Stifle issues, vet and owner both baffled!

Hi all,

This is my first time posting here, and this is going to be a long one (sorry in advance!) but I am nearly at my wits end at this point and have found excellent information, tips, and advice here in the past, so decided I would give it a shot. If you’re up for a long read about intermittent stifle lameness and different treatments that should be working but aren’t, read on!

(Perhaps some helpful background info: this post is about my 4 year old reining horse who competes at the AQHA and NRHA levels. She lives with my trainer and is ridden 5 days/week. She gets daily individual turnout and is also walked on a hot walker for ~1 hour per day.) The issues first presented upon arrival home to our barn after a 4 day long show about 6 hours away from home. The horse was perfectly sound up until the show, showed great and never took a lame step. Got on the trailer and came home. Had one day off (Monday) and the following day rode in a lesson (Tuesday) and was still sound. On Wednesday, the horse was off at the trot and canter in both directions and was given 4 days off work.

After those initial days off there was no change in lameness. Vet was called, horse was flexed and vet confirmed stifle was the area of concern, worse on the left leg than the right but showing signs of lameness in both hind legs. Radiorgraphs were taken on both stifles, no lesions or OCD’s were found, no bone chips or any other factors of concern - clean joints. Horse was injected (large stifle joint only) on both sides. After 3-5 days of stall rest she was slowly returned to full workload over the course of three weeks. By the end of the three week period she seemed improved but still not back to 100% - for the majority of every ride she would go around just fine, but then out of nowhere take 2-3 bad steps. She also wasn’t turning around quite the same, just felt uncomfortable and like she wasn’t using herself correctly. Vet was called again, she watched the horse under saddle and also flexed the horse again and determined she was still positive 2/5 after flexion. From watching her under saddle the vet advised that this was probably UFP (intermittent upward fixation of the patella) and both stifles were internally blistered. Horse was given the rest of the day off, but was then put back into normal work (as is common procedure with stifle blistering).

After two weeks, little improvement was seen. Now instead of only taking a few bad steps during a ride, she will begin the ride at the jog looking almost completely crippled, sort of hopping on the hind end and not wanting to bear much weight. After a lap around the ring she is back to jogging like normal. However, every now and then she will take 6-8 strides where she looks completely crippled again, and you can almost see where the joint just sort of looks like it locks up. These bouts come out of nowhere and are not predictable - they don’t happen when going into a corner, or a spot where the footing might be deeper, or follow any similar predictable pattern. The come completely out of nowhere and then vanish again, and the horse goes back to jogging around very normally. Again, vet came out, watched her work, flexed, and this time recommended shockwave treatment instead of blistering again right away (shockwave treatment can provide similar results to blistering but on a smaller scale). Again, one day of stall rest followed by a return to normal work.

After another week and a half, little improvement was seen and the same symptoms persist under saddle. Vet is out again. The vet is slightly perplexed because the normal courses of treatment that usually work for these symptoms are not working on this particular horse. We take radiographs of the hocks just to rule out any issues, and both limbs are perfectly clean. She decides that since the most improvement was seen after the first round of injections (not the internal blistering injections) that we should re-inject the stifles, this time doing both the large joint and the small joint on both legs. Horse is given three rest days and then slowly brought back into work. After day 4 or work, vet returns to watch horse under saddle and flex and is happy with some improvements in the horses way of going. After another 4 days the vet returns, notices little improvement but since not even a full week has passed decides not to treat anything more and wait until the following week to come back and re-assess. I was just out to ride yesterday (4 days after vet had been there last) and the horse is still on and off uncomfortable under saddle (only rode for 10 minutes max.) but still unpredictably so. She will start out looking slightly off at the jog, go into the lope and take a few bad steps but then lope around just fine. After switching directions she will look great at the jog but then going into the lope looking lame again.

So I guess I’m just looking for ideas or input if anyone might have any. My next steps from here will probably include trailering to our state clinic and consulting with a lameness specialist. We have not done ultrasounds of the ligaments because the vet did not feel they were necessary - if it were an injury to a ligament the likelihood that it would happen simultaneously in both limbs is very low. I also asked if perhaps this was an SI issue manifesting as a stifle issue, to which the vet said that the type of movement with the intermittent hopping on the hind end that suddenly clears up and the resurfaces isn’t consistent with SI pain and more clearly points to a locking stifle/patella. I just wish we had a bone chip or something that would show up on a radiograph to point to as the cause of all these issues, but this far there hasn’t been anything we can pinpoint that would have caused the lameness.

Thank you to those of you who read that entire novel!

:eek: ummm new vet

Take your horse to a specialist.

After all this time and no real diagnostic and/or improvement, your horse is in real need of a specialist who will ultrasound for ligament/soft tissue injuries.
Seriously, if x-rays were normal, the next steps should have been ultrasound.

ETA: Maybe some stall rest good be good, or at least stop the training until further diagnostic.

If it is stifle, I don’t think you want to do stall rest. Sounds like it’s time for some more diagnostics at the clinic. There are other treatment options if it’s upward fixation, from really invasive (surgical) to not so invasive (Esterone injections). More imaging is probably in order first.

“probably UFP” got me… say what? It is or it isn’t. Not probably! It’s pretty obvious when UPF happens… even my non-horsey SO was able to spot it on one of the horses at the barn I used to work at…

New vet!

Also… western saddle… I’d be making sure it isn’t hurting her.

Sounds like it’s time to ultrasound the stifle, not x-ray. Wouldn’t be surprised to see some sort of medial tear given the way you describe her discomfort. I HAVE seen it be bilateral.

P.S definitely agree if it is stifle you do not want to be doing stall rest… full T/O with hill work/conditioning regime works best for these horses… and estrone… BTDT estrone made the world of a difference.

What kind of vet is your vet? i.e. specialist or regular farm vet? I always start with my farm vet, but if I can’t get answers after 2 appts, I go to specialist (sports medicine, lameness). I certainly would get a 2nd opinion and in the meantime, don’t ride. I know it’s hard- my 5 yr old just had his R stifle injected too and I’m waiting to see how he responds. Stifles sometimes do not respond well to treatment but it sounds like you haven’t definitively determined if this is UPF or not yet.

Is the horse insured? Obviously, that helps set a budget for how far you will go with diagnostics and treatment. I would be inclined to look at fetlock and pastern in order to rule issues there in/out. Also I would confirm SI via better palpation and exam by specialist to be certain as pain can present vague confusing symptoms.

I guess you could always rule out Lymes too, to be on safe side. Does she have exposure for it?

Have hoof/feet issues been ruled out/ hoof tested?

Thank you all for your responses. From the resounding amount of “find a new vet” replies, I guess I’ll be taking her down to our state university as soon as I can get an appointment.

@IPEsq - I agree with you about the stall rest. My trainer was out of town for a 6 day show (NRBC) and during that time the horse only got daily turnout and was on the hot walker, and seemed to actually get worse when she wasn’t being worked.

@TWH Girl - the vet is just an equine vet - not a specialist in lameness - however she is the vet that works exclusively for my trainers barn and works on all the reiners there. She has a lot of experience working on these horses which is why I had trusted her expertise thus far. Also yes, my horse is fully insured for major medical. I have already spoken with an adjuster about making a claim, although this is the first time I’ve had to make a claim on a policy, so I’m not sure how it will work out with continued treatment. Hooves have been ruled out by our farrier and the vet as well with a hoof tester, but no radiographs taken of that area. Lymes test is a great idea. It is prominent in our area, however her turnout is on dry lot only so I hadn’t really considered it.

A 4yo who’s already competing, and is now sore, I would put her out to pasture until the Spring. Maybe some light riding - for fun, not conditioning - a few times a week after 1-2 months of no work, but nothing more than that.

I don’t disagree that ultrasounds could be helpful. Given the (seemingly) bilateral nature of things, she just may be flat out deeply sore.

hind suspensories and a new vet

I just went through stifle issues with my big WB g, vet did not radiograph them but US both stifles. He had synovitis both stifles, was injected and recommended adequan which I am finishing up now. Much better but he was never lame working was mildly + to flexions and sore in his low back due to compensation.

Hope you can get some answers.

My horse had very mild lameness that was isolated to the stifle. Xrays were clear, ultrasound looked fine. First we injected the stifle and things went almost back to normal but it was short lived. Then we rested for six weeks while doing a series of IRAP injections. Horse felt fabulous the first few days in walk work after IRAP, but then mildly off again after adding a few minutes of trot work. We finally wound up doing exploratory arthroscopic surgery and a torn meniscus in the stifle was found. These often do not have a good outcome as far as returning to work.

Have you looked at pssm at all? My stock horse had what looked like stifle issues but irregular and random, it was around the time that he’d already been diagnosed, I was just still waiting for his supplements to come in when the lameness started up. My horse had many of the other symptoms, but many have mostly just weird hind leg lameness

I was wondering the same thing myself. Also, I normally agree with JB, and she may be right. However, I would want a diagnosis before I turned said horse back out. If it’s an injury, it will need to be rehabbed, if it’s just plain sore, then fine. With regard to the insurance as well, you need to follow things through. They will pay for this ONE time and then exclude body parts. Spend their money now to find out exactly what’s going on…my 2cents worth. :wink:

These are all really great suggestions. I’ll have them send out the test for PSSM and do bloodwork for Lymes as well. I’ve seen a horse that had EPM and had very strange hind end issues, although his was far more severe. Would that be something to ask about? I’m afraid I don’t know much about EPM but it had crossed my mind after reading some of these alternative ideas…

I am certainly not opposed to turning her out, but as Dune said, would much rather have a real diagnosis first. After that, if turnout is the best option, she can stay in the pasture for as long as she needs to. Missing one year of showing isn’t nearly as important to me as her long-term soundness. Again, a trip to our state specialist is in order…

@Dune - thank you for the tip about the insurance, too! I plan to follow this through to whatever end may come, hopefully all on their dime :wink: After all, that’s why I pay for it!

[QUOTE=london115;8252550]These are all really great suggestions. I’ll have them send out the test for PSSM and do bloodwork for Lymes as well. I’ve seen a horse that had EPM and had very strange hind end issues, although his was far more severe. Would that be something to ask about? I’m afraid I don’t know much about EPM but it had crossed my mind after reading some of these alternative ideas…

I am certainly not opposed to turning her out, but as Dune said, would much rather have a real diagnosis first. After that, if turnout is the best option, she can stay in the pasture for as long as she needs to. Missing one year of showing isn’t nearly as important to me as her long-term soundness. Again, a trip to our state specialist is in order…

@Dune - thank you for the tip about the insurance, too! I plan to follow this through to whatever end may come, hopefully all on their dime :wink: After all, that’s why I pay for it![/QUOTE]

You’re welcome! :slight_smile: You’re right on point! Keep us posted with the outcome, will you please?

I will update this thread with results as they become available! Our local vet did send in a referral. She is drawing blood to send out for the Lyme test today. Monday morning the horse leaves for the sports medicine clinic (Merritt & Associates in Illinois if anyone is familiar) for a better diagnosis. I’m very much looking forward to getting this thing figured out! Thanks again everyone for your input!

Any progress?

Interesting thread and I would love to hear an update if available :slight_smile:

I would definitely go with ultrasounding it…we had one Reiner tear his co-lateral. Another was diagnosed with a stifle injury by two prominent vets in Oklahoma,
Come to find out after we brought him back to PA to our vet…it was a fractured ankle…hum, only three feet off guys. ?? had it been properly diagnosed the day he came up lame, our vet has no doubt he could have made a full recovery. Instead, $5,000 in surgery to make him breeding sound. Don’t be afraid to get a second opinion if it’s not making sense!

I am appalled that your vet did any kind of treatment without an ultrasound. Soft tissue injuries don’t show up on radiographs! My horse had a similar issue and wound up being diagnosed with a torn meniscus. It’s apparently most common in reining horses - we are an oddity. I’d definitely look into that before upward fixation of the patella.

Be sure and check out neck injuries. The fact that the problem is bilateral could be pointing to that.