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View Full Version : Stifle vs hock injections



workinggirl
Apr. 27, 2010, 06:15 AM
Just wondering if stifles are injected with the same solution choices as hocks or are they blistered only? thanks for the replies

vxf111
Apr. 27, 2010, 06:52 AM
Stifles can be injected with HA/other solutions like the hocks, ankle, etc. Stifles can also be internally blistered (almond oil). Different procedures.

Lone
Apr. 27, 2010, 12:18 PM
What does it mean for them to be blistered? When would you do that instead of an HA injection?

vxf111
Apr. 27, 2010, 01:14 PM
Different treatments, different reasons. Just so happens both are in the stifle area.

I've seen blistering used in an effort to "tighten up" a loose/locking patella/ligament. Not for bony changes but ligament problems. Had it done to my horse, in fact (to partial/short term success). The idea is that the almond oil is an irritant and causes the area to become tighter. I've always heard of blistering being done in combination with work-- you inject the oil then RIDE the horse consistently and the hope is that the combination of work/irritation makes the ligament less lax.

The injection goes into the joint, just like it does on the hocks. And it can be any of the lubricating chemicals/combinations that are used in the other joints (HA, cortisone, etc.) That treats bony changes, loss of joint lubrication. Doesn' treat soft tissue. Have seen this done in conjunction with rest (a few days off post injection and then slowly work back to normal workload) just like hock injections. Tried this too, no effect for my horse-- but your mileage will obviously cary based on your horse's specific problem.

Char0308
May. 12, 2010, 01:51 PM
I have always been told my trainer and Vet lower hock joint can be repeatedly injected indefinitely (as needed) usually with good results, but repeated stifle injections eventually will start to not provide relief anymore. Just something to keep in mind.

Lieslot
May. 12, 2010, 05:43 PM
Injections, is to help lubricate "joints".

To Lone & workinggirl, what I found out reading here & there,

Blistering of a stifle is to thicken up the "ligament" that runs over the stifle joint.
By administering a counterirritant into the ligament you create inflammation, the inflammation in turn creates scartissue. You want the maximum inflamation possible after blistering, hence you must *work* the horse and "not" give any painkillers, such as bute, coz by doing the latter you are minimizing the inflammation.
Whilst the procedure might be succesful for tightening up the patella ligament, it doesn't always last, plus be aware it IS very painful for the horse and you are asked to work the horse in pain.
It's something I have thought of often, with my horse with IUFP (sticky stifles), but I cannot bare the thought of having to forcework him in pain without being able to give him painkillers, if you have a timid horse, it can ruin the bond you have with the horse.

That being said the options for IUFP are very limited, estrogen injections can be succesful, but in many cases it does diddlysquat. The other option : cutting the patella ligament is not all that adviseable either, it's quite a surgery and the stifle 'joint' risks losing its stability and makes it more prone for early arthritis a couple of years past surgery.
In France they seem succesful with ligament splitting, rather then cutting. Tiny slits are made into the patella ligament under general anesthesia (have read cases under standing sedation too), horse is again asked to work fairly soon after surgery but on painkillers, ligament forms scartissue after surgery, ligament thickens hence it doesn't catch in the trocheal (sp?) grove anymore.
Basically with IUFP, the patella ligament gets caught in a similar fashion as when the horse locks its a hindleg to rest the opposite hindleg. When this happens under saddle, it feels like the horse just stepped into a pothole with a hindleg but nevertheless moves on.
I've got numerous videos of my horse in which he slips a stifle.
Just an example at 0:34 you'll see him catch his stifle.
http://www.youtube.com/watch?v=ibf-YSNZOvg
Blistering could be helpful, but I will not do so.
We have injected the stifle "joints" as well as hock joints, but that did absolutely nothing to his slipping/sticky stifles, because the joint isn't the problem the ligament that runs over the joint is what is causing the problem.

Other then surgery, the only help for such horses is work, work, work.... cavalletis, going up & down hills, backing uphill etc. Coming out of winter my horse will be much worse then going into winter after having had 3 seasons of work.

You need to find out if your horse's problem are joint or ligament related. A vet should be able to tell upon examination, but may wish to do an ultrasound of the ligament as well as X-rays of the stifle joints.
Whilst sticky stifles is almost always bilateral, weirdly enough it usually only shows on one leg. But if you were to treat (blister in that case) only the symptom leg, you'll see the opposite will then show the iufp symptoms. Hence you treat both.

Here's a good article on IUFP http://webpages.charter.net/ers/Downloads/Part-I-IUFP-OPTP.pdf

Some more on the ligament splitting done in France : http://www.equinescienceupdate.co.uk/patlig.htm

Vxf11, if you don't mind me asking, how is your horse doing at present, did you try anything other then the blistering & stifle HA/cort. injections? How painful was your horse after blistering, thanks.

wanderlust
May. 12, 2010, 07:00 PM
Lieslot- I had a horse with mildly sticky stifles who was helped dramatically by use of Estrone. You should be able to do a search on 'estrone' and find a few threads referencing it. The basic theory is that it "softens" the pelvic ligaments in such a manner that they either more easily slide over the offending ridge, or that they move slightly and aren't in a position to get stuck.

I'd definitely try a course of estrone before blistering. It works for some, not others, but it is cheap and non-invasive.

vxf111
May. 12, 2010, 07:49 PM
Vxf11, if you don't mind me asking, how is your horse doing at present, did you try anything other then the blistering & stifle HA/cort. injections? How painful was your horse after blistering, thanks.


He is retired. He was retired at age 9 due to the stifle issues, he never really had a full year of true soundness, though he had some better times mixed with bad. I first tried aggressive strengthening. It helped, but any time he was off for 2-3 days due to a thrown shoe, bad weather, etc. he regressed. Then I tried Esterone. That didn't appear to have any effect. Then I tried blistering. The horse did not show ANY pain at all, actually, and post-blistering I was told to work him regularly. he performed regular work, no issues, no signs of pain. the blister helped quite a bit, but the effects were temporary... as soon as he missed some work-- back to catching the stifle again. I considered trying the blistering again. This was a good 4 years ago and back then there weren't a TON of people in my area doing the puncturing surgery, so I didn't feel comfortable with that option. Didn't at all like the ligament cutting surgery. Turned him out for a full year and then brought him back. Same as before, good days and bad, stifle catching, anytime he lost any fitness it was worse. Tried HA/Cortisone IA injection. He was GREAT for 2 days post injection, then worse than before. Then I just made the decision to retire him.

The first time I retired him, I left the shoes on because he had pretty bad feet. He still had stifle locking throughout retirement. This go round I pulled all 4 shoes. His feet miraculously look better than EVER and he is not stifle locking... but he still doesn't move 100% sound and he will never be rideable for a sports discipline.

Lieslot
May. 12, 2010, 08:21 PM
Vxf111, :sadsmile:, wasn't expecting to hear you retired him. This is my fear too, however I can still work him at present, but boy are you right, some time off and I can start all over again.
The continuous work is hard for me, because I've only got an outdoor and NJ winters don't allow me to keep him in work during Jan/Feb.
It's extremely frustrating, eventhough I've got no high goals with this horse, just training/1st level dressage, but the slipping is holding us back.
I'd happily retire him to trailriding, but that's proving to be a problem, coz he doesn't cope all that well out on the trails (spooking) :(.
I've not given up hope, but I do fear the slipping will be with him forever. If it doesn't hurt him (which I don't think), I'll keep at it with work, if he starts to show signs of pain whilst worked then, retirement it'll be.

I have discussed the ligament splitting with some people and I'm on the fence at present, general aneasthesia on a big guy (18.1) is a concern, I'm finding out what can be done on standing sedation. He's also got shivers (although he's not showing many outward signs of that other than for shoeing), it may contribute to his slipping.

Waw, that's interesting to hear your horse was not bothered by the blistering. I followed another horse that was blistered and he was really beyond sore and the owner nearly teared up everyday she had to get on him for the first 10 days after.

Wanderlust, thanks I will do an estrone search.
How 'mildly' was your horse? I find it hard to figure out if my boy is mild or not so mild. At present he slips 2 to 3 times in the hour work on his bad days. I do have days with no slipping. He never slips when not under saddle or during turnout, so I guess this is probably mild.
It would be great if something simple as this could sort him (we like non-invasive :)), I believe there's no side effects to it.
Did your horse regress when you stopped the injections?

vxf111
May. 12, 2010, 08:26 PM
I probably could have kept him going in a non-sport horse discipline. He's sound enough to be a walk/trot trail horse with a canter thrown in here or there. But he's a spooky fruit loop who hates being outside the ring. So he's not really suitable for trail riding except for a skilled rider. I have no particular interest in trail riding anyway. It was just psychologically better to retire him, give up, and find a different horse that was physically able to meet my riding goals. I tell you what, the day I threw in the towel on him-- it was like the biggest weight was lifted from my shoulders. I still care about him and will always support him in a comfortable life-- but I no longer connect my riding goals to him, and that's a good thing. He lives with my other retiree (22 year old pony who EARNED his retirement and a halo 10 times over teaching half of Georgia, and me, to ride) at a friend's farmette. They're happy, I'm happy. It's okay.

My horse is quite a weenie, so if the blistering hurt I am sure he would have made that known. I rode him the day after the blistering (was instructed that you get the best outcome if you irritate the stifle and then WORK it so it really tightens). He never acted like that bothered him a bit. Actually, he never acted like ANY of the treatments I tried for the stifle bothered him. He did sometimes resist the strenghtening/hillwork/cavalleti-- I think that hurt a bit.

Lieslot
May. 12, 2010, 08:38 PM
But he's a spooky fruit loop :D, ohhhhhhh, yeah, tell me, I've had some serious issues with this horse on the trails.
Hmmm, I need to look into this blistering again and see how other horses react after blistering, having seen that particular horse, I just concluded I was never even going to consider this, maybe something else was going on there too.

He did sometimes resist the strenghtening/hillwork/cavalleti-- I think that hurt a bit. Okay, I do keep tabs on how & what reactions I get with him. Good to know & be aware of, I don't run into resistance all that much 'yet', but more a tensing up and his warm-up trot isn't one where he just drops his head down, he rather throws it up looking at the stars, which could be an indication of being uncomfortable.