UPDATE Another neck thread, (maybe?) time to call it?

[clburnham11]

@dmveventer he is out in a group of 3 in the daytime in a pasture and alone in a smaller paddock next to another horse overnight. I do feel like he hates being alone, but he also hates being stalled so I’m not sure which is worse it’s tough in the winter since most people want their horse inside overnight, warmer months he should be with a group all the time. I tend to lean towards out is better, but he’s been a bit stressed at night if he can’t see the other horse so I’m not so sure anymore. Or is he stressed due to neck pain? Feel like I’m going crazy, lmao

I agree; I’m going to go ahead with the x rays and see what we have. Lots to try with blanketing as well!

[Simkie]

@clburnham11

I do feel like he hates being alone, but he also hates being stalled so I’m not sure which is worse

Oh hooray this is an excellent excuse to buy another horse. You know, a pet for this guy.

[clburnham11]

@Simkie oh god don’t get me started! Though I think this has made me clinically insane already so ¯_(ツ)_/¯

[Simkie]

I mean you could be “reasonable” and just buy him a goat friend

[clburnham11]

Finally had another exam today and as many views of the neck as we could. Waiting on the radiologist review but no abnormalities noted yet… heard back from Pam with eqsoma and she doesn’t see ecvm but thinks he may have issues in the first ribs. Unable to get views of those without shipping to hospital which unfortunately might be out of my budget.

1/5 lame on right front that resolves after a few circles on the lunge line. generally grumpy and impatient today. Canter looks awful- very “flat” but has an incredible walk. Total dysfunction in the thoracic sling. Completely unable/unwilling to move his shoulders when prompted from the right. Left was fine.
.5/5 neuro-all was good until she crossed his hinds. He was very slow to correct.

My vet wants to do a pain trial for 2 weeks— gabapentin, dex, and robaxin. Reevaluate and then inject the neck. If no improvement, ship to clinic for more imaging (or retire). I’m not very hopeful these methods will help, especially if he does have the first rib malformation. Is there anything else I’m missing? Pssm crossed my mind but I don’t think it would present so assymetrical? His issues are really ALL focused in the thoracic sling area. Stark difference between the right and left. I’m honestly shocked we didn’t find glaring issues in the neck x rays today but maybe the radiologist will have more input.

As always so grateful for any thoughts and I hope this helps someone else one day!

[Arelle]

Just read your update - hadn’t seen this thread previously, but everything to me was screaming PSSM.

I’m no vet, but would a neck issue be present in the front but not the hind? In stock breed circles, we’ve seen an uptick over the last few years of wobblers and cervical compression - but it’s been more symmetrical in it’s presentation.

There’s a pretty large PSSM group on Facebook if it might help: https://www.facebook.com/groups/202978353056065 Some folks, obviously, are wacky - but it’s a good resource from a search functionality.

This is also a case where I might be tempted to make a post on the Horse Vet Corner on Facebook: https://www.facebook.com/groups/277077519400687 That group, in general, is a show (“a tree branch impaled my horse in the face six weeks ago, do you think i should call a vet?” /s)… but I’ve had some friends post exploratory issues like this where there’s a lot of data and need a bit of brainstorming for outside of the box solutions. Only verified DVMs from across the country are allowed to respond and they usually can come up with some alternative ideas.

Best of luck!

[clburnham11]

@Arelle appreciate your response! My vet thinks the right front issues are related to the neck area somehow, we just might need more advanced imaging unfortunately. Thinking potentially first rib issue that we couldn’t see in the field.

Pssm has been in and out of my mind for 2 years now! I have a lot to learn, thanks for the fb group idea. I definitely like hearing real life experiences and think I’m ok at weeding out the crazy, lol. Maybe I will write up a post for the vet corner group too. Alternative ideas would definitely be welcome… thanks again!

[Arelle]

No worries! The biggest issue with the neck is that it is notoriously very difficult to image and even if something is “ruled out”, I tend to question if it really was or if it was just missed or in an area that can’t be easily seen on x-ray.

I have a horse that I swear fractured her neck last year. Vets did not see anything, but I’d bet my salary on it based on the clinical signs then and the recovery she’s made now.

I also have a girlfriend whose horse was euthanized this summer after breaking her neck in the field. Vets at Texas A&M missed it for two days before discovering it. (https://www.facebook.com/share/p/1E8CxjLN9R/?mibextid=wwXIfr )

[clburnham11]

I have wondered the same thing, especially after his films yesterday looking ok. I’m like, should I ultrasound? I’m so hesitant to move on and feel like its “all clear”. There is so much dysfunction in the thoracic sling and he literally cannot move his front legs/shoulders to the left when asked. Hes so guarded and irritable about me being near the neck. That can’t be just poor muscle development. WHY is there poor muscle development and dysfunction, and is there anything we can actually do about it?

I’ll definitely check out that fb group and see what can be learned! It is always so helpful to hear real life experiences

[Arelle]

I did an MRI in 2022 for a horse with a mystery lameness - he’d be fine -ish but when we’d show on concrete for 2+ days he’d be lame.

X-Rays and Ultrasounds showed nothing. MRI was finally able to diagnose a DDFT tear deep in the hoof capsule we never would’ve seen otherwise.

I wonder if you could find a standing MRI, depending on cost/finances. It may be worth it, even if it’s more expensive up front, versus continuing to try to find various things and coming up empty handed.

[IPEsq]

You can try hitting the nerve roots near T1 with some steroids if you are going to try injections and see if that helps. Radiologist should be able to do it if your vet is not comfortable with that.

[clburnham11]

I truly wish that was in the budget I’m sure that would tell us a lot! I definitely think we’re missing something huge

[clburnham11]

I wondered about that, my vet had said the only neck injections option would be in the facets. I’ll have to ask further questions.

Otherwise, he was absolutely horrible today, even after a few days on gabapentin, robaxin, and a steroid. Lunging left I was actually happy since he looked GREAT compared to how he has- but going right he looked downright crippled and became aggressive. It definitely seems higher up and in the shoulder/neck area. It is SO starkly an issue going right, seemingly made even worse with the meds. I might try some injections as a last ditch effort but then I’m retiring. No option for group turnout here anymore and he’s miserable and I have to move barns anyways. Only ones I can find with group turnout are retirement options. Poor guy!

[IPEsq]

It’s definitely possible and not uncommon to do things besides inject the facet joints. Even if he has nerve pain, sometimes things like methocarbamol actually destabilize them more and it + Gabapentin may not be effective enough for nerve root pain. Feeling less stable can make them explosive or aggressive. As I probably would be too if I felt crippled or highly uncoordinated going one direction and someone made me do it. I’m so sorry.

[clburnham11]

@IPEsq

Even if he has nerve pain, sometimes things like methocarbamol actually destabilize them more and it + Gabapentin may not be effective enough for nerve root pain

that’s exactly what I was thinking, have the meds destabilized his compensatory mechanisms? Useful observation at the very least I am now considering getting him to Rood and Riddle not far from me and see what we can come up with. It would be amazing to have some sort of answer

[Long_Time_Lurker]

If your horse has the 1st rib malformation that would explain EVERYTHING. Unfortunately I had one and we had most of the same symptoms with periods of getting better then worse again. We went through many of the same diagnostics and trials and a few other things as well. It was the left side instead of her right, but otherwise every symptom sounds all too familiar. Got to sort of 3rd level dressage with changes, but could never half pass correctly to the left at trot or canter in spite of lovely half passes right. If we tried to insist she became explosive. Not just with me but also with younger stronger rider who was instructor’s protege. Finally she reared straight up (fortunately did not go over) with the young protege and I said NO MORE. She got a year off and we then tried to bring her back to work. Anything requiring left bend was a no go. More diagnostics at major clinic, and finally the malformation was found. Which of course also ruled out plan B as in broodmare. And I didn’t consider her safe for a novice who wanted to hack lightly with a history of explosive behavior even though it was only occasional and when pressed. So she became an early retiree at age 11, after having been basically NGR since age 7 or 8. And also neurotic and unpredictable to the point of violence when asked to do things it turns out were impossible for her and painful to attempt.

My point with this story is that I think you should check for the malformation, and if he has it that is very bad news and he will never significantly improve and will probably need to retire, but at least you will have a definitive answer rather than be left wondering if he could have had a great career if you had maybe tried one more thing.

[SBrentnall]

If you suspect T1 involvement, I would strongly suggest you do the ECVM x-ray series. There’s a pdf I uploaded here a while ago that details the exact angles. They have to be done at a hospital - portable machines can’t penetrated that area.

[clburnham11]

@SBrentnall

If you suspect T1 involvement, I would strongly suggest you do the ECVM x-ray series. There’s a pdf I uploaded here a while ago that details the exact angles. They have to be done at a hospital - portable machines can’t penetrated that area.

Yes, I am familiar with the protocol and we got some decent lateral and oblique views of c6 c7 that look normal but really need to get to T1. My plan for sure now is to get him to the clinic asap and get those done. I will be floored if we don’t find T1 issues

[clburnham11]

@Long_Time_Lurker

If your horse has the 1st rib malformation that would explain EVERYTHING

As sad as it is your comment is sooo helpful. I have felt so alone in this and sometimes questioning my sanity lol. I really do feel like this is the issue we are facing. It’s become so obvious it’s incredibly one sided. It’s been two years with various vets and trainers telling me he’s fine when I know he’s not fine! My guys sounds so similar to yours, he tries so hard to be good but he does get aggressive when he really just CANT do what we’re asking. I am really hopeful this gives us an answer to everything and he can retire comfortably.

Were you able to diagnose the issue with x ray at the clinic? Or did you do bone scan or mri/ct as well? Was yours missing a rib, or was it like a stub? Very interested to learn more about this condition. Thanks again for your input

[IPEsq]

There are so many different variations of the malformation that can happen. @EmilyM sent me a video from NBC that was very informative about this issue. I think it depends on the horse (their size and what the malformation is, if there) how much you can potentially see on xray versus CT. Some of the interesting things about the CT images is that there can be nerve root impingement on a “normal” side due to how the body has tried to compensate that you can’t see without taking those cross sectional views. Or issues on the abnormal side (if unilateral) due to altered anatomy. The malformation can also affect ribs at T2. If the horse is not large in the depth of their neck, and if you don’t want to do contrast for myelogram, you might be able to see farther back in some CT machines standing.

Also I’m so sorry you have been feeling gaslit by your vet team. I have been there. You aren’t nuts. You know your horse! And these behaviors are not normal for a healthy horse.