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 » Localizing Lameness in the Horse »
  Discussion on Cannot find cause of lameness
Author Message
New Member:
xddcq20

Posted on Friday, Feb 4, 2011 - 9:15 am:

After 5 months and spending $3k, vets (U Penn and others) cannot figure out what is wrong with 4 yo Welsh/TB large pony. He is slightly lame on lunge line on right rear. Under saddle, he is crippled (right rear and left front) for 10 steps and then relatively sound for the next 10 steps. Reputable vet says it one of the most "dramatic" cases she has ever seen. Nuclear scans (entire body), xrays of hooves (including navicular bones) , back, legs, shoulder and ultrasound of suspensories show nothing abnormal. He is sound out in pasture. What do I do next? He is a darling, trust worthy, and gorgeous pony.
Member:
mrose

Posted on Friday, Feb 4, 2011 - 12:06 pm:

Hi Courtney. I'm sure you'll hear from the site's vet, Dr.O,soon. However, the fact that the pony is sound when out in pasture makes me wonder about either the rider or the tack. Has saddle fit, pad fit, position when put on the pony, etc. all been checked out throughly? Is the rider sitting balanced? It's just what "hit me" when I read your post.
Member:
vickiann

Posted on Friday, Feb 4, 2011 - 2:08 pm:

Lame 10 steps and sound 10 when under saddle but okay out at pasture certainly sounds like the pony in compensating about something being uncomfortable with the tack.
New Member:
xddcq20

Posted on Friday, Feb 4, 2011 - 3:36 pm:

Sara and Vicki,

Yes, we tried a good saddle fitter - bought a $3,500 new saddle for him, in fact (I really do love this guy!). We tried a dressage saddle, a little hunter/jumper saddle, a western saddle, a gel pad, one of those really good pads, etc., even no saddle. We tried different riders (western, dressage, hunter) and a really tiny, but good, 70 pound rider. And whenever he has weight on his back, he is reluctant at times to bring forward his left shoulder. He is also lame in the opposite back leg. The New Bolton vet thought is was his rear suspensory, but nothing showed up on sonogram.

Vets have xrayed, palpated, etc. his back, and nothing shows up. He doesn't flinch or round down his back when tested. He isn't girthy either.

New Bolton vet gave me the option of putting him wiht a professional trainer to push him and "make or break him" or to rest him until the spring and try again then. I chose the rest option. But as the days grow longer and spring nears, I am worried about what to do next. Very frustrating.
New Member:
xddcq20

Posted on Friday, Feb 4, 2011 - 4:35 pm:

I left out that blocks of front left leg did NOT resolve lameness in front. Blocks of rear right leg did help rear lameness but did not completely resolve.

The following combination of blocks somewhat resolved lameness (not completely - again, lameness is highly variable): rear right leg up to hock, front leg up to and including shoulder with second block to front left hoof.
Member:
vickiann

Posted on Friday, Feb 4, 2011 - 5:12 pm:

Dr. O will have to interpret the medical aspects and meaning of the nerve block.

What a frustrating situation for you! I hope that you can find the answers.
Moderator:
DrO

Posted on Friday, Feb 4, 2011 - 10:57 pm:

Welcome Courtney,
I am sorry to hear about your darling, trust worthy, gorgeous, but very unsound pony. The first consideration here is not what is wrong with this pony but what are your goals and resources.

If you want to pursue this problem and have unlimited time and resources that you wish to devote to this problem I will have very different recommedations than if you need a pony to take to next weeks competition but are having trouble paying the current trainer/vet fees. Help us out a bit with the goals and resources and then we can try to make useful suggestions as to your next step.

I can't help myself on this and must ask exactly what diagnostic tests have been done and what the results are. Call me a romantic if I an throwing practical considerations to the wind.
DrO
New Member:
xddcq20

Posted on Saturday, Feb 5, 2011 - 8:21 am:

My goal is simply to figure out what is wrong with this pony. I have unlimited time. Resources are another matter. I have $ to spend, but after all the tests that were already done, I am leary of going for another round of extensive testing.

I can put him with a good trainer (they run around $1,500/month here), but the idea of putting my "darling" pony with someone who is going to "make or break him", kills me. If that is what I need to do, then so be it, I will do it.

I think I listed the diagnostic tests that were done above, but I'm not a vet, so perhaps I wasn't specific enough. I have the results write-up from New BOlton and can copy it if needed.

Any direction you can point me in would be much appreciated.
Moderator:
DrO

Posted on Saturday, Feb 5, 2011 - 9:32 am:

Thanks Courtney,
Considering your stated goals and resources, New Bolton's recommendation of pasture rest and time seems quite reasonable and since riding is not in your goals, I am uncertain about ever pushing the pony through what may be a painful or frustrating training program. I am not in a good position to judge this.

A shifting around lameness, poorly localized with regional anesthesia, no hot spots (inflammation mainly) to follow on the nuclear scan, and no radiographic lesions of the most likely sources of pain makes it hard to come up with anything on the rule out list. The last time I saw a horse that became dramatically lame only while under saddle had a developing skin disease that the breast plate put pressure on. The skin was not obviously diseased at this time and we localized the spot by removing the tack one piece at a time. The time before that a nail had backed out of the tree but was covered by leather. Does this problem occur with tack on only or tack and rider?

Occasionally a single leg lameness can give the appearance of both a front and rear lame. There is a rule of thumb: if the lameness is ipsilateral start with the hind limb and if the lameness is contralateral start with the front leg. On the other hand the fact the rear leg lameness seems more persistent suggests the opposite. The pattern of blocks may not be such as to feather out such a case.

I would like to see a good but succinct description of the appearance of the lameness and the results of the individual blocks and how that changes as more blocks are added. Perhaps starting with the New Bolton notes is best.
DrO
New Member:
xddcq20

Posted on Saturday, Feb 5, 2011 - 12:50 pm:

Unfortunately, the discharge papers pdf is too big to upload, so I will need to play with it in work on Monday.
Member:
xddcq20

Posted on Monday, Feb 7, 2011 - 9:29 am:

Unfortunately, I can't get the discharge papers down to the required size allowed to upload.

I re-typed most of the results shown:

Nuclear Scintigraphy: Bone phase imaging of the right and left forelimbs, neck, and back was performed. No clinically significant areas of increased radiopharmaceuitcal uptake were noted.

Lameness: The pony was sound at a walk and trot in hand on the pavement. The pony was 1 out of 5 degress lame on the right hindlimb when lunging. The right hindlimb lameness was markedly worse when the pony was ridden. While ridden, the pony's lameness was inconsistent; se verely lame at times and relatively sound at times. Abaxial and low plantar anagelisa did not improve the lameness. Subtarsal (high suspensory) analgesia resolve dhte lameness and then the pony was lame in the left forelimb. The left forelimb lameness was most apparent under saddle. Intra-articular shoulder joint alagesia did not imporvoe the lameness. Palmar digital analgesia resolved the lameness.

Radiology: Digital radiographic evaluation of the left front foot and one lateral projection of the caudal thoracic/lumpar dorsal spinuous processes was performed. No bony abnormalities were noted.

Ultrasonography: Ultrasongraphic evaluation of the right hind suspensory was performed. No soft tissue abnormalties were noted.

Diagnosis: Despite extensive evaluation, a definative diagnosis was not obtained. However, no significant underlying problems, such as upper limb or axial skeletal fracture, etc. were identified.
Moderator:
DrO

Posted on Monday, Feb 7, 2011 - 5:48 pm:

That is much clearer but one thing I want to be sure of: was the L fore block done while the hind limb "high suspensory" was still blocked.

Was any comment about hoof conformation made particularly concerning the L Fore?
DrO
Member:
xddcq20

Posted on Monday, Feb 7, 2011 - 6:34 pm:

The L fore block was done about 2 hours after the high suspensory was blocked. I do not know how long they last.

No comment on hoof conformation was made. Pony is barefoot and has always been barefoot (I have known him since birth).

I have scheduled a reputable farrier (who worked at New Bolton for 7 years) to come to look at his feet. She is a big proponent of barefoot horses and has a terrific reputation.
Member:
xddcq20

Posted on Monday, Feb 7, 2011 - 7:01 pm:

I should mention that the pony paddles (or wings - not sure which is which).
Moderator:
DrO

Posted on Tuesday, Feb 8, 2011 - 8:32 am:

2 hours??? How long a block will last will depend on the local anesthetic used, the amount put in, and well positioned the block is. But two hours is long enough for many blocks to wear off. Is it possible that if a PDN block of the left fore alone was done again that this pony would go sound again? Did they comment on this?

One thing I don't see in the notes is a history: When did the lameness start and how did it progress?
DrO
Member:
xddcq20

Posted on Tuesday, Feb 8, 2011 - 7:00 pm:

History: Pony became lame in front left slowly starting in September. He would take a few odd steps tracking clockwise (left leg on outside) and then be ok. This lameness became progressively worse. During this time he was extremely "pluggy" and didn't seem himself. By the end of September he was extremely lame - lame on lunge line as well.

Vet came out and thought it was his shoulder. He had 4 weeks of stall rest and bute. Then he was sound on lunge line and we gave him pasture rest for another 2 weeks. He seemed ok. He was extremely stiff when when we started him under saddle again. It almost looked as if he forgot how to trot (he wouldn't move his left front shoulder forward at the trot). I tried walking for 20 minutes a day under saddle and then trotting around the ring 4 times in either directioni. Tracking counterclockwise he seemed ok at the trot (at times), but tracking clockwise he was very lame (at times).

I called the vet back (it's now early December) and we did blocks on left front which did not alleviate the lameness. I do not know if she did a "PDN" block though.

What is a "PDN" block?

I think it's worth a try whatever it is.
Moderator:
DrO

Posted on Wednesday, Feb 9, 2011 - 8:30 am:

PDN block is the palmar (or posterior) digital nerve block described in the last sentence of the UPenn and appears to be in conflict with what your veterinarian found back in Dec. I would like to see a PDN and if negative one more block above it (Abaxial Sesamoid) to see if the lameness resolves as it did for UPenn. For more on diagnosing foot lamenesses see HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Hoof » Overview of Diagnosis and Diseases of the Foot.
DrO
Member:
xddcq20

Posted on Wednesday, Feb 9, 2011 - 2:09 pm:

Dr O.,

Here's what the vet who did the blocks in December wrote

"...the nerve blocks that I performed on the left front foot in December (which were an abaxial sesamoid block and a low four-point block) should have anesthetized the same area that the palmar digital block did when Phoenix was at New Bolton Center. Obviously, in December the left front foot blocks did not seem to improve the lameness. The difference is that New Bolton Center had also anesthetized the right hindlimb... so the combination of the right hindlimb and left forelimb anesthesia working together is what actually resolved the lameness."

This is a highly regarded vet.

Do you have any other ideas in a direction we should go in?

This is such a confusing and frustrating situation.
Moderator:
DrO

Posted on Thursday, Feb 10, 2011 - 4:29 pm:

Highly regarded or not, considering NBC's finding I would want to double check the above hypothesis put forward. This is where I would start because until this is localized you cannot get a diagnosis and you are left with NBC's current non-specific but time honored suggestions of tincture of time followed by a good work out.
DrO
Member:
xddcq20

Posted on Thursday, Feb 10, 2011 - 7:07 pm:

Thank you for your suggestion. I will most definitely test your hypothesis.
Member:
xddcq20

Posted on Tuesday, Apr 19, 2011 - 9:40 am:

It has been awhile since I posted, but blocking the left front hoof did not resolve the lameness.

At a trainer's suggestion, we had his hocks and stifles xrayed. Low and behold, he has arthritis in his back right hock (those 2 thin stacked bones at the bottom of the joint - she said something about "looks like they are trying to fuse"). Stifles and left hock look perfect.

The vet injected his hock and his whithers - the vet said that at some point he had broken his whithers and upon palpation, horse expressed discomfort. The vet is not convinced that the "mild hock arthritis" was the only thing bothering him.

The injections did help him quite a bit, but I'm still taking it easy with him - mostly hand walking him up hills and then doing about 20 minutes of walking under saddle. I asked him to trot for about 10 steps and he was sound for those 10 steps - i was so excited I stopped at that point because I didn't want to push him. A very light rider (100 pounder) rides him 20 minutes twice a week and he is much, much better, but still shows some discomfort when transitioning downward tracking to the right.

BTW - we started him on Adequan yesterday.
Question is - is there any hope for future soundness for this type of hock arthritis (assuming it is his hock) in a 4 year old or will he get worse over the years?
Moderator:
DrO

Posted on Thursday, Apr 21, 2011 - 12:59 pm:

Hello Courtney,
Though I am uncertain which joint you are talking about, horses with arthritis of the two low motion joints of the hock do have a chance of recovering from the condition by having the joint fuse. You will find a whole article on this at HorseAdvice.com » Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » Arthrodesis and Joint Fusion for Arthritis but be sure you review our article on hock arthritis at HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Upper Rear Limb » Overview of Diseases of the Hock (Tarsus).
DrO
Member:
vickiann

Posted on Thursday, Apr 21, 2011 - 5:32 pm:

Courtney,

One of mine was diagnosed with DJD of the same hock joint in both rear legs following flexion tests and X-rays.

The joints were injected once to reduce inflammation and improve the synovial fluid.

I keep this horse on Corta Flx and use Adequen.

My horse has been doing very well in every way -- just backs more slowly than before he got the arthritis.

It is very important to keep your horse's feet very well balanced laterally and medially.

Good luck to you.
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