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Joint injections without X-Rays?

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  • Joint injections without X-Rays?

    So I'm wondering what tools your vet uses to decide that joint injections are needed. Watching the horse? Flexion test? X-rays? The vet my barn uses for lameness watches the horse and uses these wire thingies and I don't understand how that is diagnostic. He also pokes a pressure point on the belly to diagnose ulcers. I admit that I lean towards wanting evidence that I can understand. Anyone able to explain for me?

  • #2
    Not sure about the belly thing, but a boarder just had her mare injected w/o x-rays. The vet did flexion tests, watched the mare move on various surfaces/gaits, and manipulated the leg quite a bit. The vet offered to x-ray to confirm what she thought, but the mare was older and visibly off with wonky confo in that leg, so the owner just felt like x-raying wasn't necessary to know the joint would benefit from injection, and the vet agreed. The mare is about 2 weeks post injection and is definitely moving better.
    come what may

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    • #3
      YMMV.

      For a low-risk joint like the lower joints of the hock, my vet didn't X-ray each time. In his opinion, pictures didn't match up the clinical look of the horse (how lame was he?) well enough to make X-rays each time worth the money.

      We certainly did X-ray before injecting hocks for the first time and periodically afterwards over the next decade or so.

      For "new" joints to inject or high-motion joints, I'd want X-rays as part of the lameness exam. A lameness exam can have lots of different parts. If we were considering a joint, that would include flexion and blocking at least.

      IMO, injecting high-motion joints and narrow, low-movement joints like the lower hocks are different propositions. That's why my interest in X-raying all the time (or not) would differ.
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      • Original Poster

        #4
        I guess I'm mostly baffled by injecting the first time without x-rays, because if you know there's an issue then re-injecting would make sense. I do think flexion tests are diagnostic enough, it's just the wire thingy I really don't get. If it moves a certain way by the joint then it's arthritic? I don't understand. Of course, I don't fully understand chiro either but I've seen the results. I don't know, I just am a bit of a skeptic when the treatment is somewhat invasive but the other people at the barn accept it without question (as I'm not the one paying him, I'm not going to bombard him with questions).

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        • #5
          Usually flexions are enough for the good vets around here to suggest trying injections for the average older sport horse. Never seen or heard of a wire thing. You can tell a little bit by looking at a horse's stomach (and probably feeling it to) whether they may have stomach problems, though that's less accurate I think than flexing for joint injections.

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          • #6
            My vet injected the lower hock joints of my mare with only flexion tests and watching her. We did not do x-rays. She definitely improved, to the point that her bucking at the lope completely stopped.

            We x-rayed her a few years later (my new vet had just gotten a digital x-ray machien and offered to do her hocks for free if i trailered to his house, to act as his "guinea pig" so to speak so he could figure out the software that went wtih the xray machine) and those xrays showed arthritic changes where we had already injected years prior, and in other joints in there as well.

            I don't inject her anymore becuase she's retired and "sound" on just turnout and walking/trotting trail rides.
            "If you think nobody cares about you, try missing a couple payments..."

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            • #7
              My vet was ready to go ahead with injections on the hock after a thorough exam and flexion tests, without X-rays.
              He said that X-rays may or may not be diagnostically conclusive. They may show nothing at all, but that doesn't mean the problem isn't there, and that most horses of a certain age are going to show some amount of arthritic changes with or without lameness.
              I decided to get X-rays done because I wanted to see what was going on inside, and so we could have a base line to compare to in the future.
              It's my understanding that injections are routinely done without X-rays.

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              • #8
                Seems to be the course- just had someone post on facebook about injecting their horse. I said [knowingly] didn't know she was broken- they responded w/ she's not doing it just because.
                Not my cup of tea, but plenty of Owners & Vet's happy to do it.

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                • #9
                  I would never inject joints just because and have never heard of someone injecting a horse 'just because'. I do it because my horse isn't feeling it's greatest and when the vet flexed it he felt a certain joint/joints were causing some discomfort and I wanted to ensure they were comfortable and happy doing their job.

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                  • #10
                    When I had my horse's hocks injected my vet did not do x-rays. He did flexions and watched my horse move. My vet had treated this particular horse for many years and I trust his eye and his experience. Plus my horse was I think 17.

                    The injections made a huge difference to his overall comfort and I saw the results right away.
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                    • #11
                      I did not do radiographs -- my vet is excellent and has long experience and I swear he has magic eyes and hands. With said magic eyes and hands plus what I felt, we agreed the injections were warranted and the horse was experiencing arthritic changes in his hocks. They worked wonderfully.

                      I DID radiograph (and bone scan) my younger horse because the problem did not present itself clearly and we were only able to narrow it down to "something above the stifle and behind the withers." Turned out to be some arthritic changes in his vertebrae and a set of injections had him going like new.
                      Life doesn't have perfect footing.

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                      • #12
                        I would never inject a joint without rads done first. I feel that joint injections are ridiculously overused in the equine industry to begin with. If a vet even has suspicion of joint pain, they go straight for IA injections, which help temporarily, but eventually lead to further degradation of the articular cartilage, worsening the issue (if osteoarthritis was the culprit to begin with). If the joint is radiographically normal, then I see no reason to go straight to injections without trying other treatments first (e.g. Legend or Adequan).

                        Originally posted by mvp View Post
                        We certainly did X-ray before injecting hocks for the first time and periodically afterwards over the next decade or so.
                        This I can understand; rads aren't needed every time.

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                        • Original Poster

                          #13
                          Originally posted by morganpony86 View Post
                          If the joint is radiographically normal, then I see no reason to go straight to injections without trying other treatments first (e.g. Legend or Adequan).
                          That's a good point.One of the horses in my barn is on pentosan and 3 are on previcoxx. And 16 of the 32 have gotten IA injections. 2 of those are on oral supps. 7 of the horses are 5 or younger and are only in light work so the need hasn't arisen yet. One horse just got his hocks injected and prp in both stifles and his SI. His owner said they weren't sure what was going on so they went ahead and did the prp. She thinks it's his stifles though. And I love this barn, the riding facilities are great, but there is no turnout. I wonder if a management change wouldn't be a better option for some of them. Not that there is much in the area with a place to ride year round AND turnout (and no crazy BO).
                          Last edited by eqsiu; Mar. 22, 2013, 10:36 PM. Reason: forgot about the horses on previcoxx.

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                          • #14
                            Originally posted by morganpony86 View Post
                            If a vet even has suspicion of joint pain, they go straight for IA injections
                            See this just isn't true. And if your vet is any good, they are not the ones making the decisions anyway. The owner should be making INFORMED decisions and advocating for the horse's best interest. It is the job of the vet to present the information, not make the call unless the owner so asks.

                            You also incorrectly assume that everyone here who has actually used IA injections did not use anything else first. I started with a feed-through, then used Adequan, and ended up with a combination of IA injections and Adequan. Both of the latter were wonderful tools that helped my horse be comfortable doing his job. He is now semi-retired...due to a back muscle injury. But still perfectly capable of working at lower levels with judicious use of a little "better living through chemistry" (as do I with the ginormous cartilage tear in my knee!).
                            Last edited by wildlifer; Mar. 22, 2013, 10:30 PM. Reason: typo
                            Life doesn't have perfect footing.

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                            • #15
                              My ten yr old 1.20m+ horse has never had any joint injections yet but he is on legend when he's in good work and that has so far worked swell. But I have and will inject joints when horses need it, but my vet always gives options. I have also had a horse on previcox.

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                              • #16
                                My lameness vet said that in an older sport horse with a standard set of issues X rays are not necessary because if he's seen one he's seen them all. He wouldn't suggest X rays until after an extensive lameness exam. He would have no problem doing it if I wanted to. For other types of injuries, or on a younger horse he would X ray.

                                He did say that sometimes if you inject say the hocks then the stifle hurts, or the other ankle hurts, etc.
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                                • #17
                                  Mehh. My vet rarely xrays prior to injections and 99 percent of the time the injection fixes the problem. Wear and tear is normal on hard working horses and in most cases when a horse has a sore joint it is due to inflammation related to joint disease or the beginnings of it (which in a younger horse won't even show up on an x-ray).

                                  So many people have this weird aversion to joint injections. It's like a dirty word or something. If you have a performance horse over the age of 9 or so and have never injected you are either really, really lucky to have an insanely sound horse or you are likely riding a horse that needs some help (which is the case 99 percent of the time). It's just the way she goes.
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                                  "Simple: Breeding,Training, Riding". Wolfram Wittig.

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                                  • #18
                                    If a vet even has suspicion of joint pain, they go straight for IA injections, which help temporarily, but eventually lead to further degradation of the articular cartilage, worsening the issue (if osteoarthritis was the culprit to begin with)

                                    Corticosteriods can cause degradation if used repeatedly over long periods of time , however there are many different substances that vets will use depending on various factors. It is important to realize that with DJD there is inflammation acting on the joint and that that inflammation acts to destroy the joint if it is not dealt with. Injecting can therefor seriously prolong joint health and slow the progression of DJD via counteracting the inflammation (among other things).
                                    www.svhanoverians.com

                                    "Simple: Breeding,Training, Riding". Wolfram Wittig.

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                                    • #19
                                      Originally posted by Donella View Post
                                      So many people have this weird aversion to joint injections. It's like a dirty word or something.
                                      This. I used to be one of those people. Which is why I proceeded so carefully. But I just was not fully educated about IA injections and once I got myself up to speed, I realized my fears were misplaced in my situation. That's why that whole "the more you know" thing is true!
                                      Life doesn't have perfect footing.

                                      Bloggily entertain yourself with our adventures (and disasters):
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                                      • #20
                                        Maybe because repeated joint injections can eventually degrade the joint itself...and the fact that any time you stick a needle into a joint capsule there is the remote chance of sepsis. Especially if it is done on a farm site and not in a more aspectic environment.

                                        Those are the risks that some people don't think about, but should also be considered.

                                        While we all know they are miracles for chronic or acute problems (just like me with my crappy knees and shoulders...), it's a short term fix, but continually going into a joint for short term help/relief can also speed up the demise of it.

                                        I've never been a fan of injections for this reason, unless it is a very acute situation and a one-time thing.
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