Does this smell right to you? What else do I look at? (Lameness diagnostics)

[blue_heron]

Took my young horse (5-6, not sure) in to clinic for a on/off lameness and general resistance in work. Recently it has become clearly RH, before felt like RH weakness but not lame. Biggest symptom was kind of crappy canter work and not wanting to really stand up on the right hind in work. Popped up very very slightly off ~1 mo ago and the past 2 weeks 1/5 lame. I think we’ve been dealing with the same issue since last summer. Pushing the issue causes a meltdown. She is generally a super sensitive horse, about everything and anything and is otherwise super sweet and willing. I don’t tend to anthropomorphize but the words “drama queen” do come to mind.

The morning before I brought her to the vet all the horses got excited and ripped around outside. When I went to grab her from the paddock, she was lame at the walk. On the cross ties, she was holding up her leg like it was broken. She would stand on it, didn’t fight me to pick hind feet, and happily got on the trailer to go to vet’s.

Vet did lameness evaluation. Noted that she was slightly less flexible right (doesn’t really match what I feel, I think it was more that she was guarding the right hind and moving away from vet while he was trying to flex her body). A small amount of body soreness in lumbar area and over hips.

She was lamer than I have EVER seen her at the vet’s for trot up and longing. 3/5 lame. Trotted worse on concrete than the footing in the indoor. Right lead canter was pretty sketchy-- much less separation in the hind legs than usual. Flexions were all completely uneventful except for upper joint flexions of right hind and we decided to pursue that and found:

• Stifle rads were picture perfect.
• Stifle ultrasound showed “minor effusion” in the joint but no obvious tears, no thickening.
• Teeny tiny changes in hocks, all on the very edges of the joint.
• Took hind foot rads for balance and found flat/slightly negative on both hinds, so will be addressing accordingly with farrier. Also found teeny tiny perfectly symmetrical changes around pastern.

We chose to proceed with Adequan and if it doesn’t help, try injecting the stifle. Otherwise appt was very uneventful. Vet was not worried about the very minor hind end soreness and said he would only be worried if it didn’t resolve with changing the shoeing and the RH feeling better. Did not see signs of anything neuro. I did like the vet and I’m picky. I’m a little skeptical of minor stifle effusion causing 3/5 lameness, even if the horse is a little dramatic but I do believe her. I also don’t expect lameness from arthritic changes to get worse with work. Thoughts?

[GraceLikeRain]

I would want an ultrasound of the hind suspensories

[Bonnie2]

Definitely worth a second opinion. At least have another set of eyes on the rads and u/s. I totally agree that the findings don’t seem to explain the horse. Was the pelvis/SI examined?

[CBoylen]

Mine was real lame from a similar stifle diagnosis. Go ahead and inject the stifle. See what you get before you look around more.

[blue_heron]

Not beyond palpating and flexing what we could. I totally understand the stifle and hock diagnosis. My exhaustive list of symptoms made me think we would go home with some kind of stifle injury. It is very clearly concentrated to the RH in terms of presentation. Of course it could be something else too.

[blue_heron]

Thanks! And you had good luck with the injections?

[Obsidian_Fire]

I would be checking the pelvis, SI, especially since you say there is less separation in the hind legs during canter. Also you say this horse is a ‘drama queen’, which makes me think that even minor discomfort could cause her to act “more lame” than rads would have you think. And, how are her hoof angles…

[blue_heron]

This was the first time she came up with the less separation behind. So she may have done something running around before to aggravate it further. I’m not sure.

Like I said angles were flat/slightly neg behind. Farrier was scheduled to come today so they were definitely due and will have him look at rads and address.

And yes I know she is very sensitive to I’m willing to believe feet and the swelling are bothering her. Hence the adequan and not immediately jumping to we didn’t find anything.

[kaya842]

Apologies if I missed it - what did the blocks tell you? Did she block out high up?

I second the suspensory theory.

[blue_heron]

Chose not to block for the time being.

[beowulf]

When you ride her, does her movement feel “lumpy”? Or does it feel one sided? And canter? I’ve found that stifles and suspensories can look similar in lameness, they produce a very different feel under tack.

If it feels lumpy, I would want rads of the suspensories ASAP.
If it feels one sided or crooked, it’s probably stifles or up high as the vet zeroed in on.

It’s possible this is multiple small bodily complaints at once. Sometimes when one thing goes (like NPA) everything else gets sore.

Also, might be worth pulling a lyme titer if you’re in a lyme heavy area.

[ThreeWishes]

That’s my experience with stifle and higher soreness also. Very good description. Can you expound on what you mean by “lumpy”?

[beowulf]

I know it’s hard to describe feel but I saw it once best translated as it feeling like you have a flat tire and every time that tire rotates, feeling it hit the flat side - “bahbump bahbump bahbump”. It will almost feel like the leg has a brick tied to it dragging behind if you’re especially sensitive in your seat. Or, think of rolling a cinder block and the feel that produces.

[blue_heron]

Very one sided. Feels like the flat tire feeling I attribute to stifles. I’ve seen her a couple times on the longe not come through with that leg and trip behind usually in downward transitions. Felt it once in walk. Prior to yesterday the issue with the canter were all due to not wanting to stand on the hind and feeling sucked back.

[beowulf]

@blue_heron

Very one sided. Feels like the flat tire feeling I attribute to stifles. I’ve seen her a couple times on the longe not come through with that leg and trip behind usually in downward transitions. Felt it once in walk. Prior to yesterday the issue with the canter were all due to not wanting to stand on the hind and feeling sucked back.

There’s some overlap in symptoms with both suspensories and sore SI or stifles, and every horse protects their body differently.

When you say she trips behind, is it like a trip trip, or is it a slip that feels clumsy?

Slipping would make me think stifles is right; but tripping and sucking back are classic signs of suspensories being sore.

[blue_heron]

It’s more a slip. The whole leg obviously does not come through cleanly. It’s different from leaving a toe.

I do think she is normally improved after shoeing. We’ve been making lots of small adjustments over the past year with good results. Was so hard ti tell last summer because her balance was all over the place.

Lyme has already been addressed. Totally neg.

[CBoylen]

Yes, I went with pro stride, and I wish they had warned me that it would take a little longer to see an effect than a steroid because I spent a few days panicking, but then it all worked out great.

[CBoylen]

Oh mine definitely blocked out to the stifle. Even though it didn’t look too exciting on the ultrasound. So I would block it first.

[blue_heron]

Thanks all. My plan is to give the adequan and see if any improvement or how things go the next few weeks. If no changes I will plan to block and ask to explore the suspensory route

[Demerara_Stables]

Have you done bodywork? Being a young horse and building strength would make me look at massage/acupuncture/chiro since there’s nothing significant on diagnostics.

I did a lameness on a young-ish tb this morning. 1/5 on LF. Lower limb flexions, hoof testers and hood rads all negative. Slightly positive on upper limb/neck flexion and less ROM in the neck on one side vs the other. Our next plan is acu/chiro and maybe massage, which I’m certain will resolve the issue. This horse is coming back into work and building muscle plus is a total hooligan in the field.