, and the veterinarian said to give the treatment several weeks to work, two weeks is the time you wait. If your goals and resources are elsewhere there may be better answers.
DrO
Member:
mrose

Posted on Thursday, Aug 27, 2009 - 6:56 am:

I asked about back, because back and spinal problems will cause a horse to "skip" or short stride in the rear, and often to "cross canter" or switch leads in the rear due to pain/inability to reach forward with one or both rear legs. If your horses is sore on the back, I'd really consider the back being a cause of lameness.

I'd do a through exam of his back; you can do a pretty good one yourself to just determine exactly where the soreness is. If he's sore in the loin area, where the rear of a saddle would hit, I'd really investigate whether his saddle fits correctly. A saddle that is too long or too wide can cause a lot of back problems which will show up in the gait of the horse. If you don't feel this could be the problem, can your vet do a more through exam of the back?

btw, one thing I've seen really help backs, IF that is the problem, is electro-magnetic therapy.

Normally, after chiropractic work, the chiropractor asks you not to work the horse for a day, then to slowly go back to work. I hope your guy told you this.
Member:
scrupi1

Posted on Thursday, Aug 27, 2009 - 11:15 am:

Dr. O,
I believe the reason that she focused on the hocks and suspensory was based on the flexions. She said that the combination of positive flexions for the lower joint and hock could indicate suspensory involvement. The left hind also does not track up as far as the right hind when the horse is traveling either direction on the lunge line. I did hear them talking about increased hip hike but can not remember which hip they identified and there was no mention of it on the written report. There was no tenderness to palpation of the suspensory and there was no tenderness to palpation of the brachiocephalicus muscles (she said that tenderness of the brachiocephalicus could indicate increased use of the muscles of the front end to compensate for pain/lameness in the hind end). There has also never been any heat or swelling or stocking up in either hind leg.
According to the article I should have her start to block to assist with truly diagnosing what is going on since her x-rays are clean, correct? I guess I did not understand why she said that the lameness was subtle when it was so evident to me at the canter. If we were able to block the area of the pain wouldn't the horse look better at the trot and the canter?


Sara,
The chiropractor did tell me to wait 24 hours before riding which we did. As far as I know our current saddle fits correctly but I will double check and have my trainer check as well and may try another lighter saddle for a week or so to see if it makes any difference. I will ask the vet for a more thorough exam of the back if she ends up coming back out. I will also try to get some video up in the next few days. Thank you!
Member:
mrose

Posted on Thursday, Aug 27, 2009 - 2:14 pm:

Susanne, Good luck! Subtle, and even not so subtle lameness involving the rear end can be so difficult to pin down! I know; I've been there.
Moderator:
DrO

Posted on Sunday, Aug 30, 2009 - 3:45 pm:

You have it right Susanne, blocks are the next best step and yes once the painful area is blocked out all of the lameness arrising from it will even out. Flexion tests are notoriously inaccurate at localizing lameness but sometimes might help to start you out, rarely should they be relied on for localization alone.

I know Sara was expecting this so here goes, there is very little evidence that electromagnetic therapy would likely be of any clinical benefit for muscoskeletal disease.
DrO
Member:
scrupi1

Posted on Wednesday, Nov 17, 2010 - 1:12 pm:

Hi Dr. O,
Just wanted to give a follow up on my situation with this mare. Her lameness initially improved with slow and steady work last fall into the winter and than she was given time off to try to be bred, she did not take so was put back to work again this fall and once again we started having issues with lameness. I did take her to the vet in early October but she was having more of a sound week and he did not see anything abnormal with her movement, hind leg flexions were normal and there was no tenderness to palpation. She was progressing as expected but than became more sore again.
The vet came out today and could see that she was grade one lame on her left hind, again, hind flexions were normal, there was no worsening of the gait pattern. On the lunge she was dragging her left toe a bit and was not bringing her left hind forward normally during the canter. He decided to block the stifle first and she looked better but was not completely sound so we blocked the origen of the suspensory and she was sound with equal tracking up behind and normal flight pattern of her left hind. He said that ultrasounding the origen was not going to be that useful as normally the lesion does not show up. He suggested setting up another appointment to inject both the stifle which he feels is irritated due to the fact that she is moving differently to avoid the pain from the suspensory, and to inject the origen of the suspensory at the same time to see how comfortable she will become.
He did not advise putting her on stall rest and I was just wondering if irritation at the origen of the suspensory is the same as a proximal suspensory strain and how I would go about rehabbing/increasing her work load once she returns to work after the injections.
Moderator:
DrO

Posted on Wednesday, Nov 17, 2010 - 6:07 pm:

Hello Susanne,
You will have to ask the veterinarian who used the term "irritation of the origin of the suspensory" as to what he meant. I would also ask him had he ever seen a proximal suspensory desmitis get well without enforced rest...I have not. Thinking hard of that last statement I must say I rarely have seen acute injury of the hind limb suspensory, most of these are chronic degenerative disorders and so applies to front limb suspensory problems. The hind would have less stress but I believe with acute injury I would still use some sort of enforced rest.
DrO
Member:
scrupi1

Posted on Wednesday, Nov 17, 2010 - 7:41 pm:

Thanks Dr. O,
He did say that he felt her issue was chronic (which was not a surprise seeing how it has been going on for more than a year). I have made an appointment in a week and a half to have her injected and will ask him more pinpoint questions about rest/return to work at that time. It does not make sense to me that I should expect her to go right back to work and be sound after injections when this has been going on for so long. Also, I did read that injections may hinder the healing process, in chronic cases like this, is it OK to move forward with the injections or would rest first be more indicated? Susanne
Moderator:
DrO

Posted on Thursday, Nov 18, 2010 - 4:59 pm:

Susanne, I follow the recommendations in the article. I don't think a single injection of steroids is going to hurt anything but would not be a way I would use to push a horses back into work with desmitis.
DrO
Member:
scrupi1

Posted on Thursday, Nov 18, 2010 - 6:32 pm:

Dr. O,
I would not use it as a way to push her back into work, I'm just wondering if it is worth spending the money on. If the stifle irritation is being indirectly caused by the suspensory pain wouldn't the rest for the suspensory also benefit and possibly allow the stifle inflammation to subside without use of the injections?
Moderator:
DrO

Posted on Friday, Nov 19, 2010 - 6:07 pm:

To the degree that it would relieve acute inflammation it would help with pain and healing but I am uncertain how this principle applies to your particular horse.
DrO
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