4 year old with old hock injury and "very little joint space" - will injections help?
The lameness guru finally looked at my fillies Xrays and said that it looked like she had been kicked, before I got her, and there was localized DJD, and very little space between the joint (its a high joint of the hock). He asked if she was a resell, but I told her my hopes were just to get her to be sound enough for my kids to ride around,and maybe jump a little.
He was going to think up a plan last night, and come out today or tomorrow. His thoughts right now are to inject with straight steroids. Would using Hyalaronic Acid not help though?
Soundness wise, she doesn't look bad at all, since getting her feet right, she now canters up to her dinner every day, even bucking. She is barely 4, and I am fine waiting however long it takes,before riding her again.
I wouldn't start injecting ANYTHING! The horse isn't even entirely grown up yet.
Just work her appropriately with long, slow distance to leg her up, don't do a lot of cranking in circles or longeing, and don't jump to speak of until she's 5. Make sure she gets a lot of turnout if at all possible--"Dr. Green" and slow steady work is a far better cure for injuries like this than drugs and procedures which carry risk.
OK, I spoke with my vet and voiced my concerns - using steroids on a youngster - and he said he understood. He said he had used Adaquan, both IM and IA, with good success. He had also used Polyglycan but said it didn't work as well.
I asked him about Pentosan, but I'm not sure he knew what I was talking about(??).
So, what to do?
Adequan, Polyglycan, or Pentosan? And which route?
If I start monthly shots will these need to be continued indefinitely? Would IA injections last longer? Would just a round of Adequen be beneficial?
She is turned out 24/7, and I don't lunge any of mine, though am planning on ground driving her this summer, to develops her topline.
I would probably try to inject it although depending upon how little the joint space actually is that might not be possible. I like half steroid/half hylauronic acid and follow up with a course of pentosan.
Personally I would do what ever made your horse comfortable. I am guessing your vet is suggesting straight steroid to encourage joint fusion as the ha would lubricate the joint and slow down the natural fusion process. I think if it were my horse my only objective would be to keep horse comfortable and remember horses can't see there own radiographs so your goal is maintaining physical comfort. Steroid Ha injections, legend and or adequan would be my first thought. If those were not effective I would move on to irap and or previcox. The fusion process can take many years so I personally would just focus on comfort.
Clarksdale, MS--the golden buckle on the cotton belt
You don't want fusion in the high motion part of the hock, and that is where this horse apparently has arthritis..
If possible I'd wait on the IA injections. They are the big guns, but injecting joints often comes with possible undesirable results. So one would think that they should be saved until nothing else works. Although I also know that arthritis is eating away at the cartilage, so anything to slow or stop that process before the cartilage is gone is worth trying.
I'm going through much of the same decision making with stifle arthritis and have decided to start with Pentosan--I think.
Has this vet done an actual lameness exam and seen you filly in person yet?
I'm surprised that he would go straight to steroid injections unless he felt the horse was being actively bothered by it (lame).
The upper hock joint is critical for the horses flexion and movement of that leg, so it's serious if she develops problems with it. It's not like the lower joints, when you can just get through the fusing process, inject when needed for pain management and things will be fine. If that joint starts to fuse - you're screwed.
Are you able to post the xray? If the vet thinks the filly sustained enough of a kick to cause this, I would also wonder about old soft tissue trauma, like to the collateral ligaments in the hock. A ultrasound would be a good idea to access that.
I think you're best shot is IA Adequan now, then follow up with either Pentosan or Adequan. Don't do the once a month thing - do the loading protocol. The point of the Adequan being to preserve what articular cartilage is left. I know Dr. McIlwraith at CSU really thinks well of IA Adequan for hocks.
That said - I think with her only being 4, you're fighting a losing battle here.
Yes, she has had a lameness exam with flexions, and lunging, etc however, I would certainly have a new one done, if I did go the injection route. I can post X-Rays - sure.
Watching her tonight when I fed, she looks pretty good. Honestly, I've seen lamer in a hack class at a horse show. The vet who took the X-Rays said that the injury looked pretty mild, and to put her on a joint Supplement and go on with her, nice and slow. She actually flexed pretty well, and lunged well enough that I had to convince the vet to even X-Ray her.
I just looked up an old email from the vet who took the X-rays who said that she "had some mild degenerative changes in the distal intertarsal joint of that hock" The Lameness Guru Vet was the one who also noted that there was very little space between the joint, and the injury most likely happened from a kick.
Last edited by Freebird!; May. 9, 2013 at 11:26 PM.
Depends on the drug. Depo-medrol is not indicated for high motion joints because it does bad things to the cartilage. Works just fine in the lower joints in the hock, though, where the cartilage doesn't matter.
If the goal is just to get the horse comfortable, some triamcinolone into the upper joint could be very useful.
I hesitate to judge this vet considering NONE of us have seen the horse or the rads. None of us have done a lameness exam on this horse.
If you're concerned, get a second opinion from another vet who can examine the horse and the films. Don't listen to us, particularly considering we don't even know WHICH joint in the hock it is.
Proud member of the "I'm In My 20's and Hope to Be a Good Rider Someday" clique
If it were the upper joint, I'd be thinking about Adequan IA. If it is the lower joint and its already bad, I'd be talking about speeding up the fusion - which is an entirely diffrent course of action.