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Discussion on Very intermittent lameness - just a few steps...

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Judy Henslee
Member
Username: judyhens

Post Number: 122
Registered: 1-2007
Posted on Wednesday, Jan 30, 2008 - 3:55 pm:   Edit PostPrint Post

We have a wonderful 11 year old stallion who experienced an injury to a rt. fore suspensory in April '07. There was no tearing, no significant swelling, no significant heat. Just slightly off. Work-up at A & M showed a slight enlargement of the ligament. We were advised to begin an exercise program with gradual increase in time under saddle, after the horse recovered from the acute injury. (I think it was June by that point.) Follow-up ultrasounds documented improvement, with all parts of the ligament within normal limits by early fall. Because he continues to, every now and then, take an off step or so, we had his reassessed last week. The ultrasound was completely normal. Because the hoof was slightly sensitive, X-rays of the hoof were taken. They were absolutely normal also. No laminitis, no navicular, no bony growths, no arthritis. Since he had just been trimmed, the slight tenderness was attributed to trimming, which was probably correct because all tenderness resolved the next day. Soundness exams on hind limbs earlier were normal. The studies weren't repeated. (The vet does not feel this is a compensatory issue.) He was slightly off for a few steps after flexion on the right fore. But was essentially sound on concrete and on dirt. The recommendation was to continue the exercise program to strengthen the limb, adding a little cantering in about a month if he remains essentially sound.

His symptoms are very confusing. The dressage rider who is exercising him with lots of walking and some trotting, according to A & M's recommendations, says he will be absolutely sound at walk and trot...then suddenly appears off for up to 10 steps...then is completely sound again at the walk and trot. This doesn't happen every time he is ridden - just occasionally. She also mentioned that, when he is allowed to decide whether to be ridden on the grass close to our asphalt roads or on the roads themselves, he prefers to be ridden on the asphalt. Will move over to the road and walk happily and cheerfully. She only works him on the grass though. We have a deep sand base covered with bermuda grass throughout the property. She said he is full of himself, looks alert and happy, & is not acting like he is in pain, even when he takes a few short steps. He lives in a 1 acre paddock with a run in shed. Any ideas on what can cause a few steps to be "off", then everything become absolutely normal again seconds later? He is not on any medication or supplements. - If this was a rear leg I would wonder about a locked patella/ stifle. Is there anything comparable in the foreleg?

Any suggestions would be appreciated!

Judy
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 19992
Registered: 1-1997
Posted on Thursday, Jan 31, 2008 - 7:30 am:   Edit PostPrint Post

Hello Judy,
No I cannot really give you much help with why this is occurring. Occasionally we have documented muscle spasms as the cause of such problems by palpating the tight muscle when it occurs but have not seen that in a front limb.

Unless it becomes persistent enough to identify I think the important question is does the intermittent problem seem to be getting more or less frequent and the degree of lameness better or worse.
DrO
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carolyn
New Member
Username: clee

Post Number: 1
Registered: 2-2008
Posted on Monday, Feb 4, 2008 - 10:20 am:   Edit PostPrint Post

Hi, I am rehabbing my 7 yo at this time for a similar/ mild/ intermittent right front lameness. All diagnostics were normal; except that he could be made consistently lame on hard ground with flexion and responded to a block to the hoof. I choose, since he is insured, to get to the bottom of the problem asap; and we took him to UC Davis for a CT scan. This revealed a mild lesion and inflammation of the deep digital flexor tendon and a mild asymmetry of the lateral collateral ligament. They felt the injury did not warrant "bone marrow" or PRP so he was given a coffin joint injection of HA and something else and has been on a month's stall rest, with hand grazing whenever possible...we have had the winter from hell so the snow has kept us inside. We are now either ride walking or hand walking for 25 minutes per day. He will be examined again this week. I put him on Reserpine a couple of days ago as he is getting more and more difficult to handle...so, perhaps this could be part of your problem too.
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Judy Henslee
Member
Username: judyhens

Post Number: 123
Registered: 1-2007
Posted on Monday, Feb 4, 2008 - 11:02 pm:   Edit PostPrint Post

Hi Carolyn,
Thank you for your input. I printed out your response. Our stallion is insured also so we could have more tests done if they were indicated...without it costing us a lot. We plan to send a video with your note to the specialist. The problem is catching the lame steps. Sometimes he starts out lame for a few strides. That is very rare though. More commonly, he starts out sound, takes a few off steps during the ride, and is absolutely sound immediately thereafter. Another time he might be sound for the whole ride, then, while being hand walked back to the paddock, take a few off steps. This is really weird, because it is so fleeting that you would almost have to video non-stop for several days to catch the off steps. Just gone in a heartbeat and completely normal again. So to capture this, we have to have the camera absolutely focused and ready to go. But we really want the vet to observe what we are seeing. There is just this nagging doubt that something is being over-looked...

Thanks again for your input. And yours Dr. O.!

Judy
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Chris
Member
Username: stevens

Post Number: 450
Registered: 8-2002
Posted on Tuesday, Feb 5, 2008 - 9:51 am:   Edit PostPrint Post

Hi Judy,

I had a similar thing with my horse. Would do a complete workout perfectly sound and then take 1 or 2 bad steps while cooling out and only sometimes. Very weird.

This went on for almost 1 year until he came in really off after turnout, that's when I found out he had a tendon tear. I have no idea if the tear was there earlier and it was the turnout that exacerbated it or not so this may all be coincidence.

Good Luck in tracking this down. Listen to your nagging doubt. I suspect that it's going to take some pretty sophisticated diagnosis (CT scan, MRI) to find out what's really going on in the absence of obvious consistent clinical signs. On the up side, you say you do have insurance.
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Elizabeth Kaufman
Member
Username: ekaufman

Post Number: 348
Registered: 3-2007
Posted on Tuesday, Feb 5, 2008 - 11:52 am:   Edit PostPrint Post

Hi Judy,

I assume you have ruled out the footing + tender feet (or a tender foot) as a cause for the intermittent lame steps?

Dr. O, do bone chips ever present this way?

Good luck figuring it out. Frustrating as it is, it's probably better than if he were dragging a limb. I always have to remind myself that it's better to be baffled by a mild symptom than overwhelmed by a terrible one!
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carolyn
New Member
Username: clee

Post Number: 3
Registered: 2-2008
Posted on Tuesday, Feb 5, 2008 - 12:25 pm:   Edit PostPrint Post

Footing has been an issue where I board (will be moving at the end of the month). Only problem with being "baffled by a mild symptom" is that they can easily tun into something terrible. Better to get to the root of the issues as fast as possible, esp. if horse is insured.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20035
Registered: 1-1997
Posted on Wednesday, Feb 6, 2008 - 8:01 am:   Edit PostPrint Post

"Ever" is a long time Elizabeth so I must say yes. Many disease processes might rarely present this way.
DrO
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Judy Henslee
Member
Username: judyhens

Post Number: 124
Registered: 1-2007
Posted on Wednesday, Feb 6, 2008 - 9:36 am:   Edit PostPrint Post

Thanks for everyone's input. He was completely fine for his last rides....so we don't have a video yet. Because he was slightly tender on his hoof at the last exam (done 2 days after his trimming) they did x-rays of his hoof. Everything was absolutely normal. There wasn't anything on x-ray to indicate a problem. RE: footing. We have been blessed to have "sugar" sand on the land around here. It is covered with a nice carpet of Bermuda grass. The arenas, in the tracks where the Bermuda has been ridden off, are sand. No mud, no pot holes. We have a tractor to keep it relatively level. We are thinking about digging a pond. Apparently the sand goes down for several feet. We keep the arena areas moist to avoid deep sand issues where the Bermuda has worn thin.

Would a bone chip in the hoof area/ fetlock have shown up in x-rays? Also, we think we know when the injury first occurred last April. The horse was being hand bred. He came down very hard on the mount with his right shoulder, then sort of twisted his right leg when he dismounted, which was very unusual for him. He always positions himself correctly and is a very easy breeder. Anyway the lameness was noticed within a day or so after that. Coincidence? The only thing to show up was the slight injury to the rt. suspensory, without tearing.

Thanks again for your input. I will keep you posted.

Judy
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20045
Registered: 1-1997
Posted on Thursday, Feb 7, 2008 - 8:58 am:   Edit PostPrint Post

Most likely a fracture would show up Judy but rarely there are occult fractures that are not displaced or the angle of the shot makes seeing them difficult.
DrO
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Judy Henslee
Member
Username: judyhens

Post Number: 129
Registered: 1-2007
Posted on Thursday, Apr 24, 2008 - 12:14 pm:   Edit PostPrint Post

Follow-Up:
After failing to see the "off steps" diminish in frequency (and in fact they became more frequent) we took the horse back to A & M and left him there for a complete diagnostic work-up. Blocks were done, going higher and higher without completely resolving the lameness. They ultrasounded, x-rayed, did a bone scan. Finally determined that the problem was an injury to the right shoulder (which is what we thought happened in the first place because his lameness seemed temporally related to coming down hard on the breeding mount). The diagnosis was desmitis of the medial collateral ligament right elbow (rt. fore). We were told he had some calcification. So, they recommended shock wave therapy and rest. After two treatments he seems tremendously improved. Evaluation yesterday showed about 70% improvement in lameness. We have noticed a return in freedom of movement of the right fore, he is lifting his leg much more freely even at a walk. He had a third treatment yesterday and a final treatment scheduled in 2 weeks. They ultrasounded yesterday (we think- my husband was out of the room at the time but they did some diagnostic test) and were pleased.

It was our understanding that the typical response to shock wave therapy was an initial pain free period (immediately following the treatment), followed by recurrence of pain until the ligament healed. We keep waiting for the pain to resurface, but he seems to have really turned a corner. We were also told it would take about 4 months to heal. Is that the norm? Do any of you have experience with this procedure? This particular stallion is quieter in his pasture than in an enclosed stall. We have taught him to ground collect (took all of a couple of minutes) so that he no longer risks going up and hurting his shoulder again.

Dr. O. - What has been your experience re: healing time? Rehab?

Look forward to hearing anyone's experience!

Judy
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20533
Registered: 1-1997
Posted on Thursday, Apr 24, 2008 - 6:29 pm:   Edit PostPrint Post

The nervous deinnervation lasts up to 3 weeks Judy and maybe longer with repeated treatments so the significance of the pain relief you see will have to wait until this effect wears off.

I am unclear was this a shoulder or elbow from your post. Elbow seems most likely as the shoulder does not have a clearly defined collateral ligament. This is not an injury I have had a lot of experience with and prognosis is going to depend on the amount of damage done to the ligament which is determined by the US. What do the folks who did the exam say?
DrO
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Judy Henslee
Member
Username: judyhens

Post Number: 130
Registered: 1-2007
Posted on Thursday, Apr 24, 2008 - 10:47 pm:   Edit PostPrint Post

The lameness person said they had had excellent results with shock wave therapy with this specific injury. I think it is the shoulder, but I guess I am not certain. Walter took the horse each time. They sent a disk with the bone scan on it and x-rays. There is a bright spot on the shoulder in one of them. I think the hope is to break up the calcification. Actually, I guess I don't know exactly what an elbow is...
:-( I don't really know many people who have had shock wave therapy for their horses. Just would like to know more what to expect. I think they are using the lowest "dose" which could be expected to be effective. - Also, my guess is that this is not a very common injury. Otherwise I have to assume it would have been identified earlier. Also, can we assume that they are at least treating the right place since the lameness has virtually disappeared (even if it is temporary)? That is to say, if the lameness was truly from a foot for example, and they treated the shoulder, would the pain go away because everything below the shoulder would be numb? Or do shock waves only remove pain to a certain area? - Actually I think they are also looking at the calcified area and I think maybe it is lessening.

I respect your opinion and did read your article on Shock Wave Therapy after I posted. I did see that it said 3 weeks of numbness was common. That may fit more with what they said about needing 4 months to heal....

Will keep you posted as I find out more...re: elbow vs. shoulder!

Judy
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 20538
Registered: 1-1997
Posted on Friday, Apr 25, 2008 - 7:26 am:   Edit PostPrint Post

Shockwave as a diagnostic tool hmmm....I think that could be written up Judy. As to how this effects innervation of the distal leg it would depend on which nerves are under the unit when it is turned on.
DrO
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Rodney D
Member
Username: parker66

Post Number: 30
Registered: 3-2008
Posted on Friday, Apr 25, 2008 - 4:53 pm:   Edit PostPrint Post

FWIW, I had a horse with suspensory issues who would do the same thing. Take a couple of off steps then be fine and would work out of it.
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Judy Henslee
Member
Username: judyhens

Post Number: 131
Registered: 1-2007
Posted on Saturday, Apr 26, 2008 - 10:38 pm:   Edit PostPrint Post

Rodney, they originally thought suspensory because they thought the right fore was slightly enlarged. However, all the later ultrasounds were completely normal and when compared to the non affected leg, were the same. Both were clean by ultrasound and the right was also clean by x-ray. Yet the symptoms continued. After 3 days of testing, blocks, ultrasounds, bone scans, they decided that this is the problem. I sure hope so!!!! This guy is absolutely the sweetest stallion possible and a true member of the family! We can but hope! - Rodney, did your horse fully recover?

Dr. O. Thanks for the follow-up. I will ask what nerves are distal to the therapy site. Will keep you posted on progress, especially after a couple of months!

Judy
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