My horse recently came up lame. She was adjusted by the chiro/acupuncture vet and he was concerned about her hind end being such a mess. It isn’t always so bad. Here and there over the years she has had problems but is usually fixed with the adjustment. This time it wasn’t. She takes funny steps a the trot and cantering to the right is a disaster! SHe is also sore on her right hip/flank area.
My other vet I use for routine care had mentioned her stifles. So I was going to call her out and have her check her stifles and everything else while she is there.
I have had vets miss ligament injuries in the past and try to skip to hock injections because that’s what they
“always do”. I don’t want that to happen again. I also don’t want to just inject her stifles and see if it works. I feel like that is a waste of money!
So what should a vet do to diagnosis if it is a stifle problem besides a flex test?
Ultrasound?
X-rays?
Any experiences and stories are helpful!
Thanks!
My vet first did x-rays. They look remarkably good, so he then blocked the stifle (lidocaine, I presume) like he would block the hoof or hock for diagnostic purposes. Horse went sound afterward, so we waited a week or so and then injected the stifle with HA and cortisone. It worked well and lasted around 10 months. Good luck!
Yes, diagnostics would include x-rays; an ultraound is possible but probably will not be suggested right off the bat unless the issue is felt to be a ligament issue, such as upward patellar fixation. If you don’t want to do injections to see if they work, then a joint block will at least narrow down that the stifle joint is involve (either ligament or cartilage related). A nerve block will just isolate an area, but not the stifle itself.
I would recommend a lameness vet over a farm vet for stifles as they can be easily missed or mistaken for hock issues and a vet who specializes in lameness and sports med will have the experience to spot a stifle issue and just flexion tests that help isolate this joint better.
Treatment options will vary depending on the nature of the problem but routinely include cortisone and HA injections, IRAP, ProStride, or PRP. Noltrex is another tool my vet uses, and laser therapy may help if there is residual swelling after injection therapy. For ligament issues, if it is a strain or tear, rest is the best therapy, maybe PRP. Surgery would be recommended for something such as a meniscal tear. For mechanical ligament issues like upward patellar fixation, then blistering or ligament splitting can help, along with strengthening and condition such as hill work and use of poles or cavalettis.
My new horse was just diagnosed with sticky stifles. Cantering circles is hard for him. Swaps behind in both directions on the longe and under saddle. Outside hind would stick and skip a step, causing a swap. His background is foxhunting and trail riding. He is out of shape, no topline and is generally weak in his hind end. For the next few months he will be doing lots of hill work, trotting in mostly straight lines or circles no smaller than 10m, cavaletti, might even have him drag a tire around - anything that will develop his quads. If he offers to canter on a straightaway, that’s OK but otherwise no canter circles till he’s stronger. If we see no improvement in two months, he could get estrone injections and X-rays to check for arthritis. Good luck and I hope your vet can give you a clear, treatable diagnosis.
Two personal stifle experiences of mine: First was my mare, who began sticking her patella on her left hind after significant weight loss (ulcers and teeth) and non-use. My vet blistered only her left stifle with an almond oil injection. Afterward, reconditioning, particularly using ground poles, got her back to normal. Second experience is with a horse I helped rehab back from a DDFT tear (right hind). Stall rest and a rehab program induced patella fixation bilaterally, and we began her on 28-day intervals of 2mL Estrone doses. That worked until we got her into canter work, and at 2 minutes of canter work she began to become uneven behind. Her owner’s vet advised stifle injections, as she was not showing signs of patella fixation. Stifle injections were done, but there was no improvement. She was visibly short-strided behind at the walk (prior she would exhibit signs at only the trot and canter). Vet performed extensive lameness/flex tests, patella manipulation, etc., and determined patella fixation, bilaterally, not based on visibly locking stifles, but based on her gait rhythm and looseness of patellas upon manipulation. Her owner decided to go ahead with the “splitting” procedure, where the vet causes tiny abrasions in the ligament of the patella to cause inflammation to help hold the patella on a regular track. That was performed about two weeks ago, and with stall rest and then hand-walking, she’s now back under saddle (today is day 2) and so far appears normal. If, for some reason, her patellas begin sticking again, the vet will advise blistering to both stifles. Ground poles and only walk and trot work are the plan for the first 5 days currently, then we’ll introduce canter, to see where she really is. She will continue to receive her monthly dose of Estrone. Hope these experiences help, and best of luck!
I would take your horse to a lameness specialist … not your “usual” vet. They are going to know exactly what to do with your horse.
Flexions are always a must. Nerve blocking might be worthwhile, depending on what the flexion show. X-rays don’t show much except bone BUT they are a “cheap” diagnostic to run. Ultrasound is an option, if deemed necessary.
I have just been through the whole stifle diagnostic song and dance with my horse. I use an excellent and well regarded lameness vet. The horse presented as being unwilling and really unable to pick up a canter on his left lead, and a big contusion/hematoma on the back of his stifle. We think he probably did something romping around in his paddock.
First of all, we flexed. Then we X-rayed, both the stifle and the hock, just to eliminate that as a source of the problem. When the X-rays came back clean, we ultrasounded. When they came back clean, and he didn’t come sound after two weeks of rest, we blocked. It took two appointments. first of all the foot, then the suspensory, just to make sure there wasn’t an issue in either of those two spots, then on the second appointment, after checking he hadn’t become miraculously sound in the intervening week, a joint block of the whole stifle (which is not a procedure for the faint-hearted to watch), which made him obviously sound.
The diagnosis, based on the clean ultrasound and clean x-rays, was that it’s more than likely the ACL, because you can’t see that on x-rays or ultrasounds because of where it’s buried. According to my vet the only real way to check out the ACL is by scoping, and that presents some significant risks of it’s own, and his recommendation for treatment would be the same anyway.
So, we will be doing stem cell–we go in to the clinic for “harvesting” on Monday, and we are doing the handwalking/controlled and limited turnout routine. It will be 6 months or so of healing and rehab.
Good luck with yours. I hope it’s a simple tweak!
