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Hock injections. Are there alternatives?

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  • Hock injections. Are there alternatives?

    My 10 year old OTTB gelding has struggled with soundness for a couple of years. I finally switched vets, Xrayed hocks and late last August, had them injected. That was supposed to last 6 months. He started getting uncomfortable in late January. In mid -February he had Os Phos as my vet doesn't want to inject all the time. He gets a 1/4 tab of Previcox per day.

    Now he is showing signs of stiffness again. He is dragging his hind toes again and seems uncomfortable going down hill. He is still behaving himself at the moment. I really have only been doing light work with him. A little walk and trot in the ring and out in the field. Just doing basic dressage. I would love to do some lower level dressage shows on him.

    On Xray his hocks didn't look that bad, pretty minor. The vet says he can inject again, which I guess just wears out the joint after a while or we can do shock wave. His stifles are fine. He doesn't seem to have soreness in other places, though his back and hind end would get sore and tight before we diagnosed and treated the hocks.

    I would love to hear the experiences of others What else works?

  • #2
    Toe dragging, trouble going downhill, are all signs of stifle issues. There doesn't have to be "anything" on film to still have a stifle issue.

    Have you tried Adequan?

    If injections in the hocks aren't working then my opinion is the hocks are (most likely) not the problem!

    There could also be something higher up such as SI.

    Comment


    • #3
      I'd suspect higher up issue also. If it absolutely is the hocks, a loading dose of Adequan every 6 months would help.
      20% off code for Hay Chix hay nets--http://682haychix.refr.cc/chelseaboda

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      • #4
        Adding on to the likelihood the real issue is higher up. But also adding, are you SURE it's not the feet?

        Negative or even flat plane coffin bone angles will start causing problems higher and higher up the back end. The hocks may be the first things to present as sore, and I can see injections helping for a brief time, but given that you only addressed a symptom, it's not going to last.
        ______________________________
        The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

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        • #5
          Ok... so the hock injections lasted 5 months. Then you tried some other stuff that barely made it 3 months. So it has now been 8 months since you injected the hocks?

          If so, I'd want to make sure high hind suspensory injury was ruled out. It's very close to the lower hock joint, so sometimes blocks or other injections cross-populate and make it hard to isolate one from the other.

          If the suspensories ultrasound clean, I'd inject the hocks again. Some horses need them done every 6 months, I personally wouldn't go any more frequently. If the horse needs more than that, switch from steroid/HA to a different injectable - like ProStride, Arthramid, or IA Adequan.

          If your vet knows what he or she is doing in selecting the proper steroid, injections should not harm the joint. *Obviously I'm not talking about the risk of infection, which is real and does need to be considered.

          Comment


          • #6
            Originally posted by joiedevie99 View Post
            I'd want to make sure high hind suspensory injury was ruled out. It's very close to the lower hock joint, so sometimes blocks or other injections cross-populate and make it hard to isolate one from the other.
            This. Especially in a (relatively) young-ish horse with minimal changes visible on radiographs. BTDT.

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            • Original Poster

              #7
              To be clear, last August he blocked sound at his hocks and the hock injections made a world of difference at first. It seemed like his whole body was remodeling. His tight muscles gradually went away. Toe dragging was much less but not gone completely. He was actually relaxed under saddle. He did have negative plane in his hooves about 18 months ago but I will have to check it again. Vet used to be a farrier so I will have him take another look. If nothing shows up on x ray of stifles, what do you do, block them to be sure?

              I think the vet ruled out his suspensory issues. Another thing to ask him.

              I have not tried Adequan. Vet decided on Os Phos this last go around.

              No real soreness in his SI when I palpate that area.

              He could have multiple issues. I would love to get to the bottom of this.

              Comment


              • #8
                Originally posted by JB View Post
                Adding on to the likelihood the real issue is higher up. But also adding, are you SURE it's not the feet?

                Negative or even flat plane coffin bone angles will start causing problems higher and higher up the back end. The hocks may be the first things to present as sore, and I can see injections helping for a brief time, but given that you only addressed a symptom, it's not going to last.
                ^^^this.

                My horse started having a lot of hind end problems about a year and a half ago. We seemed to get everything under control (injected hocks, stifles, SI, all spread out over time). This year (February) he was starting to drag his hind toes badly and squaring them off. I had the vet and farrier out, and his xrays showed bad angles in both hind feet. He wasn't negative....yet....but he was on his way there. My vet said that can really send everything else higher up out of whack and cause problems. He's a stifle-y horse and does get his hocks/stifles injected regularly (1x/year) and is on Pentosan.

                My farrier and vet decided on a corrective shoeing plan for his hind feet, and it really seems to be helping. I did a month of Equioxx just to help get him comfortable, but he finished that up weeks ago and is still doing great. He's in plain steel with leather rim wedge pads.

                His stifles xray just fine, nothing major is visible, but he flexed poorly and was dragging his toes, which my vet said is a sign of stifle problems/pain.

                Hope this helps! Fixing the feet has been a lot easier than trying to fix or deal with the joints so far.

                Comment


                • #9
                  i like legend for acute soreness in joints. can you give IV injections? do 4 weeks and then maintain monthly. that might help. alternatively, pro stride (https://woodsideequineclinic.com/pro-stride/) is an injection type that doesn't use steroids and a lot of vets go to that if "regular" injections aren't holding.

                  Comment


                  • #10
                    I'm confused. Why are you talking about Osphos like it's interchangeable with injections? Maybe I'm missing something, but Osphos is usually used to help with navicular/bone demineralization issues. Do people use it for joint issues? Lots of recent research has come out saying that it's not a great idea to use it for what most people are using it for (and after a $10k kidney failure episode on my own horse after we used it to help with a broken coffin bone - also, per more recent research, a bad idea - I don't disagree).

                    Lots of talk about how oral supplements are suspect, but that might be a place to start? A recent thread mentioned feeding flax oil for the anti-inflammatory properties of omega-3s. My vet prefers semi-regular Polyglycan (which is an IV shot) to any other joint products (though we do annual hock injections on my older horses in addition). I've also had friends rave about the Adequan 1/4/7 (1 IM shot every 4 days for 7 rounds/28 days), and I'm giving that a go with 2 of mine shortly.
                    __________________________________
                    Flying F Sport Horses
                    Horses in the NW

                    Comment


                    • #11
                      Originally posted by LookmaNohands View Post
                      To be clear, last August he blocked sound at his hocks and the hock injections made a world of difference at first. It seemed like his whole body was remodeling. His tight muscles gradually went away. Toe dragging was much less but not gone completely. He was actually relaxed under saddle.
                      But, that doesn't mean the hocks were the root problem, only the most obvious symptom.

                      He did have negative plane in his hooves about 18 months ago but I will have to check it again. Vet used to be a farrier so I will have him take another look.
                      IMHO, NPAs should be monitored on a very regular basis until xrays show that the internal structures are 100% resolved, either because it's all fixed, or on finding that for some reason trimming just can't get it where it should be, that appropriate shoes/pads are keeping things properly aligned. If you only knew there was an NPA 18 months ago, and haven't looked inside since, then that is step 1, before you go any further. A foot can look (pretty) normal on the outside and still have NPA

                      If nothing shows up on x ray of stifles, what do you do, block them to be sure?
                      I'd be blocking first - don't go around just randomly shooting xrays if you don't at least have an idea that the general area is sore

                      He could have multiple issues. I would love to get to the bottom of this.
                      With an NPA, it's pretty much guaranteed there are multiple layers to peel. The NPA didn't happen overnight, and it started taking "down" structures with it when it started.
                      ______________________________
                      The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET

                      Comment


                      • #12
                        Originally posted by LookmaNohands View Post
                        If nothing shows up on x ray of stifles, what do you do, block them to be sure?
                        If lameness is localized to the stifles via blocks, then radiograph and ultrasound them. That joint is just packed with soft tissue that can go bad in a variety of ways, and ultrasound is a pretty effective (and relatively inexpensive, wooo!) way to look at that.

                        Radiographing and then blocking is kinda backwards. Make sure they hurt before you go looking

                        Comment


                        • #13
                          Originally posted by PNWjumper View Post
                          I'm confused. Why are you talking about Osphos like it's interchangeable with injections? Maybe I'm missing something, but Osphos is usually used to help with navicular/bone demineralization issues. Do people use it for joint issues? Lots of recent research has come out saying that it's not a great idea to use it for what most people are using it for (and after a $10k kidney failure episode on my own horse after we used it to help with a broken coffin bone - also, per more recent research, a bad idea - I don't disagree).

                          Lots of talk about how oral supplements are suspect, but that might be a place to start? A recent thread mentioned feeding flax oil for the anti-inflammatory properties of omega-3s. My vet prefers semi-regular Polyglycan (which is an IV shot) to any other joint products (though we do annual hock injections on my older horses in addition). I've also had friends rave about the Adequan 1/4/7 (1 IM shot every 4 days for 7 rounds/28 days), and I'm giving that a go with 2 of mine shortly.
                          Osphos also seems like an odd choice for me. I suppose it could help for bone pain relating to remodeling anywhere. And that could cause some improvement in pain for about 3-6 months.

                          It sounds either like there are high supensory problems brewing and/or the source of the hock pain has not been resolved, for example, negative angles behind, long toe/low heel. Or horse is compensating for some kind of back or pelvic pain. Or, something else. Steroids in the hocks can mask proximal suspensory issues, and those can also block out to a hock block--blocks are not entirely precise especially in high motion areas.

                          Comment


                          • #14
                            What IPESQ said, ditto
                            "You can't really debate with someone who has a prescient invisible friend"
                            carolprudm

                            Comment


                            • #15
                              I’m not sure I understand the use of osphos here when Adequan/Legend/Pentosan are great less expensive options.

                              However now you know it doesn’t work, one of those expensive learning experiments. I would flex him all over again & see where you are at. Hock injections are likely needed, but 5 months for a 10yo horse is a short duration. Maybe the stifles & SI & or hind hooves are also sore causing some compensation and why he blew through the injections so quickly. I quite like flexing the hocks and stifles for Ok, need to be done again or hmmm let’s dig deeper. IME hocks are relatively easy to manage so if they need to be revisited often it’s actually something else causing the stress on the hocks, or a combo of things.

                              Has lyme been checked? I know in one of my horses as a 5yo he was quite hock sore suddenly, injected the jocks but it was really the Lyme disease causing the problem. Needed then injected again 5-6mo later and then not again until 10-12 yo.

                              Comment


                              • #16
                                Originally posted by LookmaNohands View Post
                                My 10 year old OTTB gelding has struggled with soundness for a couple of years. I finally switched vets, Xrayed hocks and late last August, had them injected.

                                On Xray his hocks didn't look that bad, pretty minor.

                                He started getting uncomfortable in late January. In mid -February he had Os Phos as my vet doesn't want to inject all the time.
                                I have the same question as the others. What was your vet's exact reasoning for doing Osphos? If there were no bony changes on the x-rays, honestly, there really is no indication for Osphos.

                                Osphos and hocks injections are certainly not the same thing.

                                I would agree to try him on a round of Adequan instead to see how that makes him feel, versus hock injections.

                                How long has he been on the Previcox? How does he feel if you stop it?


                                Originally posted by LookmaNohands View Post
                                Now he is showing signs of stiffness again. He is dragging his hind toes again and seems uncomfortable going down hill.

                                If nothing shows up on x ray of stifles, what do you do, block them to be sure?
                                As others have suggested, it is very possible he has multiple things going on, and the hocks were just the worst thing at the time. It actually is pretty rare for stifle x-rays to show anything because the issue with stifles is usually in soft tissue -- not in bone.

                                Toe dragging and problems going down hill are common symptoms of stifle problems. If weak/loose stifles are your problem, it will actually be improved with regular correct exercise, since you said he is not being worked too much currently.

                                Any possible SI problems?



                                It is not enough to know how to ride; one must know how to fall.

                                Comment

                                • Original Poster

                                  #17
                                  Originally posted by IPEsq View Post

                                  Osphos also seems like an odd choice for me. I suppose it could help for bone pain relating to remodeling anywhere. And that could cause some improvement in pain for about 3-6 months.

                                  It sounds either like there are high supensory problems brewing and/or the source of the hock pain has not been resolved, for example, negative angles behind, long toe/low heel. Or horse is compensating for some kind of back or pelvic pain. Or, something else. Steroids in the hocks can mask proximal suspensory issues, and those can also block out to a hock block--blocks are not entirely precise especially in high motion areas.
                                  Vet used Os Phos because it is known to be good for joints. I am not sure about veterinary research but there was a thread on this here a while ago: https://www.chronofhorse.com/forum/f...dy-used-it-yet

                                  My farrier suggested backing him a lot to strengthen his stifles. I did this a while ago but it was before we addressed his hocks so that is what I am going to do. My farrier watched him walk and turn up and down the aisle way and noticed that he was mostly dragging his toes as he turned. When I ride him in the arena he leaves long drag marks, most noticeable when trotting.

                                  He is generally a bit stiff behind. I do TTouch on him all the time. He has had osteopathy once this year and one chiro/accupuncture treatment too. There are no indications that he is particularly sore in his SI area. he is just generally stiff.

                                  Comment


                                  • #18
                                    So many things make this sound like suspensories.

                                    Comment


                                    • #19
                                      OP, it sounds like things have moved beyond the Osphos experiment at this time, but if you are interested, here’s a more recent thread on it -

                                      https://www.chronofhorse.com/forum/f...s-side-effects

                                      I concur with the recommendations you’ve received so far to investigate NPAs, suspensories, and stifles. You can certainly pursue getting back into regular work and backing exercises to strengthen the stifles as a first step, though from your descriptions it seems likely that you may end up needing the additional vet work in the end. Good luck!

                                      Comment


                                      • #20
                                        I agree with the posters, above, who encouraged looking at soft tissue. I diddled around doing x-rays, PT (treadmill: dry and water). We injected different joints --- you name it, for over a year, we did it.

                                        Then, probably on this BB, I heard about DSLD, and the pieces began to fall into place. I have NO IDEA why soft tissue was not on the list of potential diagnoses, but I asked my vet if we could do an ultrasound..... And there it was. A large hold in the upper suspensory.

                                        Had soft tissue been an early consideration, Goober might have been a candidate for one of several different modalities (including surgery that seems promising). But, by the time we found out, the hold was larger than a quarter.

                                        Again, I do not know (but would love to learn) why vets are so fixated on joint issues. Why did it take a year before soft tissue was considered? (and then it was Dr.Kent Allen, in Va who first suggested ruling out DSLD. Needless to say, I am very glad I got a 2nd opinion.)

                                        I encourage you to request ultrasounds of all 4 legs (DSLD is usually bilateral, but it can show up as a one legged problem, only because the other side hurts less). Even if it is not DSLD, your horse might have soft tissue issues which are clouding the picture

                                        I also encourage you to get a second opinion. We sent Dr. Allen videos of Goobs lunging, being flexed and x-rays plus farrier work. He would prefer to see the horse, but what I sent was enough for him to narrow things down.
                                        Last edited by Lord Helpus; Apr. 18, 2019, 10:09 AM.
                                        "He lives in a cocoon of solipsism" https://www.chronofhorse.com/forum/c...lies/smile.gif

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