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  Discussion on Stifle Issue?
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New Member:
Macsgirl

Posted on Sunday, Dec 25, 2005 - 8:13 pm:

Hi DrO:
I have an 11 year old Quarter Horse gelding who came off a three-month layup due to a hoof problem. Finally sound (and confirmed with no chronic issues), he was put back into a slow, gradual reconditioning program at the end of October. (Background: He is ridden huntseat, and jumps no higher than 2'6".)

On his second day of turnout (he gets 10 hours of turnout on six acres with a few other horses), he came up lame in his hind right leg. Careful examination revealed no swelling, heat, or sensitivity when palpated. We checked his hoof, fetlock, hock, and stifle...and found nothing. When standing, he was straight and square...he didn't turn his stifle outward, point, or favor the leg. He presented sound at the walk, legs moving freely in both directions.

At the trot, however, he displayed a 2/5 lameness. The caudal phase of his stride on the right hind leg was fairly normal, but the cranial phase was shortened and lowered...it resembled a hobbling motion. He was dragging his toe, as well. The lameness was most apparent tracking right (with the lame leg on the inside). Tracking left, he was better...a 1/5, if anything. As usual, the lameness was the worst around corners...in straight lines, it was barely noticeable (both directions).
Despite the lameness, my horse trotted willingly. The lameness was more apparent when he was allowed to "jog" or take shorter steps. When pushed out into a fuller stride, the lameness lessened.

The lameness was similar whether under saddle or at liberty.

Flexion tests gave no positive response. Blocks from the hock down showed no improvement. (Can't remember which specific blocks.) The vet palpated the stifles, and found that she was able to move them around very easily. Diagnosing weak stifles, she prescribed three days of Bute, followed by one week of walking only, then a week of 5 minutes of trotting, gradually building up every week as he strengthened.

After the first three weeks, he was still a little gimpy, but getting better. I had to go away on business for two weeks, so he had another "vacation", but with full day turnout. When I came back, we resumed the rehab work. I rode him once, mostly walking, with only about 10 minutes of light trotting. He was only slightly stiff on the right hind, and worked out of it quickly. Two days later, he came up lame again, exactly the same as before.

However, my trainer and I made an observation we brushed off the first time: when my horse lowered his head/neck while trotting (similar to long/low work), the lameness was SIGNIFICANTLY lessened....almost completely gone, EVEN tracking right around the corner. When he picked his head up, he would hobble, then instantly put his head down again and keep trotting. It was apparent that stretching out his topline made the pain go away, and his legs would swing freely again. This happened both AT LIBERTY and under saddle.

In addition, the lameness lessens after about 10 minutes of trotting. 20 minutes of walking beforehand doesn't do ANYTHING...but after about 10 minutes of trotting, the lameness is only half of what it started out as.

So we are back at square one. The symptoms don't seem to add up, and the local vets can't figure it out (I've had two out). It has been just a little over two months now.

My next step is to trailer up to the Equine hospital about 2 hours away for diagnostic work via ultrasound, etc.

I'm starting to think that this isn't even a stifle issue. If it were, the lameness wouldn't disappear when my horse moved out long/low, would it?

There is no pain response when his back and SI area are palpated. No muscle atrophy. We've had the saddle checked, too.

My inclination is toward a muscle issue in the hip area, but I'm not sure how common (or likely) this is?

Is there anything I am overlooking?

ANY help/thoughts would be greatly appreciated!
Moderator:
DrO

Posted on Monday, Dec 26, 2005 - 8:58 am:

As he stretches his head out front it does decrease weight on the rear legs so this is a possible explanation for the improvement. I don't see anything that really rules in or out the idea of a hip muscle CLC.

Undiagnosed hind limb lamenesses are a bugger and assuming your goals and resources lead you in this direction, you are right to go ahead and get a referral to where the exam can proceed upward until localized. I would prefer someone good at local anesthesia of the the upper limb, stifle, and possibly the hip joint block (very experimental in my mind) than someone with a ultrasound. Better to be sure of the location of the pain before diagnostic work.
DrO
Member:
Gwen

Posted on Monday, Dec 26, 2005 - 10:22 am:

Don't rule out a muscle biopsy or blood test for EPSM! I am NOT saying that is it, but my qh showed similar symptoms, and I spent thousands of dollars and several years dealing with it. It might be worth the testing...
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