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Let's play clinical case study (please?)

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  • Let's play clinical case study (please?)

    A big mare in her late teens with no history of front leg unsoundness is suddenly lame on one front leg, moderate to severe, 2-3 on 5 point scale, at trot. Sound and comfortable at walk, makes sharp turns no problem, no toe pointing, walks down hill no problem. No improvement after a month.

    Vet comes. Mare is reluctant to flex at all on lower joints, and is blocked.

    1) digital plantar -- still lame
    2) ablaxial (sp) sesamoid -- sound

    What would you suspect? What could you rule out?

    Those who respond, thanks for playing!

  • #2
    A good horseman doesn't have to tell anyone...the horse already knows.

    Might be a reason, never an excuse...


    • #3
      I second BuddyRoo.

      Blocking like that it could hundreds of things:
      Coffin joint, pastern joint, collertal ligaments of either, sesmoidian ligaments, distal sesmoid bones, distal deep flexor tendon, the list goes on and on.

      And any time a horse goes suddenly lame I still never rule out an abcess, even if it didnt block to a PDN (sometimes the PDN wont get all of the toe region).


      • #4
        Sorry, I had to pop away quickly.

        I would not discount a possible abscess given the time of year and the symptoms you describe...but the soundness at a walk kind of gives me pause on that.

        Nerve blocking can be a great tool, but in my limited experience, it can also lead you astray pretty easily.

        I would be inclined to get radiographs done.

        There's NO indication of any possible puncture from below correct? One of the things that kind of floated into the back of my mind was an infection within the hoof capsule as a result of a possible puncture. But totally playing guess the issue here.

        I'd really want rads.
        A good horseman doesn't have to tell anyone...the horse already knows.

        Might be a reason, never an excuse...


        • #5
          Jeez, it could be anything. X-rays, response to hoof testers, exam of the sole and frog?

          A big mare in her late teens who flexed positive in multiple areas wouldn't surprise me. Might be a red herring. I'd want to zero in on the unsound part of the limb and given all that's going on from the fetlock on down, I'd think a diagnosis without films is going to be tough.
          Click here before you buy.


          • Original Poster

            rads to come

            This was an impromptu lameness exam after vet was here to do shots, no x-ray machine. Will have rads done later this week.

            No response to hoof testers. Frog, hoof normal (no heat, no pulse). Big, healthy feet in general. Slight thickening of pastern joint compared to other front.


            • #7
              What type of surface did she walk/trot on?
              HR/MPL Clique

              "I am villifying you - for God's sake, pay attention!" - Peter O'Toole as Henry II, The Lion in Winter


              • Original Poster

                indoor ring footing

                But she is also lame on hard footing.


                • #9
                  That is telling - the "rule of thumb" as I know it is hard footing lameness = hard tissue injury, soft footing lameness = soft tissue injury.

                  Now look what you did - you broke the rule!
                  HR/MPL Clique

                  "I am villifying you - for God's sake, pay attention!" - Peter O'Toole as Henry II, The Lion in Winter


                  • #10
                    Originally posted by WarHorse View Post
                    That is telling - the "rule of thumb" as I know it is hard footing lameness = hard tissue injury, soft footing lameness = soft tissue injury.

                    Now look what you did - you broke the rule!

                    Or, it means there is both a hard tissue AND soft tissue injury

                    Sorry, not trying to make lite of the situation Definitely rads and ultrasounds.
                    The CoTH CYA - please consult w/your veterinarian under any and all circumstances. - ET


                    • Original Poster

                      Thanks all

                      I guess i'm worried that the blocks rule out everything except for the pastern and the joints on either end, or soft tissue. What soft tissue structures would cause lameness?


                      • #12
                        Here are some good information sheets that might help:




                        • #13
                          Blocks can be great to help us zero in on a region, but you have to understand that blocks can also "seep" into areas we didn't intend at the time and give us some false readings.

                          I wouldn't be too freaked out just yet. Not without the rads.
                          A good horseman doesn't have to tell anyone...the horse already knows.

                          Might be a reason, never an excuse...


                          • #14
                            Ringbone, collateral ligament?

                            I would say rads, no diagnoses ultrasound, we had to MRI my horses pastern last year.


                            • #15
                              Collateral lig. Very unfun. MRI...

                              Here's hoping that the radiographs show something!


                              • #16
                                Originally posted by dauntless View Post
                                Collateral lig. Very unfun. MRI...

                                Here's hoping that the radiographs show something!
                                I second this!!!!!!!!!!!! Hope your horse can easily be managed


                                • Original Poster

                                  Xrays showed roughened bone around the back of the pastern suggestive of distal sesamoid ligament damage. That is roughly the area that blocked sound, plus this horse was seen cavorting around in the deep snow in the days before pulling up lame.

                                  No ultrasound was done, and the vet recommended conservative treatment with bute and light turnout for a few weeks.

                                  Anyone had experience with distal sesamoid ligaments? Apparently the prognosis is fairly good -- and with this older mare the goal is trail/light riding or worst case scenario, pasture sound.


                                  • #18
                                    I had a gelding that tore the right fork of that ligament. He had stall rest and handwalking... I can't remember. 6-8 weeks? He was able to come back from it. There was ultrasound involved as well as some shock wave therapy once or twice. He was fine when it healed.
                                    First, say to yourself what you would be. Then do what you have to do. ~Epictectus