Bone scan, MRI, X-rays or more testing-WWYD?

[Bliss]

Pony has been lame for 4.5 months now.

Our story thus far: In June he had a pretty spectacular fall, slightly tearing his right front tendons. The tendons look fantastic, now, but Pony is still having trouble. After his tendons healed, he was still having some lameness, and he tested positive for bursitis in the right shoulder, his shoulder was injected, which alleviated some of the symptoms. He is now on again off again lame/ NQR on *both* front feet. The general consensus is that the fall was a symptom, not the cause of any current issues.

The real problem is that he is tripping and falling in the front consistently. Like every day, and getting worse/more frequent. The other real problem is that he looks 100% sound most of the time.

We haven't blocked him, because when he's been to the vet, he trots around like a champ. They don't know where to block.

We are currently waiting for EPM and Lyme tests to come back. If they come back negative, the vet recommends sending him out for a bone scan. In their opinion, he's probably got something in the neck (like, major arthritis, or it is broken somewhere). I didn't know EPM could produce front end symptoms like this, but they say it does happen.

When he trips, sometimes his fetlock knuckles over after he puts his foot down, and he has to catch himself with his other front leg. Sometimes this is successful, sometimes not, and he'll go to his knees or faceplant.

Is there anything else we could test for that would cause this? Should I just x-ray his feet and see if he's got ringbone? The vet is happy to do whatever I want, but says that as sound as he looks most of the time, it would probably be cheaper to get a bone scan based on the number of films they anticipate having to take to identify the problem.

His feet are good, he is good weight, he is mostly cheerful (except when he goes down, then he is scared) etc.

Any ideas?

[Rick Burten]

Idiopathic lameness(and constant tripping/stumbling is one definition of lameness) is a symptom of EPM or other neurological insult. It may also be that his trimmin/shoeing is not a 'good' as you think. Has his back/spine been manually evaluated for signs of soreness/weakness? Since it has only been since June since the accident, it may well be that the tendons are not as well healed as you think. Tendon injuries, even slight ones, can take up to a year+ to completely heal.

Is he only lame under saddle?

What additional radiographs do they propose taking, and why?

It may also be prudent and cost effective to have a full chiropractic exam performed on the horse.

[BuddyRoo]

I'm not a vet nor do I play one on TV...I'm just throwing some things out there....

1) Feet...what's the breakover like? "His feet are good" means different things to different people. I've seen some high heeled, long toed critters whose owners thought that was "good".

2) Cervical/Spinal arthritis would be of concern to me if there are neuro issues but no EPM or WNV and feet really are fine.

I think if it were me, I would consider doing the rads of the feet....relatively inexpensive in comparison with everything else and may at least help eliminate one possibility.

If you rule that out and a bone scan is in the budget, that would be my next step.

Best wishes. Tough situation.

[Donkey]

x-rays add up so fast $$$$$. And if you did find something in his feet there stlll might be something else somewhere else and you fight a never ending battle.

I'd do the bone scan, in a situation like this it is a good value.

[Fharoah]

I would do nerve blocks and a bone scan and take it from there. If he blocks at the heal or the pastern or fetlock then I would do an MRI. If he doesn't block well I would do a bone scan.

Best wishes!

[Bliss]

@Rick Burten: I agree, to a point. His tendons look fantastic on the ultrasound, though. At four months, I thought any muscular stuff should be healed (I was thinking maybe he still had something strained in the shoulder, but it isn't getting better, and by now...). He was checked by his chiro/acupuncture person in July, and there was nothing really unusual aside from the tendon/shoulder stuff. I've been reluctant to have him chiro-ed again since the vets said there might actually be something *broken*. Ime, chiros tend to be better with hind end stuff, than front end. He's not been ridden since June. He's been off, so...

@BuddyRoo: I hear you on the feet. ;) But I've seen so many threads degenerate into feet-only discussions....kwim? His feet look better at the moment than I've ever seen them, so I'm quite pleased with his trim.

@everyone: sounds like the bone scan is the way to go. Thanks for the good wishes. I'm grasping at straws, really, looking for help. It is gutting me to see my sweet, funny horse like this.

[scribbles]

if he did something to his neck in the fall, or had a pre existing neck issue prior to the fall it would explain the tripping, although horses with neck issues generally have problems behind...
i have a really good chiro so i dont have the same fears you have to the broken therefore not chiro issue... but maybe just acupuncture would point you in the right direction? they can see alot with the acupuncture points without doing a ton of expensive bone scans or xrays...

[Simkie]

Coming from someone who has a horse with wonky lameness issues because of c-spine arthritis: bone scan.

I'd bet money his neck lights up, and I'd bet it's pretty high up.

Good luck.

[staceyk]

If you get an MRI, don't bother with a standing one. I paid 2200 for an MRI at one clinic, and the second clinic (at a major university) tried to read them -- they said the resolution was too low to be helpful.