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  1. #1
    Join Date
    Jul. 7, 2007
    Posts
    216

    Default Let's play clinical case study (please?)

    A big mare in her late teens with no history of front leg unsoundness is suddenly lame on one front leg, moderate to severe, 2-3 on 5 point scale, at trot. Sound and comfortable at walk, makes sharp turns no problem, no toe pointing, walks down hill no problem. No improvement after a month.

    Vet comes. Mare is reluctant to flex at all on lower joints, and is blocked.

    1) digital plantar -- still lame
    2) ablaxial (sp) sesamoid -- sound

    What would you suspect? What could you rule out?

    Those who respond, thanks for playing!



  2. #2
    Join Date
    Jun. 14, 2006
    Location
    VA
    Posts
    11,372

    Default

    Rads?
    A good horseman doesn't have to tell anyone...the horse already knows.

    Might be a reason, never an excuse...



  3. #3
    Join Date
    Aug. 21, 2007
    Location
    MI
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    106

    Default

    I second BuddyRoo.

    Blocking like that it could hundreds of things:
    Coffin joint, pastern joint, collertal ligaments of either, sesmoidian ligaments, distal sesmoid bones, distal deep flexor tendon, the list goes on and on.

    And any time a horse goes suddenly lame I still never rule out an abcess, even if it didnt block to a PDN (sometimes the PDN wont get all of the toe region).



  4. #4
    Join Date
    Jun. 14, 2006
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    VA
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    Default

    Sorry, I had to pop away quickly.

    I would not discount a possible abscess given the time of year and the symptoms you describe...but the soundness at a walk kind of gives me pause on that.

    Nerve blocking can be a great tool, but in my limited experience, it can also lead you astray pretty easily.

    I would be inclined to get radiographs done.

    There's NO indication of any possible puncture from below correct? One of the things that kind of floated into the back of my mind was an infection within the hoof capsule as a result of a possible puncture. But totally playing guess the issue here.

    I'd really want rads.
    A good horseman doesn't have to tell anyone...the horse already knows.

    Might be a reason, never an excuse...



  5. #5
    Join Date
    Jan. 16, 2002
    Location
    West Coast of Michigan
    Posts
    36,321

    Default

    Jeez, it could be anything. X-rays, response to hoof testers, exam of the sole and frog?

    A big mare in her late teens who flexed positive in multiple areas wouldn't surprise me. Might be a red herring. I'd want to zero in on the unsound part of the limb and given all that's going on from the fetlock on down, I'd think a diagnosis without films is going to be tough.
    Click here before you buy.



  6. #6
    Join Date
    Jul. 7, 2007
    Posts
    216

    Default rads to come

    This was an impromptu lameness exam after vet was here to do shots, no x-ray machine. Will have rads done later this week.

    No response to hoof testers. Frog, hoof normal (no heat, no pulse). Big, healthy feet in general. Slight thickening of pastern joint compared to other front.



  7. #7
    Join Date
    Nov. 23, 2003
    Location
    Kershaw County, SC
    Posts
    434

    Default

    What type of surface did she walk/trot on?
    HR/MPL Clique

    "I am villifying you - for God's sake, pay attention!" - Peter O'Toole as Henry II, The Lion in Winter



  8. #8
    Join Date
    Jul. 7, 2007
    Posts
    216

    Default indoor ring footing

    But she is also lame on hard footing.



  9. #9
    Join Date
    Nov. 23, 2003
    Location
    Kershaw County, SC
    Posts
    434

    Default

    That is telling - the "rule of thumb" as I know it is hard footing lameness = hard tissue injury, soft footing lameness = soft tissue injury.

    Now look what you did - you broke the rule!
    HR/MPL Clique

    "I am villifying you - for God's sake, pay attention!" - Peter O'Toole as Henry II, The Lion in Winter



  10. #10
    Join Date
    Dec. 13, 1999
    Location
    Greensboro, NC
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    36,677

    Default

    Quote Originally Posted by WarHorse View Post
    That is telling - the "rule of thumb" as I know it is hard footing lameness = hard tissue injury, soft footing lameness = soft tissue injury.

    Now look what you did - you broke the rule!

    Or, it means there is both a hard tissue AND soft tissue injury

    Sorry, not trying to make lite of the situation Definitely rads and ultrasounds.
    ______________________________
    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET



  11. #11
    Join Date
    Jul. 7, 2007
    Posts
    216

    Default Thanks all

    I guess i'm worried that the blocks rule out everything except for the pastern and the joints on either end, or soft tissue. What soft tissue structures would cause lameness?



  12. #12
    Join Date
    Jun. 12, 2007
    Location
    CT
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    6,381



  13. #13
    Join Date
    Jun. 14, 2006
    Location
    VA
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    Default

    Blocks can be great to help us zero in on a region, but you have to understand that blocks can also "seep" into areas we didn't intend at the time and give us some false readings.

    I wouldn't be too freaked out just yet. Not without the rads.
    A good horseman doesn't have to tell anyone...the horse already knows.

    Might be a reason, never an excuse...



  14. #14
    Join Date
    Jun. 4, 2006
    Posts
    2,576

    Default

    Ringbone, collateral ligament?

    I would say rads, no diagnoses ultrasound, we had to MRI my horses pastern last year.



  15. #15
    Join Date
    Oct. 24, 2004
    Posts
    453

    Default

    Collateral lig. Very unfun. MRI...

    Here's hoping that the radiographs show something!



  16. #16
    Join Date
    Jun. 4, 2006
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    2,576

    Default

    Quote Originally Posted by dauntless View Post
    Collateral lig. Very unfun. MRI...

    Here's hoping that the radiographs show something!
    I second this!!!!!!!!!!!! Hope your horse can easily be managed



  17. #17
    Join Date
    Jul. 7, 2007
    Posts
    216

    Default

    Xrays showed roughened bone around the back of the pastern suggestive of distal sesamoid ligament damage. That is roughly the area that blocked sound, plus this horse was seen cavorting around in the deep snow in the days before pulling up lame.

    No ultrasound was done, and the vet recommended conservative treatment with bute and light turnout for a few weeks.

    Anyone had experience with distal sesamoid ligaments? Apparently the prognosis is fairly good -- and with this older mare the goal is trail/light riding or worst case scenario, pasture sound.



  18. #18
    Join Date
    Mar. 14, 2010
    Posts
    105

    Default

    I had a gelding that tore the right fork of that ligament. He had stall rest and handwalking... I can't remember. 6-8 weeks? He was able to come back from it. There was ultrasound involved as well as some shock wave therapy once or twice. He was fine when it healed.
    First, say to yourself what you would be. Then do what you have to do. ~Epictectus



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