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Mystery Lameness - Welcoming Suggestions

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  • Mystery Lameness - Welcoming Suggestions

    My 13 year old Quarter Horse gelding has been suffering from a lameness since springing a shoe in the beginning of September. He sprung the shoe on his right front during a lesson while overreaching, even though he had bell boots on at the time.

    After being re-shod a few days later, he came up minorly lame on his right front. We thought he was sore from having to walk on it for a day, as the shoe was way too tight to get off and a farrier could not make it out. I gave him some time off and then he was still minorly lame. Minor heat and swelling around the coronary band. The vet came out, x-rayed and thought it could be an asbcess so I soaked and wrapped for a month. He said to continue riding and I did until November when the lameness seemed to worsen. Sometimes he would work himself out of it - whether this was him actually working out of it or him using his hind end more and more as my ride went on, I'm not sure. In November, he worsened and I stopped riding him. I decided to give him a break. It became clear he was becoming worse so in December I brought him to a clinic where they did 6 nerve blocks all the way up to the shoulder (not including the elbow) and there was no improvement. He rated his lameness as "moderate to severe" front right leg lameness with a secondary left hind limb lameness. The vet declared it was not his foot and recommended scintigraphy.

    Before I dropped 2k on the scinitigraphy, I decided to have a chiro out in January. The chiro was very good but she did not feel anything abnormal or out of place said she could not help and recommended the scinitgraphy. I brought him to a very well-known and large vet where they did a full body bone scan. They also did a lameness exam with nerve blocks again, as well as an xray of neck/shoulder.
    The results are as follows:

    Nuclear Scintigraphy: Focal areas of increased radiopharmaceutical uptake were seen in the left radius, left humerus, and a very mild area of focal increased uptake in the medical wing of the right front disal phalanx. The areas of uptake in the left humerus and radius are consistent with enostosis-like lesions. These can be incidental findings; as Horse's primary lameness is in his right front, these are likely incidental findings in this case.

    Lameness: Horse was 3/5 lame with an obvious head-nod associated with the right front limb. Mild right pelvic limb lameness noted as well. On the left circle he was inconsistently 2/5 lame on the left front limb although the right front limb lameness was still ovious. Perineural analgesia was performed sequentially as follows: palmar digital nerve block, low 4 point block with dorsal branches, modified wheat block and median palmar nerve, median and ulnar nerves, and intra-articular elbow joint. Lameness improved approximately 30% follow intra-articular elbow injection.

    Radiographs: Radiographs of the cervical spine as well as right elbow joint were performed. An area of abnormal calcification was noted in the c5-c6 region, consistent with mild osteoarthritis, however this was deemed unlikely to be a source of significant lameness. Mild to moderate articular changes of the elbow, again consistent with mild osteoarthritis, were present but also unlikely to be the cause of a profound sudden onset lameness.

    Basically the vet's mind was boggled and so was mine. What's interesting to me is that his lameness improved by 30% after blocking the elbow joint, which was related to minor arthritis? The vet recommended 3 months of stall rest with gradual hand walking and then a 3 month rehab program (one month walk, one month trot, one month canter). He has been on stall rest for one month. It was recommended that I put him on Naproxen and it came out to be a whopping $200 per month for this medication. In order to determine if this medication was worth buying again, I was instructed to jog him down the barn aisle for maybe 10 seconds to see if there was any improvement - nada. I am now trying him on Fibrocox to see if that yields any improvement.

    I feel like I'm running out of options and money and would do anything to receive answers and to get my horse better. I'm driving myself insane trying to figure out what is wrong with him. After bringing him to the top vets around and receiving no answers, I figured it couldn't hurt to post here... I'm desperate. Any thoughts or suggestions would be greatly appreciated. I'm also waiting on results for a Lyme's test, just to cover my bases. He was tested for Lymes last year during a bout of lameness and tested negative.
    Last edited by hunter51; Feb. 11, 2014, 02:59 PM. Reason: Updated re: lymes test

  • #2
    Wow, that has to be incredibly frustrating to have no solid answers after all of that. I wish I could be of more help. If the elbow injection improved lameness why do they not attribute that to his issues? I'm on my phone and can't scroll up properly but I have handled WC claims for many yrs and I know cervical arthritis can cause people a lot of pain despite how bad something shows on xray. I would be inclined to push towards elbow, shoulder and c spine. The rest may help but if it's arthritis it will continue to be aggravated. The next diagnostics would be nice if they were treatments too. Personally, I would inquire if he was a candidate for Tildren or shockwave therapy in the areas I mentioned. Many horses respond to shockwave for pain relief when injections fail.

    Here is some info on Tildren:

    http://www.ceva-asiapacific.com/Prod...EN-R-Injection


    I really wish you the best with your horse and hope that you can find some answers soon. I get the going broke part too...there right now with my boy!

    Comment

    • Original Poster

      #3
      Thank you so much for the reply. I suppose they don't attribute that to his issues because of the fact it coincided to closely with the fact everything started when he pulled a shoe? I'm not entirely sure why they kind of ignored the fact his lameness improved with the elbow injection honestly but my gut tells me arthritis is a huge contributing factor and I'm hoping the Fibrocox has some positive effect.

      I didn't mention this in the first post, in attempt to trim down the amount of copy (which obviously didn't work haha) but he was lame last year during the winter in alternating front legs, which we contributed to a bad shoe job but now I'm thinking maybe his arthritis acts up in the winter. I'm glad you brought up the stall rest - I've been questioning whether it's the right thing to do lately because if it is indeed arthritis rather than an injury - zero activity will just make it worst. I will have to look into Tildren.

      Thanks for the well wishes

      Comment


      • #4
        Tildren is not yet FDA approved though it's in process. Vets can order it and apply to use it on a case by case basis. It's IV and it sounds incredible- it's nothing like Legend or Adequan, though I suppose you could try those too but they are not cheap. It just doesn't sound like he needs more diagnostics just need to find the right treatment and narrow pain to shoulder- elbow- neck. Please keep us posted on his progress.

        Comment


        • #5
          Personally, I'd ask for a steroid/HA injection in the elbow and c5-c6. The theory is that you either confirm you have located the problem when the horse jogs sound 10 days post injection, or you at least eliminate potential complicating factors in diagnosing the predominant problem.

          Second, I'd be highly suspicious that there was a soft tissue injury in the hoof along with the original pulled shoe that went undiagnosed. However, you'd likely need to do an MRI to see what, if anything, is going on in there.

          Comment

          • Original Poster

            #6
            The only thing that the vets HAVE been able to confirm is that it's absolutely not in the hoof - I suppose this is due to the many bouts of nerve blocks he's received. I will look into the steroid/HA injection - makes sense. Thank you!

            Comment


            • #7
              It sounds like the shoe issue is more of a coincidence, seeing as how he had this issue last winter too. Another thought is to get films and records and send to another reputable vet hospital or clinic for input. Maybe with some video footage too. Sometimes vets get stuck on one thing and they need a fresh pair of eyes.

              Any chance of navicular or ringbone? I would agree with injections of the cervical spine and elbow to start, and maybe try Pentosan or Adequan as follow up. If that fails, I would seriously consider the Tildren or shockwave.

              Comment


              • #8
                It is possible that when he twisted that shoe in the process he tore something in the leg. Maybe an MRI of the leg? Was there any change in the coffin bone in the xrays? What were the angles?
                Horses aren't our whole life, but makes our life whole

                Comment

                • Original Poster

                  #9
                  I think the shoe may be a coincidence as well... at first, I thought no way - they have to be related but after all of the nerve blocks in the hoof and leg - I'm not so sure that the springing of the shoe was related.

                  All three vets have ruled out ringbone and navicular. I think I may try the injections. I also brought him to three separate vets, the last one being out-of-state (UPenn - the most reputable vet around here).

                  Comment

                  • Original Poster

                    #10
                    X-rays of the hoof came out perfectly normal - he did not receive xrays of his leg. When he went to UPenn, after they finished scintigraphy, neck/elbow xrays, and nerve blocks, they for some reason didn't talk about doing an MRI (maybe because he was still radioactive from the bone scan?) - they offered to do an ultrasound but said it would've cost me upwards of 1k - I already dropped 3k total on that day and I declined. I guess an MRI might be something to consider as well.

                    Comment


                    • #11
                      OP - I have an old gelding that has cervical arthritis in 3 places. His symptoms were more neuro than lameness, and he was not safe to ride. I will tell you that the injections made him rideable again, for a good 18 months. The vet did both sides of the neck, at each location, so 6 injections total. Well worth a try in your case.
                      When he started being uncomfortable under saddle last summer, I quit riding him - he's 24 and has earned a good retirement. I will say he sure looks good when I send him around the round pen for 5 minutes once a week.
                      Good luck with him, it sucks to not know for sure what's going on.
                      We don't get less brave; we get a bigger sense of self-preservation........

                      Comment


                      • #12
                        Welcome to my world! Only dealing with the back right. Nothing really blocked, bone scan didn't show much. A ~30-40% improvement with blocking the SI and a slight hotspot there on the bonescan led us to inject there (not optimistically). No improvement. With no clear diagnosis we just went with trying extra stall time and trying to keep him quiet in turnout with ace. He also got myofascial release therapy, which also seemed to help. He has shown SLOW improvement but it has taken many months. We have just started walking under saddle (lameness started in late May). Good luck!

                        Comment


                        • #13
                          OP, I think you're right to go with your gut on this one and think that the arthritis has a lot more to do with this than the clinical findings show.

                          Every creature has it's own pain tolerance level, and his may just be quite low.

                          My guess is that the shoe grab was a RESULT of what the underlying condition is. He changed his movement because something was uncomfortable and in the process, grabbed his shoe.

                          Have you considered giving an injectable arthritic supplement a try? (legend, pentosan, etc) If he were mine, I would start there. If he showed improvement, I would then have them inject every arthritic joint and keep him on that maintenance plan indefinitely.

                          Just be careful not to try too much at once, or you won't be able to see what works.
                          Strong promoter of READING the entire post before responding.

                          Comment

                          • Original Poster

                            #14
                            FindersKeepers, you basically are reiterating everything I was just saying to a friend about last night - the fact that every animal has its own level of tolerance for pain... so while the clinical tests say the arthritis is too mild to play a large role, he may just have a low tolerance to pain. The lameness last winter also makes me point to arthritis. I'm not saying that this is the only thing playing a part in his lameness but again, my gut is telling me it's playing a large role.

                            You also made an excellent point about the shoe grab - he actually started to pull them quite often over the course of the summer... something I never had issues with prior, though I've only owned him for 2.5 years.

                            I am wondering about the pricing of these injections and how often they're done - something I will absolutely ask my vet about. Thank you for your input!

                            Comment


                            • #15
                              Hunter51 - As noted above, my gelding had 6 injections- 3 each side of the neck. They are ultrasound guided. My cost 2 yrs ago was $700, which included a $75 farm call. I found that surprisingly reasonable. My vet said that how ever long they last the first time, the second time is less long. He does not like to do them more than twice, but it is a situational thing, depending on the length of time between the injections. IE if the first set lasted 10 months and the second set only 4 months - that's bad. If the first set lasted 19 months (as mine did) and the second set lasted 13 months, that would be different. I did not do the second set but chose to retire the horse. Hopefully this makes sense. He used a steroid and antibiotic in the injection, and it was my understanding that the dosage is pretty strong consistent with the location. This is primary reason why he doesn't like to do them too often/close together.
                              We don't get less brave; we get a bigger sense of self-preservation........

                              Comment


                              • #16
                                Another concern, while you are spending all this money on the RF, the horse also has a significant LF lameness as well as an undefined level of lameness in a hind leg. So, you may be fighting a really hard battle. I'm not telling you to stop because I've seen a lot of horses helped by people that don't stop. But I've also seen a lot of horses never recover.

                                That said, if your horse had major arthritis, the bone scan would light up like a christmas tree. However, there can still be a cartilage injury that has not yet resulted in any bone remodeling. Soft tissue injuries also won't show on the bone scan and the injury may be above the blocks. You can't really block the entire leg and have the horse still have the ability to trot. The lower leg yes, but at the knee and above, no.

                                An MRI is not an option until the lameness is isolated to a single block. This is because of the time taken to do an MRI. Scanning a whole leg would take all day and you can't tell an owner you feel good about having the horse under anesthesia that long for diagnostics. A standing MRI can only do the lowest part of the limb (basically the hoof) because there is too much movement in the leg as you move up to get something other than abstract art.

                                I'd be leery of the ultrasound, especially at that price (but at least you'd have an expert ultrasound of the entire leg), because even the most skilled practitioners will have the screen lie to them. Having an expert sonographer is imperative, still no guarantee that the diagnosis is real. All that said, it might be the best chance you have right now, other than the old fashioned year of stall rest and hope for the best. Also, I wouldn't trot this horse everyday to see if it's needs the NSAIDs (as stated about naproxen) as he very likely NEEDS to be on real stall rest.

                                Best of luck with your horse! You are in a tough spot!

                                Comment

                                • Original Poster

                                  #17
                                  Thanks so much everyone for your replies and well wishes. I really do appreciate all the info and suggestions - it looks like we may have a long road ahead of us but I will update this thread with his progress and decisions I make with injections/medications,etc., in case it's able to help someone else in a similar boat.

                                  Comment

                                  • Original Poster

                                    #18
                                    Update - Horse came up positive for Lymes, in which he was negative for when tested last year. His level was 14.2 so we are currently treating him for Lymes as well.

                                    Comment

                                    • Original Poster

                                      #19
                                      Update - (Just in case this could be helpful to anyone else) After being on the Doxy for about 3 weeks, horse is almost (if not) 100% sound. If the Lyme's wasn't the full culprit, we are certain that it at least played a large part. Vet believes Lymes aggravated his pre-existing mild arthritis in the elbow and cervical spine.

                                      Should have gotten the Lyme's test from the very start but his symptoms and surrounding factors were not typical of Lymes and of course hindsight is 20/20.

                                      Comment


                                      • #20
                                        What does Lymes titer usually run?

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