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Ongoing fetlock arthritis issues... thoughts?

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  • Ongoing fetlock arthritis issues... thoughts?

    Hey all! Sorry, this will be a really really long novel. I'm just beyond frustrated at this point and wondering if any of you have had similar experiences or thoughts on my situation...

    I have a 15 year old Appendix QH gelding. I've had him for 5 years and he has had many many problems. He's had arthritic changes in his hocks since I first got him, and gets his hocks injected every year. He has also been on different joint supplements off and on. That has worked pretty well to control his hocks so far, he just comes out stiff when it gets cold out, but works out of it after a good warm up. He had one really bad abscess a few years back and also had surgery on his hock two years ago (ran through the fence in the field and had some bone chips), but he made a full recovery from that. He went really well all summer and fall.

    Then towards the end of November I pulled him out of his stall one day and his LF fetlock was swollen. Not hot at all, and no major lameness, just slightly lame when he would trot off after being flexed. At first we suspected that it was an extensor tendon injury and I initially tried to manage it. For a week or two we had him on stall rest, bute, standing bandages, cold hosing, poultices, D & C sweats, etc. After seeing no significant improvement, I had the vet out. After flexing the joint (he was slightly painful to flex), the vet thought the issue was in the joint itself and not soft tissue. The vague diagnosis was "arthritis." We took radiographs, which were all clean. The vet gave me 5 days of Equioxx, put him on weekly doses of Adequan IM, and had me continue my wrapping routine. I had to go out of town for 4 weeks, but my barn manager was awesome and continued this for me. When I came back, the swelling was mostly (though not completely) reduced and he was not painful to flex. I had the vet out for a re-check. He was really happy with his progress and gave me the OK to slowly start bringing him back into work.

    I picked up some ice boots since it's currently too cold to get the hose out and also got some Back on Track polos. I always wrap him during grooming and leave the polos on till we're done riding, then ice him for 20 minutes afterwards. We did about a week of walking, then started some light trotting. The day after we started trotting, the swelling returned, along with a bit of heat. I stopped riding, wrapped and poulticed him overnight, and he was back to his "normal" after a day or two. I called the vet and he wanted to come out and see him again. He watched me lunge him and he really wasn't significantly lame up front at the trot (he was, however, stiff behind due to his hocks). He basically told me to start over with the walking. He said he would have good days and bad days with the arthritic issues so he might have heat and swelling but as long as he's not lame I can keep going.

    I kept in contact with him bi-weekly while I was starting to ride again. After a week at 15 minutes of walking, we bumped up to 30 minutes. After half a week of that, he said we could start trotting. For 3 days, I did 1-2 minutes of trotting broken up in 10 second intervals in straight lines, spread out over the ride. The next ride he was feeling pretty good, so we did one circle to the right and he was fine. Then we did a circle to the left and he was 1/5 lame up front. Throughout this whole process, he has had good days and bad days with the heat and swelling and pain to flex. I would say that lately he has been having more bad days. This could be due to the trotting, but also in the past week the weather has cleared up so all the other horses in the barn have been getting turned out, and my horse has been throwing a fit in his stall.

    So I told all of this to my vet during our most recent conversation and he agreed that it is "not good" that he is lame at the trot to the left, and I should go back to walking. We decided to try turning him out by himself in a 10 x 30 "quarantine pen" that we have, in the hopes that he won't be as upset. The pen is currently being repaired, so we don't know how that will work out yet.

    But here is my real issue: do you think we are doing enough for him? My vet seems really happy with his progress- I know I worry a lot, but I don't think he is all that much better off right now than he was 3 months ago. He says I shouldn't worry about the heat and swelling if he's not lame, but I have a hard time getting past that. We decided we didn't want to inject steroids if we could help it for the sake of his long-term soundness. We briefly discussed other injections, but he seemed dubious of their effectiveness. He also discussed shockwave therapy as our probable next step, but hasn't discussed it since. He seems to want me to keep doing what I'm doing, but I'm seeing little to no improvement in the past month. Meanwhile, he is absolutely miserable being stuck inside. He cribs almost non-stop, throws a fit when any horse gets turned out. One of the other boarders told me he was down when she went to do his stall last week and it took her a really long time and some reinforcements to get him up- I'm really concerned for his mental health at this point in time, although hopefully going out in the pen will help with this.

    That's about it right now. Thoughts, advice, similar experiences? Reassurances that he will eventually be okay?

  • #2
    You have a diagnosis of arthritis with no arthritic changes on radiographs?

    I'd be looking for a second opinion. Honestly, it sounds like you might have a chip.

    And if you DO have arthritic changes (which show up on radiographs) HA injections are quite effective, and IRAP is an excellent next step if you're not happy with the results after HA.

    Surpass can also be very useful.

    I've never heard of using shockwave for arthritis. I thought it was more for soft tissue issues.

    But really, it sounds like second opinion time.


    • #3
      I'd be looking for a 2nd opinion, too, at this point. My totally unqualified thought based on what you have written is that you have a soft tissue injury of some kind.


      • Original Poster

        Thanks for reading through all that, both of you

        My gut is saying second opinion. The only reason I've waited this long is that the vet I'm using right now is supposedly very good, especially with lameness issues, and my barn manager has used him for 10+ years. He swore that it was not soft tissue too...

        And I currently live in a non-horsey area so there are maybe only 1 or 2 other vets I could potentially get to come out. But I'm thinking that's what I'll probably need to do... *sigh*


        • #5
          If you post where you are, people here might have some ideas for you.

          Or you could try asking some pointed questions of your current vet. Number one would be why he says "arthritis" with no arthritic changes on the radiographs.

          Just curious--are your rads digital? How many views did he take?


          • Original Poster

            I'm in the East-Central IL area- Champaign-Urbana.

            The radiographs are digital- he took 5 views, I believe. I don't have a copy right now, but I'm going to call tomorrow and ask them to send me a CD.


            • #7
              Yeah, it sounds like a chip or soft tissue problem. Chips can sometimes "hide" on radiographs (even with multiple views) one day then move around in the joint and be visible the next time you shoot rads.
              If your vet says he does have changes in his fetlock (assuming there's no chip) I would go ahead and inject it. I worked for a lameness vet and we were discussing the use of steroids and cartilage health one day. He said that nothing (not even depo) is as bad for cartilage as inflammation. That said, he would only use triamcinolone or betamethasone with HA for injecting joints, as those are much better for cartilage than depo.


              • #8
                I think I would want an ultrasound. You could block the fetlock joint directly determine if arthritis is the issue. It is possible to have cartilage loss and no bony changes, however an MRI will give you the answer. I would try an ultrasound first though.

                If it is soft tissue then a rest and controlled exersize program. If arthritis joint injection or IRAP, adequan or possibly previcoxx are good considerations.


                • #9
                  Originally posted by cheerio280 View Post
                  I'm in the East-Central IL area- Champaign-Urbana.

                  The radiographs are digital- he took 5 views, I believe. I don't have a copy right now, but I'm going to call tomorrow and ask them to send me a CD.

                  Hello. I am in Bloomington, and part of what you described is exactly what I am dealing w/my 16 yr old paint. He did something while in his pasture mid November.

                  I just took him up to Merritt yesterday. Merritt is WONDERFUL, really knows his stuff. He spent FOUR hours on my horse to find out exactly why he was lame. He blocked my horse FIVE times, but finally, I got an answer, my guy has two tears in his lateral collateral ligament. So, finally, I have an answer and game plan.

                  I had been wrapping w/stall rest, so I was treating it correctly, BUT now we have a basis of his injury.

                  He did shock wave, and I will take my guy to U of I twice for shock wave, then in 60 days, back to Merritt for a follow up.

                  Merritt thinks he will recover and be back May/June. I can NOT recommend him enough!!! He would find the issue if you took him there.


                  Just a thought, there are not any vets here that are as experienced as Merritt. Was a full and long day, but worth the drive and everything.

                  He is about 3 hours from me, so maybe 4 hours for you, but if you really want an answer of what is going on, Merritt would be a very good option for you.
                  Last edited by Shermy; Feb. 23, 2013, 11:36 PM.
                  Riding is NOT meant as an inside sport, GET out of that arena!!!