Calling all lameness detectives

[Nevada10]

6/10 update:
Vet came today and ultrasounded his SI — he had some pretty severe remodeling on one side. Nothing obvious on stifles, so we injected the SI.

OP:
I have a very tall 5 year old warmblood show hunter and I feel like something isn’t quite right with him. He looks sound under saddle and on the lunge. I made an appointment with our vet, but want to hear your thoughts first (to make sure my vet isn’t missing anything).

Issues:

1. Walking downhill. He’s very hesitant, especially on pavement, with or without a rider. Hesitant walking down steep hills with rider on grass. He trots and canters down the hill in his pasture without issue.
2. Holding up hind legs for hoof picking/farrier. He gets tight and wants to pull his foot away, and doesn’t want to bring it forward for finishing either.
3. Has been grumpy when brushing his right flank/hip/stifle.
4. Right lead is weaker than the left. He wants to get 4 beated.
5. Hind leg “gives out” under him sometimes, especially at walk, occasionally at trot.
6. He rarely lands on his left lead. His lead changes both ways are ok. Can’t do walk-canter transitions on the right lead yet.
7. This may or may not be a symptom, but he’s lazy and it takes a lot of leg to keep him cantering. He’d rather trot.
8. He does trot poles by feel, yet can jump around a 2’9” course without issue.
9. Occasionally, he will swap his hind legs on take off, especially at a tighter distance

I can’t tell how much is due to his age/size, weakness, or lameness. He is ridden 5 days per week for about 30 minutes. We vary our rides between flatwork, ground poles, and hacking in in the fields. He jumps once a week or less. He is shod on all 4. He gets oral HA every day and I did a full course of Adequan a few months ago (no change). A chiro looked at him 2 weeks ago but he wasn’t a fan and she wasn’t able to get a good assessment. His back was sore a few weeks ago and it was shockwaved.

[ZELLA]

Your vet probably will want to incorporate a neurological exam and perhaps EPM and Lyme bloodwork as part of the exam.

[IPEsq]

Sounds like back / SI region something to me as first thought (I hear ya on the tall young ones) but I might look at neck and stifles too. Could be treatable but might just need some kind of support and more physical maturity.

[beowulf]

Got a video? The symptoms you mention encompass so many issues.

[StormyDay]

The hill thing makes me think stifles. So does the reluctance to get his hind feet trimmed.

The ‘giving out’ is probably from loose/weak stifles and may or may not be connected to lameness. Unless caused by injury, that’s usually remedied by stifle strengthening activities like raised trot poles, collection work, and hill work. Some horses need way more stifle exercise than you would think.

If it was my horse, and there were no injuries present, I’d do a round of adequan and reassess in a few months. At 5 they are still growing and a lot of babies need time for their stifles to catch up.

If after the adequan there was no improvement, I’d X-ray the stifles and hocks. It’s possible the joint is trying to fuse. My 8 YO fused his hock at 6-7. He’s sound now on it and happy, but when it was fusing he lived on equioxx for a year. My vet told me to ride him as normal while it was fusing.

[Jealoushe]

Slipping it out behind is from weak stifles normally.

Your vet can easily tell if it’s this in a lameness work up.

In the meantime check out this podcast…. https://podcasts.apple.com/ca/podcast/the-horse-first-a-veterinary-sport-horse-podcast/id1435735981

[Nevada10]

Did 7 doses of Adequan in March/April

[JB]

Age 5-ish is when a lot of PSSM2 symptoms start showing up. What’s his diet?

1 - When he walks down hills on pasture without a rider, what’s his posture like?
Pavement can feel slick, so that’s not as much of a red flag

All the symptoms you mention can be hock or stifle or hip or right side of the SI. Even the hoof leading to compensatory issues higher up

They can also be EPM or PSSM2.

Got any video, especially trotting on a circle left and right, and away from the camera?

The combination of all these things make me feel right stifle.

[Nevada10]

He’s on a pretty low starch diet (gets about a pound of senior + Vermont blend, vitamin E, ground flax, spirulina (allergies), MSM, GutX (HA). He’s turned out 24/7 when the weather/bugs allow, otherwise on night turnout.

He is built straight behind — stifle was kind of my suspicion. No obvious heat or swelling. I put him on Equioxx for 2 weeks to see if that helped but didn’t notice a difference.

[JB]

straight(er) stifles are more prone to injury, and harder to get strong.

It would be worth a lameness eval, with xrays and ultrasound of the stifle

Until then, I’d stop jumping, and would go back to basic flatwork, focusing on the things that strengthen the quadriceps and all the muscles that support the stifles, no circling, not a lot of canter other than transitions into/out of, and see how things start going. Introducing the rein-back, if you haven’t already, can help as well. It’s hard work to do properly, so start with just a handful of steps 1-2 times a ride (after warming up well), a few times a week, and increase from there

[ASB_Stars]

Back lifts, tail pulls, and medium sized caveletti, five of your feet apart- and I use five.

[Nevada10]

Update: vet came today and ultrasounded his SI — he had some pretty severe remodeling on one side. Nothing obvious on stifles, so we injected the SI.

[StormyDay]

@Nevada10

Did 7 doses of Adequan in March/April

Ok I’d suggest to move on to the X-rays. It could still be loose/weak stifles, but I’d be more worried about something else going on. If there was nothing obvious in the stifles/hocks I’d look into the SI, but truthfully at 5 you may be chasing a nonexistent rabbit down the hole here. He could just be young and growing and growing can cause pain or weird gaits. If you find nothing after checking hocks,stifles, and SI, and your vet isn’t particularly concerned, I’d probably continue as usual and do a reassess in a few months. If the issues are still going on then I’d do a deeper dive.

Though, Have you done a bute trial? My vet now pushes for that instead of more invasive work ups first.
Edit: I see you did equioxx. That really needs a full month to see a difference. It builds up in the system

[IPEsq]

Actually, according to the FDA disclosures, it takes 6-8 days of Equioxx to arrive at steady state serum concentration, but you do get an effect before that is reached. And you can shorten the time frame by doing a loading dose of 2x dose for 3 days. Should not take anywhere near a month to show an effect.

But of course it isn’t going to help ulcer discomfort. In my experience, NSAIDs don’t really make a difference for cervical spine issues either. So, probably the reason no benefit was seen is that it wasn’t the type of pain helped by an NSAID, not about the dosing.

[StormyDay]

@IPEsq

Actually, according to the FDA disclosures, it takes 6-8 days of Equioxx to arrive at steady state serum concentration, but you do get an effect before that is reached. And you can shorten the time frame by doing a loading dose of 2x dose for 3 days. Should not take anywhere near a month to show an effect.

But of course it isn’t going to help ulcer discomfort. In my experience, NSAIDs don’t really make a difference for cervical spine issues either. So, probably the reason no benefit was seen is that it wasn’t the type of pain helped by an NSAID, not about the dosing.

That’s interesting. My vet told me that it could take up to a month to see improvement in my gelding. And sure enough, it took about 3 weeks before I started noticing a big difference.