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  Discussion on Chronic hind end lameness-suspect higher up
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New Member:
ksp43

Posted on Tuesday, Oct 5, 2010 - 2:59 pm:

I have a 10 year old Holsteiner mare that has had a chronic, off and on lameness for the past year.

We bred her for an '09 foal and in the summer I hauled both mare and foal. As we were unloading the mare, she banged the point of her hip hard on the side of the trailer, scraping the skin off and leaving a faint scar. Before trailer incident, she was sound and starting to be worked under saddle. 2 days after trailer incident, put her back under saddle and she was dead lame on the right hind (same hip she banged on trailer). Friend suggested I continue to lightly work her to see if she worked out of it after a week off and some bute. With work, got much worse. Dragging toe every step, 3 out of 5 lame. She nerve blocked to the Right Hind pastern supposedly. Xrays of everything below hock done and nothing was found. Ultrasound only showed slight inflammation of pastern.

The hitch is, with a couple of weeks off, she will go completely sound and if brought back to work, totally lame.

Chiro/vet/acupuncturist worked on her twice, totally sound jumping under saddle. Said she had a pinched sciatic nerve and jammed hip of an 8 out of 10. However, did not do recheck after 5th treatment and coincidentally she had time off, went back to being lame on the right hind. Right hip DrOps significantly compared to left hind when watching her trot away from behind (or it is much lower than left hip) and tripping at all gaits on right hind plus she's short on it.

A week of rest and I took her to Alamo Pintado, my vet there recommended that I start walking her under saddle as much as possible and condense a year long rehab program into a month to see where that gets us. She was diagnosed as 1 out of 5 lame, which made it tricky. Walked her for a week, then started adding trot work. The tripping slowly went away and her sounded steps looked sounder, though I am not sure if she was putting equal weight on both hind end legs...her hip might still have been DrOpping. She is very stiff in her neck and wont bend left and falls out with her right shoulder. As I started my canter work, which I think I did too much cantering too soon, she started tripping again occasionally and not moving nearly as soundly. Also, on lunge line, when she picks up the canter, occasionally she will pick it up cross-firing and switch the hind end after a step or two.

People have mentioned it could be an Sacroiliac injury or stifles. Not really sure what to do or where to go with this.
Moderator:
DrO

Posted on Tuesday, Oct 5, 2010 - 7:24 pm:

Welcome Kristin,
What was the diagnosis of the cause of the lameness from Alamo Pintado that they based there recommended exercise regimen on?
DrO
New Member:
ksp43

Posted on Tuesday, Oct 5, 2010 - 9:49 pm:

Hi Dr. O

They were not able to diagnose it. They said that they thought it was unlikely that it was a suspensory injury, but they also said that she was not lame enough to make any type of diagnosis. They really weren't sure what was going on with her. China had no changes on the flexion tests, nor on soft footing vs hard footing. They said that she was not lame enough for nerve blocking to be effective. Alamo suggested that it's possible that she needs to build muscle tone to support her joints and to start walking as much as possible, and see if she gets better or worse with a slow onset of work. If she got worse, they wanted me to do a bone scan.

She appears to have gotten much sounder. Lunged her today to see her movement. No tripping and no short steps, which used to occur every day. She picked up her leads correctly and transitioned down evenly and stepping into the trot and walk, however she is still not bearing weight on that right hind, I can still see her hip DrOpping. I try to walk her 20 mins to warm up, 20 mins to cool down at the end, in addition to walking in between trot and canter work. She definitely is much better and when I used to try to bring her back a little quicker and without the extensive walking warm up and cool down, she used to get more lame, dragging that toe.

Would it be a helpful to see a video of her trotting? Thoughts?

Thanks in advance!

Kristin
Moderator:
DrO

Posted on Wednesday, Oct 6, 2010 - 1:38 pm:

Kristen, before radiographs, ultrasounds, or a bone scan it is best to localize the lameness with blocks. There are many lesions that can be found through such procedures on sound horses. If she gets worse that is where I would start. If it cannot be localized that way further imaging is always a possibility.

The problem with a video of her is that I don't think there would be any new information. Everyone appears to agree there is a low grade lameness in the right hind and the appearance of the lameness will not localize the cause.
DrO
New Member:
ksp43

Posted on Wednesday, Oct 6, 2010 - 2:04 pm:

Hi Dr. O,

I assume you are referring to nerve blocking? Alamo has resisted nerve blocking as it is not every step and very subtle so they do not think she is lame enough for that route to be effective.

I was just wondering if her symptoms were indicative of a certain cause or region of lameness? Is it fairly safe to assume it's higher up or can lower limb lamenesses cause toe dragging?

Kristin
Moderator:
DrO

Posted on Wednesday, Oct 6, 2010 - 7:15 pm:

The reciprocal apparatus forces the joints of the hind limb to work in concert with one another so lameness from just about anywhere in the hind leg look very similar. History is helpful in the diagnosis and your history suggests a problem with the pelvis or hip, but that is not the same as a diagnosis.

Currently researchers are working at computer motion analysis of lame horses hoping to find subtle patterns that while not readily discernable to the eye help with the diagnosis but at this time this is experimental.

With the current situation you describe I recommend you follow Alamo's advice but if it worsens so it is seen every step you should ask why a bone scan would be better than a localization with blocking. There are several different types of blocks and the article associated with this discussion area covers them and the general principles behind localizing lameness.
DrO
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