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  Discussion on Frustrating hind leg lameness
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Member:
Sherm

Posted on Tuesday, Jan 10, 2006 - 11:26 pm:

Appox. 3 1/2 mths ago my dressage horse, a 17.1 Warmblood (12yo) became lame in near hind. Sound one day, lame the next. Had my Vet come out to check, and after flexion tests he could only find a very mild reaction in the stifle and lameness score of 1- 1.5. His diagnoses was possible soft tissue injury and to put him on bute for 10 days, if he improved it would confirm the diagnosis. After 10 days and no improvement I was referred to a specialist equine clinic where the vet there did more flexion tests and his conclusion was the fetlock, the horse showed very mild reaction and to my mind none at all.(no comparison flexion test was done on the other leg). After nerve blocking the fetlock and to my mind again he was no better, the fetlock and pastern were xrayed. Result was mild degenerative changes but Vet says nothing that you would not expect to see in a horse of his age and workload. Conclusion was possibly a mild ligament strain in the fetlock, bute and rest for 3 weeks. After another month, I felt there was still no significant improvement and he was taken back for more tests. After reviewing the same Xrays again, and having had no improvement still 1-1.5 lame, the vet has decided that it is DJD in the fetlock. Understandably I wasnt happy with the diagnosis as he was looking at the same xrays but giving me a different diagnosis. I asked him to be nerveblocked again for the foot, pastern and fetlock, which were done over 2 blocks and none made the horse remotely more sound (vet agreed). My question to him is why arent we looking higher up the leg? He felt that the horse responded to first flexion test on fetlock and nowhere else and because he hasnt responded to treatment for soft tissue injury, that it must be that the DJD in the fetlock is more serious than the Xrays are showing. After running out of time and not a little patience I asked him to inject joint with cortisone (my initiative, he says there it little hope of any injection working). After another 4 weeks still no improvement, and my next step is to have a bone scan to determine where the actual injury is. I have been advised to work the horse for the next 3 wks to increase any inflammtion so that it will show up more clearly or I am going to waste lots of money (as if I already havent!!)
My question is how can you diagnose pain to an area that showed NO improvement on a nerve block. Is it possible to still be in the fetlock and the horse stays lame even with nerve blocks on 2 seperate occasions. Would you suggest a bone scan on a horse that was mildly lame? What are the chances that inflammtion will show up and wont inflammation show up in the fetlock anyway because of all the injections etc he has had in the last 4 weeks? And can you have a sound horse one day (in full work) lame the next and a prognosis of DJD? I thought DJD was a gradual deterioration.

Thanks Dr O
Moderator:
DrO

Posted on Wednesday, Jan 11, 2006 - 8:11 am:

Excellent job on having the fetlock reblocked on the questionable first block. It is possible for a nerve block to give inaccurate result for 2 reasons: 1) the block missed the intended nerve 2) their are unusual nerves present you don't normally block innervating the painful area.

Careful skin testing for sensitivity helps eliminate the first and a ring block of the distal cannon makes the second very unlikely. Before I would do a bone scan, as in such cases it often gives equivocal results, I would seek a third opinion by someone who is comfortable blocking the hind leg to and including the stifle. I would start with the cannon ring and move upward.

Yes DJD can be painful one day and OK the next as anyone with a little arthritis can attest.
DrO
Member:
Sherm

Posted on Saturday, Jan 21, 2006 - 12:54 am:

Thank you for your quick response Dr O. I took your advise and sought a second opinion. Diagnosis has just been determined after xrays, bone scan, nerve block and ultrasound that what I am dealing with is proximal suspensary desmitis and a palmar cortical stress fracture of the hind leg. Lesian on suspensary is about 30% through and continues for less than 1cm. Recommendations are shock wave therapy and 6 mths rest. After reading all the articles that you provide I am still unsure as to how to proceed as his future as a dressage horse looks decidedly guarded. Would you recommend the shock wave therapy (vets will use focus machine)as increasing his chances of returning to at least the lower levels of dressage. This has been going on now for over 3 mths, starting with mild lameness (1) and now increased to 2.5 to 3. The original diagnosis of DJD in the fetlock was refuted by the bone scan and extra xrays. Have you heard of any horses that have come back from such an injury?.

A pat on the back for creating and maintaining such an informative web site ( even if the information you find is kinda depressing!)
Member:
Lilly

Posted on Saturday, Jan 21, 2006 - 8:50 am:

Sherrill,
I am very interested in your horse's condition. If you follow through with the shock wave therapy, please share the results. It sounds like your horse has a lot of potential and you want to help him out any way you can.

If you can afford yet another opinion (even if it's just a consultation), I would like to recommend Dr.Kent Allen. He is located in The Plains, VA and runs a special vet clinic with the following description: "a specialty lameness, sports medicine, pre purchase exam and state of the art diagnostic imaging practice". He has a lot of experience dealing with cases like yours (he does shock wave therapy)and his clients rank among the who's who of horses. If you are interested, check out:

www.vaequine.com/tour.php
Member:
Sherm

Posted on Saturday, Jan 21, 2006 - 9:26 pm:

Ann,

Thank you for your interest. Yes, I do love this horse and would anything (and have)to give him the best chance of becoming sound but I think shipping him to America may be a little beyond the budget as I live in Victoria Australia!!!!! He is currently at the foremost equine clinic in Aust. where before sending him I did research on their equipment and the professionalism of their vets (and also asked Dr O his opinion!)The diagnosis has been a surprise by all involved as "scout" is a big strong horse with good hind limb and foot conformation although he can be a bit of a "tool" in the paddock when turned out, tending to gallop to a sliding stop at the gate...fancies himself as a quarter horse I think! Trauma to the leg has been ruled out. They are not worried at all about what they think is a stress fracture (hard to diagnose as it is at the back of the cannon and they can just see some sclerosos of the bone on xray). After doing more research I have decided to have the shock wave therapy (3 sessions 2 weeks apart- focus machine) as it does seem to go someway to getting a better result. I will be picking him up tomorrow to start the long haul of confinement..not an easy task with an 17.1 warmblood who thinks like a shetland pony! they think he will do just as well confined in a small paddock (yard size), although they are talking 6 mths off where I read that 3 is more typical. Does anyone know of anything that can be fed, ie vitamin mineral, herb that will help repair or strengthen ligaments?..maybe even acupunture. I know Im clutching at straws but I am determined to get this horse back to where he was and will try anything. If anyone has been through this and survived I would love to hear of your experiences. Dr O does desmitis of the hind limb suspensory have a poorer outcome because you are asking the horse to take more weight on the hind leg or is there a difference between the way the front and hind leg suspensary acts/attaches? Scout will have another ulrasound after finishing the shock wave therapy so I will send an update then.

thanks again for your interest and help
Member:
Lilly

Posted on Sunday, Jan 22, 2006 - 10:21 am:

Hi Sherrill,
No, I wasn't suggesting you send your horse to America. You're too funny! I just meant sending his info, like symptoms and ultrasound photos. Dr.Allen works in the heart of eventing country up in Northern VA. He see horses that are worked under very extreme conditions. I can't believe the crap they make those horses jump!

Have you looked into stem cell therapy for injured ligaments? That looks like an exciting new area for vet medicine.

Ann
Member:
Caymie

Posted on Sunday, Jan 22, 2006 - 10:54 am:

Hi Sherrill,
My horse (also a large warmblood) was diagnosed with proximal suspensory desmitis a couple of years ago, only his was on a front leg. We had struggled with this issue off and on for quite awhile before he finally ended up with a small tear. He was head bobbing lame at the walk one day, and almost looked sound twenty four hours later after being stalled. Of course we knew he wasn't sound.
Anyway, he was treated with three shock wave treatments. And I rested (small run attached to his stall) and hand walked him for six to seven months before he was turned out. I did not turn him out until the ultrasound showed that the lesion was fully healed. I got lucky as we were having an unusually hot summer so he was quite sluggish most of the time. Handwalking a warmblood is not something I would wish on anyone.
I put him on a different supplement during that time called Recovery EQ. I tried it because of their claims that it was good for tissue healing.
And then I slowly brought him back under saddle, and I mean slowly. I started him under saddle before I ever turned him out. It was a long, slow, frustrating and at times dangerous process.
However, he fully healed from the injury and hasn't looked back since. He was young, and I think we were fortunate that the lesion healed as well as it did. I certainly think that if you do the rehab correctly, you greatly increase your chances for success.
I highly recommend the shock wave therapy. You still can't scrimp on the rehab time, but I sure do think it helped. I asked my vet about the stem cell therapy and at the time (three years ago), he did not feel as though there was enough evidence that it was effective. Maybe that has changed, I would sure inquire about it. And as to whether a hind suspensory injury has a poorer prognosis, that would also be a question for the vet. Certainly maintaining good nutrition is going to assist with the healing process as well.
I wish you and your horse all the best-and good luck!
Keep us posted,
Mary
Moderator:
DrO

Posted on Sunday, Jan 22, 2006 - 4:28 pm:

Hello All,
As you have probably read suspensory desmitis in the hind limb has a bit of a worse prognosis than the front but ECSWT has improved the chances these horses have for more on this and other therapies and rehab protocols see, Equine Diseases » Lameness » Diseases of the Lower Limb » Suspensory Desmitis, Strain, & Sprain.
DrO
Member:
Sherm

Posted on Monday, Jan 23, 2006 - 12:36 am:

hi All,

Thanks everyone for your support. I have picked Scout up this morning and he looks a million dollars, which is why it was so hard to diagnose this problem in the first place, no heat, absolutley no swelling, no marks from a trauma..just at first a mild lameness that has progressed to a more marked lameness...If I had had the proper diagnosis when he was first seen 3 1/2 months ago...well.... who knows...not blaming the vets as it was very complicated.

To further complicate matters he has contracted cellulitis in a front leg from a small cut he received in the recovery room and he is on massive doses of penicillon and gentamicin .. he already hates me for leaving him at the equine centre...boy he is really going to hate me now...hes been poked prodded, you name it hes had it. Had the first of 3 shock wave therapies today and fingers crossed it will be a good outcome. The vets here feel that I should leave the rehab till after the next scan in 4 weeks as the stress fracture complicates things. He is confined to a 15 x 15 metre yard and stable so he can exercise a little at walk but they feel rest will be the best medicine. I agree with you Mary, handwalking a warmblood whose feeling pretty darn good is not a fun thing.. Im not sure who would be walking who here!

Will keep you posted after next scan,

thanks again
sherrill
Member:
Caymie

Posted on Monday, Jan 23, 2006 - 7:03 am:

Sherrill,
That's exactly how my horse's suspensory injury presented itself as well, which made it such a challenge to diagnose. My horse is resting right now as well for an SI injury. I am working more than usual to yes, help pay my vet bills, but also so I don't have to sit around and endure the guilt that comes from being stared at by very big, sad brown eyes.
Keep us posted-
Mary
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