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  Discussion on Rx for Sacroiliac (Hunter bump)Any suggestions?
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Posted on Saturday, Sep 16, 2000 - 10:22 pm:

My 9yo Append Qtr horse has been diagnosed with SI instability after a major fall he took in a trailer. I rested him in a small paddock for a month and turned him out after that in a large field for about 4 more months. He then started training again and was doing beautifully until one day he was very lame 3/5 in the rear circling to the right. His hocks show mild changes but the lameness was so dramatic that I truly believe he most likely hurt himself slipping in the mud or something.
My question is do I rest him more (he's had one month in a stall) now on pasture or try to start SLOWLY with nothing but walking/trot with his back up? Any suggestions about chiropractics for this condition? (suggestions I am in E.Lansing MI?) or other accupuncture sites/books? I love him to death and I want to continue riding before his brain reboots! :)
Thanks for all the help!
Sarah

Posted on Monday, Sep 18, 2000 - 8:23 am:

Hello Sarah,
These are questions for your veterinarian after he has given him a good lameness exam: after all this could be anything from reexacerbation from the previous injury to a foot abscess.
DrO

Posted on Monday, Feb 25, 2002 - 6:13 pm:

This is going to be a rather long history, but I think you need all the information to understand what is happening.It does eventually pertain to spinal/back issues.

I have a 10 year old Warmblood gelding that I bought around a year and a half ago as an 3’6” Equitation horse for my daughter. He passed his pre-purchase exam fine with the only comment being that he had some minor hock changes that might need treatment/maintenaince in the future. We bought him as my vet said he seemed like a good risk.

My daughter rode and showed him for the first 6 months with no noticed soundness issues and did well with him at the shows. Temperamentally, he was more uptight going to the right. He had some excellent days, other days he was a bit of a handful, but always appeared sound. He was on no maintenaince. He was shown fairly often during those months and never seemed to have any problems.

After around 6 months he seemed to get a little “hocky” and our vet put the horse on a series of Adequan and Legend. The horse appeared to get better. Around six weeks later our horse sprung a shoe and stepped on a clip and was off for the next three weeks. Then he appeared better again. Then the horse started to show rear end lameness again. My vet put him through another series of Adequan and legend, but this time the Meds. did not help.

The horse started developing a shifting hind end lameness with concurrent lower back pain. My vet put him on Robaxin which seemed to help. The horse was fine for another week then the lameness came back. My vet suspected some sort of back/hip problem. He originally thought it was a hock problem. All this time he believed we were dealing with an “arthritis” situation, so we were told to ride though everything.

Our horse ranged from a grade 1-3 lameness on any given day. Some days he looked pretty good. Some days he came out of his stall dragging his hind feet. My vet never did any nerve blocks, but recommended we send the horse for a Scintigraphy. I listened to our vet and sent the horse for the test to be done. The results were inconclusive. It was recommended that the horse have his hocks and his hips injected “just in case”. That was done and the horse was sent home.

Months(4) went by and the horse would appear to get better and then he would go off. We continued to ride him lightly at the walk and trot as per medical advice. I had him tested for EPM, although he knew where his feet were. That test came back negative.

Finally I decided to seek alternate medical advice. I had a little left on my Major medical policy and felt I needed to get this horse evaluated by someone who might be able to figure things out. I contacted a highly recommended place in Ocala, Florida and explained the story.

I was told that by the time the scintigraphy had been done the supposed injury was chronic and would not have shown up. These new doctors told us to ride the horse everyday for 30-45 minutes hard to get things to really flare up again so something could be seen in a scintighraphy if they chose to do one. We were told to ride our horse hard, but not to break him. In the mean while, I gathered all the past info I had on the horse along with the pre-purchase films, reports, medical history, original scintigraphy, hip radiographs, and sent them to this hospital. My daughter set out to ride our horse “hard”.

Fortunately, or unfortunately for the next three weeks of hard riding the horse seemed to get miraculously better. She rode him at a walk, trot, canter, did flying changes, lateral work, and even started him back over a few fences. Finally, he became grade 2 lame again. We had the horse shipped out that day to be vetted. As it turned out, after nerve blocks, new radiographs, and a new scintigraphy, we found that the horse had two OCD lesions. One was in his right hock. The other was in his right rear ankle. We were told that the lesion in his ankle was the major problem. When that was blocked he went 95% sound. I was told these(the OCD lesions) could be seen on the original pre-purchase radiographs. Oh well…

I was told the best thing to do would be to have them(the OCD lesions) surgically removed. So our horse had surgery around four months ago. We were told to keep him stalled until the stitches were removed(2 weeks). Then he was to be hand walked for 6 weeks, then turned out in a small paddock for 2 months. Then he could g back to work. When he was shipped back to us I changed to a new vet for post-operative care and any follow up needed.

The new vet feels that while the OCD lesions were in part contributing to our horse’s lameness(on the day he was evaluated in Ocala they were 95% the cause of lameness), she also feels that our horse has Hunter’s Bumps, and feels that this too contributed to the whole scenerio.

In the four months our horse has been layed off he has suffered much muscle wasting. My vet(and I) can see a obvious difference in the level/placement of the sacral/iliac bones when standing behind the horse. They are not symmetrical. My vet feels that this horse probably injured himself sometime in his life. She said it could be an old injury from years ago that flared up, or it could be something( a more recent injury) that happened when all of this started. We won't ever know I guess.

It has now been 4 months since our horse had surgery for the OCD lesions and my new vet is telling us to put the horse back under saddle and to walk him for increasing intervals over the next 6 weeks. She wants us to slowly start building his rear end back up.

She does not paint a positive outcome. She says many horses do not recover from “Hunter’s Bumps”. We are supposed to up his exercise routine to include trotting, and then cantering, and then hopefully, jumping depending on how he does with each added exercise routine. I get the feeling that she doesn't expect him to reciver though.

Right now(today) he is grade 1 on the lung line and he flexes grade 2 in the right rear(spavin/stifle. His ankle seems fine. I have tried to get information on this problem(Hunter's Bumps), but can’t find much detailed information on treatment and prognosis on your site or any other. Do you have any other suggestions about where I can get more information on subluxation of the sacral-iliac joint and treatment for it?

Thank you, Debbie

Posted on Tuesday, Feb 26, 2002 - 7:49 am:

Try this reference first Debbie and then if you have any questions bring them back here,
References: Equine Illustrations: Leg Anatomy and Conformation: Sacroiliac Joint and Hunter Bumps.
DrO

Posted on Wednesday, Apr 3, 2002 - 7:20 pm:

Dear Dr. O,

Thank you for the reply. I have looked at what you suggested and still would like more information on the subject. In particular, I would like some information about treatment protocals for what we believe is an old injury that flared back up again. I have found very little information anywhere about subluxation of the sacral-iliac joint and it's treatment. Most of what I read consists of a few lines from an abstract or very short articles. I would like something that goes into much more depth. Is there anything like that out there?

Thanks again...Debra

Posted on Thursday, Apr 4, 2002 - 6:58 am:

Hello Debra,
Have you seen the section on SI injury in the article Equine Diseases: Lameness: Diseases of the Spine and Back? We present the results of a long time review of about a dozen cases along with diagnosis, treatment, and prognosis.
DrO

Posted on Thursday, Aug 8, 2002 - 12:57 pm:

Dr O,
My horse Aspen has just begun to show signs of the 'hunter bump' over the last 3 weeks or so.

First the changes: We did change training from dressage to hunter in preparation for a show -- which we did well (Championship). And, this training was moderatley intense; including jumping which is something Aspen and I have not done in sometime (2yrs+). I also had switched her joint supplement from Corta-Flex to Joint Combo. I am putting her back on the Corta-Flex, and we are returning to dressage type work. Working long and low, and going back to doing trail rides on the hills.

Aspen does seem to be a little bit stiffer than usual, takes a long time to warm up -- 40 mins. No signs of lameness. Aspen is a 21 yrs, TB.

The question (I have your diagrams) before I call the vet; whose usual first order is to inject the hocks. Question -- what could/would bring on this hunters bump? Is it painful to her? Is this normal for an aging TB? Is it 'curable'?
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