Vet-stumping mystery lameness

[omgtb]

Video

Okay… so this is the video

To me, it looks like the head bob is associated with the moment the RF pastern flexes toward the ground, so I could believe it was a soft tissue thing (and am already treating him that way, as well).

For the record–this is a horse that normally swings big from his shoulder, though, so the stride on the RF shoulder is almost non-existent compared to what he would normally do. He’s a lovely, floaty mover with a wonderful topline and lots of shoulder freedom. To see him go this way is heartbreaking.

As someone else said, I don’t expect injectables or oral supps to keep him young forever. I know Adequan’s intended uses… though they did actually do some studies that showed it was the only thing that did reverse arthritic changes, to some degree, and inhibit progression, to another, but I use it as a supportive therapy as part of my efforts to ease the passage of time.

[soloudinhere]

It would be extremely easy to eliminate the soft tissue/pastern issue from contention with blocking. And not that expensive.

[snowrider]

I’d suspect high suspensory based on that video.

[soloudinhere]

[QUOTE=snowrider;8626845]
I’d suspect high suspensory based on that video.[/QUOTE]

I just watched this and I’d agree.

[findeight]

Ditto simple blocking to isolate the actual source(s). Then you can know where to direct the diagnostics and not have to do the whole horse ground up. Not that expensive even if you don’t get lucky and block sound low. Takes the guess work out of it.

[omgtb]

Well, on the plus side (if there is one) he actually did follow protocol that he’d have had to follow for a high suspensory injury because he was on stall rest for almost a month, with hand walking, due to staples and inclement weather. Since then he has been doing rehab work limited to walking and trotting. He’s been on limited TO for the past two months for other reasons. It sort of sucks that we are moving right now, but that is definitely happening, no matter what, since it’s for his retirement, anyway, basically. Retirement here means retirement to trail rides (if he’s sound for them) and a life of leisure as he was already retired from jumping as of last May–to preserve him into his later years, given his history of tendon issues. Considering that he hasn’t been doing any hard work or jumping for the past year, it seems a bit unfair (I know. That’s life, and life with horses doubly so) that he’d have incurred a suspensory injury now, but it would have been taking more weight to protect the LF, so makes sense, I suppose.

Now that I think about it, I might say I felt some slight warmth and a tiny bit of swelling on the inside of the RF ankle–it was barely noticeable, but would make sense if it was a branch injury.

I will definitely have him worked up, and will rest him until that happens. I really don’t want to keep him inside though, because of the associated problems he has with that. He goes out alone and this is several months after the original injury. I certainly don’t want to keep him on stall rest before loading him in a trailer and moving him somewhere new so he does something stupid and hurts himself more. He will be isolated at the new place initially, anyway, and there’s the option to keep him in a small paddock so he might just have to hang out there longer. I guess I will just try to find a supportive balance and continue with the various therapies until I can get the vet out. Hopefully next week. I’m basically going to act like everything on him is broken or torn until then. Wrapping and poulticing the fronts certainly won’t hurt. Laser, magnetic boots, and possibly also ultrasound therapy (US after definitive diagnosis). Thanks to his history of injuries, I at least have a good arsenal for treatment.

[findeight]

Don’t see why he can’t go out…plus if it is a suspensory, the treatment is pretty much the same, extended rest, most don’t do too much actual stall rest unless it’s torn and the horse acts like a dink if turned out. Pay hundreds to be told extended rest or put him on extended rest.

My impression from the video is he’s pretty sore up front, looks like low to me, and he is also moving irregularly behind. Might be related, might be two different issues. IME compensatory lameness is not as pronounced as this is presenting.

I once had a filly with a shoulder injury, we didn’t have the diagnostics back then but it was deemed a Sweeny and was career ending. Sore as she was, she didn’t have that ouchy head bob this one does which is why I suspect something else might be going on lower. My filly sort of dropped the whole front quarter and rolled over the shoulder. No head bob. Just an observation based on my bad experience,

[ElementFarm]

I hope it’s an easily rehabbed suspensory!
Many years ago we had a lovely WB mare who came in a little sore from turnout one day. Next day was sound at walk, but a little sore at trot. Got off, gave her a cold hose and a few days off riding, but with limited turnout, since she was sound at the walk and wasn’t the type to play. 3 days later, still absolutely weight bearing/sound at walk, but off at trot. No sign of heat, swelling, or surface injury on shoulder or anywhere on the leg. Vet came out, thought she’d tweaked something, recommended stall rest for a week. After the week, she was still lame at trot so got full workup. Turned out she’d fractured her shoulder – not badly but more like a small crack. Vet thought the injury was treatable. We did 5 mos of stall rest and whatever meds vet prescribed. After 5 months, xrays showed no real improvement or healing and she was PTS. sorry that’s not a happy ending story.

[SidesaddleRider]

Yes, looks like a suspensory to me as well. I would block it (can’t believe your vet didn’t do that), and then depending on those results ultrasound it and see how much irregularity there is.

[IPEsq]

[QUOTE=findeight;8627076]
Don’t see why he can’t go out…plus if it is a suspensory, the treatment is pretty much the same, extended rest, most don’t do too much actual stall rest unless it’s torn and the horse acts like a dink if turned out. Pay hundreds to be told extended rest or put him on extended rest.

My impression from the video is he’s pretty sore up front, looks like low to me, and he is also moving irregularly behind. Might be related, might be two different issues. IME compensatory lameness is not as pronounced as this is presenting.

I once had a filly with a shoulder injury, we didn’t have the diagnostics back then but it was deemed a Sweeny and was career ending. Sore as she was, she didn’t have that ouchy head bob this one does which is why I suspect something else might be going on lower. My filly sort of dropped the whole front quarter and rolled over the shoulder. No head bob. Just an observation based on my bad experience,[/QUOTE]

I agree LH also NQR…moving irregular behind.

If he does not block sound looking at the lower limb, I’d still have the neck under consideration.

[Risuena]

Either I have acute-onset dyslexia, or this video is showing left front lameness.

And hind end something too, but hard to really see what is going on there until you block out the LF.

[capalypinto]

Looks like a left hind lameness, possibly relating to the stifle.

[omgtb]

Ohhhh I should probably mention that bubble boy has a cut on the soft tissue of the hoof above the coronet band on the left hind–it is healing nicely, but that might be what you are seeing, if you are seeing left hind. He’s very sensitive about it. He’s more reactive to it when it’s wrapped, so I had to leave it open while riding. He gave it to himself with his right hind shoe. I can’t save this horse from himself. He will, at least, not have hind shoes after his next shoeing, so he’s 50% less likely to cut himself with a shoe. He normally goes in hind polos as well but I wanted to get a baseline for what we were looking at.

LF is where the healing bow is, but his difficult direction is absolutely to the right. He almost fell over trying to stay off the right side making that turn in the video. I’d actually feel better if it was LF because that would be most likely related to the bow, but I think we’re looking at something new.

[Okay]

Get someone out there to palpate, flex and block the horse and start with the lame leg, the Left Hind.

[Hunter_Lady]

I had a similar issue with my gelding. NQR in what felt like his right shoulder. Vet told me it was in his hoof and that often what we feel when riding as a shoulder issue is actually coming from the bottom of the leg. Xray showed a DEEEEPPP crack in his bar/abscess. Vet dug it out, we packed it and horse returned to soundness for entire show season. Next year, same thing again. Same diagnosis, same treatment protocol. Hoof held up for another 9 months. Since then, we have done IRAP on his coffin and he is SPLENDIDLY sound. Almost “too” sound! They are now calling it septic pedal osteitis but, it is VERY well managed now.

[findeight]

IME, when you see irregularity in gait behind, it’s not low but something higher. I doubt a coronet cut is creating the uneven movement everybody is seeing behind. If it’s low, they move really wonky, often won’t even go forward.

[IPEsq]

I would also not suspect foot area for the hind end problem as shown on that video. Nor would I be considering a maybe warmish lower front fetlock when the comments are high suspensory injury. I’m not sure you are hearing the feedback, OP?

[capalypinto]

Check left stifle.

[omgtb]

So, this is the fun and peril of the internet. Yes, I am hearing the feedback, but the options range from neck, to high suspensory, to left front, to left hind.

This is why I asked–to hear the different stories and try to compare experiences to what I am seeing in this horse. Everyone sees something different, everyone has different experiences and it’s good to hear different anecdotes.

Based on subtle signs leading up to his pronounced lameness and his way of going under saddle (hiking the shoulder), there’s a good chance this is coming from the withers/neck area.

He’ll have a lameness workup and a neck/withers x-ray to rule that out first, before blocking anything else. Of course the vet will watch him go before doing anything. The left hind really is irregular from the cut–he’s a huge baby, and the cut was deep–it caused inflammation in the hoof.

As I mentioned, he does have stifle issues when he’s not fit, and we haven’t been able to get him fit because he’s been off. So there is some irregularity behind, but it’s not what is causing his current major issue. This is a horse with a lot of issues, and they are all constantly being managed, but we have to address them as they come up and focus on the most prominent ones. Right now he has an acute problem on top of his chronic problems.

I’m taking all of the feedback into consideration, but I also have to go with what I’m seeing firsthand and what I know about how he goes and how he feels under saddle, in conjunction with other evidence and his history. As much as I’d like to point to something based on majority vote and say “that’s it,” it’s a process, and it only makes sense to reduce the possibilities before throwing a bunch of tests at him.

The other unusual thing that has cropped up is two vertical lines of white hair on the back of his right front tendon–RF is the cannon bone he was kicked in recently. They appeared well after he was healed, and he was lame before he was kicked in the RF.

His legs have been cold and tight and he stands square up front. I don’t think it’s soft tissue.

Currently, he’s being rested, lasered, massaged and the vet will be out within the next 10 days to do a workup. That will at least rule out some major areas as suspects and hopefully get us some results.

[omgtb]

In case anyone is still following this–the vet came back and did a lameness exam yesterday.

Jogged straight on a hard surface, lunged, and went under saddle.

Previously, as in the video, he had a hard time turning to the right.

On the straight and on the lunge line, the vet felt she saw LF and possibly also LH (remembering here that his hind end issues are chronic and exacerbated by being out of work).

Lameness was more pronounced to the right on the lunge line on the first few passes, then as he warmed up, it almost disappeared, even to the right.

We then had him go US, and he was not terrible, a little uncomfortable, but the same rigid resistance to making a smaller circle that he had to the right in the video, but this time turning to the left. He didn’t want to bend right, but didn’t have that rigid, full-body resistance that he’d had before.

Because he was so back and forth, but just kind of NQR on the right side with visible lameness on the left side, we are starting with consideration of the LF foot/pastern.

However, because he is moving, now in 2 weeks and is not in dire straits, we are going to wait to do a trial where he works for 10 days on bute, basically to see if it gets better or worse. I’m kind of against heavy bute use, especially after a big move, so I might try it with just a Devil’s Claw/Yucca supplement until he’s settled and then, depending on how he improves from more (calm) turnout, see if the bute is needed. Vet’s logic is see if it gets better from anti-inflammatories and fitness, or see if it gets worse (and is therefor easier to diagnose). I’m only okay with that notion because he’s being conservatively managed already, and more time off until the move can only help him. I want to keep his stress level as low as possible for now.

It’s weird to me that the stiffness was on the complete opposite side this time. Vet feels there are two legs implicated, but it’s hard to say what the source is when his hind end is so unfit, knowing that it affects his way of going.

I’ll be lasering basically his entire body until the move, and focusing on the LF pastern, whether its compensatory or whether it’s the source, I’ve been kind of ignoring the left side and focusing on the right with the laser, which may also explain why the left side seemed worse this time.

It’s super helpful that the lameness seems to wander and wax and wane. Really makes diagnosing easy.

I’ve been told that he still gallops around the field top speed with his tail in the air, so, it must not be too awful. Maybe his way of telling me to lose a few more pounds.

Someone here did see LF, and someone else saw LH, I believe, so maybe you guys have a more subtle/predictive eye than us!