I’ve owned this horse for over 2 years now (Rhinelander Warmblood now 10 years old - Hunter discipline). Since he stepped off the plane (from Florida) 2 years ago it’s been an ongoing battle with unevenness and lameness in his gate. We first thought it was your typical lameness issues and after ruling those out with blocking, maintenance injections, and time off… we concluded that the horse had some sort of deep tissue muscle injury. Unfotunately, he had no prior history of this injury nor do we know where he could have sustained such an injury to his neck. We’ve injected the neck with corticalsteroids and when we didn’t see a big difference we did a deeper steroid injection via a specialist. After this treatment, the horse was back in working condition for 5-6 months. Finally ready to step back into the show ring again, we made it to a couple of shows before the uneveness came back. We recently did the coritcalsteroid injection again and he was doing better, until he wasn’t… I’m at a loss for what to do next and just wondering if anyone else has experienced/dealt with the lamness that comes from chronic issue. Not ready to give up yet
How challenging - I am so sorry that you are going through this.
Was the “deeper steroid injection” actually into the facet joints themselves? Do the vets suspect facet disease/arthritic changes in the vertebrae? I had a horse in training that displayed an intermittently uneven gait due to facet disease that was causing some spinal cord compression. This was diagnosed via radiographs and a subsequent myelogram.
Electro-stim acupuncture has helped this horse immensely, and is a non-invasive and fairly inexpensive option that may be worth exploring.
Here is a well-written article discussing neck injuries/arthritis: http://horseandrider.com/health/pain-neck-53421
What do the neck Xrays look like? I can’t really tell what you’ve diagnosed or injected.
Agree with IPEsq–tough to really understand what your diagnosis or treatment has been from your post.
I can tell you that I got 6 GREAT months when we injected the facets at C6/C7, but when that round wore off and we did it again, I only got a few weeks before symptoms returned. I retired the horse at that point. Thankfully, she’s not progressed at all, but she’s definitely not normal neurologically. She doesn’t swing evenly from behind and there are some apparent proprioception issues with her hind limbs.
Hi LuckyStars, IPEsq, and Simkie! Thank you for your responses. I am new to this forum and wasn’t sure what to expect.
The neck x-rays don’t show anything, we also did MRI and Bonescans with no conclusive results that hinted towards any specific type of injury (how frustrating right!?) I’ve also never heard my vet mention any type of joint or arthrtic disease … the way he was limping was the only determining factor that he was lame from the neck. We blocked his legs all the way up (stopping at each joint) and he never went 100% sound.
LuckyStars - all steroid injections have been directly into the facet joint, C4, C5, C6. Electrostem Acupuncture is an area I have yet to explore, thank you for the suggestion!
Simkie - Sorry to hear you have experienced similar issues… its tough! We did also get a great 6 months after the first facet treatment. 4 weeks ago we did a second round of facet joint treatment and he seemed to be doing so well untill yesterday. He just appears uneven and is close to the border of what would be deemed “sound” in the show ring. I did have the chriopractor out today and he seems to respond well to that type of treatment.
I guess anything to do with the facets will continue to just be a chronic problem that we have to deal with, does that sound right?
Yes, generally the problem is arthritis of the facet joints. Sometimes you can have other joint problems like OCD (which my boy has). The arthritis can be developmental, age related, or a result of something like a former fracture. But, you can see all of that on X-ray and ultrasound, especially at the locations you’ve identified. You can also have congenital or degenerative narrowing of the spinal canal, which can be seen on Xray, but it’s hard to say except for extreme cases whether or not you’d have spinal cord impingement without a myelogram. It sounds to me that if a specialist thought you needed to inject the neck at 2 or 3 sites (the facet joints are described by the two vertebrae they connect, so described as the joint at C3-4, 4-5, 5-6, etc.), then you’d have gotten a definitive diagnosis of some kind of pathology in that area.
Did you do the injections bilaterally?
Unfortunately, as with Simkie’s horse, injections don’t always work when the issue is pathology at the facet joint. Acupuncture and other therapies can help the horse maintain range of motion in the neck and to not have as much muscle pain, etc., but they are not very likely to improve the gait deficits you are seeing if the direct joint injections did not. Sorry for the bad news. I feel your pain…I anticipate a similar situation is what’s going to make me retire my horse one day.
IPEsq - The injections were done bilaterally.
I have a couple of questions… what does OCD stand for?
Also, can you help clarify what “pathology at the facet joint” means, are you just talking about some type of inflammation or irritation of the area?
OCD, Osteochondro??? Dessecans? Google OCD in horses, pops right up. It can be managed, occasionally a lesion can removed, like in a hock, but usually not cured. Degenerative joint condition is the For Dummies definition. My last horse had it in the hocks but it was never that big an issue. Fusing hocks and regular arthritic changes caused more trouble. Most of what you’ll find on OCD is hocks and stifles.
We’ve only just been able to look inside the neck and it’s very much still an evolving specialty.
http://lmgtfy.com/?q=ocd+horses , right?
@hunterjumper2213 have you considered a myelogram?
OP - Did the vet look for evidence of narrowing in the spinal column in the x-rays? Might be worth getting a second person to take a look at those radiographs.
I have had two horses with neck issues so I definitely feel for you. One was fairly functional, except that he would get a stabby gait in front. And he stumbled really badly. This went away with neck injections. I got one fairly good year, but not jumping, then a meh year after the second injections, and then I retired him. At 14 y.o.
The other one’s cervical narrowing caused a bunch of problems (do a search on my name and cervical arthritis) to the point that he became unrideable and did not have a good prognosis for a good quality of life. I had him euthanized shortly after his seventh birthday.
Findeight, OCD =/= DJD. It’s now thought to be congenital like OCDs in any joint (so, it’s developmental orthopedic disease (DOD) not DJD). Osteoarthritis on the other hand is one kind of degenerative joint disease. OCD in humans on the other hand can be congenital or the result of acute trauma…ask me how I know
OP, by pathology of the articular facet joint, I mean some kind of pathological problem like a osteochondral lesion, osteoarthritis, enlargement of the joint, remodeling due to previous trauma (like a fracture), narrowing of the spinal canal, etc.
If the spinal cord is not impinged, inflammation from cervical spine problems can also cause nerve root issues, which can also lead to gait abnormalities. Although, we can only do so much to see if there’s compression. Even with a myelogram, because the horse is laid down under anesthesia, there’s only so many positions you can put the neck in to check for impingement versus the dynamics of full movement. There’s some testing you can do for nerve root function (such as, applying sensors to the nerve roots in the shoulders), but if you can’t get the horse sound with treatment of the underlying inflammation caused by whatever joint pathology the horse has, then there’s not a lot you can really do with that information, because it doesn’t help the horse get sound enough for the show ring even if it means she’s sound enough or in enough control to be safe to ride.