HorseAdvice.com Equine & Horse Advice: Back and shoulder pain

Posted on Sunday, Apr 14, 2002 - 9:49 pm:

My 13 yr old QH g, has been off work for 7 months now. Following trips to various Veterinarian hospitals, latest diagnosis is scar tissue under right scapula. Despite all the rest and now an introduction to gentle work, my horse remains unrideable. Put a saddle on and he won't move a step; hop on bareback and if it is a really good day, you may get a few circles out of him before he stops. Presenting symptoms? He will refuse to move, almost stagger and stretch his nose to the ground as if in pain. No neurological problems detected at University. It is for all the world like a trapped nerve or similar. Too much work results in noticable pain in back and withers but rest results in stiffness and soreness too.

Any one else had such strange symptoms? Any suggestions on the best way to help him get over this problem? How do you break down scar tissue without causing the horse too much pain? I love my horse. He is very special in my life and I miss riding him so very much. Please post a reply if you can help.

By the way, he has seen an acupunturist/chiropractor regularly and has had regular dental work etc.

Jude

Posted on Sunday, Apr 14, 2002 - 10:20 pm:

I have a (human) friend who had surgery on her knee, which resulted in a lot of scar tissue. The Rx to get rid of it was daily deep massage. It worked. Maybe it would be worth a consult with an equine masseuse?

Posted on Monday, Apr 15, 2002 - 6:03 am:

Hello Jude,
The problem with physically breaking down already formed scar tissue is that it results in more scar tissue being layed down. I am not sure what the details of Melissa's friends knee but often Dr's throw around the term scar tissue rather loosely so I presume there is some misunderstanding. Physical therapy for knee issues in humans is essential and generally needed to stretch and loosen tightened muscles, ligaments, and joint capsules.

I am afraid "he will refuse to move, almost stagger and stretch his nose to the ground as if in pain" is not much to go on. Why do they think this is the problem and what specific treatments have you attempted already. Is there a historical precedent for this diagnosis?
DrO

Posted on Monday, Apr 15, 2002 - 10:37 am:

Oops, I certainly don't want to be offering misleading suggestions! In my friend's case, it was the thickened tissue along the (healed) incision, which was about 2.5" long. Her MD -- I think from the Hospital for Joint Diseases in NYC, which is sports medicine hospital -- told her daily hard massage of this area was critical to eliminating this "scar" tissue, which he said could otherwise interfere with her knee fully rehabbing. Anyhow, she did it, and it went away in something less than 2 or so months. I felt it myself before and after -- at that time, we were working together -- and the hard tissue along the incision completely disappeared. MW

Posted on Tuesday, Apr 16, 2002 - 6:32 am:

How long after the surgery was this Melissa?
DrO

Posted on Tuesday, Apr 16, 2002 - 8:53 am:

Pretty soon after -- as soon as the incision was healed. Of course, this wasn't a muscle!...
MW

Posted on Wednesday, Apr 17, 2002 - 6:26 am:

Got it Melissa, it was too early for an actual scar to be present. What the Dr. was having your friend massage was granulation tissue that sounds like it formed under the incision. When excessive, granulation tissue matures to a scar. We have an explanation of granulation tissue and the scar formation process, though in a little different context, at Equine Diseases: Skin Diseases: Wounds: First Aid, Care, and Proud Flesh: The Treatment of Proud Flesh or Exuberant Granulation Tissue.
DrO

Posted on Wednesday, Apr 17, 2002 - 12:15 pm:

Ah, ok. Understand.
MW

Posted on Monday, May 20, 2002 - 1:26 am:

After many Vet visits and 2 hospital trips, my horse has been diagnosed with scar tissue below his right scapula. A year ago, my 14 year old QH was doing light trail work and beginner dressage. He was moving beautifully, floaty and extending at trot. His problem first began on steep hills where he sometimes stopped and stretched his neck down to the ground. This condition worsened and now, if a rider gets on him, my horse will frequently refuse to take a single step forward and will stretch his neck out to the ground, clearly in an effort to relieve pain. If lunged, or turned free, my horse generally looks amazing although he occasionally cross-canters behind and can sometimes seem a little short in his right front.

He has been treated with joint supplements and regular acupuncture and chiropractic work. His teeth are regularly treated by an equine dentist.

I am at a loss to know why he can look so good running free but then seem to be in SO much pain/discomfort if a rider just sits on him bareback.

We are not aware of him ever injuring himself and he has been ridden in custom saddle although recently, I have only sat/ridden bareback.

What can be going on with his shoulder/scar tissue that could make him so reluctant to move?

Desperate for help/advise - this is a wonderful horse I am dying to ride again. Is it just a question of more rest? He spent 3 months not ridden and the soreness in his wither area went down, but then working him/riding him brought back pain again. Spine has been x rayed and shows no evidence of kissing spine or similar.

Jude

Posted on Monday, May 20, 2002 - 7:02 am:

Hello Jude,
From your first post in April (I moved the others here for continuities sake) I surmise it is the muscular connection of the scapula to the thorax. Unlike humans there is no bony connection of the front legs to the body, it is all ligaments and muscle.

When you mount a horse your weight is distributed onto this muscular connection and with many saddles and seats a preponderance of your weight ends up in the front, even partially covering and putting pressure on this structure directly. Though I am unfamiliar with a injury exactly of this type I think it could be consistant with your description. Minus your weight the horse is fairly comfortable, then add your weight and forced exercise and the horse gives up. I do not think this is hard to understand just difficult to diagnose. I would be interested in how this was diagnosed.

As to whether this will heal, it depends on the severity of the injury and the quality of the healing. The quality of the healing will be partially effected by the amount of rest the horse gets. I can tell you from having a torn muscle in the back that these injuries can nag you for decades.
DrO

Posted on Tuesday, Jun 4, 2002 - 1:19 am:

Hi Doctor O,

Thanks for responding.

Diagnosis for this theory about scar tissue beneath the scapula was made based on the following:

1. History of the 'episodes' of Miles not wanting to move, stretching his neck down etc. I kept a diary and shared those notes with the various Vets

2. No neurological problems found by Davis.

3. X rays of the spine near wither area did not reveal any bony changes

4. Vet at Stanford felt that Miles' movement of right front leg was a little short and that there was some muscle loss on that right shoulder area. He said it was reminiscent of Sweeney but wasn't that in his opinion.

5. Deep ultrasound performed on both shoulder areas near withers, looking straight down into area between shoulder and spine (about 30 cm). Signs of scar tissue on right side inconsistent with view of left shoulder.

Do you have any thoughts about how my horse might have injured himself in this way? The only incident we could pinpoint close to the initial very subtle signs of an issue was a bout of colic. Miles did roll extensively that day and was sore for a few days afterwards. The only other thing that we have struggled with is saddle fit. Miles grew out of his first custom stuffed saddle and we had a custom saddle made and fitted. All was well for the first 6 to 12 months and then it started to shift to the right. It took a while before we could get the saddle fitter to re-stuff. We then struggled with fit for several months. I wonder whether the saddle fit issue was exacerbated by the injury, or the saddle fit contributed to the injury. Chicken and egg.

Do you think that a muscular injury like this also compromises the nerves and that there is likely to be nerve pain?

Also, what is your opinion about 'remembered pain'? I am curious because I have been mixing up the physical work I am doing with my horse and he is reacting very differently to being sat on and walked out depending upon whether he is initially hand led or asked to walk off. It is almost as if he anticipates the pain if we follow the same pattern of preparation for work, but if we mix it up, he doesn't and then there is no pain.

I have just started riding him again at the walk for no more than 12 to 14 minutes. So far, so good. Miles is also being introduced to long-lining in the hopes that we can get him to work in a round outline without rider weight and that this might help his back come into shape again. Any thoughts on how to gently increase the exercise in a way that would not bother this shoulder injury?

Sorry for all the many questions but I am so excited to have someone to talk to about this.

Thanks to Melissa too for trying to help out!

Jude

Posted on Tuesday, Jun 4, 2002 - 9:03 am:

If we was rolling around I would hypothesize that the leg became excessively abducted (pulled away from the body) resulting in tearing of the muscles and ligaments. This area you describe contains the axillary plexus and is rich in nerves that can receive direct trauma from the abduction or scar tissue can encapsulate the nerves.

I do not have much faith in remembered pain as I understand the term and that is really not what you describe. I have blocked too many horses which have been lame for years and have them go completely sound. You describe an adverse reaction because the horse expects pain to follow, this is a simple conditioned response and will extinguish with time when pain does not follow.

I cannot speak as to what might or might not aggravate his shoulder injury but the most gentle way I can see to increase stress on this area is to slowly begin work on a gentle downill slope. When you point down you increase the weight taken on the front. Every 3 weeks you can increase the slope gradually thereby gently increasing the weight born by the front feet.
DrO

Posted on Saturday, Jun 8, 2002 - 8:44 pm:

Hi DrO,

Thank you for your response.

Do you have any advise about how much walking he should be able to do prior to introducing another factor like a slope? In general would you favor introducing change in gradient before change in pace?

Thanks,

Jude

Posted on Sunday, Jun 9, 2002 - 5:22 am:

Yes I think I would change the gradient at a walk before increaseing the gait to a trot as I feel it would be a more gradual increase in stress.

As to how much walking and how fast to progess you are going to have to judge that by the horses degree of lameness and his response to the exercise. Quite frankly this is such a rare injury, or perhaps it is just not diagnosed often, we do not have past experience to go on. There is a exercise regimen layed out in the article on Flexor Tendinitis (Equine Diseases: Lameness: Problems of Muscles, Tendons, Ligaments, and Bones: Flexor Tendinitis) that I have been able to adapt to other severe muscoskeletal injuries that might give you some objective advice but this should be run through the person who was smart enought to figure this all out to begin with.
DrO

Posted on Sunday, Jun 9, 2002 - 3:33 pm:

Hi DrO,

I will take a look at the article, thanks. I will call the Vet who diagnosed this and see what his advice is too. I sent him a video of the way my horse presents symptoms and I think he was going to take that to share with some colleagues at a convention- who knows? He may have additional feedback to add. I think he agrees with you, that this injury is unusual.

Another couple of quick questions: I am still detecting a little soreness in my horse's back but it is all towards the loin area, not near the injury site. My acpuncturist/chiropractor/vet, is aware that one of the Vet hospitals did spot some slight changes to the hocks consistent with my horse's age (now 14), but nevertheless, something that could contribute to back soreness. She suggested we took another look at the film and consider hock injections. My regular Vet looked at the radiographs and said that the hock issue is in the lower joint of the hock and in his opinion, doing something like injecting with Adequan would have only minimal effect. His advice was to wait until my horse is back in real work before taking this step. Any thoughts on that?

Saddle or no saddle? I had a custom made saddle but due to the soreness of my horse from this injury, I stopped using it. It is back with the maker who is ready to come fit it again once my horse is back in work. Do you think there is any downside to continuing to ride bareback for now, particularly given that the saddle did seem to add to the discomfort.

Jude

Posted on Sunday, Jun 9, 2002 - 9:29 pm:

fyi, if you do hock injections, you'd want to use HA and/or steroids, NOT Adequan. Adequan has been associated with some horrific reactions as an intra-articular.

Posted on Monday, Jun 10, 2002 - 6:50 am:

Hello Jude,
If the horse is lame behind due to the hocks I would treat them. We have quit giving Adequan IA because of the teported increase incidence of joint infections with its use. When you begin riding again I would use a saddle.
DrO

Posted on Saturday, Jun 22, 2002 - 8:05 pm:

Hi Dr O,

Can you point me towards any articles about Adquan use? What is typically being recommended instead?

Thanks,

Jude