This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Lower Limb » Overview of Diseases of the Pastern »
  Discussion on Bruising of pastern bone and coffin bone
Author Message
Member:
astbury

Posted on Friday, May 28, 2010 - 4:24 pm:

Hi all

A horse in our yard whom I frequently look after - a Connemara/TB cross who at 17 years old has had a completely illness and disease free life - came in in early March lame. After box rest and various vet visits, he was taken to our nearest Veterinary Hospital and had both xrays and MRI scan, and it was determined that he had bruising to both the lower part of the pastern bone and upper part of the coffin bone. Further box rest ensued and due to lack of improvement, the horse returned to Oakham Veterinary Hospital last week for further xrays and MRI scans. Nothing other than the bruising was shown which concerned the vets given the level of lameness (The horse crosses his "good" front leg over the bad leg - presumably to provide support). On this occasion a further specialist injected steroids between the pastern and coffin bones and much improvement was shown. The result is that they believe that the cartilage at the joint between the pastern bone and coffin bone has disintegrated or is very badly damaged - causing extreme discomfort/pain due to the "bone on bone" situation.

They have sent the horse home and for the next three months - at monthly intervals - will be giving steroid injections to see if there is any improvement.

Jarvis - the horse - is now on 1 bute a day.

Does anyone know if these sort of injuries have good outcome? Can cartilage in the horse regenerate? Will he at least be paddock sound eventually?

I have been looking around the site but can't find a similar disorder/injury.

I know that in people, such injuries are fairly common in footballers/rugby players (my husband had a knee operated on) but I guess given the weight down a horse's leg, the problem is greatly exacerbated.

Any advice from you guys - or Dr O - would be much appreciated.

Cheers

Jenny
Member:
astbury

Posted on Friday, May 28, 2010 - 4:25 pm:

Hi - Meant to say, there are no bony changes on either the pastern or coffin bones on xray.
Member:
rtrotter

Posted on Friday, May 28, 2010 - 7:30 pm:

Jenny,

If there are no bony changes, how was the bruising diagnosed?

I would be worried about the ongoing steroid injections causing more harm unless the vets are injecting with hylauronic acid along with antibiotics and steroids.
Did they try any other treatments before the horse was injected?

It seems strange to me to have a horse go from very healthy to very lame and be diagnosed with bone on bone problems. Usually, this takes years to develop and I would have thought there would have been lameness problems way before this.In addition, the lack of anything showing on the xrays, is very suspicious for something else to be going on.

To me this sounds like an acute injury and if it is I'm not at all sure there steroids would have been the right choice.

Rachelle
Member:
astbury

Posted on Saturday, May 29, 2010 - 6:55 am:

Hi RAchel

Thanks for your posting. The history of Jarvis' case was that in early March, Holly, his owner, went to fetch him and found he was lame.

Jarvis wasn't hopping lame - but quite obviously lame. There was a little heat and slight swelling around the front of the pastern bone.

Jarvis was box rested for two days and checked and because he remained lame, the vet was called.

The first vet checked him out, decided he had knocked himself and put him on a fortnights box rest and bute.

At the end of this time the bute was taken away and after 3 days Jarvis appeared totally sound and was turned out.

Unfortunately, he got very excited and flew around the field bucking rearing and kicking - with the result that he once again came in lame - but very lame this time.

The vet was called again. Tried to nerve block the horse but was unable to and prescribed more bute.

I am not sure of the timescale here but I did think it was going on rather a long time.

Vet came out again - scratched his head - as horse still very lame, and referred him on to Oakham Veterinary Hospital.

At Oakham, vets carried out an MRI scan, when the bruising to the bone was identified. Horse put on anti-inflammatories, box rested for a further 4 weeks I think. After which time the Oakham vet came to the farm to check him out.

In the intervening few weeks, Jarvis's lameness seemed to vary - some good days and some obviously bad where he was crossing his good front leg over bad leg for support.

Anyway, vet not happy with him at all and arranged for him to go back to the Hospital for further evaluation.

Again MRI scans undertaken and this time three specialists looked at the results and couldn't figure out why the horse remained so lame. The bruising shown they said would not cause the level of lameness which was apparent.

Apparently (and I wasn't there so this is third hand so to speak) one of the specialists suddenly thought of what might be going off and injected the horse between the bones - I had been told with steroids - but I think you are probably right and it was a combination of steroid, antibiotic and the other stuff.

Horse was immediately shown to be sound - or virtually so.

Vet said that he believed the cartilage between the bones was very severely damaged or disintegrating and that all they could do was inject him every month for three months to see if improvement could be achieved.


At the moment, Jarvis is on bute and boxrest. He is only on 1 bute a day and is looking very ok as he is walking around his box fine. If you lead him out though he does start to cross the leg again.

Sorry for long posting!

Cheers

Jenny
Moderator:
DrO

Posted on Saturday, May 29, 2010 - 10:02 am:

Wow I don't really know where to start with this. Crossing of the legs is not a commonly found event associated with muscoskeletal lameness. Can you explain further the symptoms you are seeing that make you think lameness. And something else bothering me about this post: if they can inject the joints why can't someone do nerve blocks. 90% of the time a few good nerve blocks is worth a dozen radiographs and MRI's at 1/100th the cost. For more on all this see HorseAdvice.com » Diseases of Horses » Lameness » Localizing Lameness in the Horse.
DrO
Member:
astbury

Posted on Saturday, May 29, 2010 - 5:08 pm:

Hi Doc O.

The Oakham vet did nerve block Jarvis when he came out prior to the last visit to the Hospital. The nerve block did produce a sounder horse on the straight but he was still crossing his legs when turning.

I think in addition Jarvis was nerve blocked on the first visit to Oakham Hospital, with very similar result - prior to the MRI scan.

As you say - nerve blocking is substantially cheaper than MRI scans - which here are about £1,000 per scan.

It is very odd - the message coming back from the people who took Jarvis to the Hospital was that they "couldn't see the cartilage at all but thought it must have disintegrated or be extensively damaged". Without speaking with the vet I can't be sure on this - although Holly's mum, who is a registered human physiotherapist went to the hospital with Holly and asked many questions in terms of "What could be done with cartilage damage in the horse" (Her knowledge is associated with sports injuries in humans).

Assuming cartilage damage has occurred during the original trauma which bruised both the pastern and coffin bones (could Jarvis have had minimum cartilage damage at the outset, exacerbated by his blast about the field?), is there any chance that cartilage can regenerate in the lower leg?

The whole scenario is very confusing - Jarvis appeared fine in his box one day - I watched him walking around on the circle (bored!) with definitely no leg crossing - and the next day I asked Holly how he was and she said "not too good" and led him out to walk a straight line on concrete and he was awful - crossing his off (good foreleg) over in front of his near (damaged limb) and looking very shaky behind too. To be perfectly honest I have never seen a lame horse behave in this way.
Member:
astbury

Posted on Saturday, May 29, 2010 - 5:12 pm:

Sorry Dr O - missed a vital question of yours - "What makes me think the horse is lame".

An interesting one - he was certainly lame when the injury first occurred - was "nodding" his head as the injured limb hit the ground.

However, now all we see I think is the crossing of the right foreleg over the left - which I assume is an attempt by Jarvis to "protect" the injured leg by taking the weight off it through placing the right leg in a weight bearing position.
Member:
rtrotter

Posted on Saturday, May 29, 2010 - 5:39 pm:

Jenny,

I am not a vet, but sometimes people make the mistake of thinking a horse is lame in one leg when it is in fact the other leg, but I am sure the vets that looked at him would know this.

I would also hope that they would know if a horse was lame behind and not in front, being lame behind might make him look lame in front.

If it is a front end lameness, the leg the horse is nodding onto is usually the sound leg not the lame leg. When they do this they are landing more heavily on the sound leg to get the weight off the lame leg, thus the nod.

The more you write about this horse the more it sounds like this horse has a neurological problem, crossing his legs, walking funny behind, seems to be unstable when walking.

I think I would get another opinion.

Rachelle
Member:
vickiann

Posted on Sunday, May 30, 2010 - 11:43 am:

I have had a horse cross over in front due to nothing more than extremely poor farrier and shoeing work.

The farrier told me to take and ride the horse anyway and that he had a suspensory problem (which had earlier been ruled out by a Vet).

There was no way I would ride a horse in such a condition, and after I got a different farrier to put improved balance into all of the feet the problem stopped.

I am not implying that this is the problem for your horse but it always a good idea to look at the basics first.
Member:
astbury

Posted on Sunday, May 30, 2010 - 2:57 pm:

Thanks for your posts Rachelle and Vicki. In the case of shoeing, Vicki, I don't think this is an issue. The horse is regularly shod by a farrier who has an excellent reputation and also does remedial work in terms of foot balance. Also, the Hospital at Oakham have a specialist farrier who I understand was there the second time Jarvis was treated. At the moment he has no shoes on.

As far as possible neurological condition is concerned, Rachelle, I did wonder the first time I saw him crossing his leg over and also the wobbly back end - but I guess the likely explanation is severe pain in one limb causing redistribution of weight elsewhere - at least where the other front limb is concerned. You are right though - if anything one would have thought the back end would have been more stable to try and give further support to the painful leg.

I guess it is possible that there is something else going on and the near foreleg - albeit with severe bruising of the bones - is a "red herring" (particularly given that the vets said that shouldn't cause so much pain) but I haven't seen him make any unusual movement since. Also the injection clearly made things much better - and today the horse has been led a very short distance to a little area where he can be grazed in hand and there is no sign of crossing of the foreleg.

He will be going back to the vet hospital in 3 1/2 weeks time for a further injection. Perhaps I should suggest to Holly that he gets the vet to do a neuro check on him. In the UK we don't get West Nile and the other main neuro diseases you get in the States but there are other possibilities.
Member:
vickiann

Posted on Sunday, May 30, 2010 - 3:09 pm:

I was reading yesterday about the outbreak of Atypical Myopathy in Europe, though just over 30 cases in UK.

https://www.horsetalk.co.nz/news/2010/03/191.shtml
Member:
astbury

Posted on Monday, May 31, 2010 - 8:33 am:

Hi Vicki - thanks for your post. Have followed the link to Atypical Myopathy. Had never of this until your post. Odd that there has been nothing in the UK Horse and Hound magazine, which normally picks up on such outbreaks.

Cheers Jenny
Moderator:
DrO

Posted on Monday, May 31, 2010 - 9:25 am:

You do describe a confusing situation and I would suggest you get written reports of all exams done to try and clarify what everyone is saying.

To help answer your hypothetical, joint cartilage with significant damage in the adult heals very poorly.
DrO
Member:
vickiann

Posted on Monday, May 31, 2010 - 9:50 pm:

Good luck with finding answers for this problem, Jenny.
Member:
astbury

Posted on Tuesday, Jun 1, 2010 - 6:00 pm:

Thanks Dr O and Vicki. Will keep you posted when I hear more and suggest Holly gets written reports from vets. Today Jarvis was still looking ok when led out to graze in hand but how much of that is masked by injection given at Oakham, and 1 bute per day I don't know.
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC