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  Discussion on Next step for potential stifle issue
Author Message
New Member:
zenaj

Posted on Sunday, Dec 1, 2013 - 12:08 pm:

Hello, this is my first post and I hope I can get some advice... My 8 yr old TB gelding had what I thought were back issue (tense at trot, swinging head to outside on corners during schooling) hence I rested him for two weeks until my regular physio (who is also approved and recommended by my vets) could come out to check (I do novice level dressage and 5-10 mi hacks and organized pleasure rides ). She diagnosed a very sore back but also on palpating sore on both stifles, worse on left. Graded 1/10 lameness behind. Back possibly caused or exacerbated by stifles (she knows my horse and his reactions and he has never reacted thus to stifle palpating). She recommended putting him on devils claw, two more weeks rest off riding (he lives out with two others 24/7) followed by 15 min walking out for two weeks when she would see him again.

It is two weeks in and his stifles appear to be just as sore, I am also rubbing comfrey oil on which is difficult as he kicks out even to light touch. At no time was there any swelling or heat that I noticed. A week ago I further confined him in a large stable yard to prevent field hi jinks as fields very muddy and slippery... I am worried bout waiting two more weeks, and wonder if there is any point if there is no improvement yet, and whether I should therefore go ahead and get more specific diagnosis. I also wonder if a serious tear or rupture can occur without swelling or heat? O could it be something like tendonitis? It seems weird that it seems so tender to touch?

Thank you
New Member:
zenaj

Posted on Thursday, Dec 5, 2013 - 11:45 am:

Hello.....it's been 4 days now and I am not sure why I have had no response to my query? I have checked and it seems most others are answered in a couple of days?

Looking forward to hearing something....
Member:
juliem

Posted on Thursday, Dec 5, 2013 - 1:40 pm:

I've been hoping to hear from Dr. O as well. I had a yearling filly with a stifle OCD and opdted for surgery with a scope, so I'm interested in his advice as well. Welcome to the site and I'm sorry you haven't had any replies. Hope you hear soon!
Moderator:
DrO

Posted on Thursday, Dec 5, 2013 - 6:11 pm:

Welcome Zena,
I try to answer here at least twice a week so it you happen to post just after answering it may sometimes be 3 or 4 days. In general I do get here more often however.

Concerning your post the answer of further diagnostics at this time or not it depends on your goals. If your goal is to get appropriate treatment as quick as possible and cost or time are not a factor you should get a more specific diagnosis now. If on the other hand time and/or money are limited it is unlikely two more weeks of rest are going to exacerbate the problem and there is a chance things will improve.

You have a undiagnosed lameness that may refer to the stifles. We have an article on this subject at Horseadvice.com » Diseases of Horses » Lameness » First Aid for the Lame Horse.
DrO
New Member:
zenaj

Posted on Tuesday, Dec 10, 2013 - 6:13 am:

Hello Dr. O. I have had my horse to the vet yesterday. On trot up and lunge, grade 2 lameness, were unable to get more than 2-3 strides at canter so concluded grade 4-5. Worse right than left. Because of sensitivity to both stifles, his age (8) and relatively late start to work, and the possibility of OCD, opted to go directly to xrays. Nothing shows on either side on radiographs. Whilst sedated palpatiion was possible and no signs of swelling in the joinit so they concluded that ultrasound would be unlikely to be helpful. Then opted for stifle block, but were unable to complete due to sensitivity (despite sedation, twitch and holding up one leg he was still kicking out on palpatiion so they decided the risk of breaking needle was too great). So now recommending either field rest for winter and see what summer brings or referral to equine specialists in Newmarket (racing centre in uk) for further work and probably bone scan.

Rather unsatisfactory... I would appreciate your thoughts. Thank you.
Moderator:
DrO

Posted on Wednesday, Dec 11, 2013 - 9:24 am:

Hello Zena,
Note that a grade 5 lameness on most commonly used scales is non-weight bearing. The degree of objection to palpation of the stifles you describe is greater than I would suspect from joint pain alone so uncertain if that is actually a good indication of the location of the lameness. Perhaps some behavioral modification to retrain your horse so that examination of the stifle is easier might help even if you decide to go to New Market. For more on this see HorseAdvice.com » Training & Conditioning Horses » Behavior and Training » Modifying a Horses Behavior: Conditioned Responses.
DrO
New Member:
zenaj

Posted on Wednesday, Dec 11, 2013 - 11:08 am:

Dr. O, thank you for your response and hello again. I am opting for further investigation, I am covered by insurance so cost is not an issue presently. I am interested that you suggest the degree of objection to palpation is too much for joint pain alone. This horse does not normally object to being manipulated anywhere.... Which is done regularly by me and by his physio... So I don't think it is behavioural, although he is now on hi dose of bute for a week so I plan to check his sensitivity again once the bute has had a chance to act. I have checked your reference for reading and cannot locate any section called training and conditioning? I have used clicker training for behavioural modification with respect to sprays and hosing, so I am assuming your references are similar, but still would like to read them.

Re the lameness grading, I suppose it is possible in the uk they use a different scale, I have heard mention 1-10, so a 4-5 would be similar to a 3 on a scale where max is 5, I would suppose. I also plan to lunge him again once bute has a chance to act, as lunging is not something he really does, so I want to check that not cantering on the lunge may be an anomaly.... If the bute is strong enough to take away the joint pain that is....

I have done further reading and have found a paper which suggests ultrasound can pick up OCD that X-ray will miss. Would you agree? The bone scan option will not be available for 2-3 weeks, likely post holidays, so I am wondering about asking my vet locally to do an ultrasound?

Thanks again for your help.

Zena
Moderator:
DrO

Posted on Saturday, Dec 14, 2013 - 3:24 pm:

Hmmm....it is not that the ultrasound is more sensitive in general than radiography but that there are "some" soft tissue lesions the US is better at detecting including some injuries to the condral cartilage (OC) but then there are OC lesions that radiography is better at detecting. In all such cases such ultrasonagraphy should be done by someone who does it daily with a lot of experience looking at the stifle. The gold standard in OCD lesions is arthroscopy but not recommended without better localization than you present above.

I would not counsel a bone scan at this point unless you truly cannot get a organized nerve and regional anestheric blocking exam done. Once the lesion is localized a MRI would be best as bone scans are not diagnostic for any particular condition. HorseAdvice.com » Diseases of Horses » Lameness » Localizing Lameness in the Horse goes over the strengths and weaknesses of each of these modalities. For more on OC lesions in particular check out HorseAdvice.com » Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » OCD and DOD in Horses.
DrO
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