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  Discussion on Unspecified, intermittent lameness
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New Member:
laurelw

Posted on Saturday, Sep 19, 2009 - 10:58 pm:

Hello, I'm hoping to get some insight and help with the circumstances that I'm experiencing with my horse.

He's a 9 yr old TB gelding used as an all-arounder - training level dressage, jumping (no higher than 2'6), trail riding, etc. In June 2008 he had a pull-back incident following which he had intermittent swelling high up in his neck which we treated with ice and bute. He showed no neurological signs (thankfully). We finally x-rayed the neck in Oct due to remaining swelling and determined that he had an avulsion fracture of the facet between C2 and C3. We continued to treat the neck with ice when swelling was present and otherwise treated with massage therapy, acupuncture and range of motion exercises.

In addition, he has been vaguely off, intermittently, at the trot going to the left ever since the pull back. The lameness is not consistent and, when apparent, is generally in small circles and going around corners. When it can been seen (more often it can be felt), it appears to be left fore with a slight head bob. At the same time he occasionally behaves as though he has hind-end discomfort evidenced by him off-loading weight even when a front foot is being held and he excessively shifts his weight when standing while mounted.

He has showed nothing of interest in response to flexions, front and rear (they have been done a number of times). He did block about 90% sound to a coffin joint block several months ago and responded about 50% to a coffin joint injection.

Recent x-rays taken show ossification of the impar ligament in the left fore. We planned a bursal injection but he blocked only 30% or so improved to a abaxial digital nerve block. We've been reluctant to do too many blocks at one time as he is allergic to procaine and it's not clear how many blocks can be done at one time without a reaction.

At the same time he continues to behave as though there is occasional hind-end discomfort. He gets regular chiropractic, acupuncture and message therapy.

My vet is recommending a full body bone scan in the interest of helping us zone in on the real estate that is causing him pain. Of particular interest is whether or not we're still dealing with any remaining effect of the neck fracture. We've never injected the neck though I'm told that it's doable.

To access a bone scan we'll have to make a five hour trip to the closest university. I'm looking for feedback regarding whether or not a bone scan would be useful particularly this long after the initial injury and after we've been dealing with this lameness for over a year. I'd also appreciate any other thoughts as to approaching this issue.

Many thanks.
Member:
mrose

Posted on Sunday, Sep 20, 2009 - 12:21 am:

I think it isn't uncommon for an accident such as you describe to affect the entire spine, especially the rear end. Our older stallion suffered a "pull back" accident which injured his neck, and as he aged he began to get more and more problems with his rear end. His hocks were suspect, although they x-rayed clean the vet said they were dry and thought hock injections would help. The injections may have helped some, but with hard work he still became "off" in the rear more and more often. He was examined by a more experienced lameness vet and after tests he felt the stallion's rear end issues were due to his neck injury. This vet said that almost always if the neck is involved, so is the rest of the spine. In our stallion's case he felt it was a nerve injury. This stallio also had message therapy and chiro work, and they seemed to give short term relief, but not long term. Due to our stallion's age (20) we retired him and he does fine with light work.

If we earlier on had known enough and been able to give him a scan or more through sonogram, we may have been able to help him.

I'd ask the vet what could be done for your horse if a spinal problem was found. Knowing that might help make your decission. Has he had sonograms or thermography done of his neck, spine, and legs? I'd wonder if that wouldn't be more beneficial?
New Member:
laurelw

Posted on Sunday, Sep 20, 2009 - 10:06 am:

Sara, thanks very much for sharing your experience. We have ultrasounded the neck with no remarkable findings. We've not ultrasounded elsewhere as we've been unable to zone in on a location. There are no obvious clues such as swelling or heat.

Thermography isn't available in our geographic area, even at the university.

Can you tell me more about your stallion's neck injury? Was there a fracture? Was the injury high up in the neck or low? What symptoms were apparent after the injury? How did you treat them? What would you have done differently had you known more earlier?

I'm sorry to pepper you with questions but I've not been able to find anyone here that has experienced such an injury. As I mentioned, we initially thought the injury was soft tissue and treated it as such. We also thought that his slight lameness after was a function of the fact that he ran off down a gravel rode once his halter broke so we thought he had bruised himself. The lameness has been intermittent since and seems to improve as he's worked and worsens when he's off.

Thanks again for sharing your experience.
Member:
mrose

Posted on Sunday, Sep 20, 2009 - 11:15 am:

While at a trainer's our stallion, I'm told, was tied up drying from a bath when some idiot started a tractor right next to him, then raised the bucket loader. The stallion tried to pull back and run, but of course couldn't. No one noticed him right away, so he pulled hard enough that he sat down.

The trainer thought he was fine at first, but rubbed him down good and let him rest the remainder of the day. The next day she rode him, and he stumbled and fell at the lope and in getting up, caught his right front foot in a bull pen panel, so struggled to raise before the trainer could get him released. So, really two accidents, but one, imo, caused by the other. The horse developed a lump on his neck and this was when I became aware of what had happened.

I took the horse to the vet and x-rays of his neck were taken and he was examined throughly by palpation of his neck, shoulders, hips and back. Our local vet thought he had strained a muscle in his neck and prescribed bute, stall rest, and messge. The horse seemed to get better in about a week.

After that incident, however, he started to appear gradually more and more "off" in the hind end. The trainer suspected hock problems due to his age, which at that time was 18. We took him to the vet and had his hock x-rayed. They showed just some minor arthritis. The vet did all the usual lameness exams, then tried to draw a little fluid from one of his hocks, and looking at the little fluid, said that his hocks were very dry and suggested hock injections, which we agreed to.

A series of injections, Adaquin I think, were given over a period of a year,and we had the chiro work on him regularly, used magnets,and message, and the horse seemed much improved, although to my eyes he still just seemed a little "off" in the rear, but our local vet couldn't find anything wrong. To me he seemed to short stride some in the rear, and to pick up his rear legs funny, especially the right one, when he backed up. He was relunctant to really get his rear end "under" like he used to. Our vet and the trainer both felt this was due to his getting older and developing some arthritis, etc.

His rear end became increasingly worse, expecially with work which involved getting his rear under, or lifting his rear legs; also any canter/lope work seemed difficult - again in the rear. I was concerned, actually, about ESPM or some neurological disorder, and took him to a vet in So. California that is a lamness specialist.

The horse was again x-rayed and had sonograms done of his rear legs, butt and neck. Also, he did thermography of his "lower" spine - around the loin area. The vet than asked me if the horse had ever had a "pull back" injury. When I told him the horse's history, he said he sees this a lot with horses that have had this type of injury. The neck, as part of the spinal column, pulls the tendons and nerves all along the back when it is pulled so hard. He said this often shows up in the rear legs. In our horse's case, he felt their was a pinched nerve or that nerve damage had been done and the older the horse got and the more he was used, the worse he would get. He told that at this point there was nothing that we could do for him other than retire him, use bute or other anti-inflatory when he seemed uncomfortable, don't let him get too heavy, and just to give him occassional light exercise or turnout.

If the extent of the injury had been discovered sooner he thought that with steroids, anti-inflamatories and physical therapy he would have been better. He said that in some cases, depending on the extent and type of injury and damage, surgery can be done, but he didn't say what kind or the long term prognoses,and I didn't ask since it didn't pertain to our stallion. Also, the horse's age worked against him. A younger horse would heal better with proper treatment.

So, our old boy is home now and seems happy. He gets pasture turn-out and a little light arena work. Mostly he hangs out and oogles the mares.

I don't know how much of this will pertain to your situation, but I thought I'd pass it on and encourage you to get further exams done by a specialist if possible and not too cost prohibitive. Money always plays into it. At our horse's age, even if it would have helped him, I wouldn't have opted for surgery for instance.

Good luck. I'm sure Dr. O will have more to say as might some of the other HA members.
Moderator:
DrO

Posted on Sunday, Sep 20, 2009 - 12:07 pm:

Hello Laurel,
It seems the main problem here is localization of the left fore associated head bob. An enthesophyte (ossification) of the impar ligament has not been studied for clinical significance but would in my opinion be highly suggestive of chronic heel lameness.

Occasionally but more frequently than we would like, regional anesthesia can be misleading in both sensitivity and specificity for pain from a certain region. Technique, aberrant nerves, other close by structures, and multiple sites of pain all can "fool us". If I were you I would like to have that foot ruled out better by having a abaxial nerve block performed. Then if needed and deemed safe, followed by a ring block done at that same level. This should take care of any aberrant nerves and questions about the lameness origin. Without localization and diagnosis you are left with empiric treatment.

Depending on severity the signs of hindlimb weakness you describe could be related to spinal cord injury or instability and fracture of one of the facets is going to increase the instability. Does forced lateral and dorsoventral flexion of the neck have any effect on the weakness?

Such hindlimb signs may also be related to muscular pain. Has the horse been evaluated for possible muscle disease?
DrO
Member:
laurelw

Posted on Sunday, Sep 20, 2009 - 1:22 pm:

Dr. O, Thank you for your insights. We did have an abaxial digital nerve block done on the left fore last week and he only improved about 30%. That's when we decided not to proceed with the bursal injection. Should we do that again and follow-up with ring block if we get the same result? I'm told that we'd need to wait at least two weeks following blocks to do a bone scan as the block sights will 'lightup' even if there is no underlying pathology. Is that consistent with your understanding?

Regarding the hindlimb weakness, forced lateral and dorsoventral flexion of the neck do not seem to have an effect on the weakness though it's been difficult to gauge as it's intermittent and somewhat vague in presentation.

We've not had him evaluated for muscle disease, I actually never considered it. He is in good flesh and has no difficultly performing his job (except for the intermittent front end lameness) and actually seems to enjoy working. It's a very interesting observation - I'll talk to my vet about it.

I very much appreciate your help.
Member:
laurelw

Posted on Sunday, Sep 20, 2009 - 1:23 pm:

Sara - thanks so much for the information regarding your experience with your stallion, that's very helpful.
Member:
mrose

Posted on Sunday, Sep 20, 2009 - 1:51 pm:

Just a thought, even something as simple as an ill fitting saddle or one that is too long can cause what appears to be lameness in the hind end. I'd double check and make sure his saddle fits right and is put on in the proper position. I believe in always ruling out the simple stuff first if you haven't done so already.
Moderator:
DrO

Posted on Monday, Sep 21, 2009 - 9:41 am:

The lack of more improvement with the ASNB makes the heel area of the hoof, and in fact the whole hoof area much less likely to be the cause but to be 99.9% sure, and to rule out the pastern, the ring block will be needed.

Yes local anesthetic causes a focal inflammation detectable on a scintigraphy (bone scan) so waiting is pretty standard. For more on this and other aspects of this expensive and questionable localizing tool see the Bone Scan subtopic in the article associated with this discussion, Localizing Lameness in the Horse. This might be a good time to review the whole article as it addresses your concerns directly.

I think your observations of no problems while working, other than the signs of front end lameness, does make chronic muscle disorders less likely.
DrO
New Member:
spryte

Posted on Monday, Sep 21, 2009 - 5:48 pm:

Hi Laurel,
your horses lameness sounds somewhat similar to mine.. She had intermittent lameness on the right fore .. and very intermittent lameness in the left hind..
To cut a long story short (eg farrier checking feet, vet visit in which she was displaying the fore limb lameness despite the fact I had called him out to asses the slight hind lameness i had seen the night before..on the strength of this I booked in to get a lameness work up..However 4 hours after he had left she was sound!.. The vet agreed it was not going to be of benefit if she was spontaneously becoming sound again)...
Anyway I booked for my horse to get a Sports massage... very interesting. On the Right side just behind the saddle as the massager worked the muscle started to spasm .. tightness could be felt along that side and down the front of the shoulder( i think these are called the subclavius muscles)..
When the massage started again on the left side at the point of the hip the massager exclaimed that there was a knot.. I felt it too (and incase i imagined it I felt the opposite side.. and the same point on my other 2 horses... no Knot).. as the massager worked this point my horse "DrOpped "on that leg.. It was suggested that this was the point of the original 'trauma' ie to the sacroiliac area.. possibly due to 'sitting' in a pull back incident.... that perhaps because of favoring that side she had caused compensatory tightness on the right.. hence right fore lameness if the muscles were going into spasm.
Anyway just thought Id let you know.. it may give you another avenue to pursue. it is all hypothesis but after following the exercises i was given to do with my horse she does (with any luck) seem to be sound now.. of course this may have happened anyway with just the very gentle riding I was doing.(just walk with some mild lateral work)
Lots of luck anyway.. i know how frustrating it is.
Rosie
Member:
laurelw

Posted on Tuesday, Sep 22, 2009 - 11:58 am:

Rosie - thanks very much for sharing your experience. I've had quite a lot of message work done on my horse since his pull back injury. We've not found an identifiable knot or experienced spasms but he does take a very odd stance at times - hind leg extended out and forward - when the therapist is working on a specific spot similar to the spot you describe on the back close to the SI. I'll continue to work with the therapist seeing if we can further pin something down. Thanks again.
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