Your opinion: Coffin joint injections necessary?

[Doctor_sOrders]

Hi all,
Reaching out to anyone who has experience with injecting their horse’s coffin joint or any vets who may want to chime in.

I had my 14 yo TB checked over yesterday as he is about to start a new job (hopefully A/O jumpers and up) and I want to be sure he is physically able. When flexing RF fetlock, horse was a off a few steps. After watching horse lunge, the vet believed it was more in the horse’s hooves than the fetlock.

We did X-rays on the fetlock and a navicular work up. Fetlock is fine, hooves look good for a 14 yo TB, but vet would like to inject coffin joint. This is the horse’s first ever injection and I am very unfamiliar with the process, especially regarding the coffin joint (never have known anyone to have done this).

I’ve read up on symptoms horses show when they are having problems in the coffin joint. My horse is a bit short strided in front, but he’s been that way the whole time I’ve owned him (over 7 years). Granted, maybe he’s needed to have that area addressed for 7 years. He doesn’t stumble much. No obvious signs of lameness.

Here are the X-rays in question:

https://drive.google.com/folderview?id=0B97zvJ7mDWBda3MyN1ZlcGhiX1U&usp=sharing

My questions are:
1.) How can you tell the coffin joint needs to be injected?
2.) What does a normal coffin joint (one not needing injections) look like?
3.) Does this horse look like a candidate that would benefit from coffin joint injections?
4.) Should I start him in his new job (just getting our flatwork refined now and jumping very minimally) and make a call if things seem different a few months down the road?
5.) Is this something that is bad enough to resolve before I even ask him to jump much more?

Thanks for your advice! I’m definitely a newbie to injections.

[beowulf]

was there effusion in the joints? why did he inject? just to help ‘oil’ up those old creaky bones?

did he inject the navicular bursa? or is it what is on the table?

14 is about the age that seriously campaigned horses can benefit from injections, if they are done for the right reasons.

in my experience, which i’ve had plenty of it, the injection makes them move much better for a short time, but does nothing to solve the issue – and after the initial period wears off you have to inject much more frequently. with most of the horses i’ve seen injected they need to be reinjected far more often than if it was a hock injection, etc. one horse in particular i knew the owners would inject almost every four months… just to keep him servicably sound… horse definitely had something else going on but they never really bothered to investigate it. for what it was worth, that horse had some horribly balanced feet - big dinnerplate feet that were very long up front.

i would dig my heels in the sand if coffin joint injections were on the table. i would need a very good reason, as seen on films, to do it. arthritis, ringbone, sidebone, old infections from abscesses inside the capsule, etc. it is not something i would do without a lot of investigating – i’d want to know WHY the joint could benefit from injection. is it because of an improper trim all these years? kissing spine? compensation because of an injury in the back? i’ve found consistently that injuries or inflammation in that area are usually secondary to a much bigger problem.

i’m no maven at reading x-rays, but it does look like you have some long toe and underrun heels going on there. that might be your first problem…

[Doctor_sOrders]

We haven’t injected yet. He’s coming back Tuesday morn to inject… Maybe. No effusion. I believe his line of thinking is more to oil the joints up, as you say.

Vet competes UL jumpers so I think in his mind, he’s looking at my situation and doing what he would do.

I was confused because as we looked at the rads, he was saying ‘this looks good for him’. What does THAT mean? Good for his age? Good for the job?.. Then he said let’s inject the coffin joint.

I’m really leaning on canceling, moving forward, and if/when the horse tells me he hurts, I’ll reassess. This horse is in no way magically conformed and comes with a past. Flipped in the gate on the track. His right side of sacrum is higher than left. We’ve been going through saddle fitting issues. A bit of neck stiffness (not sure if arthritic or not) so we have a world of problems that COULD be causing coffin joint problems I guess.

As far as hooves, he is pretty good looking for a TB. let me see if I have a nice hoof photo somewhere. I even asked about corrective shoeing, pour in pads, and vet said that his hooves were fine, just wanted to inject coffin joint.

[Doctor_sOrders]

He has bell boots on in all the hoof pics I have :lol: I’ll take a hoof pic tonight

[JBD]

I am not very good at reading X-rays but would be curious about number 14 and what looks like a touch of ringbone or something on the pastern joint.

[Doctor_sOrders]

JBD, are you seeing that upper or lower? Just trying to compare to other ringbone X-rays. May not be the best way for me to go about it. I’m debating sending the pics to the horse’s chiro who is also a vet…

[Fharoah]

If it’s coffin joint arthritis I would do IRAP and adequan.

[joiedevie99]

It sounds like you have a lot of questions for your vet that you didn’t ask. Ask your vet to pull up the xrays and walk you through what they are seeing.

Personally, I would inject a horse that flexed positive, and was short strided in front at 14 if I expected him to be working that hard. I’d rather make the horse more comfortable to do the job then allow him to work through a bit of soreness, potentially hurting something else as he tries to compensate.

[MsM]

Injecting a coffin joint is a pretty serious step so you need to be confident that it is right for this horse. At the very least I think you should speak with your vet and get more information.

You may also wish to have the radiographs looked at by a specialist. You vet could send a digital copy to a Vet School or Big Clinic for a second opinion. It is not seemingly urgent that you inject this week, so make sure you are sure of your decision. Good luck!

[merrygoround]

Id like to have Ghazzu weigh in on this.

I have the feeling that way too many veterinarians are way too quick to inject. They inject this, that and the other thing. I’d look for a second opinion.

[beowulf]

[QUOTE=merrygoround;8691001]

I have the feeling that way too many veterinarians are way to quick to inject. they inject this, that and the other thing. I look for a second opinion.[/QUOTE]

^ :yes:

[Doctor_sOrders]

I’m split on both of the opinions here: inject so he doesn’t compensate elsewhere or not inject because vets may be a bit needle happy and it may not do much (long term) anyway.
I may try and have another vet out to do more flexions and look at the xrays. I’m in no rush to do anything with this horse seeing as we are in a loaner saddle until August when the one I ordered for him comes in.
Also I’m interested in trying other avenues of prevention/treatment. Not sure how much can be done for the coffin joint though? Arthritis wasn’t even mentioned. Looks like I need to call the vet up and have a more detailed chat!

[Kyrabee]

I would get the broken back pastern axis straightened out…aka hoof balance…before I would rush to inject. It isn’t bad but every little bit at that age might cause problems, especially if the imbalance has been going on for awhile.

Susan

[Doctor_sOrders]

I just got some hoof pics but I’m working off my phone so I’ll upload those when I get back from the barn. These xrays were taken less than a week after his trim so I’m really interested in giving these to the farrier and seeing if he thinks he can help out before going the injection route, like Kyrabee said.

Also would this be a situation where we could look at Legend or Adequan as a first step? Or an anti inflammatory?

[JBD]

[QUOTE=Doctor’sOrders;8690843]
JBD, are you seeing that upper or lower? Just trying to compare to other ringbone X-rays. May not be the best way for me to go about it. I’m debating sending the pics to the horse’s chiro who is also a vet…[/QUOTE]

Lower. Not the joint below the fetlock, the one below the pastern bone

[Doctor_sOrders]

https://drive.google.com/folderview?id=0B97zvJ7mDWBdTXBQT2t3UmlReE0&usp=sharing

Here are the hoof pics from tonight if that helps at all. He was last shod Tuesday

[Doctor_sOrders]

In addition, I had a trusted friend come watch him trot around to give me an objective view. It drew a bit of a crowd and discussion at the barn. General consensus, from outsider eyes, was that he did look short up front, more so right than left (makes sense since that is where he flexed positive). Movement was described as a bit jabbing/jarring and that it almost looked like his shoulder was popping through its range of motion as he extended his leg out at the trot.

I’ll attempt to get some video tomorrow AM if the sunlight cooperates before work. Maybe I’ve watched him go for so long that I’ve missed the gradual change?

[yourcolorfuladdictio]

I think your problem is shoeing causing discomfort. He should have his shoes set back more and the toe shortened. He looks to be starting to get his heels run forward. Thus he stands more under himself breaking back at the fetlock and forward at the coffin joint. This is how ringbone develops. Chronic arthritis due to poor hoof balancing and shoeing thus developing calcifications.

Find a new farrier and you probably won’t need injections until the horse is consistently competing in the A/Os.

[mroades]

Fix the shoeing angles and ido injections to removes the inflammation that is in there from the poor angles

[Ambitious_Kate]

Your shoeing is the problem that started this. FIx the shoeing and as suggested above, give him something to reduce inflamation. But I would never give injections before addressing the reason the problem started in the first place. If you don’t fix the shoeing, you are just chasing the prohblem.