Wondering how I should proceed with the following scenario:
Horse is half canadien/half hannoverian, 12 years old, gelding, used for lower level dressage, bred and owned by myself so well aware of his history which is as follows:
Jan 2015 - I had Vet A out to do a lameness exam as I was about to start training him harder and wanted to make sure that he was good to go so to speak. Results were: horse moved freely when lunged on indoor surface but does not have a forward extended gait on the forehand, on the pavement horse moved freely and soundly with similar gait to the indoor footing, i suspect the lack of forelimb extension/animation is related to breed (Canadian horse x WB) hind limb flexions RH very subtle shorter extension for 5 steps not likely clinically significant, do not suspect any soundness issues at this time.
Feb 2015 - History: got his right hind leg stuck in a fence a couple of days ago - mild swelling, slightly off on this limb. He is in heavy training at this time, and generally has been doing well.
Exam:
Mild RH fetlock joint effusion compared to LH.
Trot straight line hard ground: Grade 1/5 RH lameness
RH distal limb flexion: mild positive
Radiographs: RH fetlock - no significant abnormalities
Plan: discussed that kick a few days ago may have exacerbated an underlying synovitis.
Advised to continue poulticing/wrapping for a few more days and fetlock joint injection.
May 2015 - Horse got mildly better after last injection but no big change and seemed to warm up out of the lameness like usual up until 2 weeks ago, now the horse isn’t warming up as quick and is more sore than usual RH on the L circle
Exam. 1/5 lame RH seem best L circle soft ground, horse starts out worse but does warm
up to inconsistent RH lameness marked shortening of the anterior phase stride, degree of
lameness doesn’t change on hard or soft ground , maybe slightly better on hard ground,
hoof testers negative, flexions mild positive distal limb, mild positive proximal limb, to
palpable abnormalities, back palpates normal, no fetlock joint effusion,
Low 4 point block no change after 20 mins
High suspensory block sound within 5 mins to the L circle, R circle now 1/5 lame on LH,
Completed rads of RH hock, ultrasound and hock injections. He was barefoot and we put full set of shoes on after this.
Ultrasound showed enlarged proximal suspensory of LH when compared to the R areas of hypoecogenicity in the area of the high suspensory, not associated with an acute tear, from chronic wear and tear, the L one also seems mildly enlarge, there are some ocios changes on theRH MT3, the finding on u/s are simliar to chronic suspensory desmitis.
Aug 2015 - Took him to Vet B who had a Lameness Locator and is our leg guru in my area.
RF and RH showed moderate lameness. During the flexion part, the comment was RH pushoff and impact going left. LH pushoff and RH impact going right. RF most likely referral from the hind. Nerve block of the RH Prox suspensory had 100% improvement, but then the RF was primary and getting worse the more he worked. We ultrasounded the RH and found the following: Stifle - elevated protuberance of the femoral condyle with small amount of synovitis but a thickened joint capsule. Suspensory - mild heterogenous pattern in the suspensory body proximally and some irregularity at the junction of the medial splint bone proximally.
Because there is some arthritic changes in the fetlock and hock, we decided on Previcox and then re evaluating.
Sept 2015 - Lameness Locator and vet deduced sound on all 4 limbs. Started rehab at this point.
During the next 4 years he went really well at First and then Second Level, scoring high 60’s and sometimes into the low 70’s. I did receive one comment about his trot extension having “uneven strides” however never anything stating he was lame (otherwise i would have stopped immediately). He has remained on Previcox. I did inject his stifles in 2017 when I found he was struggling with “sitting” more in the collected canter, and found he sometimes tripped behind with the RH during the extended trot. The injections definitely helped. The following year I decided to try injecting the hocks instead to see if we could get more “sit”. Did not see much difference in the way he went. 2019 I didnt do much with him as I was busy with work so rode less and asked less of him.
Forward to now - I have an amazing leasor that would like to buy him however we both wanted to look into how his hind legs were faring.
We took him off the Previcox for a few days prior to the appointment. The lameness locator showed mild RF pushoff lameness persisting throughout the exam. Radiographs of the fetlock pastern region did not show significant abnormalities.
We followed up with an appointment today with the thought in mind of blocking the hoof and xraying that area. The block was negative. We then thought suspensory, block was negative however. We blocked fetlock - also negative. Ended up ultrasounding elbow and found excessive fluid towards the front of the joint, shoulder (and i apologize i dont have these reports in front of me) showed some uneven/bumpy looking bone.
So very long post!! The vet is now recommending xray of the elbow and potentially shoulder region. This horse does not look lame! He has the very slightest head bob that you have to be zeroed in on to even see.
My one and only question - For a lower level dressage horse that won’t be going any higher than schooling third - should we continue down the rabbit hole or leave well enough alone until he is “actually” lame?
Any insight, ideas, thoughts welcome at this point…lol.
