--Updates-- Stifle (Or Hock?) Problem

[Dressage.For.Life.]

Very long, sorry-

To start off with, my TB retired from the track due to a minor shoulder injury that would have required a short time off (he is now 9 and working 1st, 2nd level dressage). I’ve had him since fall 06, and he has had no lameness issues that haven’t gone away in a day or two (he likes to play hard sometimes). I’ve been told that he is straight behind.

Note: he’s fine when people feel the area (stifle and hock), there is no visible swelling, he’s not in pain (no bucking, refusing to do things such as jump, move forwards, etc.) When the vet(s) has seen him in the past they thought nothing of it.

It’s seems as though he’s -always?- had a lot harder time tracking up with his right hind. I just thought I’d add- He has a very nice walk, and steps well in front of the hoof prints left by his front feet (on both sides). His canter is nice as well, and he will collect and come into a nice bouncy canter.

We all think it’s probably stifle related, but hocks are possible... I’ve been told spring 09 that it’s a weak stifle, and to work on his trot (more impulsion), small hills, etc. but he was the worst he’s ever been today (yes, I've been working on building it up). When halting under saddle, he seemed to leave his right hind behind him more. He’ll usually work out of things, but when he didn’t today I cold hosed his stifle for a few minutes and gave him 2 grams of bute with his evening grain. I did turn him out (alone) as he’s used to being out and being locked in a stall overnight could only make things worse.

A few years ago we had the chiropractor out a time or two, but I’m thinking hard before doing that again- I know from going to a chiropractor myself, that things will not hold for long, or at all, unless addressing why it happens and then changing what you do to avoid it.

The woman I do a lot of clinics with and who thought stifle weakness earlier said today after seeing him work, to maybe get x-rays. Any thoughts? Have you had anything like this happen? Should I have the vet out or go ahead and make an appointment for x-rays and further testing at the nearby vet schools large animal hospital?

Many thanks.

[ms raven]

Hey there, been here! My advice would be to get some xrays done.

Since you've been dealing with this for some time and are now asking here, I think you'd feel most at ease with getting a definite diagnosis. At the very least you will have piece of mind but more importantly you will know what to expect in terms of how the problem may progress, how it will affect your horses' performance, how to treat it and of course how to focus your training program.

My young horse was hurriedly diagnosed with a stifle problem ... she was young, she'll grow out of it. I wasn't comfortable with the answer, had a second vet out the following week (who did a more thorough exam) and she believed it to be a hock injury. We did xrays (just one hock) and confirmed it. The treatment was work, work and more work versus young horse locked in a stall for much longer than it would have happily dealt with.

I do believe the symptoms, (especially secondary ones), are quite different for each of these problems. Stifle injuries seem to be much more acute and one should most likely expect there to be some swelling and heat as a result of a strain or some type of temporary or fixed "lock" of the joint.

Hock injuries are usually much more chronic. Chronic pain leads to compensation elsewhere and often a horse with hock pain will also have back pain. For some time I had a human chiropractor turned equine chiropractor out to work with my horse. We did this until she decided she'd had enough of him and I ended up having the same feeling about them as you do. Now I use a holistic veterinarian who is also a certified equine chiropractor. She knows of what she is actually adjusting and has a need to know it well since she competes with her horses in long distance endurance. If you find a good one I think what they can do for your horse would be extremely beneficial.

There are three brief articles on this site (http://www.novickdvm.com/) that may help you narrow your focus; When Back Pain is not Back Pain,
Hock Lameness- Bone Spavin and Stifle Lameness- Upward Fixation of the Patella . You may also want to google search for additional symtoms related to these problems. They are the most common.

I've had xrays done three times and not for one second have I regreted a penny of the cost to do them.

Just my .02. Please keep us informed!

[grayarabpony]

I'd get blocks done first. If your horse is 9 he made very well have arthritic changes in his hocks, but that may not be the problem. Look at his back feet too, and make sure he doesn't have long toes/ underrun heels.

[Dressage.For.Life.]

Nerve blocks? I'll see when we contact the vet (if he's still this bad tomorrow or so) but he doesn't really show any lameness or abnormalities unless you see how uneven he is even when the impulsion is up under saddle. Arthritis is something we thought of at first, but when jumped (no, we are not jumping him when he's like is is right now), he shows no symptoms of hock problems, but I'll ask about that as well. Thanks for the information.

[Dressage.For.Life.]

Thanks for the information! Hope your horse is doing ok.

I actually read his article Stifle Lameness- Upward Fixation of the Patella and many others on the same subject when looking up information earlier; there is no "jerking" to his gaits, popping noises, his leg doesn't (even briefly) lock.

As for the back pain not really being back pain, I'll check his back for soreness, but he's never really had any issues with back pain. He'll sometimes put his ears back for a few seconds when I first put on his saddle, but that's about it (no buck, rear, etc. under saddle).

Here's a little more info-

-Unevenness in trot- drops hip and does not track up with RH. Would usually work out of his “hitch” after a few minutes. Thought to have had weak stifle but has not improved with trot work, hill work over the past few (4ish) months. Would track up at times but is rarely symmetrical. Showed no improvement this morning when he was 2 grams Bute with last evenings grain so problem is thought to be soft tissue related.

[ms raven]

Thanks! My horse is super!

You might try him on 2 grams a day for a week and see if that helps improve matters. One dose is probably not enough to get in his system and make a difference if it happens to be arthritis in his hocks. A week is not terribly long but if I was giving it for more than a few days I used to also give Zantac with the bute to try and limit any stomach upset.

This is a good article, see if the symptoms sound familiar to those described here (http://www.thoroughbredtimes.com/horse-health/2000/March/18/How-to-recognize-hock-problems.aspx).

[Perfect Pony]

I had a weird issue with my horse. She was always proclaimed sound, but slightly drug her right hind and sometimes did not track up with that leg. I had every test done on her for nearly 3 years EXCEPT xrays (because they were not "indicated" per the vets). She didn't have pain or swelling in any joints and didn't really flex off more than 1/5, or respond to blocks.

I finally insisted on xrays and found a HUGE OCD chip in her stifle!

Now I use xray and thermography first and always. Xray rules out djd, ocd, etc, thermography will tell you where there's inflamation. Both are non-invasive and inexpensive.

[Dressage.For.Life.]

I'll have to try that, but I may see what the vet says first.

Yes, sadly some of them do sound familiar. I'm probably calling the vet tomorrow, and will ask about that.

Thanks for all of your help!

[Dressage.For.Life.]

How is your horse doing?

Will my vet be able to do thermography or would I have to take my horse to the college's large animal hospital?

Many thanks.

[Perfect Pony]

You would have to find something who does equine thermography. It's usually only $100-200 for a session and they can come to you if you have a darker stall or barn to work in. It's just a small hand-held camera that reads heat patterns and can find heat and inflammation. It's a great tool for unknown lameness.

[Dressage.For.Life.]

Sorry this is so long, but any advice as to what else I can do for my horse would be great-

Took my horse to the vet today- After watching a video from my last, real ride (I’m telling you, all the videos come in handy), and doing a flexion test the vet decided that the problem was likely in his hock. Because my horse is so straight in behind (more so on the right than the left), he hyper-extends his hocks. Ted then told me that if I was planning to do higher level jumpers with him, to start looking for a new horse as he wasn’t going to hold up.

When Ted saw a darker spot on one the first x-rays, he took another shot from a different angle thinking it might be a fracture, but luckily, it wasn’t- it was just the picture. Other than that, he saw three areas that stood out to him.

Remember how I was thinking a bone spavin would match his symptoms? Well x-rays confirmed that it is a large bone spavin in his right hock. It was about 40% fused, but he said that if a horse was going to fuse, it’s almost always before their tenth birthday.

Treatment wise we had a few options: Surgery to fuse the bones is not only expensive, but there is no guarantee that it will work, and it could also lead to more arthritic changes. Shockwave therapy was another option but for 2-4 sessions at $250-$400 a session, it didn’t seem worth it (to start off with), as it to, isn’t proven. Joint injections, or finally, we could change his oral supplement to proven Cosequin and try to hold off on joint injections.

I decided to go ahead and start Legend knowing it was the most promising. So Vinnie got his first round of joint injections today- one on the top and one on the bottom of both hocks (might as well do both). It was awful seeing him sedated- he could barely stand- and he kept jerking his head. He almost fell a few times, poor guy.

Vinnie was stalled the remainder of today and he’ll be in tomorrow as well with some time on the Equiciser. He’ll be allowed outside again Thursday, and Sunday or Monday I’ll ride and see how he is. For the next two or three weeks I will be riding about once a week doing only walk (and some canter) work. While it’s possible for him to start to show some improvement in the next few days after starting Legend, it could take a few weeks. And if for some reason he doesn’t show improvement while on the Legend, medically, we’re in trouble.

I’m going to take Vinnie off of his straight glucosamine and MSM supplement and put him on one of Cosequin’s (If I can afford it...). BOT’s (Back On Track’s) hock boots are also on the list.

[appychik]

Best of luck to you and Vinnie.

Question though, was Legend injected into the joints or via IV? I've always had the Legend done separately... via IV and then having another HA/steroid injection for the joints themselves (though I've had Legend added to a joint injection, if that makes sense).

I guess the best advice is to follow what the vet recommends. Go slow with the rehab.

My boy has major stifle issues. I think I've finally figured out what works for us and that's a combo of stuff... joint injections when needed, Legend when needed (neither of those have been done in over a year though) and daily MSM and HA supps. And, 24/7 turnout. That final thing has made the biggest difference of all.

Hopefully everything goes smoothly and Vinnie's hock(s) fuse without any ill effects. I don't have any real experience with hocks, other then having my boy misdiagnosed with hock issues when in all reality it was always his stifles.

[Dressage.For.Life.]

Thanks.

The Legend was directly injected into the joints along with Depo-Medrol.

What's wrong with your guy? Also, what oral supplement do you use with him? Well I hope you continue to have good luck with managing your horses stifle problem!

Yes, Vinnie was out 24/7 but he is now being brought in in the evening for dinner and such (trying to further encourage eating as he's a hard keeper- typical TB) and then goes out again at 9 or 10 PM!

[appychik]

Originally hyperextended stifle in May '00, then again in Sept '07. Both times extremely lame... actually had arthritic changes starting back in '03 (spring) that were misdiagnosed for years as either navicular (fronts), arthritis (front fetlocks) and again as hocks. Finally got the correct diagnosis when we moved back home and the trainer looked at him :lol:... new vet agreed with diagnosis.

Then, in spring of '08 he torn the other CCL in the opposite stifle (all previous injuries were the the left, this time it was the right involved). That started all these latest issues.

Joint injections always have helped, for the most part. Tyically we've done Hyvisc with a steroid, but since he's now IR, we won't use steroids anymore. Legend injected IV seems to prolong the time between joint injections. Truthfully, Gus is probably due for another round of either Legend of Hyvisc... we'll see what the vet says in two weeks.

For supps, we're now just using MSM (10,000mg daily, though I bumped up to 20,000mg for a month to see if I notice any more improvements) and Flex Force HA (see really long thread on here about it...) at 100mg of HA daily. It's working wonders. Glucosamine never seemed to help, and from what I've read (admit it's not a lot), glucosamine is better at prevention and not great after the fact.

FWIW, I did use Recovery EQ for a while and loved it... seemed to help a lot. But then found out that Gus was IR and glucosamine is a no-no. Though Recovery EQ is supposedly safe for IR horses :confused:.

Anyways, stifles are a PITA. :no:

[Dressage.For.Life.]

Is Hyvisc similar to Legend, or what? Sorry, before about a week ago, I knew absolutely nothing about joint injections, so am obviously still learning! The ones I know quite a bit on are Legend, Adequan, and Polyglycan, but that's it.

Did you see any changes when doing 20,000mg MSM daily?

Hope all is good news when you go to the vets in a few weeks.

[Moderator 1]

Hi Dressage.For.Life ~

Just wanted to let you know that we merged your two threads on this topic so that all the info stays together.

If you ever want to draw attention to an update on an existing thread you started, you can edit your thread title by clicking on "edit" from the lower right corner of the first post, then "go advanced." Then you can add a comment like "update, post #11" or highlight a new development in the situation.

Good luck with your guy!
Mod 1

[appychik]

Is Hyvisc similar to Legend, or what? Sorry, before about a week ago, I knew absolutely nothing about joint injections, so am obviously still learning! The ones I know quite a bit on are Legend, Adequan, and Polyglycan, but that's it.

Did you see any changes when doing 20,000mg MSM daily?

Hope all is good news when you go to the vets in a few weeks.

I *think* they Hyvisc is similiar to Legend but administered differently. Not the exact same uses... but both are for joints, if that makes sense.

Adequan has never done anything for Gus, so after trying it we've never used it again. Legend has worked wonders... but again, not every drug is for every horse. Others on here have had Adequan work miracles, wish I could say the same for Gus.

For the higher dosage of MSM, it does seem to really help make Gringo more comfortable. Gringo's got a fractured coffin bone that's old (as in 4+ years) that was never diagnosed until after I had had him for like six months. He still has issues with it from time to time, and in warmer weather seems to be most comfortable. Temperature changes cause him issues and since being on the higher dose I haven't noticed as many problems. I'll be weaning him back to 10,000mg for a few months to see if he regresses. I'll also check with the vet next week to see what he recommends.