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  Discussion on Lame but radiographs can't be identified
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Posted on Thursday, Oct 26, 2000 - 9:04 pm:

Hello Dr.O:
I'm writing to get your opinion. I recently bought a standardbred yearling at public auction. Within the past month he's been harnessed/line broke and gaited (hopples)to the pace. While pacing on the track he started riding the left shaft(lame on right side)Our vet took
radiographs of both r/l ankles & hocks.The ankles and L hock checked clean so the following day our vet blocked the right hock, afterwhich he was hooked and jogged. He was totally sound. A follow up series of radiographs of the right tarsus were taken.
Our vet was uncertain making a diagnois of the radiographs so he consulted with both a senior vet and a radiologist at Guelph University. Referring to the followup series, the radiologist states "the radiographs of the right tarsus consist of dorsopalmar and dorsomedial-plantarolateral oblique projections. No significant radiographic abnormalities can be identified. Potential diagnostic possibilities which should be considered to explain the lameness and the response to intra-articular anesthesia whould be either early synovitis, although if this were the case it would be anticipated that clinically significant distention of the joint capsule would be present. Alternatively, the possibility of an early osteochonDrOsis lesion which is not radiographically apparent should also be considered. If no response to conservative treatment occurs then repeat radiographic evaluation may be helpful to identify progression of any lesion."
The 'good news' my vet said is the radiographs show nothing wrong - called it an artifact!!?
The "bad news" he says, is he's lame in the joint. The treatment he recommends is injection of acid followed by 1 week off. If the lameness persists he then recommends arthiscopic surgery. What are your thoughts/recommendations etc? Thank you Nancy

Posted on Friday, Oct 27, 2000 - 7:36 am:

I think I would give the horse considerably more time than a week to recover from apparent soft tissue injury to the joint before I would contemplate surgery on an unknown lesion. I am more likely to think 2 to 4 months rest and certainly would repeat the radiographs if still lame in 2 months. I would also be paddock resting this horse and giving daily bute and appropriate water therapy (cold water if the injury is hot, hot if it is cold) How old is the horse now?
DrO

Posted on Friday, Oct 27, 2000 - 10:09 am:

Dr. O:
The horse is a yearling!! My first posting must not have been clear regarding the vets recommendations. First; he feels injecting with
acid as well as 1 week rest (no jogging etc.)is
adequate time before starting him back jogging (not surgery) to determine the results of the acid injection.

Arthroscopic surgery is only a recommendation
if/when the acid injection is unsuccessful. It's because this leison remains "unknown", I'm told surgery will define the leison and (hopefully)correct the problem.

The colt has remained paddock rested since the first sign of him "being off"(riding the shaft). He shows no sign of soreness, swelling etc. while running in the paddock, nor prior to, jogging on the trot. However, when he swings his gait to the pace, it's apparent "something" is bothering him!
In retrospect, with the joint blocked, he paced straight and showed no soreness whatsoever. What initiated a vet call of checking the colts testicles to determine if that was the problem, has resulted in knowing it's his hock, but not knowing what it is. Very frustrating.

My trainer is apprehensive to injecting a
yearling with acid. Older horses, yes, he's never had it done on a yearling. We had discussed surgery if an OCD was evident, but surgery on an unknown leison is another story.

We are faxing off radiologist report and recommendations to our "track vet" to get his opinion, and would greatly appreciate hearing yours. Thank you, Nancy Brown

Posted on Friday, Oct 27, 2000 - 3:18 pm:

I am not sure I understand your point or question in the last post, Barbara. I did understand what you were saying about your vets diagnosis and treatment and my comments still seem applicable.

If you want to check weekly for resolution that is fine but sometimes soft tissue injuries in the joint need longer than a week to heal. I don't know what your vet means by saying "to check to see if it works". We know IA injections of H. acid will decrease inflammation in the joint but it still takes time for tissues to heal.

I still would like some clarification on the exact age in months of this horse, do you mean a 12 month old yearling or a 23 month old yearling? Without examing the horse I cannot comment directly on your case. Just reply to the diagnosis made by your vet and make suggestions that seem logical to me but need to be discussed by the vet on the case.
DrO

Posted on Friday, Oct 27, 2000 - 4:58 pm:

Thanks for the reply Dr.O:
My stating the colt is a yearling is horseracing
terminology (Jan 1/01 he turns 2) however,since his birthdate is May,his exact age is 17 months.

I understand that H.acid will decrease the inflammation in his joint, but my concern (question) is; although he's never showed signs, (visual/exam/heat)nor been treated for joint inflammation, and no abnormatities have been found in his radiographs, will the injection of acid aid in healing the soft tissue? Is it common or unusual to inject acid in a joint of a horse his age? Is a better alternative resting him and bring him back jogging later?

On the pace, it's obvious "something" bothers him. My understanding of "check to see if it works" remark of the vets is; if after the hock's been injected he still acts like the hock's bothering him, then, arthroscopic surgery is recommended.

The radiologist report only lists "possibilities"(early osteochonDrOsis lesion/early synovitis)and suggests 'conservative treatment' be used. In this case, what would you
consider conservative treatment? Sadly, the nature of this 'business' is getting a horse to the track at two. The last thing I want to do is critically "push" a yearling.
Thank you Nancy

Posted on Friday, Oct 27, 2000 - 8:20 pm:

Hello Nancy,
As we breed Thoroughbreds, (a stakes winning son of Secretariat for anyone looking to breed a sport mare) I am familiar with how vague a term a yearling is. A horse born Dec 31st is technically, in SB or TB rules, a yearling at 2 days of age while one born Jan 1st remains a yearling until 24 months old, that is why I asked for clarification.

As pain is one of the cardinal signs of inflammation, your horse has shown signs of inflammation in the joint. I know of no reason his age should contraindicate the use of acid. Rest is always the best treatment for acute inflammation.

The items I list above are the conservative treatments i recommend.
DrO
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